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The need for sustainable fuels has resulted in the production of renewables from a wide range of sources, in particular organic fats and oils. The use of biofuel is becoming more widespread as a result of environmental and economic considerations. Several efforts have been made to substitute fossil fuels with green fuels. Ester molecules extracted from processed animal fats and organic plant materials are considered alternatives for the use in modern engine technologies. Two different methods have been adopted for converting esters in vegetable oils/animal fats into compounds consistent with petroleum products, namely the transesterification and the hydro-processing of ester bonds for the production of biodiesel. This review paper primarily focuses on conventional and renewable biodiesel feedstocks, the catalyst used and reaction kinetics of the production process.

The Rationale: Dural tear is a serious complication during hypertelorism corrective surgeries. Identifying the tear and managing requires considerable expertise. Managing large dural tears correctly is necessary to prevent cerebrospinal fluid (CSF)-related complications in craniofacial surgery. Patient Concerns: The patient presented with hypertelorism as a part of the Tessier Cleft 0 and sought to correct the widely placed eyes. Diagnosis: Large critical-sized dural tear during modified box osteotomy surgery. Treatment: Besides successful modified box osteotomy surgery, the critical-sized dural tear was managed with fascia lata and fibrin glue. Outcomes: There was no CSF leak or related complication postsurgically indicating successful sealing and healing of the dural tear. Take-Away Lessons: The synergistic mechanism by which fascia lata graft and fibrin glue help to hermetically seal the critical-sized defect, especially when there are variable amounts of hydrostatic-hydrodynamic forces of CSF exerting pressure on the patched area, is discussed.

Background Some patients with glioblastoma multiforme (GBM) survive 3–5 years (or longer) after diagnosis. The goal of this study was to identify differences between the long-term survivors (LTS) and those who had a shorter overall survival (non-LTS groups). Methods This study was a retrospective analysis of prospectively maintained surgical databases. All patients who underwent safe maximal resection for GBM were included. Demographic, clinical, radiologic, and pathologic data were obtained from electronic medical records. Values of the biomarkers of systemic inflammation were computed from the preoperative hemogram reports. Patients with an overall survival (OS) ≥36 months were defined as the LTS group and were compared with the non-LTS groups (OS Results Patients in the LTS group were younger, had a better baseline performance status, and were more likely to have undergone near- or gross-total resection. LTS was associated with lower Ki67 labeling, MGMT methylation, IDH mutation, and lack of p53 overexpression. Several novel findings were generated by this study. A longer pretreatment duration of symptoms was associated with a longer OS. Higher pretreatment levels of the absolute neutrophil count, neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, derived neutrophil-lymphocyte ratio and systemic index of inflammation, and lower levels of the absolute eosinophil count and eosinophil-lymphocyte ratio all correlated with a shorter OS. Conclusions Several differences were identified between the LTS and non-LTS groups. These differences will likely be incorporated into future prognostic models. They may also aid in differentiation between recurrent disease and treatment-related changes.

Machining performance of an optimally designed prototype of a 2 degree of freedom PKM (parallel kinematic machine) is optimized in this work. The effect of machining parameters upon the surface quality of machined components is studied. Pocket milling operations are performed at various feed, speeds, and depth of cut on PKM and conventional CNC milling machine. The surface roughness of the machined component is measured, and the results are compared. Taguchi approach is used to design the experiment and analysis of variance is employed to obtain the optimal cutting conditions. The depth of cut is noticed as the most significant parameter that affect the surface roughness. The first version of the PKM prototype shows machining performance similar to the conventional CNC machine. The study establishes the machining capability of PKM and offers scope for developing dynamically superior substitute over the CNC machine tool.

Introduction: Chromosomal anomalies constitute a potentially burdening and distressing group of illnesses which if screened/diagnosed in time can offer respite to the expectant family. Currently detection is based on a host of screening tests followed by Chorionic villous sampling or amniocentesis which are invasive procedures associated with a mild risk of pregnancy loss and have a long turnaround time. Non-invasive pre-natal testing uses sensitive and specific techniques to overcome the issue and has the potential to replace the conventional diagnostic tests. Materials and Methods: A total of 700 consecutive Ante natal cases reporting to Gynaecology OPD in two centres over a duration of two years were screened using protocols applicable as per gestational age. 39 screen positive high risk positive cases were further subjected to NIPT and CVS/amniocentesis and the detection rates compared. Results: In the primary outcome it was found that the detection rates were comparable with NIPT and conventional diagnostic tests and both showed equivocal results. Conclusion: The study suggests no significant difference in the detection rates on NIPT vs the conventional karyotype. However, the results need to be interpreted in the light of low incidence rates of chromosomal anomalies in general population. While a universal application of the test is desirable cost factor needs to be permissive for it to be beneficial in a holistic manner. Keywords: Chromosomal anomalies, Non-invasive Pre-natal testing (NIPT), Chorionic villous sampling, Amniocentesis, karyotyping, Cell free DNA, Quantitative polymerase chain reaction.

This work presents energy, exergy, and thermoeconomic analysis of an advanced Kalina power generation system. In every key component of the proposed system, cost-balance and auxiliary equations are typically developed which is solved efficiently through MATLAB coding. The cost-effectiveness of the entire system is assessed by the determination of thermoeconomic variables for the individual components. The energy analysis of the advanced Kalina cycle system (AKCS) proves marginal improvement to the medium temperature heat recovery Kalina cycle system (KCS). The relative cost difference in HE5, turbine, HE6, and condenser are quite larger than other components of AKCS emphasizing more focus on these components is required. The low values of HE5 (11.77 %) and pump1, P 1 (13.33 %) insist that the performance of these two components has to be improved by capital investment into a better and improved design. The energy performance maximizes at operating conditions of 45 bar turbine inlet pressure, 72–74 °C separator inlet temperature, 0.94 ammonia concentration at the condenser and 0.83 separator inlet concentration. The thermoeconomic performance minimizes at operating conditions of 30 bar turbine inlet pressure, 68 °C separator inlet temperature, 0.89 ammonia concentration at the condenser and 0.79 separator inlet concentration.

A parametric investigation of a novel ammonia water mixture power generation system is performed in this study. The overall performance and feasibility of the system of the proposed system are assessed from thermoeconomic, conventional exergy and advanced exergy perspectives. For better heat recovery in the existing medium-temperature heat recovery Kalina system, auxiliary solar heater is considered in the proposed design to improve the overall performance in terms of energy and exergy. The system performance parameters investigated include cycle efficiency, net output, total product cost rate, exergoeconomic factor and total exergy destruction rate. The simulation of the energy and exergy analysis was performed using Python coding. In this respect, the parametric investigation revealed that the cycle efficiency, net output, total product cost rate, exergoeconomic factor and total exergy destruction rate of the system at optimized conditions are 15.5%, 280 kW, 136 $/GJ, 66% and 120 kW, respectively. The irreversibilities of each component and overall system were evaluated and it was found that the turbine accounts for the highest exergy destruction among all components, contributing nearly 13% of the total exergy destruction of the system. Advanced exergy analysis was also performed that involved characterizing the exergy destruction as endogenous, exogenous, avoidable, and unavoidable, leading to specific recommendations for improving the performance of the system. Conventional exergy analysis suggests that the turbine, HE4, and separator are the components typically identified for improvement. The advanced exergy analysis in this study, however, indicated that the separator should be the primary focused for performance improvement, followed by the HE4 and turbine.

Introduction Tumors are generally considered as red flags to manual therapy. The purpose of this report is to describe the clinical course of a patient diagnosed with spinal Schwannoma at L2-L3 level, who was referred to physiotherapy (PT) for the treatment of low back pain radiating to the left lower limb. Case description A 30-year old man previously diagnosed with L2-L3 Schwannoma was referred for physiotherapy for the treatment of radiating pain. The patient had not responded favorably to symptomatic management. As the patient's history and physical examination were consistent with a mechanical dysfunction, it was decided to manage the patient along similar lines. The patient was treated with McKenzie extension and central postero-anterior mobilization over T4-T6 vertebrae. This intervention was followed up with strengthening and aerobic exercises. Results The outcomes were measured by the numerical rating scale (NRS), Oswestry Disability Index (ODI) and the Global rate of Change (GRC) scale. The patient responded well to McKenzie extension exercises and Thoracic mobilization. The NRS (7 at rest; 10 on activity) at the time of referral reduced to (2 on activity) at the time of discharge. The outcomes were maintained after 7 months. Conclusion This case suggests that there is a need to undertake a detailed musculoskeletal examination and mobilization may be safely performed in patients diagnosed with spinal schwannomas. An individualized tailored approach may be beneficial in these patients.

The purpose of this paper is to show the use of the Six Sigma methodology in improving the first pass rate of an ALH4CT engines during manufacturing. The paper follows case study, design and manufacturing approach. The case study was performed in a leading automotive based company in India. The application of the Six Sigma methodology resulted in a reduction of tolerance-related problems and improved the first pass yield from 95 to over 99 percent. A number of tools and techniques in the Six Sigma tool box have been utilized for data analysis and drawing valid and sound conclusions. Using Pareto analysis, the primary causes for each of the defects were analyzed. As per the analysis, it is absorbed that the loss of power due to wrong flywheel marking was the major cause for engine rejection. The fixture of the rotary table has been modified by placing a sleeve in the dwell pin locator. This sleeve used to reduce the play between the flywheel and the table. This in turn would correct the flywheel marking, thereby increasing the pass of percentage. The results of the case study have provided greater stimulus within the production facilities for wider application of the methodology as a powerful problem solving methodology. Keywords: Six Sigma, Business Process Improvement, Automotive Industry, Change Management, Data Analytics How to cite this article: P Pathmanaban, B Naresh, Ganesh SS et al. Six Sigma Methodologies for Increasing the First Pass Rate of Engines in Manufacturing. J Adv Res Qual Control Mgmt 2019; 4(1): 24-30.

Background and Purpose: The purpose of this case report is to describe the benefits of manual therapy techniques, including mobilization and stretching, in the management of a patient with chronic ...

The Kalina cycle is a binary mixture power generation system optimised for a range of waste heat recovery applications, which has received considerable attention as an energy efficient power genera...

Physiotherapy plays a key role in the management of cerebral palsy (CP) and comprises of various therapeutic interventions in enhancing the various physiological and functional outcomes. Though physiotherapy is used widely and recommended by all members of the health-care team, the effectiveness of physiotherapy is inconsistent. The objective of this review was to summarize and evaluate the effectiveness of physiotherapy interventions in children with CP. PubMed and Cochrane database were searched from January 2006 to April 2017 using the Medical Subject Heading and general keywords. Only systematic reviews and meta-analysis on PT interventions in children diagnosed with CP were included. Two reviewers independently assessed the methodological quality and retrieved the results. Thirty-four systematic reviews were identified that distinguished 15 different interventions. Moderate evidence of effectiveness was found for constraint-induced movement therapy for upper limb recovery, goal-directed/functional training, and gait training to improve gait speed. Conflicting evidence was found for the role of exercises on strength training and cardiorespiratory training. Intervention such as neurodevelopmental therapy (NDT) was found ineffective. This review suffer from limitations such as including reviews that had small sample size and that had considered heterogeneity of treatment interventions. Hence, the effectiveness of most PT interventions is found to be limited. On the basis of the present evidence, functional goal-oriented approaches are found to be effective and future research is required to determine the best ways to improve functional outcomes in children with CP.

International audience; First, second, third, and fourth-generation biofuels are continuously evolving as a promising substitute to petrodiesel catalyzed by energy depletion, economic and environmental considerations. Bio-diesel can be synthesized from various biomass sources, which are commonly divided into FAME and renewable biodiesel. FAME biodiesel is generally produced by the transesterification of vegetable oils and fats while renewable diesel is produced by hydro-deoxygenation of vegetable and waste oils and fats. The different generation, processing technologies and standards for FAME and renewable biodiesel are reviewed. Finally, the life cycle analysis and production cost of conventional and renewable biodiesel are described.

Kalina cycle (KC) has been contemplated as one of the energy-efficient power generation cycles. It is suitable for various waste heat recovery applications. It is one of the competitors to Organic ...

Aims The World Health Organization has recommended a moderate intensity physical activity of 150 min, or 75 min vigorous-intensity physical activity per week to achieve optimal health benefits. It is not known if Indian populations who indulge in leisure time physical exercises satisfy these recommendations. Methods This study used a questionnaire to obtain data regarding demographic details, current engagement in leisure time physical activities, and dosages of these exercises from participants between 18 and 64 years of age. Results Data was collected from a total of 390 participants (231 males and 159 females). 50.76% and 34.35% of the participants reported exercising voluntarily and for health benefits respectively. Most participants (94.61%) indicated exercising without prescription. 55.38% and 12.82% of the participants under and above 38 years of age perform moderate to vigorous intensity exercises respectively. Conclusion The over-all results of this study indicate that the participants’ choices of leisure time physical exercises are based on their personal choices and beliefs. The exercise intensities undertaken do not meet the global recommended intensities, especially in those above 38 years of age. Professionals and facilities to engage the public in the WHO recommended intensities of physical activity needs to be established.

Background The etiopathogenesis of orofacial pain remains complex and a number of pain referral patterns for this region have been reported in the literature. The purpose of this report is to describe the assessment and successful clinical management of orofacial pain possibly attributable to cervical origin. Case description A 55-year-old male teacher with a 3-year history of pain in the right lower jaw, radiating to the ear, consulted our institute for assessment and management. The patient was unsuccessfully treated for dental pain and trigeminal neuralgia. The patient's functioning was grossly limited and the patient was unable to sleep because of severe pain. Current and previous medical and physical examinations revealed no infection, malignancies, or sinusitis. Palpation revealed no temporomandibular disorder, tenderness or myofascial trigger points. Examination of the cervical range of motion showed a reduction in rotation to the right side. The patient was treated for upper cervical joint dysfunction involving mobilization of the first three cervical vertebrae and motor control exercises. The patient had an almost complete resolution of symptoms and reported significant improvement in the Patient Specific Functional Scale (PSFS) and the Global Rating of Change (GRC) scale. Conclusion This case study demonstrates the importance of considering, assessing and treating the cervical spine as a possible source of orofacial pain, and the positive role of cervical mobilization on these disorders.

Objectives: Parallel Kinematic Machines (PKMs) are closed loop mechanisms. The present study is to find optimal workspace volume of two configurations of translational 3-DOF PKM and optimal location for machining. Methods/ analysis: Kinematic analysis is carried out to find the joint angles of the two configurations of the PKM. Optimal dimensions of two configurations of PKM are obtained considering Workspace Volume Index (WVI) as objective. A source code is developed in MATLAB to find the optimal dimensions using Genetic Algorithms (GAs) and Particle Swarm Optimization (PSO). Velocity analysis is carried out for configuration-I. The optimal location for best machining for configuration-I is identified using condition number of the jacobian matrix of the PKM. Findings: Using kinematic analysis the joint angles of the two configurations of PKM is obtained. Performance index like Workspace Volume Index (WVI) is introduced for the two configurations of PKM. Using WVI as an objective the optimal dimensions of two configurations of PKM are found using GA and PSO. It is observed from the results configuration-II has more WVI compared with configuration-I. Velocity analysis is done for configuration-I of PKM and from this analysis the location of singularities and non-singularities of the PKM was located. It was observed from the results the optimal location for machining is at the middle plane. Application/Improvements: The novelty of the present work lies in finding the optimal WVI of two configurations of 3-DOF PKM using GA and PSO. This PKM could be used as machine tool for 2-D contouring machining and other applications. Keywords: Optimal Workspace Volume, 3-DOF GA, PKM, PSO

In this paper, we fabricate a large-area chemiresitive type MoS2/graphene films sensor is grown by spray pyrolysis technique. The prepared sensor films were characterization by XRD, SEM, TEM Raman and BET analysis. The synergistic effect between MoS2 and graphene through the CVD method produces such a hierarchical layer-by-layer assembly of the thin film structure. MoS2/graphene hybrid films not only show enhanced NO2 sensitivity compared to NO2 sensitivity alone. Graphene or MoS2 films, but they also exhibit characteristics of rapid response and strong reproducibility. Selectiveness and stability findings demonstrate the outstanding sensing properties of the MoS2 thin film sensor. The MoS2/G showed higher sensitivity (81%) towards NO2 gas at the concentration of 1000 ppm followed by graphene (22 %) and MoS2 (45 %) based sensors in sequence. The MoS2/G sensor also exhibits fast response (12 s) and recovery time (17 s) than other sensor samples. The concept of operation and sensing mechanism behind their impressive results has also been studied in depth. The effect of humidity on the performance of gas sensing was also discussed in the point of practical device applications.

User generated content in the social media platforms are being considered as an important source for information about consumers and other emerging trends by the businesses. Using Twitter analytics, the paper presents insights on trends and discussions about the Internet of Things (IoT). Using relevant hashtags, 40,387 tweets were collected in early 2016. The analysis had followed three major approaches: descriptive analysis, content analysis and network analysis. The tools R and NodeXL were used for the analysis. The findings showed major themes like business concerns, scope of applications, security, emerging smart technologies and manufacturing. The sentiments of emotions and polarity differed across these themes. The top individual and industrial influencers were identified. The analysis also detected the highly-associated words and hashtags, and different user communities and how they are connected. Business implications of the findings and limitations are also elaborated.

BACKGROUND: Radial club hand (RCH) is characterized by a wide array of hand and forearm anomalies. Various treatment approaches have been described depending upon the stages of RCH. The major drawback of these studies is that the effectiveness of these interventions was reported on clinical and radiological outcomes. With the increasing focus on patient-centered care nowadays, we wanted to identify the components associated with functioning and evaluate the effectiveness of two surgical procedures on functional outcomes using the International Classification of Functioning, Disability and Health (ICF)-based tools. MATERIALS AND METHODS: We identified 14 children from our records (nine boys, five girls) with a mean age of 5.6 years, classified as Bayne types III–IV and classified them into two groups; those who were operated by centralization (group 1) and ulnarization of the carpus with ulnar shortening osteotomy procedure (group 2). The outcomes were evaluated by the brief ICF core set for the child and youth with cerebral palsy up to the age of 5 and the brief ICF core set for hand conditions for a period of 1 year after surgery. RESULTS: The results showed that both the operative techniques showed improvement in the structure component (s730-structure of upper extremity). ICF categories of d445-hand and arm use, d530-toileting, and d880-engagement in play showed a change in frequencies of more than 40% after surgery and were maintained till follow-up. However, categories related to muscle power functions (b730), muscle tone (b735), fine hand use (d440), hand and arm use (d445) and engagement in play (d880) showed no significant improvement (p > 0.05). There were no differences between both the surgical procedures in improving the outcomes (p > 0.05). CONCLUSION: We conclude that surgical techniques may be more appropriate to improve the cosmetic or structural appearance of the upper extremity than functioning.

Studies have shown a clinical relationship between trigger points and joint impairments. However the cause-and effect relationship between muscle and joint dysfunctions in trigger points could not be established. The purpose of this study was to investigate effects of mobilization and ischemic compression therapy on cervical range of motion and pressure pain sensitivity in participants with latent trigger point in the upper trapezius muscle. Ninety asymptomatic participants with upper trapezius latent trigger point were randomized in to 3 groups: mobilization, ischemic compression and a control. The outcomes were measured over a 2 week period. Repeated measures ANOVA showed statistically and clinically significant pre to post improvement in both the interventional groups compared to control (p

Objective: Our objective was to compare the change in research informed knowledge of health professionals and their intended practice following exposure to research information delivered by either Twitter or Facebook. Methods: This open label comparative design study randomized health professional clinicians to receive “practice points” on tendinopathy management via Twitter or Facebook. Evaluated outcomes included knowledge change and self-reported changes to clinical practice. Results: Four hundred and ninety-four participants were randomized to 1 of 2 groups and 317 responders analyzed. Both groups demonstrated improvements in knowledge and reported changes to clinical practice. There was no statistical difference between groups for the outcomes of knowledge change (P = .728), changes to clinical practice (P = .11) or the increased use of research information (P = .89). Practice points were shared more by the Twitter group (P Conclusion: Research information delivered by either Twitter or Facebook can improve clinician knowledge and promote behavior change. No differences in these outcomes were observed between the Twitter and Facebook groups. Brief social media posts are as effective as longer posts for improving knowledge and promoting behavior change. Twitter may be more useful in publicizing information and Facebook for encouraging course completion.

Purpose Correlation of body mass index (BMI) with clinical outcome in patients with glioblastoma is not well documented. Hence, we studied the association between survival and pretreatment BMI in glioblastoma patients. Methods and Materials In this retrospective study, only patients with histopathology-confirmed glioblastoma were included. Their BMIs were calculated from height and weight measurements and recorded in medical records at their first examination. Treatment plans for all patients consisted of concurrent radiation therapy and temozolomide, followed by maintenance therapy with temozolomide. The primary endpoint was overall survival (OS). Univariate and multivariate Cox proportional hazards models were used to estimate the mortality risk associated with BMI as a continuous and categorical variable. A BMI of 18.5 to 24.9 kg/m2 was classified as normal, 25.0 to 29.9 kg/m2 as overweight, and ≥30.0 kg/m2 as obese. Results Data from 392 patients treated from January 2008 through June 2016 were analyzed. At a median follow-up of 48.6 months, the median OS was 13.5 months in normal subjects, 15.4 months in overweight subjects, and 15.1 months in obese subjects. A total of 81% of the patients died. The hazard ratios for overweight and obese patients were 0.70 (95% confidence interval, 0.54-0.92; P = .009) and 0.66 (95% confidence interval, 0.45-0.98; P = .04), respectively, when adjusted for age, Karnofsky performance score, and extent of resection. Sex, diabetes, and hypertension had no significant interactions. Conclusions Patients with elevated BMIs had significantly better OS in our series of patients. The mechanism of this interaction needs to be explored further to understand this association.

In this paper, kinematics and dynamics modeling of a typical 3-Degree of freedom (DOF) translational Parallel kinematic machine (PKM) is carried out. The kinematic structure of PKM consists of three limbs, connecting the base and the tool platform. Each limb consists of an arm and a forearm with joints Prismatic-revolute-revolute-revolute (PRRR). The arrangement of joints are in such a way that the tool platform will have pure translational motion along the Cartesian axes. Inverse kinematic relations that are necessary to find the slider positions and joint angles for a given position of tool platform are derived. The dynamics model is then derived based on Natural orhogonal complement (NOC). The inverse dynamics equations presented are used to compute actuator forces. The actuator forces using NOC are validated with those obtained based on Lagrangian method. The effect of slider, arm, and forearm inertia on the actuator forces is studied to know whether to neglect the arm and forearm inertias while computing the actuator forces for PKM. Finally, an attempt is made to find the optimal location of a circular trajectory using Genetic algorithms (GA) with minimization of Grand total actuator force (GTAF) as objective function.

Background and Purpose Spasticity is a major disabling symptom in patients post stroke. Although studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) can reduce spasticity, the duration of single session TENS is a subject of debate. The purpose of this study was to determine the sustainability of the effects of TENS applied over common peroneal nerve in the reduction of ankle plantar-flexor spasticity and improving gait speed in patients post stroke. Methods Thirty patients (11 women and 19 men) (mean age of 46.46 years) were randomly assigned to group 1 (task oriented exercises), group 2 (TENS for 30 min and task oriented exercises) and group 3 (TENS for 60 min and task oriented exercises) for a period of five sessions per week for 6 weeks. All patients were assessed for ankle plantar-flexor spasticity, passive ankle dorsi-flexion range of motion, clonus and timed up and go test at the time of recruitment to study, at 3 and 6 weeks of therapeutic intervention. Results The overall results of the study suggest that there was a decrease in ankle plantar flexor spasticity, ankle clonus and timed up and go score in all the groups. A greater reduction of spasticity was seen in TENS groups (groups 2 and 3) when compared to control. No significant improvement was found in timed up and go test (TUG) scores between groups. Conclusion Both 30 min and 60 min of application of TENS are effective in reducing spasticity of ankle plantar flexors, improving walking ability and increase the effectiveness of task related training. Based on the effect size, we would recommend a longer duration application for the reduction of spasticity. Copyright © 2015 John Wiley & Sons, Ltd.

Rehabilitation interventions are expected to ensure best possible recovery and minimize functional disability in stroke survivors. However, not many studies have investigated patterns of recovery and outcomes after stroke in low-income countries. The objective of this study is to identify the biological, psychological, and social components associated with functioning over time in Indian stroke patients using the International Classification of Functioning, Disability and Health (ICF)-based tools and the Functional Independence Measure (FIM).The functioning profile of stroke survivors who received a standard multi-disciplinary rehabilitation was prospectively assessed using the ICF and the FIM at admission (baseline), at 1224 weeks. Descriptive analyses were performed to identify changes in the frequencies of ICF categories and qualifiers from admission to follow-up.One hundred and twenty-seven participants (mean age of 56 years) with mean FIM score 68 at baseline participated and completed the study. The mean FIM score at follow-up was 108. The numbers and frequency of ICF categories for activities and participation reduced after rehabilitation. More numbers of environmental factors were identified as barriers at follow-up (15 out of 33) compared to baseline. Within the components of Activities and Participation, significant improvement in functioning was found in 43 out of 51 categories.The results show a reduction in frequencies in ICF activities and participation categories corresponding to basic activities of daily living. Categories corresponding to employment and social integration showed little or no improvement.

While studies have looked into the effects of Maitland mobilization on symptom relief, to date, no work has specifically looked at the effects of Mulligan mobilization. The objective of this work was to compare the effectiveness of Maitland and Mulligan's mobilization and exercises on pain response, range of motion (ROM) and functional ability in patients with mechanical neck pain.A total sample of 60 subjects (21-45 years of age) with complaints of insidious onset of mechanical pain that has lasted for less than 12 weeks and reduced ROM were randomly assigned to: group I - Maitland mobilization and exercises; group - II Mulligan mobilization and exercises; and group-III exercises only, and assessed for dependent variables by a blinded examiner.Post measurement readings revealed statistical significance with time (p 0.00) and no significance between groups (p 0.05) indicating no group is superior to another after treatment and at follow-up. The effect sizes between the treatment groups were small.Our results showed that manual therapy interventions were no better than supervised exercises in reducing pain, improving ROM and neck disability.

In this paper, a typical 3-degree of freedom (3-DOF) translational parallel kinematic machine (PKM) is studied and analyzed whose tool platform has only translations along X-, Y- and Z-axes. It consists of three limbs, each of which have arm and forearm with prismatic-revolute-revolute-revolute (PRRR) joints. Inverse kinematics analysis is carried out to find the slider coordinates and joint angles for a given position of tool platform. Stiffness modeling is done based on the compliance matrices of arm and forearm of each limb. Using the stiffness modeling the variations of minimum and maximum translational stiffness in the workspace are analyzed. For various architectural parameters of the 3-DOF PKM the tendency of variations on the minimum and maximum stiffness over the entire workspace is studied; and also the deflections of the tool platform along X, Y, and Z directions with respect to various forces are presented.

Despite the popularity and an increased use of bone morphogenetic protein to improve bone healing in patients with congenital pseudoarthrosis of the tibia (CPT), no previous study has compared its efficacy against any other procedure. We randomised 20 consecutive patients (mean age 4.1 years) with CPT (Crawford type IV) associated with neurofibromatosis type 1(NF1) and no previous history of surgery into two groups. Group 1 received recombinant human bone morphogenetic protein-7 (rhBMP-7) along with intramedullary Kirschner (K)-wire fixation and autologous bone grafting; group 2 received only K wire and grafting. Outcome measures were time to achieve union, Johnston grade, tibial length and the American Orthopaedic Foot and Ankle Society (AOFAS) score, which were evaluated preoperatively and at five year follow-up. Study results showed that patients in group 1 achieved primary bone union at a mean of 14.5 months [standard error (SE) 5.2], whereas group 2 took a mean of 17.11 months (SE 5.0). However, the log-rank test showed no difference in healing times between groups at all time points (P = 0.636). There was a statistically significant pre- to post operative improvement (P

Fibular hemimelia is the most common lower extremity congenital longitudinal deficiency leading to cosmetic deformity, pain, and gait disturbance. Eight-plate hemiepiphysiodesis has proven to be successful in correcting angular deformity of the knee; it is an easy surgical technique and yields a more rapid rate of correction. The aim of this study was to determine the effectiveness of eight-plate hemiepiphysiodesis in bilateral genu valgum resulting from fibular hemimelia and overall height improvement in two girls and four boys with a mean age of 22 months who were followed up for a period of 18 months. The variables studied were arm span, the total height ratio, intermalleolar distance, tibiofemoral angle, and activity. All the parameters improved significantly. The mean improvement in the valgus was 7.41°. The mean intermalleolar distance reduced by 19.5 cm, and all patients achieved a significant improvement in lower limb function. Although there was significant improvement in total height, it still lagged behind arm span at the time of final follow-up. The results of eight-plate hemiepiphysiodesis were found to be satisfactory. We conclude that it is a reasonable treatment option for young patients with an adequate growth potential.

In this paper, stiffness modelling and analysis of a typical 3-DOF parallel kinematic machine (PKM) that provides translational motion along X, Y and Z axes is presented. The mechanism consists of three limbs each having an arm and a forearm with prismatic-revoluterevolute-revolute joints (PRRR). The joint arrangement is in such a way that the moving or tool platform maintains same orientation in the entire workspace. Through inverse kinematics, the joint angles for a given position of tool platform necessary for the stiffness modelling and analysis are obtained. The stiffness modelling is based on the compliance matrices of arm and forearm of each limb. Typical non-dimensional performance indices, namely, workspace volume index (WVI), global translational stiffness index (GTSI), and global rotational stiffness index (GRSI), are introduced and used to study the influence of dimensions. Attempts are also made to find the optimal dimensions of the translational PKM using multi-objective optimization based on the genetic algorithms (MOGA) in MATLAB. The methodology presented and the results obtained are useful for predicting the performance capability of the PKM under study.

Objectives The present study was aimed at investigating the effect of curcumin in combination with prednisolone for the effective treatment of arthritis with reduced side effects when glucocorticoids therapy is indicated. Methods Arthritis was induced in wistar rats by subplantar injection of Freund's complete adjuvant, and animals were observed for the symptoms of arthritis during the period of 21 days. Combined treatment of curcumin with various doses of prednisolone (1.25, 2.5 and 5 mg/kg) was evaluated in order to ascertain the efficacy and toxicity induced by steroid. Key findings Arthritic animals showed significant increase in tumour necrosis factor-α and IL-1β levels in paw tissue and IL-1β in serum. Combined therapy of curcumin with low doses of prednisolone showed pronounced beneficial effect on joint swelling, leucocyte count and biochemical parameters compared with prednisolone groups. Among the different doses used in the study, prednisolone at 1.25 mg/kg in combination with curcumin showed beneficial anti-arthritic activity and also reduced the steroid toxicity. This is evidenced by increase in body weight, low toxicity to immune organs, reduction in leucocyte count, increase in spleen anti-oxidant enzymes and potent inhibition of cytokines in combination group. Conclusion Therefore, combined treatment of curcumin with low doses of prednisolone may find therapeutic use in arthritis.

Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results.

Kalina power plants have an efficient system of heat recovery compared with a single-fluid system because of a better temperature match between hot and cold fluids. The high-temperature reg...

BACKGROUND Studies have shown that farming is associated with many agricultural workers experiencing low back pain (LBP). The rehabilitation of these workers should facilitate their functioning, activities and level of participation in an adequate way. OBJECTIVE The objectives of this study were to identify the health components associated with LBP and to evaluate the effectiveness of the interventions in returning agricultural workers with LBP to their vocation using the International Classification of Function (ICF) -based tools. METHODS Thirty-one full time agricultural workers from 3 different Indian states were prospectively assessed using the ICF core set for LBP. ICF core sets permitted analysis of limitations of function from both the participant and rehabilitation team's perspectives. Each ICF category was rated using an ICF qualifier. The components identified were linked to the ICF categorical profile and assessment sheet. The clinicians identified the global, service program and cycle goals based on ICF. The participants' functioning was followed over a 4-month period. RESULTS After intervention, the participants were able to undergo their routine activities without increases in pain. However, on returning to active farming, participants noted few improvements in the components d410 (changing basic body position), d415 (maintaining body position), d430 (lifting and carrying objects), d465 (moving around using equipment), d850 (remunerative employment) and d859 (work and employment, other specified and unspecified). CONCLUSION The results of the study conclude that the current interventions for LBP are not effective in returning agriculture workers with LBP in India to pain-free farming. There is an urgent need to individualize the health needs of agriculture workers.

The incidence of flatfoot is approximately 5% in children and adults. The symptomatic form of a flexible flatfoot produces subjective and objective complaints, including gait disturbances. Surgical intervention is considered when conservative management fails. The arthroereisis procedure provides a stable foot and durable correction. However, to the best of our knowledge, no study has evaluated the effectiveness of this procedure on gait parameters.Fifteen children with painful flatfeet (10 males; 5 females) with a mean age of 12 years and 6 months underwent the calcaneo stop procedure. Radiographic, gait analysis and functional measures were evaluated to assess the changes pre- and post-operatively.All children were followed up for a mean period of 4 years and 6 months. The overall results of the study exhibited statistically significant improvement for all radiographic variables, functional measures and range of motion investigated in the study (Although there was no significant improvement in the kinematic and kinetic variables investigated, this study supports the calcaneo-stop procedure as a reliable and effective procedure for treating paediatric flexible flatfoot.إن نسبة الأقدام المسطحة في الأطفال والبالغين هي حوالي ٥٪. ويُنتج النوع المصحوب بالأعراض من الأقدام المسطحة المرنة شكاوى ذاتية وموضوعية مثل اضطرابات المشية. ويُلجأ إلى التدخل الجراحي عند فشل العلاج التحفظي. وقد بينت الأبحاث أن إجراءات التقييد المفصلي توفر قدما مستقرة وتصحيحا متينا٬ إلا أنه لم تقم أي من الدراسات بتقييم فاعلية هذا الإجراء على معالم المشية.أُجريت عملية “إيقاف عظمة العقب” على ١٥ طفلا لديهم أقداما مسطحة مؤلمة (١٠ أولاد و٥ بنات) بمتوسط عمر ١٢ سنة و٦ أشهر. وتم تقييم الأشعة وتحليل المشية والقياسات الوظيفية لمعرفة التغيرات قبل وبعد العملية.تمت متابعة جميع الأطفال لمدة متوسطها ٤ سنوات و٦ أشهر. وأظهرت النتائج العامة للدراسة تحسنا ذا قيمة إحصائية لجميع المتغيرات الإشعاعية والقياسات الوظيفية ومدى الحركة التي تم التحقق منها في الدراسة. على الرغم من أن الدراسة أظهرت تحسنا في جميع المعالم الزمنية التي تم قياسها عند تحليل المشية٬ إلا أن النتائج لم تُظهر أي اختلافات ذات قيمة إحصائية في المتغيرات الحركية القياسية والحركية قبل وبعد الجراحة.على الرغم من عدم وجود تحسن ذي قيمة في المتغيرات الحركية القياسية والحركية التي تم التحقيق فيها٬ نستنتج بأن عملية “إيقاف عظمة العقب” هي عملية فعالة ويمكن الاعتماد عليها في علاج القدم المسطحة المرنة لدى الأطفال.

During the heat recovery in a Kalina cycle, a binary aqua–ammonia mixture changes its state from liquid to vapor, the more volatile ammonia vaporizes first and then the water starts vaporization to match temperature profile of the hot fluid. In the present work, a low temperature Kalina cycle has been investigated to optimize the heat recovery from solar thermal collectors. Hot fluid coming from solar parabolic trough collector with vacuum tubes is used to generate ammonia rich vapor in a boiler for power generation. The turbine inlet conditions are optimized to match the variable hot fluid temperature with the intermittent nature of the solar radiation. The key parameters discussed in this study are strong solution concentration, separator temperature which affects the hot fluid inlet temperature and turbine ammonia concentration. Solar parabolic collector system with vacuum tubes has been designed at the optimized power plant conditions. This work can be used in the selection of boiler, separator and turbine conditions to maximize the power output as well as efficiency of power generation system. The current model results a maximum limit temperature for separator as 150 °C at the Indian climatic conditions. A maximum specific power of 105 kW per kg/s of working fluid can be obtained at 80% of strong solution concentration with 140 °C separator temperature. The corresponding plant and cycle efficiencies are 5.25% and 13% respectively. But the maximum efficiencies of 6% and 15% can be obtained respectively for plant and Kalina cycle at 150 °C of separator temperature.

OBJECTIVES The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. METHODS In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. RESULTS Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p 0.05). None of the studied factors, except baseline pain (R = 0.227, R2 = 0.051, p

BACKGROUND AND PURPOSE Spasticity is a major disabling symptom in patients post stroke. Though studies have demonstrated that electrical stimulation (ES) can reduce spasticity and improve passive ankle range of motion (ROM), not many studies have evaluated the effectiveness of ES on active ankle ROM. The purpose of this study was to determine the effectiveness of Faradic and Russian currents in the reduction of ankle plantar-flexor spasticity and improving motor recovery in patients post stroke. METHODS Eighty-three patients (29 females and 54 males; mean age of 57.12 years) were randomly assigned to Group 1 (task-oriented exercises), Group 2 (Faradic current for 10 min and task-oriented exercises), and Group 3 (Russian current for 10 min and task-oriented exercises) for a period of 5 sessions per week for 6 weeks. All patients were assessed for soleus and gastrocnemius muscles spasticity measured by modified modified Ashworth scale; active and passive range ROM measured by goniometer; and functional ambulation measured by modified Emory Functional Ambulation Profile at the time of recruitment to study and after 6 weeks. RESULTS Both the types of stimulation and exercises were not associated with improvements in modified Emory Functional Ambulation Profile (p > 0.05). The results showed that all the groups are effective in improving passive ankle ROM (p

Background and objectives Decreased activity of hip abductor musculature has been suggested as a contributing factor for the disease progression in participants with symptomatic knee osteoarthritis (OA). In this study, the effectiveness of 6 weeks isolated hip abductor strengthening on WOMAC, 6 minute walk test and hip strength and endurance in participants with symptomatic medial compartment knee OA were studied. Material and method Thirty persons with medial compartment knee OA were randomized to hip abductor strengthening group (n = 15) and conventional group (n = 15). Both the groups received intervention for 5 times per week for 6 weeks. 6 minute walk test, health status (WOMAC), hip strength (by modified syphgmomanometer) and hip endurance (number of repetitions) were assessed at baseline and post intervention. The dependent variables were analyzed using 2 × 2 ANOVA, with repeated measurement as second factor to determine the effects of the intervention on each outcome variable. Results Significant group-by-time interactions were observed for each variable of interest. Post hoc testing revealed that all the outcome measures improved significantly in the hip abductor strengthening group following the 6-week intervention than the control group. Conclusion The incorporation of hip-strengthening exercises may be considered along with conventional exercises when designing a rehabilitation program for persons with knee OA.