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Background: Randomized controlled trials (RCTs) investigating the efficacy of bispectral index (BIS) to reduce intra-operative awareness (IOA) have reported conflicting results. The purpose of this meta-analysis is to consolidate results from RCTs to assess the efficacy of BIS in reducing IOA when compared to controls. Secondary outcomes included time to extubation, time to spontaneous and/or verbal eye opening, PACU discharge time, and utilization of inhaled anesthetics. Methods: RCTs which reported on one of the primary and/or secondary outcomes were included. Literature search utilized keywords "randomized control trial" and "intraoperative awareness." Meta-analysis was performed using RevMan 5. Results: Twenty-seven RCTs were included in the study with a total of 35,585 patients, with 18,146 patients in the BIS and 17,439 in the control group. Eighteen of 14,062 patients (0.12%) and 42 of 16,765 (0.25%) reported definite IOA in the BIS and control group, respectively, with no statistically significant difference. BIS was effective in reducing the time to spontaneous eye opening by an average of 1.3 minutes and the time to extubation by an average of 1.97 minutes. There was no difference in PACU discharge times among the groups. There was a significant decrease in consumption of sevoflurane but no difference in desflurane and propofol compared to the control group. Conclusion: While BIS monitoring results in decreased incidence of intra-operative awareness by half, it was not statistically significant. BIS provides modest benefits with regard to reducing the time to extubation, the time to spontaneous eye opening, and consumption of sevoflurane. Level of evidence: I. [ABSTRACT FROM AUTHOR]

Epilepsy is one of the most common neurological disorders globally, affecting about 50 million people, with nearly 80% of those affected residing in low- and middle-income countries. It is characterized by recurrent seizures that result from abnormal electrical brain activity, with seizures varying widely in manifestation. The exploration of the biomechanical effects that seizures have on brain dynamics and stress levels is relevant for the development of more effective treatments and protective strategies. This study uses a blend of experimental data and computational simulations to assess the brain's physical response during seizures, particularly focusing on the behavior of cerebrospinal fluid and the resulting mechanical stresses on different brain regions. Notable findings show increases in stress, predominantly in the posterior gyri and brainstem, during seizures and an evidence of brain displacement relative to the skull. These observations suggest a dynamic and complex interaction between the brain and skull, with maximum shear stress regions demonstrating the limited yet essential protective role of the CSF. By providing a deeper understanding of the mechanical changes occurring during seizures, this research supports the goal of advancing diagnostic tools, informing more targeted treatment interventions, and guiding the creation of customized therapeutic strategies to enhance neurological care and protect against the adverse effects of seizures. [ABSTRACT FROM AUTHOR]

Hydrogen and natural gas are promising alternatives to fossil fuels in combustion engines for sustainable environment. Consumption of fossil fuels is a matter of growing concern that needs to be dealt with seriously for a sustainable, better tomorrow as fossil fuels have dreadful implications on the environment. Therefore, there is an urgent need across the globe to quest for environmentfriendly alternative fuels, which can power internal combustion engines. Moreover, regulated and unregulated emissions from engines have been affecting human health and the environment. In this review article, hydrogen in combination with natural gas along with diesel as a pilot fuel is investigated. The impactsof exhaust gas recirculation with hydrogen and natural gas are also discussed. It is observed from the review that an H2 proportion of up to 5–30% is beneficial in combination with natural gas as well with other alternative fuels. The further increase in the hydrogen proportion create the problem of backfiring, knocking as well as increasing the NOx emissions. The transportation and storage are the biggest problems with the hydrogen fuel. Among the alternatives, gaseous fuels have great importance, and they need proper attention for inclusion in the CI engine as a fuel used in dual-fuel mode. [ABSTRACT FROM AUTHOR]

Background: Treatment-resistant schizophrenia (TRS) is one of the most disabling forms of schizophrenia. The Indian population being different in its sociodemographic factors, clinical profiles, and family structures, the experience of the efficacy of clozapine here is insufficient. Aim: The aim of the study is to explore the efficacy of clozapine in TRS over 3 months of drug use. Materials and Methods: It was an open-label interventional 12-week follow-up study, with 30 consenting adults with TRS determined as per modified Conley and Kelly's criteria of treatment resistance. The patient's sociodemographic and clinical details were recorded. Oral clozapine was initiated with gradual up-titration after preclozapine workup. The Positive and Negative Syndrome Scale (PANSS) score was assessed at baseline and reviewed at 4 weekly intervals. Results: By the end of 12 weeks, on an average dose of 494 ± 113.83 mg/day, 36.67% of patients reported 25%-50% improvement in PANSS score. The maximum improvement was seen in the positive symptoms subscale followed by the general and negative symptoms subscale. Conclusion: This study enlightens the dosage differences and efficacy of clozapine in the management of TRS in the Indian population. [ABSTRACT FROM AUTHOR]

Blunt trauma patients commonly present with multiple rib fractures, which increases overall morbidity and mortality due to pulmonary complications. Effective chest wall analgesia may be challenging due to positioning difficulty, body habitus, anticoagulation issues with neuraxial interventions, etc. Serratus anterior plane block has been shown to be beneficial in anterior and lateral rib fractures in recent studies. We propose the efficacy of this block in posterior rib fractures as well, through this small case series of blunt trauma patients with posterior rib fractures, reporting significant pain relief after the block. [ABSTRACT FROM AUTHOR]

A new integrated experimental technique is used to design viable and cleaner fuel blends with selective fuel contents. In diesel combustion engines, higher PM and NO x emissions are the major pollutants that need to be addressed simultaneously. The selection of fuel components based on emission formation tendencies is a promising approach to reduce these emissions. Aromatics highly affects the emission in diesel-fueled engines, especially PM. The present study provides a comprehensive knowledge database on a range of aromatics that need to be removed from the fuel during production processes for better performance and lower engine emissions. To investigate the effects of aromatic species and content on emissions, 16 different aromatic species were tested in 8, 13, and 18% volumetric concentrations in an alkane-based fuel. The experiments were conducted at 850 and 1500 rpm engine speed conditions. The ranking system was developed to rank the aromatics based on their overall performance in terms of PM and NO x emissions. The blend with 8% tert-butylbenzene showed a maximum PM reduction of 73.1% due to higher hydrogen atoms relative to carbon. Better atomization with higher volatility due to the lower density of this blend promoted oxidation rather than pyrolysis. NO x emissions were found to be maximum of 10.4% lower with 8% o-Xylene in the blend due to lower heat release rate. Improved heat distribution over the premixed and diffusion combustion modes due to this blend's optimum physical properties helped reduce the in-cylinder temperature. A consideration of equal weightage to NO x and PM emissions, 8% tert-butylbenzene is the most promising aromatic candidate for cleaner fuel production. • Fuel blends were formulated using 16 aromatic species. • Potential approach of simultaneous reduction of PM and NOx is proposed. • tert-butylbenzene was found to be most promising aromatic for future fuel formulation. • Methylnapthalene should be avoided from fuel due to its higher PM emission formation tendency. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the effect of physiotherapeutic intervention to improve the deviated balance of pregnant women. Method: A total of 174 subjects were included in the study out of which 62 had postural deviation. They were divided into three groups, two intervention groups and one control group. The target population consisted of women in the antenatal stage, randomly selected from Obstetrics and Gynecology OPD, PGIMER, Chandigarh. The study was conducted over a period of 3 years (2014– 2017). They were advised exercises, postural correction, regular walking, and hot water fomentation. Six follow-ups were taken into consideration throughout the pregnancy and postnatal stage. Result: The impact of the intervention package on both ante-natal and postnatal women with balance problems showed significant improvement. Conclusion: Postural deviations, pain, heaviness in the lower limb, incontinence, breathlessness, etc., are common complaints during and after pregnancy. The problem starts early in pregnancy and increased over time and may persist throughout life if treatment does not start early in the pregnancy. This intervention can be practiced in primary care setting after giving proper training to the health care workers by experienced physiotherapists. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy brings about many changes in mothers' body which continue even after the baby is born. After a vaginal delivery, taking good care of the mother is an essential part of postpartum care and to maintain overall fitness. Objective: The purpose of this research was to evaluate the effect of a physiotherapeutic intervention to improve the maternity fitness of Indian women. Methodology: It was a three-group RCT (randomized controlled trial). The target population consisted of women in ante and postnatal stage, 50 participants (58 were included in the end) in each group, randomly selected from Obstetrics and Gynecology OPD of a tertiary care hospital in North India. The study was carried out in the department of PRM (Physiotherapy). A total of 174 participants was included in the study and was divided into three groups, two intervention groups, and one control group. The target population consisted of women in ante and postnatal stage, randomly selected from ANC (Antenatal clinic) and PNC (Post-natal clinic). The study was conducted over a period of 4 years (2014–2018). They were advised to do exercise, postural correction, regular walking, and electrotherapy modalities and six follow-ups throughout their pregnancy. Outcome measures like (Visual Analogue Scale = VAS): Low and upper back pain relief (n = 158), Leg cramps (n = 41), Coccyx pain (n = 36), Sacro-iliac joint pain (n = 26) was considered. Results: The impact of the intervention package on both ante-natal and post-natal women with fitness-related health problems showed significant improvement. Conclusion: Pain, leg cramp and heaviness in the lower limb, coccyx pain, etc., during pregnancy are common complaints that start early in pregnancy and may persist throughout life if treatment does not start early in the pregnancy. [ABSTRACT FROM AUTHOR]

Formaldehyde is one of the vital chemicals produced by industries, transports, and domestic products. Formaldehyde emissions adversely affect human health and it is well known for causing irritation and nasal tumors. The major aim of the modern indoor formaldehyde control study is in view of energy capacity, product selectivity, security, and durability for efficient removal of formaldehyde. The two important methods to control this harmful chemical in the indoor environments are photocatalytic oxidation and catalytic oxidation with noble metals and transition metal oxides. By harmonizing different traditional photocatalytic and catalytic oxidation technologies that have been evolved already, here we give a review of previously developed efforts to degrade indoor formaldehyde. The major concern in this article is based on getting the degradation of formaldehyde at ambient temperature. In this article, different aspects of these two methods with their merits and demerits are discussed. The possible effects of operating parameters like preparation methods, support, the effect of light intensity in photocatalytic oxidation, relative humidity, etc. have been discussed comprehensively. [ABSTRACT FROM AUTHOR]

Karakoram mountains range in north-western part of Himalayas is about 500 km in length and hosts some of the world's highest peaks and longest glaciers. It is characterized by steep slopes and polar climate. Snowfall and avalanches are observed almost throughout the year. Many lives have been lost in the past in these mountains due to avalanches. This study focuses on avalanche hazard mitigation work undertaken in eastern part of Karakoram mountains, a complex of glaciers including Siachen and other connected glaciers on the eastern side of Saltoro Ridge. From the forecasting point of view, the snowpack on the slopes of Karakoram mountains almost always has unstable layers and hence continual avalanche threat exists. The structural mitigation measures are infeasible due to steep, unstable and glaciated terrain. The method of slope stabilization by preventive triggering of small avalanches holds promise but necessary infrastructure is difficult to install and maintain. Consequently, the effective avalanche hazard mitigation in the area is a challenging task. The paper describes the general terrain, climatological and avalanche characteristics of the area. Further, it elaborates the infrastructure set up, various tools and products developed to assist the avalanche practitioners in organizing safe camping and movements in the area particularly the snow-meteorological observatory network, weather modelling products, avalanche forecasting models, terrain visualization tools, hazard mapping and risk analysis, and experiences of preventive triggering of avalanches. [ABSTRACT FROM AUTHOR]

Context: Architecture of a software system represents the key design decisions and therefore its quality plays an important role to keep the software maintainable. Code smells are indicators of quality issues in a software system and are classified based on their granularity, scope, and impact. Despite a plethora of existing work on smells, a detailed exploration of architecture smells, their characteristics, and their relationships with smells in other granularities is missing. Objective: The paper aims to study architecture smells characteristics, investigate correlation, collocation, and causation relationships between architecture and design smells. Method: We implement smell detection support for seven architecture smells. We mine 3 073 open-source repositories containing more than 118 million lines of C# code and empirically investigate the relationships between seven architecture and 19 design smells. Results: We find that smell density does not depend on repository size. Cumulatively, architecture smells are highly correlated with design smells. Our collocation analysis finds that the majority of design and architecture smell pairs do not exhibit collocation. Finally, our causality analysis reveals that design smells cause architecture smells. [ABSTRACT FROM AUTHOR]

Patients with head and neck cancer represent a vulnerable population at particular risk of opioid dependence due to frequent histories of substance abuse, requirement of extensive surgery, and the synergistic toxicity of multimodal therapy. Regional anesthetic techniques have been used by other surgical disciplines to facilitate early recovery after surgery and decrease postoperative patient narcotic requirements. This pilot study investigates the efficacy of a preoperative regional analgesia using stellate ganglion block in lateralized head and neck cancer surgery. From our early results, stellate ganglion blockade may hold promise as an effective preoperative intervention for controlling early postoperative pain, lessening narcotic requirements, and improving quality of life. [ABSTRACT FROM AUTHOR]

Traditional k-means clustering algorithm is sensitive to the choice of initial cluster centers and leads to local optimal results. k-means++ is a hybrid k-means clustering algorithm which specifies the procedure to initialize the cluster centers before proceeding with the standard k-means algorithm. Inspired by nature, some contemporary optimization techniques such as Cuckoo, Bat and Krill Herd algorithms etc., are used for optimization as they mimic the swarming behaviour and allows to cooperatively move towards an optimal objective within a reasonable time. In this paper, these nature-inspired techniques are used for optimizing k-means++ clustering algorithm to enhance clustering quality and generate new hybrids of unprecedented performance. The results of the evaluation experiments on the integration of nature-inspired optimization methods with k-means++ algorithm are reported. [ABSTRACT FROM AUTHOR]

Here, we highlight the potential translational benefits of delivering FLASH radiotherapy using ultra-high dose rates (>100 Gy·s-1). Compared with conventional dose-rate (CONV; 0.07-0.1 Gy·s-1) modalities, we showed that FLASH did not cause radiation-induced deficits in learning and memory in mice. Moreover, 6 months after exposure, CONV caused permanent alterations in neurocognitive end points, whereas FLASH did not induce behaviors characteristic of anxiety and depression and did not impair extinction memory. Mechanistic investigations showed that increasing the oxygen tension in the brain through carbogen breathing reversed the neuroprotective effects of FLASH, while radiochemical studies confirmed that FLASH produced lower levels of the toxic reactive oxygen species hydrogen peroxide. In addition, FLASH did not induce neuroinflammation, a process described as oxidative stress-dependent, and was also associated with a marked preservation of neuronal morphology and dendritic spine density. The remarkable normal tissue sparing afforded by FLASH may someday provide heretofore unrealized opportunities for dose escalation to the tumor bed, capabilities that promise to hasten the translation of this groundbreaking irradiation modality into clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this case report is to describe an occurrence of a rare complication of lead extrusion, which was observed 10 months after spinal cord stimulator (SCS) implantation. Methods: A patient with low back pain and failed back surgery syndrome underwent implantation of a SCS without complications. Ten months after implantation, one SCS lead extruded from her lower back leading to surgical removal of the leads. Results: After identifying the complication of a SCS lead extruding from the patient's back, a surgical revision was performed to remove the SCS leads but retain the implantable pulse generator (IPG) in the gluteal region. During the surgery, it was noted that the anchors were in the appropriate position, sutured and fibrosed to a deep fascial layer. There were no complications from the surgical revision and no infectious process was observed. Conclusions: We report the occurrence and management of a rare complication of SCS lead extrusion after SCS implantation for failed back surgery syndrome. After recognition, removal of the leads with retention of the IPG was able to effectively resolve the complication. The revising procedure was well tolerated but resulted in the recurrence of the patient's previous low back pain. We believe that knowledge of this case and its management will aid future physicians in the recognition and management of this rare complication of SCS implantation. Furthermore, as there is a paucity of literature discussing the management of lead extrusion after SCS implantation, we hope that this case report will spur additional research on the management of this complication. [ABSTRACT FROM AUTHOR]

Biodiesel is a promising fuel which shows potential and gradually received attention as a best alternate feedstock for diesel engine. Previous investigations have shown that use of double biofuels in a diesel engine can be a promising aspect for complete elimination of diesel from compression ignition engines which will decrease our dependency on fossil fuels. The tribological performance of injection system is primarily based on the lubricity characteristics of the fuel. So, it is imperative to a more diversified research about the impact of using double biofuels in engine. In the present investigation, different biodiesel-oil blends were investigated using the ASTM D6079 by the reciprocatory friction monitor. The effect of temperature variation on lubricity characteristics was also studied. The biodiesel-oil blends shows improvement in results as compared to diesel. Biodiesel is prone to oxidation due to availability of unsaturation in their moieties. The effects of oxidation on lubricity characteristics were also studied. It was also found that the operating conditions collectively affected the lubricity characteristics of tested feedstocks. [ABSTRACT FROM AUTHOR]

A 74-year-old female underwent an uneventful bilateral thoracoscopic maze procedure for persistent atrial fibrillation with continuous transesophageal echocardiographic (TEE) guidance. She presented six weeks later with persistent fever and focal neurological signs. Computed tomography of the thorax revealed air in the posterior LA, raising suspicion for an abscess versus an atrioesophageal fistula (AEF). Before undergoing an exploratory median sternotomy, an esophagogastroduodenoscopy (EGD) was performed by the surgeon to check for any esophageal pathology. This however, resulted in sudden hemodynamic compromise that required intensive treatment with vasopressors and inotropes. In this case-report, we review the various intraoperative risk factors associated with the development of AEF during cardiac ablation procedures as well as the potential hazards of esophageal instrumentation with TEE, naso- or oro- gastric devices, and/or an EGD when an AEF is suspected. [ABSTRACT FROM AUTHOR]

In the present time, need of biogenic lubricants is the focusing area which will be biodegradable, avirulent and eco-friendly. Current experimental tests depict the effect of ‘Phyllanthus emblica’ a non-edible feedstock through pin on disc tribo tester. Tests were conducted to evaluate the impact of 0, 10, 20 and 30 % blending of Phyllanthus emblica with SAE20W40 lubricating oil on cylinder liner and piston ring. Promising results have been manifested with 10 % blending of biodiesel (BD) with lubricating oil in terms of coefficient of friction and specific wear rate in comparison with other examined feedstock. For analysis of wear debris in the used oil analytical ferrography was also done. The effects of temperature on wear and friction characteristics have also been discussed. [ABSTRACT FROM AUTHOR]

The Computational fluid dynamics ( CFD) based analysis is carried out to investigate the thermal and hydraulic performance of circular rib roughened triangular passage Solar air heater ( SAH). The circular ribs were provided over the absorber plate. The roughness parameter such as relative roughness pitch ( P/ e) and relative roughness height ( e/ D) varies from 4 to 20 and 0.015 to 0.06 (in four sets), respectively, the Reynolds number (Re) varies from 4000 to 18000. The flow governing equations were solved using commercial ANSYS (Fluent) software. The predicted Nusselt number ( Nu) and friction factor ( f) are validated with the available experimental results. The thermal and hydraulic performance of roughened duct is estimated in the form of Nusselt number and friction factor, respectively. The Thermohydraulic performance parameter ( TPP) is also evaluated depending on the friction factor ( f) and Nusselt number ( Nu) values for SAH. The maximum Thermohydraulic performance parameter ( TPP) is observed at Reynolds number of 15000 in case of relative roughness pitch ( P/ e) and relative roughness height ( e/ D) value of 12 and 0.06, respectively. [ABSTRACT FROM AUTHOR]

The amount of pressure on the automotive industry, competition facing from other automotive manufacturers, or the rules and regulations imposed by administrative bodies, biodiesel is turning out as a favourite alternative for almost all-ongoing research in the area. In the present experimental study, aamla biodiesel is used in different volumetric ratios of 25 % (B25), 50 % (B50) 75 % (B75) and 100 % (B100) as a fuel in Compression-ignition (CI) engine. This paper presents the study of performance, emission and combustion characteristics of aamla biodiesel. Aamla biodiesel is a new non-edible feedstock for diesel engine. The experimental result shows that HRR and cylinder pressure for biodiesel is found to be less than diesel. In terms of performance, B25 shows the best results as compared to other blends. As biodiesel content increases in fuel, exhaust emission decreases. According to environmental aspects, biodiesel used as a fuel in a diesel engine is quite advantageous. [ABSTRACT FROM AUTHOR]

Calling context profiling has proved out to be extremely useful in program understanding and optimization. Calling contexts can be organized in several ways, such as Dynamic Call Tree (DCT), Calling Context Tree (CCT), Hot Calling Context Tree (HCCT), Approximate Calling Context Tree (ACCT) and Calling Context Uptree (CCU). This paper conducts a comparative performance analysis on all major calling context data structures using the evaluation of a set of dynamic cohesion and coupling metrics at package, class and method levels on a set of open source java applications. The results imply that DCT, CCT and CCU are all similar in metric accuracy but vary in time and space requirements. ACCT, while incurring least time and space overhead, generates highly inaccurate and misleading results. The performance of HCCT is highly dependent on a predetermined hot-context threshold value. It was concluded that CCT outperforms others in comprehensive representation of inter-procedural control flow and collection of dynamic metrics for a program, in terms of both time-space overhead and accuracy. [ABSTRACT FROM AUTHOR]

To improve operational efficiencies while providing state of the art healthcare services, hospitals rely on information technology enabled physician referral systems (IT-PRS). This study examines learning curves in an IT-PRS setting to determine whether agents achieve performance improvements from cumulative experience at different rates and how information technologies transform the learning dynamics in this setting. We present a hierarchical Bayes model that accounts for different agent skills (domain and system) and estimate learning rates for three types of referral requests: emergency (EM), nonemergency (NE), and nonemergency out of network (NO). Furthermore, the model accounts for learning spillovers among the three referral request types and the impact of system upgrade on learning rates. We estimate this model using data from more than 80,000 referral requests to a large IT-PRS. We find that: (1) The IT-PRS exhibits a learning rate of 4.5% for EM referrals, 7.2% for NE referrals, and 12.3% for NO referrals. This is slower than the learning rate of manufacturing (on average 20%) and more comparable to other service settings (on average, 8%). (2) Domain and system experts are found to exhibit significantly different learning behaviors. (3) Significant and varying learning spillovers among the three referral request types are also observed. (4) The performance of domain experts is affected more adversely in comparison to system experts immediately after system upgrade. (5) Finally, the learning rate change subsequent to system upgrade is also higher for system experts in comparison to domain experts. Overall, system upgrades are found to have a long-term positive impact on the performance of all agents. This study contributes to the development of theoretically grounded understanding of learning behaviors of domain and system experts in an IT-enabled critical healthcare service setting. [ABSTRACT FROM AUTHOR]

Background and Objectives: Osteoarthritis (OA) is a common rheumatological disorder. It is a degenerative joint disorder characterized by destruction of articular cartilage and formation of a new bone at the joint surfaces. Its onset is usually in older age group. Both men and women are affected, but symptoms in women occur earlier and appear to be more severe than in men. Knee joint is the most commonly affected region of the body. Predominant feature is pain along with decrease in the range of motion. One of the worst things about OA is its negative effect on the quality of life. The aim of this study is to find out prevalence of OA knee in different age groups & in different sexes and effect of exercise rehabilitation program on pain, range of motion, strength, cardiovascular fitness and functional level of patients with OA knee. Methods: A group of 200 patients of established osteoarthritis of knee ranging in age from 40-65 years were included in the study.Patients were randomly divided into two groups: Group A (Experimental Control Group, n=100) and Group B (Experimental Group, n=100). Patients of experimental control group were treated with conventional physiotherapy program and patients of experimental group were treated both with conventional physiotherapy program and exercise rehabilitation program which includes mild intensity long duration exercise program. Both the groups were treated for two months. Following parameters were assessed at the start of exercise rehabilitation program, in the middle (after 1 month) of the study and at the end (after 2 months) of exercise rehabilitation program: Weight, BMI, pulse, HR, BP, pain, range of motion, strength of muscles, cardiovascular fitness & functional level. Results: The results showed that there is a frequency of 15.5%, 46% & 38.5% of osteoarthritis knee patients in the age group of 40-50 years, 51-60 & > 60 years respectively and prevalence in males & females is 31% & 69% respectively. The mean values of weight & BMI at 0 month was 71.81 ± 6.62 and 27.65 ± 2.47 (in males) and 73.24 ± 6.32 and 28.06 ± 3.33 (in females) which was reduced to 63.00 ± 7.07 and 24.24 ± 2.49 (in males) and63.37 ± 6.15 and 24.26 ± 2.91 (in females) after 2 months of exercise rehabilitation program. There is significant reduction in level of pain whereas range of motion, strength, cardiovascular fitness and functional level were improved significantly.Conclusion: It is concluded that exercise rehabilitation program which includes mild intensity long duration exercise program causes significant decrease in weight & BMI in knee OA patients along with reduction in level of pain whereas range of motion, strength, cardiovascular fitness and functional level were improved. [ABSTRACT FROM AUTHOR]

We have previously demonstrated that uPA is overexpressed in pancreatic tumors. In an attempt to diagnose these tumors earlier, we sought to determine whether uPA could be identified in endoscopic retrograde cholangiopancreatography obtained brushings in patients with malignant pancreatic and biliary strictures. Secondarily, uPA wasmeasured in the serum of this patient population. uPA overexpression was identified in the cytologic tissue in 8 of 11 patients (72.7%). Serum analysis demonstrated a 2-fold higher concentration of uPA in the pancreaticobiliary cancer patients (1.27 versus 0.56 ng/mL; P = .0182). Also, uPA overexpression correlated with serum levels (P < .0001). This study confirms that uPA can be detected in the ERCP cytologically obtained tissue and is frequently present in a higher concentration in the serum of pancreaticobiliary cancer patients. A larger sample size will be required to address its value as a sensitive marker for the diagnosis of pancreatic or biliary cancers. [ABSTRACT FROM AUTHOR]

Presents letters to the editor on medical issues and research. Details of fecal occult blood tests for colorectal cancer; Information on positional right-to-left shunting; Discussion on skin ulcers and tuberculosis outbreaks; Information on gamma-interferon for severe chronic active Epstein-Barr virus.

Clustering algorithms can be optimized using nature‐inspired techniques. Many algorithms inspired by nature, namely, firefly algorithm, ant colony optimization algorithm, and so forth, have improved clustering results. k‐means is a popular clustering technique but has limitations of local optima, which have been overcome using its various hybrids. k‐means++ is a hybrid k‐means clustering algorithm that gives the procedure to initialize centre of the clusters. In the proposed work, hybrids of nature‐inspired techniques using cuckoo and krill herd algorithm are implemented on k‐means++ algorithm to enhance cluster quality and generate optimized clusters. The designed algorithms are implemented, and the results are compared with their counterparts. Performance parameters such as accuracy, f‐measure, error rate, standard deviation, CPU time, cluster quality check, and so forth are used to measure the clustering capabilities of these algorithms. The results indicate the high performance of newly designed algorithms. [ABSTRACT FROM AUTHOR]