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We present a novel Digital Twin Framework for a portable table-top sized temperature-controlled system constructed entirely using free and open-source software programs. By utilizing tools such as Robotic Process Automation (RPA) and a PLC program, the entire process was automated to achieve a true Digital Twin. Further, a mathematical model was constructed for the temperature-controlled system. The data from the physical model and the mathematical model was then compared and a what-if scenario was analyzed to predict and prevent a potential failure in the physical system. Additionally, a simulation model was created to visualize the results.

Background Over-prescription of opioids after surgery remains common. Residual and unnecessarily prescribed opioids can provide a reservoir for nonmedical use. We therefore tested the hypothesis that a decision-support tool embedded in electronic health records guides clinicians to prescribe fewer opioids at discharge after inpatient surgery. Methods We studied 21,689 surgical inpatient discharges in a cluster randomized multiple crossover trial from July 2020 to June 2021 in four Colorado hospitals. Hospital-level clusters were randomized to alternating eight-week periods during which an electronic decision-support tool recommended tailored discharge opioid prescriptions based on prior inpatient opioid intake. During active alert periods, the alert was displayed to clinicians when the proposed opioid prescription exceeded recommended amounts. No alerts were displayed during inactive periods. Carryover effects were mitigated by including 4-week washout periods. The primary outcome was oral morphine milligram equivalents prescribed at discharge. Secondary outcomes included combination opioid/non-opioid prescriptions and additional opioid prescriptions until day 28 after discharge. A vigorous state-wide opioid education and awareness campaign was in place during the trial. Results The total postdischarge opioid prescription was a median [quartiles] of 75 [0, 225] oral morphine milligram equivalents among 11,003 patients discharged when the alerts were active and 100 [0, 225] morphine milligram equivalents in 10,686 patients when the alerts were inactive, with an estimated ratio of geometric means of 0.95 (95% CI: 0.80, 1.13; P = 0.586). The alert was displayed in 28% (3,074/11,003) of the discharges during the active alert period. There was no relationship between the alert and prescribed opioid/non-opioid combination medications or additional opioid prescriptions written after discharge. Conclusions A decision-support tool incorporated into electronic medical records did not reduce discharge opioid prescribing for postoperative patients in the context of vigorous opioid education and awareness efforts. Opioid prescribing alerts might yet be valuable in other contexts. Registered at ClinicalTrials.gov (NCT04446975)

Immune cell dysregulation and lymphopenia characterize COVID-19 pathology in moderate to severe disease. While underlying inflammatory factors have been extensively studied, homeostatic and mucosal migratory signatures remain largely unexplored as causative factors. In this study, we evaluated the association of circulating IL-6, soluble mucosal addressin cell adhesion molecule (sMAdCAM), and IL-15 with cellular dysfunction characterizing mild and hypoxemic stages of COVID-19. A cohort of SARS-CoV-2 infected individuals (n = 130) at various stages of disease progression together with healthy controls (n = 16) were recruited from COVID Care Centres (CCCs) across Mumbai, India. Multiparametric flow cytometry was used to perform in-depth immune subset characterization and to measure plasma IL-6 levels. sMAdCAM, IL-15 levels were quantified using ELISA. Distinct depletion profiles, with relative sparing of CD8 effector memory and CD4+ regulatory T cells, were observed in hypoxemic disease within the lymphocyte compartment. An apparent increase in the frequency of intermediate monocytes characterized both mild as well as hypoxemic disease. IL-6 levels inversely correlated with those of sMAdCAM and both markers showed converse associations with observed lympho-depletion suggesting opposing roles in pathogenesis. Interestingly, IL-15, a key cytokine involved in lymphocyte activation and homeostasis, was detected in symptomatic individuals but not in healthy controls or asymptomatic cases. Further, plasma IL-15 levels negatively correlated with T, B, and NK count suggesting a compensatory production of this cytokine in response to the profound lymphopenia. Finally, higher levels of plasma IL-15 and IL-6, but not sMAdCAM, were associated with a longer duration of hospitalization.

Background Erythrocyte transfusions are independently associated with acute kidney injury. Kidney injury may be consequent to the progressive hematologic changes that develop during storage. This study therefore tested the hypothesis that prolonged erythrocyte storage increases posttransfusion acute kidney injury. Methods The Informing Fresh versus Old Red Cell Management (INFORM) trial randomized 31,497 patients to receive either the freshest or oldest available matching erythrocyte units and showed comparable mortality with both. This a priori substudy compared the incidence of posttransfusion acute kidney injury in the randomized groups. Acute kidney injury was defined by the creatinine component of the Kidney Disease: Improving Global Outcomes criteria. Results The 14,461 patients included in this substudy received 40,077 erythrocyte units. For patients who received more than one unit, the mean age of the blood units was used as the exposure. The median of the mean age of blood units transfused per patient was 11 days [interquartile range, 8, 15] in the freshest available blood group and 23 days [interquartile range, 17, 30] in the oldest available blood group. In the primary analysis, posttransfusion acute kidney injury was observed in 688 of 4,777 (14.4%) patients given the freshest available blood and 1,487 of 9,684 (15.4%) patients given the oldest available blood, with an estimated relative risk (95% CI) of 0.94 (0.86 to 1.02; P = 0.132). The secondary analysis treated blood age as a continuous variable (defined as duration of storage in days), with an estimated relative risk (95% CI) of 1.00 (0.96 to 1.04; P = 0.978) for a 10-day increase in the mean age of erythrocyte units. Conclusions In a population of patients without severely impaired baseline renal function receiving fewer than 10 erythrocyte units, duration of blood storage had no effect on the incidence of posttransfusion acute kidney injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Roll-to-Roll (R2R) printing techniques are promising for high-volume continuous production of substrate-based products, as opposed to sheet-to-sheet (S2S) approach suited for low-volume work. However, meeting the tight alignment tolerance requirements of additive multi-layer printed electronics specified by device resolution that is usually at micrometer scale has become a major challenge in R2R flexible electronics printing, preventing the fabrication technology from being transferred from conventional S2S to high-speed R2R production. Print registration in a R2R process is to align successive print patterns on the flexible substrate and to ensure quality printed devices through effective control of various process variables. Conventional model-based control methods require an accurate web-handling dynamic model and real-time tension measurements to ensure control laws can be faithfully derived. For complex multistage R2R systems, physics-based state-space models are difficult to derive, and real-time tension measurements are not always acquirable. In this paper, we present a novel data-driven model predictive control (DD-MPC) method to minimize the multistage register errors effectively. We show that the DD-MPC can handle multi-input and multi-output systems and obtain the plant model from sensor data via an Eigensystem Realization Algorithm (ERA) and Observer Kalman filter identification (OKID) system identification method. In addition, the proposed control scheme works for systems with partially measurable system states.

Objectives In the present investigation, bioadhesive buccal tablets were prepared using the sustained-release polymer hydroxypropyl methylcellulose (HPMC) K100M, bioadhesive polymer neem gum, and an impervious backing layer of ethyl cellulose. Nicorandil is sensitive to the first-pass effect; therefore, a buccal-adhesive dosage form can avoid this effect. Materials and methods We used the direct compression technique to prepare the tablet formulation. A 32 full factorial design was composed in which the amounts of HPMC K100M (X1) and neem gum (X2) were chosen as the independent variables and the dependent variables were the percentage drug release at 6 h (Y1) and mucoadhesive strength in grams (Y2). Various in vitro parameters, i.e. thickness, friability, hardness, weight variation, surface pH, moisture absorption ratio, dissolution studies, and drug release kinetics, and ex vivo parameters like mucoadhesive strength and mucoadhesion time were determined for the prepared tablets. We subjected the optimized batch to a comparison with the marketed formulation and stability studies were performed. Results The formulation containing a 50:50 ratio of neem gum and HPMC K100M (F5) was considered optimum. The zero-order release kinetics model best fitted the optimized batch release profile, suggesting the system would release the drug at a constant rate. Conclusion The release by the optimized formulation of the drug at a sustained rate along with its bioadhesive nature showed that the buccal route can be an option for the administration of nicorandil.

Background: Before the advent of neoadjuvant chemotherapy (NC), the standard of care for node-positive breast cancer patients was to undergo complete axillary lymph node dissection (ALND). These patients also generally receive adjuvant radiation (AR), including axillary lymph node radiation. However, ALND and AR have been shown to increase the risk of secondary lymphedema to 20-30%. When treated with NC, resolution of all nodal metastasis to pathologically confirmed node-negative disease occurs in approximately 40% of patients. Such patients are eligible for targeted axillary dissection (TAD), which involves removal of clipped biopsy-positive node and sentinel nodes. TAD patients also receive AR, and their lymphedema rate has been reported at 10-12%. There is considerable variability on recommended protocols for lymphedema prevention in these patients. The goal of this study was to investigate whether TAD in combination with comprehensive physical therapy can further reduce the risk of lymphedema in node-positive breast cancer patients receiving NC. Methods: An IRB-approved retrospective review was conducted of 29 consecutive patients undergoing NC and localization of axillary nodes for their breast cancer surgery between Aug 2016 and Dec 2018. Patients with negative nodes intra-operatively underwent TAD only whereas those with positive nodes underwent ALND. Comprehensive physical therapy program included deep myofascial release, range of motion exercises, and stretching. Patients with ALND were provided prophylactic compression sleeve for 3 months. The main outcome measures were Lymphedema Index (L-DEX) scores (normal range -10 to +10) and range of motion at 1 month post-surgery. Lymphedema was also monitored clinically for a median duration of 7 months post-surgery. Baseline characteristics and outcomes between the TAD and ALND groups were compared. Results: A total of 16 patients underwent TAD whereas 13 underwent ALND (Table 1). Post-NC stages were 11 Stage 0, 3 Stage I, 9 Stage IIB, 5 Stage III A, 1 Stage IIIC. 10 patients completed breast conservation surgery, 13 had mastectomy with implant-based reconstruction (9 nipple-sparing mastectomy, 4 skin-sparing mastectomy), and 6 had mastectomy without immediate reconstruction. The clipped node was localized at a median of 1 day (range 1-35) before surgery, and 100% of the clipped nodes were retrieved. 28/29 (97%) patients underwent AR (1 patient refused). There were no statistically significant differences in pre-op L-DEX and 1-month post-op L-DEX between TAD and ALND groups. At 1-month post-op, 22 patients had full and 7 had limited range of motion. Two ALND patients with BMI of 25.8 and 32.2 kg/m2 developed lymphedema at 9.2 and 16 months respectively after surgery and were successfully managed with physical therapy. None of the 29 patients experienced tumor recurrence after a median follow-up of 7 months. Conclusion: This preliminary study found no evidence of lymphedema in TAD and ALND patients at one month following surgery. After a median follow-up of 7 months, 15% of ALND patients but no TAD patients experienced lymphedema. Prospective studies with large sample sizes are needed to further investigate the role of TAD combined with physical therapy in reducing the risk of lymphedema. Table 1: Comparison of patient characteristics and outcomes between TAD and ALND (N=29)CharacteristicTAD (n=16)ALND (n=13)P-valueMedian age in years49.654.50.28Median BMI in kg/m226.432.20.16Response to NCComplete response10 (62.5)1 (7.7)0.01*Partial response6 (37.5)9 (69.2)No response0 (0)3 (23.1)Median sentinel nodes removed320.02*Median size of clipped node (mm)15200.04*Median follow-up duration in months7.75.80.37Median number of PT visits380.20Median L-DEX score pre-op-1.5-1.30.73Median L-DEX score 1 month post-op-2.72.10.55Median L-DEX score difference (post-op minus pre-op)0.4-0.10.98Range of motion 1 month post-opFull14 (87.5)8 (61.5)0.10Limited2 (12.5)5 (38.5)Deep myofascial release to axilla and breast 1 month post-opYes12 (75)11 (84.6)0.53No4 (25)2 (15.4)Lymphedema during long-term follow-upYes0 (0)2 (15.4)No16 (100)11 (84.6)0.10Values in parentheses are column percentages*P Citation Format: Miral Amin, Karan Shah. Evaluating the use of targeted axillary dissection and comprehensive physical therapy to reduce the risk of lymphedema in node-positive breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-22.

Ballistic impact induces complex stress states on fiber-based armor systems. During impact fibers undergo multiaxial loading which includes axial tension, axial compression, transverse compression, and transverse shear. Transverse compression induced by the projectile leads to permanent deformation and fibrillation of fibers resulting in degradation of material tensile strength. Previous work (Sockalingam et al. Textile Res. J 2018) has shown a reduction of 20% in the tensile strength of Dyneema® SK76 single fibers subjected to 77% nominal transverse compressive strains. Experimental investigation of quasi-static transverse compression on Dyneema® SK-76 yarns, unconstrained in the lateral direction, indicate an average of 4% reduction in tensile strength of yarns compressed to 77% nominal strains. In this work we use finite element modeling techniques to understand the difference in residual tensile strength between single fibers and yarns observed in laterally unconstrained transverse compression experiments. Finite element study of the transverse compression response of single fibers and yarns indicate that local strains developed in fibers within the yarn are much lower than the local strains developed in single fibers subjected to a given nominal strain and may explain the less reduction in strength observed in yarns.

Cold Spray (CS) process is a solid-phase metal deposition technique capable of depositing micro to nanosized particles on a substrate without melting the particles. The CS process thus retains the original mechanical and chemical properties of the coating material. Residual stresses are an important factor affecting the quality, strength, and performance of the coated substrate in CS process. Currently, there is a lack of clear understanding of the residual stress generation in CS process and its control measures. Existing studies have not investigated the type III residual stress in CS process. This study attempts to investigate the effects of impact velocity and angle of impact on the Type III residual stress generation in CS process using molecular dynamics simulation technique. The study considers the impact of nanosized copper particles on copper substrate and the magnitude of the residual stresses is monitored. It is seen that the coated surface retains both tensile and compressive residual stresses. A higher angle impact shows higher compressive residual stresses, which are beneficial to industrial applications. Similarly, 400 m/s impact velocity showed the highest distribution of compressive residual stress on the body. The study results would be crucial in extending the industrial applications of the CS process.

In India, almost 18 million visually impaired people have difficulties in managing their day-to-day activities. Hence, there is a need to develop an application that can assist them every time and give vocal instructions in both English and Hindi. In this paper, we introduced a robust lightweight Android application that facilitates visually impaired individuals by providing a variety of essential features such as object and distance detection, Indian currency note detection, and optical character recognition that can enhance their quality of life. This application aims to have a user-friendly GUI well suited to the needs of the blind user and modules like Object Recognition with Image Captioning so that the visually challenged user can gain a better understanding of their surroundings.

High performance carbon and glass fibers are widely used as reinforcements in composite material systems for aerospace, automotive, and defense applications. Modifications to fiber surface treatment (sizing) is one of the ways to improve the strength of fibers and hence the overall longitudinal tensile strength of the composite. Single fiber tensile tests at the millimeter scale are typically used to characterize the effect of sizing on fiber strength. However, the characteristic length-scale governing the composite failure due to a cluster of fiber breaks is in the micro-scales. To access such micro-scale gage-lengths, we aim to employ indenters of varying radii to transversely load fibers and use scanning electron microscope (SEM) with digital image correlation (DIC) to measure strains at these lengthscales. The use of DIC technique requires creation of a uniform, random, and high contrast speckle pattern on the fiber surface such as that shown in Figure 1. In this work, we investigate the formation of sub-microscale speckle pattern on carbon fiber surface via sputter deposition and pulsed laser deposition techniques (PLD) using Gold-Palladium (Au-Pd) and Niobium-doped SrTiO3 (Nb:STO) targets respectively. Different processing conditions are investigated for both sputter deposition: sputtering current and coating duration, and PLD: number of pulses respectively to create sub-micron scale patterns viable for micro-DIC on both sized and unsized carbon fibers. By varying the deposition conditions and SEM-imaging the deposited patterns on fibers, successful pattern formation at sub-micron scale is demonstrated for both as-received sized and unsized IM7 carbon fibers of average diameter 5.2 μm via sputter deposition and PLD respectively.

This survey revolves around 8 research papers primarily focused on detection of Social Distancing using Deep Learning algorithms, for effectively combating Coronavirus (COVID-19). The main goal is to detect violation of social distancing practices. Several studies have been conducted and various innovative methods have been suggested. This paper aims to compare the proposed methods and their results. Till a vaccine is developed, social distancing is the only concrete way to control the spread of the disease. So, an accurate and feasible solution to detect social distancing is crucial.

Objectives Curcuma caesia has shown positive results in treating number of diseases, but till date no work was reported on its activity in diabetic neuropathy. So, the present review aims at exploring several hypothesis which can be proposed to explain further its utility in diabetic neuropathy by its antioxidant property, anti-inflammatory, CNS depressant effect, antibacterial and antifungal property. For finding the accurate and exact detail, a thorough review of all the available research and review article was done. A number of book chapters and encyclopaedias were taken into consideration to find out the origin, botany and genetics. The databases were searched using different keywords like antioxidant, inflammation, turmeric, diabetic neuropathy. Key findings After getting data on pathogenesis of diabetic neuropathy, it has been found out that its role as antioxidant will reduce the level of oxidative stress which is the main reason for the occurrence of the present complication. Apart this, the anti-inflammatory activity will further prevent the inflammation of neurons and antibacterial effect will inhibit the spread of infection. Combining all the factors together, the plant can be utilized in the treatment of diabetic neuropathy. Summary Curcuma caesia can be proved as a useful approach in the treatment of diabetic neuropathy.

Cancer is an uncontrolled and abnormal growth of cells in the body. Gene that guards the cell cycle and function as tumor suppressor is p53 (also called as the guardian of the genome) which is encoded by the TP53 gene. Various events like DNA damage, heat shock, hypoxia and oncogene over expression, results in activation of p53.Thus, it plays a major role as a regulatory protein which regulates various diverse biological responses, responsible for genetic stability by preventing genome mutation. More than 50% mutations in human cancers along with the increase in expression of murine double minute 2 gene (mdm2), has been found as one of the reason for cancer progression. Murine double minute 2 (MDM2) is the negative regulator of p53 gene forming an autoregulatory feedback loop controlling each other cellular levels. Murine double minute 2 is unique E3 ubiquitin ligase protein which is responsible for ubiquitination and degradation of p53 gene. Many drugs/compounds have been developed for reactivation of p53 gene by inhibiting MDM2 interaction with p53, using MDM2 antagonism, inhibiting E3 ubiquitination of p53. Many compounds have entered clinical trials in haematological malignancies. This review will throw some light on reactivation of p53 gene by MDM2 and its homologues.

Suppliers play a major role in enhancing an organization’s effort for achieving corporate competitiveness, hence, posing as one of the most important aspects for today’s firms. The identification and analysis of tangible and intangible factors involved while making supplier selection requires going through complex decision making process. The decision has to be based on multiple factors depending on business priorities, making it a Multi Criteria Decision Method (MCDM) problem. In this paper, the methodology has been constructed keeping in mind critical factors such as Acceptable Quantity, Quality Rating and Lots received on time. The authors have projected an integration of Analytical Hierarchal Process (AHP) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) for making the selection. The first stage conceives the factors influencing the decision making and the following stage helps in getting an optimal supplier. The proposed method has been used for a calibration laboratory.

The manufacturing system of the next generation demands intelligence, flexibility and the ability to have the quality of being interoperable. The heart of Industry 4.0 - based system is an environment called Smart Factory which fosters automation and self-optimization. It brings in new elements that changes the traditional manufacturing by integrating the current requirements. The notion of Smart Manufacturing can be aided by employing Cloud Computing. Cloud computing based manufacturing blends the hardware and software assets altogether forming a new paradigm. In this paper, cloud manufacturing has been implemented by making use of function blocks (FB) in Programmable Logic Controller (PLC) based operations. Three deployment models of cloud-based Distributed Process Planning (DPP) service are investigated and one of them has been employed to achieve the concept of smart factory. The proposed framework is applicable in PLC-based unit of food industry.

To test whether patients who experience hypotension in the post-anesthesia care unit or during surgery are most likely to experience hypotension on surgical wards.A prediction study using data from two randomized controlled trials.Operating room, post-anesthesia care unit, and surgical ward.550 adult patients having abdominal surgery with ASA physical status I-IV.Blood pressure measurement per routine intraoperatively, and with continuous non-invasive monitoring postoperatively.The primary predictors were minimum mean arterial pressure (60,65,70 and 80 mmHg) and minimum systolic blood pressure (70,75,80,85 mmHg) in the post-anesthesia care unit. The secondary predictors were intraoperative minimum blood pressures with the same thresholds as the primary ones. Our outcome was ward hypotension defined as mean pressure 70 mmHg or systolic pressure 85 mmHg. A threshold was considered clinically useful if both sensitivity and specificity exceeded 0.75.Minimum mean and systolic pressures in the post-anesthesia care unit similarly predicted ward mean or systolic hypotension, with the areas under the curves near 0.74. The best performing threshold was mean pressure 80 mmHg in the post-anesthesia care unit which had a sensitivity of 0.41 (95% confidence interval [CI], 0.35, 0.47) and specificity of 0.91 (95% CI, 0.87, 0.94) for ward mean pressure 70 mmHg and a sensitivity of 0.44 (95% CI, 0.37, 0.51) and specificity of 0.88 (95% CI, 0.84, 0.91) for ward systolic pressure 85 mmHg. The areas under the curves using intraoperative hypotension to predict ward hypotension were roughly similar at about 0.60, with correspondingly low sensitivity and specificity.Intraoperative hypotension poorly predicted ward hypotension. Pressures in the post-anesthesia care unit were more predictive, but the combination of sensitivity and specificity remained poor. Unless far better predictors are identified, all surgical inpatients should be considered at risk for postoperative hypotension.