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This work proposes a new model of reconfigurable intelligent surface (RIS) called cognizable RIS (CRIS) that is specifically designed to meet the unique demands of users who require extreme-ultra-reliable and low-latency Communication (xURLLC) in the sixth generation (6G) wireless networks. The programmable elements in the proposed CRIS unit can adapt to different modes of operation to provide significant performance gain. To improve reliability at the receiver, we integrate unmanned aerial vehicles with the CRIS module, which enhances network performance through beamforming and mobility. Our study focuses on maximizing the sum throughput in a multiple-input multiple-output scenario using the rate-splitting multiple access communication system. To achieve this, we introduce a novel hybridized multi-agent-based deep reinforcement learning (DRL) algorithm for optimal resource allocation that maximizes the sum throughput. We incorporate long-short-term memory (LSTM) networks into our proposed DRL to address the temporal dependencies due to stochastic channel conditions. By utilizing the proposed LSTM-based multi-agent DRL (MA-DRL) algorithm, we achieve notable gains of 11.7% and 26.9% in sum throughput over widely recognized DRL benchmark algorithms, all while adhering to xURLLC’s stringent maximum packet error probability constraint of 10−9.

The rapid reduction in bird populations and the imminent prospect of avian extinction have profound effects on global ecosystems, putting vital ecological services and processes in jeopardy. Finding endangered bird species is a major problem for scientists, making it more difficult to come up with practical conservation plans. In order to meet this need, we provide an integrated system that combines MFCC-based feature extraction with state-of-the-art deep learning models CNN, LSTM, and VGGish to accurately identify bird species from audio recordings. Our method makes use of each model’s special strengths: VGGish represents extensive audio features, LSTM handles temporal dependencies, and CNN handles spatial hierarchies. Our framework seeks to improve species categorization efficiency and accuracy by utilizing these cutting-edge methods, supporting conservation efforts, and reducing the negative ecological effects of rapid population reduction. We work to provide ornithologists and conservationists with the resources they need to protect biodiversity and maintain the integrity of our ecosystems by continuously collecting data and disseminating information.

This letter examines an integrated sensing and communication (ISAC) scheme for multi-user systems under full-duplex (FD) architecture. We examine an FD-ISAC system where the base station is responsible for target detection and shares the same resources for simultaneous downlink (DL) and uplink (UL) communication. For a green FD-ISAC architecture, our primary focus is addressing the robust energy efficiency maximization (EEM) problem. This involves the integrated beamforming design for the DL, UL, and radar users and UL transmission power. The optimization process follows constraints such as worst-case rate constraints, limitations imposed by bounded channel state information (CSI) error, transmit power constraints, and specific quality of service requirements. To address the EEM problem, we use an iterative algorithm that employs successive convex approximation (SCA) and second-order cone programming (SOCP) to achieve near-optimal resource allocation. Average energy efficiency and average spectral efficiency were compared for the proposed EEM algorithm and the benchmark spectral efficiency maximization (SEM) algorithm. Simulation results show that the FD-ISAC scheme significantly outperforms the conventional half-duplex scheme w.r.t. system performance.

Efforts toward sustainable environmental development encompass global initiatives to enhance water quality, sanitation, and wastewater management. This study addresses the energy-intensive nature of sewage water treatment, which is critical for curbing water pollution. We propose a 15-layer Deep Neural Network (DeepNNet-15) to analyse energy conversion and nutrient levels. Constructed with dense layers of up to 10 neurons each, featuring ReLU activation, DeepNNet-15 utilises a benchmark sewage water dataset for training. With 11 input and five output neurons, including energy and nutrient parameters, DeepNNet-15 predicts parameters with less than 3 % error. Its deep learning performance demonstrates over 90 % accuracy, precision, and above 97 % specificity. The practical significance of this research lies in the demonstrated efficacy of DeepNNet-15 in forecasting energy conversion efficiency and nutrient levels in treated sewage water. By harnessing advanced neural network architecture and machine learning techniques, this study offers a tangible contribution to sustainable environmental practices. It equips stakeholders with a robust tool to enhance sewage water treatment efficiency and effectiveness. It aligns with global sustainable development goals and promotes pollution mitigation, resource optimisation, and a cleaner, healthier environment.

International differences in the incidence of many cancer types indicate the existence of carcinogen exposures that have not yet been identified by conventional epidemiology make a substantial contribution to cancer burden1. In clear cell renal cell carcinoma, obesity, hypertension and tobacco smoking are risk factors, but they do not explain the geographical variation in its incidence2. Underlying causes can be inferred by sequencing the genomes of cancers from populations with different incidence rates and detecting differences in patterns of somatic mutations. Here we sequenced 962 clear cell renal cell carcinomas from 11 countries with varying incidence. The somatic mutation profiles differed between countries. In Romania, Serbia and Thailand, mutational signatures characteristic of aristolochic acid compounds were present in most cases, but these were rare elsewhere. In Japan, a mutational signature of unknown cause was found in more than 70% of cases but in less than 2% elsewhere. A further mutational signature of unknown cause was ubiquitous but exhibited higher mutation loads in countries with higher incidence rates of kidney cancer. Known signatures of tobacco smoking correlated with tobacco consumption, but no signature was associated with obesity or hypertension, suggesting that non-mutagenic mechanisms of action underlie these risk factors. The results of this study indicate the existence of multiple, geographically variable, mutagenic exposures that potentially affect tens of millions of people and illustrate the opportunities for new insights into cancer causation through large-scale global cancer genomics.

Municipal solid waste landfills require a liner system to prevent the migration of landfill leachate into the surrounding environment. Currently, liner system selection and design processes are primarily based on engineering performance, cost, and ease of construction and rarely consider sustainability. This study assessed the sustainability of four different composite liner systems, considering their technical equivalence through leachate infiltration rates and employing the triple bottom line (TBL) approach, which considers environmental, economic, and social impacts. The four composite liner systems evaluated included: (1) geomembrane (GM) over compacted clay liner (CCL) (denoted as GM/CCL), (2) GM over geosynthetic clay liner (GCL) (denoted as GM/GCL), (3) GM over soil mixed with lime and cement (SA) (denoted as GM/SA), and (4) GM over fly ash mixed with bentonite (FAB) (denoted as GM/FAB). The life cycle stages of each system, including material extraction, construction, monitoring, and disposal were also analyzed. The study was conducted for the DeKalb Landfill in DeKalb, Illinois, USA. Life cycle assessment was performed using the Eco-Indicator and TRACI method in SimaPro 8.0.1 to quantify environmental impacts. The results showed that GM/FAB was the most sustainable liner system in terms of environmental impact and second in economic and social impacts. On the other hand, GM/GCL was deemed the most preferred in terms of economic and social impacts.

Subsampling down-conversion has not been a popular choice for mixer-first RF front-ends for two interdependent reasons. One, the subsampling down-conversion is inherently heterodyne in nature. Two, as a consequence to one, the passive mixer transparency property can not be exploited for providing impedance matching at the RF port by impedance translation. In this work, an eight-path quarter-rate subsampling (QRSS) mixer-first direct down-conversion architecture is proposed to address these issues. The proposed architecture simultaneously achieves quadrature direct down-conversion and impedance matching by using the third harmonic of the QRSS frequency, $f_{s}$ . The impedance matching is achieved by exploiting the eight-path passive mixer transparency property. Compared to RF sampling receivers, this architecture employs a sampling frequency $f_{s}$ three times lesser than $f_{\text {RF}}$ , saving on the power consumption of nonoverlapping clock generation, distribution circuits, and frequency synthesizer. A test chip is fabricated in 1.2-V, 65-nm CMOS with an active area of 0.32 mm2. The subsampling eight-path mixer, baseband low-noise amplifier (LNA), and ${\text{g}_{m}}$ -cell consume a power of $800 \mu \text{W}$ , 23 mW, and 3 mW, respectively, for a target bandwidth of 90 MHz. Nonoverlapping clock generation circuit consumes 2–9.2 mW, over the band 0.4–1.8 GHz. The receiver has a double sideband (DSB) noise figure of 4.7 dB, a conversion gain of 22 dB, an in-band (IB)-IIP3 of −1 dBm, and OB-IIP3 of +8 dBm.

The global health crisis caused by the COVID-19 pandemic has evolved rapidly to overburden health care organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes and percutaneous coronary intervention. The reasons for such abrupt changes in health care delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted during the pandemic. This review discusses the impact of COVID-19 on important aspects of acute MI care.

Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.

For the purpose of this investigation, carbon and Kevlar fiber-reinforced plastics were subjected to dynamic testing. Carbon-Kevlar fibers are included into the LY 556 resin and AR 951 hardener. Fiber makes for 40% of the study's total weight. The carbon and Kevlar composites were created by hand lay-up. The orientation considered in this research is 0/0 and 0/90 for both carbon and Kevlar composites. Advanced characterizations such as TMA and DMA has been integrated in this research. By using DMA (Dynamic Mechanical Analyzer) and the thermomechanical Analyzer (TMA), the dynamic properties were acquired. ASTM E756 was used to conduct the tests. Composite heating at room temperature to 1200 C was the temperature variable under investigation. The studies were conducted on TMA and DMA with a force of 0.002N, respectively. DMA uses a three-point bending loading design for its samples. Temperature affects the dimensions, storage modulus, loss modulus, and tan delta.

A patent foramen ovale (PFO) is present in 27-35% of the population. Right to left cardiac shunts predispose patients to arterial emboli in the presence of venous thromboembolisms. Paradoxical embolus should be suspected in patients with deep venous thrombosis (DVT) and arterial emboli. A 45-year-old man with hypercoagulability and history of DVT presented with a week-long history of chest pain, shortness of breath, and left arm numbness. Imaging showed a saddle pulmonary embolus (PE) and emboli involving the aortic arch, left common carotid, and left subclavian artery. The patient proceeded with an endovascular thrombectomy of the pulmonary artery, followed by open thrombectomy. Echocardiogram confirmed a right to left intra-cardiac shunt consistent with a PFO. Paradoxical emboli are rare manifestations of venous thromboemboli in patients with right to left intra-cardiac shunts. Patients should be evaluated for these to help prevent further manifestations.

A wireless sensor network is one of the networks that is highly demanding by various real-time networking applications nowadays. A huge amount of sensor nodes is deployed in the network randomly and distributed. Most of the applications using wireless sensor network (WSN) are surveillance monitoring applications like a forest, home, healthcare, environment, and remote monitoring systems. Based on the application usage, the type of sensor, a number of sensor nodes are deployed in such a manner where the sensors can be used effectively. But the sensor nodes are restricted in the battery and sensing region. Thus, the battery of the sensor nodes is decreased based on the nodes’ function. The energy level of the sensor nodes highly affects the network lifetime. Improving the energy efficiency in WSN is one of the most important challenging tasks. Most of the earlier research works have proposed various methods, techniques, and routing protocols, but they are application dependent and as a common method. So, this paper is motivated to propose a Multi-Conditional Network Analysis (MCNA) framework for saving the energy level of the sensor nodes by reducing energy consumption. The MCNA framework involves two different clustering processes with cluster head selection, choosing the best nodes based on the signal strength, and the best route for data transmission. The data transmission is done by cluster based on source-destination based. The simulation results proved that the proposed MCNA framework outperforms the other existing methods.

Metal matrix composites are light and robust materials that are widely used in a variety of industrial applications. In this study, Graphene Nanoparticles (GNP) were subsequently reinforced with Al6061 Aluminium (Al) alloy at various weight percentage ratios (0, 0.1, 0.3, 0.4), and Nanocomposites were created using the stir-casting process. Scanning electron microscopy was used to characterise the structures, and tensile and hardness tests were performed to assess the composites' mechanical characteristics. The microstructural data demonstrate that nano-composites are distributed randomly. This research found that adding graphene nanoparticles to materials increased yield strength, ultimate tensile strength, as well as hardness. The as-cast tensile strength and compressive strength of the GNP/Al6061 Nanocomposites were increased by 37% and 34%, respectively, when compared to the unreinforced Al6061 alloy. The results show that Sample 2 (Al 6061 per cent + GNP 1 per cent) has better hardness properties than the other two samples because the reinforcement materials have been increased. Through these experiments, the mechanical properties of a composite material were made better than they were with the GNP.

Reconfigurable subsampling mixer-first RF front-end is a potential candidate for low-power applications as it operates at a low clock frequency and hence consumes low power. However, the subsampling down-conversion has not been employed in mixer-first RF front-ends due to the disadvantage of high noise figure from inherent noise folding and lack of RF port impedance matching because of nonzero IF down-conversion. To address the above two issues, first, a subsampling multipath down-conversion mixer scheme is proposed for rejecting $3f_{s}/4$ and $5f_{s}/4$ down-conversions, thereby alleviating the effect of noise folding, leading to low noise figure. Second, an IF-stage impedance matching scheme is proposed that provides $50~\Omega $ matching at the RF port of the mixer using an IF-LNA in shunt with an $M$ -phase switch-capacitor filter. The analysis of the proposed scheme in terms of noise figure, conversion gain, and harmonic rejection is presented. The proposed subsampling mixer-first RF front-end is implemented in 1.2 V, 65-nm CMOS technology. The prototype occupies an active area of 0.33 mm2, the switch-capacitor mixer and $M$ -phase filter consume $400~\mu \text{W}$ of power, and IF amplifier and nonoverlapping clock generation circuit consume 25 mW and 6–12.6 mW of power, respectively. The RF front-end achieves a 6.5-dB noise figure, 15.1-dB conversion gain, 50-dB harmonic rejection ratio (HRR), and +10-dBm IB-IIP3.

This letter investigates a full-duplex (FD) non-orthogonal multiple access (NOMA) enabled multiuser transmission with backscatter communication (FD-MTBC), where a multiuser downlink NOMA network is served by an FD source while backscatter devices transmit their information to the source simultaneously. Considering the constraints for successive interference cancellation (SIC) and the desired target uplink sum rate, we formulate an optimization problem to maximize the downlink sum rate. Further, we propose an iterative algorithm that jointly optimizes the power allocation coefficient and reflection coefficient to maximize the downlink sum rate. The effectiveness of the proposed algorithm is demonstrated using simulation results.

Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India.Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures.Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001).Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels.

Purpose: [177Lu]Lu-DOTATATE and [177Lu]Lu-PSMA-617 used for targeted radionuclide therapy are very often prepared in the hospital radiopharmacy. The preparation parameters vary depending upon the specific activity of the 177Lu used. The aim of this study was to develop optimized protocols to be used in the nuclear medicine department for the preparation of patient doses of the above radiopharmaceuticals. Method: 177Lu (CA and NCA) were used for radiolabeling DOTATATE and PSMA-617. Parameters studied are 177Lu of different specific activity and different peptide concentrations and two different buffer systems. Paper and thin layer chromatography systems were used for estimating the radiochemical yield as well as radiochemical purity. Solid-phase extraction was used for the purification of the labeled tracers. Results: [177Lu]Lu-DOTATATE was prepared with CA 177Lu (n= 13) and NCA177Lu (n= 6). Four batches each of [177Lu]Lu-PSMA-617 were prepared using CA and NCA 177Lu. Radiochemical yields > 80% and final product with less than &lt; 1% radiochemical impurity could be obtained in all batches which were used for therapy. Conclusion: Robust protocols for the preparation of clinical doses of [177Lu]Lu-DOTATATE and [177Lu]Lu-PSMA-617 were developed and used for the preparation of clinical doses. The quality of the SPECT images of both the tracers are consistent with the expected uptake in respective diseases.

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment for abdominal aortic aneurysms (AAAs). Common complications include endoleaks, which are continued blood flow into the aneurysm sac external to the graft. Type I endoleaks occur proximally or distally, resulting from inadequate seals between the graft and artery. Type III endoleaks stem from defects between components in modular grafts or fabric tears. Re-intervention is indicated for type I and III endoleaks due to pressurization of the aneurysm sac resulting in a high risk of rupture. A 68 year-old man presented with an infrarenal AAA and underwent EVAR. He developed a late type I endoleak requiring reintervention with a stent graft cuff, and later presented with a recurrent type I endoleak and type IIIb endoleak. The AAA increased in size to 18 cm with contained rupture, requiring emergent endograft explantation and repair with a bifurcated Dacron graft. His postoperative course was uncomplicated.

Atomistic molecular dynamic simulations were performed to investigate the adsorption behavior of poly(acrylic acid) (PAA) and poly(methacrylic acid) (PMA) at the CCl4–H2O interface for isotactic, atactic,and syndiotacticforms. The conformational, orientation, and solvation behaviors of PAA and PMA chains at the interface were studied as a function of the degree of ionization (f). The calculated density profiles show that adsorption occurs only when degree of ionization is less than a critical value (ionization of 20% groups). The density profiles of different groups show the existence of carboxylic acid and carboxylate groups toward the aqueous phase and methyl groups toward the oil phase, relative to the interface. The radius of gyration values and dihedral distributions of completely adsorbed chains (i.e., for f= 0) reveal their existence in an extended conformation at the interface, in contrast to their coiled structure in bulk aqueous solution. The size of adsorbed chains (f< 0.2) decreases with increase in degree-of-ionization due to looping of chain toward water; the extent of looping depends on the distribution of charge on the chain. The carbonyl and methyl groups of uncharged PAA and PMA show two set of orientations corresponding to direction toward water and oil phases and this preferential orientation decreases with increase in degree-of-ionization. Significant differences in orientation distribution, dihedral angle, and hydration were observed among different tacticities of PMA which primarily reflect the hydrophobic nature of isotacticPMA as compared to other tacticity. The number of hydrogen bonds between the polyelectrolyte and water is much lower at the interface relative to the bulk aqueous phase as determined by the population of water in the interface region as well as charge on the polyelectrolyte.

Photovoltaic power is most important cause of energy subsequently it is simultaneously clean and limitless. PV power conversion devices must be maintained at MPP there to maximize the energy production of Solar array. To get the most energy out of the Solar array, MPPT monitoring is necessary. In recent times, a slew of strategies for controlling the voltage was presented. Power electronic devices developments for the combination of wind and solar power generation are discussed. Based on the dependability and development of each technology, conversations concerning developments and trends in sustainable source systems are provided. The consumption of electricity generated is increasing exponentially, and as a result, the incorporation of photovoltaic panels into distribution companies is increasing rapidly as well, even though it has a substantial impact on the show’s voltage stability. The purpose of this report is to look at how solar PV integration affects distribution transmission energy reliability. The analysis is carried out using RSCAD software, with one of the radial distribution networks with the lowest voltage profile accessible during the maximum of linked loads. Furthermore, the influence of current and voltage on the transmission or distribution system is compared by analyzing distribution system configuration with various solar PV system penetration rates. The simulated findings show that as the penetrating capability of the PV system increases, large harmonic distortion levels are injected, indicating that the solar photo system should only integrate corresponding to the highest capability the connection can sustain. When a PV technology is connected further than this maximum penetration of renewable energy sources, it produces considerable harmonic components, which harms the system that improves. Total voltage output frequency and current consumption distortion are determined to be 4.98 percent and 14.99 percent, correspondingly, at the maximum diffusion way that enables the permissible harmonic distortion limitation. Thus, the research presents the uses of Grid Integration to estimate the performance and the quality of the solar PV model.

Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.

•The study addresses a literature gap on the utilization, reuse and disposal of thermoplastic masks.•Thermoplastic masks are often reused in curative treatments, government-run and busy centres.•The preferred way of disposal of used thermoplastic masks is through biomedical waste management.•Radiotherapy technologists are conscious for environmental effects of thermoplastic mask disposal.

Graphical Abstract

Carbon nanotube-based solar thermal fluids are being studied in this field for their thermo-physical characteristics. Using TiO2and water as the basic fluids in 100:0, 75:25, and 50:50 ratios, nano-fluids were generated. The MWCNTs were dispersed in these three base fluids at a weight fraction of 0.25, and 0.5% and 0.75%, respectively. For the duration of two months, the zeta potential variation is studied to determine the stability of dispersion. The hot disk method and Anton Paar viscometer were used to measure thermal conductivity and dynamic viscosity. Adding MWCNTs to the basic fluids resulted in a 12–21% increase in thermal conductivity. Although viscosity was shown to increase in the 50–70 °C range, it was found to have a less impact at higher temperatures.

Flexible flow-shop scheduling problem (FFSP) is an extended special case of basic flow-shop scheduling problem (FSP). FFSP is treated as complex NP-hard scheduling problem. A good scheduling practice enables the manufacturer to compete effectively in the marketplace. An efficient schedule should address multiple conflicting objectives so that customer satisfaction can be improved. In this work, a novel approach based on teaching-learning-based optimisation (TLBO) technique incorporated with maximum deviation theory (MDT) is applied to generate schedules that simultaneously optimise conflicting objective measures like makespan and flowtime. Results indicate that the proposed multi-objective TLBO (MOTLBO) outperforms non-dominated sorting genetic algorithm II (NSGA-II) and multi-objective particle swarm optimisation (MOPSO) in majority of the problem instances.

Purpose: The clinical demand of 6-l-[18F] FDOPA is gaining rapidly for imaging neurodegenerative diseases by using positron emission tomography. Hence, large-scale production of 6-l-[18F] FDOPA is necessary. This paper describes our experience on the production of 6-l-[18F]FDOPA via nucleophilic synthesis using NEPTIS module and a commercially available cassette based chemistry. Method: 6-l-[18F]FDOPA production could be completed in three synthetic steps by using ABX nitro precursor. The precursor is first labeled with18F by replacing a –NO2leaving group followed by purification using a solid phase cartridge. In the subsequent step, the radiolabeled precursor is oxidized using meta chloroperoxy benzoic acid hydrolyzed to remove the four different protecting groups. The product is finally purified in a series of solid phase cartridges to yield radiochemically pure 6-l-[18F]FDOPA. Results: Total 36 batches of 6-l-[18F]FDOPA were produced. The decay uncorrected yield were 5.5 ± 1.5% (n= 33) which corresponds to a decay corrected yield of 11.8 ± 3.2% (n= 33). The radiochemical purity of the product obtained is always > 95%. Conclusion: The yields obtained are low and hence there is a need to improve synthetic chemistry. In order to understand the efficiency of each step, a detailed analysis using the radioactive traces obtained from the automated module was carried out. The radiolabeling yield of precursor is only about 50% and there is subsequent reduction in activity in the oxidation as well as hydrolysis steps. Despite the low radiochemical yields, the product obtained was suitable for imaging.

In data analysis applications for extraction of useful knowledge, clustering plays an important role. The major shortcoming of traditional clustering algorithms is exhibiting poor performance in solving complex data cluster problems. This research paper introduces a novel hybrid optimization technique based clustering approach. This paper is designed with two main objectives: designing efficient function optimization algorithm and developing advanced data clustering approach. In achieving the first objective, the standard TOA is first enhanced by hybridizing with Lévy flight trajectory and benchmarked on 23 functions. A new clustering approach is developed by conjoining k-means algorithm and Lévy flight TOA. Tested the numerical complexity of the proposed novel clustering approach on 10 UCI clustering datasets and 4 web document cluster problems. Conducted several simulation experiments and done an analysis of the results. The obtained graphical and statistical analysis reveals that the proposed novel clustering approach yields better quality clusters.

Benzoic acid–monofluorobenzoic acid combinations are known to form solid solutions, whereas benzoic acid–pentafluorobenzoic acid system forms a cocrystal. To decipher the gradation from solid solution to cocrystal between these extremes, we executed the cocrystallization of benzoic acid with several of its poly-fluoro (di-, tri-, and tetra-) substituents. The fluorine atom, with its sheer geometric position and intermolecular (hydrogen and halogen) bonding ability, is found to steer the transformation from a solid solution to a cocrystal in this family of compounds. We found, among others, a novel crystal entity in the benzoic acid–3,4,5-trifluorobenzoic acid combination that shows characteristics of both a solid solution (a single disordered molecule in the crystallographic asymmetric unit) and a cocrystal (a distinct crystal structure as compared with the parent compounds). This solid solution-cum-cocrystaltherefore acts a connecting link in the evolution of cocrystals from solid solutions in benzoic acid–fluorobenzoic acid systems. In addition, the cocrystallization of benzoic acid with 2,6-difluorobenzoic acid and 2,4,6-trifluorobenzoic acid resulted in eutectics, which appears to be due to the supramolecular incompatibility invoked by out-of-plane carboxylic acid in the latter compounds.

Dhat syndrome is a common semen-loss related physical and psychological distress usually reported by young males. The treatment mainly centres around nonpharmacological strategies such as psychoeducation. Most of the patients present as outpatients to alternative medicine or nonpsychiatry branches and treatment is usually not delivered. Some of the reasons may include perceived need for longer duration of sessions with the patient, available literature with complex psychiatric jargon and barriers to treatment due to stigma attached to psychiatry. This article presents a two session therapy proposal for Dhat syndrome that could be useful as a brief intervention over tele-consultations, and in consultation liaison clinics by nonpsychiatrists as well.

Purpose: To present the data on primary hyperparathyroidism (PHPT) in pregnancy from India obtained from a large database maintained over 15 years. Methods: We retrieved data of all women with gestational PHPT from the Indian PHPT registry between July 2005 and January 2020, and compared their clinical, biochemical, and other characteristics with age-matched non-pregnant women with PHPT. Results: Out of 386 women, eight had gestational PHPT (2.1%). The common presenting manifestations were acute pancreatitis (50%) and renal stone disease (50%); two were asymptomatic. Five women (62.5%) had a history of prior miscarriages. Seven patients (88%) had preeclampsia during the present gestation. Serum calcium and intact parathyroid hormone (iPTH) were not statistically different from the age-matched non-pregnant PHPT group. Six patients with mild-to-moderate hypercalcemia were medically managed with hydration with/without cinacalcet while one patient underwent percutaneous ethanol ablation of the parathyroid adenoma; none underwent surgery during pregnancy. Mean serum calcium maintained from treatment initiation till delivery was 10.5 ± 0.4 mg/dl. One patient had spontaneous preterm delivery at 36 weeks; the remaining patients had normal vaginal delivery at term. None had severe preeclampsia/eclampsia. Fetal outcomes included low birth weight in three newborns (37.5%); two of them had hypocalcemic seizures. Conclusion: The prevalence of gestational PHPT was 2.1% in this largest Indian PHPT cohort, which is higher than that reported from the West (&lt; 1%). Gestational PHPT can lead to preeclampsia and miscarriage. Pregnant PHPT patients with mild-to-moderate hypercalcemia can be managed with hydration/cinacalcet; however, long-term safety data and large-scale randomized controlled trials are required.

Introduction Despite a high burden of stroke, access to rapid brain imaging is limited in many middle- and low-income countries. Previous studies have described the astroglial protein GFAP (glial fibrillary acidic protein) as a biomarker of intracerebral hemorrhage. The aim of this study was to test the diagnostic accuracy of GFAP for ruling out intracranial hemorrhage in a prospective cohort of Indian stroke patients.Patients and methods This study was conducted in an Indian tertiary hospital (Christian Medical College, Ludhiana). Patients with symptoms suggestive of acute stroke admitted within 12 h of symptom onset were enrolled. Blood samples were collected at hospital admission. Single Molecule Array technology was used for determining serum GFAP concentrations.Results A total number of 155 patients were included (70 intracranial hemorrhage, 75 ischemic stroke, 10 stroke mimics). GFAP serum concentrations were elevated in intracranial hemorrhage patients compared to ischemic stroke patients [median (interquartile range) 2.36 µg/L (0.61–7.16) vs. 0.18 µg/L (0.11–0.38), p < 0.001]. Stroke mimics patients had a median GFAP serum level of 0.14 µg/L (0.09–0.26). GFAP values below the cut-off of 0.33 µg/L (area under the curve 0.871) ruled out intracranial hemorrhage with a negative predictive value of 89.7%, (at a sensitivity for detecting intracranial hemorrhage of 90.0%).Discussion The high negative predictive value of a GFAP test system allows ruling out patients with intracranial hemorrhage.Conclusion In settings where immediate brain imaging is not available, this would enable to implement secondary prevention (e.g., aspirin) in suspected ischemic stroke patients as soon as possible.

An attempt is made to study the influence of dispersion of Groundnut shell ash (GSA) on the hardness and density of Aluminum Metal Matrix Composite. It is an attempt to use agricultural waste in trying to enhance the mechanical properties of the already existing materials. The work deals with the use of groundnut shell ash, mixed with aluminum using stir casting process. . The composites with varying percentage of groundnut shell ash from 0% to 6% were prepared. The prepared specimens were tested before and after the heat treatment process in terms of its hardness using a Rockwell Hardness Tester. The present work attempts to compare the hardness and density of prepared composites as compared to the alloy. The comparison is carried out before and after the heat treatment process. The results indicate the increasing hardness value and reducing density of composites.

Phlegmasia alba dolens is a rare sequela of acute extensive venothrombus of the iliofemoral segments. Rarely, phlegmasia alba dolens can also result from clotted inferior vena cava filter. A 39-year-old with protein S deficiency, and prior inferior vena cava filter placement after remote trauma presented to the emergency department with progressive bilateral lower extremity pain and swelling. Venous duplex revealed extensive bilateral deep vein thromboses from the external iliac veins to popliteal veins, as well as thrombophlebitis of the left great saphenous vein. Venography confirmed patency of the suprarenal vena cava with abrupt occlusion of the infrarenal segment at the level of the inferior vena cava filter. The filter was removed followed by endovascular thrombectomy and adjunctive venoplasty. The patient progressed well and discharged on therapeutic anticoagulation. This case illustrates that a staged endovascular approach may be utilized for acute on chronic caval thrombosis and filter removal.

This paper addresses the robustness of large-scale closed-loop structured systems in the sense of arbitrary pole placement when subject to failure of feedback links. Given a structured system with input, output, and feedback matrices, we first aim to verify whether the closed-loop structured system is robust to the simultaneous failure of anysubset of feedback links of cardinality at most γ. Subsequently, we address the associated design problem in which given a structured system with input and output matrices, we need to design a sparsest feedback matrix that ensures the robustness of the resulting closed-loop structured system to simultaneous failure of at most any γfeedback links. We first prove that the verification problem is NP-complete even for irreduciblesystems and the design problem is NP-hard even for so-called structurally cyclicsystems. We also show that the design problem is inapproximable to factor (1−o(1))logn,where ndenotes the system dimension. Then we propose algorithms to solve both the problems: a pseudo-polynomial algorithm to address the verification problem of irreducible systems and a polynomial-time O(log n)-optimal approximation algorithm to solve the design problem for a special feedback structure, so-called back-edgefeedback structure.

To mitigate the adverse effects of nutrient stress under elevated atmospheric [CO2] on grain mineral composition and cooking quality, selection of crop varieties that are productive and maintain grain nutritional quality is important. Rice (Oryza sativaL.) varieties, IR64-Pup1.1, IR64, and Kasalath, were grown in open top chambers (OTC) with elevated [CO2] (700 ± 50 ppm), OTC with ambient [CO2], and open control-ambient [CO2] with two levels of phosphorus (P), low (7.96 mg P kg−1soil) and sufficient (22.9 mg P kg−1soil) to study the interactive effects of P and [CO2] on grain quality. Grain quality traits varied significantly among varieties under elevated [CO2] but P nutrition effect was not significant. The concentration of N reduced significantly but P, K, Mg, and Ca increased under elevated [CO2] compared to open control-ambient [CO2]. Micronutrients Cu, Mn, Ni, and Zn increased significantly except Fe, while Al increased by > 50% under elevated [CO2] compared to open control-ambient [CO2]. Free sugars (glucose, fructose, and maltose) increased 3 to 5-folds but protein decreased significantly as C:N ratio altered at elevated [CO2]. Among cooking qualities, elevated [CO2] increased amylose and gel consistency resulting in increased viscosity of cold paste gel of cooked rice and boiling time of rice grain. Grain dimension was not affected by elevated [CO2] or P level. Among varieties, IR64-Pup1.1 performed better under elevated [CO2] irrespective of P levels as compared to Kasalath and IR64. Ours is the first report on grain quality assessment of IR64-Pup1.1 under elevated [CO2] and low P availability.