ADIC: Anomaly Detection Integrated Circuit in 65nm CMOS utilizing Approximate Computing

In this paper, we present a low-power anomaly detection integrated circuit (ADIC) based on a one-class classifier (OCC) neural network. The ADIC achieves low-power operation through a combination of (a) careful choice of algorithm for online learning and (b) approximate computing techniques to lower average energy. In particular, online pseudoinverse update method (OPIUM) is used to train a randomized neural network for quick and resource efficient learning. An additional 42% energy saving can be achieved when a lighter version of OPIUM method is used for training with the same number of data samples lead to no significant compromise on the quality of inference. Instead of a single classifier with large number of neurons, an ensemble of K base learner approach is chosen to reduce learning memory by a factor of K. This also enables approximate computing by dynamically varying the neural network size based on anomaly detection. Fabricated in 65nm CMOS, the ADIC has K = 7 Base Learners (BL) with 32 neurons in each BL and dissipates 11.87pJ/OP and 3.35pJ/OP during learning and inference respectively at Vdd = 0.75V when all 7 BLs are enabled. Further, evaluated on the NASA bearing dataset, approximately 80% of the chip can be shut down for 99% of the lifetime leading to an energy efficiency of 0.48pJ/OP, an 18.5 times reduction over full-precision computing running at Vdd = 1.2V throughout the lifetime.Comment: 1

Parametric optimalization of submerged fermantation conditions for xylanase production Bacillus cereus BSA1 through Taguchi Methodology

Extracellular xylanase production of Bacillus cereus BSA1 was optimized under submerged fermentation using Taguchi orthogonal array (OA). An L18 layout of OA was constructed at three-levels of six factors, i.e. temperature, pH, and xylan, Na2HPO4, NH4NO3 and NaCl concentrations, influencing the xylanase synthesis. The enzyme production was studied in 18 parallel batch systems using different levels of each factor. The results were processed with Qualitek-4 software using ‘bigger is better’ quality character, and combination of 35 oC; pH 6.0; and xylan 0.5; NH4NO3 0.5, Na2HPO4, 0.1; NaCl 0.05 concentrations (in w/v %) with a predictive xylanase production of 7.404 U/ml was obtained. Fermentation experiment was performed for further validating the statistical output, and it resulted 10.24% in the xylanase yield (from 6.44 U/ml to 7.10 U/ml) as compared to one variable at a time (OVAT) design. Interaction effects of the factors individually and in combination can be evaluated by using Taguchi method design of experiment

Thermodynamic and kinetic characteristics of an a-amylase from Bacillus licheniformis SKB4

An amylolytic bacterial strain, Bacillus licheniformis SKB4 produced maximum amylase at pH 6.5 at 42 °C, and at late stationary phase (24 h) of growth. Starch and peptone were found the best supporting carbon and nitrogen source with C:N ratio of 1:2 for amylase production. The purified enzyme was non-responsive to most of the metal ions except K+ and Mg++ (1.0 mM). The enzyme was stable and active at pH 6.5. The enzyme showed optimum temperature at 90 °C with 10 min of half life (t½) at 100 °C. The Q10 of the enzyme was 1.0. The thermodynamic principles like activation energy, free energy for substrate binding and transition state of the enzyme were found 31.53, 5.53 and -17.4 KJ/Mol of starch, respectively. The kinetic constant like Vmax, Km, K catand catalytic efficiency (Kcat/Km)for starch were found to be 1.04 μmol mg-1 min-1, 6.2 mg ml-1,2 × 103 S-1 and 3.22 × 102 ml mg-1 S-1,respectively. All these findings suggested that this amylase has unique characteristics for starch hydrolysis in respect to thermostability and kinetic properties

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Soil conservation issues in India

Despite years of study and substantial investment in remediation and prevention, soil erosion continues to be a major environmental problem with regard to land use in India and elsewhere around the world. Furthermore, changing climate and/or weather patterns are exacerbating the problem. Our objective was to review past and current soil conservation programmes in India to better understand how production-, environmental-, social-, economic- and policy-related issues have affected soil and water conservation and the incentives needed to address the most critical problems. We found that to achieve success in soil and water conservation policies, institutions and operations must be co-ordinated using a holistic approach. Watershed programmes have been shown to be one of the most effective strategies for bringing socio-economic change to different parts of India. Within both dryland and rainfed areas, watershed management has quietly revolutionized agriculture by aligning various sectors through technological soil and water conservation interventions and land-use diversification. Significant results associated with various watershed-scale soil and water conservation programmes and interventions that were effective for reducing land degradation and improving productivity in different parts of the country are discussed

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Management and Outcomes of Meconium ileus, A six-year review: Pain Management: Oral Acetaminophen Versus Topical Lidocaine With/Without Epinephrine in Neonatal Circumcision

Introduction: Meconium ileus is one of the most common causes of intestinal obstruction in the newborn, accounting for 9–33% of neonatal intestinal obstructions1. It is characterized by the lack of excretion of meconium caused by impaction of thick, desiccated protein rich pallet like meconium in the distal part of ileum, associated with clinical and specific radiological findings of intestinal obstruction2. It is the intestinal obstructive variant of cystic fibrosis3, Recent studies demonstrate that it can occur frequently without association of cystic fibrosis. The exact pathogenesis of MI in the absence of cystic fibrosis is yet to be known, a spectrum of genetic and pathological abnormalities may play a role4. Two forms of meconium ileus can be described, simple and complex meconium ileus4,5. In 1969, Noblett suggested the use of Gastrografin enema to treat uncomplicated meconium ileus7. Many surgical options have been used in the surgical treatment of meconium ileus including resection with Primary anastomosis, Mikulicz ileostomy, Bishop–Koop operation, and Santulli stoma. Resection with primary anastomosis was first described in 1962 9,15. An alternative to this approach was small bowel resection with creation of a stoma and eventual closure of the stoma with an end-to-end anastomosis. A distal chimney enterostomy (Bishop-Koop procedure) involves resection of disparately enlarged ileal loop filled with inspissated meconium and anastomosis between the end of the appropriately sized proximal segment to the side of the distal segment of bowel approximately 4 cm from the opening of the distal segment and the distal end is brought out as the ileostomy8, the reverse of the distal chimney enterostomy is the Santulli and Blanc proximal enterostomy. The Mikulicz double-barreled enterostomy where both proximal and distal loop was exteriorized. Bishop-Koop enterostomy has advantages over other procedure16,17,18 as 1) it provides access for insertion of a catheter into distal bowel for post operative instillation of solubilizing agents for irrigation, 2) there is also decreased ostomy drainage after 12- 24 hrs of post operative period, so there will be less fluid and electrolyte loss, and 3) Permits an eventual enterostomy closure by bedside ligation of chimney stoma, avoiding another laparotomy for resection and anastomosis of bowel. Here we compare between various methods of treatment of meconium ileus and relative outcome and complications for each method.   Materials and Methods:  This is Retrospective study was conducted from March 2016- February 2022 in the Department of Paediatric Surgery, SVPPGIP, S.C.B Medical College and Hospital Cuttack, Odisha. Patients with clinical and radiological suspicion of meconium ileus were included in the study. They were grouped according to the severity as simple or complicated meconium ileus. Then Many surgical options have been used in the surgical treatment of meconium ileus including resection with Primary anastomosis, Mikulicz ileostomy, Bishop–Koop operation, and Santulli stoma. Resection with primary anastomosis was first described in 1962 9,15. An alternative to this approach was small bowel resection with creation of a stoma and eventual closure of the stoma with an end-to-end anastomosis. A distal chimney enterostomy (Bishop-Koop procedure) involves resection of disparately enlarged ileal loop filled with inspissated meconium and anastomosis between the end of the appropriately sized proximal segment to the side of the distal segment of bowel approximately 4 cm from the opening of the distal segment and the distal end is brought out as the ileostomy8, the reverse of the distal chimney enterostomy is the Santulli and Blanc proximal enterostomy. The Mikulicz double-barreled enterostomy where both proximal and distal loop was exteriorized. Bishop-Koop enterostomy has advantages over other procedure16,17,18 as 1) it provides access for insertion of a catheter into distal bowel for post operative instillation of solubilizing agents for irrigation, 2) there is also decreased ostomy drainage after 12- 24 hrs of post operative period, so there will be less fluid and electrolyte loss, and 3) Permits an eventual enterostomy closure by bedside ligation of chimney stoma, avoiding another laparotomy for resection and anastomosis of bowel. Here we compare between various methods of treatment of meconium ileus and relative outcome and complications for each method.   Materials and Methods:  This is Retrospective study was conducted from March 2016- February 2022 in the Department of Paediatric Surgery, SVPPGIP, S.C.B Medical College and Hospital Cuttack, Odisha. Patients with clinical and radiological suspicion of meconium ileus were included in the study. They were grouped according to the severity as simple or complicated meconium ileus. Then they were followed up and grouped according to type of intervention carried out. After diagnosis, babies were admitted, resuscitation and stabilization of patients done, Parents were counselled about possible treatment options and prognosis for each patient separately. Patients with simple meconium ileus without any other associated radiological or clinical complication are first treated with conservative management by gastrografin enema under USG guidance. Failed cases and all other simple and complicated cases subjected to different surgical modalities as mention above.   Results: During the study period of six years, total 91 cases (7.5%) were diagnosed to be MI and included in this study. Among 91, 50 were male and 41 were female, 30 cases were Uncomplicated or simple, and 61 cases were complicated MI. Out of 30 simple MI, 18 were managed conservatively and rest 13 cases were managed with operative procedures. Among patient treated with nonoperative management only 7 responded and improved and 9 didn’t responded. 84 cases including all cases of complicated MI were treated by exploratory laparotomy. 49 cases were treated by Bishop-Koop ileostomy, 19 Mickulitz double barrel ileostomy and Santuli procedure were done in 11 patients. Primary anastomosis was done only in 5 cases. All cases were followed up for post-operative complications. 13 cases expired during follow up.   Conclusion:    MI is a neonatal emergency which need early diagnosis, referral from peripheral hospital and early intervention by Pediatric surgeons. Proper evaluations, careful applications of conservative management, timely and proper surgical interventions may improve survival. Among all surgical procedure Bishop Koop ileostomy procedure is better option to treat MI both in uncomplicated and complicated groups.