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This paper presents the design of an ultra-wideband high-efficiency extended resistive continuous class B/J (ERCB/J) power amplifier (PA). Beyond an octave bandwidth, the conventional class B/J mode is inappropriate. Whereas the existing resistive-reactive class J modes present an overlapped impedance space at the expense of the efficiency and power degradation or voltage swing beyond 4VDD. Therefore, this paper presents a novel ERCB/J mode to achieve overlapping impedance space promising high efficiency over a multi-octave bandwidth. A design scheme is presented to map loads of the proposed mode to frequencies in the targeted multi-octave band to design a feasible matching network. For the proof of concept, a PA has been designed based on ERCB/J using commercialized GaN HEMT. This PA operates from 0.5-3.25 GHz, exhibiting fractional bandwidth of 146.7%. The peak drain efficiency of 60-70.1% and peak output power of 39.1-41.75 dBm are obtained at saturation over the operating band. The PA has also been tested with a two-tone signal with 10 MHz spacing and a 10 MHz LTE signal.

Aim & Objective: Anatomy set forth the fundamentals of human body in the course of all health care professionals. Cadaveric dissection is the principal way to understand the Human anatomy by the medical students. Donated bodies fulfill the need of cadavers in learning and teaching anatomy. Apart from the use of cadavers students must be aware of particulars regarding body donation. The aim of present study is to assess the knowledge of medical students on body donation. Methods: The research work is questionnaire based study carried out among 263 undergraduate medical students in Siddhartha medical college, Vijayawada. Structured questionnaire was prepared and distributed among the students. The data was collected, compiled and analyzed. Results: All the study members knew the term body donation. Majority of the students are unaware of the time limit to donate the body and the age limit of body donation. 57.03% knew who can donate body. 89.7% knew that the death certificate is mandatory during body donation process. 60.45% had clear idea of reasons for body rejection when donated. 96.57 % had clear idea about the uses of donated body. 59.31% of the students were willing to donate their body and 93.53% were interested in propagating the message of body donation. Conclusion: Our study suggests that the medical students should be aware of act, process and committee of body donation before they involve in the propagation about body donation among public. Keywords: Awareness, anatomy act, body donation, donation forms.

Purpose To report 15-year incidence rate of visual loss (blindness and visual impairment [VI]), causes, and risk factors for participants in Andhra Pradesh Eye Disease Study III (APEDS III). Design Population-based cohort study. Methods From 2012 to 2016, all rural participants were interviewed and underwent a comprehensive eye examination, including dilated fundus examination and imaging. Presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) were measured using a standard logarithm of Minimum Angle of Resolution chart at 3 meters. World Health Organization (WHO) and United States of America (USA) categories of VI and blindness were used. Incident visual loss was defined as the development of or worsening of visual loss of one or more categories. Results In APEDS I, 7,771 rural participants were examined using stratified, random-cluster systematic sampling; in APEDS III, 5,395 participants (69.4% of rural or 52.4% of total participants) were re-examined. Using WHO categories, the crude incidence rate of any visual loss based on PVA and BCVA were 14.6 (95% confidence interval [CI]:13.6-15.7) and 6.3 (95% CI: 6.1-6.4) per 100 person-years, respectively. Using USA criteria, the values were 22.6 (95% CI: 22.3-23.0) and 10.6 (95% CI: 10.3-10.8) per 100 person-years, respectively. More than 90% of visual loss was attributable to cataract and uncorrected refractive error. Using WHO categories, significant independent risk factors for the incident visual loss were increasing age, female gender, illiteracy, past or current smoker, and current use of alcohol. Using the USA definition, an additional risk factor was lower level of education. Conclusions The high incidence likely reflects poor access to eye care in this population, which needs to be taken into account when planning eye care programs.

Purpose Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT). Methods This study was conducted as a part of the ongoing study titled "Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN)." Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment. Results A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%-97.7%) and the specificity was 93.4% (95% CI: 91.6%-94.9%). Positive predictive value was 41.9% (95% CI: 32.3%-51.9%) and negative predictive value was 99.5% (95% CI: 98.8%-99.9%) with a moderate agreement (0.54; 95% CI 0.49-0.64) between VT screening and screening with SVS. Conclusion The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.

Background:Induction of labour is the process of initiating the labour by articial means post 24 weeks of gestation. This study was undertaken to compare the efcacy and safety of vaginal Misoprostol [25-50ug] with intracervical Dinoprostone gel (0.5mg) for induction of labour at term in terms of efcacy of drug, feto-maternal outcome, side effects and complications of drugs. Methods: 400 nulliparas at term admitted in the OBG ward were included in this study. They were randomly allocated to two groups A& B. Group A (200 women) received tablet Misoprostol 25 micrograms vaginally 4 hrly to a maximum of 3 doses and Group B (200 women) received Dinoprostone gel 0.5mg intracervically 6 hrly to a maximum of 3 doses. Comparison was done in terms of induction to delivery interval, rates of instrumental and LSCS delivery, need for NICU care and cost-effectiveness. ADRs, if any were documented and proper care taken. Results: The mean induction to delivery interval was less in the Misoprostol group than Dinoprostone group (12 hrs vs. 22 hrs). 82% patients delivered in the rst 24 hrs in Misoprostol group compared to 54 % patients in Dinoprostone group. Group A had a higher success rate (80% vs.75%) and also required less augmentation of labor ( 35% vs. 65%) compared to group B. Need for LSCS was also lower in Misoprostol group (13% vs. 18%). Need for instrumentation and incidence of NICU admission was similar in both groups. Misoprostol was more cost effective compared to Dinoprostone. Conclusions: The Misoprostol group had a shorter induction to delivery interval, more number of deliveries in the rst 24 hrs of induction and a reduced need of augmentation of labor with oxytocin. There was no signicant difference in the rate of caesarean section, hyper-stimulation syndrome, neonatal and maternal morbidity between the two groups. Thus, Misoprostol appears to be safer, cheaper and more efcacious alternative for induction of labor especially for non-fetal indications as compared to Dinoprostone gel.

Purpose To report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III). Methods The baseline APEDS I included 7771 participants of which 6447 (83%) were traced and 5395 (83.7%) were re-examined in APEDS III. To estimate the incidence of pterygium, we selected participants who were 30 years and above at baseline (4188), of which 2976 were traced and 2627 (88.3%) were examined, and based on inclusion criteria, 2290 participants were included in the study. The incidence rate of pterygium was defined as the proportion of people free of pterygium at baseline who had developed the condition at 15-year follow-up (range 13–17 years). Univariate and multivariable analyses for risk factors were undertaken. Results The sex-adjusted incidence rate of pterygium was 25.2 per 100 person-years (95% CI 24.8 to 25.7) which was significantly higher for men than women (26.3 per 100 person-years (95% CI 25.6 to 27.0) and 24.7 (95% CI 24.1 to 25.3) respectively). At the multivariable analysis, male gender (RR: 1.35, 95% CI 1.0 to 1.83), no formal education (RR: 2.46, 95% CI 1.22 to 4.93), outdoor occupation (RR: 1.47, 95% CI 1.14 to 1.9) and lower body mass index (BMI) ( Conclusions The overall incidence rate of pterygium was high in this rural population, especially in men and those engaged in outdoor activities, lack of formal education and with lower BMI. It is likely that greater exposure to ultraviolet light is a major contributing factor, thus warranting preventive strategies.

Purpose of the study: India and Japan share strong cultural and economic ties. The economic relationship between the two Asian giants strengthened with the signing of the CECA agreement during the year 2011. The current research would focus on assessing the bilateral trade relations between both the countries and attempts to identify the commodity trade potential to enhance the future trade between them. Methodology: The study is based on secondary sources of data collected through the United Nations Conference for Trade and Development, WTO, IMF, RBI, and the Japanese Trade Databases. The annual data for the period 2005 to the year 2016 has been used to analyse the Intensity Indices and the Gravity Coefficient values between India and Japan. Similarly, the annual data from the year 2008 to 2015 is used to calculate the RCA and RID index values and finally, the average RCA and RID (2008-2016) are used for analysis to identify the commodity trade potential between both the countries. Main Findings: The study concludes that the trade share of Japan in India’s overall trade has been falling significantly over the years which could be seen through the declining Export Intensity and Import Intensity Indices of India with Japan. However, the overall analysis presents that 28 commodities were feasible for trade between India and Japan from the 56 commodities computed for the study which exhibits a strong potential for enhancing future bilateral trade relations between both the countries. Applications of this study: India had made a strategic move with its Look East Policy during the year 1991 to accelerate its trade relations with the East Asian countries and later with its success the same was transformed into Act East Policy during the year 2014. The current study would prove to be useful in shaping the policy changes in this direction. Novelty/Originality of this study: The study focuses on the bilateral trade relations between the two important Asian giants, India, and Japan during the post comprehensive economic cooperation agreement between the two. Further, the study identifies the areas of commodity trade potential which paves the direction for new trade between the countries to tap the untapped trade potential.

Tumoral calcinosis is a rare clinical and pathological entity, characterized by deposition of calcium in different sites of human body particularly in peri-articular tissues. It incidence is usually seen in young adults as a slowly growing, painless, firm to bony hard mass. Asymptomatic when small in size but larger masses can cause pressure symptoms due to compression of surrounding tissues or restriction of mobility of the joints. It can be predicted by typical radiological findings with the help of serum calcium and phosphorus levels but is confirmed only by histopathological examination. Many times, it isn’t very easy to diagnose this condition preoperatively and can be mistaken as soft tissue sarcoma both clinically and radiologically. Subtyping of this lesion depends on serum calcium, phosphorus levels, family history and co-morbid conditions like chronic renal failure. Hemodialysis, hypervitaminosis-D, milk-alkali syndrome, hyperparathyroidism, etc are responsible for the secondary causes. Treatment modality depends on the subtype, which can be medical or by surgical intervention. The present study was a case of adolescent male with a slowly growing swelling over the right hip region for 4 years. There was no traumatic history or any significant family history. Serum calcium and phosphorus levels were within normal limits. Radiology showed well-demarcated lobulated solid-cystic mass swelling measuring 7.8x3.9x3.5cm suggestive of sarcoma. The tumor was excised and sent for histopathological examination. Grossly, it was a ovoid solid-cystic firm to hard mass, microscopy showed large areas of dystrophic calcification with cystic spaces surrounded by foreign body giant cell reaction. Correlating with history, clinical findings, biochemical findings, the diagnosis of primary normophosphatemic tumoral calcinosis was made.

Purpose: To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India. Methods: An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9). Results: In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses. Conclusion: A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.

This letter presents the design of a continuous class E/F power amplifier (PA) using model-based nonlinear embedding. The theoretically calculated continuous class E/F loads defined at the current source reference plane (CRP) may not guarantee feasible loads at the extrinsic package reference plane (ERP) due to nonlinear parasitic. Hence, a design space is analyzed to map the correct mode of the class E/F continuum over broadband to obtain feasible loads. A scheme is presented to assign fundamental current component ( $\phi$ ) to various frequencies over the band to obtain a tradeoff between best bandwidth and feasibility of a passive matching network. A nonlinear embedding model is used to project the loads from CRP to ERP. As a proof of concept, a continuous class E/F PA is designed using CGH27015F. The prototype developed has measured a drain efficiency of 60.2%–76.5% from 1.5 to 2.9 GHz which corresponds to 63.6% fractional bandwidth.

Background Hepatocellular Carcinoma (HCC) is a severe complication of cirrhosis and the incidence of HCC has been increasing in the United States (US). We aim to describe the trends, characteristics, and outcomes of hospitalizations due to HCC across the last decade. Methods We derived a study cohort from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult hospitalizations due to HCC were identified using the International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). Comorbidities were also identified by ICD-9/10-CM codes and Elixhauser Comorbidity Software (Agency for Healthcare Research and Quality, Rockville, Maryland, US). Our primary outcomes were in-hospital mortality and discharge to the facility. We then utilized the Cochran-Armitage trend test and multivariable survey logistic regression models to analyze the trends, outcomes, and predictors. Results A total of 155,436 adult hospitalizations occurred due to HCC from 2008-2017. The number of hospitalizations with HCC decreased from 16,754 in 2008 to 14,715 in 2017. Additionally, trends of in-hospital mortality declined over the study period but discharge to facilities remained stable. Furthermore, in multivariable regression analysis, predictors of increased mortality in HCC patients were advanced age (OR 1.1; 95%CI 1.0-1.2; p< 0.0001), African American (OR 1.3; 95%CI 1.1-1.4;p< 0.001), Rural/ non-teaching hospitals (OR 2.7; 95%CI 2.4-3.3; p< 0.001), uninsured (OR 1.9; CI 1.6-2.2; p< 0.0001) and complications like septicemia and pneumonia as well as comorbidities such as hypertension, diabetes mellitus, and renal failure. We observed similar trends in discharge to facilities. Conclusions In this nationally representative study, we observed a decrease in hospitalizations of patients with HCC along with in-hospital mortality; however, discharge to facilities remained stable over the last decade. We also identified multiple predictors significantly associated with increased mortality, some of which are potentially modifiable and can be points of interest for future studies.

Among the urinary bladder malignancies, infiltrating urothelial carcinoma is the most common while sarcomatoid variant is a rare malignancy. As the literature shows only few published case reports, We present a case of polypoidal mass of urinary bladder which was excised by TURBT (Transurethral Resection of Bladder Tumor) procedure and histopathologically diagnosed as sarcomatoid squamous cell carcinoma. Keywords: Sarcomatoid carcinoma, Urinary bladder.

This study presents the design of a broadband continuous mode power amplifier (PA) with an active harmonic injection (HI). Since the injected harmonic signal is generated on-board using a frequency doubler, this design has a single radio frequency input. The generated second harmonic is injected at the drain terminal of a gallium nitride high-electron-mobility transistor used in designing continuous class B/J PA. A design space in terms of amplitude and phase of the injected harmonic signal is analysed to obtain the loads that operate the PA in the continuous class B/J mode at the current generator reference plane. The proposed design strategy is verified by designing a prototype with a frequency doubler and a PA using 10 and 15 W gallium nitride high-electron-mobility transistors, respectively. The measured drain efficiency of 60.04-70.96% and output power of 40.17-42.6 dBm is obtained from 1 to 1.9 GHz. This corresponds to a broadband operation of 900 MHz with 62% fractional bandwidth. The designed HI-PA is also tested with a 20 MHz long-term evolution signal whose corresponding adjacent channel power ratio is better than -47.76 dBc in the overall band after applying digital predistortion.

Purpose To report on the 15-year incidence of primary angle closure disease (PACD) among participants aged ≥40 years in rural southern India Design Population-based longitudinal incidence rate study Methods Setting: 3 rural study centres. Study population: Phakic participants aged ≥40 years who participated in both examination time points. Observation procedures: All participants at the baseline and at the mean 15-year follow-up visit underwent a detailed interview, anthropometry, blood pressure measurement, and comprehensive eye examination. Automated perimetry was attempted based on predefined criteria. Main outcome measures included development of any form of PACD, as defined by the International Society for Geographical and Epidemiological Ophthalmology (ISGEO), during the follow-up period in phakic participants, who did not have the disease at baseline. Results We analyzed data obtained from 1,197 (81.4% out of available 1,470) participants to calculate the incidence of the disease. The mean age (standard deviation) of the study participants at the baseline was 50.2 (8.1) years, with 670 male (45.5%) and 800 female (54.4%) participants. The incidence rate per 100 person-years (95% confidence interval) for primary angle closure suspect, primary angle closure, and primary angle closure glaucoma was 8.8 (8.4, 9.2), 6.2 (5.9, 6.6), and 1.6 (1.4, 1.8), respectively. Thus, the incidence of all forms of PACD was 16.4 (15.9, 17) per 100 person-years. On logistic regression analysis, female gender was a significant risk factor whereas presence of myopia was protective. Conclusions This study reports long-term incidence of PACD from rural India. It has implications for eye health care policies, strategies, and planning.

This paper presents a methodology to improve the efficiency of a power amplifier in broadband using an active harmonic injection. The harmonic signal is injected to operate the power amplifier similar to the Class J mode. The second harmonic signal is generated on-board using a frequency doubler whose input is the same as that of the power amplifier. As a proof of concept, a prototype is designed with frequency doubler using 10 W GaN HEMT that generates a second harmonic signal and injects at the drain of main PA designed with 15 W GaN HEMT. The measured results show the drain efficiency of 60.02% to 75.13% with the output power of 42.3 to 42.99 dBm over the band of 600 MHz ranging from 1.2-1.8 GHz. The measured carrier to third order intermodulation distortion is better than -15 dBc in the overall operating band.

Background To compare the agreement and diagnostic accuracy of vision screening conducted by trained community eye-health workers (CEHWs) and teachers with reference to vision technicians in Movva Mandal (sub-district) in Krishna District in the Indian state of Andhra Pradesh. Methods As part of a large epidemiological study on visual impairment in children, vision screening was conducted in all the schools in a sub-district. The children were screened using a screening card with 6/12 tumbling E optotypes by trained CEHWs, teachers and a vision technician. Teachers were included if they had screened at least 100 children and had at least five children identified with visual impairment. Results Of a total 6,197 children from 75 schools, 4,929 children were screened by all three categories of examiners (one vision technician, five CEHWs and 79 teachers). The overall agreement between the vision technician and CEHWs was 0.84 (95 per cent CI: 0.79–0.9) with a range of 0.77–0.9. Overall sensitivity of CEHWs to detect visual impairment was 83.3 per cent (95 per cent CI: 73.6–90.6) with a range of 71.4–87.1 per cent. Overall agreement of the five teachers with the vision technician was 0.81 (95 per cent CI: 0.74–0.88) with a range of 0.32–0.92. The overall sensitivity of teachers to detect vision problem was 72.3 per cent (95 per cent CI: 61.4–81.6) with a range from 20 per cent to 85.7 per cent and specificity was near 100 per cent. Conclusion There was no significant difference in the agreement and diagnostic accuracy of CEHWs and teachers compared to those of the vision technician. There was a large variability among teachers, which needs to be considered in school vision screening programs.

Background: Coronary artery disease (CAD) is the major disease leading to cause mortality and morbidity. The imbalance between the generation of reactive oxygen species (ROS) and the intrinsic antioxidant defense system leading to the oxidative stress, has been implicated in the pathogenesis of the cardiovascular disease. The formed free radicals and subsequent lipid peroxidation may be responsible for myocardial damage in patients undergoing percutaneous coronary interventions. Therefore, the understanding of the pathophysiological role of ROS generated during or after coronary interventions is essential to improve the success rate of these procedures. Aims and Objective: The aim of this study was to evaluate the time course changes of oxidant and antioxidant status, in patients undergoing percutaneous coronary interventions (PCI). Materials and Methods: The study included 120 consecutive patients (117 males, 3 females; mean age 58.4 years) who underwent elective PCI. Coronary angiography and coronary angioplasty were performed according to the standard protocols. Blood samples were taken just before (0hrs) and at 4 hrs and 24 hrs after coronary interventions to determine the oxidative status i.e. plasma malondialdehyde (MDA) and for antioxidative status, erythrocyte glutathione peroxidase (GPx), erythrocyte glutathione (GSH) and plasma ferric reducing ability of plasma (FRAP). Results: There was significant increase in MDA levels (1.87±0.34, 1.90±0.46, p=0.000), at 4hrs and 24hrs after coronary interventions when compared to baseline levels. After coronary interventions, the GPx activity (12.96±8.37, 12.3±7.76, p=0.000) and FRAP levels (0.73±0.21, 0.70±0.23, p=0.001 respectively) were found to be increased significantly at 4hrs and 24hrs. However, the glutathione levels (2.40±0.57, 2.47±0.53, p=0.040) were decreased at 4hrs and 24hrs after coronary interventions. Conclusion: Our study demonstrates that presence of oxidative stress in coronary interventions. The increase in antioxidants in the present study may be due to paradoxical increase in oxidant levels in patients undergoing coronary interventions. Asian Journal of Medical Sciences Vol.8(2) 2017 29-33

Introduction:Haemovigilance is a set of surveillance procedures covering the whole transfusion from collection of blood and its components to the follow up of its recepients.Haemovigilance programe of India was launched on 10 th December 2012 . Objective:To identify and prevent occurence or recurrence of transfusion related unwanted events and to increase the safety ,efficacy and efficiency of blood transfusion. Materials And Methods:Transfusion reactions reported over a period of 3 months(march,april,may 2016)were reviewed and analysed. Results:A total of 2445 units of whole blood and components were transfused in this period.In this 1330 units of whole blood,950 units of packed cells,65 units of platelet rich plasma and 100 units of fresh frozen plasma were transfused.Acute transfusion reactions(ATR) encountered were 16(0.65%).Out of which ATRs with whole blood were(n= 7,p=0.13 ),with packed cells were(n= 2, p=0.19),with platelets were(n= 4,p=0.18)and with frozen plasma were (n=3,p=0.53).Allergic reactions were most common ATRs seen with whole blood transfusions.Febrile reactions were the second most ATRs.Least number of ATRs are seen with packed cells.Obstetrics and gynaecology department recieved most of blood transfusions(58.27%),while paediatric department stood second(8.6%). Conclusion:The overall incidence of ATRs in this hospital is 0.65%.Though there are no leucoreduction facilities, the ATRs are less due strict aseptic compatability testing.

AIM To study the variations in the arrangement of renal hilar structures in human cadavers which are observed in anteroposterior direction. MATERIALS & METHODS Forty two (42) embalmed cadaveric kidneys are observed for studying the variations, the renal hilar structures arrangement and for branching of renal vessels. The number of branches of renal artery, number of supernumerary renal arteries & arrangement of structures at the hilar and prehilar region is studied. RESULTS In the present study, 29 kidneys were having normal renal arteries, whereas 13 kidneys were having the supernumerary renal arteries. In these 29 kidneys group, 15 kidneys (51.7%) were having common pattern of renal hilar structures, arrangement is RV-RA-RP in an anteroposterior direction. In 7 kidneys (24.1%), AD & PD of RA are present in between the RV & RP. In 4 kidneys (13.4%), RV is present in between AD, PD of renal artery. CONCLUSION Information about the arrangement of renal hilar structures is very important for general surgeons, urologists & transplant surgeons because this knowledge minimises the intraoperative & postoperative complications.

This paper reports a comparative investigation on acoustic comfort of classrooms in vernacular and modern school buildings in tropical warm humid climate. In this type of climate the intrusion of external noise into the classrooms along with cross ventilation is unavoidable. Preliminary investigation on the evaluation of acoustic comfort carried in secondary schools located in Kollam district of Kerala State in India have been reported. As a step ahead, in order to understand the performance of vernacular school classroom in comparison with that of a modern classroom, an initial survey was conducted in classrooms of ten vernacular and 10 modern schools. Further a detail investigation was carried out in a vernacular and modern school building located in the same site. The study was conducted by measuring the two important acoustic parameters viz., background noise and reverberation time which affect the acoustical comfort in the classrooms. The level of satisfaction of the users was evaluated through questionnaires distributed to teachers and students. The result of the scientific analysis was compared to user’s response. The study reveals that modern classrooms are more preferred than vernacular classrooms acoustically, by the teachers and students. The study also confirms a strong need of improving the acoustical comforts in the classrooms.

Background: Malleus, incus and stapes are the three ear ossicles present in middle ear. The auditory ossicles of the middle ear have a fundamental role in transmission of sound. The aim of this study was to determine development of ear ossicles from prenatal to postnatal life which will be of great help for an ENT surgeon who should be well conversant with the anatomical details of middle ear prior to undertake reconstruction procedures for the improvement of sound conduction in conductive deafness. Methods: The study was conducted in 25 foetuses and 25 adult ossicles after removal from temporal bones of embalmed cadavers. Vernier caliperse was used to measure different morphometric parameters to study growth and development of ossicles. Results: Malleus: The average length of Malleus varies from 4 to 7.24mm in foetuses and adults respectively. The length of the anterior process was variable and some of the processes were quite long. Incus: The incus had minimum morphological variations in the ossicles. Its length ranges from 4.97-6.94mm. Stapes: The stapes had maximum morphological variations in the ossicles. The variations of stapes were in the neck, the cruses and the foot plate. The variations seen in stapes were no neck, a short or a long neck. The cruses of the stapes had symmetry or asymmetry. Length varies from 2.45-3.8mm. Conclusions: Ossicles at 20 weeks of prenatal life were cartilagenous, and at 24 weeks they were ossified and surrounded by mesenchyme. Postnatal changes were minimal. These parameters of Ossicles will help in designing of implants and treating hearing loss.

Background The rationale, objectives, study design and procedures for the longitudinal Andhra Pradesh Eye Disease Study are described. Design A longitudinal cohort study was carried out. Participants Participants include surviving cohort from the rural component of Andhra Pradesh Eye Disease Study. Methods During 1996–2000, Andhra Pradesh Eye Disease Survey was conducted in three rural (n = 7771) and one urban (n = 2522) areas (now called Andhra Pradesh Eye Disease Study 1). In 2009–2010, a feasibility exercise (Andhra Pradesh Eye Disease Study 2) for a longitudinal study (Andhra Pradesh Eye Disease Study 3) was undertaken in the rural clusters only, as urban clusters no longer existed. In Andhra Pradesh Eye Disease Study 3, a detailed interview will be carried out to collect data on sociodemographic factors, ocular and systemic history, risk factors, visual function, knowledge of eye diseases and barriers to accessing services. All participants will also undergo a comprehensive eye examination including photography of lens, optic disc and retina, Optic Coherence Tomography of the posterior segment, anthropometry, blood pressure and frailty measures. Main Outcome Measures Measures include estimates of the incidence of visual impairment and age-related eye disease (lens opacities, glaucoma and age-related macular degeneration) and the progression of eye disease (lens opacities and myopia) and associated risk factors. Results Of the 7771 respondents examined in rural areas in Andhra Pradesh Eye Disease Study 1, 5447 (70.1%) participants were traced in Andhra Pradesh Eye Disease Study 2. These participants will be re-examined. Conclusions Andhra Pradesh Eye Disease Study 3 will provide data on the incidence and progression of visual impairment and major eye diseases and their associated risk factors in India. The study will provide further evidence to aid planning eye care services.

Purpose: To study the causes of severe vision impairment (SVI) and blindness among children in Andhra Pradesh (AP) and Telangana State (TS) in South India. Methods: A total of 299 children from 10 schools for the blind were examined between January and December 2017. The schools were chosen from 3 districts of AP (Guntur, Krishna and West Godavari) and 2 districts of TS (Adilabad and Mahabubnagar). The World Health Organization Prevention of Blindness' eye examination protocol for children with blindness or visual impairment (VI) was followed. Results: Based on presenting visual acuity (PVA), 248 children (82.9%) were blind, 16 children (5.3%) had SVI, 18 (6%) had moderate VI, and 17 (5.7%) were normal. The most common anatomical cause of blindness or SVI was whole globe anomaly (32%), followed by an abnormality in the retina and vitreous (26.6%). While whole globe anomalies were high both in AP (33.8%) and TS (21.6%), lens-related pathologies were higher in TS (29.7%) and retina-related abnormalities were higher in AP (29.3%). The most common cause was related to heredity (40.5%). Etiology was unknown in 33.5% of cases. Overall, 37.1% of the causes were avoidable. In AP, 33.4% were avoidable whereas in TS nearly 60% were avoidable. Conclusion: Whole globe anomaly constitutes a major cause of SVI and blindness, especially in AP. Lens-related pathologies were higher in TS. Nearly 40% of the causes were avoidable. Hence, robust screening methods and strategies must be established for timely intervention to reduce the burden on VI in children.

Training and development is vital protective device for improving employee performance and organizations retain accumulative training budget on yearly basis with believe that it will earn them competitive edge. The main objective of this study is to examine the effectiveness of training and development on employees' performance and organization competitive advantage in the Alpha global sourcing Pvt Ltd. Descriptive research method was adopted for this study using hundred valid questionnaires which were completed by using simple random sampling technique. The data collected were judiciously examined using descriptive statistics to represent the raw data in a meaningful manner. The results show that strong relationship exists between training and development, employees' performance and competitive advantage. Summary of the findings indicates that there is strong relationship between the tested dependent variable and independent construct. However, management should not relent in their quest to train their staff to develop new ideas that will keep improving and retaining employee performance. N. Veena | P. Asha Latha "A Study on Effectiveness of Training and Development with Reference to Alpha Global Sourcing Pvt. Ltd, Banglore" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-5 , August 2018, URL: https://www.ijtsrd.com/papers/ijtsrd16951.pdf

ObjectiveTo examine barriers to the uptake of referral services from secondary care centres to higher level tertiary care centres.DesignCross-sectional study.SettingSecondary care hospital in Khammam District in the Telangana state of India.ParticipantsNine hundred and three patients who were referred from a secondary care centre to tertiary care centres between June 2011 and December 2012, were over the age of 18 and lived within 50 km of the secondary care centre were identified. Six hundred and sixteen (68.2%) of these patients were successfully contacted, and 611 (99%) of those contacted consented to participation in the study.InterventionsThose who attended at higher centres after referral (compliant) and those who failed to attend (non-compliant) were interviewed with a standard questionnaire designed for the study.Primary and secondary outcome measuresOutcome measures were barriers to the uptake of eye care services for the non-compliant participants and the associated risk factors for non-compliance.ResultsOf the contacted patients, 418 (68.4%) were compliant and 193 (31.6%) were non-compliant. The mean age of interviewed patients was 48.4 years (SD: 17.9 years) and 365 (59.7%) were male. Of those who did not comply with their referral, the major identified barriers were ‘cannot afford treatment cost’ (30%) and ‘able to see adequately’ (20.7%). Multivariable analysis showed that participants in the non-compliant group were more likely to have had only one prior visit to the centre (OR: 2.5, 95% CI 1.6 to 3.9), be referred for oculoplastic services (OR: 3.0, 95% CI 1.0 to 8.8) and to be the main earning member of the family (OR: 1.9, 95% CI 1.2 to 2.8).ConclusionsNon-compliance with referrals in this population is largely attributable to economic and attitudinal reasons. Focusing on these specific barriers and targeting groups at higher risk of non-compliance could potentially improve uptake of referral services.

Stepper motors are electric motors that are used extensively in safety-critical applications such as auto, medical devices, and surgical robots. A popular trend is the use of FPGA-based digital control for stepper motors. We present a formal verification methodology for 6 types of stepper motor (SM) control. Our methodology is based on the theory of Well-Founded Equivalence Bisimulation refinement , where both formal specifications and implementations are treated as transition systems. We define formal specifications for six types of Stepper Motor control. We also develop correctness proof obligations for FPGA implementations of stepper motor control. The methods are demonstrated using six case studies. The specifications are simple, with less than 50 transitions. We have used our methodology to verify FPGA controllers with millions of transitions against these simple specifications.

While doing a routine dissection in an 85 years old cadaver, it was observed that the coeliac trunk arised as gastro splenic trunk and the common hepatic artery arised from the superior mesenteric artery instea d of the coeliac trunk. Knowledge of anatomical variants of coeliac trunk, hepatic vascular structures is of great importance in general surgery, especially hepatic surgery. As coeliac trunk supplies the foregut, the anomaly and morphometric variation may lead to abnormalities of the foregut and its derivatives. This leads to anatomical, surgical and clinical complications. This knowledge is also of great importance with regard to liver transplantations, laparoscopic surgeries, radiological procedures, and the treatment of penetrating injuries involving the peri - hepatic area

AIM: To assess the knowledge and awareness of Therapeutic Drug Monitoring (TDM) among 2nd, 3rd and final year medical students. This study was conducted to assess the level of knowledge and the knowledge gap and awareness of Therapeutic Drug Monitoring (TDM) among 2 nd , 3rd and final year medical students of Govt. Medical College, Ananthapuramu to conclude regarding importance of Therapeutic drug monitoring in the curriculum of second M.B.B.S. In our study Third year students were considered as final year. It was a Cross-Sectional Questionnaire Based Study where 300 M.B.B.S medical students were surveyed with a questionnaire Proforma after taking an informed consent. 75% of second M.B.B.S students had good level of knowledge about what happens to a drug in the body. 54% of second M.B.B.S students had good knowledge regarding the need to monitor therapeutic level of a drug. Only 2% of second M.B.B.S Students given correct answers about the investigation of TDM. No second M.B.B.S student had the knowledge of instrument used for TDM. 65% of second M.B.B.S. students and 76% of Final M.B.B.S thought that TDM is a new term to them in Pharmacology and affirmed the need for incorporation of TDM in second M.B.B.S curriculum. The present study shows that there is a substantial gap of knowledge about Therapeutic drug monitoring(TDM) in second M.B.B.S students and M.B.B.S final year ,so there is a need of incorporation of Therapeutic drug monitoring(TDM) in second M.B.B.S curriculum.

Financial services organizations around the world are experiencing drastic change. Financial services firms are turning to big data technologies and Hadoop to reduce risk, analyze fraud patterns. Ability of Big Data platforms to process and analyze unstructured data efficiently unlike current platforms that are limited to handling structured data. This flexibility makes it possible to gain insights from different variety of data. Big data can be analyzed for insights that lead to better decisions and strategic business moves. For most organizations, big data is the reality of doing business. It's the proliferation of structured and unstructured data that floods your organization on a daily basis - and if managed well, it can deliver powerful insights. Big data analytics is the process of examining large data sets containing a variety of data types -- i.e., big data -- to uncover hidden patterns, unknown correlations, market trends, customer preferences and other useful business information. The analytical findings can lead to more effective marketing, new revenue opportunities, better customer service, improved operational efficiency, competitive advantages over rival organizations and other business benefits. Keywords: Big data analytics, Fraud Detection, Hadoop Clusters, Tools

Wireless sensor networks consist of a network of autonomous sensors that can reconfigure themselves so as to sense the environment in the most significant manner. However, a significant challenge in the practical application of these networks exists in credible authentication and network security. This paper proposes a secure authentication protocol which is considered as a pro-active method, where a user is strongly verified before accessing the data, it is the modified Adhoc On-Demand Distance vector (AODV) Routing protocol that provides many security principles to the user such as checking sequence number, IP address and threshold values. The performance of proposed algorithm is compared with the existing alogorithm based on the following parameters such as Throughput, End to End delay and packet delivery ratio. The results shows that the proposed protocol possesses many advantages against the popular black hole attack. This work has been carried out using NS2 software and the result obtained testifies the effectiveness of the proposed protocol. Keyword: Authentication protocol, AES security, AODV routing protocol, Black hole attack, Wireless sensor network (WSN).

During the educational gross anatomy dissections of the infra-clavicular part of brachial plexus of a 50-year-old male cadaver in our department of anatomy,Andhra medical college, Visakhapatnam, we have encountered a neuroanatomical variation. The lateral cord of brachial plexus and its branches, had a different configuration. On the right side ,the median nerve received very few fibres from the lateral cord of brachial plexus during its formation. On both sides the musculo-cutaneous nerve has given an accessory branch which again joined the main trunk of the median nerve.This variation has clinical importance in median nerve lesions and its distinctive diagnosis. Lesions of the median nerve, if lesion was proximal to this accessory branches, muscles and cutaneous innervations related to this branch were normal.

Background: The sciatic nerve is the largest and widest nerve in the body and is derived from ventral rami of spinal nerves L2 to S3. Sciatic nerve appears in the Gluteal region below Piriformis from Pelvic cavity by passing through Greater Sciatic foramen. In between the Ischial tuberosity and greater trochanter of Femur, it reaches the back of the thigh. At the superior angle of Popliteal fossa, it divides into Tibial and common Peroneal (fibular) nerves. The division varies, and it may occur within the pelvis, Gluteal, upper, mid and lower part of thigh. The anatomical variations of the level at which the Sciatic nerve divides is considered important by Neurosurgeons, Anaesthetists, Orthopaedicians and Surgeons.Methods: This study was conducted on 52 lower limbs to determine the level of sciatic nerve bifurcation and its variations on 26 embalmed human cadavers. The data was analyzed manually using numbers, frequencies and percentages.Results: The findings of this study states that in 2 limbs (3.84%) the nerve divided in the gluteal region; in 4 limbs (7.69%) in the pelvic region; in 10 limbs (19.23%) at the junction between upper and middle thigh. The highest incidence of division occurs in 36 limbs (69.23%) at the superior angle of the popliteal fossa.Conclusions: The findings of this study revealed that the majority of sciatic nerve divisions occur at the superior angle of popliteal fossa while some divided into other regions such as Pelvis, Gluteal and thigh regions.

Introduction: The present study has examined the effect of elevated glucose levels on osmotic fragility of erythrocytes. Osmotic fragility determines the rate of hemolysis of erythrocytes. Blood glucose is the sole energy source for erythrocytes. Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia and has become a major public health problem globally. Diabeties is the risk factor for osmotic fragility. Aim: the aim of the present study is to describe erythrocyte osmotic fragility changes from type II diabetes to non diabetes. Materials and methods: The osmotic fragility test is a measure of the resistance of erythrocytes to hemolysis by osmotic stress. The study was conducted on (n=60) aged between 50-55 years, case group will include 30 type II diabetes who were randomly selected from outpatients of the Malla Reddy Hospital, Suraram. Control group involves 30 non diabetic individuals. Parameters selected for study are initial hemolysis, complete hemolysis, median corpuscular hemolysis, haemoglobin, haemoglobin A1c, Fasting blood sugar, post prandial blood sugar and respective parameters were compared in both the groups. Results & discussion: In this study when type II diabetics were compared with non diabetic individuals, there was a significant change in osmotic fragility of type II diabetics when compare to non diabetic controls. Conclusion: Hyperglycemia causes structural changes in red cell corpuscles which lead to osmotic stress. Hence, it is necessary to rule out investigations of pathogenic mechanisms induced by red cell fragility to prevent complications of diabetes mellitus.

The data encryption standard is a pioneering and farsighted standard which helped to set a new paradigm for encryption standards. But now DES is considered to be insecure for some application. Asymmetric mask protected DES is an advanced encryption method for effectively protecting the advanced DES. There are still probabilities to improve its security. This paper propose a method, which introduce a RSA key generation scheme in mask protected DES instead of plain key, which result in enhancement in the security of present asymmetric mask protected DES. We further propose a Vedic mathematical method of RSA implementation which reduce the complexity of computation in RSA block thereby resulting in reduced delay (four times)that improves the performance of overall system. The software implementation was performed using Xilinx 13.2 and Model-Sim was used for the simulation environment.

This paper presents the design and simulative analysis of MEMS sensor which can be used as pressure sensitive capacitor of Intraocular Pressure (IOP) sensor. An IOP sensor is an LC tank circuit which can be used as diagnostic device for glaucoma disease. This sensor detects pressure in Intraocular range i.e. 0–60mmHg in terms of capacitance. In this paper, different shapes and structures of diaphragm are investigated and found that 4 slotted square diaphragm as optimum. A battery less design was proposed by coating the diaphragm with Teflon (polytetrafluoroethylene) which is highly electronegative. The sensor yields a displacement sensitivity of 9.577×10−5μm/Pa and 13.186×10−5μm/Pa for diaphragm with and without Teflon coating respectively. The capacitive sensitivity has also increased from 5.916×10−7 1/Pa to 10.758×10−7 1/Pa with Teflon coating. It can be seen that, displacement and capacitive sensitivities were improved by 1.3 and 1.8 times respectively by using 4 slotted square diaphragm coated with Teflon. The greatest advantage of the proposed design is the removal of external biasing.

Ameloblastic fibroma (AF) and related lesions comprise a complex group of mixed odontogenic tumors. Ameloblastic fibrodentinoma (AFD) is a rare tumor and is considered as a histological variant of AF showing inductive changes that lead to the formation of dentin. Although the most common site for this tumor is the posterior mandible, hereby we are reporting a case of AFD in the anterior maxillary region which is a very rare site for this group of tumors. The present case report highlights the clinical, radiological and histological presentation of AFD in order to raise awareness for the earlier diagnosis and precise management of this rare pathological entity.

The incessant growth in urbanization, and the population explosion associated with it, has resulted in an increased discharge in sewage disposal lagoons and has led to their overloading. This results in the improper functioning of these lagoons, which greatly affects the treatment of sludge and wastewater. The influents, which carry along with them a huge load of substance, referred to as socioeconomically generated sediments (SeGSs), substantially reduce the capacity of the lagoons and the retention time of the sewage water and sludge. This situation poses a major challenge to municipal engineers and town planners, and to overcome it, either periodic or once-per-lifetime desiltation of these lagoons is warranted. However, in present-day megacities, there are several concerns associated with the desiltation process, viz., selection of the most economical and efficient technique, the availability of dumping ground(s), and transportation of the SeGSs to these dumping grounds. This is where utilization of SeGSs as a manmade resource could be a good initiative towards sustainable development. However, this endeavor entails a holistic understanding of the SeGSs by conducting detailed investigations to characterize them based on their physical, chemical, morphological, and microbial attributes before postulating a strategy for their sustainable utilization. With this in view, extensive sampling of the SeGSs from sewage disposal lagoons located in the western part of India was conducted followed by their very comprehensive characterization. Details of the methodologies adopted for this exercise were presented in this manuscript, and recommendations were made to utilize SeGSs for sustainable development in the most efficient manner.

Two brothers are reported with congenital ptosis and esotropia, one of whom also has polythelia. This particular constellation of clinical features has not previously been described, although comparison with recorded families does show significant overlap with the pedigree reported by Frydman et al.

During routine dissection in the Department of Anatomy, Andhra Medical College, we have found the absence of Pectoralis major on one side i.e., left side. The Pectoralis major and minor of right side are well developed. The clavicular fibres of left Pectoralis major are well developed. whereas the sternocostal fibres were absent. The Pectoralis minor on that side was thinned out. The relative literature of such an anatomical variant is discussed during the presentation.