Study of graphene p-n junctions formed by the electrostatic modification of the SiO2 substrate.

We study the transport properties of mm-scale CVD graphene p-n junctions, which are formed in a single gated graphene field effect transistor configuration. Here, an electrical-stressing-voltage technique served to modify the electrostatic potential in the SiO2/Si substrate and create the p-n junction. We examine the transport characteristics about the Dirac points that are localized in the perturbed and unperturbed regions in the graphene channel and note the quantitative differences in the Hall effect between the perturbed and unperturbed regions. The results also show that the longitudinal resistance is highly sensitive to the external magnetic field when the Hall bar device operates as a p-n junction.

Hybrid manifold smoothing and label propagation technique for Kannada handwritten character recognition.

Handwritten character recognition is one of the classical problems in the field of image classification. Supervised learning techniques using deep learning models are highly effective in their application to handwritten character recognition. However, they require a large dataset of labeled samples to achieve good accuracies. Recent supervised learning techniques for Kannada handwritten character recognition have state of the art accuracy and perform well over a large range of input variations. In this work, a framework is proposed for the Kannada language that incorporates techniques from semi-supervised learning. The framework uses features extracted from a convolutional neural network backbone and uses regularization to improve the trained features and label propagation to classify previously unseen characters. The episodic learning framework is used to validate the framework. Twenty-four classes are used for pre-training, 12 classes are used for testing and 11 classes are used for validation. Fine-tuning is tested using one example per unseen class and five examples per unseen class. Through experimentation the components of the network are implemented in Python using the Pytorch library. It is shown that the accuracy obtained 99.13% make this framework competitive with the currently available supervised learning counterparts, despite the large reduction in the number of labeled samples available for the novel classes.

Psoas Muscle Area as a Predictor of Transcatheter Aortic Valve Implantation Outcomes.

BACKGROUND: Frailty is a well-recognised predictor of outcomes after transcatheter aortic valve implantation (TAVI). Psoas muscle area (PMA) is a surrogate marker for sarcopaenia and is a validated assessment tool for frailty. The objective of this study was to examine frailty as a predictor of outcomes in TAVI patients and assess the prognostic usefulness of adding PMA to established frailty assessments. METHODS: Frailty assessments were performed on 220 consecutive patients undergoing TAVI. These assessments used four markers (serum albumin, handgrip strength, gait speed, and a cognitive assessment), which were combined to form a composite frailty score. Preprocedural computed tomography scans were used to calculate cross-sectional PMA for each patient. The primary outcomes were all-cause mortality at 1-year and post-procedure length of hospital stay. RESULTS: Frailty status, as defined by the composite frailty score, was independently predictive of length of hospital stay (p=0.001), but not predictive of 1-year mortality (p=0.161). Albumin (p=0.036) and 5-metre walk test (p=0.003) were independently predictive of 1-year mortality. The PMA, when adjusted for gender, and normalised according to body surface area, was not predictive of 1-year mortality. Normalised PMA was associated with increased post-procedure length of stay within the female population (p=0.031). CONCLUSIONS: A low PMA is associated with increased length of hospital stay in female TAVI patients but does not provide additional predictive value over traditional frailty scores. The PMA was not shown to correlate with TAVI-related complications or 1-year mortality.

Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice.

Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.

Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship.

Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.

Size dependence- and induced transformations- of fractional quantum Hall effects under tilted magnetic fields.

Two-dimensional electron systems subjected to high transverse magnetic fields can exhibit Fractional Quantum Hall Effects (FQHE). In the GaAs/AlGaAs 2D electron system, a double degeneracy of Landau levels due to electron-spin, is removed by a small Zeeman spin splitting, [Formula: see text], comparable to the correlation energy. Then, a change of the Zeeman splitting relative to the correlation energy can lead to a re-ordering between spin polarized, partially polarized, and unpolarized many body ground states at a constant filling factor. We show here that tuning the spin energy can produce fractionally quantized Hall effect transitions that include both a change in [Formula: see text] for the [Formula: see text] minimum, e.g., from [Formula: see text] to [Formula: see text], and a corresponding change in the [Formula: see text], e.g., from [Formula: see text] to [Formula: see text], with increasing tilt angle. Further, we exhibit a striking size dependence in the tilt angle interval for the vanishing of the [Formula: see text] and [Formula: see text] resistance minima, including "avoided crossing" type lineshape characteristics, and observable shifts of [Formula: see text] at the [Formula: see text] minima- the latter occurring for [Formula: see text] and the 10/7. The results demonstrate both size dependence and the possibility, not just of competition between different spin polarized states at the same [Formula: see text] and [Formula: see text], but also the tilt- or Zeeman-energy-dependent- crossover between distinct FQHE associated with different Hall resistances.

Fat augments leptin-induced uterine contractions by decreasing JAK2 and BKCa channel expressions in late pregnant rats.

Altered lipid metabolism in obesity causes pregnancy complications in humans and animals. Leptin levels increase in pregnancy, as well as obesity. However, the effect of obesity on uterine leptin receptors and its distal signaling is not clear. The present study aimed to understand the effect of increased fat on leptin signaling in rat uterus. Wistar female rats were fed with an HF diet (40% Fat, 17% Sucrose, 1.25% Cholesterol, 0.75% Cholic acid) for 6 weeks before the mating and during pregnancy. HF diet significantly increased the fat depots, liver weight, serum, and tissue cholesterol levels. It produced fatty degeneration in the liver and caused infiltration of inflammatory cells, cystic endometrial glands, and sub endometrial fibrosis of the uterus. In isometric tension experiments, leptin caused a significant increase in uterine contractions in high fat-fed animals compared to control animals. Analysis of receptor expressions revealed no significant difference between the groups. However, a significant decrease in the JAK2 and BKCaα mRNA expression was observed in the uterus of high fat-fed rats. No change in the BKCaß, eNOS, iNOS, MLCP, and MLCK mRNA expressions was noticed in the HF group compared to the control. The findings of the present study suggest that the contractile response to leptin in the uterus of high fat-fed rats may be attributed to reduced signaling through JAK2 and, lowered expressions of BKCa channel α subunits.

Effect of maximum density and internal heating on the stability of rotating fluid saturated porous layer using LTNE model.

The impact of heat generated inside the porous layer containing a fluid and density maximum when the porous structure is studied analytically subjected to rotation for the case of unlike temperatures of both solid and fluid phases. Two equations each representing solid and fluid phases are used as energy equations. The linear stability theory is used and is based on normal mode technique. Galerkin method is used to find the Eigen values of the problem. The rotation of the porous layer provides extra strength to the system, protecting the structure from instability, however internal heat generation does not support the system in retaining its strength, causing the system to destabilize. Both the conductivity ratio and the density function have a negative impact on system stability. Consequently, the rotation parameter Ta stabilizes the system, whereas internal heat generation, conductivity ratio, and density function destabilizes the onset of convection.

Persistence and diffusion behaviour of chlorpyrifos in five different species of vegetables: A comparative analysis.

Understanding of pesticide persistence and diffusion on the fresh vegetables are extremely important in food safety and decontamination process. In this study, we examine the persistence and diffusion behaviour of chlorpyrifos pesticide in five different species of vegetables. The chlorpyrifos pesticide was spiked on the vegetable surfaces and the extracted samples from peel and tissues were subjected to Gas Chromatography equipped with a Flame Photometric Detector (GC-FPD). Further, the chlorpyrifos diffusion behaviour was compared with the osmotic potential, shear strength, cuticular chemical profile and microstructure of peel surface of vegetables. The persistence analysis results revealed that chlorpyrifos level was decreased in peel surface and diffusion rate was increased in inner tissue with respect to durations. Within 72 h exposure, chlorpyrifos reached 0.7 cm depth into the inner tissue of vegetables. Significant level of chlorpyrifos diffusion with P ≤ 0.05 was observed in beetroot (2.47%), khon khol (1.46%) and brinjal (0.92%) compared to cucumber and potato. Remarkably, there was no direct linkage between the chlorpyrifos diffusion rate, osmotic potential and toughness of vegetables. In addition, the Gas Chromatography Mass Spectroscopy (GC-MS) and Scanning Electron Microscopy (SEM) analyses revealed that epicuticular surface microstructure and chemical profiles were not correlated with the chlorpyrifos diffusion in all the tested vegetables. The study results concludes that chlorpyrifos diffusion is vegetable species specific and it is highly variable between the species.

Machine Learning and Image Analysis Applications in the Fight against COVID-19 Pandemic: Datasets, Research Directions, Challenges and Opportunities.

COVID-19 pandemic has become the most devastating disease of the current century and spread over 216 countries around the world. The disease is spreading through outbreaks despite the availability of modern sophisticated medical treatment. Machine Learning and Image Analysis research has been making great progress in many directions in the healthcare field for providing support to subsequent medical diagnosis. In this paper, we have propose three research directions with methodologies in the fight against the pandemic namely: Chest X-Ray (CXR) images classification using deep convolution neural networks with transfer learning to assist diagnosis; Patient Risk prediction of pandemic based on risk factors such as patient characteristics, comorbidities, initial symptoms, vital signs for prognosis of disease; and forecasting of disease spread & case fatality rate using deep neural networks. Further, some of the challenges, open datasets and opportunities are discussed for researchers.

Fluid resuscitation in trauma: what are the best strategies and fluids?

BACKGROUND: Traumatic injuries pose a global health problem and account for about 10% global burden of disease. Among injured patients, the major cause of potentially preventable death is uncontrolled post-traumatic hemorrhage. MAIN BODY: This review discusses the role of prehospital trauma care in low-resource/remote settings, goals, principles and evolving strategies of fluid resuscitation, ideal resuscitation fluid, and post-resuscitation fluid management. Management of fluid resuscitation in few special groups is also discussed. CONCLUSIONS: Prehospital trauma care systems reduce mortality in low-resource/remote settings. Delayed resuscitation seems a better option when transport time to definitive care is shorter whereas goal-directed resuscitation with low-volume crystalloid seems a better option if transport time is longer. Few general recommendations regarding the choice of fluid are provided. Adhering to evidence-based clinical practice guidelines and local modifications based on patient population, available resources, and expertise will improve patient outcomes.

Five years review of extraction frequencies at S.D.M. College of dental sciences and Hospital in orthodontic department.

BACKGROUND: To find out the frequency of extraction in general, in Class I, Class II Class III patients, and to compare the frequency of extraction among sex and age. MATERIAL AND METHODS: 550 cases were selected retrospectively having detailed case history, complete records of facial photographs, lateral cephalogram, orthopantomographs and study models. Frequency of extraction was evaluated separately for class I, class II and class III malocclusion and for sex and ages, using the records collected. RESULTS: Show that there was 59.80% of extraction in general. Comparison of sex shows that there were 66.60 of extraction in females. The mean age of males for extraction was 17.85 +/- 4.18 and the mean age of females was 18.36 +/_ 4.89. Among all the groups, Class I malocclusion shows 89% of extraction. CONCLUSIONS: There was higher frequency of extraction comprising in general. Comparison of sex shows that there was higher frequency of extraction in females. Comparison of age shows that extraction frequency is more in late adolescent period. Among all the groups, Class I malocclusion shows higher frequency of extraction. Key words:Extraction, frequency, malocclusion.raumatic neuroma; palisaded encapsulated neuroma; oral palisaded encapsulated neuroma.

A dataset for automatic contrast enhancement of microscopic malaria infected blood RGB images.

In this article we introduce a malaria infected microscopic images dataset for contrast enhancement which assist for malaria diagnosis more accurately. The dataset contains around two hundred malaria infected, normal, species and various stages of microscopic blood images. We propose and experimentally demonstrate a contrast enhancement technique for this dataset. This simple technique increases the contrast of an image and hence, reveals significant information about malaria infected cells. Experiments on the dataset show the superior performance of our proposed method for contrast enhancement of malaria microscopic imaging.

Transcatheter aortic valve implantation: a new standard of care.

Aortic stenosis is the most common valvular lesion requiring intervention and with an ageing population, its burden is likely to increase. Increasing comorbidity and a desire for less invasive treatment strategies has facilitated the expansion of percutaneous aortic valve therapies. Robust clinical trial data are now available to support the role of transcatheter aortic valve implantation (TAVI) in patients of prohibitive, high and now intermediate surgical risk. The introduction of a Medicare Benefits Schedule reimbursement is likely to see TAVI use grow exponentially in Australia over the next 5 years. Clinical trials evaluating low risk patients may be the final frontier to see TAVI become the standard of care for most patients with severe aortic stenosis.

Effects of renal sympathetic denervation on myocardial structure, function and perfusion: A serial CMR study.

BACKGROUND AND AIMS: Echocardiographic studies have shown improvements in cardiac indices associated with renal sympathetic denervation (RDN), however, the benefits on myocardial perfusion have never been assessed. This trial was designed to study the effects of RDN on myocardial perfusion using cardiac magnetic resonance (CMR) imaging. METHODS: A total of 14 patients with resistant hypertension were recruited for RDN and myocardial perfusion, alongside other CMR indices, was assessed at baseline and at 6 months. RESULTS: RDN showed significant reduction of mean office blood pressures from 181/100 ±â€¯19/16 mmHg to 147/85 ±â€¯19/17 mmHg, 6 months after the procedure (p < 0.0001). This was combined with significant improvement in regional aortic distensibility (p < 0.02) and associated with trends of improved myocardial perfusion reserve index (baseline = 2.2 ±â€¯1; 6 months = 2.9 ±â€¯1 units) (p = 0.08). Left ventricular end systolic volume index decreased from baseline to 6 months post procedure, 27 ±â€¯13 ml/m2vs. 22 ±â€¯10 ml/m2 (p = 0.03), but there was no significant change in left ventricular end diastolic volume index (p = 0.09). There was significant improvement in mean left ventricular ejection fraction from 68 ± 10% to 72 + 9%, 6 months post procedure (p = 0.04). T1 mapping failed to detect fibrosis in these patients at baseline and therefore no change was noted, however, extracellular volume percent improved from 46 ±â€¯4% at baseline to 41 ±â€¯8% at 6 months (p = 0.002). CONCLUSIONS: This study demonstrates that renal sympathetic denervation increased myocardial perfusion by 32% as assessed by CMR, and, this was associated with improvements in cardiac volumes and function. Larger well controlled and randomized studies are required to assess the clinical significance of these findings.

Oral impacts on daily performance: Validity, reliability and prevalence estimates among Indian adolescents.

BACKGROUND: Dental diseases negatively influence people's oral health-related quality of life and thus their perceived need for dental care. OBJECTIVES: To test the validity and reliability of an Indian version of Oral Impacts on Daily Performance (OIDP) index for college students and to identify age and sex-specific OIDP prevalence estimates. METHODS: Cross-sectional descriptive survey was conducted among 800 professional and non-professional bachelor degree college students of Udaipur, India aged between 17 and 24 years. Oral health-related quality of life among the college students was assessed through OIDP, tested for validity and reliability and then prevalence rates were estimated. Chi square test was employed for statistical analysis. Cronbach's alpha was found to be 0.82. RESULTS: Sixty percent subjects reported at least one oral impact in last 6 months with overall mean OIDP score of 2.49±3.92. The most commonly affected performances were cleaning teeth (24%) and eating (12%). A significant association in oral impacts on daily performances among college students was observed with age (P=.001) but not with gender (P=.053). CONCLUSIONS: The validity and reliability of OIDP and also the prevalence of oral health-related impacts were found to be high. OIDP index showed acceptable psychometric properties in the context of an oral health survey among Indian college students.

Delayed massive haemothorax 10 days following percutaneous nephrolithotomy.

A 56-year-old man presented with massive right haemothorax 10 days following percutaneous nephrolithotomy (PCNL) for complex, large-bulk, right renal stones. Antiplatelet medication started following coronary stenting 7 months ago was stopped 5 days prior and resumed 2 days following surgery. Stones were cleared through two tracts, one supracostal, with placement of ureteral stent but no nephrostomy. He was discharged the next day with an unremarkable chest X-ray. He developed cough and fever after 1 week. Three days later he presented with acute dyspnoea, blood pressure of 100/60 mm Hg, pulse of 120/min and haemoglobin of 9.0 g/dL. Chest X-ray and CT scan showed a large right haemothorax. Two-litre haemothorax was drained by intercostal drainage with prompt recovery. Haemothorax is a rare complication following PCNL usually after supracostal access. Most occur at or immediately following surgery. Infection and early resumption of antiplatelet medication might have contributed to his presentation with delayed secondary haemorrhage from a pleural injury.

Renal sympathetic denervation increases renal blood volume per cardiac cycle: a serial magnetic resonance imaging study in resistant hypertension.

AIM: Preclinical studies have demonstrated improvements in renal blood flow after renal sympathetic denervation (RSDN); however, such effects are yet to be confirmed in patients with resistant hypertension. Herein, we assessed the effects of RSDN on renal artery blood flow and diameter at multiple time points post-RSDN. METHODS AND RESULTS: Patients (n=11) with systolic blood pressures ≥160 mmHg despite taking three or more antihypertensive medications at maximum tolerated dose were recruited into this single-center, prospective, non-blinded study. Magnetic resonance imaging indices included renal blood flow and renal artery diameters at baseline, 1 month and 6 months. In addition to significant decreases in blood pressures (p<0.0001), total volume of blood flow per cardiac cycle increased by 20% from 6.9±2 mL at baseline to 8.4±2 mL (p=0.003) at 1 month and to 8.0±2 mL (p=0.04) 6 months post-procedure, with no changes in the renal blood flow. There was a significant decrease in renal artery diameters from 7±2 mm at baseline to 6±1 mm (p=0.03) at 1 month post-procedure. This decrease was associated with increases in maximum velocity of blood flow from 73±20 cm/s at baseline to 78±19 cm/s at 1 month post-procedure. Notably, both parameters reverted to 7±2 mm and 72±18 cm/s, respectively, 6 months after procedure. CONCLUSION: RSDN improves renal physiology as evidenced by significant improvements in total volume of blood flow per cardiac cycle. Additionally, for the first time, we identified a transient decrease in renal artery diameters immediately after procedure potentially caused by edema and inflammation that reverted to baseline values 6 months post-procedure.