Common Fixed Point Theorems for Four Mappings in Fuzzy 2-Metric Spaces

In this paper some common fixed point theorem have been proved as  a generalization of result of Seong Hoon Cho [1] the conditions for continuous self mappings S,T of complete fuzzy 2-metric space (X, M,*) have been characterised to have a unique common fixed point in X. AMS Mathematics Subject Classification: 47H10, 54H25 Key words and phrases: Compatible mapping, common fixed poin

Deep learning based automated epidermal growth factor receptor and anaplastic lymphoma kinase status prediction of brain metastasis in non-small cell lung cancer

Aim: The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement groups and to compare the accuracy with classification based on semantic features on imaging. Methods: Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were EGFR positive, 43 patients were ALK positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, EGFR mutation and ALK rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ2)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI). Results: In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to ALK positive were non-smokers as compared to double negative groups (P = 0.03). There was a 10-fold increase in ALK positivity as compared to EGFR positivity in ring enhancing lesions patients (P = 0.015) and there was also a 6.4-fold increase in ALK positivity as compared to double negative groups in meningeal involvement patients (P = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying ALK rearrangement and EGFR mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model. Conclusions: Both semantic features and DL model showed comparable accuracy in classifying EGFR mutation and ALK rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken

Humility in medical practice: a qualitative study of peer-nominated excellent clinicians

Abstract Background Humility has recently been conceptualized as a positive, multifaceted attribute in fields outside of medicine, such as psychology and philosophy. In medicine, there has been limited study into the nature of humility and its role in clinical practice. We sought to develop a deeper understanding of humility in medical practice through the lived-experiences of peer-nominated excellent clinicians. Methods We conducted a qualitative study with secondary analysis of transcripts from individual open ended, semi-structured interviews of 13 peer nominated physicians [7 (54%) female] at an academic centre. Using constant comparative analysis, the transcripts were analyzed for instances where humility was discussed as it related to clinical practice. Results Participants perceived humility to be an important driver for excellence in clinical practice. This was further explained using two overarching themes: an inward, intellectual perspective and an outward, social perspective. The physician’s inward perspective was their view of their abilities and limits, their self-confidence, and their intellectual openness and adaptability to the limitations and evolving nature of knowledge in medicine. Their outward perspective was an understanding and appreciation for the larger system in which they worked, an openness to others, and valuing patients’ experience. Through these perspectives, humility positively influenced clinical care, learning and curiosity, motivation in the care of others, and relationships with team members and patients. Conclusions Humility in medicine is a rich, multifaceted construct that was perceived to be a driver for excellence in medical practice by peer-nominated excellent clinicians. Humility was seen as an active force in formulating and calibrating a clinician’s perspective of self and of others, and as such, positively influencing clinical practice. These findings will help inform a discourse in medical education and faculty development about the important role of humility in medical practice

In vivo proton magnetic resonance spectroscopy (MRS) study of post polio residual paralysis (PPRP) patients

In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indicate that the presence or absence of intra-myocellular lipids (IMCL) is related to the severity of the paralysis. It is observed that mildly paralyzed patients are comparable (p > 0.05) with the control subjects in relation to the presence of IMCL, while moderate and severely paralysed patients are comparable (p > 0.05) in relation to the absence of IMCL. In addition, there is reduction or complete absence of creatine, carnitine and choline metabolites in severely paralyzed patients. The ability to detect noninvasively the subtle differences in in vivo, the lipid compartments of muscle may prove to be a valuable tool in understanding the pathogenesis of muscle diseases. This could open up the possibilities in designing effective rehabilitative exercise programs or development of new drug therapies

Aches and Pains with a Shocking Rash

Peer Reviewe

Effectiveness of Exercise Protocol on Upper Arm Dysfunction and Quality of Life among Women with Breast Cancer: Randomized Controlled Trial

Introduction: Upper arm dysfunction occurs after breast cancer surgery and include one or more of following arm impairments like decreased shoulder range of motion, strength, pain, numbness, swelling, weakness, and lymphedema. The objective of study was to assess the effectiveness of exercise protocol on upper arm dysfunction and quality of life (QOL) among women with breast cancer who have undergone mastectomy with axillary lymph node dissection.Methods: A randomized controlled trial (Time series design) included 44 women with breast cancer in All India Institute of Medical Sciences (AIIMS), New Delhi and who were scheduled for mastectomy with axillary lymph node dissection. Purposive sampling was done. Subjects were randomly allocated to experimental (n=22) and control group (n=22). However, 40 patients completed the study till 8 weeks. Subjects in experimental group received exercise protocol from post-surgery day 1 to 8 weeks while control group received standard routine care. Data regarding socio demographic and clinical characteristics were collected at baseline. Upper arm dysfunction and quality of life were assessed by structured questionnaires at baseline (post-surgery day 1) at 2 weeks and at 8 weeks.Results: The two groups were homogenous with regard to socio-demographic variables and clinical characteristics at baseline. The experimental group had significant reduction in upper arm dysfunction, seen by reduction in mean subjective symptom score (p<0.0001) and DASH scores (p<0.0001) as compared to control group. There was significant improvement in Quality of life scores in experimental group as compared to control group with p value <0.0001 indicating improvement in quality of life after 8 weeks of intervention.Conclusion: Exercise protocol administration from day 1 after surgery to 8 weeks was effective in reducing upper arm dysfunction and improving the quality of life among breast cancer patients who have undergone mastectomy with axillary lymph node dissection

Acceptance of Endoscopes in Otology – An Indian Perspective and Review of the Literature

Introduction The role of endoscopes in the ear, nose, and throat (ENT) field has been described since the 1980s; It started with endoscopic nasal surgeries, followed by otological and laryngological procedures, and, since then, it has experienced a rapid evolution. Endoscopes help otologists understand how to approach difficult areas of middle ear, as well as the physiology of middle ear cleft. Objectives Despite the introduction of endoscopes in the field of otology, microscopes are still widely used in clinics and in operation theaters either alone or with endoscopes. The present study, which was conducted amongst otologists in India, is on their experience with and knowledge of the use of the endoscope compared to microscopes. Materials and Methods A Google form-based questionnaire comprising 18 questions was developed and sent online to otologist all over the country. The final dataset included responses from 354 active otologists. Results Out of 354 participants, only 3% had more than 5 years of experience in endoscopic ear surgery (EES), and 16.1% had never worked with an endoscope. Endoscopes were used in clinics and in operation theaters by 74.9% of the participants. Conclusion There has been a rise in the acceptance and use of endoscopes among Indian otologists and otology surgeons in last few decades

Reputation And Decision Making Under Ambiguity: A Study Of Us Venture Capital Firms' Investments In The Emerging Clean Energy Sector

This study examines the role of reputation on decision making under ambiguity. Drawing on social cognition and behavioral theories, we propose that a firm's reputation exerts dual pressures on its decision making under ambiguity. On the one hand, a firm's reputation increases its aspirations for future performance and promotes its engagement in risky strategies to achieve them. On the other hand, preserving the already established reputation requires a firm to deliver consistent performance over time, which promotes greater use of risk reduction strategies. Our analyses of the U.S. venture capital firms' investments in the clean energy sector from 1990 to 2008 demonstrate that while reputable firms are more likely to invest in the emerging sector, they also employ risk reduction strategies more extensively. The sector's legitimation further influences these firms' investment decisions both directly and through its interaction with firm reputation