Search

Aim: To evaluate the dentist’s knowledge, attitudes, and barriers towards silver diamine fluoride (SDF) in Tricity (Panchkula, Chandigarh, Mohali), India. Materials and Methods: A cross-sectional study was conducted using a selfadministered online questionnaire among 422 dental practitioners in Tricity (Panchkula, Chandigarh, Mohali), India from 25th August 2021 to 10th September 2021. The outcome variable of the study were knowledge, attitude, and barriers toward Silver Diamine Fluoride. A pretested questionnaire on a 5-point Likert scale was used. Results: A total of 55% of respondents strongly agreed and agreed that SDF is a good treatment option for primary teeth that are not in the esthetic zone. The barrier to its usage is being not readily available commercially, with the highest score of 48%. Conclusion: Increased efforts in SDF education may lead to greater use of this innovative approach to the management of cavitated carious lesions. The most cited barrier to the use of SDF is tooth staining associated with arresting caries.

In this study, we provide an IoT-based approach for observing and managing a hydroponic system. A multitude of sensors is built into the system to assess important factors like temperature, humidity, nutrient levels, pH, and water levels. These sensors are linked to a microcontroller or single-board computer, which gathers and sends the data to a platform that is situated in the cloud for archival and analysis. A web or mobile application allows users to remotely access the data and manage the system. The system also features automated control that modifies humidity, temperature, and nutrient levels according to sensor data and predetermined criteria. The suggested system provides an all-inclusive and effective approach for regulating and monitoring hydroponic systems, and it is easily adaptable to various hydroponic conditions and systems. We show our suggested system's utility and viability through experiments and results.

Study Design Retrospective study. Objective To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. Methods In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. Results It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21–30 years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. Conclusions To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.

Introduction: Effective communication is a keystone of the nurse patient relationship. Communicating with comatose patients is always challenging for healthcare professionals. In order to provide quality nursing care, we need to communicate with patients whether conscious or unconscious. This study was aimed to evaluate the effectiveness of training program on knowledge and practice of nurses working in ICUs regarding Individualized Communication Protocol with comatose patients. Methods: A quantitative pre-experimental research approach was used with one group Pre-Test- Post-Test-only Design. Total enumeration sampling technique was used to select 171 Staff Nurses from the selected ICUs. A structured questionnaire containing knowledge and skill items were used to assess knowledge and practice related to communication. Result revealed that there was significant improvement in knowledge post test score (20.09±3.21) after intervention as compared to pretest scores (13.23±2.96 with p-value of 0.0001. Data also represented significant improvement in practice posttest score (30.96±4.46) as compared to pretest score (6.75±1.57) with p-value of 0.0001. Discussion: Study revealed that teaching programme was effective in improving nurse’s knowledge and practice regarding Individualized Communication Protocol. Results strongly recommend for regular training sessions for health care professionals which help them to improve communication by enabling them to enhance their practice.

Ludwig angina is a potentially lethal acute cellulitis of the floor of the mouth and neck, including submandibular, submental and sublingual spaces and ultimately leading to airway obstruction. Computed tomography (CT) of the neck with upper thorax has been used in emergency once the airway obstruction is secured to evaluate the severity of the infection, to assess any abscess and mediastinal extension. Therefore knowledge of imaging features of Ludwig’s angina is essential to ensure an accurate diagnosis and initiation of early treatment. CT also plays an important role in evaluation for need of surgical intervention. However, MRI is superior to CT because of its excellent soft tissue contrast and demonstration of various fascial compartments' involvement.

Introduction: Surgery may be complex in some bone and soft tissue tumors. Preoperative intra-arterial embolization is a developing method for benign and malignant tumors. The present study was done to assess the outcome on the size of tumor and blood loss by preoperative tumor embolization and pain relief in patients with inoperable tumors. Materials and Methods: Twenty-five patients with biopsy-proven bony tumors of extremities were subjected to embolization. In 12 cases, embolization was done preoperatively to decrease the blood loss. In 13 patients, it was done as a palliative treatment to reduce pain, as patients were inoperable. The embolization was done with the right Judkins catheter. Some cases were done with a microcatheter. The material used for embolization was either polyvinyl alcohol (PVA) particles, microcoils, or gel foam used in various combinations, selectively into the feeding vessel. Results: Mean age of the patients was 44.5 years. Fifteen were male and 10 were female. A total of 60 vessels were embolized, 25 with gel foam, 24 with PVA particles, and 11 with microcoils. In 90% of operated patients, gel foam was used, whereas, in almost 100% of nonoperated patients, PVA particles were used. There was a significant decrease in blood loss in patients with preoperative embolization (865 ± 420 vs. 1633 ± 660 ml). In patients with palliative embolization, the mean pain score before embolization was 6.32–2.58, which was decreased to 3. 2–1.53. Conclusion: Preoperative and palliative transarterial embolization of soft tissue and bony tumors is a safe, effective, and minimally invasive modality for pain relief and de-vascularization of large bony tumors in anatomically difficult locations.

The aim of this study was to evaluate sphenoid sinus pneumatisation and its anatomical relation with adjacent neurovascular structures in Indian population. We performed a retrospective cross-sectional study, in which the pattern of sphenoid sinus pneumatization was studied on high-resolution computed tomography scans (n = 400), and association of the optic nerve, vidian canal and foramen rotundum along with related morphometric measurements were studied. Out of 400 CT scans, 60.5% were males. Majority had sellar type of pneumatization (89.5%) and single intersinus septum (68%). The most common configuration of relation of optic nerve canal was DeLano type 2 (34.75%). Vidian canal (VC) and Foramen rotundum (FR) were found dehiscent in 40.5% and 6.38% respectively. Average distance of FR from midline on right and left side was 16.3 ± 2.19 mm and 16.7 ± 2.23 mm respectively. Average distance of VC from midline on right and left side was 12.4 ± 5.84 mm and 12.4 ± 4.18 mm respectively. Average right FR to VC distance was 4.17 ± 2.16 mm and left FR to VC was 4.44 ± 2.20 mm. Anatomical variations of the sphenoid sinus are well known. In the present study, we have tried to highlight the importance of knowledge of various anatomical variations in relations to sphenoid sinus as they are critical in planning of surgery. Pre-operative radiological study and correlation is inevitable to assess type and extent of sinus pneumatisation, bony dehiscence and septal terminations to avoid injury to vital structures.

Acharya Sushruta described various surgeries meticulously. During the ancient time, Acharya Sushruta per-formed various major and minor surgeries with surprisingly great accuracy and thus was able to treat dread-ful diseases. The proper knowledge of Sharira was essential to meet this high standard of accuracy. Especial-ly, during performing any surgery or Sira Vedhan one must be aware of the vital points, Marma and the Avedhya Sira present in the body. This is because even a slight trauma to these may lead to severe compli-cations such as severe pain, any deformity or even death of a person. There are 107 Marmas and 98 Avedhya Siras mentioned by Acharya Sushruta. Most of the name of Avedhya Sira are same as nomencla-ture of Marma. For example, Brihati is a name of Avedhya Sira and is also a Marma. Here an effort has been made to study the role of Marma Sthan in confirmations of Avedhya Sira with special reference to Urvi (Bahavi) Sira in upper extremity. Keywords: Avedhya Sira, Marma, Urvi Sira

Shredded dust originated during mechanical dismantling of waste electrical and electronic equipments (WEEEs) is enriched source of some valuable metals which might be lost as unworthy waste. Composition analysis of shredded dust printed circuit boards (PCBs) revealed the presence of 12.75 mg g(−1) copper (Cu) and 10.34 mg g(−1) silver (Ag) along with some other metals (Fe, Ni, and Au). Low concentration of precious metal, such as gold (Au i.e., 0.04 mg g(−1)) classified this shredded dust as low-grade scrap. Despite low concentration of Au this e-waste can be considered as potential “secondary ore” to recover other valuable metals like Ag. To improve the efficiency of Ag bioleaching using Pseudomonas balearica SAE1, pretreatment of e-waste was done using cost-effective ferric chloride (FeCl(3)) chemical lixiviant. The concentration of FeCl(3) lixiviant was optimized to recover Cu metal prior to bioleaching process. Bioleaching of Ag was done under optimized conditions by Pseudomonas balearica SAE1 using 100 mL Luria Broth (LB) medium, 5 g L(−1) glycine, pH 9, temperature 30 °C and 150 rpm. 95% Cu was recovered with 1% FeCl(3) prior to bioleaching. Ag solubilization was increased for treated e-waste (36%) as compared to untreated e-waste PCBs (25%). Prerecovery of Cu enhanced Ag bioleaching, as available cyanide was utilized by Ag metal. Therefore, this study provides an economical hybrid method to enhance retrieval of precious metal (Ag) by Pseudomonas balearica SAE1 with economic and ecofriendly redox lixiviant even from low-grade e-scrap. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-021-02977-4.

Susac Syndrome (SS) is a rare unique autoimmune underdiagnosed disorder characterized by the clinical triad of central nervous system (CNS) dysfunction, sensorineural hearing impairment, and branch retinal artery occlusion (BRAO). Objectives The purpose of reporting the case is to succinctly highlight this enigmatic condition with focus on otological and audiological aspect of SS and also to augment awareness of this disease among otolaryngologists neurologists, psychiatrists and ophthalmologists. Additionally we reviewed the otological menifestations and audiological findings related to SS. Methods A case of 38 year old female is presented with bilateral SNHL as the initial symptom of SS. The review of otological and audiological findings of previous 10 year case reports was executed using the PRISMA protocol on 20 cases. Results It was seen that inspite of the ear being one of the main organs involved in the SS very few had undergone detailed audiological assessment. Our review of literature showed that only 40% cases had done audiological assessment other than PTA, out of which only 5% had undergone complete audiological workup. 30% of the patients were having auditory symptoms as presenting chief complaint. Conclusion Otolyryngologists should keep SS in differentials when a case of SNHL of unknown etiology is encountered.We emphasize the use newer noninvasive Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnostic tools like Optical coherence tomography (OCT), MRI and detailed audiological tests for timely diagnosis of SS. Further multidisciplinary assessment protocols should be used to prevent the development of severe sequelae.

To evaluate the impact of change in p-value threshold from 0.05 to 0.005, on published Randomized Controlled Trials (RCTs) over the last ten years in the field of chronic rhinosinusitis.A search of the PubMed database from 1st January 2011 to 31st December 2020 was conducted to include all RCTs that used p-value to determine the effects of an intervention. Data extracted included p-values, type of intervention, publishing journal with indexing, registration, funding, and multi- or single center status. The proportion of primary endpoints having p 0.005 was determined first, followed by those with p 0.005 but0.05. Logistic regression analysis was used to determine if any trial characteristic was associated with reporting of significant p-values.In total, 168 primary endpoints were identified from 123 RCTs. On analysis, 80 had a p-value0.05, i.e., statistically significant on conventional parameter. Out of these, 53.75% had a p-value0.005, which would retain significance under the proposed threshold, and the remaining 46.25% to be reclassified as "suggestive". None of the trial characteristics were contributing to reporting of conventional or proposed p-values on logistic regression analysis.Lowering the p-value threshold would render 46.25% of a decade of published RCTs results (in the field of CRS) to be reclassified as merely "suggestive" and not significant. Trial characteristics were not found contributing to reporting of p-value0.005 or even0.05.II.

In the present study, the momentum and heat transfer aspects from an isothermally rotating cylinder immersed in a power-law fluid, confined symmetrically and asymmetrically between two parallel walls are considered. The governing equations are solved numerically for the rotational Reynolds number ( 10 − 3 ≤ R e ≤ 40 ) , Prandtl number ( 1 ≤ P r ≤ 100 ) , power-law index ( 0.02 ≤ n ≤ 1 ) , blockage ratio ( 10 − 3 ≤ β ≤ 0.9999 ) and asymmetry ratio ( 10 − 4 ≤ γ ≤ 1 ) to elucidate the role of these parameters on the momentum and heat transfer characteristics. The results reported herein pertain to the two dimensional, steady, incompressible power-law fluid in the laminar flow region. The numerical strategy and method used here are validated by comparing the present results with some of the available experimental and numerical studies, showing good agreements. As far as can be ascertained, it is the first systematic numerical study of a rotating cylinder immersed in power-law fluids elucidating the complex interplay between the rheological and kinematic parameters. The flow field is visualized by plotting the streamlines and, hydrodynamic forces and torque acting on the rotating cylinder are computed. The numerical results are supplemented by a lubrication approximation analysis relevant to highly confined cases, i.e., large values of β. In this case, when confinement increases, the asymptotic scaling of the torque is given by e − 1 / 2 where e denotes the non-dimensional gap between the cylinder surface and the nearest wall. The heat transfer characteristics are presented in terms of the isotherm contours, and the local and average Nusselt numbers as functions of the aforementioned governing parameters. The rate of heat transfer exhibits a positive dependence on the Reynolds number, Prandtl number, confinement and the degree of asymmetry while the shear-thinning behavior decreases the rate of heat transfer above the corresponding value in Newtonian fluids. Finally, the present results are consolidated by fitting them in the form of a predictive correlation for the average Nusselt number for different blockage ratios studied herein.

Titanium -dioxide (TiO2) has garnered immense interest as a potential photon absorber after the discovery of its photocatalytic properties. However, its absorption is limited to the ultraviolet region of the solar spectrum. Despite numerous efforts being made, the challenge to extend its absorption capability to the entire visible and near infrared region (vis-NIR) still exists, which together constitute about 90 % of the solar spectrum. In this dissertation, a multiphase nano TiOx network, rich in defects and oxygen vacancies, has been presented which can absorb photons over a broader range of the solar spectrum. Experimental studies were initially conducted to phase functionalise titanium towards enhanced photon absorption via a single step, ultrashort laser pulse material interaction process. This phase functionalised titanium, characterised to be uniquely composed of multiple oxide phases of titanium, can effectively absorb photons in the vis-NIR region. Using the above study as a template, a complex three-dimensional self-assembled nano network composed of similar multiphase titanium oxides, was then synthesised. Free of any external dopants, it exhibits a remarkable absorption of photons ranging from 300-1000 nm. To further improve the absorptive properties of this ‘multiphase nano TiOx network’, particularly in the lower visible range, the phenomenon of Surface Plasmon Resonance was utilised via its hybridisation with gold and gold/palladium alloy. This successfully resulted in further optimisation of its absorption. The final study of the multiphase nano TiOx was done to understand the fundamental physics behind its broadened photon absorptive behaviour. The condition of synthesis was varied by introducing various contrasting plasma environments. Pronounced disorders and oxygen defects of varying degrees within the crystalline structure were observed. The enhanced and broadened absorption spectrum achieved was attributed to such defects and disorders. The research done in this thesis demonstrates a unique nanomaterial based on multiple oxides phases of titanium that is capable of absorbing photons both in the visible and NIR regions. The contribution made towards the synthesis, investigation and subsequent manipulation of the self-assembled multiphase nano TiOx network can thus be exploited in various photon harvesting applications like photovoltaics and photo catalysis, where such a broadband photon absorption is desirable.

Hydrocarbon-Selective catalytic reduction (HC-SCR) is one of the potential methods to remove NOx emissions from diesel engine, lean burn petrol engines and natural gas engines exhaust. Ag/Al2O3 is a good catalyst for HC-SCR of NOx under lean-burn conditions. Further, addition of small amount of H2 is effective for enhancing HC-SCR activity. This effect is unique to silver and to specific Ag/support combinations, namely, Ag/γ-Al2O3. Various HC reductants, such as: octane, decane, dodecane and propane, have been reported in the literatures. Only a single study on LPG as a reductant over Cu-ZSM catalyst was reported. There was no work reported on H2 assisted LPG over Ag/Al2O3 catalyst. Thus, this gap in the literature is filled with the present investigation of NO reduction over 2 wt.% Ag/Al2O3 catalyst using LPG reductant. The fresh and used catalyst was characterized by various techniques like low temperature N2-adsorption, XRD, XPS and SEM. There was practically no change in the characteristics of the fresh and used catalyst. Two different reductants of CO and LPG were compared for SCR of NO over the catalyst without and with H2-assisted. The experiments were performed in a fixed bed tubular flow reactor under the following conditions: 100mg catalyst; 0.13% NO, 2.5% LPG/CO, 1% H2, 10% O2, rest Ar; total flow rate 60 mL/min; temperature ambient 400 oC and pressure 1 atm. Around 100% conversion of NO was achieved using LPG reductant. Light off temperature of NO reduction significantly reduced by H2assisted LPG reductant. The maximum conversion of NO with CO was limited to 35.15% at temperature of 224 oC and above. Whereas, 97.79 % NO conversion was achieved at 365 oC with LPG reductant. While, the maximum conversions with H2-LPG and H2-CO reductants were 100 and 99.46% at 117 and 220 oC, respectively. Therefore, H2-LPG-SCR of NOx over 2 wt.% Ag/Al2O3 catalyst system can be used to get 100% reduction at low temperature. Copyright © 2018 BCREC Group. All rights reservedCORRECTION:This article has been updated. A correction to this article is available online at: https://doi.org/10.9767/bcrec.15.2.7659.603-603CHANGE HISTORY:An error appeared in Corresponding Author in a paper entitled “Studies on H2-Assisted Liquefied Petroleum Gas Reduction of NO over Ag/Al2O3 Catalyst” published in Bulletin of Chemical Reaction Engineering & Catalysis. The Corresponding Author is corrected to be:* Corresponding Authors. Tel: +919415268192. Email: rprasad.che@itbhu.ac.in (R. Prasad) Tel: +917505072607. Email: dyadav.rs.che13@iitbhu.ac.in (D. Yadav)

Firms in many industries are faced with challenges in effectively managing their sourcing portfolios, defined as a firm’s collection of different sourcing choices (e.g., domestic in-house, domestic outsourcing, offshore outsourcing and captive offshoring) used to conduct a particular value-chain activity. While existing research provides valuable insights on the key factors driving firms’ decision-making regarding individual sourcing choice, important questions remain regarding antecedents and the evolution of portfolios of sourcing choices. We adopt a co-evolutionary perspective to answer the questions of how firms configure their sourcing portfolios, and what triggers changes in these configurations over time. In this study, we examine changes in bio-pharmaceutical firms’ sourcing portfolios for clinical trials. Based on qualitative case study analysis of four firms in this industry, we identify and track changes in internal and external processes of variation, selection and retention. Our study contributes to the co-evolutionary perspective on offshoring and outsourcing by refining the organizational level of analysis to consider portfolios as an important unit of analysis, and also by identifying evolutionary processes and mapping an evolutionary trajectory of changes in sourcing portfolios.

Background: Antenatal assessment of fetal weight is important part in the management decisions during labour, thereby improving perinatal outcome. There are a large number of clinical methods and ultrasonic formulae for predicting fetal birth weight (EBW) with varying degrees of accuracy. This study was an attempt to compare the accuracy of three clinical and three ultrasonic methods in Indian population. The method with highest accuracy can be used in high and low resource setting in a country like ours with diverse resource settings. Methods: This was a prospective non randomized cohort study done on 100 antenatal patients in PGIMER, Dr. RML Hospital; New Delhi from Nov 2011 to Jan 2013 EBW (Expected Birth Weight) was calculated applying the 6 formulae three clinical and three ultrasonic and statistical analysis done after delivery comparing with ABW (Actual Birth Weight). Results: Accuracy in all ABW within 10% of ABW was 94 % with Johnson's method, 92 %with Dares method and 62 % with obstetrical equation. It was 100% with Hadlock 2 equation, 96% with Shepherd's and 86% with Warsoff equation Sensitivity for IUGR i.e. wt

Correction to: Bulletin of Chemical Reaction Engineering & Catalysis (2018), 13 (2): 227-235 (doi:10.9767/bcrec.13.2.1307.227-235)An error appeared in Corresponding Author in a paper entitled “Studies on H2-Assisted Liquefied Petroleum Gas Reduction of NO over Ag/Al2O3 Catalyst” published in Bulletin of Chemical Reaction Engineering & Catalysis. The Corresponding Author is corrected to be:* Corresponding Authors. Tel: +919415268192. Email: rprasad.che@itbhu.ac.in (R. Prasad) Tel: +917505072607. Email: dyadav.rs.che13@iitbhu.ac.in (D. Yadav)——————The original article can be found online at: https://doi.org/10.9767/bcrec.13.2.1307.227-235——————Copyright © 2020 by Authors, Published by BCREC Group. This is an open access article under the CC BY-SA License (https://creativecommons.org/licenses/by-sa/4.0).How to Cite: Singh, P., Yadav, D., Thakur, P., Pandey, J., Prasad, R. (2020). Correction to: Studies on H2-Assisted Liquefied Petroleum Gas Reduction of NO over Ag/Al2O3 Catalyst. Bulletin of Chemical Reaction Engineering & Catalysis, 15 (2): 603-603 (doi:10.9767/bcrec.15.2.7659.603-603)Permalink/DOI: https://doi.org/10.9767/bcrec.15.2.7659.603-603

Prior research has demonstrated the importance of government policy in fostering innovation in sectors that face market failures, such as renewable energy. We examine the impact of policy on renewable energy innovations in emerging economies, which face market as well as institutional failures. We investigate how differences in the focus of policies may drive technology development efforts in different directions. Specifically, we propose that demand pull policies foster innovations in mature technologies by encouraging exploitation of readily available technologies, while supply push policies foster innovations in novel technologies by encouraging exploration and alleviating resource constraints in research and development. Using information on policy initiatives and renewable energy patents, we develop comparative case studies of four emerging economies over the years 2000–2015 in the renewable energy sector – Turkey, India, Brazil, and China. Our case findings illustrate that countries with a focus on pull policies innovate primarily in mature technologies, whereas ones with a focus on push policies have substantial innovations in novel technologies. We present a typology of policy and innovation focus, informed by our conceptual framework and case studies.

In E.N.T clinical practice, patients with nasal obstruction due to deviated nasal septum is a common presentation. Nasal airway obstruction is a common cause of upper airway obstruction further leading to obstructive and hypoxic manifestations. Mean platelet volume (MPV) levels increase in hypoxic conditions. MPV is one of the platelet activation index which reflects the platelet production rate. Present prospective study conducted in the department of Otorhinolaryngology and Head and Neck surgery, Gandhi Medical College and Hamidia Hospital, Bhopal, on 63 patients with the clinical evidence of DNS and 63 healthy age matched subjects as control group, aimed to evaluate the relationship between MPV levels and nasal obstruction due to deviated nasal septum (DNS). The diagnosis of patients with DNS was based on anterior rhinoscopy and endoscopic nasal examination. Blood samples were collected before surgical correction. In present study, the authors found that there is preponderance of DNS in the age group of 25-45 years being the most active age group, males having the higher incidence. Majority of cases of DNS being left sided and of obstructed type. MPV were significantly higher in patients with DNS than the control group. Among the cases MPV being higher in females and in the impacted type of DNS. Present study reemphasized the concept that MPV is increased in chronic nasal obstruction due to DNS and this increase is in accordance with the severity of DNS.

Purpose – The purpose of this paper is to introduce and discuss the concepts of service convergence and service integration, illustrate them in the context of the medical tourism industry, and link them to factors that contributed to the success of a medical tourism firm. Design/methodology/approach – The basis for the conceptual development of service convergence and service integration is an in-depth case study of Bumrungrad International Hospital (BIH) in Thailand. Based on semi-structured interviews and archival data, BIH's business model is analyzed and factors are identified that led to its success in the industry. Findings – BIH's success can be attributed to nine key initiatives that enhanced customer focus, operational efficiency, and service quality. These initiatives supported BIH's twofold business model of product differentiation and globally competitive prices. The firm's activities led to the integration of medical and hospitality services resulting in a new, enhanced product. Competitors adopted BIH's service integration approach, which started the service convergence trend in the medical tourism industry. Research limitations/implications – The conceptual foundations for service convergence and service integration are laid in this paper and can serve as the basis for future research. Practical implications – Insights from BIH's business model can guide firms in medical tourism and related industries on how to innovate and how to successfully implement their service products. Originality/value – This paper introduces the term service convergence and discusses its mechanisms. Furthermore, it identifies success factors of a leading firm in the medical tourism industry and links them to service integration.

The more progress achieved in endoscopy, the more superficial cancers in head and neck region have been diagnosed. There are, however, some areas difficult to observe, particularly the hypopharynx, due to closure of this space. Examination of hypopharynx form an essential part of head and neck examination especially in the suspected malignancies as well as in the cases with unknown primary. As the flexible fiber-optic nasopharyngolaryngoscopy forms an essential part of examination of hypopharynx, the present study aims to evaluate the effectiveness of various manoeuvres devised to aid in better visualization of the hypopharynx. The present prospective study is an observation carried out on 30 patients, which had been followed up for hypopharyngeal or laryngeal disease, in the OPD of the department of Otorhinolaryngology and head and neck surgery in Gandhi Medical College and associated hospital, Bhopal, M.P. In the present study, authors compared the visibility of subsites of hypopharynx in 30 patients undergoing trans nasal flexible fibre optic endoscopy in normal seated position and with head torsion, valsalva manoeuvre and the Killian position. The authors concluded that the above mentioned manoeuvres facilitated the visualization of the entire circumference of the hypopharynx during endoscopic examination, are non invasive and easy to perform and so should be included as a part of routine examination while performing flexible fibre optic endoscopy.

H1B work visas are utilized to contract profoundly talented outside specialists at low wages in America which help firms and impact U.S economy unfavorably. In excess of 100,000 individuals for every year apply tight clamp for higher examinations and also to work and number builds each year. Selections of foreigners are done by lottery system which doesn’t follow any full proofed method and so results cause a loophole between US-based and foreign workers. We endeavor to examine petitions filled from 2015 to 2017 with the goal that a superior prediction model need to develop using machine learning which helps to foresee the aftereffect of the request of ahead of time which shows whether an appeal to is commendable or not. In this work, we use seven classification models Decision tree, C5.0, Random Forest, Naïve Bayes, Neural Network and SVM which predict the status of a petition as certified, denied, withdrawal or certified with-drawls. The predictions of these models are checked on accuracy parameter. It is found that C5.0 outperform with the best accuracy of 94.62 as a single model but proposed model gives better results of 95.4 accuracies which is built by machine ensemble method and this is validated by 10 fold cross-validation.

Inadequate absorption of Near Infrared (NIR) photons by conventional silicon solar cells has been a major stumbling block towards the attainment of a high efficiency “full spectrum” solar cell. An effective enhancement in the absorption of such photons is desired as they account for a considerable portion of the tappable solar energy. In this work, we report a remarkable gain observed in the absorption of photons in the near infrared and visible region (400 nm–1000 nm) by a novel multi-phased oxide of titanium. Synthesised via a single step ultra-fast laser pulse interaction with pure titanium, characterisation studies have identified this oxide of titanium to be multi-phased and composed of Ti3O, (TiO.716)3.76 and TiO2 (rutile). Computed to have an average band gap value of 2.39 eV, this ultrafast laser induced multi-phased titanium oxide has especially exhibited steady absorption capability in the NIR range of 750–1000 nm, which to the best of our knowledge, was never reported before. The unique NIR absorption properties of the laser functionalised titanium coupled with the simplicity and versatility of the ultrafast laser interaction process involved thereby provides tremendous potential towards the photon sensitization of titanium and thereafter for the inception of a “full spectrum” solar device.

Nasal allergy is characterized by an IgE mediated inflammatory response of nasal mucosa to allergens and it has a close association with Asthma. Nasal allergy has been demonstrated to be a strong risk factor for the onset of asthma in adults. Spirometric parameters like Forced expiratory volume at timed interval of 1 s (FEV1) and forced expiratory flow (FEF25-75 %) are impaired in patients with nasal allergy or allergic rhinitis. The FEF25-75 % has been evidenced to be a reliable marker of early bronchial impairment in nasal allergy. Nasal allergy may be considered as the first step of the progression of respiratory allergy towards asthma. It has been demonstrated that FEF25-75 % is useful in predicting the presence of airway hyper responsiveness.It may be a more sensitive indicator of chronic airway obstruction than FEV1 and is considered as a risk factor for the persistence of respiratory symptoms in asthmatic patients. The impact of allergic rhinitis or nasal allergy on asthma (ARIA) guidelines, clearly underlined the role of allergic rhinitis as risk factor for asthma development. The possible presence of spirometric abnormalities in patient with allergic rhinitis has been well documented. So keeping this in mind, present study is undertaken to evaluate the impairment of spirometric parameters, like FEV1, FEF25-75 %, and forced vital capacity, in patients with nasal allergy and to predict the presence of airway hyper responsiveness.

Lipids are the major cell membrane components, essential for various biological functions including cell growth and division for the maintenance of cell integrity of normal and malignant tissues. The changes in lipid profile have been associated since long with cancer and hypocholesterolemia has been observed in patients with cancers of various organs. The objective of the present study is to evaluate the alterations and clinical significance of plasma lipid profiles in untreated head and neck malignancies. The present case–control study comprises of newly diagnosed and histologically confirmed, 100 head and neck malignancy cases diagnosed between 1st July 2013 and 30th June 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery, Gandhi Medical College, Bhopal. Fasting blood samples were collected and the lipid profile studied. In present study, the authors found that there is a preponderance of head and neck malignancy in the age group of 41–60 years, males having the higher incidence. Malignancy involving oral cavity were the commonest and majority were well differentiated. Statistically, there was a highly significant reduction of mean serum total cholesterol (TC), triglycerides and high density lipoproteins (HDL) in the subjects of head and neck malignancy as compared to the control group. TC and HDL were also found significantly lower among those with habit of tobacco consumption.

Aims: The present study was aimed to identify the bacterial isolates causing chronic suppurative otitis media (CSOM) and to study their antimicrobial susceptibility pattern. Subjects and Methods : Totally, 120 patients of CSOM complaining of ear discharge were included in the study. Aural swabs were taken and sent immediately to the microbiology laboratory and processed. Bacterial isolates were identified using standard methods, and antibiotic susceptibility testing was done. Results: In the present study, from 120 cases of tubo-tympanic type of CSOM, majority that is, 82 (63.56%) were Gram-negative; Pseudomonas sp. 48 (37.21%) were the most common bacteria isolated followed by Staphylococcus aureus 32 (24.81%). Among Pseudomonas aeruginosa, the most common isolated bacteria, meropenem has the highest susceptibility rate (97.91%); among S. aureus, vancomycin has the highest susceptibility rate (100%). Conclusions: Pseudomonas sp. and S. aureus were found to be the common cause of CSOM in the present study. These organisms are found to be less susceptible to the routinely used drugs such as quinolones and aminoglycosides and also the resistance pattern of the micro-organisms usually keeps changing. Hence, judicial use of antibiotics is recommended.