To determine the role of targeted four node sampling (FNS) in axillary mapping in operable breast cancer

Aim: to determine the role of targeted four node sampling (FNS) in axillary mapping in operable breast cancer. Methods: The present analytical hospital based study was conducted among histopathologically and cytologically confirmed patients of operable breast cancer admitted to inpatient department of General Surgery, Sri Krishna Medical College and Hospital, Muzaffarpur, India July 2019 to February 2020. A total of 30 patients, node negative operable cases of carcinoma breast after 3 cycles of neoadjuvant chemotherapy, were enrolled. Lymph node mapping was done by injecting 3 - 5 ml of methylene blue dye, just before surgery. Results: The sensitivity, specificity, positive predictive value and negative predictive value of 83.12%, 90.27%, 72.31% and 94.25% respectively for four node sampling of axilla, among operable breast cancer patients having node negative axilla. Conclusions: Targeted four node sampling using methylene blue dye can be considered as an alternative method for sentinel lymph node. Further study should be conducted to establish it as a reliable method for axillary lymph node staging

Optimal Corridor Selection for a Road Space Management Strategy: Methodology and Tool

Nationwide, there is a growing realization that there are valuable benefits to using the existing roadway facilities to their full potential rather than expanding capacity in a traditional way. Currently, state DOTs are looking for cost-effective transportation solutions to mitigate the growing congestion and increasing funding gaps. Innovative road space management strategies like narrowing of multiple lanes (three or more) and shoulder width to add a lane enhance the utilization while eliminating the costs associated with constructing new lanes. Although this strategy (among many) generally leads to better mobility, identifying optimal corridors is a challenge and may affect the benefits. Further, there is a likelihood that added capacity may provide localized benefits, at the expense of system level performance measures (travel time and crashes) because of the relocation of traffic operational bottlenecks. This paper develops a novel transportation programming and investment decision method to identify optimal corridors for adding capacity in the network by leveraging lane widths. The methodology explicitly takes into consideration the system level benefits and safety. The programming compares two conflicting objectives of system travel time and safety benefits to find an optimal solution

Multi-Predictor Fusion: Combining Learning-based and Rule-based Trajectory Predictors

Trajectory prediction modules are key enablers for safe and efficient planning of autonomous vehicles (AVs), particularly in highly interactive traffic scenarios. Recently, learning-based trajectory predictors have experienced considerable success in providing state-of-the-art performance due to their ability to learn multimodal behaviors of other agents from data. In this paper, we present an algorithm called multi-predictor fusion (MPF) that augments the performance of learning-based predictors by imbuing them with motion planners that are tasked with satisfying logic-based rules. MPF probabilistically combines learning- and rule-based predictors by mixing trajectories from both standalone predictors in accordance with a belief distribution that reflects the online performance of each predictor. In our results, we show that MPF outperforms the two standalone predictors on various metrics and delivers the most consistent performance

Age-Appropriate Immunization (AAI) as an Intractable Issue Subsequent to Coverage

Background: Age appropriate immunization (AAI) observed as an important issue irrespective of vaccine coverage. Aim: To study the extent of AAI in a state with high coverage for fully immunized (FI) coverage. Subjects and Methods: A rapid cross-sectional survey was done in all 12 districts of Himachal Pradesh, India using World Health Organization (WHO) approved 30 cluster techniques in every district. Mean age (in days) with 95.0% confidence interval (CI) was calculated to ascertain gap between vaccines; BCG, DPT/Hep B (1,2,3) and measles. Results: About 82.0% mothers possessed immunization card of 2491 surveyed children and coverage was found to be 84.9% for both BCG and DPT/Hep B-1, and 84.8%, 83.9%, and 82.7% for DPT/Hep B-2, 3 and measles respectively. The mean age of immunization observed to be 21.0 (95.0% CI: 19.1- 22.8) for BCG, 76.5 (95.0% CI: 73.8-79.4) for DPT/Hep B-1, 112.4 (95.0% CI: 109.3-115.5) for DPT/ Hep B-2, 148.0 (95.0% CI: 144.8-151.3) for DPT/Hep B-3, and 302.7 (95.0% CI: 299.5-305.6) days for measles. Mean gap in days between vaccines was observed as 58.1 (95.0% CI: 55.4-60.8) between BCG and DPT/Hep B-1, 42.6 (95.0% CI:40.4-44.7), 44.2 (95.0% CI:42.3-46.5), and 162.1 (95.0% CI: 159.3-164.8) between DPT/Hep B-1 and 2, DPT/Hep B-2 and 3, and DPT/Hep B-3 and measles respectively. Variation across districts was also observed for mean age of immunization and gap between vaccines. Conclusion: AAI observed as a public health issue adjunct to vaccination coverage in order to improve the quality of immunization services.Keywords: Age appropriate immunization, Mean ag

To obtain information about prescribing pattern of antibiotics: a prospective hospital based observational study

Objective: To obtain information about prescribing pattern of antibiotics in the tertiary care teaching hospital. Methods: The present prospective hospital based observational study was conducted among patients admitted to inpatient department of General Surgery, Sri Krishna Medical College and Hospital, Muzaffarpur, India from April 2019 to October 2019. Patients above 18 years of either sex were included in the study. Results: A total of 138 prescriptions were studied. Mean age of the study population was 38.16 years. Mean number of medicines prescribed per prescription was 4.69 and mean number of antibiotics per prescription was 2.18. Conclusion: Cephalosporin was the preferred or most prescribed choice of drug for prophylaxis followed by penicillin’s. Our study brings to the fore some common but serious lapses in antibiotic prescription patterns and emphasizes the need for proper and appropriate use of antibiotics

Climate change impact on livelihood and vulnerability: a case study of mushar community in saptari district in Nepal

This dissertation is submitted in partial fulfillment of the requirements for the degree of Master in Disaster Management, 2010.Cataloged from PDF version of Dissertation.Includes bibliographical references (page 51- 53).Climate change impact and vulnerability towards the change on the poor people has always been significant aspect of issue and discussion worldwide. With the green house gases increasing various consequences of climate change is pressurizing the resources on which people are dependent for their livelihood. Various studies done in country level and worldwide has proven that Nepal is one of the worst sufferers of climate change. Climate change is also being proved as doldrums for making people more vulnerable to shocks and stresses more over burden on livelihood capitals i.e. natural, physical, social,financial and human. The main objective of the paper was to assess vulnerability and impacts of climate change on livelihood among Mushar communities in Saptari district of Nepal at Koshi basin. For this research participatory tools for assessing climate change was used with various other tools like interview, observation etc for the validating the findings. To assess the information literature were reviewed from different journal article, published books,government policies, meteorological and hydrological data and other unpublished thesis work and articles. Different livelihood resources like agriculture, water, forest, public health and settlements are vulnerable to climate change. The result shows that there is increasing trend of rainfall and discharge in the Koshi River. Also the average temperature is in the increasing trend for the Koshi basin inviting different trouble for the livelihoods aspect in form of flood,cold wave, illness, livestock disease etc creating more challenge in the livelihood of the Mushar community. Though all households in the VDC( Village Development Committee) are vulnerable to climatic crisis, the problem is more acute for the poor, landless, children, women, large sized family among the Mushar family. To cope with the impacts the community is use saving and credit, wood selling and other activity,disaster preparedness plan and disaster management committee as strategy.Awareness raising and capacity building are among the coping strategies provided by the government institution and NGO's in the area. Thus the study suggest to address the climate change challenges for the community with the help of study at micro level and making plans policies and programme of adaptation for the Mushar community to withstand the shocks of climate change for the most vulnerable group.Sushant, SharmaM. Disaster Managemen

Modeling the Goodput of TCP NewReno in Cellular Environments

In this paper, we present an analytical model that characterizes TCP NewReno's goodput as a function of round-trip time, average time duration between handoffs, average number of packets reordered during a handoff, and the congestion window threshold. In cellular networks, the effective packet-loss probability for a flow experiencing handoffs is not exactly equal to the physical-layer packet-loss probability; it also depends on the frequency of handoffs and the number of packets that may arrive out of order at the receiver due to handoffs. With the emergence of technologies such as WiMax and Ultra Mobile Broadband (UMB), understanding the effect of handoffs and packet reordering on the goodput of TCP becomes very important for the designers of next generation cellular networks. Existing TCP throughput models cannot be used to understand the precise effect of handoffs and the resultant packed reordering on TCP's goodput. In this paper, we present a model of TCP NewReno goodput that captures the effect of handoffs. We validate the model by performing actual file transfers between different hosts that are connected by a router which emulates the wireless environment with handoff events and packet reordering

Morphofunctional Diversity of Diaspores of Some Range Grasses of Punjab (India)

Grasslands occupy almost half of the terrestrial expanse of India ranging from coastal to alpine regions. Whyte (1958) defined ‘grassland as the land on which graminaceous species represent the dominance if not the exclusive vegetation’. Grasslands comprise the main source of fodder for the 500 million cattle population in the country besides providing habitat to several plant and animal species. But the grasslands are shrinking due to the pressure of intensive agriculture and urbanization not only in expanse but also in their biodiversity. In this context there is an urgent need to develop not only a policy towards a sustainable utilization of grassland resources but also to devise strategies to replenish and refurbish their productivity and biodiversity. Grasses have an unmatched ecological significance as well. They occur in nearly all the terrestrial ecosystems and habitats of the world and provide cover to nearly a fifth of the land surface. Taxonomic diversification and geographic diversification occurred during the Eocene in several phases beginning with the crown node of bambusoid grasses (53mya) and continuing with the pooid (47-38 mya), chloridoid (35-25mya) and panicoid (26mya) groups (Kellogg, 2001). With their origin in the southern land masses, grasses are believed to have spread to Eurasia via the Indian land mass

Temperature-dependent Optoelectronic Properties of Quasi-2D Colloidal Cadmium Selenide Nanoplatelets

Colloidal Cadmium Selenide (CdSe) nanoplatelets (NPLs) are a recently developed class of efficient luminescent nanomaterial suitable for optoelectronic device applications. A change in temperature greatly affects their electronic bandstructure and luminescence properties. It is important to understand how-and-why the characteristics of NPLs are influenced, particularly at elevated temperature, where both reversible and irreversible quenching processes come into picture. Here we present a study on the effect of elevated temperature on the characteristics of colloidal CdSe NPLs. We used an effective-mass envelope function theory based 8-band k$\cdot$p model and density-matrix theory considering exciton-phonon interaction. We observed the photoluminescence (PL) spectra at various temperatures for their photon emission energy, PL linewidth and intensity by considering the exciton-phonon interaction with both acoustic and optical phonons using Bose-Einstein statistical factors. With rise in temperature we observed a fall in the transition energy (emission redshift), matrix element, Fermi factor and quasi Fermi separation, with reduction in intraband state gaps and increased interband coupling. Also, there was a fall in the PL intensity, along with spectral broadening due to an intraband scattering effect. The predicted transition energy values and simulated PL spectra at varying temperatures exhibit appreciable consistency with experimental results. Our findings have important implications for application of NPLs in optoelectronic devices, such as NPL lasers and LEDs, operating much above room temperature.Comment: Published in Royal Society of Chemistry, Nanoscale (12 pages, 9 figures