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A 36-year-old woman complained of bilateral lower limb weakness for the last 3 days. She could move her upper limb, neck, and facial muscles and had no respiratory or swallowing difficulties. About 4 years ago, she complained of sudden weakness involving her lower limbs. Two years later, she had another episode involving only the right upper limb. In both cases, she was hypokalemic and received oral and intravenous potassium. She is a known diabetic and has polycystic ovary disease. Her blood pressure was 150/100 mm Hg, and body mass index was 29. Her serum potassium was 2 mEq/L, plasma renin 5 ng/dL, plasma aldosterone 0.63 µIU/mL, and aldosterone to plasma renin activity ratio 8. Cushing syndrome was considered a possibility. Subsequent analysis indicated a baseline cortisol level of 19.6 µg/dL at 8 Am. A screening overnight 1-mg dexamethasone suppression test (DST) showed 17 µg/dL cortisol. The low-dose DST revealed a cortisol level of 10.8 µg/dL. Adrenocorticotropin level was 196 pg/mL, and 24-hour urinary cortisol level was 1284 mg/dL. A high dose of 8-mg DST at 11 Pm to find the source of hypercortisolism performed yielded 15.9 µg/dL. Magnetic resonance imaging of the pituitary displayed a well-defined, heterogeneously enhanced mass lesion (15 × 13 × 11 mm) in the sella with mild suprasellar extension. Transsphenoidal resection and stereotactic radiosurgery were performed on the tumor with hormone replacement and glycemic control following surgery. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is usually a progressive disease impacting almost all the bodily functions. Hypothyroidism is diagnosed when low levels of the thyroid hormones result in elevated levels of thyroid-stimulating hormone (TSH), whereas subclinical hypothyroidism (SCH) is diagnosed when TSH levels are elevated above the upper limit of the assay reference range with normal thyroid hormone levels. As the heart is the main target of thyroid hormone activity, hypothyroidism may precipitate or aggravate heart failure, influencing heart rate and blood pressure (BP) while increasing cardiovascular (CV) stiffness and also cardiomegaly. Subclinical hypothyroidism can cause changes in cardiovascular function same as observed in overt hypothyroidism there by indicating that cardiac effects progress from subclinical disease through overt hypothyroidism. Aims and objectives: To study the effect of subclinical hypothyroidism on clinical, biochemical and cardiac profile in the patients aged between 18 to 80 years in tertiary care centre. Materials and methodology: The present cross-sectional study was conducted in the department of General Medicine by recruiting the patients aged between 18 to 80 years, willing to give consent and are newly diagnosed subclinical hypothyroidism patients among in-patients and out-patients attending Rajarajeswari Medical College and Hospital. Results: Out of 100 patients included in our study, 74 patients were found to be at lower risk, 26 patients at intermediate and high risk. . Age, Obesity and Co-morbid conditions has significant positive association with the CVS risk. Moderately significant changes were observed in the ECG and 2D Echo changes among the patients with high-risk category than those with low and intermediate risk. Conclusion: All the study subjects were at risk of developing cardiovascular complication in their future based on the Framingham Risk Score. Although, the incidence of SCH was found to be common among young age group, the CVS risk score was increased with the age. Hence, we advocate that all the patients diagnosed with SCH must be screened for CVS risk assessment to initiate the early treatment and avoid the further complications. [ABSTRACT FROM AUTHOR]

Background: The incidence of Thyroid dysfunction in diabetics is higher than that of general population. Undiagnosed thyroid dysfunction may affect the metabolic control and enhance cardiovascular and other chronic complications in diabetic patients. Diabetes mellitus is one of the most common disease in the world and is acquiring epidemic Proportions in developed and developing countries. Indians are genetically more susceptible to diabetes. The prevalence of Type 2DM is on the rise much more rapidly, which is due to increasing obesity and reduced activity levels. Several studies have assessed the relationship between thyroid function and micro-vascular complications in patients with T2DM. Few studies have examined the relationship between subclinical hypothyroidism(SCH) and vascular complications in patients with Type 2 diabetes mellitus. Objectives: To study the association between TSH levels and microvascular complications of Type 2 DM. Materials and Methods: A total of 100 type 2 diabetes patients (40 males and 60females) were enrolled in this cross-sectional study. Subjects were evaluated for neuropathy, thyroid function, diabetic retinopathy, and diabetic kidney disease. TSH was divided into 3 levels: 0.27-2.49 mU/l, 2.5-4.2 mU/l and >4.2mU/l and <10 mU/l with normal FT4 Results: Our study found statistically positive association of elevated TSH and microalbuminuria, macroalbuminuria, low GFR and impaired vibration sensation. Our study found no association between elevated TSH and age, diabetes duration, HbA1c levels and retinopathy. Conclusion: In our study we could not establish an association between TSH levels and diabetic Retinopathy. However, we found an association between elevated TSH levels and Diabetic Neuropathy and DKD. Hence it is ideal to screen all patients with Diabetes for Thyroid dysfunction, as elevated TSH levels in these patients can be an indicator of underlying micro-vascular complications. However, more research, involving more subjects is required with regard to the above. [ABSTRACT FROM AUTHOR]

Background: Conn's syndrome, also known as primary aldosteronism, is a rare disease that can manifest at a young age. Resolving the underlying cause of hypertension is crucial, as seen in this case report. Clinical Case: A 17-year-old female patient was admitted with a history of recurrent fever over the past 6 months, bifrontal headaches, palpitations, and myalgia for the past 4 months. Examination revealed resistant hypertension, and laboratory results showed persistent hypokalemia and an elevated aldosterone/renin ratio. CT imaging revealed a left adrenal adenoma. A laparoscopic intervention successfully addressed the uncontrolled hypertension. Histological examination confirmed a diagnosis of a benign adrenal cortical adenoma. Conclusion: Post-surgery, the patient's overall condition significantly improved, and blood pressure was effectively controlled. This case report underscores the rare presentation of Conn's syndrome in young individuals and emphasizes the importance of investigating specific underlying causes of hypertension to prevent associated morbidity and mortality. Figure 1. Conns syndrome, CT scan, histology section gross. CECT scan of abdomen and pelvis - left adrenal adenoma gross section - cut section adrenal gland -showing 2 cysts one on medial side 1*1cm and inferiolateral side 1*0.5cm histology of the removed adrenal confirmed diagnosis of benign adrenal cortical adenoma Table 1. Conns syndrome investigations Table 2. Conns syndrome investigations [ABSTRACT FROM AUTHOR]

Alarm systems are essential for the safe and efficient operation of process industries. However, complex plant connectivity and process interactions could cause many correlated alarms in practice and thus compromise alarm system performance. To address correlated alarms, it is desired that alarm correlations are discovered from historical Alarm and Event (A&E) logs, so the obtained results could help improve alarm configurations or design suppression strategies. Motivated by this problem, a systematic method to extract alarm correlation is proposed in this work and the contributions are: (1) Correlated alarms and their occurrence orders are captured as correlation patterns through pattern mining, and such patterns are characterized by statistical features. (2) Alarm correlations and their statistical features are visualized as network graphs to indicate process interactions and identify alarms for prioritized analysis. To demonstrate the effectiveness of the proposed method, case studies are provided using an industrial simulation benchmark Vinyl Acetate Monomer (VAM) plant model. • A systematic method to discover and analyze correlated alarms is proposed. • Alarm correlations are extracted as correlation patterns from historical data. • Correlation patterns and their statistical features are visualized as network graphs. • The analysis captures process interactions and helps prioritize alarm management. [ABSTRACT FROM AUTHOR]

Background The ideal severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) testing method would be accurate and also be patient-performed to reduce exposure to healthcare workers. The aim of this study was to compare patient-performed testing based on a morning saliva sample with the current standard testing method, healthcare worker-collected sampling via a nasopharyngeal swab (NPS). Methods This was a prospective single center study which recruited 217 asymptomatic adult male participants in a coronavirus disease 2019 (COVID-19) quarantine center who had tested positive for SARS-CoV-2 8–10 days prior to isolation. Paired NPS and saliva specimens were collected and processed within 5 hours of sample collection. Real time reverse transcription polymerase chain reaction (RT-PCR) targeting Envelope (E) and RNA-dependent RNA polymerase (RdRp) genes was performed and the results were compared. Results Overall, 160 of the 217 (74%) participants tested positive for COVID-19 based on saliva, NPS, or both testing methods. The detection rate for SARS-CoV-2 was higher in saliva compared to NPS testing (93.1%, 149/160 vs 52.5%, 84/160, P <.001). The concordance between the 2 tests was 45.6% (virus was detected in both saliva and NPS in 73/160), whereas 47.5% were discordant (87/160 tested positive for 1 whereas negative for the other). The cycle threshold (Ct) values for E and RdRp genes were significantly lower in saliva specimens compared to NP swab specimens. Conclusions Our findings demonstrate that saliva is a better alternative specimen for detection of SARS-CoV-2. Taking into consideration, the simplicity of specimen collection, shortage of PPE and the transmissibility of the virus, saliva could enable self-collection for an accurate SARS-CoV-2 surveillance testing. [ABSTRACT FROM AUTHOR]

Background. The spread of carbapenem-resistant A. baumannii (CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility to β-lactams. The aim of this study was to analyze β-lactamase genetic compositions of CrAb in Malaysia. Methods. Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016. Results. Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multiple β-lactamase genes. blaOXA-23 (n = 13) and blaOXA-66 (n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harbor blaADC, blaOXA-51-like, and blaOXA-23-like genes. blaTEM (n = 7), blaNDM-1 (n = 3), blaCARB-8 (n = 1), and blaPER-3 (n = 1) are amongst other β-lactamase genes found in this study. ISAba1 was found upstream to blaOXA-23 (n = 13), blaOXA-66 (n = 1), and blaADC (n = 11). All blaNDM-1 isolates had ISAba125 (mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008 and Tn2009 but were negative for Tn2007. Conclusion. Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings. [ABSTRACT FROM AUTHOR]

Introduction. Leptospirosis is an acute febrile illness, known for its protean clinical manifestations and the challenge in differentiating from other infectious diseases. Standardized confirmatory test is antibody dependent and not accessible by the suburban community. This study measures efficiency of an immune-chromatographic assay, Leptocheck WB, in detecting acute leptospirosis. Methods. A total of 142 sera were used for kit evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing rapid kit results with gold standard laboratory, microscopic agglutination test (MAT). Results. We found this rapid kit to have a sensitivity and specificity of 66.6% and 78.9%, respectively, whereas the PPV and NPV of the kit appeared to be 73.3% and 73.2%, respectively. Discussion. Test efficiency of this rapid kit is reasonable. It is specific in detecting leptospiral antibody and assures clinician of accurate diagnosis by having higher PPV and NPV. It is prompt and efficient in comparison with conventional methods in assisting differential diagnosis. High sensitivity and specificity leptospirosis rapid test is indeed a crucial measure to assist the diagnosis of acute undifferentiated febrile illnesses. [ABSTRACT FROM AUTHOR]

Cardiac Resynchronization Therapy and QRS Axis. Background: Mildly symptomatic heart failure (HF) patients derive substantial clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D) as shown in MADIT-CRT. The presence of QRS axis deviation may influence response to CRT-D. The objective of this study was to determine whether QRS axis deviation will be associated with differential benefit from CRT-D. Methods : Baseline electrocardiograms of 1,820 patients from MADIT-CRT were evaluated for left axis deviation (LAD: quantitative QRS axis -30 to -90) or right axis deviation (RAD: QRS axis 90-180) in left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific interventricular conduction delay QRS morphologies. The primary endpoints were the first occurrence of a HF event or death and the separate occurrence of all-cause mortality as in MADIT-CRT. Results: Among LBBB patients, those with LAD had a higher risk of primary events at 2 years than non-LAD patients (20% vs 16%; P = 0.024). The same was observed among RBBB patients (20% vs 10%; P = 0.05) but not in IVCD patients (22% vs 23%; P = NS). RAD did not convey any increased risk of the primary combined endpoint in any QRS morphology subgroup. When analyzing the benefit of CRT-D in the non-LBBB subgroups, there was no significant difference in hazard ratios for CRT-D versus ICD for either LAD or RAD. However, LBBB patients without LAD showed a trend toward greater benefit from CRT therapy than LBBB patients with LAD (HR for no LAD: 0.37, 95% CI: 0.26-0.53 and with LAD: 0.54, 95% CI: 0.36-0.79; P value for interaction = 0.18). Conclusions: LAD in non-LBBB patients (RBBB or IVCD) is not associated with an increased benefit from CRT. In LBBB patients, those without LAD seem to benefit more from CRT-D than those with LAD. (J Cardiovasc Electrophysiol, Vol. 24, pp. 442-448, April 2013) [ABSTRACT FROM AUTHOR]

This paper presents a modeling technique to study the vibroacoustics of multiple-layered viscoelastic laminated beams using the Biot damping model. In this work, a complete simulation procedure for studying the structural acoustics of the system using a hybrid numerical model is presented. The boundary element method (BEM) was used to model the acoustical cavity, whereas the finite element method (FEM) was the basis for vibration analysis of the multiple-layered beam structure. Through the proposed procedure, the analysis can easily be extended to another complex geometry with arbitrary boundary conditions. The nonlinear behavior of viscoelastic damping materials was represented by the Biot damping model taking into account the effects of frequency, temperature, and different damping materials for individual layers. The curve-fitting procedure used to obtain the Biot constants for different damping materials for each temperature is explained. The results from structural vibration analysis for selected beams agree with published closed-form results, and results for the radiated noise for a sample beam structure obtaine dusing a commercial BEM software are compared with the acoustical results of the same beam by using the Biot damping model. [ABSTRACT FROM AUTHOR]

The authors discuss the logic behind the call by the global community of mental health professionals (MHP) and researchers calling for action on global mental health (GMH). The call acknowledges the acute shortfall of resources, which it plans to overcome with increased government expenditure, primarily on community based services. Meeting the challenges of GMH needs an understanding of globalized mental health and research on how global economic and political forces structure mental health.

Risk of Mortality for Ventricular Arrhythmia. Background: There are limited data regarding the incidence and prognostic significance of ventricular arrhythmias (VA) in ambulatory continuous flow left ventricular assist device (LVAD) patients. Methods: Sixty-one consecutive patients from November 1, 2006 through December 31, 2010 with an LVAD and implantable cardioverter defibrillator that survived to discharge from the LVAD implantation admission were studied. Follow-up began from date of discharge with both devices in situ and ended with death, transplant, on June 1, 2011. Pre-LVAD VA history was related to the primary endpoints of post-LVAD VA, mortality, and the combined endpoint of post-LVAD VA/mortality. Results: During a mean follow-up of 622 days 19 patients (31%) experienced VA (14 episodes of VT, 5 episodes of VF). Pre-LVAD VA was predictive of post-LVAD VA (hazard ratio [HR] 2.91, P = 0.026) and the combined post-LVAD VA/mortality endpoint (HR 2.70, P = 0.021) but only displayed a nonsignificant association with mortality (HR 2.30, P = 0.11). In multivariate analysis, pre-LVAD VA remained a significant predictor of post-LVAD VA (HR 2.84, P = 0.03) and the combined post-LVAD VA/mortality endpoint (HR 2.65, P = 0.025). Post-LVAD VA was the strongest univariate predictor of mortality (HR 13.92, P < 0.001) and remained so after multivariate adjustment (HR 9.69, P = 0.001). Post-LVAD VA occurred at a mean of 1 year from mortality events with 45% within 1 month. Conclusions: Pre-LVAD VA is a significant predictor of post-LVAD VA but not of mortality. VA in the continuous flow LVAD population carries a significant risk of mortality often within the first month. (J Cardiovasc Electrophysiol, Vol. 23, pp. 515-520, May 2012) [ABSTRACT FROM AUTHOR]

Squeeze film damping effects naturally occur if structures are subjected to loading situations such that a very thin film of fluid is trapped within structural joints, interfaces, etc. An accurate estimate of squeeze film effects is important to predict the performance of dynamic structures. This paper presents a finite element solution to the coupled fluid–structure problem of squeeze film dampers. The squeeze film is governed by the linearized isothermal Reynolds equation, which is known from lubrication theory. The structure which is modeled using Reissner–Mindlin plate theory is discretized by four-noded two-dimensional shear deformable isoparametric plate elements. The coupled finite element formulation is derived and an alternative solution to obtain damped eigenvalues and eigenvectors is presented. The coupling between fluid and structure is handled by considering the pressure forces and structural surface velocities on the boundaries. The effects of the driving parameters on the frequency response functions are investigated. It was found that the ambient pressure has no significant effect on the frequency responses, unlike on the damping force of dynamical MEMS systems. The results obtained from the presented model are compared with the experimental and analytical results available in the literature and a very good agreement is found. [ABSTRACT FROM PUBLISHER]

Patients with congenital structural heart disease (CSHD) and inherited arrhythmias (IAs) are at high risk of ventricular tachyarrhythmias and sudden cardiac death. The present study was designed to evaluate the short- and long-term outcomes of patients with CSHD and IA who received a wearable cardioverter-defibrillator (WCD) for the prevention of sudden cardiac death. The study population included 162 patients with CSHD (n = 43) and IA (n = 119) who were prospectively followed up in a nationwide registry from 2005 to 2010. The mortality rates were compared using Kaplan-Meier survival analysis. The mean age of the study patients was 38 ± 27 years. The patients with CSHD had a greater frequency of left ventricular dysfunction (ejection fraction <30%) than did the patients with IA (37% vs 5%, respectively; p = 0.002). The predominant indication for WCD was pending genetic testing in the IA group and transplant listing in the CSHD group. Compliance with the WCD was similar in the 2 groups (91%). WCD shocks successfully terminated 3 ventricular tachyarrhythmias in the patients with IA during a median follow-up of 29 days of therapy (corresponding to 23 appropriate WCD shocks per 100 patient-years). No arrhythmias occurred in the patients with CSHD during a median follow-up of 27 days. No patients died while actively wearing the WCD. At 1 year of follow-up, the survival rates were significantly lower among the patients with CSHD (87%) than among the patients with IA (97%, p = 0.02). In conclusion, our data suggest that the WCD can be safely used in high-risk adult patients with IA and CSHD. Patients with IA showed a greater rate of ventricular tachyarrhythmias during therapy but significantly lower long-term mortality rates. [ABSTRACT FROM AUTHOR]

The article discusses issues related to the shortage of human resources for health in India in relation to efforts by the Indian government to move towards universal health coverage. It presents a background of the country's commitment to providing a universal, affordable health care to its citizens. It cites the lack of a significant improvement in public health education due to the fact that it is restricted to medical colleges. The state of human resources in health is also described.

The viscoelastic damping treatment is a very popular method for attenuating vibration and noise problems. It provides the designer much flexibility in adjusting the system damping to eliminate resonances in the structures. A survey of the previous research on material damping models found inadequacies in developing the numerical models of multiple-layer constrained layers and the introduction of the combination of different viscoelastic damping materials through advanced frequency domain damping models. In this paper, a detailed numerical analysis and design of a multiple-layer constrained damping structure using the Biot damping model are presented to investigate the vibration performance. The nonlinear curve fitting of the complex shear modulus and the transient response solution of the numerical viscoelastic damping structure are also discussed. By the proposed approach, the simple beam problem that is presented can be easily extended to the industrial problem with arbitrary geometries and boundary conditions. The validation of this numerical approach is proven by comparison with the previous closed-form results. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the applicability of an in situ technique based on ISO 13472-1 standard for measuring the acoustic absorption coefficient of grass and artificial turf surfaces for normal incidence from a sound source. The in situ method is based on acoustic impulse response measurement of the material surface. A maximum length sequence (MLS) signal is played through a loudspeaker and the acoustic response from the surface is recorded using a single microphone. The fast Hadamard transform and fast Fourier transform based digital signal post-processing algorithm provides the acoustic absorption coefficient of the surface under test. The normal incidence acoustic absorption coefficient of a commercial artificial quash surface of Dow Co. obtained from this method was compared with the results from the ASTM E1050 impedance tube method for the same surface. The acoustic absorption coefficients of a test-site grass surfaces were measured for 30mm and 100mm length of grass blades in wet and dry soil conditions. Substantial difference in the acoustic absorption coefficient was observed for a similar grass-like artificial surface used for estimating sound power of commercial garden equipments and lawnmowers. The advantage of the in situ method lies in its ability to measure the normal incident acoustic absorption coefficient of any planar surface as installed or in situ. Additionally a quick testing time of less than a minute with the use of a laptop sound card based inexpensive data acquisition system is the main feature of this robust method. [Copyright &y& Elsevier]

While interest in golf has been growing over the years, many golf courses have been losing money. This article describes a spreadsheet-based performance evaluation system for a Texas golf course. A profit-linked, multi-factor productivity measurement model is used on multiperiod data to analyze performance, isolate problem areas, and recommend measures to revitalize the course. [ABSTRACT FROM PUBLISHER]

Mohan Rao traces the history of the last five years of India's population momentum in relation to state and central policies. He argues that despite the Cairo rhetoric taken up in New Delhi this does not find reflection in policies in the states, and indeed in many other policies emanating from the centre. Looking at the laws and practices and the struggles of women's health groups in Indian states, he suggests that doomsday demo graphic discourses continue to dictate reproductive health policy based on the assumption that social and economic problems stem primarily from population growth. [ABSTRACT FROM AUTHOR]

Viscoelastic layered systems provide a simple and flexible solution for damping vibration of sheet metal panels. They also help to effectively eliminate noise from resonant structures and surfaces. This article presents an analytical formulation to predict the stiffness and damping of three layered beams with two different viscoelastic materials adjacent to each other. The complex modulus approach is used to model the elastic and shear moduli of the viscoelastic material and closed-form equations are derived for predicting system stiffness and damping. The model is derived for unsymmetrical setups using variational methods. Experiments are conducted on simply supported three-layered beams at different temperatures to validate theoretical results. Similar results are obtained from both the theoretical model and the experiments. A procedure for the optimization of structural and material parameters for maximizing the damping and minimizing the system mass for a given temperature and frequency range is also presented. [ABSTRACT FROM AUTHOR]

Abstract: This paper describes the framework for a comprehensive productivity analysis procedure and presents a prototype expert system that attempts to provide this analysis. The importance of this work stems from the current lack of formal, integrated methodologies that go beyond productivity measurement for interpreting and evaluating performance data. This system was developed using spreadsheet software for the measurement part and expert systems development software with an interface to spreadsheets for the rest. It incorporates rules for recognizing time-series patterns as well as the degree of severity. The system can further be developed to include diagnosing the root causes of problems and also recommending possible solutions or further analyses. [Copyright &y& Elsevier]

This paper describes a comparison, both analytically and experimentally, between two widely used loss factor estimation techniques frequently used in statistical energy analysis. Analytical models of simple spring/mass/damper systems were created to compare frequency-averaged loss factor values from the single subsystem power injection method and the impulse response decay method. The parameters of the analytical models were varied to study the effects of the total number of modes, amount of damping, location of modes within frequency bands, and the width of the frequency bands on loss factor estimation. The analytical study shows that both methods give accurate loss factor values as long as the damping values remain realistic for linear systems and at least one modal resonance is present in each frequency band. These analytical results were verified experimentally by measuring the loss factors of simple steel plates, with and without damping treatments applied. © 2005 Acoustical Society of America. [ABSTRACT FROM AUTHOR]

An analytical formulation Is presented for predicting the stiffness and damping of constrained layered beams that have multiple viscoelastic damping layers. A model is derived for symmetrical setups using variational methods. The equations to evaluate the stiffness and damping are derived in closed form and can be evaluated for different boundary conditions. The complex modulus approach is used to model the elastic and shear moduli of the viscoelastic material. A parametric analysis has been conducted to study the effects of different parameters on the damping and stiffness of the system under simply supported boundary conditions. The optimization process to obtain structural and material parameters maximizing system damping for a given temperature and frequency range is also presented. [ABSTRACT FROM AUTHOR]

In this paper, the application of passive damping technology using viscoelastic materials to control noise and vibration in vehicles and commercial airplanes is described. Special damped laminates and spray paints suitable for mass production and capable of forming with conventional techniques are now manufactured in a continuous manner using advanced processes. These are widely used in the automotive and aerospace industry in a variety of applications to reduce noise and vibration and to improve interior sound quality. Many of these recent applications are not readily available for dissemination in academe and archival literature. It is hoped that the material presented in this paper will be useful for instruction and further research in developing new and innovative applications in other industries. [Copyright &y& Elsevier]

In quantitative models of international conflict, the variables' causal effects are generally assumed to be constant over historical time. Yet, qualitative liberal theorizing, especially that of Immanuel Kant, has tended to emphasize a dynamic perspective based on the theme of progress. To bridge this gap between method-imposed stasis and theoretical dynamics, a framework featuring time-varying parameters is applied to the democratic peace hypothesis. The model strongly confirms a dynamic reinterpretation of Kant's theory. Results show that dispute probabilities decline steadily among democratic states over time, and the democratic peace hypothesis is not just a transient cold war effect. This result is robust to statistical control involving geopolitical and liberal control variables, including alliances, capabilities, and economic development. [ABSTRACT FROM AUTHOR]

Describes a profit-linked productivity measurement model. Excel application of the model; Benefits; Extensions.

Background: India has the highest tuberculosis (TB) burden, accounting for one-fifth of the global incidence and two-third of the cases in Southeast Asia with an estimated 1.9 million new cases every year. Identifying and treating latent TB infection (LTBI) can reduce the risk of development of active disease by up to 90%, thereby decreasing a major burden to the prevalence of the disease, and thus reducing potential sources in future. Aim: Early diagnosis of LTBI by tuberculin skin test (TST) and a newer interferon-gamma release assay (IGRA). Materials and Methods: Seventy-seven clinically asymptomatic household contacts (≤18 years) of confirmed pulmonary TB patients were enrolled to compare the performance of TST and IGRA to diagnose LTBI. At baseline, all participants underwent testing for IGRA and TST. Results: TST showed positivity of 22%, while IGRA demonstrated positivity of 40% in the diagnosis of latent TB. Kappa value at 95% confidence interval was 0.4753, indicates a moderate agreement between the two tests. This indicates that IGRA is a better predictor of latent TB. Maximum positive percentage was in the age group of 16–18 years in both the tests followed by 1–5 years. Conclusion: IGRA is a better predictor or diagnostic marker of LTBI. Although TST remains the preferred method of testing LTBI, IGRAs like ETB-Feron; a more efficient diagnostic test can be preferred based on patient affordability, logistics, and individual preferences. [ABSTRACT FROM AUTHOR]

Editorial. Discusses evidence of an impending critical shortfall in general practitioners to work in deprived areas in Great Britain. Decrease in the number of medical students specializing in general practice; How a planned increase in enrollment at medical schools may not solve the shortfall problem; Opinion that doctors need to be trained and better compensated to work in deprived areas.

This work aims at optimizing the power density of Graphite/NiO composite ink-based flexible thermoelectric generators by varying the concentration of nickel oxide nanoparticles annealed at different temperatures. NiO nanoparticles containing porous structure, higher microstrain, dislocation in their lattice structure, and higher resistivity due to the varied annealing temperature reduced the carrier concentration and mobility resulting in the enhanced Seebeck coefficient, power output, and power density. Flexible thermoelectric generator screen printed with Graphite/NiO composite ink consisting of an optimum of 3.0 wt% NiO nanoparticles annealed at 400 °C exhibited superior performance. The maximum power density, Seebeck coefficient, and power output shown by this device at 100 °C temperature gradient are 4.10 mW/m2, 47.06 µV/K, and 0.80 nW, respectively. This work demonstrates the suitability of graphite and nickel oxide composite for the screen-printed flexible thermoelectric generator for low-temperature applications. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy that is usually associated with preceding respiratory or gastrointestinal infection and has the hallmark manifestation of ascending flaccid paralysis. We report an atypical presentation of GBS. Case Report: A 76-year-old male presented with acute onset of diaphoresis and altered mental status. He subsequently developed severe bradycardia and refractory hypotension, which initially responded to dopamine infusion. A temporary pacemaker wire was placed to stabilize the heart rate but hypotension persisted. Acute autonomic dysfunction was suspected. Head and chest imaging was unrevealing. Lumbar puncture revealed albuminocytologic dissociation that was consistent with a diagnosis of GBS. Hospital course was complicated with acute kidney injury and metabolic acidosis. Plasmapharesis was initiated. The patient eventually died of multi-organ failure. Conclusions: Autonomic dysfunction is a known but rare presentation of GBS. In patients presenting with refractory bradycardia and hypotension, GBS should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Outcomes of patients with implanted left ventricular assist device (LVAD) implantation experiencing a cardiac arrest (CA) are not well reported. We aimed at defining the in-hospital outcomes of patients with implanted LVAD experiencing a CA.Methods: The national inpatient sample (NIS) was queried using ICD9/ICD10 codes for patients older than 18 years with implanted LVAD and CA between 2010-2018. We excluded patients with orthotropic heart transplantation, biventricular assist device (BiVAD) implantation and do not resuscitate (DNR) status.Results: A total of 93,153 hospitalisations between 2010 and 2018 with implanted LVAD were identified. Only 578 of these hospitalisations had experienced CA and of those, 173 (33%) hospitalisations underwent cardiopulmonary resuscitation (CPR). The mean age of hospitalisations that experienced a CA was 60.61±14.85 for non-survivors and 56.23±17.33 for survivors (p=0.14). The in-hospital mortality was 60.8% in hospitalisations with CA and 74.33% in hospitalisations in whom CPR was performed. In an analysis comparing survivors with non-survivors, non-survivors had more diabetes mellitus (DM) (p=0.01), and ischaemic heart disease (IHD) (p=0.04). Age, female sex, peripheral vascular disease and history of coronary artery bypass graft (CABG) were independently associated with increased mortality in our cohort. Also, ventricular tachycardia (VT) and CPR were independently associated with in-hospital mortality. During the study period, there was a significantly decreasing trend in performing CPR in LVAD hospitalisations with CA.Conclusion: In conclusion, age, female sex, peripheral vascular disease, history of CABG, VT and CPR were independently associated with in-hospital mortality in LVAD hospitalisations who experienced CA. [ABSTRACT FROM AUTHOR]

Electrical discharge machining (EDM) is one of the earliest non-traditional machining processes, based on thermoelectric energy between the workpiece and an electrode. In this process, the material is removed electro thermally by a series of successive discrete discharges between two electrically conductive objects, i.e., the electrode and the workpiece. The performance of the process, to a large extent, depends on the material, design and manufacturing method of the electrodes. Electrode design and method of its manufacturing also affect on the cost of electrode. Researchers have explored a number of ways to improve electrode design and devised various ways of manufacturing. The paper reports a review on the research relating to EDM electrode design and its manufacturing for improving and optimizing performance measures and reducing time and cost of manufacturing. The final part of the paper discusses these developments and outlines the trends for future research work. [ABSTRACT FROM AUTHOR]

Chromite ore pellets are used for ferrochrome production by the smelting reduction process. The strength and porosity of the sintered pellets play a significant role in smelting reduction. Granulometry of the chromite fines used for pellet production is an imperative enabler which controls the pellet strength and porosity by packing of particles and formation of bonds due to melting of gangues at high temperature sintering. The effect of chromite ore granulometry and sintering process parameters was evaluated to improve the metallurgical performance of pellets in a submerged arc furnace. The drop test, compressive strength and porosity of sintered pellet samples from plant and laboratory tests were evaluated. Mathematical correlations of the pellet properties (strength and porosity), ore granulometry and sintering parameters were determined using Statistica (ver7), statistical software package. It was found that ore granulometry, i.e. particle size, plays a vital role in the pelletisation process by controlling the number of contact points for bond formation and due to different liberation and smelting reduction characteristics of gangue minerals. It was concluded that for Sukinda chromite ores, required pellet properties can be achieved by maximising the 74–37 μm fraction of chromite fines in the charge and sintering at 1000°C. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents a stochastic dislocation model of fatigue crack propagation in ductile alloys under variable-amplitude load. The model is built through collective motion of a large number of dislocations. Four basic dislocation mechanisms, the generation, gliding, annihilation and pinning of dislocations are accounted for through a series of constitutive rules and incorporated into this model. Model predictions are in agreement with leading fracture mechanics-based models and experimental data under both constant-amplitude and variable-amplitude loads. The load extrusion effect caused by overloads is explained using a push-off mechanism of pinned dislocations. The randomness of fatigue crack growth is also addressed in this paper by investigating the evolution of dislocation distribution in the grain at the crack tip of a specimen. Since it has been experimentally established that dislocations play a vital role in fatigue, the physics and micro mechanisms of fatigue crack growth can be better understood by such a stochastic dislocation model as presented in this paper. Dislocation model simulations in literature so far have been able to predict few fatigue trends but are not sufficiently accurate to be used in engineering, where fracture mechanics-based (bulk) models are deemed more reliable. [Copyright &y& Elsevier]

Introduction: The role of anticoagulation in octogenarians and nonagenarians with atrial fibrillation (AF) is controversial due to the lack of evidence from randomized controlled trials (RCTs), owing to the under representation of these patients in clinical trials. Aim: In the present meta-analysis we aim at comparing the clinical benefits and risk of anticoagulation (AC) with no AC in octogenarians and nonagenarians. Methods: We systematically searched MEDLINE/PubMed, EMBASE/Ovid, and Web of Science databases from the inception to October, 2020. Studies were eligible for inclusion if they met the following criteria: studies comparing AC with no AC in patients aged 80 or more for AF and reported thromboembolic events (TE) and bleeding outcomes. We used Mantel-Haenszel method with a Paule-Mandel estimator of Tau2 with Hartung Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Outlier analysis was used to adjust for statistical heterogeneity. Results: A total of 10 observation studies and 1 RCT were included in the final analysis. There was no difference in the risk of TE with AC in octogenarians and nonagenarians compared with no AC, before [RR: 0.87, 95% CI 0.62–1.23, I2: 71%, GRADE confidence "very low"] and after [RR: 0.83, 95% CI 0.66–1.04, I2: 55.5%] adjusting for statistical heterogeneity among studies. In the unadjusted analysis, no difference in the risk of bleeding events was observed between both groups [RR: 1.05, 95% CI 0.62–1.77, I2: 86%, GRADE confidence "very low"]. After adjusting for heterogeneity, AC was associated with an increased risk of bleeding compared with those not receiving AC [RR: 1.57, 95% CI 1.44–1.71, I2: 0%]. AC in octogenarians was not associated with a net clinical benefit compared with no AC. Conclusions: This meta-analysis did not demonstrate any difference in the risk TE in octogenarians and nonagenarians with AF on AC vs. no AC, in both the adjusted and unadjusted analyses. Also, the risk of bleeding events in the unadjusted analysis was similar between both groups. The adjusted analysis showed an increased risk of bleeding in the AC group compared with no AC group. More data is needed to establish safety and efficacy of AC in this vulnerable patient population. The results of this analysis should be interpreted with caution due to the observational nature of most studies included, and the only RCT reported lower rates of TE and similar risk of bleeding. [ABSTRACT FROM AUTHOR]

Background: This meta‐analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) are limited by cost and availability. Methods: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra‐cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random‐effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P <.001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P <.001. GCS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P <.001. Conclusion: LVGLS and GCS were significantly lower in extra‐cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBD) associated-chronic inflammation and autonomic dysregulation may predispose to arrhythmias. However, its exact prevalence is unknown. Thus, we aimed to ascertain the prevalence of arrhythmias in patients with IBD. Methods: We queried the Nationwide Inpatient Sample (the largest publicly available all-payer inpatient USA database) from 2012 to 2014. We used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) discharge codes to identify adult patients (⩾18 years) with IBD and dysrhythmias (supraventricular tachycardia (SVT), atrial fibrillation, atrial flutter, ventricular tachycardia (VT), or ventricular fibrillation). Furthermore, we identified risk factors for cardiovascular disease. We divided patients into 2 cohorts, IBD cohorts, and non-IBD cohort. The independent effect of a diagnosis of IBD on the risk of dysrhythmias was examined using a multivariable logistic regression model controlling for multiple confounders. Results: We identified 847 235 and 84 757 349 weighted hospitalizations among patients with IBD and non-IBD cohorts, respectively. Patients with IBD were less likely to be hospitalized for dysrhythmias than the non-IBD (9.7% vs 14.2%, P <.001). The hospitalization odds for dysrhythmias among patients with IBD were less than the general population (OR 0.87; 95% CI 0.85-0.88). However, the prevalence of SVT and VT was indifferent between the 2 groups. Male sex, age of over 60, and white race were risk factors for dysrhythmias. Conclusion: Despite prior reports of a higher prevalence of arrhythmias among patients with IBD, in a nationwide inpatient database, we found lower rates of hospitalization-related-arrhythmias in the IBD population compared to that of the general population. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding patients with tuberculosis.