Optimization of Micro-Wire EDM Operation Using Grey Taguchi Method

Micro-wire EDM is an emerging technology in the field of Micro-machining to fabricate very complex micro products. Micro wire EDM is a very complex process involving the different process parameters. In the present investigation an optimization of micro wire EDM has been carried out using Grey Taguchi method. The parameters involved are voltage, capacitance, feed rate and wire speed. MRR and kerf width are taken as the response criteria. Experimental investigation has been carried out in multi-process Micro-EDM machine. Wire electrical discharge machining process is a highly complex, time varying & stochastic process. This is used in the fields of dies, molds; precision manufacturing and contour cutting etc. any complex shape can be generated with high grade of accuracy and surface finish using CNC WEDM. The output of the process is affected by large no of input variables. Hence a suitable selection of input variables for the wire electrical discharge machining (WEDM) process depends heavily on the operator’s technology & experience. WEDM is extensively used in machining of conductive materials when precision is of prime importance. Rough cutting operation in wire EDM is very challenging one because improvement of more than one performance measures viz. Metal removal rate (MRR), surface finish & cutting width (kerf) are of prime importance. This paper proposes optimal parameter setting. Using taguchi's parameter design, significant machining parameters affecting the performance measures are identified as pulse peak current, pulse on time, and duty factor. The effect of each control factor on the performance measure is studied individually using the plots of signal to noise ratio. The study demonstrates that the WEDM process parameters can be adjusted so as to achieve better metal removal rate, surface finish, electrode wear rate

Global, regional, and national levels of maternal mortality, 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Peer reviewe

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1�4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980�2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age�sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95 uncertainty interval UI 5·7�6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7�53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3�43·6) to 2·6 million (2·6�2·7) neonatal deaths and 47·0% (35·1�57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6�3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license

Global, regional, and national levels of maternal mortality, 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10�54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68 in 1990 to more than 80 in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91 coverage of one antenatal care visit, 78 of four antenatal care visits, 81 of in-facility delivery, and 87 of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care�including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Empowering the Path from Stiffness to Recovery in Adhesive Shoulder Capsulitis Complexity

Adhesive shoulder capsulitis, also called arthrofibrosis, is a complex medical condition characterized by excessive scar tissue around the glenohumeral joint, causing stiffness, pain, and reduced functionality. Its historical evolution, from "scapulohumeral periarthritis" to "adhesive capsulitis," traces back to the 20th century. However, the underlying pathology remains unclear, posing diagnostic and treatment challenges. The condition progresses through phases: pain, stiffness, and eventual recovery, each with distinct clinical features. Emerging research shifts the understanding from fibrosis-focused to inflammation and fibrosis combined. Risk factors include age, gender, prior shoulder trauma, and diabetes. It primarily affects older individuals, women, and those with medical comorbidities, particularly diabetes. Diagnosis relies on identifying specific markers like capsule contracture, synovial loss, and adhesions, while differentiation from similar shoulder disorders is crucial. Treatment encompasses non-operative options (physical therapy, medication) and more invasive interventions (manipulation under anesthesia, arthroscopic capsulotomy). This review offers a broad view of adhesive capsulitis, covering its history, causes, risk factors, diagnosis, and various treatments. By exploring its multifaceted dimensions, the aim is to improve understanding and management of this intricate condition, enhancing the lives of those affected

Prevalence and determinants of spacing contraceptive use among rural married women of Jammu, India

Introduction: Promotion of family planning, especially the use of contraceptive methods is essential to secure the well-being and development of society. Despite rise in the temporary contraceptive usage over the years, the implementation of the spacing method has been indicated lower in rural as compared to the urban areas of India. This study aims to find out the prevalence and determinants of current use of spacing contraceptives among married rural women of Jammu district, Jammu and Kashmir. Material and Methods: A community-based, cross-sectional study was conducted from January to June 2018 among married rural women. The survey was conducted house to house, and data were collected with the help of a questionnaire and BG Prasad Scale. Multi-stage sampling procedure was adopted to select the participants. Bivariate and multivariable logistic regression model was fitted to identify the factors associated with the current use of spacing contraceptive methods. Results: The current use of spacing contraceptive among married women was found to be 16.4%. The male condom was the most used method (55.7%) as well as most preferred contraceptive (46.8%). Lack of knowledge was reported as the main reason for not using contraceptive method. The current use of spacing contraceptive method was significantly higher among the upper socioeconomic status (adjusted odds ratio (AOR) 2.37(1.06–5.29), women with higher education (AOR ) 5.04 (0.68–37.18), living in nuclear family (AOR 1.90; CI: 1.01–3.60), with 2 or more surviving children (AOR ) 2.45 (1.27–4.73), and living near health center (AOR) 1.69 (0.91–3.14). Conclusion: Effective targeted programs along with conduction of more field researches that give scientific information should be implemented to achieve the desired goal of contraceptive usage in the rural area among married couples

Evolution and Exploration of Azadirachta indica in Dentistry: An Update

Despite great achievements globally in oral health of populations, dental caries and periodontal diseases are the most important oral health burdens particularly among under-privileged groups in developed and developing countries. Nonetheless, oral cancer is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries. Apart from the traditional therapeutic modalities available so far that are usually synthetic drugs, researchers are presently discovering unexplored horizons of herbs for curing these ailments. One such beneficial herb is Azadirachta indica (Neem) that has been widely accepted throughout the world for its innumerable medicinal properties. The limitless benefits of neem has been documented in Indian traditional medicinal books like ‘Charak – Samhita’ & ‘Sushruta – Samhita’. Neem tree has been valued long back, since centuries by the Indian citizens for cleaning the teeth, skin diseases, consumption as a tonic & eradicating worms etc & many more. The present review discusses the in-vivo, in-vitro and animal studies utilizing the electronic databases Pubmed, Embase and Google Scholar till 31st December 2016 that highlights the medicinal properties of this wonder herb from oral health point of view suggesting its role as anti-gingivitis, anti-microbial, antiplaque, anticandidiasis, anti-periodontitis, effective endodontic irrigant, dental erosion therapy, anticaries & oral cancer therapy. Although the results are encouraging, but more scientific validation is required so that the incorporation of this ayurvedic herb into modern dentistry could be justified

Cutaneous sporotrichosis: Unusual clinical presentations

Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/ available