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Background and aims Early goal-directed therapy (EGDT) provides preset goals to be achieved by intravenous fluid therapy and inotropic therapy with earliest detection of change in the hemodynamic profile. Improved outcome in cardiac surgery patients has been shown by perioperative volume optimization, while postoperative intensive care unit (ICU) stay can be decreased by improving oxygen delivery. Our aim of this study was to study the outcome of EGDT in patients undergoing elective cardiac surgery. Materials and methods This is a prospective single institute study involving a total of 478 patients. Patients were divided into group I, who received standard hospital care, and group II, who received EGDT. Postoperatively, patients were observed in ICU for 72 hours. Hemodynamics, laboratory data, fluid bolus, inotrope score, complication, ventilatory time, and mortality data were collected. Results Postoperative ventilatory period (11.12 ± 10.11 vs 9.45 ± 8.87, p = 0.0719) and frequency of change in inotropes (1.900 ± 0.9 vs 1.19 ± 0.61, p = 0.0717) were lower in group II. Frequency of crystalloid boluses (1.33 ± 0.65 vs 1.75 ± 1.09, p = 0.0126), and quantity of packed cell volume (PCV) used (1.63 ± 1.03 vs 2.04 ± 1.42, p = 0.0364) were highly significant in group II. Use of colloids was higher in group II and was statistically significant (1.98 ± 1.99 vs 3.05 ± 2.17, p = 0.0012). The acute kidney injury (AKI) rate was (58 (23.10%) vs 30 (13.21%), p = 0.007) lower and statistically significant (p = 0.007) in group II. Conclusion Early goal-directed therapy reduces the postoperative ventilatory period, frequency of changes in inotropes, and incidence of AKI, and decreases ventilation hours, number of times inotropes changed, and AKI. How to cite this article Patel H, Parikh N, Shah R, Patel R, Thosani R, Shah P, et al. Effect of Goal-directed Hemodynamic Therapy in Postcardiac Surgery Patients. Indian J Crit Care Med 2020;24(5):321–326.

This article explores how resilience as a concept is being increasingly mobilised within the Education in Emergencies (EiE) community. Using content and a close textual analysis, it identifies the concept’s growth in prominence within key EiE documents arguing it has been employed to serve a range of different purposes. It contends, however, that dominant conceptualisations of resilience within the EiE community are reflective of a number of shifts around the problem, subjects and purposes of education provision in such conflict-affected contexts. This serves to limit the transformative potential of resilience, particularly in regards to contributing to positive peace.

Background Retrospective reviews have found the use of stored packed red blood cells (PRBCs) in priming to be associated with increased risk of postoperative complications. The purpose of study was to prospectively investigate the influence of duration of storage of PRBCs used in priming the cardiopulmonary bypass (CPB) circuit on the metabolic profile of the patients, and postoperative outcome after paediatric cardiac surgery. Methods Between January 2015 and December 2015, 198 consecutive children operated for cardiac surgery using CPB and received blood for priming the circuit were included. Patients were divided into two groups based on the duration of storage of the blood, newer PRBCs group who received blood stored for ≤14 days and the older PRBCs group who received blood stored for >14 days. Results Mean duration of blood storage used for priming in newer PRBCs blood group (n = 103) was 8.4 ± 3.7 days while it was 21.9 ± 4.5 days in older PRBCs group (n = 95). Metabolic parameters of the PRBCs improved to physiological limits in both the groups after initiation of CPB. Postoperative hepatic, pulmonary, haematological complications, sepsis and multi-organ failure were more in the old PRBCs group. However, the difference was not significant. Similarly, there was no significant difference in incidence of prolonged mechanical ventilation, intensive care unit stay and hospital stay and mortality between the two groups. Conclusions Metabolic parameters of the stored blood become normal after initiation of CPB irrespective of duration of storage. In paediatric patients without significant co-morbidity, undergoing cardiac surgery, transfusion of washed stored blood up to 28 days in CPB priming is safe especially if lesser amount of transfusion is required.

Introduction: Nanophthalmos characterized by short axial length, high lens-to-eye ratio and thick sclera, is more prone to develop uveal effusion syndrome (UES). This rare entity can result in idiopathic exudative detachment of the choroid, ciliary body and retina. Abnormality in the scleral thickness with resultant obstruction of the vortex veins and reduced trans-scleral drainage of fluid is responsible for exudative retinal detachment (ERD). Methods: A retrospective study of UES in nanophthalmic patients treated with partial thickness sclerectomy in tertiary eye care centre from January 2015 to June 2019. Five eyes of five patients (four males and one female) with a diagnosis of nanophthalmos suffered from angle closure glaucoma associated with ERD. Raised intra-ocular pressure (IOP) not amenable to conservative medical management were subjected to surgery. Lamellar sclerectomy was performed in two or more quadrants without drainage which was judged on the basis of maximum amount of exudative fluid present in the subsequent quadrants. Results: The average age at surgery was 39.2 years and the mean follow-up duration was 9.2 months (6 to 18 months). Revision sclerectomy was required in 2/5 (60%) eyes. The serous fluid gradually resolved and retina remained reattached at the end of final follow up. The useful vision was preserved and IOP was normalized. Conclusion: Nanophthalmic UES remains a challenging clinical entity. Partial thickness sclerectomy may be an effective option in the treatment of nanophthalmic UES, not amenable to the conventional medical management in a low resource setup.

Cladophialophora bantiana is a rare melanized neurotropic fungus. We report a case of cerebral pheohyphomycosis due to C. bantiana in an immunocompetent child. The patient was a 12-year-old male who presented with a headache, intermittent vomiting associated with decreased movements of the right upper and lower limbs, and right-sided deviation of the mouth. Brain magnetic resonance imaging showed multiple conglomerated lesions in the left gangliocapsular region and corona radiata with perilesional edema and mass effect and a few small ring-enhancing lesions also. Aspiration of brain abscess sent for a culture and isolated C. bantiana. The clinical and radiological presentations are similar to the common organisms such as tuberculosis and thus can be misleading while diagnosis. Despite aggressive management, the patient succumbed to his illness. It is imperative to isolate microorganisms, using all microbiological tests. Fungi should also be considered irrespective of the immunocompetency.

AIM: To evaluate the anatomical and visual outcome following removal of intraocular foreign body (IOFB) through pars planavitrectomy.MATERIAL & METHODS: A retrospective analysis of 11 cases of retained posterior segment foreign body that underwent pars planavitrectomy for removal of foreign body during the period of January 2013 to August 2017 was conducted. Demographics of patients, mechanism and details of injury, Snellen best corrected visual acuity, examination results at presentation and after surgery, any diagnostic imaging and surgical procedure were recorded and analysed.RESULTS: Out of eleven eyes of eleven patients (mean age= 25.4}8.6, range 22 50 years; all male) preoperative retinal detachment and endophthalmitis was seen in 27.3% and 36.4% of cases respectively. Eighty-two percent of cases presented within 17 days of sustaining injury. Foreign body size ranged from 2mm to 8 mm and all were magnetic metal. After vitrectomy and removal of foreign body, the number of eyes with vision of hand motion or worse decreased from 72.7% to 27.3%. Similarly 45.5% of eyes gained best corrected postoperative visual acuity of better than 6/60. Anatomical success could be achieved in 81.8% of eyes.CONCLUSION: Anatomical outcome following vitrectomy in eyes with retained posterior segment IOFB in terms of retinal attachment is sufficient; however, visual outcome can be affected by other collateral ocular injuries and their sequelae.Journal of Universal College of Medical Sciences, Vol. 5, No. 2, 2017, Page: 45-48

We report the case of a 14-year-old female who had tetralogy of Fallot along with anomalous origin of the left pulmonary artery from the ascending aorta with co-dominant double aortic arch forming a complete vascular ring compressing the oesophagus along with a left main coronary artery to right ventricular outflow tract fistula. She underwent surgical correction without conduit placement.

DOI: https://doi.org/10.3126/nepjoph.v10i2.23012 Introduction: Pars plana vitrectomy in combination with intraocular tamponade with silicone oil is a standard technique in the treatment of complex retinal detachment. Although the use of silicone oil has improved the results of retinal detachment surgery, its removal is recommended due to the ocular complications related to its long term use. However, retinal redetachment can occur after silicone oil removal. Objective: To evaluate the anatomical and visual outcome after silicone oil removal (SOR) in eyes with complicated retinal detachment. Material and Methods: We retrospectively analyzed 64 eyes of 64 consecutive patients of silicone oil removal over a period of 12 months. All eyes had undergone standard 3 ports pars plana vitrectomy with silicone oil placement for complicated retinal detachment. Cases that completed at least 1 month follow up duration after SOR were included in the study. Anatomical success after SOR was achieved in 56 of 64 eyes (87.5%). Seven of 8 redetachments (87.5%) were seen in eyes with silicone oil tamponade duration of less than 6 months. Visual acuity improved or was stabilized in 49 of 64 eyes (76.6%). Using paired T-test, it was found that there was no significant difference in pre and post SOR visual acuity. Postoperative ocular hypertension, corneal decompensation, band shaped keratopathy and hypotony was observed in 9.4%, 4.7%, 6.4% and 21.9% respectively. Conclusion: Although there was no significant improvement in visual acuity, redetachment and complication rates were comparable to other studies. The duration of endotamponade was not significantly associated with the redetachment rate. Key words: Silicone oil removal, Redetachment, Visual outcome, Keratopathy, ocular hypertension. Keywords: Silicone oil removal, Redetachment, Visual outcome, Keratopathy, ocular hypertension

A critical and more nuanced understanding of the multifaceted relationship between projects of peacebuilding and educational provision is starting to develop. Drawing on an epistemological and ontological anchor of critical realism, and a methodology informed by the application of cultural political economy analysis and the strategic relational approach to understanding educational discourses, processes and outcomes, we illustrate how the ‘many faces’ of education in conflict-affected situations can be better theorised and conceptually represented. In doing so, we link goals of peacebuilding to those of social justice, and reinvigorate the notion of education playing a transformative rather than a restorative role in conflict-affected contexts. Making such ideas concrete, we provide examples of how such an analytical framework can be employed to understand the multi-faceted relationship between education and projects of social transformation in conflict-affected environments across the globe.

Applying the Strategic Relational Approach, this paper analyses the circumstances behind and educators’ strategies in response to education reforms in two nation-states undergoing socio-political transformation – Bolivia and Timor-Leste. Despite the starkly different histories and contemporary context of each nation, we suggest that transformation in both settings is driven by a desire to unshackle histories of colonisation and social conflict. Education reform, at least discursively, aims to dislocate past practices and replace them with a new material reality. In such spaces, we find that teachers are acting as strategic political actors, but in ways that are historically situated and driven by real and perceived personal and professional constraints. Their actions lead to particular types of ‘resistance’ and strategic action, leading to outcomes that are simultaneously continuous and disconnected from the past.

Modern day conflict presents a unique challenge to the disaster response and humanitarian community. Different to many disasters, conflict manifests itself over a protracted period, with varying levels of severity and no clear beginning or end. Increasingly children are the victims of such conflict, with their basic rights threatened. Education systems are increasingly vulnerable to attack either through direct violence and intimidation inflicted on children or teachers, or indirectly through the destruction of schooling infrastructure, the loss of school personnel, or restrictions on the movement of civilians and goods. While education has historically remained the ‘poor cousin’ within a humanitarian response package, it is increasingly acknowledged that high demand for education exists in conflict-affected situations. In recent years, attempts have been made to merge the education in emergencies and disaster risk/response communities. As greater attention and research inquiry is made into how education can promote resilience and protection to children affected by conflict, and respond effectively to the trauma, a critical exploration of how resilience is understood and acted upon in such settings is needed. This paper, using the case study of Gaza Strip within the Occupied Palestinian Territories, suggests that while programmatic interventions focussed on supporting the resilience of children and the institutional networks of support on which these children rely may deliver short-term benefits, a restoration of the status quo or the effective adjustment of these individuals and institutions to a new state of normalcy may be ineffective and counter-productive in the medium to long-term.

Epilepsy surgery has become an accepted treatment for drug resistant epilepsy in infants and children. It has gained ground in India over the last decade. Certain epilepsy surgically remediable syndromes have been delineated and should be offered surgery earlier rather than later, especially if cognitive/behavioral development is being compromised. Advances in imaging, particularly in MRI has helped identify surgical candidates. Pre-surgical evaluation includes clinical assessment, structural and functional imaging, inter-ictal EEG, simultaneous video -EEG, with analysis of seizure semiology and ictal EEG and other optional investigations like neuropsychology and other newer imaging techniques. If data are concordant resective surgery is offered, keeping in mind preservation of eloquent cortical areas subserving motor, language and visual functions. In case of discordant data or non-lesional MRI, invasive EEG maybe useful using a two-stage approach. With multi-focal / generalized disease, palliative surgery like corpus callosotomy and vagal nerve stimulation maybe useful. A good outcome is seen in about 2/3rd of patients undergoing resective surgery with a low morbidity and mortality. This review outlines important learning aspects of pediatric epilepsy surgery for the general pediatrician.

We report a rare case of common arterial trunk with intact ventricular septum, a large patent arterial duct, and normally developed aortic arch. We discuss its possible embryology, emphasizing the phenotypic differences from aortopulmonary window, and describe our surgical management.

Objective Ventricular septal defect (VSD) is among the most common congenital heart diseases encountered in pediatric cardiac patients. Apical muscular VSD constitutes nearly 2% of defects, which may or may not be associated with other congenital heart defects. The purpose of our study is to present our innovative and simple surgical technique using custom-made low-profile polytetrafluoroethylene (PTFE) single disc device for closing multiple apical muscular and isolated apical muscular VSD. Method Between January 2010 and July 2013, 17 patients with isolated or multiple apical muscular VSDs with or without associated heart diseases underwent operation at our institute. The apical VSD was closed using our custom-made low-profile single disc polytetrafluoroethylene device. The operative technique and the technique used to prepare the single disc device are detailed. Results Seventeen patients of ages ranging from 3 months to 7 years underwent operation over 3 years. One 8-month-old patient with transposition of the great arteries with multiple VSDs died after 35 days due to severe pulmonary artery hypertension and sepsis. Another newborn infant with infracardiac total anomalous pulmonary venous connection with a 4-mm apical VSD also died after 3 days because this VSD could not be identified. All other patients are doing well on follow-up. Conclusions The technique described by us has the advantage of apical VSD closure through the left ventricle without left ventriculotomy. Our technique is simple and cost-effective.

The democratic evaluative tradition has sought to change evaluation practice towards approaches and techniques that generate diverse forms of knowledge and foster public deliberation over a programme's merit and worth. This paper locates one evaluation method, ‘Most Significant Change’ (MSC), within this tradition. Drawing on two different evaluations – one, of a comprehensive economic sector assistance package to the Government of Tokelau, and the other of a psychosocial and academic support intervention for pre-adolescent children in conflict-affected regions of the Gaza Strip – the paper provides evidence of how MSC can capture unexpected outcomes, act as a tool for real-time formative learning, and expose the competing theories, logics and values behind programme activity. The examples within the paper also provide evidence of how MSC begins to redistribute traditional power relationships in assessing the merit and worth of observed impacts by increasing the legitimacy of local programme knowledge, and engaging all parties in evaluative decisions. By doing so, MSC, the paper argues, better serves the purposes of learning, improvement and mutual accountability which should sit at the core of good development practice.

Increasingly, the imperative for improving educational quality in schooling systems throughout the developing world is harnessed to a particular set of teaching and learning practices, such as child-centred, child-friendly or learner-centred pedagogy (LCP). Such was the case in Timor-Leste where, after independence, LCP was heavily promoted as a panacea for an education system that was perceived to be irrelevant, outmoded and of poor quality. While LCP was readily adopted into policy discourse, less support and attention were given to the substantive incorporation of LCP into teacher practice. When strategically borrowed in such a fashion, the paper suggests little promise remains for LCP to meaningfully improve student learning processes or outcomes in Timorese classrooms.

The paper analyses the context in which education in Aceh acts strategically to advance an agenda of social transformation. Applying a cultural, political economy analytical framework, it identifies ways in which education is embedded in key cultural, political, economic and social struggles at present. They include: (1) the redistribution of educational opportunities and access; (2) ambiguous spaces for democratic representation in a decentralised educational structure; (3) competing notions of how diversity is acknowledged within Indonesia and Aceh Province; and (4) conflicted approaches to reconstruction following the 2004 tsunami and end of conflict in 2005.

The objective of present work was to develop a “tablets in capsule” system for facilitating both immediate and pulsatile drug deliveries of theophylline to mimic the circadian rhythm of nocturnal asthma. The system comprised of capsule filled with two tablets, first pulse and second pulse tablet prepared by wet granulation method. First pulse tablet was not coated and was responsible for providing loading dose whereas; second pulse tablet was coated with Eudragit L100 and Eudragit S100 to release drug in colon after specific lag time. Two independent variables, amount of polymers and coating thickness, were optimized by 32 full factorial design. The optimum formulation consisted of Eudragit L100: Eudragit S100 in 1:1.5 ratio and coating thickness of 20 % (w/w). In vitro drug release of “tablets in capsule” system in three different media (pH 1.2, pH 6.8, and pH 7.4) revealed immediate and pulsatile release patterns.

The purpose of present research work was to design and optimize compression coated tablet to provide an immediate release of hydrochlorothiazide in stomach and extended release of metoprolol succinate in intestine. Compression coated tablet was prepared by direct compression method which consisted of metoprolol succinate extended release core tablet and hydrochlorothiazide immediate release coat layer. Barrier coating of Hydroxy Propyl Methyl Cellulose (HPMC) E15LV was applied onto the core tablets to prevent burst release of metoprolol succinate in acidic medium. A 32 full factorial design was employed for optimization of the amount of polymers required to achieve extended release of drug. The percentage drug release at given time Q3, Q6, Q10, Q22; were selected as dependent variables. Core and compression coated tablets were evaluated for pharmaco-technical parameters. In vitro drug release of optimized batch was found to comply with Pharmacopoeial specifications. Desired release of metoprolol succinate was obtained by suitable combination of HPMC having high gelling capacity and polyethylene oxide having quick gelling capacity. The mechanism of release of metoprolol succinate from all batches was anomalous diffusion. Optimised batch was stable at accelerated conditions up to 3 months. Thus, compression coated tablet of metoprolol succinate and hydrochlorothiazide was successfully formulated.

Acute type A aortic dissection is a surgical emergency. Unfortunately, the early outcome of surgical correction has not improved significantly over the past 20 years (Chiu and Miller, 2016). There is still conflict regarding operative extent and optimal conduct of the operation (Chiu and Miller, 2016). Stanford type A aortic dissection deforms the aortic root and causes aortic regurgitation. On rare occasion, there can be circumferential intimal disruption. Because of the critical, general and hemodynamic state of patients, surgery carries high risk. Two cases with circumferential Stanford type A aortic dissection were detected; Case I had interposition graft while Case II underwent Bentall's procedure.

Motivations to reform curriculum in post-conflict, or post-colonial states are often driven by the need to (re) construct a cohesive and publicly legitimated national identity that is starkly different to that which existed prior. This paper explores the context behind such action in the Timor-Leste (East Timor) and some challenges which policy makers and citizens have wrestled with in developing and implementing the country's first post-independence primary curriculum. The author argues that specific aspects of this new curriculum have effectively alienated and/or divided large segments of its population, despite a desire for the reforms to result in a more inclusive, democratic and distinctly “Timorese” educational system. The assertion is that the desire to institute change rapidly after independence has in fact hampered the ability of the reforms to constructively serve the political and social project of nation building. The paper cautions that education's role in promoting human development, and reducing the triggers of conflict in this country hang in the balance as long as this new curriculum fails to deliver on its aspirations.

Information Extraction is a process to retrieve Information from Natural Language Text or unstructured text by automated process. OBIE[1] (Ontology based Information Extraction) is one of the most emerging subfields of Information Extraction. Where Ontology is a formal and explicit specification of conceptualization which plays a crucial role in the process of Information Extraction[2]. Ontology has potential to support to build a Semantic Web and also plays a vital role in the Knowledge Representation. This paper attempts to survey some relevant research in the field of Ontology Based Information Extraction.

Total anomalous systemic and pulmonary venous connection is an extremely rare congenital cardiac anomaly. We present our unique experience of managing this complex partially diagnosed cardiac anomaly in a 16-month-old boy. The systemic venous anomaly was not detected during the initial preoperative evaluation. He was doing well on follow-up, with normal pulmonary artery pressure.

As two of the convenors responsible for the thematic group on Education and Conflict at the 2013 Comparative Education World Congress in Buenos Aires, we envisaged, in line with the conference theme of New Times, New Voices, a group of papers which would show how studies investigating the myriad faces of education in conflict are situated within the broader discipline of comparative and international education.

Many peace-building and conflict resolution projects across the world include the use of the arts (e.g. theatre, music, dance, painting, storytelling). The utilization of art in this way is aimed to help people from across communities to overcome their fears and prejudices by learning about each other through creativity and imagination with the aim of building a future where the break-down of social trust, which sometimes spirals down into violence, is less likely to occur.

Cor triatriatum with partial atrioventricular canal defect is a rare congenital cardiac anomaly. We report a case of cor triatriatum and partial atrioventricular canal defect in association with horseshoe lung.

Arthrogryposis is a heterogeneous birth defect characterized by limitation of movement at multiple joints. One in 3,000 infants is born with arthrogryposis, and at least a third of these cases have a genetic cause. Four distinct types of X-linked arthrogryposis have been reported, and a severe lethal form recently was mapped to Xpll.3-qll.2. We now report an extended family affected with a novel variant of X-linked arthrogryposis that involves only the lower limbs. Linkage analysis with polymorphic DNA markers maps the disease locus in this unique family to the long arm of the human X chromosome between DXS1220 and DXS1205 in Xq23-27.

In this paper, we describe our EnglishHindi and Hindi-English statistical systems submitted to the WMT14 shared task. The core components of our translation systems are phrase based (Hindi-English) and factored (English-Hindi) SMT systems. We show that the use of number, case and Tree Adjoining Grammar information as factors helps to improve English-Hindi translation, primarily by generating morphological inflections correctly. We show improvements to the translation systems using pre-procesing and post-processing components. To overcome the structural divergence between English and Hindi, we preorder the source side sentence to conform to the target language word order. Since parallel corpus is limited, many words are not translated. We translate out-of-vocabulary words and transliterate named entities in a post-processing stage. We also investigate ranking of translations from multiple systems to select the best translation.

We present the surgical management of an adult patient with circumflex aortic arch (CAA). We performed a ventral aorta repair with transposition of the left subclavian artery (LSCA) and resection of the arch. The usefulness of sternotomy and cardiopulmonary bypass in the management of these patients is described.

Calls for increasing levels of partnership and collaboration between schools and the communities they operate in have been heavily promoted on the global stage over the past decades. This has largely been driven by neoliberal rationalities that view parents and students as self-interested ‘clients’ and ‘consumers’ of their schools. However, counter-hegemonic projects in Latin America have sought to strengthen the role of citizen-actors in state functions, including education, as a mechanism for deepening democratic deliberation and repositioning the entitlement of citizens to shape the purposes and functions of primary education. This chapter examines how reforms to school governance structures in Bolivarian Venezuela appropriated greater ‘voice’ to citizen-actors over the actions of their schools and how these changes brought about the possibility for a changed role and purpose for schools within their communities. The specific possibilities and challenges that participants within these governance bodies faced are situated in the broader political discourses, social structures and institutional histories within which they operated in 2006, when the empirical work for this chapter was conducted.

The aim of present research was to produce carvedilol compression coated tablet to provide biphasic drug release.A compressed coated tablet made of a sustained release core tablet and an immediate release coat tablet. Both the core and the coat contained carvedilol. The sustained release effect was achieved with polymers (HPMC K4M and PEO WSR 205) to modulate the release of the drug. The powder blends for core and coat tablets were evaluated for angle of repose, bulk density, compressibility index, and drug content. Compressed coated tablets were evaluated for thickness, diameter, weight variation test, drug content, hardness, friability, disintegration and in vitro release studies.The powder blends showed satisfactory flow properties, compressibility, drug content and all the tablet formulations showed acceptable pharmaco-technical properties. Carvedilol contained in the fast releasing component was released within 3 min, whereas the drug in the core tablet was released at different times up to 24 h, depending on the composition of the matrix tablet. The mechanism of drug release was fickian diffusion or anomalous behavior.Batch F7, containing 10 mg PEO WSR 205 and 5 mg HPMC K4M, showed maximum similarity with theoretical profile and zero order drug release kinetic.

Deformable coated materials hold promises for numerous new technologies. In this research, extrusion of polymer coated metal rods was investigated. Analytical models based on upper bound method were developed to evaluate axisymmetric conical die extrusion of precoated materials. The rigid-plastic boundaries were optimized to obtain minimum extrusion power and to predict coating failure. From the models, the critical extrusion die angle can be derived. The analytical results agreed well with the results from the finite element simulation. The developed models can be used for extrusion die design and process analysis and can lead to lower cost and environmental friendly manufacturing technologies.

Background & Aims: Recent years have seen an increase in industry sponsorship of clinical trials throughout medicine. We conducted a study to evaluate the association of industry sponsorship to published outcomes in gastrointestinal (GI) clinical research. Our aims were (1) to evaluate the trends in the source of funding for GI clinical research during the period from 1992 to 2002–2003, (2) to determine whether the source of study funding predicted the likelihood that a study would publish results that favor the drug or device being tested, and (3) to determine whether differences exist in the methodologic quality of the investigational study methods used in studies funded by private industry versus other sources. Methods: We selected all clinical studies evaluating a drug or device from 4 prominent GI journals (Gastroenterology, The American Journal of Gastroenterology, Hepatology, and Gastrointestinal Endoscopy). All studies were abstracted by using a standardized data abstraction form. We evaluated the trends in funding source for studies published during the years 1992, 2002, and 2003. All selected studies were scored for methodologic quality by using a previously validated scoring system. The percentage of studies that reported outcomes that favored the device or drug being tested against the standard therapy or placebo was determined for each funding source. A funnel plot was constructed to assess for the presence of negative publication bias. Results: A total of 6326 studies were reviewed. For the 1992 trend data, 1860 studies were reviewed, and 135 were selected for inclusion in the study. Ninety-five studies were studies involving the investigation of drugs, and 40 studies involved the testing of a device. For the 2002–2003 data 4466 studies were reviewed, and 315 were selected for inclusion in the study. Two hundred twenty-two studies were clinical trials involving the investigation of drugs, and 93 were clinical trials involving devices. In comparing 1992 to 2002, the percentage of studies funded by industry sources more than doubled from 10% to greater than 28% of the total studies assessed. There was an associated decline in the proportion of studies with funding from non-industry sources during this period (62% to less than 48%). The percentage of studies that did not disclose a funding source fell modestly from 28% to 24%. We found that 86% of studies funded by private industry reported a result favorable to the study drug or device, and 83% of studies funded by academic sources reported a result favorable to the study drug or device (P = .572). On average, studies funded by private industry had a higher methodology score than studies funded by traditional academic sources (75 of 100 vs 65 of 100; P = .005). Analysis of the funnel plot did not reveal evidence of bias against the publication of small studies with insignificant results. Conclusions: The proportion of research funded by industry has more than doubled during the last decade and currently comprises almost half of the funding for GI clinical research. Industry-sponsored studies are, on average, of superior methodologic quality to studies funded by other sources. Industry-sponsored studies in leading GI journals were no more likely than other studies to publish results that favored the study sponsor, although an extremely high percentage of all studies in these journals reported positive results. There has been only a modest decline in studies not acknowledging a funding source.

Many routing protocols for mobile ad hoc networks have been developed. These protocols find a route to a destination if such a route exists. We present a novel protocol that delivers messages between disconnected hosts, that is, when no route exists between them. Our protocol uses the nodes moving between the neighbourhoods of the source and destination nodes to act as carriers of the messages. We describe the protocol in detail, provide an initial simulation-based evaluation of its performance compared to both a naive scheme and the optimal scheme, and discuss some extensions to the protocol that we are exploring.

Malaria is one of the most widespread parasitic infection in Asian countries affecting the poor of the poor. In an effort to develop an effective vaccine for the treatment of malaria, various attempts are being made worldwide. If successful, such a vaccine can be effective for treatment of both Plasmodium vivax and Plasmodium falciparum. This would also be able to avoid complications such as drug resistance, resistance to insecticides, nonadherence to the treatment schedule, and eventually high cost of treatment in the resource-limited settings. In the current compilation, the details from the literature were collected by using PubMed and Medline as search engines and searched for terms such as malaria, vaccine, and malaria treatment. This review collates and provides glimpses of the information on the recent malaria vaccine development. The reader will be taken through the historical perspective followed by the approaches to the malaria vaccine development from pre-erythrocytic stage vaccines, asexual stage vaccines, transmission blocking vaccines, etc. Looking at the current scenario of the malaria and treatment strategies, it is an absolute need of an hour that an effective malaria vaccine should be developed. This would bring a revolutionary breakthrough in the treatment modalities especially when there is increasing emergence of resistance to existing drug therapy. It would be of great purpose to serve those living in malaria endemic region and also for travelers which are nonimmune and coming to malaria endemic region. As infection by P. vivax is more prevalent in India and other Asian subcontinent and is often prominent in areas where elimination is being attempted, special consideration is required of the role of vaccines in blocking transmission, regardless of the stages being targeted. Development of vaccines is feasible but with the support of private sector and government organization in terms of regulatory and most importantly financially, being an expensive venture.