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Introduction: Phalanx fractures of the lower limb have high rates of union when manage conservatively. Case Report; A 26-year-old male with fracture of great toe proximal phalanx fracture which was initially managed conservatively with buddy strapping, who missed follow-up and presented late to outpatient department at 6 months with persistence of pain and difficulty in weight bearing. Here, we treated the patient with L-facial plate (2.0 system). Conclusion: Fracture non-union of proximal phalanx can be managed surgically with L- facial plates and screw and bone grafting which will provide full weight bearing and walk normally without any pain and with adequate range of movements. Keywords: Fracture, non-union, facial plates, bone grafting.

Employee retention describes the various measures undertaken by firms for retention of their employees. Hypermarkets are large retail space that offers broad range of daily necessities and groceries where the study was carried out. The employee retention at the hypermarket in Coimbatore city was examined using percentage analyses, correlation, and Garrett ranking for a period of 3 months. Based on the percentage analysis, it is found that majority of the employees were female and received an average monthly salary range of Rs. 5000-15000. Turnover intention scale and Perceived Organizational Support Scale (POS-8) were used in the correlation analysis. It specified that turn over intention is inversely proportional to perceived organization support. According to Garrett ranking, a competitive wage package (61.56%) was the main factor driving employee retention. A plan for employee retention, such as offering bonuses, organisational support and extra reward packages, can significantly reduce the intention of turnover.

In recent years, many types of composites materials are used in leading edges of materials technology, with ultra-demanding applications such as automotive, structural applications etc. Among the various composites, the widely used and oldest composite material is fiber-reinforced composites. Banana fibers act as the most common of all reinforcing fibers for FRP composites. Although these composites have some principal merits such as high strength, high chemical resistance, and excellent insulating properties, etc., natural fibers are now considered as serious alternatives for the use in composites, due to increased environmental awareness and consciousness throughout the world. For various engineering applications, natural fiber-reinforced polymer composites are being worked with. Various natural fibers such as jute, sisal, palm, coir, and banana are used as reinforcements. The reinforcement that is used in vinyl ester resin matrix is banana fiber. This work shows the study of treatment of sodium hydroxide (NaOH) in addition with alumina (Al2O3) particulate on fibers. The result that is inferred from the study is that the flexural strength value of UT, UT + Al2O3, T + Al2O3 has increased with increase in fiber content.

Electronic gadgets have become vital in basic need of individual. The advances in technology, makes it necessary to satisfy different functional needs of users. Therefore, it is important to suggest gadgets for users according to personal preference and various constraints of electronic gadgets. A gadget recommendation system is proposed by integrating various requirements from users.

In this article, a coplanar waveguide-fed planar antenna is proposed for vehicular communication applications. The proposed antenna consists of a modified Z-shaped radiator and designed on a FR4 substrate with a footprint of 40 × 30 × 1.6 mm3. The design is further made reconfigurable structure for providing switching among the operating bands of the antenna by incorporating the BAR64-03 W PIN diodes. The proposed antenna operates the switching among the complimentary operating bands exist under 2.39–2.8 GHz, 3.32–4.11 GHz, 7.34–9.03 GHz has been observed under different switching conditions. The proposed design also exhibits circularly polarized radiation characteristics under operating bands makes this antenna as a hybrid reconfigurable design. The measured results of fabricated antenna are in good correlation with simulated results. The radiation performance is analysed for stand-alone reconfigurable antenna and the virtual environment on a vehicle body.

Diesel engines have been the “primus motor” of transportation in the world since along time now. However, the exhaustion of fuel supplies and increased fuel rates needs alternative fuels. A considerable amount of interest has been shown by researchers to evaluate different plant and vegetable oils as are placement of diesel. Based on this background NOx emission is produced during combustion of fuels at high temperature. Excessive release of NOx causes several effects on living organisms and environment. In this work, the efforts to reduce NOx emission by developing Catalytic converter device for a diesel engine fueled with diesel and Cedar wood biodiesel fuel are discussed. Catalytic converter is vital after treatment technology attempted in this work to simultaneous control of NOx, HC, and PM emissions. The experiment was conducted on a 1500rpm, four-stroke, diesel engine with single cylinder which is water cooled.

While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system.

Evidence suggests that growth in providers' prices drives growth in health care spending on the privately insured. However, existing work has not systematically differentiated between the growth rate of hospital prices and that of physician prices. We analyzed growth in both types of prices for inpatient and hospital-based outpatient services using actual negotiated prices paid by insurers. We found that in the period 2007-14 hospital prices grew substantially faster than physician prices. For inpatient care, hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent, while physician prices grew 6 percent. A majority of the growth in payments for inpatient and hospital-based outpatient care was driven by growth in hospital prices, not physician prices. Our work suggests that efforts to reduce health care spending should be primarily focused on addressing growth in hospital rather than physician prices. Policy makers should consider a range of options to address hospital price growth, including antitrust enforcement, administered pricing, the use of reference pricing, and incentivizing referring physicians to make more cost-efficient referrals.

Objectives Point-of-care ultrasound is a valuable tool with potential to expedite diagnoses and improve patient outcomes in the emergency department. However, little is known about national patterns of adoption. This study examined nationwide point-of-care ultrasound reimbursement among emergency medicine (EM) practitioners and examined regional and practitioner level variations. Methods Data from the 2012 Center for Medicare and Medicaid Services Fee-for-Service Provider Utilization and Payment Data include all practitioners who received more than 10 Medicare Part B fee-for-service reimbursements for any Healthcare Common Procedure Coding System code in 2012. Odds ratios (ORs) and descriptive statistics were calculated to assess relationships between ultrasound reimbursement and practice location, nearby presence of an EM residency, and time elapsed since practitioner graduation. Results Of 52,928 unique EM practitioners, 391 (0.7%) received limited ultrasound reimbursements for a total of 16,389 scans in 2012. Urban counties had an OR of 5.4 (95% confidence interval, 3.8–7.8) for receiving point-of-care ultrasound reimbursements compared to rural counties. Counties with an EM residency had an OR of 84.7 (95% confidence interval, 42.6–178.8) for reimbursement compared to counties without. The OR for receiving reimbursement was independent of medical school graduation year (P = .83); however, recent graduates performed more scans (P = .02). Conclusions A small minority of EM practitioners received reimbursements for point-of-care ultrasound from Medicare beneficiaries. These practitioners were more likely to reside in urban and academic settings. Future efforts should assess the degree to which our findings reflect either low point-of-care ultrasound use or low rates of billing for ultrasound examinations that are performed.

The present generation widely makes use of en number of composites in the field of materials technology, with a very high performance and costs appropriate for the applications such as structural and automotives etc. Fiber reinforced composites are those composites that are called as the oldest and frequently used composite materials, in which Banana fibers are the most common ones. Nowadays consciousness and environmental awareness about using natural fibers as a serious alternative has been keep on increasing globally. And also in these present days natural fiber reinforced polymer composites are being widely used in various engineering applications. Natural fibers such as jute, sisal, palm, coir and banana are the most commonly used reinforcements. In vinyl ester resin matrix banana fibers have been used as reinforcement. This work deals with the study of effect of sodium hydroxide (NaOH) on fibers in addition with alumina (Al2O3) particulate. It is seen that the flexural strength value of UT, UT+ Al2O3, T+ Al2O3 has increased with increase in the fiber content.

Research and development in Natural Language Processing (NLP) has made significant progress over the last decade. Many robust NLP systems have been developed for handling machine translation, question-answering, summarization, topic detection, cluster analysis, information extraction, named entity recognition (NER), etc. Despite this advancement in NLP research, the results are still not accessible for common desktop users. In the current scenario, it is difficult to integrate a new NLP tool with the existing text processing applications. To overcome this, we have implemented a service deployer framework based on DBus[1] for the seamless integration of NLP applications with desktop clients like email clients, word processors, browsers etc. This framework enables NLP researchers to make their products equipped for the desktop clients with minimal efforts.

Background/Objectives : Concrete mixture consists of cement, fine and coarse aggregates. India possesses a wide variety of stones such as granite, marble, stone, sandstone, limestone and many others. Here, the properties of granite chips are studied and compared with the conventionally used aggregate material. Since granite is a lighter material compared to aggregates, its use in concrete will lead to reduced self weight on members and hence reduced dead load on columns and eventually, the foundation system. Methods/Statistical Analysis: Concrete cubes and cylinders of standard dimensions of M20 grade are cast. Four mix ratios are adopted, ranging from fully conventional concrete to concrete with coarse aggregate completely replaced with granite chips. Compressive strength and split tensile strength tests were conducted on all the test specimens at 7-days, 21-days and 28-days time periods. Findings: Based on the compressive strength test and split tensile strength test in the laboratory on various proportions with granite chips as coarse aggregate and it is compared with the conventional concrete. Applications/Improvements : It is concluded that concrete with 10% replacement of granite chips possesses great strength and since granite chips, considered here are recycled materials, this usage is not only beneficial stability-wise, but also cost-wise.

In a highly digitalized world we live today, the data to be transmitted are confidential at times, and in such cases there are many malicious intruders who try to access this information. Steganography is one recent method to provide reliable security. Steganography is the science of embedding data into different covers such that the data embedded is imperceptible; the aim is to embed and deliver secret messages in digital objects without suspicion. The covers that can be used cover all forms of digital multimedia. This paper deals with “Multimedia Steganography” in the most common forms of multimedia- Image, Video and Audio.

This paper presents a computational model for heat transfer in direct fired pusher type reheat furnaces for heating steel billets prior to plastic working. Radiation, which is the dominant mode of heat transfer in the furnace chamber, is modelled in a detailed manner. The model incorporates several features of radiation heat transfer that are typical of reheat furnaces, such as non-grey participating gas in the chamber and specular/diffuse reflection off the furnace surfaces. Radiation heat transfer in the furnace chamber and conduction within the billets are modelled using the finite volume method (FVM). Convection heat flux on the billets is calculated using correlations from the literature. Overall, the model is capable of predicting the radiative heat flux distribution within the furnace, as well as the resulting temperature distribution within the billets as they pass through various zones in the furnace. Several key process parameters have been identified, and their effects on the heating process of the billets are studied.

We report a six-month-old male infant with mesenchymal hamartoma of the liver which was left untreated. Repeat CT scan 1 year later showed regression and calcification of the tumor. The child is well 3 years later.

Background/Purpose: It is well realized that Anderson-Hyne's pyeloplasty fails to improve the drainage pattern and renal functional parameters in a few cases of hydronephrosis because of pelviureteric junction (PUJ) obstruction. The purpose of this study is to delineate the lower extent of the abnormally innervated pelviureteric junction by S-100 immunohistochemistry, which requires surgical removal. Methods: Thirty pelviureteric junction (PUJ) specimens were analyzed by histology and by S-100 immunohistochemistry after serial sectioning of the resected ureter and compared with the variables age, calyceal separation, parenchymal thickness, differential renal function, glomerular filtration rate (GFR), and the measured constricted ureteral segment on gross examination. Results: No significant correlation was noted ( P > .05) when the histology was analyzed to find any association with any of the variables studied. The length of the visible constricted segment ranged from 2 mm to 15 mm (mean, 5.37 mm). The abnormally innervated segment was much longer than the length of the visible constricted segment in 24 and of the same length in 5 specimens. However, in 1 case, the abnormal innervation segment was shorter than the macroscopic constriction by 3 mm. The maximum difference in length between the visible constriction and the lower limit of defective innervation was 8 mm. Conclusions: The abnormally innervated ureteral segment below the PUJ in hydronephrosis is longer than the visible constricted segment at the time of surgery, and the ureter should be excised at least 8 mm or more beyond the visible lower limit of the constricted segment in cases of Anderson-Hyne's pyeloplasty.

Chronic and recurrent perianal abscess is an uncommon condition in children. Tuberculosis is thought to be the common etiology for such a presentation in India. We report a case of a child with colonic and perianal disease due to Crohn's disease and emphasize the disastrous complication due to delayed diagnosis.

A 3 1/2-month-old male infant presented with cholestatic jaundice. Peroperative cholangiogram showed a gall bladder and small but patent extrahepatic bile ducts. Liver histology showed paucity of interlobular bile ducts. The child is being treated medically for his symptoms.