MCML D-Latch Using Triple-Tail Cells: Analysis and Design

A new low-voltage MOS current mode logic (MCML) topology for D-latch is proposed. The new topology employs a triple-tail cell to lower the supply voltage requirement in comparison to traditional MCML D-latch. The design of the proposed MCML D-latch is carried out through analytical modeling of its static parameters. The delay is expressed in terms of the bias current and the voltage swing so that it can be traded off with the power consumption. The proposed low-voltage MCML D-latch is analyzed for the two design cases, namely, high-speed and power-efficient, and the performance is compared with the traditional MCML D-latch for each design case. The theoretical propositions are validated through extensive SPICE simulations using TSMC 0.18 µm CMOS technology parameters

Clinical significance of accessory foramina in adult human mandible

Background: The mandible is the strongest and largest bone of facial skeleton. It consists of one horseshoe-shaped body and a pair of rami. On external surface of body in the midline there is a faint ridge i.e. symphysis menti indicating the line of fusion of two halves of mandible during development. The aim of this study is to describe the position and incidence of accessory foramina on the inner surface of the body and rami of both sides of mandible to provide simple important reliable surgical landmarks.Methods: The present study was conducted on 100 dried adult human mandibles. Bones which had deformities, asymmetries, external pathological changes and fractures were excluded from the present study.Results: In 97% cases at least one accessory foramen was observed on inner surface of mandible. The accessory lingual foramen was found to be constant finding with incidence of 81%. Frequency of infraspinous or sublingual foramen was 58%, of lateral foramen was 50% and that of accessory mandibular foramen was 39%.Conclusions: The anatomical knowledge about the common location and incidence of accessory foramina in mandible are important for surgeons and anaesthetists performing surgeries in the area around mandible. These accessory foramina transmit neurovascular bundles which provide accessory innervations to the roots of teeth.  Thus proper knowledge of accessory foramina are important in relation to achieving complete inferior alveolar nerve block and for avoiding injury to neurovascular bundle passing through them

Bandwidth Extension of High Compliance Current Mirror by Using Compensation Methods

Due to the huge demand of high-speed analog integrated circuits, it is essential to develop a wideband low input impedance current mirror that can be operated at low power supply. In this paper, a novel wideband low voltage high compliance current mirror using low voltage cascode current mirror (LVCCM) as a basic building block is proposed. The resistive compensation and inductive peaking methods have been used to extend the bandwidth of the conventional current mirror. By replacing conventional LVCCM in a high compliance current mirror with the compensated LVCCM, the bandwidth extension ratio of 3.4 has been achieved with no additional DC power dissipation and without affecting its other performances. The circuits are designed in TSMC 0.18 μm CMOS technology on Spectre simulator of Cadence

A Modified Implementation of Tristate Inverter Based Static Master-Slave Flip-Flop with Improved Power-Delay-Area Product

The paper introduces novel architectures for implementation of fully static master-slave flip-flops for low power, high performance, and high density. Based on the proposed structure, traditional C2MOS latch (tristate inverter/clocked inverter) based flip-flop is implemented with fewer transistors. The modified C2MOS based flip-flop designs mC2MOSff1 and mC2MOSff2 are realized using only sixteen transistors each while the number of clocked transistors is also reduced in case of mC2MOSff1. Postlayout simulations indicate that mC2MOSff1 flip-flop shows 12.4% improvement in PDAP (power-delay-area product) when compared with transmission gate flip-flop (TGFF) at 16X capacitive load which is considered to be the best design alternative among the conventional master-slave flip-flops. To validate the correct behaviour of the proposed design, an eight bit asynchronous counter is designed to layout level. LVS and parasitic extraction were carried out on Calibre, whereas layouts were implemented using IC station (Mentor Graphics). HSPICE simulations were used to characterize the transient response of the flip-flop designs in a 180 nm/1.8 V CMOS technology. Simulations were also performed at 130 nm, 90 nm, and 65 nm to reveal the scalability of both the designs at modern process nodes

Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

New Improved Fractional Order Differentiator Models Based on Optimized Digital Differentiators

Different evolutionary algorithms (EAs), namely, particle swarm optimization (PSO), genetic algorithm (GA), and PSO-GA hybrid optimization, have been used to optimize digital differential operators so that these can be better fitted to exemplify their new improved fractional order differentiator counterparts. First, the paper aims to provide efficient 2nd and 3rd order operators in connection with process of minimization of error fitness function by registering mean, median, and standard deviation values in different random iterations to ascertain the best results among them, using all the abovementioned EAs. Later, these optimized operators are discretized for half differentiator models for utilizing their restored qualities inhibited from their optimization. Simulation results present the comparisons of the proposed half differentiators with the existing and amongst different models based on 2nd and 3rd order optimized operators. Proposed half differentiators have been observed to approximate the ideal half differentiator and also outperform the existing ones reasonably well in complete range of Nyquist frequency