Deep Reinforcement Learning based Path-Planning for Multi-Agent Systems in Advection-Diffusion Field Reconstruction Tasks

Many environmental processes can be represented mathematically using spatial-temporal varying partial-differential equations. Timely estimation and prediction of processes such as wildfires is critical for disaster management response, but is difficult to accomplish without the availability of a dense network of stationary sensors. In this work, we propose a deep reinforcement learning-based real-time path-planning algorithm for mobile sensor networks traveling in a formation through a spatial-temporal varying advection-diffusion field for the task of field reconstruction. A deep Q-network (DQN) agent is trained on simulated advection-diffusion fields to direct the mobile sensor network to travel along information-rich trajectories. The field measurements made by the mobile sensor network along their trajectories enable identification of field advection parameters, which are required for field reconstruction. A cooperative Kalman filter developed in previous works is employed to receive estimates of the field values and gradients, which are essential for reconstruction as well as for the estimation of the diffusion parameter. A mechanism is provided that encourages exploration in the field domain once a stationary state is reached, which allows the algorithm to identify other information-rich trajectories that may exist in the field improving reconstruction performance significantly. Two simulation environments of different fidelities are provided to test the feasibility of the proposed algorithm. The low-fidelity simulation environment is used for training of the DQN agent. The high-fidelity simulation environment is based on Robot Operating System (ROS) and simulates real robots. We provide results of running sample test episodes in both environments which demonstrate the effectiveness and feasibility of the proposed algorithm

Non-Invasive Ventilation in Acute Hypoxemic Respiratory Failure

Non-invasive Ventilation (NIV) has emerged as an useful aid for management of pulmonary diseases specifically in cases of respiratory failure. NIV provides respiratory support without the need of an endotracheal tube, helping in avoiding the complications associated with intubation such as tracheal trauma, infection, bleeding, injury to the lung tissues and aspiration. NIV has turned out to provide substantial benefit in the management of chronic obstructive pulmonary disease, acute respiratory distress syndrome, cardiogenic pulmonary edema and in cases of neuromuscular disorders. It has now become an integral tool in the management of respiratory failure, both at home as well as hospital settings including critical care units. All patients of respiratory failure irrespective of causes likeAcute exacerbations of COPD, Acute pulmonary edema, Exacerbations of cystic fibrosis, asthma, or restrictive lung disease and Pneumonia admitted in intensive care unit/high dependent units are suitable for NIV. Noninvasive ventilation is standard of care in chronic respiratory failure and has replaced invasive ventilation in such settings. Its flexibility in use and ease of administration allows it to be acceptable by patients as well as caregivers

Psychosocial Maladjustments among Adolescent School Students in Delhi, India

Background: Accumulating evidences are showing that strengthening protective psychosocial factors in adolescents make important contributions in improving developmental outcomes. Hence the present study was conducted to study the psychosocial maladjustments and their determinants among adolescent school students in Delhi, India.Materials and methods: Questionnaire based cross sectional study was conducted from February 2013 to September 2013 in four schools in South Delhi. All students studying in class 11 and 12 were included. Complete enumeration of the study subjects was done. Pareek’s Pre Adolescent Adjustment Scale (PAAS) was used to find psychosocial maladjustments among adolescent school students in five psychosocial domains (Home, School, Teachers, Peers and General). Data were analyzed using SPSS version 21.Results: The prevalence of home, school, teacher, peer and general psychosocial maladjustment were found to be 12.6%, 13.2%, 13.4%, 18.9% and 31.5% respectively. The risk of psychosocial maladjustment in all psychosocial domains was found to be higher among males, students studying in class twelve and belonging to lower socio-economic class. Conclusion: The study has revealed that psychosocial maladjustment in different psychosocial domains is present among adolescent school students in Delhi. This demands behavioral interventions in several psychosocial environments like home, school, peers and public places

Space Solar Power Aids Space Settlement

The Grand Prize for the 2011 NASA Ames Space Settlement Contest went to a team of 7 students (11-12 grades) from Punjab, India for creating the Hyperion Space Settlement. This year the contest received 355 submissions from 1078 students sponsored by 114 teachers. Entries came from 14 countries: Australia, Bulgaria, Canada, China, India, Ireland, Japan, Pakistan, Romania, Singapore, Turkey, Ukraine, United Arab Emirates, and the United States. The prize was conferred on the students during the International Space Development Conference 2011 (ISDC 2011) held in Huntsville, Alabama, USA. Advisors: The teachers of Spring Dale Senior School in Amritsar, India. Stephen Buchanan of Ohio University served as a Space Journal Liaiso

Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p<0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p<0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study

One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis

Weaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success

Invasive mechanical ventilation (IMV) for management of chronic obstructive pulmonary disease (COPD) associated respiratory failure is increasing in Intensive Care Units. However, IMV is not without its own complications. Hence, aim of managing such patients is to get them off the ventilator as early as possible. This bridging process from IMV to extubation is called weaning in which mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing. Many objective parameters have been defined for weaning success. Many of these patients are difficult-to-wean because of various pathophysiologic mechanisms that are of particular relevance to patients of COPD. The following review focuses on these mechanisms and how to troubleshoot patients who are difficult-to-wean

Primary pleural primitive neuroendocrine tumor: A rare entity

The rare primitive neuro-ectodermal tumors (PNET) are classically described as tumors of the airways that can metastasize to the pleura. We describe here, a rare case of a PNET originating from the pleura in a 52-year-old, nonsmoker female. The patient presented with clinical features of a right sided pleural effusion. Thoracoscopic pleural biopsy revealed malignant small round cell proliferation consistent with PNET, and the final diagnosis was confirmed by immune-histochemical analysis. Fiberoptic bronchoscopy, contrast enhanced computed tomography chest, and positron emission tomography scan did not reveal any primary lung lesion. The patient underwent pleurodesis for symptom relief but refused any definitive therapy

Severe Refractory Pulmonary Sarcoidosis: Case Report and a Review of Newer Therapeutic Options

Patients with sarcoidosis who fail to improve on corticosteroids pose a therapeutic challenge for clinicians, because there is a lack of consensus guidelines to manage these patients with other therapeutic options. Herein, we report one such patient with severe progressive sarcoidosis and review the alternative treatment options in patients with sarcoidosis who progress over corticosteroid therapy

Refractory bronchovascular pleuropulmonary mucormycosis: Case report and difficulties in management

Pulmonary mucormycosis is a life-threatening opportunistic fungal infection. It is considered as a disease of immunocompromised state and is rarely seen in immunocompetent patients. We here report a case of refractory bronchovascular pleuropulmonary mucormycosis, who despite early detection, optimal management with liposomal amphotericin B, and posaconazole therapy followed by surgery, progressed further and led to a fatal outcome. Dual antifungal therapy combined with surgery is the only definitive treatment option available in the literature. Many new therapeutic options for mucormycosis treatment have become available but none have shown promising results, and larger studies are required to assess their efficacy