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Objectives Sinonasal and skull base tumors comprise a heterogeneous group of malignancies with a significant rate of distant recurrence (DR). The aim of this study was to analyze tumor and host factors, including pretreatment neutrophil-to-lymphocyte ratio (NLR), that predict DR in these patients. Materials and Methods We retrospectively reviewed sinonasal tumors and/or tumors involving the skull base treated with surgery between 1973 and 2015 (n = 473). We stratified NLR using the top 5 percentile as cutoff. Factors predictive of outcome were determined by Cox proportional hazards model. Results Most tumors were primary (81%) and 67% had skull base resection. The most common site was the nasal cavity (37%) and the most common histology was squamous cell carcinoma (34%). Most patients presented with advanced primary tumor stage (pT3/T4; 80%) and most had no regional neck disease (pNx/N0; 93%). A total of 104 patients developed DR. The 5-year overall and disease-specific survival for patients who developed DR were 36.4% and 35.8%, compared to 69.0% and 74.9% for patients who did not. Patients with DR had a higher percentage of NLR-high patients compared patients without DR (11% vs 3%, p = .006). In a multivariable analysis, melanoma histology (HR = 5.469, 95% CI 3.171–9.433), pT3/T4 (HR = 2.686, 95% CI 1.150–6.275), pN+ (HR = 6.864, 95% CI 3.450–13.653), and NLR-high (HR = 3.489, 95% CI 1.593–7.639) were independent predictors of DR. Conclusion Melanoma histology, pT, pN, and high NLR predict DR, suggesting that both tumor and host factors need to be considered. NLR may act as a surrogate marker of the hosts immune system.

Halogen-free, environmentally-friendly, and economically viable lubricant additives, which can furnish excellent miscibility with mineral lube base oils and enhance the tribological properties, are gaining increasing interest for the formulation of new generation lubricants. Herein, aminoguanidine salt-based deep eutectic solvents (DESs) having variable mole ratios of fatty acid (as a hydrogen bond donor; HBD) are synthesized through a single-step facile approach. The detailed chemical characterizations based on FTIR and NMR (1H and 13C) confirmed the synthesis of DESs via a hydrogen-bonding network. A linear correlation between the shear stress and shear rate implied Newtonian fluidic behaviour of these DESs. An increasing mole ratio of octanoic acid decreased the viscosity and thermal stability of resultant DESs. The long alkyl chain of HBD furnished good compatibility of these DESs with SN 150 mineral lube base oil. The DESs as additives to SN 150 mineral lube oil improved the viscosity index by 12% and enhanced the tribological properties for steel tribopair by decreasing the wear volume (94%) and coefficient of friction (30%). The detailed analyses of worn scars revealed the formation of DESs-derived tribochemical thin film. The low shear strength of DESs-derived lubricious and protective thin film between steel tribopair facilitated the sliding and avoided the direct contact between the steel tribopair, consequently, significant enhancement of tribological properties.

Introduction This study aimed to investigate the factors which may predict mortality and neurological disability at one year follow up in patients of tuberculous meningitis (TBM) in India. Methodology Patients with TBM were prospectively enrolled from July 2012 to September 2014 from four tertiary care hospitals of Delhi. The demographic characteristics, clinical features and laboratory findings were collected and patients were followed up till 1 year. These were analyzed by univariate and multivariate multinomial logistic regression analysis to identify predictors of adverse patient outcome at 1 year follow up. Results Out of 478 patients enrolled, 391 patients could be followed up to 1 year. Sixty-four patients (16.3%) died and 150 patients (39%) survived with one or more neurological disability. Altered sensorium, motor deficit, cranial nerve palsy, seizures, isolation of M. tuberculosis and presence of multi-drug resistance were independently associated with any adverse outcome (death or disability) but by multivariate analysis only motor deficit, altered sensorium and isolation of M. tuberculosis on culture produced a statistically significant model for prediction of patient outcome. Conclusion The three-predictor model with motor deficit, altered sensorium and isolation of M. tuberculosis produced a statistically significant model with correct prediction rate of 60.4%. These three variables predicted death with odds ratio of 39.2, 6.7 and 2.1 respectively in comparison to recovery whereas only motor deficit and isolation of M. tuberculosis predicted neurological disability at 1 year with odds ratio of 3.9, 2.4 respectively.

Gene therapy is being considered as a promising modality for more than two decades now. It has been used for a number of difficult-to-treat conditions and has shown good results in some of the conditions, but not that effective in some others. Overcoming the initially faced hindrances, the research in the field of gene therapy resurged. India is one the major Asian countries where gene therapy-related research and centers have shown remarkable growth, despite certain constraints faced by the researchers. Current article discusses the different types of gene therapy along with its clinical implications and its current status in Indian context.

The increasing need for high-quality diesel fuel can be fulfilled by using environmental friendly, high-performance additives. We have synthesized novel fatty acid-derived multifunctional additives coupled with phosphazene moiety having the backbone of alternative nitrogen and phosphorous atoms which provided stability, while the additives possessed affinity for the metal surface to form a surface-complex film leading to the hindered metal contact and providing friction-reducing and antiwear properties. In addition, the applicability of the synthesized additives was investigated by testing the anti-oxidant and anticorrosion properties in polyethylene glycol (PEG200) which was taken as the reference base fluid. A rotating bomb oxidation test was used to evaluate the anti-oxidant characteristics, and a four-ball test for the tribological properties. Among the synthesized additives, phosphazene ester of erucic acid exhibited the best antiwear and antifriction properties; however, phosphazene ester of oleic acid was found to be the best anti-oxidant additive.

Background: Acquired immunodeficiency syndrome (AIDS) has emerged as one of the most serious public health problems in India. The parents of HIV-infected children are more likely to die and thus render the children orphan. The sociodemographic characteristics of children with HIV infection are different than the other children of the same age group. With the diverse range of manifestations, the symptoms of HIV/AIDS can appear in children at any time during the course of infection. After appearance of various signs/symptoms, the parents wander to various health agencies for relief and thus lose their vital time. Aims: The present study was conducted (1) to study the sociodemographic profile of children living with HIV/AIDS and (2) to know the treatment-seeking behavior of HIV/AIDS patients before coming to the tertiary hospital. Materials and Methods: The study was a hospital-based cross-sectional study where 216 children registered at the pediatric ART clinic of a tertiary care hospital in Delhi and their caregivers were included in the study. Semi-structured, pretested interview schedule was used for data collection through face-to-face interviews. Results: Out of the 216 children, males outnumbered females in the ratio of 2.48:1. Most of the children were in the age group of 10–14 years (48.1%) and the majority belonged to urban areas (63.4%). Most of the children were going to school. Majority of children (46.3%) belonged to social class-4. Hospitals (62.5%) were consulted first followed by private practitioners (33.3%) by these patients after appearance of earliest symptoms. Presenting symptoms of HIV in children were not specific and the most common symptom was fever (79.1%) followed by not gaining weight (69.4%), recurrent diarrhea (65.3%), cough (41.7%) and vomiting (30.6%). The average number of consultations sought by these patients before coming to this hospital was 2.34 per patients. Hospitals (39.8%) and prior experience at same hospital (33.3%) were the most common source of information about the ART center.

We assess the existence and persistence of manager skill using a unique and broad database of institutional manager returns within the U.S. fixed-income universe. We define prime alpha as the residual return after adjusting for the main fixed-income factors (credit and duration) and find that it is persistent across time. Prime alpha is a strong indicator of manager skill because managers with high prime alpha tend to continue to exhibit high prime alpha. We also show evidence that raw manager returns are not persistent because they are influenced by the cyclical nature of factor returns.

Advances in mammography have sparked an exponential increase in the detection of early-stage breast lesions, most commonly ductal carcinoma in situ (DCIS). More than 50% of DCIS lesions are benign and will remain indolent, never progressing to invasive cancers. However, the factors that promote DCIS invasion remain poorly understood. Here, we show that SMARCE1 is required for the invasive progression of DCIS and other early-stage tumors. We show that SMARCE1 drives invasion by regulating the expression of secreted proteases that degrade basement membrane, an ECM barrier surrounding all epithelial tissues. In functional studies, SMARCE1 promotes invasion of in situ cancers growing within primary human mammary tissues and is also required for metastasis in vivo. Mechanistically, SMARCE1 drives invasion by forming a SWI/SNF-independent complex with the transcription factor ILF3. In patients diagnosed with early-stage cancers, SMARCE1 expression is a strong predictor of eventual relapse and metastasis. Collectively, these findings establish SMARCE1 as a key driver of invasive progression in early-stage tumors.

Reconfigurable manufacturing system (RMS) has emerged as a cost effective mechanism that helps the manufacturing organizations to stay competitive in a global scenario where economic pressures and varying product and production demands are perpetually changing in a fiercely dynamic environment. In this context, RMS is seen as one of the current manufacturing structures, which rapidly adjusts to nuances of production capacity and functionality and is capable of producing variety of products, as and when needed, by incorporating principles: some, which are developed and the others that are in an evolutionary stage. This manuscript attempts to survey the characterization of RMS and evolution of research to improve reconfigurability. To facilitate this, an extensive literature review is carried out and an attempt is made to identify the unexplored research areas and proposes directions for future research. It is expected that, this will help researchers, designers and practicing engineers by making them aware of current trends in this area that has become a necessity for the very survival of the manufacturing sector.

Precise estimation of annual maintenance budget (AMB) drives appropriate maintenance actions. There appears to be a dearth of historical data to evaluate the AMB for a particle accelerator system as these are not many. This paper presents a case study on estimating the AMB of such a system for its contextual conditions using relational matrix of the budget variables. The diagonal elements of the matrix represent the variables while the off-diagonal elements signify the degree of influence among these. The maintenance budget function is evaluated from this matrix and is used to evaluate the AMB for the Pelletron system as a percentage of its asset replacement value. The actual maintenance expenditure on the Pelletron system was found to be within 2.07% of the estimated AMB. The approach is expected to aid the maintenance managers of similar systems, which operate under contextual conditions unique to their laboratory.

Purpose Maintenance actions are initiated by the annual maintenance budget (AMB) allocated for a plant system. It ensures that the assets are kept in a healthy and reliable state. The purpose of this paper is to scientifically evaluate the AMB for an air conditioning (AC) plant system, which forms an integral part of facility management. Design/methodology/approach This paper estimates the AMB of an AC system for specific contextual conditions using incidence matrix of the budget influencing variables. The diagonal elements of the matrix represent the values of the budget variables, whereas the off-diagonal elements represent the degree of influence among these. The maintenance budget function is derived from this matrix and is used to evaluate the AMB for the AC system as a percentage of its asset replacement value (ARV). Findings The AMB for the AC plant system considered in the work is evaluated as 11.1 per cent of ARV for the conditions unique to its context. The actual maintenance expenditure is lower by 7.6 per cent than the estimated value of the budget. Research limitations/implications The results of the methodology are a good guide for practicing facility managers. The shortcoming of the methodology is that it relies on fixed weights of the inter-relations among the budget variables, which may not be necessarily true. Practical implications This approach is expected to aid the maintenance managers in envisaging the AMB for their plant systems which operate under contextual conditions specific to their plant. Originality/value There is no evidence to indicate existence of maintenance budget evaluation methodology for an AC plant system based on its contextual conditions. This paper attempts to fill this gap.

Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.

Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for “diabesity.”

This survey was conducted among 125 pediatricians working in public and private child care facilities of Delhi. Prescription rates of routine vitamin D supplementation varied between 70-100% for various groups of infants, despite non-availability of government guidelines. Pediatricians in private practice more frequently prescribed vitamin D supplementation to term healthy infants as compared to government pediatrician (91.4% vs 71.6%; P=0.005).

Traumatic abdominal wall hernias (TAWHs) are relatively uncommon entities. Common mechanisms that predispose to such hernias include motor vehicle accidents, seat belt injuries, fall from height, handlebar injuries, and bullfighting. Bullhorn injury leading to TAWHs is an uncommon mechanism. We report here one such patient who was managed by laparoscopic transperitoneal anatomical repair of the defect using polypropylene suture. The patient recovered well without any complication and is being followed up. Such small defects can be managed laparoscopically and tissue-only repair using a nonabsorbable suture is a feasible option. Our case is the first reported case of bullhorn-injury associated traumatic hernia managed laparoscopically and first reported case of TAWH in an adult which was managed by laparoscopic sutured tissue-only repair.

We consider a team of heterogeneous agents that is collectively responsible for servicing and subsequently reviewing a stream of homogeneous tasks. Each agent (autonomous system or human operator) has an associated mean service time and mean review time for servicing and reviewing the tasks, respectively, which are based on their expertise and skill-sets. The team objective is to collaboratively maximize the number of "serviced and reviewed" tasks. To this end, we formulate a Common-Pool Resource (CPR) game and design utility functions to incentivize collaboration among team-members. We show the existence and uniqueness of the Pure Nash Equilibrium (PNE) for the CPR game. Additionally, we characterize the structure of the PNE and study the effect of heterogeneity among the agents at the PNE. We show that the formulated CPR game is a best response potential game for which both sequential best response dynamics and simultaneous best reply dynamics converge to the Nash equilibrium. Finally, we numerically illustrate the price of anarchy for the PNE.

Herein, we report commercially available carbon-supported-palladium (Pd/C)-catalyzed

Objective:To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged Design:Cross-sectional comparative study.Setting:Tertiary-care hospital catering mainly to the urban poor of East Delhi, India.Participants:Children aged n140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus andCryptosporidiumantigen detection, and subtyping of diarrhoeagenicEscherichia coli(DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months.Results:Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P= 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93v. 64 %;P< 0·001; OR = 7·25; 95 % CI 2·57, 20·4).Cryptosporidiumwas detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups.Conclusions:Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.

Conventional algorithms for selecting study designs are difficult to use for a novice researcher, especially the postgraduate students. An inherent limitation of using the existing algorithms is the requirement of a priori knowledge of the characteristics of various study designs. We propose a simple and novel 3-question approach to select study designs. The questions are asked in a stepwise manner with answers in 'yes' or 'no'. The responses to each of these questions lead the researcher towards choosing the appropriate study design. We believe that this 3-question approach would be useful for unexperienced researchers in selecting study designs, besides serving as a tool to teach-learn selection of study designs.

Reconfigurable machine tools are emerging as new generation machine tools for dealing with the fluctuating market scenario and immense competition between original equipment manufacturers. New approaches, mechanism and designs principles are required for the development of these machine tools in manufacturing systems. A lot of research work has been done in reconfigurable machine tool (i.e. lathe, milling, shaper, NC, CNC etc.) but still less work has been conducted to develop reconfigurable drilling machine. This paper presents a modular approach to develop Reconfigurable Drilling Machine Tool, which will allow the machine not only to reconfigure the modules in a certain way for performing a specific task but also to develop a new type of machine which can incorporate all the features of reconfiguration for the production of multiple part families on a single platform. A module library, which includes basic and auxiliary modules, is implemented on this machine tool to explain the core features (i.e. scalability, modularity, convertibility and flexibility). Probably, this proposed design contributes a theoretical approach for the reconfiguration features of drilling machine in Reconfigurable Manufacturing System and this proposed design is illustrated through a figure, which is developed on design software (i.e. solid works platform).

In view of easy availability and increasing trend of consumption of fast foods and sugar sweetened beverages (fruit juices and drinks, carbonated drinks, energy drinks) in Indian children, and their association with increasing obesity and related non-communicable diseases, there is a need to develop guidelines related to consumption of foods and drinks that have the potential to increase this problem in children and adolescents.To review the evidence and formulate consensus statements related to terminology, magnitude of problem and possible ill effects of junk foods, fast foods, sugar-sweetened beverages and carbonated drinks; and to formulate recommendations for limiting consumption of these foods and beverages in Indian children and adolescents.A National Consultative group constituted by the Nutrition Chapter of the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines and policy regulations. Detailed review of literature was circulated to the members, and the Group met on 11th March 2019 at New Delhi for a day-long deliberation on framing the guidelines. The consensus statements and recommendations formulated by the Group were circulated to the participants and a consensus document was finalized.The Group suggests a new acronym 'JUNCS' foods, to cover a wide variety of concepts related to unhealthy foods (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). The Group concludes that consumption of these foods and beverages is associated with higher free sugar and energy intake; and is associated with higher body mass index (and possibly with adverse cardiometabolic consequences) in children and adolescents. Intake of caffeinated drinks may be associated with cardiac and sleep disturbances. The Group recommends avoiding consumption of the JUNCS by all children and adolescents as far as possible and limit their consumption to not more than one serving per week. The Group recommends intake of regional and seasonal whole fruits over fruit juices in children and adolescents, and advises no fruit juices/drinks to infants and young children (age2y), whereas for children aged 2-5 y and5-18 y, their intake should be limited to 125 mL/day and 250mL/day, respectively. The Group recommends that caffeinated energy drinks should not be consumed by children and adolescents. The Group supports recommendations of ban on sale of JUNCS foods in school canteens and in near vicinity, and suggests efforts to ensure availability and affordability of healthy snacks and foods. The Group supports traffic light coding of food available in school canteens and recommends legal ban of screen/print/digital advertisements of all the JUNCS foods for channels/magazines/websites/social media catering to children and adolescents. The Group further suggests communication, marketing and policy/taxation strategies to promote consumption of healthy foods, and limit availability and consumption of the JUNCS foods.

E governance has brought in considerable benefits both to citizens and the administration. From the administration point of view, many routine aspects of administration categorized as programmable work can be computerized thereby increasing efficiency and reducing cost. From the citizen’s point of view, e governance would mean automation and standardization of government service delivery thereby eliminating red tape. The reduction in frequency of human interfacing can be an important benefit from the perspective of citizen, as it could minimize delays and chances of corruption. E governance can indeed be very successful if citizen’s perception of the e-governance is properly studied and measures taken to improve the situation. In this paper the citizen’s perception of e-governance is studied empirically. Based on the response to a structured questionnaire administered to 400 citizens approaching e-seva centers, a statistical study on their perception using Pearson Correlation is made, Chi-Square Test for goodness of fit is conducted and relevant conclusions drawn. The process of sampling is attempted to be done on a quasi-random basis to ensure that the sample is as representative as the population seeking the services to minimize sampling errors.

We study optimal fidelity selection for a human operator servicing a queue of homogeneous tasks. The service time distribution of the human operator depends on her cognitive dynamics and the level of fidelity selected for servicing the task. Cognitive dynamics of the operator evolve as a Markov chain in which the cognitive state increases (decreases) with high probability whenever she is busy (resting). The tasks arrive according to a Poisson process and each task waiting in the queue loses its value at a fixed rate. We address the trade-off between high quality service of a task and consequent loss in value of future tasks using a Semi-Markov Decision Process (SMDP) framework. We numerically determine an optimal policy and establish its structural properties.