FINITE ELEMENT ANALYSIS AND RELIABILITY STUDY OF MULTI-PIECE RIMS

Multi-piece wheels or rims used on large vehicles such as trucks, tractors, trailers, buses and off-road machines have often been known for their dangerous properties because of the large number of catastrophic accidents involving them. The main causes for these accidents range from dislocation of the rim components in the assembly, mismatch of the components, manufacturing tolerances, corrosion of components to tires. A finite element analysis of a two-piece rim design similar to one manufactured by some of the prominent rim manufacturers in the USA is undertaken. A linear static deformation analysis is performed with the appropriate loading and boundary conditions. The dislocation of the side ring with respect to the rim base and its original designer intent position is established using simulation results from ANSYS and actual rim failure cases. Reliability of the multi-piece rims is analyzed using the failure data provided by the rim manufacturers in connection with a lawsuit (Civil Action No. 88-C-1374). The data was analyzed using MINITAB. The effect of an OSHA standard (1910.177) on servicing multi-piece rims was studied for change in failure patterns of different rims. The hazard functions were plotted and failure rates were calculated for each type of rim. The failure rates were found to be increasing suggesting that the standard had minimal effect on the accidents and failures. The lack of proper service personnel training and design defects were suggested as the probable reasons for the increasing failure rates

Drug utilization study in the paediatric department of a tertiary care teaching hospital

Background: Rational drug use is one of the main concerns of the health care system in India. Paediatric population being more vulnerable require additional focus to achieve this goal. Objectives of the study were to evaluate the prescription patterns according to WHO guidelines and the diseases, for which they are being prescribed, to identify the common diseases and common medications used.Methods: A cross sectional study was done in the paediatrics department for a period of 2 months. All the paediatric prescriptions were evaluated using WHO core indicators like average number of medicines per encounter, percentage of medicines from the essential drug lists and also complimentary indicators like utilization of different dosage forms and diagnostic patterns. Statistical Analysis: Data was analyzed and represented as frequency (n) and percentage (%).Results: 89 out of 302 prescriptions had 2 medicines per encounter, 100% of medicines were included from the Essential Drug List (EDL), 59.4% of the medicines were in generic format of prescription.Conclusions: This study gives a positive outlook at the utilization pattern of drugs with all the indicators specifically Essential Drugs List. Regular auditing, continuous medical education and evidence-based medicine can help in improving the health care

Identification of low birth weight babies by birth weight-independent anthropometric measures

Introduction: Birth weight (BW) is the single most important factor that affects neonatal mortality and infant and childhood morbidity. Most of the deliveries in rural areas are conducted at home, often by traditional birth attendants and relatives, where the facility to weigh the baby is not possible. There is a constant search for simple and effective method to identify at-risk low BW (LBW) babies. Objectives: The objectives of this study were to identify a single or combination of anthropometric data that reliably identify LBW babies. Materials and Methods: This was a cross-sectional study conducted in neonatal care unit of a teaching hospital. The study subjects included 141 singleton newborns with gestational age of between 32 and 42 weeks andwithin 24 h of birth were included in the study. Newborns that were sick or having congenital anomalies were excluded from the study. In all newborns, gestational age assessment and anthropometric data measurement were done within 24 h of birth by trained residents. Results: Male (54.0%) and female babies (46.0%) were similar in proportion. The mean BW was 2.54±0.53 kg and 43.3% were LBW babies (<2.5 kg). Calf circumference (CC), chest circumference (CHC), midarm circumference (MAC), head circumference (HC), and crown-to-heel length (CHL) showed significant and high positive correlation of 0.887, 0.871, 0.807, 0.77, and 0.724, respectively, with BW. The cutoff values corresponding with a BW of <2.5 kg with high sensitivity were as follows: CC ≤10.5 cm, CHC ≤32 cm, MAC ≤10 cm, HC ≤33.8 cm, and CHL ≤50 cm. Conclusions: CC was the single most usefulanthropometric measure to predict LBW. Its sensitivity of 100% with relatively higher specificity of 67.5% indicates its ability mainly to rule out LBW in a baby, if CC is >10.5 cm

A study of hydraulic properties of high level waste simulant

The purpose of this study was to determine the unsaturated hydraulic properties of High Level Waste simulant by applying inverse modeling and parameter estimation methods and data obtained by experiments. Saltcake simulant was placed in column equipped with tensiometers and flow meters. Variable pressure boundary conditions ranging from 100 to 500 cm were applied along the column, outflow and the pressure head were measured with respect to time. The experimental data was analyzed using an inverse modeling software and the van Genuchten\u27s hydraulic parameters for unsaturated porous media were determined. In addition, the unsaturated hydraulic conductivities were obtained as a function of the moisture content. Hydraulic conductivities ranged from 5.36E-5 to 4.29E-2 cm/hr. The data was analyzed to determine the percentage reduction in storage capacity as a function of applied pressure. The experimental results were compared with output from direct simulations of interstitial fluid drainage from a column and showed good agreement. While there are several studies on determining the saturated hydraulic conductivities, this work demonstrates that the van Genuchten unsaturated model is a valid model and can be applied for three dimensional modeling and for determining the level of separation of radioactive waste (Cs 137) using interstitial fluid drainage

GENTAMICIN POPULATION PHARMACOKINETICS IN INDIAN PEDIATRIC PATIENTS

Objective: The objective of this study was to characterize gentamicin population pharmacokinetics (PKs) in Indian pediatric patients.Methods: Population PK analysis was performed with nonlinear mixed-effect model software. The data set was inspected using both first order (FO)and FO conditional estimate (FOCE) methods by the inclusion of both patient and pathological conditions.Results: A total of 26 patients were involved in this study with 54 observations. The patient covariates, including body weight, gender, age, andcreatinine clearance (CLCR), were analyzed in a stepwise fashion to identify their potential influences on gentamicin PKs. The final modelgives the clearance (CL) and volume of distribution (V) by FO method as CL=θ1*(CLCR/35.14)+θ3*(WT/14.25)+θ5*(AGE/6.14)*EXP(θ1),V=θ2*(WT/14.25)+θ4*(CLCR/35.14)+θ6*(AGE/6.14)*EXP(θ2) and by FOCE method as CL=θ1*(CLCR/35.14+)θ3*(AGE/6.14)*EXP(θ1),V=θ2*(WT/14.25)+θ4*(CLCR/35.14)+θ6*(AGE/6.14)*EXP(θ2).Conclusion: The final model estimates of CL and V were 0.0014 L/hr/kg and 0.646 L/kg, respectively, and by FOCE method were 0.0014E-06 L/hr/kgand 0.774 L/kg, respectively. These parameters will be helpful in individualizing the loading and maintenance doses in pediatric patients.Keywords: Population pharmacokinetics, Gentamicin, Nonlinear mixed-effect model, Pediatrics

Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate

Background: The treatment of displaced proximal humeral injuries still throws challenges in identifying variables to prognosticate the outcome and optimizing a good clinical result. This study attempts to analyze the functional outcome of surgery of such fractures with proximal humeral interlocking system (PHILOS) plate and evaluate variables which help in predicting the prognosis.Methods: This is a retrospective and prospective study of 30 patients with displaced proximal humerus fractures - 2 part, 3 part, 4 part and fracture dislocations according to Neer classification, surgically treated using PHILOS plate during 2011 and 2014. Evaluation of patients was done on follow-up by an independent observer for union by radiographs and functional assessment by Constant-Murley score and DASH (disabilities of the arm, shoulder and hand) score.Results: The mean age of the patients was 40.4 years (range 18-65). 83.3% of the patients were male. The mean follow-up was 18.9 months (4-36 months). The mean Constant-Murley score and the DASH score were 76 and 16 respectively at the last follow-up. Our analysis showed that the patient’s age, delay in surgery, and Neer’s classification influenced the prognosis of the fracture. Medial metaphyseal extension in the fracture or an intact medial neck showed a better outcome. Complications were seen in 5 patients. Avascular necrosis was seen in 3 patients.Conclusions: Osteosynthesis of displaced proximal humeral fractures with PHILOS plate provides a good outcome, with low complication rate. Patient’s age and the type of fracture based on Neer’s classification prognosticate the outcome.

Efficient access control technique to maintain health records in cloud

We propose a novel attribute based encryption scheme for fine-grained and adaptable access control to PHRs information in cloud computing. The plan creates shared information by the normal access subpolicy which depends on various patients' entrance arrangements. At that point the plan joins the encryption of PHRs from various patients. Hence, both time utilization of encryption and decryption can be diminished. Medical staff require changing dimensions of access to PHRs. The proposed plan can likewise bolster multi-benefit get to control with the goal that therapeutic staff can get to the required dimension of information while augmenting quiet security. Through usage and reenactment, we show that the proposed plan is effective regarding time. In addition, we demonstrate the security of the proposed plan dependent on security of the ciphertext-strategy attribute based encryption scheme

Assessment of Ponseti technique of manipulation and serial casting in idiopathic clubfoot

Background: Congenital talipes equinovarus is one of the commonest congenital foot deformities. Ponseti technique of treatment of clubfoot has gained popularity in the last few decades. Feet treated by Ponseti technique are supple, flexible and pain free. We have treated congenital idiopathic clubfoot with Ponseti technique at our institute and present our results.Methods: Forty eight feet in thirty children with clubfoot were treated by Ponseti technique in our institute. The study was conducted from December 2013 to December 2015. Parents were counselled regarding treatment protocol and maintenance with bracing was closely monitored. Each child was followed up for a minimum of six months. Pirani score was used to objectively document progress of treatment.Results: The average number of casts required for complete correction was 6.6. 38% feet required tendoachilles tenotomy. Higher the initial Pirani score, more number of casts were required to achieve full correction. Number of casts needed for complete correction did not correlate to time of presentation.Conclusions: Ponseti method is very effective in correcting congenital idiopathic clubfoot deformity. It’s easy to learn, is inexpensive and can completely correct the deformity. In developing nations, well trained Orthopaedic surgeons can treat these children effectively and decrease disabled population.

Analysis of the results of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nail or various plate combinations

Background: Ipsilateral femoral shaft and hip fractures are commonly encountered following high energy trauma. Despite many treatment methods, controversy exists regarding the optimal management of these fractures. This study was planned to compare reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients with these fractures.Methods: 25 patients with ipsilateral femoral shaft and hip fractures were operated by one of the  two modalities - cancellous lag screws or dynamic hip screw for fracture hip and compression plate fixation for fracture shaft of the femur (Group I, 13 patients) and Reconstruction-type intramedullary nailing  alone (Group II, 12 patients) -  depending on surgeon's preference. The functional results of the patients were assessed with the system used by Friedman and Wyman. Radiological and functional assessment was done by an independent evaluator blinded to the surgical procedure.Results: The mean age was 33.6±4.03 in group I and 35.3±4.04 years in group II (p=0.70). The average follow up was 15 months. The average union time for femoral neck fracture was 15.75±0.89 and 16.48±1.40 (p=0.36) weeks and for fracture shaft was 19.27±1.18 and 20.06±1.16 (p=0.15) in group I and group II respectively. 10 patients (76.9%) in group I and 9 (75%) in group II showed good functional results. Two patients needed re-operation in group I and one patient in group II.Conclusions: Ipsilateral femoral shaft and hip fractures can be treated satisfactorily either with nailing alone or various plate combinations with similar outcome