116 research outputs found

    Modified Echo State Network-enabled Dynamic Duty Cycle for Optimal Opportunistic Routing in EH-WSNs

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    Minimizing energy consumption is one of the major challenges in wireless sensor networks (WSNs) due to the limited size of batteries and the resource constrained tiny sensor nodes. Energy harvesting in wireless sensor networks (EH-WSNs) is one of the promising solutions to minimize the energy consumption in wireless sensor networks for prolonging the overall network lifetime. However, static energy harvesting in individual sensor nodes is normally limited and unbalanced among the network nodes. In this context, this paper proposes a modified echo state network (MESN) based dynamic duty cycle with optimal opportunistic routing (OOR) for EH-WSNs. The proposed model is used to act as a predictor for finding the expected energy consumption of the next slot in dynamic duty cycle. The model has adapted a whale optimization algorithm (WOA) for optimally selecting the weights of the neurons in the reservoir layer of the echo state network towards minimizing energy consumption at each node as well as at the network level. The adapted WOA enabled energy harvesting model provides stable output from the MESN relying on optimal weight selection in the reservoir layer. The dynamic duty cycle is updated based on energy consumption and optimal threshold energy for transmission and reception at bit level. The proposed OOR scheme uses multiple energy centric parameters for selecting the relay set oriented forwarding paths for each neighbor nodes. The performance analysis of the proposed model in realistic environments attests the benefits in terms of energy centric metrics such as energy consumption, network lifetime, delay, packet delivery ratio and throughput as compared to the state-of-the-art-techniques

    Случай раннего выявления метастазов в бедренной кости у больного раком полового члена

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    Background. Bone metastasis is very common in the advanced stage of numerous carcinomas. In penile carcinoma, lymph nodes metastasis is somehow common but it is very rare reported to be secondary from penile cancer. till the date, there are only few cases of penis carcinoma reported bone metastasis in literature worldwide.Case Presentation. Herein, We presented a 51-year-old Nepalese male with squamous cell carcinoma of penis. computed tomography (ct) scan of the patient revealed that there was carcinoma involving glans penis and precure with bilateral external & internal inguinal lymphadenopathies. After then, the patient was under gone for partial penectomy and bilateral inguinal lymphadenectomy and complete 6-cycle chemotherapy. After one year of treatment, patient developed thigh pain and headache and he advised to have magnetic Resonance imaging (mRi) of brain, 99mTc-MDP whole body bone scan and ct scan of pelvis and thigh. The examination report reveals that there was a sclerotic change in vertex of skull bone and moderate 99mTc-MDP uptake in right proximal shaft of femur just below the neck d/d metastasis. The histopathological examination of the true cut biopsy taken from the lesion of the femur showed metastatic keratinizing squamous cell carcinoma which is rare case of femoral shaft bone metastasis secondary from penile carcinoma. Then patient was sent for surgical reconstruction of femur. Based on the case studies review femur shaft bone metastasis from penile cancer is extremely rare.Conclusion. The best of our knowledge; this is the first early detected bone metastases to shaft of the femur in a patient with penile cancer. early diagnosis helps to radical treatment as well as palliative treatment. surgery is the preferred option of the treatments, especially for metastatic foci in the long bones.Аннотация Метастазы в кости часто встречаются на поздних стадиях разных злокачественных новообразований. Для рака полового члена характерно лимфогенное метастазирование, костные метастазы встречаются очень редко. На данный момент в мировой литературе зарегистрировано лишь несколько случаев рака полового члена с метастазами в кости.Описание клинического случая. Мы представляем описание клинического случая плоскоклеточного рака полового члена у 51-летнего мужчины из Непала. Компьютерная томография (КТ) выявила рак полового члена, локализованный на головке и крайней плоти с двусторонней паховой лимфаденопатией. Пациенту выполнена частичная пенэктомия, двусторонняя паховая лимфаденэктомия, проведено 6 курсов адъювантной химиотерапии. Через один год после завершения лечения у пациента появились боли в бедре и головная боль, рекомендована МРТ головного мозга, сканирование костей скелета с 99mTc-MDP и КТ таза и бедра. Обследование показало наличие склеротических изменений в теменной кости черепа и умеренное накопление 99mTc-MDP в проксимальном отделе правом бедренной кости ниже шейки. Гистологическое исследование биоптата, взятого из очага в бедренной кости, выявило метастаз ороговевающего плоскоклеточного рака, что является редким случаем метастазирования рака полового члена в диафиз бедренной кости. Пациент был направлен на хирургическую реконструкцию бедренной кости. Согласно обзору клинических исследований, метастазы в диафизе бедренной кости при раке полового члена встречаются крайне редко.Заключение. Представлен первый случай раннего выявления костных метастазов в диафизе бедренной кости у пациента с раком полового члена. Ранняя диагностика помогает как радикальному, так и паллиативному лечению. Хирургическое вмешательство является предпочтительным вариантом лечения, особенно при метастатических очагах в длинных костях

    Design of SOI MOSFETs for Analog/RF Circuits

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    678-685In this paper, the concept of integration of a high voltage trench MOSFET (HVT MOSFET) and low voltage trench MOSFET (LVT MOSFET) is proposed. Insulator (Dielectric) isolation technique is used for the implementation of HVT and LVT MOSFETs on Silicon-on-Insulator (SOI) layer side by side. The HVT MOSFET consists of two gates which are placed in separate trenches in the drift region. The proposed structure minimizes ON-resistance (Ron) along with increased breakdown voltage (Vbr) due to reduced electric field, creation of dual channels, and folding of drift region in vertical direction. In HVT MOSFET, the drain current (ID) increases leading to enhanced trans conductance (gm) by simultaneous conduction of channels which improves the cut-off frequency (ft) and maximum oscillation frequency (fmax). On the other side, LVT MOSFET consists of a gate placed within a SiO2 trench to create two channels on either side of gate. The parallel conduction of two channels provides enhancement in ID, gm, fmax and ft. The performance analysis of HVT MOSFET and LVT MOSFET is carried out using 2D simulation in the device simulator (ATLAS)

    Design of SOI MOSFETs for Analog/RF Circuits

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    In this paper, the concept of integration of a high voltage trench MOSFET (HVT MOSFET) and low voltage trench MOSFET (LVT MOSFET) is proposed. Insulator (Dielectric) isolation technique is used for the implementation of HVT and LVT MOSFETs on Silicon-on-Insulator (SOI) layer side by side. The HVT MOSFET consists of two gates which are placed in separate trenches in the drift region. The proposed structure minimizes ON-resistance (Ron) along with increased breakdown voltage (Vbr) due to reduced electric field, creation of dual channels, and folding of drift region in vertical direction. In HVT MOSFET, the drain current (ID) increases leading to enhanced trans conductance (gm) by simultaneous conduction of channels which improves the cut-off frequency (ft) and maximum oscillation frequency (fmax). On the other side, LVT MOSFET consists of a gate placed within a SiO2 trench to create two channels on either side of gate. The parallel conduction of two channels provides enhancement in ID, gm, fmax and ft. The performance analysis of HVT MOSFET and LVT MOSFET is carried out using 2D simulation in the device simulator (ATLAS)

    Democratic Middle Ground in Nepal: A Perspective from the North American Nepali Diaspora

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    The call of our time is to safeguard the accomplishments of the 1990 Peoples Movement, to restore sovereignty to the people, and to work towards the middle ground to resolve the nation\u27s core problems. History teaches us that recognizing, adopting and adhering to the middle path takes much vision and courage. The natural instinct is to stick to one\u27s own interpretation of the world (usually based on narrow self-interest) and to shun ideas and individuals that require a moderation of one\u27s views. However, success in politics and statecraft, more so than in any other area of human affairs, is hinged to the middle ground in a way that ultimately requires friend and foe to migrate sufficiently towards each other so that the peoples\u27 business can move forward and flourish. We urge all political forces in Nepal to recognize that great achievements in the affairs of nations come about when leaders practice the art of compromise. There is no dishonor for Nepal\u27s monarch and political leaders if they follow the path of the likes of Gandhi, Nehru and Mandela.\u2

    Nurses are underutilised in antimicrobial stewardship e Results of a multisite survey in paediatric and adult hospitals

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    Objectives: Explore perceptions and attitudes of nurses in regard to antimicrobial stewardship (AMS), their roles as nurses, and identify differences in perceptions and attitudes across paediatric and adult settings. Methods: Electronic survey administered to nursing staff across three public Australian tertiary institutions with AMS facilitated by a shared electronic approval and decision support system. Results: Overall 65% (93/142) of nurses who completed the survey were familiar with the term AMS, and 75% recognised that they were expected to have a role alongside other disciplines, including ward pharmacists (paediatric 88%, adult 73%; p = 0.03). Hand hygiene and infection control (86%), patient advocacy (85%) and knowledge of antimicrobials (84%) were identified most often as AMS roles for nurses. However, 57% of nurses reported that their knowledge of antimicrobials was minimal or limited. Nurses generally agreed that requirement to obtain approval is an effective way to reduce inappropriate antimicrobial use (median scores: paediatric 2.0 [agree], adult 1.0 [strongly agree]; p = 0.001). Only 35% of paediatric and 58% of adult nurses perceived that their role includes ensuring approval for restricted antimicrobials (p \u3c 0.01). Most nurses identified AMS teams (85%), pharmacists (83%) and infection control teams (paediatric 68%, adult 84%; p = 0.04) as sources of AMS support. Areas of interest for support and education included appropriate antimicrobial selection (73%) and intravenous to oral antimicrobial switch (paediatric 65%, adult 81%, p = 0.03). Conclusion: Nurses consider AMS activities within their roles, but are underutilised in AMS programs. Further engagement, education, support and acknowledgement are required to improve nursing participation

    Evaluation of antidiabetic efficacy of Murraya koenigii on Streptozotocin induced diabetes in experimental rats

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    Background: The medicinal plant Murraya koenigii shown to have a wide variety of pharmacological activities (hypoglycemic and hypolipidemic). Objective of this study is the present study was designed to evaluate Antidiabetic and Hypolipidemic property of Murraya koenigii in experimentally induced diabetes in rats.Methods: Experimental diabetes was produced with single dose of Streptozotocin (STZ): 45 mg/kg IP. The rats were randomly allocated in various groups for 37 days. After the confirmation of diabetes on 7th day (>200 mg/dl), hydroalcoholic extract of Murraya koenigii (500 mg/kg) was administered orally to experimental rats from day 7th day and continued for 37 days thereafter. Various antidiabetic (Glucose, HbA1C), metabolic (Lipid profile), safety (pancreatic lipase, Creatinine, SGPT, Histopathology of Liver and Kidney) were evaluated in various group.Results: Efficacy of Murraya koenigii was observed on various parameter of diabetes. Administration of STZ resulted in a significant decrease in diabetic changes (increase in blood glucose, HbA1C), altered lipid profile (p<0.01) in the Control group rats as compared to sham group. Murraya koenigii treatment demonstrated significant antidiabetic indicated by restoration of blood glucose, HbA1C level (p<0.01) compared to Control group. In addition, Murraya koenigii also documented hypolipidemic property of test drug. As per biochemical assessment of Pancreatic lipase, Serum creatinine, SGPT and Histopathological report, the test drug reduce the pancreatic, liver and renal marker and also showed safe to pancreas, Liver and kidney. The histopathological assessment of the liver and kidney confirmed the biochemical findings.Conclusions: The study concluded that the Murraya koenigii possess antidiabetic efficacy

    Evaluating Antibiotic Treatment Guideline Adherence to Ongoing Antibiotic Stewardship in a Tertiary Care Setting:A Retrospective Observational Study

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    Antimicrobial resistance (AMR) is widely regarded as an increasing threat to global public health. Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The present study aimed to assess physician's adherence to hospital antibiotic treatment guideline recommendations in Nepal and determine predictive variables with a significant association. This was a retrospective, monocentric observational review to investigate the adherence to endorsed guidelines using the medical records of adults admitted to the hospital with a diagnosis of urinary tract infection (UTI), pneumonia, or skin and soft tissue infection (SSTI) from January 2018 to December 2019. Of the 2,077 medical records that were reviewed (954 UTI, 754 pneumonia, and 369 SSTI), 354 (17%) met the study inclusion criteria, which included 87 UTI, 180 pneumonia, and 87 SSTI patients. Among eligible patients with antibiotic prescriptions, the following were adherent to guideline recommendations: 33 (37.9%) UTI, 78 (43.3%) pneumonia, and 23 (26.4%) SSTI. The overall extent of adherence to hospital antibiotic treatment guidelines for the use of antibiotics among adult inpatients diagnosed with these common infections was 37.9%. Patients who received ceftriaxone (OR = 2.09, 95% CI = 1.18-3.71, p=0.012) and levofloxacin (OR = 4.63, 95% CI = 1.30-16.53, p=0.018) had significantly higher adherence to treatment guidelines. This study revealed a low adherence rate despite the availability of updated guidelines for antibiotic prescriptions. The findings confer an urgent need to confront antibiotic prescription patterns in such tertiary care centers for tailored interventions to improve adherence to antibiotic guidelines.</p

    Outcome analysis of Cohen’s cross trigonal ureteric reimplantation in paediatric age group

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    Introduction: Cohen’s cross trigonal ureteric reimplantation is the gold standard for surgical management of vesicoureteric reflux (VUR) in children with high success rate. The objective of this study was to evaluate and assess the outcome of open Cohen’s procedure in children with VUR.  Methods: A retrospective review of all patients with VUR who underwent Cohen’s procedure between March 2010 and February 2020 was done. The following were recorded for each patient: age, sex, grade of reflux, operative time, outcome and complications.  Results: The series consisted of 40 patients (25 girls and 15 boys) who underwent Cohen’s procedure with a mean age of 32 months (6 months to 8 years). Bilateral repairs were performed in 16 patients (40%) in the same setting and unilateral repair in 24 patients (60%). Twenty-two patients (55%) had grade IV VUR, 13 patients (32.5%) had grade V VUR and 05 patients (12.5%) had grade III VUR. Mean operative time for bilateral repairs was 249.4(200-290) minutes and 158.3(130-180) minutes for unilateral repair respectively. The mean length of hospital stay was 10.55 (7-15) days. Major complications included two persistent VURs, and one case of bladder hematoma. Postoperative ultrasound abdomen in all patients and micturating cystourethrogram in few patients was obtained, in which 38 patients (95%) had normal study. Conclusion: Cohen’s uretric reimplantation is a standard procedure in paediatric VUR. For better outcome, patient selection and refinement of operative technique should be pursued

    Outcome analysis of Cohen’s cross trigonal ureteric reimplantation in paediatric age group

    Get PDF
    Introduction: Cohen’s cross trigonal ureteric reimplantation is the gold standard for surgical management of vesicoureteric reflux (VUR) in children with high success rate. The objective of this study was to evaluate and assess the outcome of open Cohen’s procedure in children with VUR.  Methods: A retrospective review of all patients with VUR who underwent Cohen’s procedure between March 2010 and February 2020 was done. The following were recorded for each patient: age, sex, grade of reflux, operative time, outcome and complications.  Results: The series consisted of 40 patients (25 girls and 15 boys) who underwent Cohen’s procedure with a mean age of 32 months (6 months to 8 years). Bilateral repairs were performed in 16 patients (40%) in the same setting and unilateral repair in 24 patients (60%). Twenty-two patients (55%) had grade IV VUR, 13 patients (32.5%) had grade V VUR and 05 patients (12.5%) had grade III VUR. Mean operative time for bilateral repairs was 249.4(200-290) minutes and 158.3(130-180) minutes for unilateral repair respectively. The mean length of hospital stay was 10.55 (7-15) days. Major complications included two persistent VURs, and one case of bladder hematoma. Postoperative ultrasound abdomen in all patients and micturating cystourethrogram in few patients was obtained, in which 38 patients (95%) had normal study. Conclusion: Cohen’s uretric reimplantation is a standard procedure in paediatric VUR. For better outcome, patient selection and refinement of operative technique should be pursued
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