Thermal Management of Vehicle Interior Temperature for Improvement of Fuel Economy

The passenger compartment of a vehicle parked directly under the sun in the summer can reach uncomfortably high temperatures. Solar radiation may affect the durability of surfaces such as a dashboards and leather seats. Extended exposure to high temperature reduces the lifespan of some electronics in the instrument panel. VOCs, Volatile organic compounds, also increase due to high temperatures in the vehicle cabin leading to poor air quality. When the driver and passengers enter the vehicle and turn on the AC system, there is a duration of time wherein there is thermal discomfort. The duration depends on how fast the AC system is able to extract the heat from the cabin and transfer it to the outside. In addition, the amount of heat which is entrapped in the passenger compartment affects the amount of work the AC system has to perform to remove the heat from the compartment. In return, this has a significant effect on fuel consumption. A transient energy balance model is developed to perform thermal analysis for various thermal inputs. This model is able to provide the temperature distribution and energy accumulation for surfaces inside the cabin. The primary objective of this research is to optimize factors like glass types, roof insulation, materials, thicknesses, underbody heat insulation, and exterior and interior colours using DFSS–Design for Six Sigma. The optimization of these parameters will reduce the load on the AC system while also improving component durability, air quality, and thermal comfort

Étude de l’importance de sujets cliniques dans un cursus de gastro-entérologie à l’intention des résidents en pédiatrie

Background: Focused objectives provide effective learning. Pediatric residents in Canada follow objectives set by the Royal College of Physicians and Surgeons of Canada (RCPSC) with the goal of becoming competent general pediatricians. During the gastroenterology rotation, it remains unclear as to what clinical problems listed in the aforementioned objectives are crucial to understand as part of general pediatric practice. The purpose of this study was to identify the gastroenterological conditions of most importance to incorporate into a focused curriculum for pediatric residents. Methods: All pediatricians across four Canadian Atlantic provinces were surveyed by a mailed questionnaire. Questions included demographics and ranking of the 14 clinical problems currently listed in the RCPSC objectives along with six more generated after input was gained from pediatric gastroenterologists. Results: Of the 234 pediatricians surveyed, 132 (56%) responded, 48% of whom were general pediatricians. Celiac disease, gastroesophageal reflux, and obesity (currently not on the RCPSC list) were identified as important/very important conditions to understand by 94.4%, 96.1%, and 96.0% of respondents, respectively. There were no significant differences in rankings between general pediatricians and subspecialists. A large majority recommended that a rotation in gastroenterology be mandatory during pediatric residency. Conclusions: Pediatricians from four Canadian Atlantic provinces recommended a list of gastrointestinal conditions to be included in pediatric residency training. It would be important to consider these recommendations to keep the training curriculum in sync with real world needs.Contexte : L’établissement d’objectifs ciblés favorise un apprentissage efficient. Au Canada, les résidents en pédiatrie poursuivent les objectifs fixés par le Collège royal des médecins et des chirurgiens du Canada (CRMCC) pour devenir de bons pédiatres généralistes. Durant le stage en gastro-entérologie, les problèmes cliniques à prioriser dans cette liste d’objectifs, en vue d’une pratique pédiatrique générale, demeurent imprécis pour les résidents. Cette étude visait à identifier les troubles de l’appareil digestif les plus importante à inclure à un cursus ciblé à l’intention des résidents en pédiatrie. Méthodologie : On a mené un sondage auprès de pédiatres des quatre provinces de l’Atlantique en leur envoyant un questionnaire par la poste.  Les questions visaient à obtenir des données démographiques et leur demander de classer 14 troubles faisant actuellement partie de la liste du CRMCC, puis six autres après avoir recueilli des avis auprès de gastro-entérologues pédiatriques. Résultats : 132 (56 %) des 234 pédiatres sondés, dont 48 % étaient des pédiatres généralistes, ont répondu au questionnaire.  La maladie cœliaque, le reflux gastro-œsophagien et l’obésité (maladie qui ne figure pas actuellement sur la liste du CRMCC) ont été jugés comme des troubles importants ou très importants à connaître par 94,4 %, 96,1 % et 96,0 % des répondants, respectivement.  On n’a observé aucune différence significative entre le classement des pédiatres généralistes et celui des surs-spécialistes.  Une grande majorité de répondants ont recommandé qu’un stage en gastro-entérologie devienne obligatoire durant la résidence en pédiatrie. Conclusions : Les pédiatres des quatre provinces de l’Atlantique ont recommandé une liste de troubles de l’appareil digestif à inclure au programme de résidence en pédiatrie. Il serait important de tenir compte de ces recommandations pour que le programme de formation reste adapté aux besoins de la réalité

Another D in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis.

Ketogenic diet or very-low-carbohydrate diet gained widespread popularity in the 1990s due to their favorable effects on weight loss and diabetes among others with good short-term safety data. People on ketogenic diets exist in a state of dietary ketosis in which the body production of ketone is equal to consumption and no harmful effects of ketonemia occur. However, in face of stress, the harmless dietary ketosis can lead to profound acid-base disturbances due to massive overproduction of ketone bodies that overwhelms the acid buffer system of the body. A handful of case reports have been published on this topic calling the safety of ketogenic diet into question. In this article, we chronicle a unique case of ketogenic (Atkins) diet-associated ketoacidosis, and we present a comprehensive literature review on the etiology of ketoacidosis

Our experience with van nes rotationplasty for locally advanced lower extremity tumours

Abstract OBJECTIVE: To present an early experience with the time-tested technique of Van Ness Rotationplasty to save distal lmbs. METHODS: Van Nes Rotationplasty for locally advanced lower extremity tumours. A reterorespective audit was conducted at Aga Khan University Hospital, Karachi, and comprised cases of bone and soft tissue sarcoma who underwent Van Ness Rotationplasty over seven years from January 2005 to December 2011. Demographic data, family history, past history, co-morbids, date since diagnosis, duration of symptoms, type of tumour, metastasis, pre-op and post-op functional status, recurrence and survival were collected. RESULTS: Of the 351 cases of bone and soft tissue sarcoma, 9 (2.6%) underwent Van Ness Rotationplasty and were included in the study. The mean duration of symptoms was 7±3SD months (range: 8-41 months). All except 1(11.1%) were osteogenic sarcomas. All except 1(11.1%) involved distal femur. Overall, 7(77.8%) had localised Enneking stage IIB disease. Two (22.2%) patients expired due to metastatic disease, but none had local recurrence. Complete excision of tumour was achieved in all (100%) patients. Longest follow-up was of 34 months while the shortest was of 6 months. No local recurrences were noted. Functional recovery was good. Two (22.2%) patients had simultaneous sciatic nerve repair as part of the primary procedure. Both of them had good motor function at the time of final follow-up. Mean Musculoskeletal Tumour Societyscore was 23.88±2SD. CONCLUSIONS: Van Nes Rotationplasty was found to be a successful alternative to amputation in cases of locally advancedtumours of distal femur or proximal tibia

Size premium, value premium and market timing: evidence from an emerging economy

Purpose - This study aims to investigate the market timing strategy in different market conditions (i.e. up, down, normal and in-financial-crisis situation) in the emerging market of Pakistan over the period 1995 to 2015. Furthermore, this study tests the validity of the capital asset pricing model (CAPM) and Fama and French model. Design/methodology/approach - This study considers monthly stock returns of 167 firms and constructs six different portfolios on the basis of different size and book to market ratio. The Treynor and Mazuy model is used to capture the market timing strategy. Findings - The results indicate evidence of the market timing in normal market conditions. However, there is less supportive evidence of market timing in up-market, down-market and in-financial-crisis situations. This study also confirms the validity of the capital asset pricing model and Fama and French three-factor model with strong support of value premium and size premium in the stock market. Practical implications - The findings of this study are helpful to companies in estimating the cost of issuing equity more accurately. The investors can use market timing to make their investment in a more better and profitable manner. Originality/value - Unlike other previous studies, this study considers an extended period to test the validity of the capital asset pricing model and Fama and French model. In addition, this study is novel in testing the marketing timing of the firms in the context of emerging economy of Pakistan.Objetivo - Este estudio tiene como objetivo investigar la estrategia de sincronización del mercado en diferentes condiciones de mercado (es decir, situación al alza, a la baja, normal y en situación de crisis financiera) en el mercado emergente de Pakistán durante el período 1995 a 2015. Además, este estudio prueba la validez de la modelo de valoración de activos de capital (CAPM) y modelo Fama y francés. Diseño / metodología / enfoque - Este estudio considera los rendimientos mensuales de las acciones de 167 empresas y construye seis carteras diferentes sobre la base de diferentes tamaños y relaciones entre libros y mercado. El modelo de Treynor y Mazuy se utiliza para capturar la estrategia de sincronización del mercado. Recomendaciones - Los resultados indican evidencia de la sincronización del mercado en condiciones normales de mercado. Sin embargo, hay menos evidencia de apoyo de la sincronización del mercado en situaciones de mercado al alza, a la baja y en situaciones de crisis financiera. Este estudio también confirma la validez del modelo de fijación de precios de los activos de capital y el modelo de tres factores de Fama y el francés con un fuerte apoyo de la prima de valor y la prima de tamaño en el mercado de valores. Implicaciones prácticas - Los hallazgos de este estudio son útiles para que las empresas estimen con mayor precisión el costo de emisión de acciones. Los inversores pueden utilizar la sincronización del mercado para hacer su inversión de una manera mejor y más rentable. Originalidad / valor - A diferencia de otros estudios anteriores, este estudio considera un período extendido para probar la validez del modelo de valoración de activos de capital y el modelo francés y de Fama. Además, este estudio es novedoso al probar el momento de comercialización de las empresas en el contexto de la economía emergente de Pakistán

Significance of Neuropilin-1 (CD 304) Expression in Paediatric B- Lineage Acute Lymphoblastic Leukemia (ALL)

Background: To determine the prognostic significance of NRP-1 (CD304) expression in paediatric B-lineage Acute Lymphoblastic Leukaemia (ALL) patients. Methods: In this comparative study newly diagnosed cases (aged 1-15 years) of B-ALL were selected. Age and sex matched, 21 healthy controls were also included in the study to assess the NRP-1 expression on peripheral blood lymphocytes. A minimum 1ml of blood and bone marrow aspirate samples were taken in EDTA vacutainer and immunophenotyping was done on gated blast cells using an extensive panel of antibodies including myeloid markers (CD13, CD33 and cytoplasmic anti-MPO) and lymphoid markers (CD34, CD2, CD3, CD5, CD7, CD4, CD8, HLA DR, CD10, CD19, CD22; cytoplasmic CD3, CD22, CD79a and nuclear anti-TdT). The sample was considered NRP-1 positive if 20% or more of the gated blast cells expressed it . Man-Witney U test and Kruskal Wallis test were used for non-parametric data. The p value <0.05 was considered significant. Results: Out of 66 B-ALL patients, 53% were males. There were 20 (30%) NRP-1 positive and 46 (70%) NRP-1 negative patients. The prognosis of NRP-1 positive group was poor as compared to NRP-1 negative group with high blast percentage (80%) (p= 0.042), low morphological remission rate (21%) (p=0.004) and low survival rate (29%) (p=0.009). The mean survival days in dead patients was also less (22.75 days). Conclusion: NRP-1 over expression is associated with disease progression and severity in paediatric B-ALL patients

Anosmia in Parkinson’s Disease in Pakistan: A Matched Case – Control Study

Objective:  To assess olfactory dysfunction in Parkinson's disease (PD) patients in Pakistan utilizing an autochthonous smell test. Setting:  Tertiary care center, single-center study. Materials and Methods:  Eighty-seven non-demented patients with PD, who fulfilled Queen Square Brain Bank Criteria were enrolled at the Movement Disorder Clinic, Lahore General Hospital (LGH), Lahore. Fifty-eight controls matched by gender, age, and place of residence were enrolled among patients and visitors attending other hospital clinics. Both groups underwent olfactory testing using the Pakistani Smell Identification test (PKSIT). The participants were required to identify the smell from a set of choices and were scored out of 10. Results:  Among patients in the study group, the mean duration of disease was 4.7 years (range 6 months to 19 years). The PD onset mean age was 52.15 ± 13.02 years among patients. The mean number of smell test items accurately recognized by the PD patients was 4.55 ± 2.4. A multiple linear regression demonstrated that age (P < 0.05) but not disease duration (P = 0.899) was a significant determinant of the smell test result in PD and control groups. The mean number of smell test items appropriately recognized by the controls was 7.33 ± 1.69. Logistic regression showed that the PKSIT had 73.2% sensitivity and 84.3% specificity to distinguish PD from control. Conclusion:  PKSIT being easily available, cheap, and more convenient to use in the Pakistani population, can be used in the evaluation of olfactory dysfunction in PD subjects

Preventive gabapentin versus pregabalin to decrease postoperative pain after lumbar microdiscectomy: A randomized controlled trial

Study design: Randomized controlled trial.Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing lumbar microdiscectomy were randomized to group A (gabapentin) or group B (pregabalin) and started on trial medicines one week before surgery. The VAS for pain was recorded at 24 hours and one week postoperatively.Results: Both groups had similar baseline variables, with mean ages of 42 and 39 years in groups A and B, respectively, and a majority of male patients in each group. The mean VAS values for pain at 24 hours for gabapentin vs. pregabalin were comparable (1.97±0.84 vs. 1.6±0.87, respectively; p=0.087) as were the results at one week after surgery (0.27±0.45 vs. 0.3±0.46, respectively; p=0.79). None of the patients required additional analgesia postoperatively. After adjusting for age and sex, the VAS value for group B patients was 0.028 points lower than for group A patients, but this difference was not statistically significant (p=0.817, R2=0.018).Conclusions: Pregabalin is equivalent to gabapentin for the relief of postoperative pain at a lower dose in patients undergoing lumbar microdiscectomy. Therefore, other factors, such as dose, frequency, cost, pharmacokinetics, and side effects of these medicines, should be taken into account whenever it is prescribed