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INTRODUCTION: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based (‘Aardram’) initiative. It was envisioned that the mission’s implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care. METHODS: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema. RESULTS: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of ‘Aardram’ primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed. CONCLUSION: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.

SETTING: Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation. OBJECTIVE: To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems. DESIGN: This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study. RESULTS: Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation. CONCLUSION: The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals.

Air pollution is a worldwide problem having impacts on both local and global scales. According to the World Health Organization (WHO), air pollution causes 7 million deaths every year, with 4.2 million attributed to exposure to outdoor air pollution. Compared to the reference methods defined in the Air Quality Directive, the use of low-cost air quality sensors for monitoring ambient air pollution would reduce air pollution monitoring costs and would also allow larger spatial coverage especially in remote areas where monitoring with traditional facilities is uneasy. Theses multi-sensors were either calibrated against standard gas mixtures or using artificial neural network under field conditions. The later method resulted in mixed results either satisfactory for short periods or generally weak for longer data series. This project mainly focuses on the adaptive calibration of the low-cost sensors using the trained machine learning model. The performances of several field calibration methods for low-cost sensors, including linear/multi linear regression and supervised learning techniques will be compared. A cluster of ozone, nitrogen dioxide, nitrogen monoxide, carbon monoxide and carbon dioxide sensors will be operated. Subsequently, the accuracy of the predicted values will be evaluated for about a period. These predicted values are fed through the training model and the model will run accordingly and it will adapt all the error situations. This will be useful to the automobile industry in the current situation for smoke emission control and also for many refinery industries in which low-cost sensors can be used with the following modelling for the higher accuracy. This would reduce the cost and also yields more accuracy beyond the varying situation. Keywords: 1) Low-Cost Sensors (LCS) 2) Internet of Things (IoT)

The role of macro minerals (trace mineral elements) in biological systems has been described in several animals. However, the knowledge in fish is mainly limited to iron, copper, manganese, zinc and selenium as components of body fluids, cofactors in enzymatic raactions, structural units of non- enzymatic macromolecules, etc. Investigations in fish are comparatively complicated as both dietary intake and water borne mineral uptake have to be considered in deterging the mineral budgets. The importance of trace minerals as essential ingredients in diets, although in small quantities, is also evident in fish. Serum levels of some important macro minerals such as sodium (Na+), potassium (K+), calcium (Ca),phosphorous and magnesium (Mg) have been studied in four freshwater fishes collected from a local market as these fishes are edible fishes and are extensively purchased by the local public in the Kalaburagi city. These minerals play significant role in accumulation of nutrients, osmoregulation, homeostasis and other physiological activities of the fish particularly during breeding period. The blood serum level of these macro minerals determined in four local fresh water fishes are, Labeo rohita, Catla catla, Cirrhana mrigala and Pangusius becocurti. The results of macro mineral concentration level were compared among them and it is indicated that there is difference. The serum sodium level in all the four types of fishes is at higher level in comparison to other minerals. The variation and the order of concentration of minerals in all four types of fishes found to be as: sodium> potassium> phosphorous> calcium> magnesium. The aquatic body in which these fishes are harbored has required mineral concentration needed for various physiological activities in the process of nutritional absorption, osmoregulation and homeostatic mechanisms. Hence, the levels of blood serum macro minerals found in these fishes are though lesser during breeding period in the present study are considered to be in normal levels as reported in other fishes.

This article proposes a unified controller for Cuk converter assisted variable speed wind turbine driven self-excited induction generator (SEIG) in dc nanogrid configuration for rural electrification. Cuk converter assisted SEIG based wind energy conversion system (WECS) is considered as a master source in the proposed nanogrid, which operates in both grid-connected and islanded mode of operation. In grid connected mode, the system operates in maximum power point tracking (MPPT) under varying wind velocity. A single sensor, modified perturb and observe (P&O) MPPT algorithm, which is independent of the generator parameter is developed and implemented through Cuk converter. During a fault, the WECS necessitates to operate in islanded mode with voltage regulation to supply the local loads continuously. The unified control strategy is developed for selecting the mode of operation, which are MPPT and voltage regulation in grid-connected and islanded mode, respectively. Harmonic spectrum analysis is carried to justify the selection of diode bridge rectifier over semicontrolled/controlled rectifier. The effectiveness and feasibility of the proposed system is verified by means of MATLAB/Simulink. To demonstrate the operational capability, a laboratory scaled prototype is fabricated and tested under various dynamic scenarios.

Unifiedpowerqualityconditioners (UPQC’s) allocate the lessening of voltage& current-disturbances that might influence receptive electrical-loads while reimbursing the load reactive power. Different control systems have been proposed to assess the immediate yield voltage of the series dynamic power channel of the UPQC be that as it may, as a rule, these controllers just can remunerate a sort of voltage aggravation. This work proposes a PR controller for UPQCs which permits the heap current-harmonics and responsive capacity to be repaid at the framework side while maintaining a strategic-distance from the impact of voltage plunges, over-voltages and voltage-harmonics on the nearby loads. The controller qualities can be set up on-line without changing its fundamental structure. The execution of the proposeddcontroller has been assessed through simulationntests.

Currently lot of patients is rising every day in different parts of our world. A wide range of transformation is happened in healthcare environment. Definitely Body sensor network is vital technology in healthcare environment which is used for studying purpose that functioning on IoT. Lot of Health monitoring system can be existing in environmental then operational damages. This kind of system cannot be guaranteed the patient data for end to end trust. Various existing system performance is poor for energy consumption as well as latency then communication overhead. In this paper, proposed secure scheme for Trust Attribute based Lightweight Authentication (TALA) for IoT Health Care which provides the security from IoT application. The accuracy, the transmission overhead also reduced and limited latency is achieved by the proposed system.

WSN include Internet Protocol (IP) which extends the Internet of Things (IoT) related to routine life. Security is main thing in emerging technology for IOT application. Therefore, WSN has lot of issues which include: (i) To promote the sensor devices efficiently during the transmission of data for consuming low energy (ii) To resolve the security issues of data faced at the time of transmission through large area of networks. In this paper, to overcome the above issues the novel scheme is proposed. A Secure based smart home automation system in IOT application is built for this study. Furthermore, the data transmission utilizes the energy using Low power consumption protocol using RPLS and to secure the data a data security scheme ECPABE have been proposed here. The performance of proposed protocol shows the limited energy consumes and proposed ECPABE provides better security level to IoT data than the existing schemes. The results show the proposed scheme security analysis is efficient as well as secure.

The market for electric vehicles has been growing enormously over the last two years and should continue to expand exponentially. This requires a large domestic and commercial charging network. The EV charging infrastructure that enables electric vehicle adoption relies heavily on partnerships between the private and public sectors, including utilities, government agencies, automakers, and the general public. Electric vehicles are shifting energy paradigms for mobility around the world. Many factors contribute to a consideration of fueling with electricity: When to charge, where to charge, how fast can the vehicle charge, and who will charging affect? As more electric vehicles pull power from the grid, utilities will need to address the increasing demand drivers will place on the grid. Energy storage and source from solar PV systems provides an eloquent solution to power providers and drivers alike.

The conventional system of irrigation how efficient and well managed it may be wastes up to 50% of the water supplied. Purpose of this paper is to provide a user-oriented and standalone irrigation solution for soil monitoring and water conservation, based on network of sensor. Using the input from the user the system will act automatically. It not only reduce the water waste but also is cost efficient and easy to operate. Different parameters like soil moisture, temperature and humidity are imported in order to calculate the efficient quantity of water needed. This system uses different sensors like soil moisture sensor, humidity sensor and temperature sensor to take required data. In this paper, the proposed project uses sensor having low power consumption reducing load overall. The system also stores the input and uses it for forecasting. The concept of IoT is implied in this paper. The control of motors are automated powered by solar panels. The data is stored in table format. All data is accessible via internet. This system can help the user to gain vital data about the fields irrespective of the weather condition.

Artificial lighting in buildings is accountable for a remarkable portion of overall energy consumption. It is thus necessary to reduce especially for zero energy buildings (ZEBs). Daylight harvesting holds the immense potential of reducing energy consumption but it can disturb the occupants' optical preferences if harvested in excess. A semi-transparent building integrated photovoltaic (BIPV) module which can generate clean energy at the building site and allows the reduced daylight harvesting through, has been proposed as the envelope of the building facade . Hence, to minimize energy consumption and enhancing occupants' visual preferences, a smart lighting system with daylight harvesting through BIPV for an office building is proposed in this paper. The advantages associated with a low-voltage DC (LVDC) distribution system for the proposed system in ZEB is highlighted. Moreover, the opportunity of energy-saving across the proposed artificial lighting system with BIPV as the envelope of the building is investigated with occupants’ visual preference levels in different sky conditions. Results show that the proposed lighting system can be fully energized by the energy generated from the BIPV module. Moreover, a significant amount of surplus energy was also reported. Further, the economic and environmental footprint analysis of the BIPV as a building envelope is presented. The result indicates a competent levelized cost of energy (LCOE) when comparing with the existing utility grid.

GST also known as the Goods and Services Tax is defined as the giant indirecttax structure designed to support and enhances the economic growth of a country. More than150 countries have implemented Goods and Service Tax so far. Even in the worldwideeconomic crisis India showed remarkable survival in its economic system. The proposedGoods and Services Tax is expected to be another milestone in the Indian economic growth.The radical aim of Goods and Service Tax is to uniform the separated indirect tax system inIndia and to avoid the cascading effect in taxation. The impact going to make by Goods andService Tax will be a transformation in the entire tax system and will go beyond Indianborders. The implementation of Goods and Service Tax will reduce tax burden onmanufacturers and thus encourages for the higher production. This process will increase theexport of India and it will increase the total Gross National Product. Avoidance of cascadingeffect empowers the manufacturers to produce to their optimum capacity and retards growthin the Indian Economy

BACKGROUND In India, pancreatitis seems to be more common among alcoholics. Being a developing nation, most of the affected families live in poverty. So, the hospital expenses in treatment of pancreatitis are a burden to them. Many investigations are required for calculating the severity scoring systems will increase the patient's cost. In order to predict the severity of the disease earlier, a simple scoring system is evaluated using routine blood count which will enable us to provide aggressive treatment for those progressing to severe pancreatitis and lower the morbidity and mortality. MATERIALS AND METHODS A prospective collection of data among 100 sequential patients admitted with a diagnosis of pancreatitis based on Atlanta criteria are enrolled and data collected for severity, amylase, lipase, CECT, serum creatinine, and neutrophil lymphocyte ratio, at the time of admission, 24 hours, 48 hours and analyzed using independent variable t test. RESULTS Out of 100 patients 96% were males, alcohol was the leading cause 98%, severe pancreatitis was noted in 20% mortality was 4%, NLR was progressively increasing from 12 to 15 in severe group compared to 4 to 6 in mild group the difference was significant (p value – 0.004). CONCLUSION The overall mortality due to acute pancreatitis has remained 10-15% in the past 20 years. Accurate predictors of the severity of acute pancreatitis are important because they influence clinical decision making. Neutrophilic Lymphocytic Ratio (NLR) was calculated among these patients and was found to be increased in acute pancreatitis. It was significantly higher in severe pancreatitis patients than the mild pancreatitis patients. It is thus a cost effective tool. NL R is a simple indicator of the prognosis of pancreatitis which would help in providing aggressive treatment to those patients progressing to severe pancreatitis.

Most of the existing P2P content distribution schemes implement a random or rarest piece first dissemination procedure to avoid duplicate transmission of the same pieces of data and rare pieces of data occurring in the network. This problem can be solved using peer-to-peer content distribution based on network coding scheme. Network coding scheme uses random linear combination of coded pieces. Hence the above stated problem can be solved ease and simple. Our proposed mechanism uses network coding mechanism in which several contents of same message is grouped into different group and coding operation is performed only within the same group. The interested peers are also divided into several groups with each group have the responsibility to spread one set of contents of some message. The coding system is designed to assure the property that any subset of the messages can be utilized to decode the original content as long as the size of the subset is suitably large. To meet this condition, dynamic smart network coding scheme is defined which assures the preferred property, then peers are connected in the same group to send the corresponding message, and connect peers in different groups to disseminate messages for carrying out decoding operation. Moreover, the proposed system can be readily expanded to support topology change to get better system performance further in terms of reliability, link stress and throughput. The simulation results prove that the proposed system can attain 20 to 25% higher throughput than existing systems, it also further attains good reliability, link failure and robustness to peer churn., Comment: this article consists of 14 pages

Wind energy conversion system (WECS) based DC nanogrid topology is proposed in this paper. The WECS topology is based on self-excited induction generator (SEIG) which is cost effective, and has rugged construction and combination of diode bridge rectifier (DBR) with DC-DC converter to implement the maximum power point tracking technique. The combination of diode DBR with DC-DC converter allows simple control structure due to one controllable switch as compared to complex control in the conventional controlled/semi-controlled rectifier with six controllable switches. Further, proposed DC nanogrid topology enhances the SEIG efficiency due to the reduction of harmonic injection on machine side from DBR implementation. The detailed harmonic spectrum analysis is carried out by developing the laboratory scale prototype of DBR based SEIG topology for WECS to justify the selection of DBR instead of the controlled rectifier. Further, to analyze the effect of different types DC-DC converter to make combination with the DBR. Afterwards, the dynamic performance of the proposed DC nanogrid topology is analyzed to understand the selection of the DC-DC converter with DBR for different DC grid voltage conditions.

Background Depression is twice more prevalent among women but remains unidentified in primary care. Objective We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18–60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women. Results The internal consistency reliability (Cronbach’s alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86–0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88–0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4–92.6), specificity of 90.1% (95% CI, 84.5–95.6%), positive predictive value of 73.4% (95% CI, 62.4–84.4%) and negative predictive value of 93.9% (95% CI, 90.2–97.6%). The accuracy was 88.2% (84.0–92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73–0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%. Conclusion When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.

Background In low and middle income countries where mental health resources are limited, community based depression intervention models, which can be implemented through the existing health system, are extremely relevant. Objective To test the effectiveness of Community based Depression Intervention Programme (ComDIP), newly developed by us, to reduce severity of depression in women, compared to the treatment as usual (TAU). Methods An RCT (Trial registration Number: CTRI/2011/08/001978, Clinical Trials Registry -India) was conducted in a primary care setting in Trivandrum, Kerala, South India. Health workers screened 422 women, aged 18–60 years, using PHQ-9. Sixty women with HAM-D (Hamilton Depression Rating scale) score above 19 were randomized to receive either ComDIP or TAU. Primary care physicians and health workers together implemented ComDIP which had psycho-social intervention and drug treatment. Those in TAU arm were referred to available mental health services. Primary outcome was measured at 8 weeks, by HAM-D. Results At baseline and 8 weeks, mean (SD) HAM-D scores were 29.2 (5.8) and 12.2 (9.3) respectively among women in ComDIP; and 28.6 (5.1) and 21.7 (12.4) respectively among those in TAU (p = 0.02, effect size = 0.82). Conclusions ComDIP, implemented through existing health system is an effective public health programme to manage women with depression in primary care.

Anticancer approaches may employ change of molecular structure to enhance preventive influence of chemical agents. The present examination concerned the potential anticancer impact of modified heterocyclic compounds. A strategy was developed to combine tetrazole moieties from different diamines with 2-aminobenzoic and substituted benzoyl chloride compounds with attention to synthesis, characterization and assessment of cancer preventive activity, applying IR, 1HNMR, 13CNMR and Mass spectra.

A simple control strategy has been proposed for maximum power point tracking (MPPT) mode and constant output power mode operation of variable speed wind turbine system employing wound rotor induction generators (WRIGs). The control strategy proposed in this paper has been implemented using TMS320LF2407A real time digital signal processor (DSP) and detailed procedure for such implementation is given. The salient feature of the proposed controller is that it employs only a single switch, which is an IGBT chopper and does not require any mechanical sensors or machine parameters. This makes the overall controller simple, flexible and robust. Further, space heating and battery loads are connected at rotor side of the machine through a diode bridge rectifier and the IGBT chopper. A method has been developed for the analysis of such grid connected WRIGs with variable external resistance at the chopper circuit. The successful working of the proposed controller has been amply demonstrated through extensive simulation and experimental results on the WRIG system for MPPT and constant output power operation.

A 19-year-old castrated male Arab/Quarter horse presented with an extensive history of cutaneous metastatic melanoma. Over a period of 8 months, a total of 8 doses of plasmid DNA vaccine expressing the Streptococcus pyogenes emm55 gene (pAc/emm55) were administered intratumorally at 300 μg/dose via a needless injector. Upon completion of the vaccination protocol, the size of the injected lesions, on average, were reduced by 40.3% from the initial size measurements. Lesions that were not injected were reduced by 47.6%. The overall reduction in total tumor burden was 42.3%. Tumor regression was also associated with the augmentation of antimelanoma IgG antibody response, thus implying that an induction of an effective antimelanoma response would be of great advantage in the management of equine melanoma.

The primary objective of this study was to find the performance of the 2009 probable case definition of dengue and compare it with the definition given by the WHO-SEAR expert group in 2011.A cross-sectional study was conducted in Thiruvananthapuram district of Kerala, which is hyperendemic for dengue. A consecutive series of 851 participants defined by the selection criteria were recruited from the primary, secondary, and tertiary health care settings. Sensitivity, specificity, predictive values, and likelihood ratios of the clinical case definitions were calculated using reverse transcriptase-polymerized chain reaction (RT-PCR) as gold standard in case of fever less than or equal to 5 days and serology (IgM positivity) for fever5 days. Diagnostic odds ratio (DOR) was also calculated as a single indicator of performance of the case definition.The 2009 World Health Organization (WHO) case definition had a sensitivity of 76·4% (69·6-82·1) and negative predictive value of 87·5%. The 2011 WHO-SEAR expert group case definition had a higher sensitivity of 87·9% (82·2-91·9) but lower negative predictive value of 86·6%. The three independent criteria which were significantly associated with dengue were thrombocytopenia less than 150,000 (OR 2·80), leukopenia (OR 2·28), and absence of backache (OR 2·68). The performance of 2009 case definition was better (DOR 2·4) than the 2011 WHO-SEAR expert group case definition. This was further enhanced when thrombocytopenia was specified as platelet count less than 150,000 (DOR2·7). When 'no backahe' was added as an additional criteria, the performance of both definitions improved.The 2009 WHO case definition has better discriminatory power than the 2011 WHO-SEAR expert group case definition. The performance of 2009 WHO case definition is enhanced by specifying thrombocytopenia as platelet count less than 150,000. The inclusion of 'no backache' further improves the discriminatory power. This may be more useful in primary care settings, to rule out dengue.

In this paper, two different converter topologies for a basic new switched capacitor diode converter with a reduced number of power electronics components, suitable for grid connected photovoltaic applications were proposed. The two different structures of switched diode multilevel converter proposed were: (i) cascaded switched diode and (ii) cascaded switched diode with doubling circuit. The switched-diode multilevel converter was compared with other recent converters. In addition, a new dc offset nearest level modulation technique was proposed. This proposed dc offset technique offers low voltage total harmonic distortion (THD) and high RMS output voltage. The proposed modulation technique was compared with conventional nearest level modulation (NLM) and modified NLM control techniques. The performance of the proposed dc offset modulation technique was implemented using a FPGA Spartan 3E controller and tested with a novel switched capacitor-diode multilevel converter. However, to prove the authenticity of the switched-diode multilevel converter and modulation technique, a laboratory-based prototype model for 7-level and 13-level converters was developed.

Objective Diabetes mellitus and depression are major public health problems and are significantly linked with each other. This research study intends to assess for undiagnosed depression and its predictors among adult diabetic patients. Methods A cross-sectional study was done among 100 patients with type 2 diabetes mellitus attending the diabetic clinic of a tertiary care hospital. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9). Chi-square test was performed and odds ratios (OR) with 95% confidence interval (95% CI) were obtained. Mann Whitney U and Pearson correlation tests were done. Logistic regression was carried out to determine the predictors of depression and adjusted odds ratios with 95% confidence intervals were obtained. Results The prevalence of depression was 49% (95% CI 39.1–58.9%). The predictors of depression were female gender, elevated fasting blood sugar (FBS) level, physical disability and lack of physician's advice about lifestyle modifications. FBS values were significantly higher in depressed individuals as compared to the non-depressed (p value 0.002). A positive correlation (r = 0.38, p value 0.01) was obtained between PHQ-9 scores and the FBS values of the diabetic subjects. Conclusions Subjects with diabetes are highly prone for comorbid depression. Physicians should be sensitive towards the need for assessing for possible depression and its risk factors in diabetic patients.

Acute Renal Failure is an intractable problem, which can be actively and effectively managed, but can be prevented only to a little extent. Acute renal failure requiring dialysis is associated with high mortality and morbidity. In a study conducted by analyzing the literature and taking 15897 acute renal failure patients, it was found that mortality rates in most studies exceeded 30% [1]. Despite technical advancements in the management of acute renal failure over the last 50 years, mortality rates seem to have remained unchanged at around 50% [1]. In Kerala, the studies on acute renal shut down are sparse. Also the clinicodemographic profile of patients with acute renal failure varies in different parts of the world. Our objective was to study the clinicodemographic profile of acute renal failure patients who underwent renal replacement therapy and to identify the determinants of outcome at discharge or death. The present study is a retrospective cohort of 107 patients who required renal replacement therapy in Medical College, Thiruvananthapuram. The relevant data were collected from the case records of patients by a data collection sheet. Outcome was taken as survived or expired at the time of discharge or death. Continuous variables were represented as means and standard deviations. The statistical significance assessed by Odds ratio and Chi-square test. The present study had a mortality of 32.7% with women more prone. The average age of the subjects was 43.16±16.45 years. Univariate analysis of the variables with the outcome like women gender (p=0.490), pre-morbidities (p=0.079), only one comorbidity in a patient (p=0.769), oliguria on the day of Ist dialysis (p=0.549), oliguria on the next day of the Ist dialysis (p=0.363) and Liano’s score 0.3 & above on the day of Ist dialysis (p=0.065) were associated with increased mortality. Ages 45 years & above (p=0.006), sepsis syndrome (p=0.0008), more than one co-morbidity in a patient (p=0.032) and Liano’s score on the day after the Ist dialysis (p=0.024) were associated with obvious increase in mortality, which were statistically significant. Snake envenomation had the best prognosis (p=0.037) and serum creatinine level had weak association with outcome (p=0.065). The study conducted on 107 patients revealed 32.7% mortality. Snake envenomation had the best prognosis and sepsis syndrome the worst. Age 45 years & above and women gender were bad prognostic indicators. Pre-morbidities, co-morbidities and oliguria were probable bad indicators. Liano’s score 0.3 and above was a good predictor of mortality. Unfortunately, serum creatinine level had only weak association with the outcome.

OBJECTIVE—Antilymphocyte serum can reverse overt type 1 diabetes in NOD mice; yet, the therapeutic parameters and immunological mechanisms underlying the ability for this agent to modulate autoimmune responses against β-cells are unclear, forming the rationale for this investigation. RESEARCH DESIGN AND METHODS—A form of antilymphocyte serum, rabbit anti-mouse thymocyte globulin (mATG), was utilized in a variety of in vivo and in vitro settings, each for the purpose of defining the physiological, immunological, and metabolic activities of this agent, with particular focus on actions influencing development of type 1 diabetes. RESULTS—We observed that mATG attenuates type 1 diabetes development in an age-dependent fashion, only proving efficacious at disease onset or in the late pre-diabetic phase (12 weeks of age). When provided at 12 weeks of age, mATG reversed pancreatic insulitis, improved metabolic responses to glucose challenge, and rapidly increased frequency of antigen-presenting cells in spleen and pancreatic lymph nodes. Surprisingly, mATG therapy dramatically increased, in an age-dependent fashion, the frequency and the functional activity of CD4+CD25+ regulatory T-cells. Adoptive transfer/cotransfer studies of type 1 diabetes also support the concept that mATG treatment induces a stable and transferable immunomodulatory repertoire in vivo. CONCLUSIONS—These findings indicate that an induction of immunoregulation, rather than simple lymphocyte depletion, contributes to the therapeutic efficacy of antithymocyte globulin and suggest that time-dependent windows for the ability to delay or reverse type 1 diabetes exist based on the capacity to enhance the functional activity of regulatory T-cells.

This paper presents the enhancement of power quality for a microgrid system at distribution level using Shunt active power filter. The main objective of this paper is to identify a suitable pulse generation technique for obtaining a better compensation capability of shunt active power filter. The compensation capability of the device is mainly depends on the regulation of DC link capacitor voltage. Conventionally fixed hysteresis current control technique has been used. To raise the performance of shunt active power filter, an adaptive hysteresis current control technique has been proposed here. The performance of proposed technique has been verified for different operating condition in the platform of MATLAB/SIMULINK model.

Type 1 diabetes is one of the more costly chronic diseases of children and adolescents throughout North America and Europe, exhibiting an average estimated prevalence rate of nearly 0.2%. It occurs in genetically predisposed individuals when the immune system attacks and destroys specifically the insulin-producing beta cells of the pancreatic islets of Langerhans. While routine insulin therapy can provide diabetic patients with their daily insulin requirements, non-compliance and undetected hyperglycemic excursions often lead to subsequent long-term microvascular and macrovascular complications. The only real cure for type 1 diabetes is replacement of the beta cell mass, currently being accomplished through ecto-pancreatic transplantation and islet implantation. Both of these procedures suffer from a chronic shortage of available donor tissue in comparison to the number of potential recipients. To circumvent this need, three alternative approaches are being intensively investigated: (1) the production of surrogate cells by genetically modifying non-endocrine cells to secrete insulin in response to glucose challenge; (2) the trans-differentiation of non-endocrine stem/progenitor cells or mature cells to glucose-responsive adult tissue; and (3) the regulated differentiation of islet stem/progenitor cells to produce large numbers of mature, functional islets. In recent years, each of these approaches has made impressive advances, leading to the most important question, 'how soon will this new science be available to the patient?' In the present review, we discuss some of the recent advances, focusing primarily on the differentiation of islet stem cells to functional endocrine pancreas that may form the basis for future treatment.

Type 1 diabetes (T1D) is an autoimmune disease characterized by hyperglycemia following the destruction of the insulin-producing beta cells of the pancreatic islets of Langerhans by the body's own immune system. Although routine insulin injections can provide diabetic patients with their daily insulin requirements, this treatment is not always effective in maintaining normal glucose levels. A true "cure" is considered possible only through replacement of the beta cell mass, by pancreas transplantation, islet implantation, or implantation of nonendocrine cells modified to secrete insulin. With the recent success of islet implantation to reverse T1D, this procedure has become a welcome therapy for T1D patients. Unfortunately, this procedure is hampered by the limited number of transplantation quality pancreata available for the harvesting of islets. This shortage has sparked great interest in finding a replacement for organ donation, primarily the possible use of stem cell-derived islets starting with stem cells, or alternatively the harvesting of nonhuman islets. This review focuses on progress with growing islets in the laboratory from stem cells and a comparison between this developing technology and the current use of islets harvested from nonhuman sources.

Cancer immunotherapies are emerging as promising treatment modalities in the management of the disease. As a result, cancer vaccines are considered to be immensely crucial in preventing recurrence, a well-known nemesis in cancer patients because they have the potential to activate memory antitumor immunity. Due to poor antigenicity and self-tolerance, most tumor antigens require interventional vaccine therapies to provide an adequate "danger" signal to the immune system in order to activate a robust, clinically meaningful antitumor immunity. It has been postulated that this requirement may be achieved by providing bacterial and/or viral immunogens to prime this type of immune response. Briefly, we provide here a method of transfecting whole tumor cells with plasmid DNA encoding an immunogenic bacterial protein such as Emm55, which was derived from Streptococcus pyogenes (S. pyogenes). Subsequent inactivation of the transfected cells by irradiation (100 Gray) prevents replication. This type of whole-cell vaccine, e.g., ImmuneFx™, has demonstrated activity in a murine neuroblastoma model, in canine lymphoma patients with naturally occurring disease, and in many cancer types in companion animals. The protocols described in this chapter provide the necessary materials and methodologies to manufacture such a vaccine.

Cancer immunotherapies are emerging as promising treatment modalities in the management of the disease. As a result, cancer vaccines are considered to be immensely crucial in preventing recurrence, a well-known nemesis in cancer patients because they have the potential to activate memory antitumor immunity. Due to poor antigenicity and self-tolerance, most tumor antigens require interventional vaccine therapies to provide an adequate "danger" signal to the immune system in order to activate a robust, clinically meaningful antitumor immunity. It has been postulated that this requirement may be achieved by providing bacterial and/or viral immunogens to prime this type of immune response. Briefly, we provide here a method of transfecting whole tumor cells with plasmid DNA encoding an immunogenic bacterial protein such as Emm55, which was derived from Streptococcus pyogenes (S. pyogenes). Subsequent inactivation of the transfected cells by irradiation (100 Gray) prevents replication. This type of whole-cell vaccine, e.g., ImmuneFx™, has demonstrated activity in a murine neuroblastoma model, in canine lymphoma patients with naturally occurring disease, and in many cancer types in companion animals. The protocols described in this chapter provide the necessary materials and methodologies to manufacture such a vaccine.

Chaudhari M, Cornelius JG, Schatz D, Peck AB, Ramiya VK. Pancreatic stem cells: a therapeutic agent that may offer the best approach for curing type 1 diabetes. Abstract: Type 1 (insulin-dependent) diabetes is one of the most costly chronic diseases of children and adolescents in North America and Europe. It occurs in genetically predisposed individuals when the immune system attacks and destroys specifically the insulin-producing beta cells of the pancreatic islets of Langerhans. Although routine insulin injections can provide diabetic patients their daily insulin requirements, non-compliance commonly results in blood glucose excursions that eventually lead to microvascular and macrovascular complications and early death. The only real ‘cure’ for type 1 diabetes is replacement of the beta-cell mass which, today, is either an ectopancreatic transplant or an islet of Langerhans implant. Two new developments may offer additional options: surrogate, non-endocrine cells genetically modified to secrete insulin in response to high blood glucose levels; and stem cells that possess the capacity to differentiate to endocrine pancreas. In this short review, we discuss the efforts currently being made to regulate pancreatic stem cell growth in order to produce large numbers of functional islets that can be used as implants. Hopefully, autologous stem cell-derived islet cell implants without lifelong immunosuppressive therapy may one day be realized.

Ductal structures of the adult pancreas contain stem cells that differentiate into islets of Langerhans. Here, we grew pancreatic ductal epithelial cells isolated from prediabetic adult non-obese diabetic mice in long-term cultures, where they were induced to produce functioning islets containing alpha, beta and delta cells. These in vitro-generated islets showed temporal changes in mRNA transcripts for islet cell-associated differentiation markers, responded in vitro to glucose challenge, and reversed insulin-dependent diabetes after being implanted into diabetic non-obese diabetic mice. The ability to control growth and differentiation of islet stem cells provides an abundant islet source for beta-cell reconstitution in type I diabetes.

Although expressed at very low levels in islets of NOD mice, GAD65 is a candidate islet autoantigen. Two transgenic lines of NOD/Lt mice expressing high levels of human GAD65 from a rat insulin promoter were generated. Transgenes were integrated on proximal chromosome 15 of the A line and on the Y chromosome of the Y line. Transgenic A-line mice were obligate hemizygotes, since homozygous expression resulted in developmental lethality. A twofold higher level of hGAD65 transcripts in A-line islets from young donors was associated with higher GAD protein and enzyme activity levels. Y-line males developed diabetes at a similar rate and incidence as standard NOD/Lt males. In contrast, A-line mice of both sexes exhibited a markedly lowered incidence of diabetes. Insulitis, present in both transgenic lines, developed more slowly in A-line mice and correlated with a reduction in the ratio of gamma-interferon to interleukin-10 transcripts. Splenic leukocytes from young A-line donors transferred diabetes into NOD-scid recipients at a retarded rate compared with those from nontransgenic donors. Further, nontransgenic NOD T-cells transferred diabetes more slowly in NOD-scid recipients that were congenic for A-line transgenes as compared with standard NOD-scid recipients. Primed T-cell responses and spontaneous humoral reactivity to GAD65 failed to distinguish transgenic from nontransgenic mice. Quantitative differences in expression level or insertional mutagenesis are possible mechanisms of protection in the A line.

Insulin-dependent diabetes (IDD), being an autoimmune disease, offers several opportunities for immunological interventions that may result either in the reduction of disease severity or in delaying diabetes onset. Among the various experimental preventative approaches, parenteral immunization with islet-specific autoantigens appears to be practically simpler and promising. We have previously shown that immunization with insulin, insulin B chain and B chain epitope (p9–23), but not insulin A chain, in incomplete Freund's adjuvant (IFA) and in alum (with B chain) delayed/prevented diabetes onset in NOD mice. Here we demonstrate the protective efficacy of affinity purified GAD 65 in IFA. While both insulin B chain and GAD 65 significantly delayed the onset of diabetes (P=0.001), a recently described tyrosine phosphatase (IA–2) antigen did not (P=0.38). Interestingly, B chain immunization reduced the incidence of cyclophosphamide (CY)-accelerated diabetes by about 50–55%. We also provide further evidence that B chain, upon increased adsorption to alum, could improve on its protective capacity in NOD mice.