Study protocol: Delayed intervention randomised controlled trial within the Medical Research Council (MRC) Framework to assess the effectiveness of a new palliative care service

Background: Palliative care has been proposed to help meet the needs of patients who suffer progressive non-cancer conditions but there have been few evaluations of service development initiatives. We report here a novel protocol for the evaluation of a new palliative care service in this context. Methods/Design: Using the MRC Framework for the Evaluation of Complex Interventions we modelled a new palliative care and neurology service for patients severely affected by Multiple Sclerosis (MS). We conducted qualitative interviews with patients, families and staff, plus a literature review to model and pilot the service. Then we designed a delayed intervention randomised controlled trial to test its effectiveness as part of phase II of the MRC framework. Inclusion criteria for the trial were patients identified by referring clinicians as having unresolved symptoms or psychological concerns. Referrers were advised to use a score of greater than 8 on the Expanded Disability Scale was a benchmark. Consenting patients newly referred to the new service were randomised to either receive the palliative care service immediately (fast-track) or after a 12-week wait (standard best practice). Face to face interviews were conducted at baseline (before intervention), and at 4–6, 10–12 (before intervention for the standard-practice group), 16– 18 and 22–24 weeks with patients and their carers using standard questionnaires to assess symptoms, palliative care outcomes, function, service use and open comments. Ethics committee approval was granted separately for the qualitative phase and then for the trial. Discussion: We publish the protocol trial here, to allow methods to be reviewed in advance of publication of the results. The MRC Framework for the Evaluation of Complex Interventions was helpful in both the design of the service, methods for evaluation in convincing staff and the ethics committee to accept the trial. The research will provide valuable information on the effects of palliative care among non-cancer patients and a method to evaluate palliative care in this context

Thermodynamic properties of an interacting hard-sphere Bose gas in a trap using the static fluctuation approximation

A hard-sphere (HS) Bose gas in a trap is investigated at finite temperatures in the weakly-interacting regime and its thermodynamic properties are evaluated using the static fluctuation approximation (SFA). The energies are calculated with a second-quantized many-body Hamiltonian and a harmonic oscillator wave function. The specific heat capacity, internal energy, pressure, entropy and the Bose-Einstein (BE) occupation number of the system are determined as functions of temperature and for various values of interaction strength and number of particles. It is found that the number of particles plays a more profound role in the determination of the thermodynamic properties of the system than the HS diameter characterizing the interaction, that the critical temperature drops with the increase of the repulsion between the bosons, and that the fluctuations in the energy are much smaller than the energy itself in the weakly-interacting regime.Comment: 34 pages, 24 Figures. To appear in the International Journal of Modern Physics

Numerical modeling and analysis of Ti6Al4V alloy chip for biomedical applications

The influence of cutting forces during the machining of titanium alloys has attained prime attention in selecting the optimal cutting conditions to improve the surface integrity of medical implants and biomedical devices. So far, it has not been easy to explain the chip morphology of Ti6Al4V and the thermo-mechanical interactions involved during the cutting process. This paper investigates the chip configuration of the Ti6Al4V alloy under dry milling conditions at a macro and micro scale by employing the Johnson-Cook material damage model. 2D modeling, numerical milling simulations, and post-processing were conducted using the Abaqus/Explicit commercial software. The uncut chip geometry was modeled with variable thicknesses to accomplish the macro to micro-scale cutting by adapting a trochoidal path. Numerical results, predicted for the cutting reaction forces and shearing zone temperatures, were found in close approximation to experimental ones with minor deviations. Further analyses evaluated the influence of cutting speeds and contact friction coefficients over the chip flow stress, equivalent plastic strain, and chip morphology. The methodology developed can be implemented in resolving the industrial problems in the biomedical sector for predicting the chip morphology of the Ti6Al4V alloy, fracture mechanisms of hard-to-cut materials, and the effects of different cutting parameters on workpiece integrity

Explaining deep neural networks: A survey on the global interpretation methods

A substantial amount of research has been carried out in Explainable Artificial Intelligence (XAI) models, especially in those which explain the deep architectures of neural networks. A number of XAI approaches have been proposed to achieve trust in Artificial Intelligence (AI) models as well as provide explainability of specific decisions made within these models. Among these approaches, global interpretation methods have emerged as the prominent methods of explainability because they have the strength to explain every feature and the structure of the model. This survey attempts to provide a comprehensive review of global interpretation methods that completely explain the behaviour of the AI models. We present a taxonomy of the available global interpretations models and systematically highlight the critical features and algorithms that differentiate them from local as well as hybrid models of explainability. Through examples and case studies from the literature, we evaluate the strengths and weaknesses of the global interpretation models and assess challenges when these methods are put into practice. We conclude the paper by providing the future directions of research in how the existing challenges in global interpretation methods could be addressed and what values and opportunities could be realized by the resolution of these challenges

Study of rationality and utilization pattern of antimicrobials in ear, nose, throat outpatient department of Tertiary Care Hospital, Nanded

Background: Antimicrobials are most commonly prescribed drugs worldwide. Around 50% of the prescriptions of antimicrobial drugs are either not needed, inappropriate or in wrong doses. With the widespread use of antimicrobial agents (AMAs), the prevalence of resistance has increased. To evaluate the prescription pattern and utilization of AMA in ear, nose, throat (ENT) outpatient department (OPD) of Tertiary Care Hospital, Nanded.Methods: This prospective study was conducted in ENT OPD of Dr. Shankarrao Chavan Government Medical College, Nanded over a period of 3 months. During this period, approximately 1100 patients visited ENT OPD and 600 prescriptions were evaluated. The excluded patients were of post-operative follow-up and of patients undergoing medical examination for fitness and handicap certificate. Data were collected by using specially designed case report form. Appropriateness of AMA was assessed by Kunin’s modified criteria.Results: Total 600 prescriptions were analyzed out of which (91%) consist of AMA. Most of them reported with upper respiratory tract infections (URTI) (30.4%), chronic suppurative otitis media (21.4%), acute suppurative otitis media (10.4%), tonsillitis (3.3%), sinusitis (2.7%), and others (15%). Amoxicillin (43.9%) was preferred AMA followed by ciprofloxacin (30.6%), cotrimoxazole (5.8%), azithromycin (3.2%), doxycycline (3.2%) cefixime + clavulanate (3.2%), and amoxicillin + clavulanate (1.8%). Single antibiotic was preferred in all prescriptions. In the concomitant medications, antihistaminics were prescribed in 97.22% of patients, non-steroidal anti-inflammatory drugs in 94.96% of patients, and antacids in 87.76% of patients. Fixed-dose combinations were used in 10% of prescriptions. Brand names of AMA were used in 10% of prescriptions. As per the Kunin’s modified criteria, 83% of patients received AMA therapy appropriately, while 17% patients inappropriately.Conclusions: Amoxicillin is the most common AMA prescribed and URTI is the most common diagnosis made. All AMAs should be prescribed only when needed and should be used in proper dose and for proper duration. Institution wise antibiotic policy should be used to contain resistance. Proper training and regular orientation programs of the juniors’ doctors for judicial use of AMAs will foster the habit of rational prescribing of AMA

From Local Velocities to Microwave Background

The mass density field as extracted from peculiar velocities in our cosmological neighborhood is mapped back in time to the CMB in two ways. First, the density power spectrum ($P_k$) is translated into a temperature angular power spectrum of sub-degree resolution ($C_l$) and compared to observations. Second, the local density field is translated into a temperature map in a patch on the last-scattering surface of a distant observer. A likelihood analysis of the Mark III peculiar velocity data have constrained the range of parameters for $P_k$ within the family of COBE-normalized CDM models (Zaroubi et al 1996), favoring a slight tilt in the initial spectrum, $n<1$. The corresponding range of $C_l$'s is plotted against current observations, indicating that the CMB data can tighten the constraints further: only models with ``small'' tilt ($n\sim 0.9$) and ``high'' baryonic content ($\Omega_b \sim 0.1$) could survive the two data sets simultaneously. The local mass density field that has been recovered from the velocities via a Wiener method is convolved with a Boltzmann calculation to recover $10'$ resolution temperature maps as viewed from different directions. The extent of the CMB patch and the amplitude of fluctuations depend on the choice of cosmological parameters, e.g., the local 100\hmpc sphere corresponds to $90'$ to $30'$ at the CMB for $\Omega$ between 1 and 0 respectively. The phases of the temperature map are correlated with those of the density field, contrary to the contribution of the Sachs-Wolfe effect alone. This correlation suggests the possibility of an inverse reconstruction of the underlying density field from CMB data with interesting theoretical implications.Comment: 16 pages, 6 figures. Submitted to Ap.

Non-Invasive Driver Drowsiness Detection System.

Drowsiness when in command of a vehicle leads to a decline in cognitive performance that affects driver behavior, potentially causing accidents. Drowsiness-related road accidents lead to severe trauma, economic consequences, impact on others, physical injury and/or even death. Real-time and accurate driver drowsiness detection and warnings systems are necessary schemes to reduce tiredness-related driving accident rates. The research presented here aims at the classification of drowsy and non-drowsy driver states based on respiration rate detection by non-invasive, non-touch, impulsive radio ultra-wideband (IR-UWB) radar. Chest movements of 40 subjects were acquired for 5 m using a lab-placed IR-UWB radar system, and respiration per minute was extracted from the resulting signals. A structured dataset was obtained comprising respiration per minute, age and label (drowsy/non-drowsy). Different machine learning models, namely, Support Vector Machine, Decision Tree, Logistic regression, Gradient Boosting Machine, Extra Tree Classifier and Multilayer Perceptron were trained on the dataset, amongst which the Support Vector Machine shows the best accuracy of 87%. This research provides a ground truth for verification and assessment of UWB to be used effectively for driver drowsiness detection based on respiration