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In this study, a CFD computational model has been established to properly simulate complex correctly expanded supersonic flow generated by a three-dimensional C–D nozzle for the purpose of Thrust Vector Control (TVC) simulations. Jet tabs affixed to the perimeter of the nozzle exit are used to achieve thrust vectoring. This study focuses on the estimation of the force on the tabs due to the jet issued from the C–D nozzle using Ansys 19.2 three-dimensional density based solver, implicit formulation with SST K–ω turbulence model. The force is calculated for different tab configurations based on tab sector angles of 60°, 90°& 120° for the designed Mach number and X/D ratio of 0.7. The nozzles with Mach 1.6, Mach 1.8 and Mach 2.0 designed using SolidWorks are compared. It has been observed that with an increase in sector angle, tab force increased by an average of 70 % for sector angle of 60° to 90° and 36 % for sector angle of 90° to 120°. [ABSTRACT FROM AUTHOR]

Introduction: Catheter-Related Blood Stream Infections (CRBSI) are an important complication of both non tunnelled and tunnelled haemodialysis catheters, but are often poorly reported for tunnelled haemodialysis-catheters. Aim: To assess the rate, aetiology, and outcomes of CRBSI in patients using a tunnelled catheter at 12-month and 18-month audits at the newly-opened haemodialysis unit having care bundle as a part of routine catheter care. Materials and Methods: A retrospective cross-sectional study involving two audits of CRBSI risk (12-month and 18-month audit) was conducted by the dialysis unit doctors and nursing staff at Medanta Super-Specialty Private Hospital, Indore, Madhya Pradesh, India. Centres for Disease Control (CDC) and prevention core intervention/care bundle for Blood Stream Infections (BSI) reduction were incorporated as a part of routine catheter care. The 12-month (May 2018 to April 2019) and 18- month (May 2018 to November 2019) internal clinical audit were evaluated to assess the impact of care bundle on incidence of CRBSIs. Kidney-Disease-Outcome Quality-Initiative (KDOQI)- 2006-criteria was used to define CRBSI. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0 software (IBM Corporation, New York, United States). Descriptive and dispersion statistical analysis was done for studied variables. Results: Total patients in 12-months audit with tunnelled haemodialysis catheter were 14 (7 male and 7 female) with median age 64 years and in 18-months audit patient with tunnelled haemodialysis catheter were 18 (11 male and 7 female) with median age 67.5 years. CRBSI incidence was 2.58 per 1000 catheter days at the end of 12-month, with 132 (71.25- 202.25) days of median catheter use. Over the 18-month, the incidence of CRBSI dropped to 1.99 per 1000 catheter days. Median period of catheter use increased to 149.5 (83.5-294.5) days. The primary organisms isolated were predominantly gram negative bacterias. Conclusion: Tunnelled catheters may be a reasonable alternative vascular access for haemodialysis in patients with arteriovenous fistula failure as implementation and maintenance of multidisciplinary care bundle reduces CRBSI rate in such patients.

Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Similarly, magnesium the blockade of N-methyl-D-aspartate (NMDA) receptor and calcium channel has an important meaning to anesthesia. However, side effects could be cardiac or respiratory complications. Therefore, we compared the intrathecal dexmedetomidine and magnesium sulphate for post-operative analgesia requirement reduction in patients undergoing spinal anaesthesia and analysing hemodynamic changes. All three drugs (dexmedetomidine, magnesium sulphate and hyperbaric bupivacaine) proved to be haemodynamically stable as clinically significant bradycardia and hypotension were not observed in any of the groups. The incidences of side effects were negligible in all the three groups. In conclusion, although longer duration of effect can be obtained by the addition of either dexmedetomidine or magnesium to intrathecal hyperbaric bupivacaine, dexmedetomidine showed a significantly prolonged effect and a faster onset with fewer side effects. [ABSTRACT FROM AUTHOR]

The emotional state of the learner is an important factor that must be taken into consideration during evaluating learning process and managing learning flows in computer based learning environments. This factor has a significant impact on the process of interaction between the learner and the learning environment. Enriching this type of interaction make the learning flow more dynamic based on emotional and mental responses of the learners. This approach can manage various learning flows based on learner's capabilities which lead to enhance the learning process outcome. This article provides data on learners' emotional states during their interaction with learning environment and other data that describe their learning activities and learning flows. The learning activities data is a combination of data that represents summary of learners' emotional states and data that represents the mental responses per learning session. All of emotional states data and mental responses data are used to provide the next learning level for each learner using fuzzy rules. The datasets are hosted in the Mendeley Dataset Repository (Megahed, 2019). Keywords: Fuzzy, Deep learning, Facial expressions, Learners, Learning environment, Emotional states