Priority setting for research in health care: An application of value of information analysis to glycoprotein IIb/IIIa antagonists in non-ST elevation acute coronary syndrome

The purpose of this study is to explain the rationale for the value of information approach to priority setting for research and to describe the methods intuitively for those familiar with basic decision analytical modeling. A policy-relevant case study is used to show the feasibility of the method and to illustrate the type of output that is generated and how these might be used to frame research recommendations. The case study relates to the use of glycoprotein IIb/IIIa antagonists for the treatment of patients with non-ST elevation acute coronary syndrome. This is an area that recently has been appraised by the National Institute for Health and Clinical Excellence

Modelling and real-time control of a high performance rotary wood planing machine

Rotary planing is one of the most valuable machining operations in the timber processing industry. It has been established that cutting tool inaccuracy and forced vibration during the machining process are the primary causes of surface quality degradation. The main aim of this thesis is to design a control architecture that is suitable for adaptive operation of a wood planing machining in order to improve the quality of its surface finish. In order to achieve the stated goal, thorough understanding of the effects of machine deficiencies on surface finish quality is required. Therefore, a generic simulation model for synthesising the surface profiles produced by wood planing process is first developed. The model is used to simulate the combined effects of machining parameters, vibration and cutting tool inaccuracy on the resultant surface profiles. It has been postulated that online monitoring of surface finish quality can be used to provide feedback information for a secondary control loop for the machining process, which will lead to the production of consistently high quality surface finishes. There is an existing vision-based wood surface profile measurement technique, but the application of the technique has been limited to static wood samples. This thesis extends the application of the technique to moving wood samples. It is shown experimentally that the method is suitable for in-process surface profile measurements. The current industrial wood planing machines do not have the capability of measuring and adjusting process parameters in real-time. Therefore, knowledge of the causes of surface finish degradation would enable the operators to optimise the mechanical structure of the machines offline. For this reason, two novel approaches for characterising defects on planed timber surfaces have been created in this thesis using synthetic data. The output of this work is a software tool that can assist machine operators in inferring the causes of defects based on the waviness components of the workpiece surface finish. The main achievement in this research is the design of a new active wood planing technique that combines real-time cutter path optimisation (cutting tool inaccuracy compensation) with vibration disturbance rejection. The technique is based on real-time vertical displacements of the machine spindle. Simulation and experimental results obtained from a smart wood planing machine show significant improvements in the dynamic performance of the machine and the produced surface finish quality. Potential areas for future research include application of the defects characterisation techniques to real data and full integration of the dynamic surface profile measurements with the smart wood planing machine

Study of reactivity pattern of hormone receptors in patients with breast cancer at a tertiary care hospital, Aurangabad, India

Background: Breast cancer is one of the most common malignancies affecting the female population worldwide. Prognosis and management of breast cancer are influenced by variables such as stage, grade, and hormone receptor status. Tumours that express ER and/or PR have a better prognosis and most of them respond well to hormonal therapy. In addition to hormone receptors, HER2 has emerged in recent years as an important independent predictive marker.Methods: All surgically operated female cases of breast carcinoma which were submitted for immunohistochemistry test for estrogen, progesterone and human epidermal growth factor receptor-2 in the Department of Pathology, MGM Medical College, Aurangabad for the duration of December 2015 to October 2017 were included in this prospective study. A total of 50 patients were taken up for the study.Results: The maximum age of the patients were in the 4th -5th decade and were mostly premenopausal. The tumour was maximum involving the right breast, upper outer quadrant and were BI-RADS 4. Majority were grade 2 and were invasive ductal carcinoma. Hormone receptor status showed ER positivity 48%, PR positivity 46% and HER2 positivity 28%.Conclusions: So, to conclude, immunohistochemical analysis of ER, PR and HER2 receptors is widely available at a reasonable cost and provides valuable prognostic, predictive and therapeutic information. Although we could see different patterns of hormonal receptor status, irrespective of the histological grade, type and lymph node status in our study, HER2 testing along with ER/PR status should be performed routinely in all the patients diagnosed of breast cancer as this will help the clinicians to manage the patients further

Anderson Transition in Disordered Graphene

We use the regularized kernel polynomial method (RKPM) to numerically study the effect disorder on a single layer of graphene. This accurate numerical method enables us to study very large lattices with millions of sites, and hence is almost free of finite size errors. Within this approach, both weak and strong disorder regimes are handled on the same footing. We study the tight-binding model with on-site disorder, on the honeycomb lattice. We find that in the weak disorder regime, the Dirac fermions remain extended and their velocities decrease as the disorder strength is increased. However, if the disorder is strong enough, there will be a {\em mobility edge} separating {\em localized states around the Fermi point}, from the remaining extended states. This is in contrast to the scaling theory of localization which predicts that all states are localized in two-dimensions (2D).Comment: 4 page

Foci of Schistosomiasis mekongi, Northern Cambodia: II. Distribution of infection and morbidity.

In the province of Kracheh, in Northern Cambodia, a baseline epidemiological survey on Schistosoma mekongi was conducted along the Mekong River between December 1994 and April 1995. The results of household surveys of highly affected villages of the East and the West bank of the river and of school surveys in 20 primary schools are presented. In household surveys 1396 people were examined. An overall prevalence of infection of 49.3% was detected by a single stool examination with the Kato-Katz technique. The overall intensity of infection was 118.2 eggs per gram of stool (epg). There was no difference between the population of the east and west shore of the Mekong for prevalence (P = 0.3) or intensity (P = 0.9) of infection. Severe morbidity was very frequent. Hepatomegaly of the left lobe was detected in 48.7% of the population. Splenomegaly was seen in 26.8% of the study participants. Visible diverted circulation was found in 7.2% of the population, and ascites in 0.1%. Significantly more hepatomegaly (P = 0.001), splenomegaly (P = 0. 001) and patients with diverted circulation (P = 0.001) were present on the west bank of the Mekong. The age group of 10-14 years was most affected. The prevalence of infection in this group was 71.8% and 71.9% in the population of the West and East of the Mekong, respectively. The intensity of infection was 172.4 and 194.2 epg on the West and the East bank, respectively. In the peak age group hepatomegaly reached a prevalence of 88.1% on the west and 82.8% on the east bank. In the 20 schools 2391 children aged 6-16 years were examined. The overall prevalence of infection was 40.0%, ranging from 7.7% to 72.9% per school. The overalls mean intensity of infection was 110.1 epg (range by school: 26.7-187.5 epg). Both prevalence (P = 0.001) and intensity of infection (P = 0.001) were significantly higher in schools on the east side of the Mekong. Hepatomegaly (55.2%), splenomegaly (23.6%), diverted circulation (4. 1%), ascites (0.5%), reported blood (26.7%) and mucus (24.3%) were very frequent. Hepatomegaly (P = 0.001), splenomegaly (P = 0.001), diverted circulation (P = 0.001) and blood in stool (P = 0.001) were significantly more frequent in schools of the east side of the Mekong. Boys suffered more frequently from splenomegaly (P = 0.05), ascites (P = 0.05) and bloody stools (P = 0.004) than girls. No difference in sex was found for the prevalence and intensity of infection and prevalence of hepatomegaly. On the school level prevalence and intensity of infection were highly associated (r = 0. 93, P = 0.0001). The intensity of infection was significantly associated only with the prevalence of hepatomegaly (r = 0.44, P = 0. 05) and blood in stool (r = 0.40, P = 0.02). This comprehensive epidemiological study documents for the first time the public health importance of schistosomiasis mekongi in the Province of Kracheh, Northern Cambodia and points at key epidemiological features of this schistosome species, in particular the high level of morbidity associated with infection

An Unusual Case of Tuberculous Lymphadenitis and Comparison of Various Methods for Diagnosis of Tuberculous Lymphadenitis

Although tuberculous lymphadenitis (TBLN) is extremely common in India, sometimes it may pose a diagnostic dilemma even after multimodality testing. This case report is about a patient who had undergone multiple fine needle aspirations (FNAC), Ziehl-Neelsen staining of aspirate, GeneXpert Nucleic acid amplification test (TBNAAT), biopsy and immunohistochemistry before arriving at a provisional diagnosis by hematoxylin-eosin staining of additional deeper sections. Additional information obtained by TBNAAT is whether the isolated strain is sensitive to Rifampicin. Emergence of multidrug resistance tuberculosis (resistance to rifampicin and INH) and extensively drug resistant strains implying resistance to fluoroquinolones and second-line injectable drugs can be a huge problem in the management of the disease. She is now under treatment and follow up. This case report highlights that caseation necrosis on FNAC even in the absence of acid-fast bacilli and a negative TBNAAT is strongly suggestive of tuberculous aetiology and may be used for initiating definitive treatment. A comparison of results of ZN stain of aspirate with TBNAAT for 22 cases of clinically suspected TBLN is also brought out