Feature - Based Approach to Automatic Fixturing System Planning ForUniform Polyhedra Workpiece

This paper demonstrates the design of an algorithm to represent the design stages of fixturing system that serve in increasing the flexibility and automation of fixturing system planning for uniform polyhedral part. This system requires building a manufacturing feature recognition algorithm to present or describe inputs such as (configuration of workpiece) and built database system to represents (production plan and fixturing system exiting) to this algorithm. Also knowledge base system was building or developed to find the best fixturing analysis (workpiece setup, constraints of workpiece and arrangement the contact on this workpiece) to workpiece

Development of Job Scheduling and Machine Loading System in FMS

Manufacturing industries are rapidly changing from production of scale to production of scope characterized by short product life cycles and increased product varieties. This implies a need to improve the efficiency of job shops while still maintaining their flexibility. These objectives are achieved by Flexible manufacturing systems (FMS). The basic aim of FMS is to bring together the productivity of flow lines and the flexibility of job shops, this duality of objectives makes the management of FMS complex. In this research, the loading problem in FMS, which is viewed as selecting a subset of jobs from the job pool and allocating them among available machines, is considered. The research investigates the number of machine loading approaches, which aim to meet the delivery dates of production orders, and at the same time reduce the manufacturing cost

Skin cancer classifier based on convolution residual neural network

Accurate automatic classification of skin lesion images is a great challenge as the image features are very close in these images. Convolution neural networks (CNN) promise to provide a potential classifier for skin lesions. This work will present dermatologist-level classification of skin cancer by using residual network (ResNet-50) as a deep learning convolutional neural network (DLCNN) that maps images to class labels. It presents a classifier with a single CNN to automatically recognize benign and malignant skin images. The network inputs are only disease labels and image pixels. About 320 clinical images of the different diseases have been used to train CNN. The model performance has been tested with untrained images from the two labels. This model identifies the most common skin cancers and can be updated with a new unlimited number of images. The DLCNN trained by the ResNet-50 model showed good classification of the benign and malignant skin categories. The ResNet-50 as a DLCNN has verified a significant recognition rate of more than 97% on the testing images, which proves that the benign and malignant lesion skin images are properly classified

Lupus cystitis presenting with urinary symptoms.

We present a case of a young woman presenting with irritative lower urinary tract symptoms and microscopic hematuria who was diagnosed with systemic lupus erythematosus (SLE). Abdominal ultrasound revealed bilateral hydronephrosis and a thickened bladder wall. Cystoscopic evaluation revealed severe diffuse inflammation, erythema and hemorrhage at the trigone with punctate extensions to the bladder base. She was treated with prednisone and mycophenolate mofetil with improvements in her symptoms and ultrasound findings. Lupus cystitis is a rare manifestation of SLE

Hypodensities Within Hematoma Predict Outcome After Spontaneous Intracerebral Hemorrhage

ABSTRACT Background and objective: Radial nerve is injured due to a variety of reasons. The objective of this study was to determine the clinical spectrum, risk factors and electrophysiologic aspect of radial nerve injury presenting to a tertiary care hospital in Lahore. Methods: This descriptive prospective cross-sectional study was conducted at department of Neurology, Mayo hospital Lahore from July 2022 to December 2022 and comprised patients with isolated radial nerve injury on the basis of history and clinical examination regardless of their gender, above 15 years of age. NCS/EMG was done on a Japanese machine Nihon Kohden by an expert as per recommended protocol for electrodiagnostic evaluation of a suspected radial nerve injury and interpreted by consultant neurologist. Results: Of 75 patients, 52(69.3%) were males and 23(30.7%) were females. The most common etiology turned out to be misplaced intramuscular injection in 45(60%) of the patients. The site of lesion in most cases was in the spiral groove in 36 (40%) of the patient. Most of the patients i.e. 71(94.7%) had a wrist drop. Evidence of reinnervation was present in 30(40%) of patients. Conclusion: Most cases of radial nerve injury presented with a wrist drop in which the commonest etiology was misplaced intramuscular injection. The site of lesion in most cases turned out to at the level of spiral groove, and the nature of lesion was primarily axonal loss followed by secondary demyelination

Venous Thromboembolism in Cancer: An Update of Treatment and Prevention in the Era of Newer Anticoagulants

Cancer patients are at major risk of developing Venous Thromboembolism (VTE), resulting in increased morbidity and economic burden. While a number of theories try to explain its pathophysiology, its risk stratification can be broadly done in cancer related, treatment related and patient related factors. Studies report the prophylactic use of thrombolytic agents to be safe and effective in decreasing VTE related mortality/ morbidity especially in postoperative cancer patients. Recent data also suggests the prophylactic use of low molecular weight Heparins (LMWH’s) and Warfarin to be effective in reducing VTE’s related to long term Central Venous Catheter (CVC) use. In a double blind, multicenter trial, a new Ultra LMWH Semuloparin has shown to be efficacious in preventing chemotherapy associated VTE’s along with other drugs such as Certoparin and Nadoparin.. LMWH’s are reported to be very useful in preventing recurrent VTE’s in advanced cancers and should be preferred over full dose Warfarin. However their long term safety beyond 6 months has not been established yet. Further, this manuscript discusses the safety and efficacy of different drugs used in the treatment and prevention of recurrent VTE’s including Bemiparin, Semuloparin, oral direct thrombin inhibitors, parenteral and direct oral factor Xa inhibitors

Wheat Antioxidants, Their Role in Bakery Industry, and Health Perspective

Wheat grains and its fractions contain significant level of antioxidant activity and many phytochemicals, such as phenolic acids (ferulic and vanillic acids), carotenoids, and tocopherol are beneficial in curing many disorders. The beneficial phytochemicals are mostly present in aleurone fraction of wheat bran. The phytochemicals and antioxidants present in wheat have several health benefits, such as their ability to act as antioxidants, immunoenhancers, and inhibitors of certain lesions, which have been demonstrated for phenolic. Many wheat antioxidants are similar to the antioxidants present in wheat, but their characteristics are also unique in nature. The regular consumption of these antioxidant compounds in whole grains is associated with a reduced risk of many heart diseases and several forms of cancers and improves the regulation of blood glucose. Wheat antioxidants play a vital role in bakery industry mostly in bread industry. People are getting aware to use the bakery products that are prepared from the white flour due to proper nutrition, healthy lifestyle, improved nutritional composition, and functional properties. In nutshell, wheat antioxidants including phytochemicals synergistically improve the health status of consumers by consuming the products having complete nutrition

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence of Temporomandibular Disorder Symptoms among Orthognathic Patients in Southern Germany: Retrospective Study

This study investigated the prevalence of temporomandibular disorder (TMD) among patients before and after orthognathic surgery and assessed the effect of orthognathic surgery on each of the TMD symptoms (clicking, pain, crepitus, and MRI findings). A sample of 100 consecutive patients undergoing bimaxillary surgery for correction of craniofacial deformities (31 male and 69 female), with ages ranging between 17 and 58 years (mean age: 27.7 ± 9.3 years), were interviewed and examined regarding signs and symptoms of TMD. Clinical examination and X-ray and magnetic resonance imaging of the temporomandibular junction were performed at the time of surgery and 1 year thereafter. The prevalence of TMD preoperatively and postoperatively was 35% and 27%, respectively. A high frequency of relief was found in the patients with TMD symptoms (74.3%; 19 (70.3%) of patients had reduced clicking, 7 (87.5%) patients had reduced pain, 4 (100%) patients had reduced crepitus, and 4 (57.1%) patients showed changes in MRI findings), 12 patients who were asymptomatic before surgery developed clicking in TMJ after surgery, 3 developed pain, and 3 developed crepitus. TMD problems can occur in a variety of patients, including those who have facial deformities, and require orthognathic surgery. However, orthognathic surgery may not predictably treat or reduce the symptoms of TMD