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Introduction: The purpose of the study was to calculate, tumor control probability (TCP) and normal tissue complication probability (NTCP) in cervical cancer patients and to clinically correlate the outcomes with a follow-up period of 24 months. Materials and Methods: One hundred and fifty patients were included in the present study who received 46 Gy/23 fractions/4½ weeks of external beam radiotherapy with concurrent cisplatin chemotherapy, followed by intracavitary brachytherapy of 3 different fractionations regimens, i.e., 9.5 Gy per fraction of two fractions (50 patients in Arm1), 7.5 Gy per fraction of three fractions (50 patients in Arm2), and 6.0 Gy per fraction of four fractions (50 patients in Arm3). Results: The median TCP value for Arm1, Arm2, and Arm3 was 99.6%, 94%, and 98.1%, respectively, (P < 0.01). The median NTCP value for bladder in Arm1, Arm2, and Arm3 was 0.17%, 0.04%, and 0.07%, respectively, (P = 0.05). The median NTCP value for rectum in Arm1, Arm2, and Arm3 was 4.73%, 4.35%, and 3.17%, respectively, (P = 0.052). The overall survival (OS) of 90%, 86%, and 84% was found for Arm1, Arm2, and Arm3, respectively, at 24 months of follow-up. Conclusion: TCP, NTCP, and OS rates were found higher in Arm1 as compared to the other two arms. The complications found in all arms were less, low grade, and manageable. Hence, Arm1, i.e., 9.5 Gy per fraction of two fractions can be concluded as the optimum fractionation regime in terms of radiobiological parameters as well as overall patient comfort.

Background: The aim of the current study was to compare three different dose-calculating algorithms, i.e., superposition (SP), fast SP (FSP), and convolution (CV), for breast cancer patients treated with intensity-modulated radiotherapy (IMRT) and field-in-Field forward plan IMRT (FiF-FP-IMRT). Materials and Methods: The current retrospective study involved 100 postmastectomy breast cancer patients who were given radiotherapy using IMRT and FiF-FP-IMRT planning techniques. All the initially SP-calculated plans were recalculated with the same monitor units for FSP and CV algorithm without change in any of the other planning parameters. The isodose distribution and various plan evaluating parameters, for example, conformity index (CI), homogeneity index, and uniformity index target volume and normal structure doses were compared and analyzed for all the different algorithm calculated plans. Results: In the IMRT plans, all the target and normal structure dose-volume parameters showed a significant difference between all the three different algorithms with P < 0.05. In the FiF-FP-IMRT plans, CV algorithm showed a significant difference in most of the target and normal structure dose-volume parameters. Among quality indexes, only CI showed a significant difference between all the algorithms in both the planning techniques. R50 showed a significant difference with the CV algorithm in both the planning techniques. Conclusion: The change in the dose calculation algorithm resulted in dosimetric changes which must be evaluated by the medical physicists and oncologists while evaluating treatment plans. In the current study with breast patients, the results obtained for target and normal structure doses using the CV algorithm are overestimated as compared to SP and FSP algorithms, producing variable results in air and bony normal structures. However, the ipsilateral lung V5 parameter and the ipsilateral humeral head mean dose were found to be underestimated by the CV algorithm as compared to the SP and FSP algorithm in both the planning techniques.

Background: Duration of untreated psychosis (DUP) is an important modifiable factor affecting schizophrenia outcomes. A dearth of research in India on untreated versus treated schizophrenia warrants further research. Methods: This was a longitudinal study in a tertiary hospital over 2 years. Inpatients diagnosed with schizophrenia ( N = 116), aged 18–45, were divided into untreated and treated groups. Diagnostic confirmation, severity assessment, and clinical outcome were done using ICD-10 criteria, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) scale. Follow-up was done at 12 and 24 weeks. DUP was measured, and its association with the outcome was assessed. Results: Final analysis included 100 patients, 50 each of previously untreated and treated. Untreated patients had lower age and duration of illness (DOI), but higher DUP ( p < .001). Treated patients showed much improvement on CGI-I at 12 weeks ( p = .029), with no difference at 24 weeks. PANSS severity comparison showed no difference, and both groups followed a declining trend. In untreated patients, age of onset (AoO) was negatively correlated with severity (except general symptoms at baseline) at all follow-ups (‘ r ’ range = −0.32 to –0.49, p < .05), while DOI showed a positive correlation with negative and general symptoms at 12 weeks ( r ~ 0.3, p < .05). Treated patients showed inconsistent and lower negative correlation between AoO and PANSS, with no correlation between severity and DOI. The mean sample DUP was 17.9 ± 31.6 weeks; it negatively correlated with education ( r = –0.25, p = .01) and positively with PANSS severity (‘ r ’ range = 0.22 to 0.30, p < .05) at all follow-ups, especially negative symptoms. Patients with no or minimal improvement on CGI at 24 weeks had higher DUP (Quade’s ANOVA F[1,98] = 6.24, p = .014). Conclusion: Illness variables in untreated schizophrenia affect severity, which has delayed improvement than treated schizophrenia. Higher DUP is associated with negative symptoms of schizophrenia.

Abstract Facile ionic mobility within host frameworks is crucial to the design of high-energy-density batteries with high-power-densities, where the migration barrier (E m ) is the governing factor. Here, we assess the accuracy and computational performance of generalized gradient approximation (GGA), the strongly constrained and appropriately normed (SCAN), and their Hubbard U corrections, GGA+U and SCAN+U, within the density functional theory-nudged elastic band framework, in the prediction of E m as benchmarked against experimental data. Importantly, we observe SCAN to be more accurate than other frameworks, on average, albeit with higher computational costs and convergence difficulties, while GGA is a feasible choice for “quick” and “qualitative” E m predictions. Further, we quantify the sensitivity of E m with adding uniform background charge and/or the climbing image approximation in solid electrolytes, and the Hubbard U correction in electrodes. Our findings will improve the quality of E m predictions which will enable identifying better materials for energy storage applications.

In the present study, radiation shielding and protection ability of prepared Flyash-lime-Gypsum (FaLG) bricks has been studied in terms of energy exposure build up factors and dose parameters. The energy exposure build up factors of Flyash-lime-Gypsum (FaLG) bricks have been calculated for the energy range of 0.015 MeV–15 MeV and for penetration depth upto 40 mfp directly using a new and simplified Piecewise Linear Spline Interpolation Method (PLSIM). In this new method, the calculations of G.P fitting parameters are not required. The verification and accuracy of this new method has been checked by comparing the results of exposure build up factor for NBS concrete calculated using present method with the results obtained by using G.P fitting method. Further, the relative dose distribution and reduced exposure dose rate for various radioactive isotopes without any shielding material and with Flyash-lime-Gypsum (FaLG) bricks have been calculated in the energy range of 59.59–1332 keV. On the basis of the obtained results, it has been reported that the prepared Flyash-lime-Gypsum (FaLG) bricks possess satisfactory radiation shielding properties and can be used as environmentally safe storage facilities for low level nuclear waste.

Background: Diabetes mellitus is a chronic noncommunicable disease, and hypertension (HT) is the most common comorbidity which affects their quality of life (QoL). Aim: The aim of the study was to assess the effects of antihypertensive agents (viz., amlodipine, ramipril, telmisartan, and ramipril with telmisartan) on the blood pressure (BP) and QoL. Methodology: It was an open-labeled prospective intention-to-treat study done in diabetic hypertensive patients (CTRI/2016/10/007340). Patients were randomly assigned antihypertensive agents, namely, amlodipine, ramipril, telmisartan, and a combination of ramipril with telmisartan (RT) in four groups. They were evaluated for BP, blood sugar level, and QoL at baseline and 24th week. Results: After 24 weeks of therapy, systolic BP (SBP) and diastolic BP (DBP) were significantly reduced in all groups. In amlodipine, there was a mean percentage fall of SBP by 15.85% (confidence interval [CI]: 21.38–28.13) and DBP by 11.22% (CI: 8.41–12.70); in ramipril – 14.4% (CI: 18.61–25.15) and 12.4% (CI 8.88–13.99); telmisartan – 18.4% (CI: 24.89–10.79) and 14.6% (CI 10.79–16.24); and in RT group, SBP 17.7% (CI: 23.38–29.18) and DBP 12.4% (CI: 9.05–13.02). QoL score increased by 30.56% (CI: 14.30–10.90), 30.94% (CI: 14.21–10.68), 28.07% (CI: 14.89–11.20), and 28.84% (CI: 15.49–11.77), in respective groups (P < 0.0001, each). However, they were nonsignificant between the study groups (P > 0.05). Conclusion: Amlodipine, ramipril, telmisartan, and a combination of RT are equally effective to improve BP and QoL among diabetic hypertensive patients. However, amlodipine and telmisartan lacked in dry cough and more tolerable than the ramipril and RT therapy. Henceforth, amlodipine and telmisartan are better choice to control HT among DM patients.

Background and Aims: Sensory afferent nerve branches of lower six thoracic and upper lumbar nerves innervate the anterior abdominal wall and are the therapeutic focus of local anesthetics to provide analgesia for the abdominal surgical incision. Central neuraxial and regional analgesia can provide better control of pain due to right subcostal incision used in open cholecystectomy and attenuate the need for opioids. The earlier studies which showed the benefit of the thoracic paravertebral block (TPVB) for analgesia after upper abdominal surgeries did not compare TPVB with oblique subcostal transversus abdominis plane (OSTAP) block. Therefore, the current study compares the analgesic efficacy of TPVB and OSTAP block in open cholecystectomy. Material and Methods: Seventy consenting adults scheduled for open cholecystectomy were allocated to one of the two groups: ultrasound-guided TPVB (Group I) and ultrasound-guided OSTAP block (Group II). The primary objective of this study is to assess and compare tramadol consumption in 48 h in both the groups along with VAS in post anesthesia care unit, and then at 2, 4, 6, 8, 12, 24, and 48 h. The secondary objective of the study is to assess the incidence of PONV. Results: The number of doses of rescue analgesia required was less in Group I when compared with Group II (P < 0.001). Patients in Group I had significantly lower pain scores than Group II. Although in the initial 8 h, both groups had comparable pain scores, after 8 h, these scores were significantly lower in patients in Group I. Less postoperative nausea and vomiting was seen in Group I patients (11.7%) in comparison to Group II (18.1%). Conclusion: Ultrasound-guided TPVB is superior to OSTAP block because of its association with decreased postoperative opioid consumption, lower VAS score, and reduction in opioid-related side effects. Thus, it should be strongly considered as a part of multimodal analgesia regimen in upper abdominal surgeries.

Background: Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. Methods: This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18–45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. Results: Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. Conclusions: PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.

Metal additive manufacturing (AM) has become a predominant process for manufacturing complex metal parts. However, research on controlling the geometric tolerances of the metal AM printed parts and assemblies is scarce. This paper presents a methodology to conduct a geometric tolerance and manufacturing assemblability study of the parts manufactured by metal AM. An assembly benchmark test artifact (ABTA) is designed to include mating features with given assembly conditions based on geometric tolerancing quantifiers. For virtual analysis, prediction phase ABTA samples are generated by using systematic and random field theory deviations. The prediction phase deviations are then calibrated using deviations from a numerical simulation based on thermo-mechanical finite element model of the part. These samples or ‘skin model shapes’ are subjected to geometric tolerance and assemblability study. For experimental validation of the method, geometric tolerance quantification and actual assembly was conducted on laser powder bed fusion (LPBF) fabricated parts. The comparative analysis of the experimental and virtual results validates the new methodology and its ability to provide reliable information regarding assemblability, size dimensions and geometric tolerances. The method can be extended to any AM process for performing a virtual tolerance and manufacturing assemblability study.

Purpose: The objective of this cross-sectional, noninterventional, 6-month observational study was to assess the adequacy of pain management in patients with cancer admitted to the Oncology Department of Guru Gobind Singh Medical College in Faridkot, India. Methods and Materials: A total of 348 patients with cancer were recruited for evaluation of the prevalence of inadequate cancer pain management using the Brief Pain Inventory Pain Management Index. Results: The current study included 127 males (36.5%) and 221 females (63.5%). The most prevalent cancer type was genitourinary; 268 patients (77%) had inadequately managed pain. A significant correlation was observed between poorly managed pain and age groups, analgesic used, and body mass index. Conclusion: Our observation of inadequate pain management among 77% of patients indicates that pain management was insufficient in three quarters of the patients in this study. Accumulating data regarding the inadequacy of cancer pain management is crucial to improve symptom management. Better management of pain not only alleviates pain symptoms but also increases the quality of life for patients with cancer.

Background: Tracheobronchomalacia (TBM) refers to a condition in which structural integrity of cartilaginous wall of trachea is lost. Excessive dynamic airway collapse (EDAC) is characterized by excessive invagination of posterior wall of trachea. In both these conditions, airway lumen gets compromised, especially during expiration, which can lead to symptoms such as breathlessness, cough, and wheezing. Both these conditions can be present in obstructive lung diseases; TBM due to chronic airway inflammation and EDAC due to dynamic compressive forces during expiration. The present study was planned with the hypothesis that TBM/EDAC could also produce expiratory wheeze in patients with obstructive airway disorders. Hence, prevalence and factors affecting presence of this entity in patients with obstructive airway diseases were the aims and objectives of this study. Materials and Methods:Twenty-five patients with obstructive airway disorders (chronic obstructive pulmonary disease [COPD] or bronchial asthma), who were stable on medical management, but having persistent expiratory wheezing, were included in the study. They were evaluated for TBM/EDAC by bronchoscopy and computed tomographic scan of chest. The presence of TBM/EDAC was correlated with variables including age, sex, body mass index (BMI), smoking index, level of dyspnea, and severity of disease. Results: Mean age of the patients was 62.7 ± 7.81 years. Out of 25 patients, 14 were males. TBM/EDAC was found in 40% of study subjects. Age, sex, BMI, severity of disease, frequency of exacerbations and radiological findings etc., were not found to have any association with presence of TBM/EDAC. Conclusion: TBM/EDAC is common in patients with obstructive airway disorders and should be evaluated in these patients, especially with persistent expiratory wheezing as diagnosis of this entity could provide another treatment option in these patients with persistent symptoms despite medical management.

We have performed temperature dependent inelastic neutron scattering measurements to study the anharmonicity of phonon spectra of AgC4N3. The analysis and interpretation of the experimental spectra is done using ab-initio lattice dynamics calculations. The calculated phonon spectrum over the entire Brillouin zone is used to derive linear thermal expansion coefficients. The effect of van der Waals interaction on structure stability has been investigated using advanced density functional methods. The calculated isothermal equation of states implies a negative linear compressibility along the c-axis of the crystal, which also leads to a negative thermal expansion along this direction. The role of elastic properties inducing the observed anomalous lattice behavior is discussed.

We have carried out first principles calculations of the vibrational and thermodynamic behavior in NiSi and isostructural compound NiGe. Phonon density of states has also been measured in NiSi using inelastic neutron scattering techniques. We find that the vibrational spectra of the two compounds are very different, due to the difference in the size and mass of Si and Ge. Interesting anomalous thermal behavior of NiSi due to anharmonic phonons is brought out well in our calculations, particularly the negative thermal expansion (NTE) along the b-axis of the orthorhombic unit cell. Large difference in thermal expansion behavior of NiSi and NiGe is very well reproduced by the calculations. Additionally, calculations enable to identify the phonon modes which lend major contribution to the negative thermal expansion behavior in NiSi, and reasons for negligible NTE in NiGe. Such typical representative modes at the zone-boundary along b-axis involve transverse vibrations of Si/Ge along c-axis.PACS numbers: 78.70.Nx, 63.20.-e, 65.40.–b.

With the recent progress in personal care robots, interest in wearable exoskeletons has been increasing due to the demand for assistive technologies generally and specifically to meet the concerns in the increasing ageing society. Despite this global trend, research focus has been on load augmentation for soldiers/workers, assisting trauma patients, paraplegics, spinal cord injured persons and for rehabilitation purposes. Barring the military-focused activities, most of the work to date has focused on medical applications. However, there is a need to shift attention towards the growing needs of elderly people, that is, by realizing assistive exoskeletons that can help them to stay independent and maintain a good quality of life. Therefore, the present article covers the rapidly evolving area of wearable exoskeletons in a holistic manner, for both medical and non-medical applications, so that relevant current developments and future issues can be addressed; this includes how the physical assistance/rehabilitation/compensation can be provided to supplement capabilities in a natural manner. Regulatory guidelines, important for realizing new markets for these emerging technologies, are also explored in this work. For these, emerging international safety requirements are presented for non-medical and medical exoskeleton applications, so that the central requirement of close human–robot interactions can be adequately addressed for the intended tasks to be carried out. An example case study on developing and commercializing wearable exoskeletons to help support living activities of healthy elderly persons is presented to highlight the main issues in non-medical mobility exoskeletons. This also paves the way for the potential future trends to use exoskeletons as physical assistant robots, as covered by the recently published safety standard ISO 13482, to help elderly people perform their activities of daily living.