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Diaphragmatic dysfunction has been increasingly documented to play a critical role to determine ventilator dependency and failure of weaning.The goal was to study the diagnostic accuracy of diaphragmatic rapid shallow breathing index (D-RSBI) as a predictor of weaning outcomes in comparison to RSBI.A prospective observational study on consecutively admitted patients who were intubated and mechanically ventilated for a duration of at least 48 hours was carried out. The right hemidiaphragm displacement [diaphragm displacement (DD)] was calculated by M-mode ultrasonography, and respiratory rate (RR) and tidal volume (TV) were documented from the ventilator readings. Rapid shallow breathing index (RSBI) was measured as RR/TV (in liters); D-RSBI was calculated as RR/DD (in millimeters) and expressed as breath/minute/millimeter. Extubation failure was defined as the reinstitution of mechanical ventilation at the end of, or during the spontaneous breathing trial (SBT), re-intubation or the need of noninvasive ventilation (NIV) for the patient within 48 hours of extubation.Of 101 screened patients, 50 patients met the inclusion criteria, of whom 45 patients had successful SBT, and finally, 41 patients could be successfully extubated. Hence, the overall rate of weaning failure in the study population was 18%. The areas under the receiver operator characteristic (ROC) curves for D-RSBI and RSBI were 0.97 and 0.70, respectively (Diaphragmatic rapid shallow breathing index has a positive correlation and greater diagnostic accuracy than RSBI, the conventional weaning index.Shamil PK, Gupta NK, Ish P, Sen MK, Kumar R, Chakrabarti S

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; publichealth care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

In [S. Das, M. K. Sen and S. K. Maity, Leavitt path algebras for power graphs of finite groups, J. Algebra Appl., doi:10.1142/S0219498822502097], we studied several algebraic properties of Leavitt path algebra of the directed power graph [Formula: see text] and also of the directed punctured power graph [Formula: see text] of a finite group [Formula: see text]. In this paper, we compute the Grothendieck group of purely infinite simple Leavitt path algebra of the directed punctured power graph of a finite group.

Introduction: Bcl 2 is one of the unique proto-oncogene, localized to mitochondria & interfering with apoptosis independent of promoting cell division. Bcl-2 is overexpressed mostly in SCLC and in a minority of the NSCLC. Cyclin D1 is an important cell cycle regulatory protein which controls the cell cycle transition from G1 to S phase. Materials and Methods: Here, we studied immunohistochemical expression of Bcl 2 & Cyclin D1 in 40 lung cancer patients to evaluate the immunohistochemical expression of Bcl 2 & Cyclin D1 in primary lung cancer, its expression with histological subtypes of lung cancer & to correlate the expression of Bcl 2 & Cyclin D1 with the clinical stage of disease. Results: The immunohistochemical expression of Bcl 2 & Cyclin D1 was studied in 40 cases of lung cancer and was also correlated with the histological subtypes. Out of 40 cases of lung carcinoma, 21 cases (52.5%) were positive and 16 cases (40%) were negative for Bcl 2. Among histological subtypes, Bcl 2 was significantly higher in patients with small cell carcinoma, (80%) followed by squamous cell carcinoma, (78.57%). Out of 40 cases of lung carcinoma, 16 cases (40%) were positive and 21 cases (52.5%) were negative for Cyclin D1. Among histological subtypes, expression of Cyclin D1 was significantly higher in patients with adenocarcinoma, (52.38%) as compared to Squamous cell carcinoma (35.71%). The immunohistochemical expression of Bcl 2 and Cyclin D1 was correlated with the clinical staging of lung cancer. We observed higher Bcl 2 expression in stage 3 disease (81.82%) followed by stage 4 disease (55%). Higher Cyclin D1 expression was seen in patients with stage 4 disease (80.00%). None of the stage 2 and stage 3 patients showed any expression with cyclin D1. Conclusions: In our study, higher Bcl 2 expression was associated with small cell carcinoma of lung and among non small cell carcinoma its expression was higher in squamous cell carcinoma. Cyclin D1 expression was observed mostl

The Square element graph over a semigroup S is a simple undirected graph S q ( S ) whose vertex set consists precisely of all the non-zero elements of S , and two vertices a , b are adjacent if and only if either a b or b a belongs to the set { t 2 : t ∈ S } ∖ { 1 } , where 1 is the identity of the semigroup (if it exists). In this paper, we study the various properties of S q ( S ) . In particular, we concentrate on square element graphs over three important classes of semigroups. First, we consider the semigroup Ω n formed by the ideals of Z n . Afterwards, we consider the symmetric groups S n and the dihedral groups D n . For each type of semigroups mentioned, we look into the structural and other graph-theoretic properties of the corresponding square element graphs.

The aim of this paper is the characterization of algebraic properties of Leavitt path algebra of the directed power graph [Formula: see text] and also of the directed punctured power graph [Formula: see text] of a finite group [Formula: see text]. We show that Leavitt path algebra of the power graph [Formula: see text] of finite group [Formula: see text] over a field [Formula: see text] is simple if and only if [Formula: see text] is a direct sum of finitely many cyclic groups of order 2. Finally, we prove that the Leavitt path algebra [Formula: see text] is a prime ring if and only if [Formula: see text] is either cyclic [Formula: see text]-group or generalized quaternion [Formula: see text]-group.

If [Formula: see text] is a ring then the square element graph [Formula: see text] is the simple undirected graph whose vertex set consists of all non-zero elements of [Formula: see text] and two distinct vertices [Formula: see text] are adjacent if and only if [Formula: see text] for some [Formula: see text]. In this paper, we provide some necessary and sufficient conditions for the connectedness of [Formula: see text], where [Formula: see text] is a ring with identity. We mainly characterize some special class of ring [Formula: see text] which we call square-subtract ring for which the graph [Formula: see text] is connected.

In this paper we continue our study of the graph Γ 1 ( R ) defined over a ring R with unity. Γ 1 ( R ) is a simple undirected graph having all the non-zero elements of R as its vertices and two vertices a, b are adjacent if and only if either a b = 0 or b a = 0 or a + b is a unit in R. Concentrating on the graph Γ 1 ( Z n ) , we look at several properties like degrees, girth, Eulerianity, planarity etc. We also look at some properties of the graph Γ 1 ( R ) taken over matrix rings and of the graph Γ 1 ( F ) over a finite field F.

The order prime divisor graph 𝒫𝒟(G) of a finite group G is a simple graph whose vertex set is G and two vertices a, b ∈ G are adjacent if and only if either ab = e or o(ab) is some prime number, where e is the identity element of the group G and o(x) denotes the order of an element x ∈ G. In this paper, we establish the necessary and sufficient condition for the completeness of order prime divisor graph 𝒫𝒟(G) of a group G. Concentrating on the graph 𝒫𝒟(Dn), we investigate several properties like degrees, girth, regularity, Eulerianity, Hamiltonicity, planarity etc. We characterize some graph theoretic properties of 𝒫𝒟 (ℤn), 𝒫𝒟 (Sn), 𝒫𝒟 (An).

The author [S. M. Yusuf, Inverse semimodules, J. Natur. Sci. Math. 6 (1966) 111–117.] introduced inverse semimodules. In this paper, we introduce Clifford semimodules. The Clifford semimodules have been characterized here as a strong [Formula: see text]-semilattice of [Formula: see text]-modules. The congruences on inverse semimodules, specially, the [Formula: see text]-module congruences, have been characterized here completely.

This article summarizes the anatomical basis as well as the various pathophysiological mechanisms that are considered to be crucial in development of sleep-disordered breathing. The anatomic factors that predispose to the occurrence of pharyngeal collapse are considered. The collapsible tube model for understanding the behavior of human pharyngeal airway, transmural pressure, intraluminal pressure, surrounding tissue pressure, closing pressure of pharyngeal airway, and critical closing pressure are discussed. The role of nose in snoring and obstructive sleep apnea (OSA) is also touched on. The role of obesity on upper airway is outlined. These include the mechanical consequences of fat deposition within the maxillomandibular enclosure on pharyngeal collapsibility and possible influences of visceral fat on OSA. An overview of pharyngeal anatomy and musculature, pharyngeal muscle activity during wake/sleep, and neural regulation of sleep and breathing is given. Factors pertaining to the loss of pharyngeal dilator muscle activation, change in central respiratory drive, and OSA-induced neuropathy/myopathy are discussed. Abnormalities of central neuronal output and control of breathing are explained. The impact of end-expiratory lung volume on upper airway resistance is also discussed. The use of computational modeling to predict responses to upper airway surgery in OSA is discussed. Novel methods such as manipulation of the arousal threshold and measures to reduce a high loop gain (oxygen therapy, acetazolamide) are also briefly discussed.

Insomnia is one of the commonest sleep disorders encountered in primary care as well as sleep medicine practice. In this review article, the nosology of insomnia is outlined in the light of the recently published International Classification of Sleep Disorders-3rd Edition. A standardized schema is then described as to how to approach a patient presenting with insomnia symptoms. The various tools that may be utilized in this work-up are briefly discussed.

The impact of obstructive sleep apnea syndrome on cardiovascular morbidity and mortality is phenomenal. There is a strong evidence base in terms of several longitudinal as well as cross-sectional studies in support of this fact. However, the evidence in favor of its association with hypertension is stronger than with coronary artery disease, arrhythmias and stroke. Prevalence studies on OSAHS have demonstrated an increased odds ratio for hypertension above the background population. Also, prevalence of hypertension is known to increase proportionate to the severity of sleep disordered breathing. Cross-sectional prevalence studies on cardiovascular disease and OSAHS have shown an increased risk of coronary artery disease (CAD) amongst patients with OSAHS. Prevalence of OSA is significantly higher in patients with atrial fibrillation (AF) than in patients without past or current AF. Pulmonary arterial hypertension, congestive heart failure and sudden cardiac death are also commonly associated with OSAHS. Interventional studies clarify the role of effective treatment of this disorder with CPAP. Therapy with CPAP, therefore, should be expected to impact the prognosis of cardiovascular consequences of this syndrome.

The Course Experience Questionnaire (CEQ) is a 36-item instrument that is intended to measure six different aspects of students’ perceptions of the academic quality of their programmes. It has been widely used in Western countries, and it has also been used in non-Western countries, including China, Hong Kong, Japan and Pakistan. Nevertheless, in the latter countries, it has sometimes not been possible to identify the full range of constructs that were supposed to be measured by the original CEQ. We translated the CEQ into Bengali and administered this to 552 science students at 15 higher secondary schools in West Bengal, India. A confirmatory factor analysis found that their responses provided a poor fit to the original six-factor model of the CEQ. An exploratory factor analysis identified just four constructs, which reflected good teaching, generic skills, student support and appropriate workload. The items with salient loadings on the four factors were used to construct four scales. The students’ scores on three of the four scales showed satisfactory levels of internal consistency. A factor analysis of their scores on all four scales yielded one overarching factor that could be interpreted as a measure of perceived academic quality. A reduced version of the CEQ consisting of the 30 items that constitute these four scales can be recommended as a measure of students’ perceptions of the academic quality of programmes in West Bengal.

The purpose of the paper is to study g-hypergraph which is a generalization of the notion of hypergraph. This generalization is made in terms of h-relation on X, which is in fact a relation from X to P(X). Every g-hypergraph \(\mathcal{G}\) can induce a graph \({G_{_{\mathcal{G}}}}\) the connectedness of which is shown to be a necessary and sufficient condition for \(\mathcal{G}\) to be connected. An h-relation defines a weight function by means of which balanced g-hypergraph is defined and studied here.

Let [Formula: see text] be a commutative ring with [Formula: see text]. Let [Formula: see text] be a graph with vertices as elements of [Formula: see text], where two distinct vertices [Formula: see text] and [Formula: see text] are adjacent if and only if [Formula: see text] for some non-zero idempotent [Formula: see text] in [Formula: see text]. In this paper, we establish a relation between completeness of the graph [Formula: see text] and regularity of the ring [Formula: see text]. For a finite commutative ring [Formula: see text] with [Formula: see text], we show that the chromatic number of [Formula: see text] is equal to the number of regular elements in [Formula: see text]. Moreover, we characterize some graph theoretic properties of [Formula: see text] and finally we characterize Eulerian property of the graph [Formula: see text].

In this paper we introduce the notion of almost idempotent semirings as the semirings with semilattice additive reduct satisfying the identity x + x2= x2, and characterize eight subclasses of the variety [Formula: see text] of all almost idempotent semirings corresponding to the eight subvarieties of the variety [Formula: see text] of all normal bands. Every almost idempotent semiring S is a distributive lattice of rectangular almost idempotent semirings. Given a semigroup F, the semiring Pf(F) of all finite non-empty subsets of F is almost idempotent precisely when F is a band, and in this case, Pf(F) is freely generated by the band F in the variety [Formula: see text]. This semiring Pf(F) is free in a subclass of [Formula: see text] if and only if F is in the corresponding subvariety of [Formula: see text].

A semiring S whose additive reduct is a semilattice is called a k-regular semiring if for every a∈S there is x∈S such that a+axa=axa. For a semigroup F, the power semiring P(F) is a k-regular semiring if and only if F is a regular semigroup. An element e∈S is a k-idempotent if e+e2=e2. Basic properties of k-regular semirings whose k-idempotents are commutative have been studied.

Introduction: It has been observed that since heart failure is highly prevalent and central sleep apnea (CSA) is common in patients with a failing heart, heart failure is the commonest cause of CSA in the general population.

The undirected power graph G(S) of a semigroup S is an undirected graph whose vertex set is S and two vertices a,b∈S are adjacent if and only if a≠b and am=b or bm=a for some positive integer m. In this paper we characterize the class of semigroups S for which G(S) is connected or complete. As a consequence we prove that G(G) is connected for any finite group G and G(G) is complete if and only if G is a cyclic group of order 1 or pm. Particular attention is given to the multiplicative semigroup ℤn and its subgroup Un, where G(Un) is a major component of G(ℤn). It is proved that G(Un) is complete if and only if n=1,2,4,p or 2p, where p is a Fermat prime. In general, we compute the number of edges of G(G) for a finite group G and apply this result to determine the values of n for which G(Un) is planar. Finally we show that for any cyclic group of order greater than or equal to 3, G(G) is Hamiltonian and list some values of n for which G(Un) has no Hamiltonian cycle.

Fifty pregnant female subjects aged 20–35 yrs in the third trimester of their pregnancy and reportedly snoring during sleep who were attending the ante-natal out patients department (ANC OPD) of Safdarjang Hospital were recruited into the study (study group). An equal number of non-snoring pregnant females of the same age group who were attending the same OPD were taken as controls. They were asked to respond to a standard sleep questionnaire that was based on sleep apnea scale (SAS)3 and Epworth sleepiness scale (ESS). All the subjects in the study group underwent a sleep study (polysomnography) after evaluation of questionnaire. Respiratory distress index (RDI) was calculated as a sum of apnea, hypopnea and flow limitations. The study and control groups were followed during pregnancy and labour. Comparison of complications and outcomes of pregnancy in mother and fetus was done among the study and control groups. Parameters specifically looked for were development of preeclampsia and eclampsia, IUGR, and lower Apgar score.

The concept of \(\Gamma \)-semigroup is a generalization of semigroup. Let S and \(\Gamma \) be two nonempty sets. S is called \(\Gamma \)-semigroup if there exists a mapping \(S\times \Gamma \times S\longrightarrow S\), written as \((a, \alpha , b)\longrightarrow a\alpha b\), satisfying the identity \( (a\alpha b)\beta c\) \(=\) \(a\alpha (b\beta c) \) for all \(a, b, c\in S\) and \( \alpha , \beta \in \Gamma \). This article is a survey of some works published by different authors on \(\Gamma \)-semigroups.

In this paper, we introduce a new representation of simple undirected graphs in terms of set of vectors in finite dimensional vector spaces over \(\mathbb {Z}_2\) which satisfy consecutive 1’s property, called a coding sequence of a graph G. Among all coding sequences we identify the one which is unique for a class of isomorphic graphs, called the code of a graph. We characterize several classes of graphs in terms of coding sequences. It is shown that a graph G with n vertices is a tree if and only if any coding sequence of G is a basis of the vector space \(\mathbb {Z}_2^{n-1}\) over \(\mathbb {Z}_2\).

We introduce the notions of fuzzy hypersemigroup, fuzzy hypergroup, fuzzy hyperideal, homomorphism, hyper congruence, fuzzy homomorphism, fuzzy hypercongruence. The purpose of this note is the study of some characterization of fuzzy hypersemigroup, fuzzy hyperideal of a fuzzy hypersemigroup and homomorphism and hypercongruence on a hypersemigroup.

A new kind of regular orthogroups, namely, the LR-normal orthogroups is introduced and investigated. In particular, we will introduce the gearing techniques for fitting semigroup components on a semilattice in the construction of LR-normal orthogroups.

Let S be a semigroup. This paper studies the intersection graphs of fuzzy semigroups. It is shown that the fuzzy intersection graph Int(G(S)), of S, is complete if and only if S is power joined. If Γ(S) denotes the set of all fuzzy right ideals of S, then the fuzzy intersection graph Int(Γ(S)) is complete if and only if S is fuzzy right uniform. Moreover, it is shown that Int(Γ(S)) is chordal if and only if for a,b,c,d ∈ S, some pair from {a,b,c,d} has a right common multiple property. It is also shown that if Int(G(S)) is complete and S has the acc on subsemigroups, then S is cyclic.

Regular semigroups S with the property eS ⊆ Se or Se ⊆ eS for all idempotents e ∈ S include all left and right Clifford semigroups. Characterizations of such semigroups are given and their structure investigated, in particular in terms of spined products of left and right Clifford semigroups with respect to Clifford semigroups.

In this paper, we generalize Clifford semirings to left Clifford semirings by means of the so-called band semirings. We also discuss a special case of this kind of semirings, that is, strong distributive lattices of left rings.

In this paper, we introduce p-ideals in semirings. A new form of regularity, which is compatible with p-ideals, is defined. Our aim is to explore the possibilities of establishing an ideal theory in semirings, going alongside the existing literature of semiring theory.

National Geophysical Research Institute (Council of Scientific & Industrial Research)

Clifford semigroups are certain interesting class semigroups and looking for regular semigroups close to this is natural. Here we discuss the leftright Clifford semigroups.

Semirings of formal power series over semirings, in particular, over k-semifields, are studied. It is also shown that the semiring of formal power series S[[x]] over a k-semifield S becomes a local semiring. Moreover, the Jacobson radical of S[x]] over a k-semifield S is described.

relations of the two reducts. We identify important subvarieties and give structure theorems for special types of such semirings.

In this paper we show that a fuzzy finite automation M 1 has an equivalent minimal fuzzy finite automation M . We also show that M can be chsen so that if M 2 is equivalent to M 1 , then M is a homomorphic image of M 2 .

In this paper we introduce the concept of a covering of a ffsm by another, admissible partitions and relations of a ffsm, μ-orthogonality of admissible partitions, irreducibile ffsm, and the quotient of a ffsm induced by an admissible partition of the state set.

We introduce the concepts of fuzzy transformation semigroups, coverings, cascade and wreath products for fuzzy finite state machines. In order to overcome some of the difficulties which arise from the fuzzification of these concepts, we also introduce the notions of polysemigroups and weak coverings.

We introduce the concept of a max-min fuzzy language, FLν(M), and a min-max fuzzy language, FL ⋏ (M) , recognized by a type of fuzzy automaton M. We show that if L1 and L2 are finite-valued Fν-regular languages, then so are L1 ∪ L2 and L1 ∩ L2. We give a form of a fuzzified pumping lemma which we use to give a necessary and sufficient condition for FL ν (M) to be nonconstant.

In this paper we characterize the class of semiringsSfor which the semirings of square matricesMn(S)overSare (left)k-artinian. Also an analogue of the Hilbert basis theorem for semirings is obtained.