Strategic Tower Defence Game

This research is based on intelligent strategy game known as Tower Defence in which players have to make strategic decisions to defend their tower from their enemies. This an interesting game where people can test their wits. In this game  the players can build and upgrade their tower to prevent higher damage  from enemies. This game requires quick strategic decisions and is fun to play. There are wide array of weapons/equipments that the player can access by using earning points. This game is developed by using Unity platform using C#. This game is easy and understandable as compare to other tower defence games available in market and can be played by players of all  age. This intelligent strategy game is highly competitive and will help sharpen your brain too

Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat

Haemophagocytic lymphohistiocytosis (HLH) in Human Immunodeficiency Virus (HIV) infected individuals can either be due to the disease itself or due to associated infections/malignancies. The treatment for HLH requires immunosuppressive therapy but administering immunosuppressive therapy to an already immunosuppressed patient (HIV infection) is complex. We present two such cases of HLH in patients infected with HIV. In the first case, no alternate cause for HLH was found even after extensive investigations and it was attributed to the uncontrolled HIV replication. Patient was started on dexamethasone for the same but succumbed to hospital acquired pneumonia. The second patient was diagnosed with Hodgkin's lymphoma but he succumbed to his illness before initiating immunosuppressive therapy for HLH. We report these cases to highlight the dilemma and a need for further research in this direction

Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p<0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p<0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

Perioperative hyperglycemic response to single-dose dexamethasone in patients undergoing surgery under spinal anesthesia

Abstract Background Dexamethasone is a potent corticosteroid when comes to effectively preventing postoperative nausea and vomiting (PONV). However, some studies have documented its association with hyperglycemia. In our study, we compared the effect of single-dose dexamethasone (8 mg) on blood glucose concentrations among diabetics and non-diabetic patients who received spinal anesthesia for elective lower abdominal and lower limb surgeries. Results We recruited 80 patients and divided them into two groups of 40 patients each. After dexamethasone administration, diabetic patients had an early peak rise of blood glucose levels at 3 h, (157.85 ± 12.19) compared to 6 h, (125.30 ± 14.95) in non-diabetics. In diabetic patients, blood glucose levels remained consistently over the baseline and maximum rise was seen at 12 h (188.25 ± 41.33), which obviated the need or administration of injection insulin. Hyperglycemia can lead to a variety of physiological derangements. Conclusions Although dexamethasone is a useful means of successful prevention and treatment of PONV, the clinician should use his clinical judgment before administering dexamethasone. Trial registration CTRI, CTRI/2020/06/025765, Registered 02 June 2020, prospectively registered, http://ctri.nic.in/Clinicaltrials/login.php

Gamification of Upper Limb Rehabilitation in Mixed-Reality Environment

The advancements in mixed reality (MR) technology in recent years have provided us with excellent prospects for creating novel approaches to supplement conventional physiotherapy to maintain a sufficient quantity and quality of rehabilitation. The use of MR systems to facilitate patients’ participation in intensive, repetitive, and task-oriented practice using cutting-edge technologies to enhance functionality and facilitate recovery is very encouraging. Multiple studies have found that patients who undergo therapy using MR experience significant improvements in upper limb function; however, assessing the efficacy of MR is challenging due to the wide variety of methods and tools used. Because of these challenges, a novel approach, gamified MR-based solution for upper extremity rehabilitation, is proposed, which is an MR application for the Microsoft HoloLens 2, complete with game levels, and can measure the ranges of motion of the arm joints. The proposed rehabilitative system’s functionality and usability were evaluated with ten healthy adult participants with no prior arm-related injuries and two occupational therapists (OTs). The system successfully provided rehab exercises for upper limb injuries through interactive mixed-reality games. The system can mimic upper limb behavior without additional sensors during rehab sessions. Unlike previously researched technologically-based rehabilitation methods, this method can integrate arm–joint data within the application and are independent of one another. The results and comparisons show that this system is relevant, accurate, and superior to previous VR-based rehabilitation methods because the VR-based system is blind to the surroundings, whereas the proposed approach has spatial awareness of the environment

Development of processing maps and constitutive relationship for thermomechanical processing of Aluminum Alloy AA2219

Isothermal uniaxial compression tests were conducted on aluminum alloy AA2219 to study the evolution of microstructure over a wide range of temperatures (300-500 °C) and strain rates (0.001-100 s−1) with a view to study the flow behavior and concurrent microstructural evolution. True stress-true strain curves showed only a gradual flow softening at all temperatures except at 300 °C where strain hardening was followed by severe flow softening. Processing map delineating the stable ‘safe’ and unstable ‘unsafe’ regions during hot working is developed and validated by comparing the microstructures observed in the deformed compression specimens. Optimum processing parameters (temperature 450 °C and strain rate 0.001 s−1) for hot deformation of AA2219 were proposed based on contour maps of efficiency of power dissipation and strain rate sensitivity parameter. The activation energy value (Qavg) of AA2219 for hot working was computed to be 169 kJ/mol. Finally, a constitutive equation for hot working of AA2219 was established as: ε˙=4.99×109⋅exp(0.06149σ)⋅exp(−168.958/RT)ε˙=4.99×109⋅exp⁡(0.06149σ)⋅exp⁡(−168.958/RT).by S. V. S. Narayana Murty, Aditya Sarkar, P. Ramesh Narayanan, P. V. Venkitakrishnan and Jyoti Mukhopadhya

Microstructure and mechanical properties of cryorolled aluminum alloy AA2219 in different thermomechanical processing conditions

In the present study, aluminum alloy AA2219-T87 bars were cryorolled to various amounts of deformation in two pre-deformation conditions: (1) without solution treatment i.e., as-received T87 (WST-CR) and (2) with solution treatment (ST + CR). The solution treated and cryorolled bars were further annealed leading to a third condition: (3) solution treated, cryorolled, and annealed (CR + Annealed). Room-temperature mechanical properties have been evaluated for all three cryorolled conditions. Significant improvement in the 0.2 pct YS and UTS values was obtained for bars cryorolled to cross-sectional area reduction of more than 50 pct in the solution-treated condition (ST + CR), whereas for bars cryorolled in the without solution-treated condition (WST-CR), only an improvement in the 0.2 pct YS was observed. Cryorolling did not enhance the precipitation kinetics nor did it increase the response of the alloy to aging. The mechanical properties were correlated to the microstructures obtained by optical and transmission electron microscopy. Microstructural evolution in the ST + CR condition indicated gradual progression of the principal restoration mechanism from dynamic recovery (DRV) to dynamic recrystallization with an increasing amount of plastic deformation. Transmission electron microscopy of WST-CR and ST + CR specimens showed an increase in dislocation density as a function of the amount of deformation indicating suppression of DRV at cryogenic temperatures. Cryorolling in the solution-treated condition to cross-sectional area reduction of more than 50 pct (ST + 70 pct CR) was found to impart an optimum combination of strength and percent elongation in the present study.by Aditya Sarkar, K. Saravanan, Niraj Nayan, S. V. S. Narayana Murty, P. Ramesh Narayanan, P. V. Venkitakrishnan and Jyoti Mukhopadhya