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Background The appropriate management of a fine needle aspiration (FNA) supply cart and equipment set up is essential to ensure the smooth and optimal operation of a busy FNA clinic. We applied Lean strategies such as value stream mapping (VSM), the 5S method (Sort, Set in order, Shine, Standardize, Sustain), and Kanban to remove waste and improve patient flow in an FNA clinic. Methods The workflow analysis suggested that existent problems such as suboptimal inventory management and unavailability of standard operating procedures (SOPs) caused a 10% to 85% increase in total procedure time. To improve inventory management, we created a 2-bin Kanban system. We used the "Scan to Web" app and a Google Drive form to create a cost-effective electronic inventory management system. We distributed the essential SOPs in the format of video clips using our YouTube channel and leveraged barcode technology to access the links. Results Upon completion of our process improvement project, we succeeded to eliminate the stock-out events and maintain a process cycle efficiency of 87%. The 5S audit checklist result increased from 6% to 100% implementation, which is consistent with focused improvement. The developed inventory system enabled us to track the supply usage, forecast demands, and improve the accuracy of orders. Conclusions Lean methods such as VSM, 5S, and Kanban combined with open source technologies can be implemented to ensure material availability, track inventory, and provide immediate access to SOPs on demand. The developed system also led to increased efficiency and improved flow, as well as responsiveness to changes in demand.

Academic stress is the most common mental state that medical students experience during their training period. To assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles against academic stress adopted by students. Methods: It was a cross sectional study done among medical students from first to fourth year. Standard self-administered questionnaires were used to assess academic stress and coping behaviour. Mean age of the 400 participants was 20.3 ± 1.5 years. 166(41.5%) of them were males. The academic stress was found to be of mild, moderate and severe level among 68(17%), 309(77.3%) and 23(5.7%) participants respectively. Overall coping with stress was found to be poor, average and good among 15(3.8%), 380(95%) and 5(1.2%) participants respectively. Passive emotional (p = 0.054) and passive problem (p = 0.001) coping behaviours were significantly better among males. Active problem coping behaviour (p = 0.007) was significantly better among females. Active emotional coping behaviour did not vary significantly between genders (p = 0.54). Majority of the students preferred sharing their personal problems with parents 211(52.7%) followed by friends 202(50.5%). Binary logistic regression analysis found worrying about future (p = 0.023) and poor self-esteem (p = 0.026) to be independently associated with academic stress. Academic stress although a common finding among students, the coping style to deal with it, was good only in a few. The coping behaviours were not satisfactory particularly among male participants. This along with other determinants of academic stress identified in this study need to be addressed during counselling sessions.

Quantifying gait analysis helps to understand neurological gait disorders, balance and posture that may provide information to design and develop exoskeleton technologies. In this current study, we employed mobile phone accelerometers to understand the kinematic differences between male and female based on Froude (Fr) number as a combination of velocity and acceleration. The average Fr number of female subjects showed higher amplitude in hip and ankle whereas in male subjects’ activity was higher in knee and shoulder suggesting a possible fall risk. The gait variability between the subject groups with different weights were analysed during stance and swing. Fr numbers of shoulder, elbow, wrist, pelvis, and ankle showed significant differences across groups which indicates that gait patterns can be classified according to weight and age. Also, how gait spatio-temporal parameters changed during activity of lower body joints in young adults while transporting backpack with multiple loads was assessed. For all the subjects, an instantaneous variation in pelvis was observed while carrying loads that can be attributed to result in a postural change. The extracted patterns may be used as potential markers in machine learning/deep learning to understand human gait which can be of great use to clinicians to predict the pathological conditions.

This paper proposes to use Fast Fourier Transformation-based U-Net (a refined "fully convolutional networks") and perform image convolution in neural networks. Leveraging the Fast Fourier Transformation, it reduces the image convolution costs involved in the Convolutional Neural Networks (CNNs) and thus reduces the overall computational costs. The proposed model identifies the object information from the images. We apply the Fast Fourier transform algorithm on an image data set to obtain more accessible information about the image data, before segmenting them through the U-Net architecture. More specifically, we implement the FFT-based convolutional neural network to improve the training time of the network. The proposed approach was applied to publicly available Broad Bioimage Benchmark Collection (BBBC) dataset. Our model demonstrated improvement in training time during convolution from 600 − 700 ms/step to 400–500 ms/step. We evaluated the accuracy of our model using Intersection over Union (IoU) metric showing significant improvements.

In this era, social media has become a platform for education, e-commerce, job seeking and many more. This work intends to create a digital portfolio which helps freshers to upgrade their skillsets, create their resume according to the company profile and as per the company requirements, interacting with people of similar interests and giving a chance to showcase their skills on the current platform. Students will be rated according to their performances and will be awarded badges. This platform will not only help students to work on themselves but also give confidence to them while entering into the corporate world.

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by frequent exacerbation phenotypes independent of disease stage. Increasing evidence shows that the microbiota plays a role in disease progression and severity, but long-term and international multicenter assessment of the variations in viral and bacterial communities as drivers of exacerbations are lacking. Methods Two-hundred severe COPD patients from Europe and North America were followed longitudinally for 3 years. We performed nucleic acid detection for 20 respiratory viruses and 16S ribosomal RNA gene sequencing to evaluate the bacterial microbiota in 1179 sputum samples collected at stable, acute exacerbation and follow-up visits. Results Similar viral and bacterial taxa were found in patients from the USA compared to Bulgaria and Czech Republic but their microbiome diversity was significantly different (P P 0.17; P 0.39; P Conclusions This study highlights bacterial taxa in lung sensitization and viral triggers in COPD exacerbations. It provides a global overview of the diverse targets for drug development and explores new microbiome analysis methods to guide future patient management applications.

Geocell is a soil reinforcement technique which is established to be a versatile method in terms of its efficiency in lateral confinement of the soil and cost-effectiveness. This study provides an overview of the bearing capacity and settlement characteristics of sand bed reinforced with coir geocells in comparison with HDPE–geocell-reinforced sand bed and unreinforced sand bed. A series of model plate load tests on the reinforced sand bed were conducted in a steel tank in the laboratory. The bearing capacity of coir geocell-reinforced sand was found to be two times higher than that of HDPE–geocells-reinforced sand bed. This paper also demonstrates the performance of HDPE and coir geocells with seashell as infill material in comparison with sand. Substantial results were obtained, and maximum bearing capacity was achieved for a combination of 20% seashell and 80% sand infilled in coir geocell. The preference of reinforcing soil with more economical and environment-friendly coir geocell and seashell is practicable as well as sustainable.

There are various judgments of the Supreme Court governing the validity of “notings” which are mere notes made in a department file while a matter is being processed, to initiate an action. The validity of 'notings' is to be decided and adjudicated upon from the facts and circumstances of each case in issue. This paper aims at looking 'Notings' from the purview of Article 166 of the Constitution.

The question of what phonetic quality defines rhotics as a natural class has been debated. Clinical reports indicate that in many languages, rhotics are developmentally late to emerge and subject to errors that are resistant to remediation, suggesting that rhotics may be distinguished by “complexity in articulation.” In American English, the complexity of articulation may derive from its doubly articulated nature; simultaneous palatal and pharyngeal tongue constrictions are consistent features across variants. For other languages with a rhotic liquid, however, it is unclear if this pharyngeal constriction gesture is also an articulatory feature. Using ultrasound, this study compares rhotics from different language families to describe the presence or absence of pharyngeal constriction. Results indicate that pharyngeal constriction is observed across languages in rhotic allophones that have been described as difficult for children to acquire.