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Medical image diagnosis by machine decrease the doctor load and increases the efficiency of treatment as well. Many of diagnosis process depends on chemical data and some are depend on digital images. This work focus on brain tumor medical image diagnosis by segmenting the tumor region in the image. For tumor detection neural network was trained by the model. Selected features extract from the image by fish schooling genetic algorithm for training of neural network It was obtained that fish schooling based genetic feature selection has increases the detection accuracy of trained model. Experiment was done on real dataset and results compared with existing techniques of tumor detection from MRI images.

Single crystals of copper (II) complex of P-Toluene sulfonic acid (PTSC) suitable for photonic applications were grown by slow evaporation technique. Single-crystal X-ray diffraction analysis (SXRD) shows that PTSC crystallizes in monoclinic system with a centrosymmetric space group (P21/c). The presence of red hallows and blue bumps in the shape index of the Hirshfeld surface confirms the NLO activity of the material. Fourier transform infrared spectroscopy vibrational analysis inferred the functional groups present in the synthesized PTSC. The synthesized material has good mechanical properties, and tight atomic packaging with six water molecules reveals its possible utilization in device fabrication applications. The dielectric constant was found to be high due to the inclusion of Cu2+ in the crystal lattice. Linear optical parameters such as bandgap energy, refractive index, extinction coefficient, optical conductivity, electrical conductivity, optical electronegativity, and Urbach energy are calculated from Ultraviolet Visible (UV–Vis) spectral analysis which depicts that the grown PTSC has high optical activity and can be used in the photonic application. The violet and green emission nature of PTSC was examined through Photoluminescence emission studies. The intensity-dependent third-order non-linear optical absorption property of the title material was studied using Z-scan analysis and PTSC exhibits two-photon absorption-induced optical limiting action. The non-linear optical (NLO) behavior of PTSC suggests the possible use in laser-driven applications as it can effectively control the laser to safe level.

Se encontró que la precisión de la estimación del volumen de órganos internos realizada con ultrasonido (EE. UU.) Es multifactorial. Por lo tanto, nuestro objetivo fue describir y validar la evaluación de volumen de la ecografía y las fórmulas estándar de estimación de volumen para órganos intraabdominales de diferentes formas utilizando bazos y riñones. Se escanearon riñones cadavéricos disecados (n = 25) y bazos (n = 29) para obtener medidas lineales y volúmenes autogenerados por ultrasonido (USV). Se utilizaron medidas lineales para calcular los volúmenes manualmente con fórmulas de estimación de volumen elipsoide, prolate y Lambert. Los volúmenes reales (AV) de los órganos se obtuvieron mediante el método de desplazamiento de agua. Se comparó la precisión de la evaluación del volumen de USV y diferentes fórmulas comparando el sesgo, la precisión y el análisis de la gráfica de Bland-Altman. El procedimiento de medición de volumen y lineal de EE. UU. Fue confiable con acuerdos altos entre observadores e intraobservadores (lineal: α de Chronbach = 0,983 a 0,934; volúmenes: α de Chronbach = 0,989). Las estimaciones de USV fueron precisas con una alta correlación con AV y un bajo sesgo de estimación (-5,9%). Además, las fórmulas prolate (sesgo = -0,75%) y elipsoide (sesgo = -3. 75%) fueron confiables con un sesgo insignificante en los volúmenes estimados. Por el contrario, la fórmula de Lambert no fue confiable debido a un alto sesgo (41,6%). Para todos los métodos evaluados, el error de estimación se encontró relacionado con el tamaño del órgano (T = 3.483; p = 0.001), principalmente cuando el órgano evaluado es mayor de 50 ml. Además, se encontró que el error de estimación de forma está relacionado con la fórmula de estimación de volumen usado. la fórmula de Lambert no fue confiable debido a un alto sesgo (41,6%). Para todos los métodos evaluados, el error de estimación se encontró relacionado con el tamaño del órgano (T = 3.483; p = 0.001), principalmente cuando el órgano evaluado es mayor de 50 ml. Además, se encontró que el error de estimación de forma está relacionado con la fórmula de estimación de volumen usado. la fórmula de Lambert no fue confiable debido a un alto sesgo (41,6%). Para todos los métodos evaluados, el error de estimación se encontró relacionado con el tamaño del órgano (T = 3.483; p = 0.001), principalmente cuando el órgano evaluado es mayor de 50 ml. Además, se encontró que el error de estimación de forma está relacionado con la fórmula de estimación de volumen usado.

Neurological manifestations of SARS-CoV-2 are increasingly being recognised and can arise as a result of direct viral invasion, para-infectious or postinfectious immune mechanisms. We report a delayed presentation of COVID-19 postinfectious immune-mediated encephalitis and status epilepticus occurring in a 47-year-old woman 4 weeks after SARS-CoV-2 pulmonary disease. SARS-CoV-2-specific IgG and IgM antibodies were detected in her cerebrospinal fluid with features of encephalitis evident in both magnetic resonance imaging of the brain and electroencephalogram. She made a complete recovery following treatment with high-dose intravenous corticosteroids and intravenous immunoglobulins. Diagnosis of COVID-19 postinfectious encephalitis may prove challenging in patients presenting many weeks following the initial infection. A high index of clinical suspicion and testing intrathecal SARS-CoV-2-specific antibodies are key to its diagnosis. Early immunotherapy is likely to result in a good outcome.

The reality of climate change is harsh and it’s a bitter truth for most of our farmers. In the present situation, climate change is one of the most important challenges to food security. Pertinent actions are, therefore, needed to address these challenges to enable the agricultural sector to significantly contribute to the attainment of agriculture development. Climate adaptive agricultural approach is an approach for developing agricultural strategies to secure sustainable food security under climate change. Through CAA the quality and quantity of agricultural production can be increased and production costs can be decreased. For example, with climatologically data it is also possible to recognize bad weather conditions and to be more prepared to minimize the damage. Many projects have recently adopted with the idea of climate smart agriculture for mitigating the challenges of climate change. With the help of suitable extension approaches we can effectively disseminate various climate smart agricultural practices to farming community.

Background Association between early diagnosis of chronic kidney disease (CKD) and low morbidity and mortality rate has been proven. Thus, tools for early CKD diagnosis are vital. Ultrasonography has been widely used to diagnose and monitor the progression of CKD. Objectives To determine the performance of selected renal ultrasonographic parameters for the diagnosis of early CKD. Methods In a cohort of patients diagnosed with CKD (n = 100), diagnostic performance of ultrasonographically measured renal length (RL), renal cortical thickness (RCT), and parenchymal thickness (PT) was determined using receiver operating curve analysis; correlation of each parameter with the associated comorbidities and serum creatinine (Scr) levels was also determined. Severity of CKD was graded with estimated glomerular filtration rates (eGFR). Results Of all patient participants, 85 had severity grades 2 or 3. Mean (standard deviation) Scr was 1.88 (0.60) mg/dL; eGFR was 43.3 (11.85) mL/min/1.73 m2. RL was 9.01 (0.83) cm, PT was 1.32 (0.22) cm, and RCT was 6.0 (0.10) mm. PT and RCT were positively correlated with eGFR (P = 0.01 and 0.002, respectively). Early CKD was better predicted by PT (area under the curve (AUC) 0.735; 82% sensitivity; 30% specificity; 68% positive predictive value (PPV)) and RCT (AUC 0.741; 82% sensitivity; 48% specificity; 51% PPV); severe CKD was better predicted by RL (AUC 0.809; 67% sensitivity; 26% specificity, 45% PPV; 13% negative predictive value). Conclusion Index ultrasonic parameters show a diagnostic role in different stages of CKD. The index ultrasound and biochemical parameters showed a complementary role in predicting renal dysfunction.

Cave-dwelling organisms share different ecological and evolutionary relationships with caves. Based on these interactions, they are categorized as troglobites, troglophiles, and trogloxenes. In India, caves are meagerly explored, and thus cave study is in its infancy in India. Through the present study, we attempted to understand and model the distribution of crickets (Family Phalangopsidae), a critical group of insects - being the primary consumers in the cave ecosystems. We sampled seven caves using belt transects (N = 184; total area covered = 1294.9 m2) with 1 m width. During the survey, we encountered 818 individual crickets (116.85 ± 47.16 SD per cave). Of these, 87.7% encounters were on walls, 7.09% were on the ceiling, and 5.13% were on the cave floor. We used the Single-species Multi-season occupancy model to calculate the overall, zone-wise, and cave-specific occupancy. Cricket occupancy in Baratang caves is seasonal and highly zonal, with detectability ≤1. The cave with less distinct zones has more consistent occupancies and zero chances of extinction and colonization. Hence, these caves serve as suitable habitat for the source population. A negative correlation of cave morphometric features (cave volume, wall surface area, and floor surface area), and density of crickets (p < 0.05), might need further validation. The study shows the need for detailed studies regarding cricket taxonomy and ecology towards establishing the conservation importance of the species and their habitat in the islands.

Coronavirus is one of the causative agents for multiple human respiratory illnesses. A novel coronavirus, similar to the one that caused severe acute respiratory syndrome (SARS) in 2003, was identified as the cause of the current pandemic of coronavirus disease (COVID-19), which was first reported in late December 2019 in Wuhan, China. Since then, this novel coronavirus has spread across the globe, with most identified COVID-19 cases and fatalities occurring in the United States. In this Perspective, we discuss coronavirus pathogenicity, conventional antiviral therapies, prophylactic strategies, and novel treatment strategies for COVID-19. We highlight the application of CRISPR technology as an emerging pan-antiviral therapy. We also discuss the challenges of in vivo delivery of CRISPR components and propose novel approaches to achieve selective delivery exclusively into SARS-CoV-2-infected cells with high efficiency by hijacking the surface proteins of SARS-CoV-2.

Background In image-assisted volume estimation, the volume of the object is calculated with a formula, using linear measurements of the objects. Since the volume estimation accuracy is thought to be influenced by the shape of the object, the volume estimation error would be related to the calculation formula used. Purpose To evaluate the volume estimation accuracy of selected volume calculation formulae, for different shaped objects. Material and Methods Globular (n = 5), elongated (n = 5), and near-spherical shaped plastic objects (n = 5), filled with water were subjected to ultrasound (US) and computed tomography (CT) in February 2018, to obtain the length, width, depth, and estimated volumes (EV). The volume was calculated manually using prolate, ellipsoid, and Lambert formulae. The actual volume (AV), EV, and calculated volumes were compared. Results The AV was in the range of 10–445 mL. The reliability of measurements was high as assessed by the intra-class variability (Cronbach’s alpha = 0.992). The EV has shown a high correlation to AV (US: ρ = 0.914, P Conclusion The shape of the object and the calculation formula used has an impact on the volume estimation accuracy.

Background Aetiology of chronic kidney disease (CKD) has shown geographical clustering. Renal ultrasound (USS) is used to diagnose CKD, but USS features are known to vary with aetiology of CKD. Objectives To describe aetiological factors and USS features of CKD. Methods Renal USS was performed in diagnosed adult CKD patients (n=100) and a control group (CG) with normal renal function (n=90). Demographic data, associated comorbidities, serum creatinine values, renal length (RL), renal cortical echogenicity, and number of renal cysts were recorded. CKD severity was graded. Results Hypertension (38%) and diabetes (17%) were commonest aetiological factors of CKD. Severity of CKD was as follows: 35% grade 3a, 39% grade 3b, 11% grade 2, and 15% grade 4. Mean RL of CKD group (9.07cm; SD=0.84) was significantly lower (p

Lean manufacturing is one of the most widely used tools in the contemporary manufacturing industry to improve the business performance via achieving higher efficiencies at reduced cost structures. However, the apparel industry has not yet been able to realize the full potential benefit scheme of this change initiative. Thus, this research is formulated to identify key barriers faced by the apparel industry which hinder the utilization of the full spectrum of lean benefits. A comprehensive literature review was conducted along with the feedback from the industry professionals to identify key barriers of lean implementation which were categorized under six lean tools. A pilot study was conducted targeting lean practitioners and identified three lean tools (TPM, 5-S and Kanban) as the most decisive tools for further investigations. A detailed survey questionnaire formulated on those prioritized lean tools was distributed to lean practitioners (executives and managers) in lean implemented Sri Lankan apparel factories. Quantitative feedback was obtained using ‘1-5 Likert Scale’ and prioritized using ‘Relative Importance Index’ to identify the most critical barriers pertaining to the feasibility of lean implementation and continuation. A comprehensive list of recommendations was developed using the findings of the literature and the qualitative feedback from the survey.

Background Unintentional injuries among adolescents is a major public health problem the world over. A great majority of the annual deaths among adolescents is due to unintentional injuries; it is also the leading cause of death among adolescents in the world. The aim of this study was to estimate the incidence of injuries and their associated factors among school going adolescents aged 13–17 years using data from the most recent Global School-Based Health Survey (GSHS) conducted in Sri Lanka. Methods A cross-sectional survey was conducted using a self-administered questionnaire, among 3262 adolescents attending government schools. The sample was selected through a two-staged cluster sampling technique. In the first stage, 40 schools were selected using probabilities proportional to school enrollment size, from all schools in the country that have classes in grades 8–12. Then, from the selected schools, classes were selected using systematic equal probability sampling with a random start. The weighted prevalence was calculated, and logistic regression analysis was conducted in order to determine the correlates. Results During the 12 months before the survey, 35.8% (95% CI-30.7 - 41.1) of the students reported being seriously injured one or more times. The injuries were more common among males, but were equally common among the two different age groups (13–15 age group vs 16–17 age group). The most common type of injury was cut or stab wounds (5.5%), followed by broken bones/dislocated joints (5.3%). Multivariable analysis revealed that only a few factors were associated with injury, such as being of the male sex, being bullied, being physically attacked, and/or being in a physical fight. Conclusion This study demonstrated that the prevalence of serious unintentional injuries among school going adolescents is a major public health problem in Sri Lanka. This timely and comprehensive survey would help policy makers and researchers identify the unmet needs related to adolescent injuries. Furthermore, evidence generated form the study should be given due consideration when designing school-based interventions to prevent adolescent injuries.

The chapter explores historical conditions which assisted the rise of an exploitative merchant cum usurer class in the rural economy causing rural stratification along with the rise of Sri Lanka’s commercial bourgeoisie. It explores involvement of natives in coffee plantations whereas existing studies underscore arrack renting in the rise of commercial bourgeoisie. The chapter further illustrates how ancient Singhalese were able to reconcile uneven demand for labour in paddy agriculture by combining exchange labour system with equal division of water-supply to the fields through a centrally managed social organisation, which enabled the more or less permanent release of labour to non-agricultural pursuits. The rise of entrepreneurial bourgeoisie within the paddy economy of Sri Lanka and their lack of agency in capitalist transformation of paddy cultivation are also examined.

Cerebral venous sinus thrombosis (CVST) is an uncommon disease entity. In contrast-enhanced computed tomography (CT) or magnetic resonance venography (MRV) images of the brain, CVST usually manifests as a filling defect of the dural venous sinuses. Brain parenchymal involvement in CVST can be ranged from parenchymal oedema to haemorrhagic infarctions. Though the most frequent cause of haemorrhagic infarction in brain is CVST, other rare causes such as cerebral venous outflow obstruction due to neck vein pathology have been reported. We report a rare case of haemorrhagic brain infarctions secondary to bilateral internal jugular vein thrombosis in a 17-year-old woman, who has presented with worsening headache and seizures. She had high susceptibility of getting venous thrombosis for being a young female on oral contraceptive pills. While reporting a rare cause of cerebral haemorrhagic infarctions, this case report highlights the need for having a high degree of suspicion to diagnose CVST. Further, this case report emphasises the value of prompt and adequate imaging of neck veins if the haemorrhagic infarction presents with patent cerebral venous sinuses.

Background: Pembrolizumab monotherapy showed durable antitumour activity and manageable safety in patients with metastatic triple-negative breast cancer. We aimed to examine whether the addition of pembrolizumab would enhance the antitumour activity of chemotherapy in patients with metastatic triple-negative breast cancer. Methods: In this randomised, placebo-controlled, double-blind, phase 3 trial, done in 209 sites in 29 countries, we randomly assigned patients 2:1 with untreated locally recurrent inoperable or metastatic triple-negative breast cancer using a block method (block size of six) and an interactive voice-response system with integrated web-response to pembrolizumab (200 mg) every 3 weeks plus chemotherapy (nab-paclitaxel; paclitaxel; or gemcitabine plus carboplatin) or placebo plus chemotherapy. Randomisation was stratified by type of on-study chemotherapy (taxane or gemcitabine–carboplatin), PD-L1 expression at baseline (combined positive score [CPS] ?1 or, Breast Cancer Research Foundation, BCRF; Pfizer; AstraZeneca; Merck; Roche; Samsung; Merck Sharp and Dohme, MSD; Eisai, JC reports personal fees and research funding paid to his institution from Roche, AstraZeneca, Merck Sharp & Dohme, and Eisai; personal fees from Celgene, Cellestia, Biothera Pharmaceutical, Merus, Seattle Genetics, Daiichi Sankyo, Erytech, Athenex, Polyphor, Lilly, Servier, GlaxoSmithKline, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim, Kyowa Kirin, Novartis, Pfizer, Samsung Bioepis; research funding paid to his institution from Ariad Pharmaceuticals, Bayer Healthcare, F Hoffman-La Roche, Guardanth Health, Piqur Therapeutics, Puma C, and Queen Mary University of London, outside the submitted work. In addition, JC has a MedSIR patent pending. DWC reports research support from Merck during the conduct of the study; research support paid to his institution from Merck, Pfizer, and GlaxoSmithKline; personal fees from Merck, Roche–Genentech, AstraZeneca, GlaxoSmithKline, Novartis, Pfizer, Puma, Agenda, Exact Sciences, and Dynamo Therapeutics, outside the submitted work. In addition, DWC has a Biomarkers of TTK inhibitors patent pending. HSR reports funding for sponsored studies paid to the University of California San Francisco from Pfizer, Novartis, Lilly, Roche–Genentech, Macrogenics, OBI, Merck, Eisai, Immunomedics, Daiichi Sankyo, Seattle Genetics, and Odonate; travel support for educational meetings from Daiichi Sankyo, Mylan, Pfizer, Merck, AstraZeneca, Novartis, and Macrogenics; and consulting fees from Samsung and Puma, outside the submitted work. S-AI reports grants from AstraZeneca, Eisai, Pfizer, Roche, and Daewoong; an advisory role for AstraZeneca, Amgen, Eisai, Hanmi, Novartis, Lily, MedPacto, Pfizer, and Roche; and travel expenses for presentation from Novartis, outside the submitted work. CG reports Advisory Board fees from Merck Sharp & Dohme and Roche; and speaker's bureau fees from Bristol Myers Squibb and AstraZeneca, outside the submitted work. CHB reports grants and fees from Merck Sharp & Dohme for clinical research consulting during the conduct of the study; consulting–advisory role fees from Boehringer Ingelheim, GlaxoSmithKline, and Bayer; consulting–advisory role fees and grants for clinical research from Novartis, Pfizer, Roche–Genentech, Eisai, Merck Sharp & Dohme, and AstraZeneca; grants for clinical research from Abbvie, Amgen, Astellas Pharma, Bristol Myers Squibb, Celgene, Covance, Lilly, Medication, Merck Serono, and PharmaMar; grants for academic research projects from CPO, Pontificia Universidade Católica do Rio Grande do Sul, Latin American Cooperative Oncology Group, Grupo Brasileiro Estudos Câncer Mama, and Instituto Nacional de Câncer-Brazil, outside the submitted work. HI reports a grant from Merck Sharp & Dohme during the conduct of the study; honoraria and consulting fees from Novartis, AstraZeneca, Pfizer, Lilly, Daiichi Sankyo, Eisai, and Chugai; and a grant from Chugai, outside the submitted work. NM reports honoraria and research funding paid to his institution from Chugai, AstraZeneca, Pfizer, Eli-Lilly, Eisai, Takeda, Kyowa-Kirin, Merck Sharp & Dohme, Novartis, and Daiichi Sankyo, outside the submitted work. EG reports non-financial support from Merck Sharp & Dohme during the conduct of the study; honoraria, consulting–advisory fees and meeting support from Novartis, Roche, Bristol Myers Squibb, and Pfizer; and honoraria from AstraZeneca and Astellas, outside the submitted work. SL reports research funding or consulting fees paid to her institution from Bristol Myers Squibb, Roche–Genentech, Puma Biotechnology, Pfizer, Seattle Genetics, Novartis, Merck Sharp & Dohme, Eli Lilly, Aduro Biotech, GI Therapeutics, AstraZeneca, and GlaxoSmithKline; and non-remunerated consultancy for Bristol Myers Squibb, Roche–Genentech, Pfizer, Seattle Genetics, Novartis, Merck Sharp & Dohme, and AstraZeneca, outside the submitted work. In addition, SL is supported by the National Breast Cancer Foundation of Australia Endowed Chair and the Breast Cancer Research Foundation, New York. ZG, JZ, GA, and VK are employees of Merck Sharp & Dohme and own stock or stock options in Merck. PS reports consultancy fees from Pfizer, AstraZeneca, Novartis, Roche, Merck Sharp & Dohme, Boehringer Ingelheim, Bayer, Eisai, Celgene, and Puma; consultancy fees to his spouse from Genentech and Roche; and grants or funding to his institution from Roche, Genentech, Oncogenex, Novartis, Astellas, and AstraZeneca, outside the submitted work. All other authors declare no competing interests., The authors thank the patients, their families and caregivers for participating in this trial, all of the investigators and site personnel, and the following employees of Merck Sharp & Dohme: Wilbur Pan, Deborah Card, Eleanor Readinger, Shana Hamm, Roger Maxwell, and Krystal Bourdon, for collection of data, supervision of research, provision of study materials or patients or administrative or logistical support; Aline Galvao, for collection of data, supervision of research, administrative or logistical support, and review of imaging data related to the primary end point; Donna Letizia, for collection of data and imaging expertise; Jennifer Kimmel, for study management; Mercedes Bustamante, for data collection and management; Xuan Zhou and Madhusudhan Reddy Papasani, for statistical expertise; Christine McCrary Sisk, for medical writing and editorial assistance; and Joseph C Naggar and Michele McColgan, for administrative or logistical support.

Introduction: Chronic kidney disease (CKD) is a global & local health problem. Serum creatinine (Scr) is an indicator of renal function. Ultrasound is a freely available safe, reliable imaging modality, commonly used to assess kidneys in CKD. Association of renal length and Scr in CKD is evaluated in this study, as such data is lacking for Sri Lankan population. Methodology: A descriptive cross sectional observational study was conducted at the Radiology Unit of the Base Hospital Tissamaharama from March to August 2017 (as a preliminary study of a large ongoing study), using 41 patients with normal Scr (control group) and 74 patients diagnosed with CKD. The Scr values done within the last three months were evaluated. Absolute renal length was measured ultrasonically by an experienced Radiologist, who was blind to the patient’s serum creatinine value, with Mind-ray ultra sound scanner. Results: Study population (n=115) consists of control group (n=41) and CKD patients (n=74) where 40% were females and 60% of were males. Mean age was 58.3 years & mean renal length in control group was 9.6cm and CKD group was 9.0 cm. A significant difference observed in renal length in control and CKD groups (

Background Immunotherapy has historically been of interest in the management of metastatic renal cell cancer (mRCC) because of its relative chemoresistance and the reproducible but low incidence of spontaneous remission in metastatic disease. Recently, targeted immunotherapies in the form of checkpoint inhibitors have shown durable responses in approximately 20%-30% of patients with solid tumors, with a much more acceptable side-effect profile. Anti-programmed death receptor 1 (PD-1)/programmed death receptor ligand 1 antibodies rely on the presence of host T cells in the tumor microenvironment to be stimulated in order to activate an antitumor response. The presence of tumor antigens augments this stimulation. This has led to further research into combination therapy with anti-PD-1 inhibitors and radiotherapy, chemotherapy, or targeted therapy with the aim of increasing the response rate to these agents. Materials and methods We describe three cases of patients with mRCC treated with anti-PD-1 antibody therapy in combination with targeted therapy (bevacizumab), anti-cytotoxic T lymphocyte antigen 4 therapy (ipilimumab), or radiotherapy. We perform a comprehensive literature review on combination immunotherapy and the scope for the future. Results Two patients had a complete clinical response within 3 months of commencing treatment. The third patient had a further significant response to radiotherapy outside the field of treatment after initial response to anti-PD-1 therapy, which lasted for over 12 months. Conclusion We are now in the era of immunotherapy with promising results in select patients. However, the number of complete remissions with single agents are low. This report demonstrates the potential for combination therapy in mRCC to produce complete responses and improved survival rates. Whether these results equate to cure in a subset of patients requires longer follow-up. Further evaluation of dosing regimens, sequencing methods, and biomarkers to select patient population is required to advance this treatment strategy. Implications for practice Multiple phase I-III studies exploring the benefit of combination immunotherapy are currently under way. Further research into predictive biomarkers to identify the cohort of patients who gain this benefit is pertinent. This case series demonstrates that the combination of immunotherapy with other treatments can lead to complete responses, even in patients with initially bulky disease. Combination therapy with immunotherapy seems to cause more durable responses in patients with metastatic renal cell cancer compared with monotherapy. Significantly longer follow-up is necessary to determine whether durable complete response confers a cure in a select group of patients.

In this paper, a 10T Static Random Access Memory bit cell is proposed to meet design specification for performance, stability, area and power consumption. In every state of SRAM cell designs low power and increased noise margin plays an important role. The conventional 6T SRAM cell is very much prone to noise during read operation. In order to overcome the Read SNM problem in the 6T SRAM cell designers have implemented many other SRAM configurations such as 8T, 9T, 10T. These SRAM cell configurations improve the read stability but increase the power consumption. We proposed a 10T SRAM cell which can solve all these problems by introducing the transmission gate and using stacking effect in the configuration. In this paper different SRAM cells analyzed on the basis of power and read stability and we proposed a 1-bit SRAM memory array using the proposed 10T SRAM bit cell that achieves cell stability, lower power consumption and lesser area. The proposed circuit was implemented in Mentor Graphics Design Architect, simulated using Mentor Graphics ELDO at supply voltage of 1.8V with the help of TSMC 180nm technology. Micro wind is used to draw layout of SRAM cells and peripherals.

Background Volume estimation of organs using two-dimensional (2D) ultrasonography is frequently warranted. Considering the influence of estimated volume on patient management, maintenance of its high accuracy is empirical. However, data are scarce regarding the accuracy of estimated volume of non-globular shaped objects of different volumes. Purpose To evaluate the volume estimation accuracy of different shaped and sized objects using high-end 2D ultrasound scanners. Material and Methods Globular (n=5); non-globular elongated (n=5), and non-globular near-spherical shaped (n=4) hollow plastic objects were scanned to estimate the volumes; actual volumes were compared with estimated volumes. T-test and one-way ANOVA were used to compare means; PResults The actual volumes of the objects were in the range of 10–445 mL; estimated volumes ranged from 6.4–425 mL ( P=0.067). The estimated volume was lower than the actual volume; such volume underestimation was marked for non-globular elongated objects. Regardless of the scanner, the highest volume estimation error was for non-globular elongated objects (Conclusion The 2D ultrasonography can be recommended for volume estimation purposes of different shaped and different sized objects, regardless the type of the high-end scanner used.

India is a fast growing economy and emerging to be a global leader. The energy requirement for any evolving nation is on the rise. Over dependence on diminishing fossil fuels has cost us pollution and its after effects as the reward. Wind energy is emerging to be one of the leading power sources from natural resources. New and improved methods of harnessing wind energy are being developed. Conventional windmills although much in use have their own limitations in installation and maintenance. Bladeless windmills can overcome these limitations and harness wind energy more efficiently and cost effectively. This journal paper depicts the principle of working and the output obtained from the prototype of a bladeless windmill.

Lead Farmer Centered Extension Advisory and Delivery Services (LEADS) is a pilot extension system revolving around Lead farmer – Satellite farmer concept on an Agro Ecological Zone basis within a district. The present study was conducted in the Kollam and Palakkad districts of Kerala state to compare the perception level of the farmers towards LEADS regarding the effectiveness in implementation of LEADS of both districts. From the study conducted, it was clear that the perception of farmers was found to be more in Kollam than in Palakkad district in terms of effectiveness of the extension system.

Early detection of alzheimer disease is an essential process of the elderly persons when they are with the mild cognitive impairments. This work adapts the smart home based alzheimer disease detection by recording the daily activities of the resident’s equipped with the sensor devices in their appliances as smart home. Using sensor data based clinical assessment of alzheimer patient is very complex as it is uncertain to predict such vague monitoring and understanding its deep characteristics. To acquire the deep characteristics of sensor dataset unlike the existing conventional supervised learning paradigm, this paper constructs an optimized self-learning model known as reinforcement learning process. This proposed model Deep Recurrent Q Learning based Reinforcement Model (DRQLRM) Process comprised of two stages they are pretraining using recurrent neural network to overcome the overfitting and fine tuning of the parameters involved in deep neural network and Deep Q learning process is used as reinforcement approach which uses the agents rewards and penalties to determine the optimal agents and their experience to predict the unknown pattern in the uncertain condition in effective way. The proposed model produced better result in CASA smart home test bed for investigating the presence of alzheimer

Radioimmunotherapy (i.e., the use of radiolabeled tumor targeting antibodies) is an emerging approach for the diagnosis, therapy, and monitoring of solid tumors. Often using paired agents, each targeting the same tumor molecule, but labelled with an imaging or therapeutic isotope, radioimmunotherapy has achieved promising clinical results in relatively radio-resistant solid tumors such as prostate. Several approaches to optimize therapeutic efficacy, such as dose fractionation and personalized dosimetry, have seen clinical success. The clinical use and optimization of a radioimmunotherapy approach is, in part, influenced by the targeted tumor antigen, several of which have been proposed for different solid tumors. Glypican-1 (GPC-1) is a heparan sulfate proteoglycan that is expressed in a variety of solid tumors, but whose expression is restricted in normal adult tissue. Here, we discuss the preclinical and clinical evidence for the potential of GPC-1 as a radioimmunotherapy target. We describe the current treatment paradigm for several solid tumors expressing GPC-1 and suggest the potential clinical utility of a GPC-1 directed radioimmunotherapy for these tumors.

A community-based descriptive cross-sectional study was carried out among children aged 1 to 4 years residing in an urban setting of Sri Lanka to assess the incidence and associated family-related factors of unintentional injuries. A total of 458 children were recruited using simple random sampling technique, giving a response rate of 91.6%. The incidence of unintentional injuries that needed medical attention during the study period of 3 months was 28.1 per 100 children (95% CI = 19.46-36.74). The factors that were significantly associated with the occurrence of unintentional injuries among children are low monthly income of the family ( P = .045), low social support to the mother of index child ( P = .022), nonauthoritative type of parenting of the mother of index child ( P = .039), cared by person other than mother during day time ( P = .002), frequent arguments between parents ( P = .004), and frequent alcohol consumption of father ( P = .001).

Irritability and crying are common modes of presentations of diseases in infancy. We had a very rare encounter of an infant presenting with non-specific clinical features caused by cholidocholithiasis that underwent spontaneous resolution within couple of days of onset of symptoms. Systematic analysis of clinical features and judicial use of imaging would often help identification of rare pathologies in this age group such as cholidocholithiasis as seen in this baby.

Introduction Alzheimer's disease (AD) is a complex and heterogeneous disease that affects neuronal cells over time and it is prevalent among all neurodegenerative diseases. Next Generation Sequencing (NGS) techniques are widely used for developing high-throughput screening methods to identify biomarkers and variants, which help early diagnosis and treatments. Objective The primary purpose of this study is to develop a classification model using machine learning for predicting the deleterious effect of variants with respect to AD. Methods We have constructed a set of 20,401 deleterious and 37,452 control variants from Genome-Wide Association Study (GWAS) and Genotype-Tissue Expression (GTEx) portals, respectively. Recursive feature elimination using cross-validation (RFECV) followed by a forward feature selection method was utilized to select the important features and a random forest classifier was used for distinguishing between deleterious and neutral variants. Results Our method showed an accuracy of 81.21% on 10-fold cross-validation and 70.63% on a test set of 5785 variants. The same test set was used to compare the performance of CADD and FATHMM and their accuracies are in the range of 54%–62%. Conclusion Our model is freely available as the Variant Effect Predictor for Alzheimer's Disease (VEPAD) at http://web.iitm.ac.in/bioinfo2/vepad/ . VEPAD can be used to predict the effect of new variants associated with AD.

Introduction: Renal sizes are of immense use to diagnose renal pathologies. As ethnic variations are known to influence renal sizes, we aimed to assess the ethnic variations in bipolar renal length (RL) and kidney to body height ratio (KBR) of a young adult Sri Lankan population. Methods: Healthy adults were recruited, by excluding subjects with previous renal surgeries, renal diseases, or other chronic illnesses. Bilateral RLs were measured sonographically. Results: The study sample consisted of 215 individuals (100 females) with an age range of 19-36 years (mean age=24 years). Mean right RL was 9.77±0.78cm; mean left RL was 10.16±0.83cm; mean KBR of the right kidney was 0.60±0.05mm/cm and left kidney was 0.63±0.05mm/cm. Right and left RLs and KBRs of males were 9.82±0.76cm; 10.3±0.78cm and 0.59±0.05mm/cm; 0.62±0.05mm/cm respectively and same parameters in females were 9.71±0.8cm; 10.0±0.9cm and 0.62±0.05mm/cm; 0.64±0.05mm/cm respectively. Irrespective of gender, left RL and KBR were higher than those of the right side (p Conclusions: This preliminary study can be considered as the first step in establishing age and gender specific reference values for RL and KBR for a Sri Lankan population. Due to ethnic variations, accuracy of using renal nomograms from other populations as reference values raises serious concerns.

Background: Tobacco and smoking are the established risk factors for oral cancer, but studies have reported the occurrence of oral cancer, even in the absence of these established factors. This indicates the need to identify other possible risk factors. In recent years, viral carcinogens have gained interest in which human papillomaviruses (HPVs) are the most researched risk factor in oral carcinogenesis. Therefore, we conducted this study to evaluate the presence of HPV-16 in potentially malignant and malignant lesions of the oral cavity. Methods: The current study comprised 40 patients, and they were divided into two groups: Group A: 20 patients with histopathologically diagnosed oral potentially malignant disorders (leukoplakia/erythroplakia) and Group B: 20 patients with histopathologically diagnosed oral squamous cell carcinoma (OSCC). Tissue samples were collected from all patients and made into formalin-fixed paraffin-embedded (FFPE) blocks. Polymerase chain reaction (PCR) test was carried out to detect the presence of HPV-16. Results: In our study, we found that none of the FFPE tissue samples was positive for the HPV-16 genome using the conventional PCR technique. The level of significance (P value) was set at P

Objective: To assess the impact of diabetes and pre diabetes on the sputum smear conversion among patients with tuberculosis Methods: Retrospective analysis performed using the clinical records of the district tuberculosis clinic, Gampaha district, Sri Lanka from September to October 2016. Patients with extra pulmonary TB were excluded. Results: 336 out of 428(78.5%) were analyzed. 231 were undergone sputum smear examinations at second month of treatment. Median age 50(18 to 78) years. Males 159(68.8 %%). Smear positive pulmonary TB 172 (74.5%), smear negative pulmonary TB 44(19%), relapsed previously 7(3%) and previously defaulted 8(3.5%). 20(8.7%) had pre diabetes, and 82(35.5%) had diabetes. 41(17.7%) had sputum smear positivity at the second month of treatment and 190(82.3%) had negative smears. 18 (22%) of diabetes patients failed to convert at two months compared to 23(15.4%) at nondiabetic group. Altogether 24(23.5%) patients with diabetes or pre diabetes were failed to convert at the second month of therapy. There is a statistically significant risk of sputum non conversion among patients with diabetes or pre diabetes (odds 2.0(1.0 to 4.0) p = 0.04). Conclusion: Patients with diabetes or pre diabetes had a significant risk of sputum non conversion at the second month of anti tuberculosis therapy.

Background The regulatory requirements for approval of generic medicines and the format of compiling drug dossiers vary among regulatory authorities. The variation is particularly wide between High-income countries (HIC) and lower and middle-income countries (LMIC) with different regulatory frameworks. In this study, document requirements for approval of generic products, approval timelines, and consideration of bioequivalence and/or biowaiver data by Regulatory Authorities (RAs) of 10 selected jurisdictions was studied. Methods The guidelines and procedures from 5 purposively chosen RA of HIC and4 regional RAs relevant for Sri Lanka were compared with the Sri Lankan National Medicines Regulatory Authority (NMRA). Information available in the official websites of the selected RAs, published journal articles and via personal communication was collected in2016. Drug approval timelines achieved in Sri Lanka was obtained from data available from another study. Results Common technical dossier (CTD) format of the International Council on Harmonization (ICH) for registration of pharmaceuticals (ICH:CTD) or the Association of South East Asian Nations (ASEAN) CTD format (ACTD) was used by all RAs studied except Sri Lanka which use its own dossier format. Nine out of ten RAs studied request BE data or justification for not submitting BE data for generic medicines. Sri Lanka requested BE studies only for antimicrobials, antiepileptic drugs and narrow therapeutic index drugs. Biowaivers are allowed for Biopharmaceutics Classification System (BCS)-based Class 1drugs in Singapore and India. USA, EMA, Canada and South Korea allowed biowaiver for BCS Class1and Class 3drugs but Sri Lanka does not accept BW at present. Nine NMRAs out of the ten studied reported legislated timelines for approval of generic pharmaceuticals except Sri Lanka. Conclusions Streamlining the drug regulatory systems in LMIC such as Sri Lanka with that of HIC would facilitate an effective drug regulatory system based on reliance on decisions made by stringent regulatory authorities. Findings of this study encourage Sri Lanka to adopt a CTD format for regulatory submission of drug dossiers. Expanding the BE requirement drug list and accepting BCS-based biowaivers for BSC class 1 and 3 drugs during registration of generic drugs when it is scientifically justified is also recommended for Sri Lanka.

Background: Biologic based therapies are frequently used as Complementary medicines in diabetes. The aim of this study was to identify the commonly used herbal remedies and their preparations in Sri Lankan patients with type2 diabetes. Methods: This is a descriptive, cross-sectional study of 220 diabetic patients using herbal remedies for perceived glyceamic benefit. Results: All the patients used their regular conventional medications together with herbal remedies. The most commonly used medication was metformin (91.4%). Ivy gourd (Coccinia grandis) was the most commonly used herbal remedy (32%), followed by Crepe ginger (Costus speciosus) (25%) and Bitter gourd (Momordica charantia) (20%). Herbal remedies used less frequently were Finger millet (Eleusine corocana) (5%), Anguna leaves (Wattakaka volubilis) (5%), Goat weed (Scoparia dulcis) (4%), Selacia reticulata (4%), Fenugreek (Trigonella Foenum Graecum) (3%) and Tree turmeric (Coscinium fenestratum) (0.5%). None of the patients used commercially available over-the-counter herbal products. The common preparations were salads (72.8%), curries (12.8%), herbal tea (6%) and herbal porridges (6%). Conclusion: The practice of using household ingredients as complementary medicines is common in Sri Lanka. Few herbal remedies and their methods of preparation have limited evidence for efficacy. In view of the frequent use by diabetic patients each needs to be documented for reference and scientifically explored with regard to their hypoglycaemic potential. [J Intercult Ethnopharmacol 2015; 4(2.000): 138-142]

Apprehension of a dentist to treat a pregnant woman is nearly reasonable considering the vast number of changes taking place in the body. These vast changes could pose a significant risk to the health of a pregnant woman undergoing dental treatment. This makes it mandatory for a dentist to be aware of the dos and don’ts of treating such patients to ensure maximum safety to the mother and her growing foetus. It is important to fully understand the specific changes occurring during each trimester to appropriately modify the treatment approach starting from scheduling of appointments and correct chair positions to major surgical procedures. Knowledge about the pharmacological actions and limitations of drugs administered during this period is essential. Each branch of dentistry has a distinct modality of treating expectant mothers. Hence, the purpose of this article is to emphasize on the dental services that a pregnant woman can receive without hesitation and to give a complete picture to the dentist regarding the specific alterations that he needs to make in treating such patients.

BACKGROUND Associations between certain environmental and lifestyle factors and Parkinson's disease (PD) have been reported in several studies, but information on these factors and Parkinson's Disease (PD) in South Asia, is limited. OBJECTIVE To determine associations between lifestyle factors and PD in an urban clinic-based study in Sri Lanka. METHODS In this case-control study, demographic and lifestyle factor data (including diet, coffee/tea drinking, smoking, alcohol status) was collected from an unselected cohort of PD patients and age and gender-matched controls attending clinics in Greater Colombo, Sri Lanka. Associations between lifestyle factors and PD status were assessed using Logistic Regression analysis, while links with age of PD onset were explored with Kaplan Meier and Cox Regression survival analyses. Results with p

Genetic disorders can be identified and treated in the most suitable manner by knowing the pattern of its bases. DNA sequencing is the process of detection of the order in which these nucleotides are arranged in DNA. To overcome the disadvantages of traditional methods of DNA sequencing CMOS ISFET sensors can be used. Dual mode CMOS ISFET has the provision for image sensing which makes the DNA sequencing more accurate.

Wavelength division multiplexing (WDM) divides the huge bandwidth available on a fiber into several non-overlapping wavelength channels and enables data transmission over these channels simultaneously. Failure of the optical fiber causes loss of huge amount of data which can interrupt communication. There are several approaches to ensure network survivability. In survivability, we consider dedicated protection in this paper in which backup paths are configured at the time of establishing connections. If a primary path is failed, the traffic is rerouted through backup path with a short recovery time. In this paper, we investigate the performance by calculating the spectrum efficiency variation for dedicated protection in WDM networks. Spectrum efficiency is calculated by dividing the total traffic bit rate by the total spectrum used. In this paper, we carry out the investigation with detailed simulation experiments on different single-line rate (SLR) scenarios such as 100 Gbps, 400 Gbps, and 1Tbps. In addition, this paper focuses on four standard network topologies which consist of different number of links to identify how the spectrum efficiency varies for each network. Our findings are as follows. (1) Spectrum efficiency for each SLR are almost similar and comparable in all the network topologies. (2) Unlike network topology with low number of links, the spectrum efficiency for network topology with high number of links are higher, therefore, the spectrum efficiency increases when the number of links are increased. (3) The spectrum efficiency is lower when the number of primary links are higher even though in all the network topologies.

261 Background: Miltuximab is a chimeric antibody targeting Glypican-1 which is overexpressed in prostate cancer. Miltuximab has shown promising safety and efficacy in radioimmunotherapy models of prostate cancer. Methods: Metastatic patients (prostate, pancreatic and bladder) were dosed with unlabelled Miltuximabfollowed by the infusion of 1 mg/250MBq 67Ga-Miltuximab. Patients underwent whole body gamma and SPECT/CT scans up to 144 hours post-infusion. Standard of care imaging was performed at least 14 days before and after participation. Safety was evaluated by an external monitoring committee. Total organ exposure was determined by dosimetry of whole-body gamma scans. Antibody pharmacokinetics were also determined. Results: 12 patients were enrolled into the trial. Miltuximabwas well tolerated and did not elicit any drug-related adverse reactions. Liver and spleen uptake of 67Ga-Miltuximabwas observed from 30 min to 72 hours post dose. Pre-infusion of unlabelled Miltuximab resulted in reduced liver accumulation and increased distribution in the rest of the body. Miltuximab targeting to sites of active progressive disease was observed in certain prostate cancer patients who had failed enzalutamide treatment. Dosimetry analysis combined with antibody pharmacokinetic data was used to establish safe dose limits for a Phase 1 study. Conclusions: This study is the first in human for Miltuximaband demonstrates its potential for further clinical evaluation as a theranostic in prostate cancers and formed the basis for a Phase I imaging and therapy study planned for 2019. This study will use 89Zr-labelled Miltuximab to screen eligible patients and confirm tumour localisation, followed by treatment with 177Lu-labelled Miltuximab. Clinical trial information: ACTRN12616000787482.

The literacy rate and standard of living of the tribal people in Wayanad district in Kerala is still very low and constant efforts are being made by the State government and Central government to improve their conditions. The present study was conducted during 2016-17 in districts of Thirunelly, Mananthavady and Panamaram panchayats. From each panchayat, 30 tribal women and 10 men agricultural labourers were selected making to a total of 120 respondents. The study shows that majority of the tribal women experienced high level of geographic, economic and political legal exclusion.

Kidney to body height ratio (KBR) is considered as a better parameter compared to absolute renal length (RL) in renal size evaluation. Ethnic variations are described for renalsizes. Studies pertaining to renal length are scares for Sri Lankan population. Current study was conducted to evaluate RL and KBR for a group of Sri Lankan adults.

Ultrasonographically measured renal cortical echogenicity (RCE) is known to increase in chronic kidney disease (CKD) and of value in predicting the degree of renal function impairment. Renal function is routinely assessed by serum creatinine levels (Scr) and estimated glomerular filtration rate (eGFR). The aim of the study was to evaluate the association of RCE with Scr and eGFR in CKD subjects.

Cultivation, adding up to an important aspect in GDP (Gross Domestic Produce), has been affected tremendously over the past few decades due to the use of chemicals. Due to rapid urbanization and industrialization, arable land under cultivation is decreasing enormously. Organic farming, being the need of the hour, is opted as one of the widely chosen methodology to overcome the prevailing problem in cultivation. Advancements in agriculture have proven to serve the cultivators in a number of ways. Cultivation of crops is being done at home, which consumes limited amount of space and cost. To bring in another technological advancement by breaking all barriers, for organic farming is the Hydroponics where consumption of space and water are way too minimal. Hydroponics is a method of growing plants purely using water and nutrients, without soil. The proposed hydroponic system is built upon the concepts of embedded system. The system facilitates the growth of multiple crops under a single controller. Necessary supplements for the crops are provided based on the inputs obtained from the pH sensor and the water level sensor used. The water and nutrient supply to the different varieties of crop is controlled and monitored at regular time intervals. An efficient algorithm has been proposed for controlling all the functionalities. Automation of the hydroponic system improves the efficiency and reduces manual work.

Manual attendance has been carried out for many years which is time consuming and also provides erroneous results. The faculty has to maintain the attendance record in registers and file using pen and paper. With the development in technology, we have to look for an automated way for managing attendance. Using mobile phones provide an alternative way in this direction. The proposed system helps the teaching faculty members to maintain attendance of each class they handle. The attendance is recorded using voice automation and then updated in the database maintained for the attendance. The system also enables the teacher to mail periodic reports of the student to their parents. Thus it bridges the communication gap between the faculty members and the parents.