Bootstrap tests for simultaneous monotone ordering of effects in a two-way ANOVA

In a two-way additive analysis of variance (ANOVA) model, we consider the problem of testing for homogeneity of both row and column effects against their simultaneous ordering. The error variances are assumed to be heterogeneous with unbalanced samples in each cell. Two simultaneous test procedures are developed-the first one using the likelihood ratio test (LRT) statistics of two independent hypotheses and another based on the consecutive pairwise differences of estimators of effects. The parametric bootstrap (PB) approach is used to find critical points of both the tests and the asymptotic accuracy of the bootstrap is established. An extensive simulation study shows that the proposed tests achieve the nominal size and have very good power performance. The robustness of the tests is also analyzed under deviation from normality. An "R" package is developed and shared on "GitHub" for ease of implementation of users. The proposed tests are illustrated using a real data set on the mortality due to alcoholic liver disease and it is shown that age and gender have a significant impact on the increasing incidence of mortality.

Multicomponent synthesis via acceptorless alcohol dehydrogenation: an easy access to tri-substituted pyridines

Herein, we report palladium supported on a hydroxyapatite catalyst for synthesizing tri-substituted pyridines using ammonium acetate as the nitrogen source via acceptorless alcohol dehydrogenation strategy. The strategy offers a broad substrate scope using inexpensive and readily available alcohols as the starting material. The catalyst was prepared using a simple method and analyzed by several techniques, including FE-SEM, EDS, HR-TEM, BET, XRD, FT-IR, UV-visible spectroscopy, and XPS, demonstrating the anchoring of Pd nanoparticles on hydroxyapatite in the zero oxidation state. Moreover, several controlled experiments were carried out to understand the reaction pathway and a suitable mechanism has been proposed.

Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak

We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.

S-Alkylation of dithiocarbamates via a hydrogen borrowing reaction strategy using alcohols as alkylating agents

Herein, we report an operationally simple, environmentally benign and scalable approach towards the synthesis of S-benzyl/alkyl dithiocarbamates via a hydrogen borrowing reaction between alcohols and dithiocarbamate anions catalyzed using a hydroxyapatite-supported copper nano-catalyst. This strategy has a broad substrate scope and offers high yields of products using inexpensive and readily available alcohols as starting materials. The catalyst was prepared by easy and straightforward methods and analyzed by several analytical techniques, e.g., FESEM, HR-TEM, BET, XRD, EDS, and XPS, demonstrating the anchoring of Cu nanoparticles on hydroxyapatite in the zero oxidation state.

Initial results from near-infrared spectroscopy on ADITYA-U tokamak

Spectroscopy in vacuum ultraviolet (VUV) and visible ranges plays an important role in the investigation and diagnosis of tokamak plasmas. However, under harsh environmental conditions of fusion grade devices, such as ITER, VUV-visible systems encounter many issues due to the degradation of optical components used in such systems. Here, near-infrared (NIR) spectroscopy has become an effective tool in understanding the edge plasma dynamics. Considering its importance, a NIR spectroscopic diagnostic has been developed and installed on the ADITYA-U tokamak. The system consists of a 0.5 m spectrometer having three gratings with different groove densities, and it is coupled with a linear InGaAs photodiode array. Radiation from the ADITYA-U edge plasma has been collected using a collimating lens and optical fiber combination and transported to the spectrometer. The spectrum in the NIR range from the ADITYA-U plasma has been recorded using this system, in which Pa_β and Pa_γ along with many spectral lines from neutral and singly ionized impurities have been observed. The influxes of H and C have been estimated from measurements. The H influx value is found to be 2.8 × 10¹⁶ and 1.9 × 10¹⁶ particles cm^-2 s^-1 from neutral hydrogen lines H_α and Pa_β, respectively, and the C influx value is found to be 3.5 × 10¹⁵ and 2.9 × 10¹⁵ particles cm^-2 s^-1 from the neutral carbon and singly ionized carbon, respectively. A good agreement is seen between these results and the results obtained by using a routine photomultiplier tube based diagnostic.

Usability study of a sleeve attachment device for enhancing ease of use of metered dose inhalers in children

BACKGROUND

Children with asthma often lack the strength to activate their pressurised metered dose inhaler (pMDI). A recently developed sleeve device that attaches to a pMDI reduces the activation force of pMDIs from 36 - 39 Newtons (N) to 12.6 N and monitors the remaining doses with a built-in counter.

OBJECTIVES

To examine the usability and patient experience of the Easy Squeezy (ES) sleeve attachment device in the paediatric patient population.

METHODS

This cross-over study included 40 participants aged 5 - 10 years, half of whom had previous experience in using a pMDI. The experienced participants had used a pMDI for at least 1 year, and the inexperienced participants had no experience of using a pMDI. Participants and their parents recorded their responses on the ease of use, perceptions and satisfaction with using the pMDI alone and the pMDI with the ES.

RESULTS

The participants felt that it was easier for them to activate the pMDI using the ES. They liked the ES device more than the pMDI and felt happier using the ES device. The parents reported that their children would be happier using the ES and would find it easier to activate the pMDI using the ES, that the built-in counter in the ES would make it easier to keep track of the doses, and that their children would be more likely to take the ES to school and use it there compared with the pMDI. They would recommend the ES to other parents and were willing to buy the device with their own money.

CONCLUSION

The paediatric participants and their parents reported that the ES made it easier for children to activate the pMDI, that the counter made it easier to keep count of the doses, and that the aesthetics of the ES could potentially remove the stigma attached to use of a pMDI.

Retrospective audit of serum vitamin D levels in patients who underwent Latarjet procedure for anterior shoulder instability

BACKGROUND: The aim of this study was to review vitamin D levels in patients who underwent Latarjet procedures at a tertiary teaching hospital and a private clinic. METHODS: A retrospective review of clinical and radiological records was performed for 22 patients who underwent Latarjet procedure between November 2017 and June 2019. Postoperative vitamin D levels were retrieved and classified into sufficient (> 75 nmol/L), insufficient (25-75 nmol/L), and deficient (< 25 nmol/L) groups. Two observers assessed radiographic images of the patients at six weeks and three months after surgery. Any bone resorption, fracture and nonunion were reported, and interobserver reliability was analysed using the intraclass correlation coefficient (ICC). RESULTS: The median age was 20.5 years and was predominantly male. A little more than two-thirds (68.1%) of the patients were found to have insufficient or deficient levels of vitamin D. One patient from the insufficient group had postoperative bone resorption. Good interobserver reliability was observed with the ICC value being 0.86. CONCLUSION: This study found a prevalence of insufficient/deficient vitamin D levels in young patients undergoing a Latarjet procedure. This study serves as a reminder to orthopaedic surgeons that vitamin D deficiency is prevalent among patients undergoing Latarjet Level of evidence: Level 4.

Active microrheology using pulsed optical tweezers to probe viscoelasticity of lamin A

Lamins are nucleoskeletal proteins of mammalian cells that stabilize the structure and maintain the rigidity of the nucleus. These type V intermediate filament proteins which are predominantly of A and B types provide necessary tensile strength to the nucleus. Single amino acid missense mutations occurring all over the lamin A protein form a cluster of human diseases termed as laminopathies, most of which principally affect the muscle and cardiac tissues responsible for load bearing functionalities of the body. One such mutation is A350P which causes dilated cardiomyopathy in patients. It is postulated that a change from alanine to proline in the α-helical coiled-coil forming 2B rod domain of the protein might severely disrupt the propensity of the filaments to polymerise into functional higher order structures required to form a fully functional lamina with its characteristic elasticity. In this study, we have elucidated for the very first time, the application of active microrheology employing oscillating optical tweezers to investigate any alterations in the viscoelastic parameters of the mutant protein meshwork in vitro, which might translate into possible changes in nuclear plasticity. We confirmed our findings from this robust yet fast method by imaging both the wild type and mutant lamin A networks using a super resolution microscope, and observed changes in the mesh size which corroborate our measured changes in the viscoelastic parameters of the lamins. This method could thus be extended to conduct microrheological measurements on any intermediate filament protein thus bearing significant implications in laminopathies and other diseases associated with intermediate filaments.

Does the intra-operatively measured leg length correction compare to the post-operative radiograph in total hip replacement surgery?

ABSTRACT BACKGROUND: This study aims to analyse the accuracy of the Vertical Measurement System™ (VMS) in assessing the leg length correction (LLC) during total hip arthroplasty (THA) by comparing the intra-operative measurements to the radiographic measurements obtained six weeks post-operatively Patients and methods: A prospective cohort study was conducted in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THAs were performed by four surgeons. Pre-operative leg length discrepancy (LLD) measurements were obtained in 92 patients. The VMS was used to predict intra-operative LLC, and this measurement was compared to the post-operative LLC measured on the six-week follow-up X-ray. These measurements were statistically compared using the Mann-Whitney U test. RESULTS: The difference between the intra-operative VMS calculation and the six-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.1±3.3 mm. In the cohort, 82% of the patients (n=75) were within 5 mm of the target LLC, and 96% of patients (n=88) were within 10 mm of the target LLC. The mean absolute residual LLD at six weeks was 3.2±3.1 mm. CONCLUSION: The intra-operative LLC measurement obtained using the VMS accurately predicts the six-week post-operative radiographic LLC measurement Level of evidence: Level 4 Keywords: total hip replacement, leg length discrepancy, leg length correction, vertical measurement system, comparative study, longitudinal study

Outcomes of primary fusion in high-energy Lisfranc injuries at a tertiary state hospital

ABSTRACT BACKGROUND: High-energy Lisfranc injuries are relatively uncommon but can lead to severe disability and morbidity. Primary fusion is a treatment option that can improve outcomes and reduce the reoperation rate. The aim of this study was to evaluate our series of primary fusions for high-energy Lisfranc injuries, looking specifically at type of fusion, time to union, non-union rates, reoperation rates and quality of reduction METHODS: Patients who underwent surgery for Lisfranc injuries were identified from the REDCap surgical database and then retrieved from records. Only cases of primary fusion in adults were included. We excluded low-energy sprains and athletic injuries, ipsilateral lower limb injuries and cases where reduction and fixation were done. Radiographs were analysed from the iSite Enterprise PACS system (Philips® RESULTS: Between 2013 and 2018, 12 cases of high-energy Lisfranc injuries were identified where primary fusion was done. Seven patients (58%) underwent fusion of the first, second and third tarsometatarsal (TMT) joints. The first and second TMT joints were fused in only one case (8%), and the second and third TMT joints were fused in four cases (33%). Only one patient (8%) had removal of implants. Compression plating was the technique of choice used for fusion. There was l0o% union rate and average time to union was 84 days. Acceptable reduction was observed in nine cases (75%). Three cases (25%) of malreduction were found, among which one patient had pre-existing hallux valgus CONCLUSION: The majority of patients who underwent primary fusion of at least one TMT joint had good radiological outcome. Further studies with better clinical follow-up are needed Level of evidence: Level 4 Keywords: Lisfranc, tarsometatarsal, outcome, fusion

An intra-operative device for parallel drilling and femoral landmark estimation during medial patellofemoral ligament reconstructive surgery

ABSTRACT BACKGROUND: The aim of this study was to design and test a device to guide medial patellofemoral reconstruction surgeries. Materials and methods: A three-dimensional (3D) printed, modular and cost-effective medial patellofemoral ligament (MPFL) reconstruction guide, Pat-Rig, was designed with parallel holes running in the medio-lateral direction. This device was manufactured using a commercial additive manufacturing facility, and bench tested using a custom-built test rig. CT scans of patella bones were reconstructed, and the device was tested on four 3D-printed patellas of various sizes. RESULTS: The device was successful in guiding the surgical drill into the patella to drill parallel holes adhering to the current surgical requirements and specifications. The device was augmented with an innovative radiopaque scale which can allow the surgeon to accurately predict the landmarks to drill and measure the drill depth of the tunnels. CONCLUSION: There are no devices on the market that accurately predict the drill locations on the patella during MPFL reconstruction surgeries. The device, Pat-Rig, was found to overcome the current limitations of the MPFL surgeries and was able to provide satisfactory surgical guidance during the reconstruction. Level of evidence: Level 5 Keywords: knee surgery, patella, orthopaedic, MPFL reconstruction, 3D-printed, novel surgical device.

Synthesis and characterization of a homogeneous and silica supported homoleptic cationic tungsten(vi) methyl complex: application in olefin metathesis

A method for the synthesis of a homogeneous cationic tungsten(vi)pentamethyl complex [(WMe₅)⁺(C₆F₅)₃BMe^-] from neutral tungstenhexamethyl (WMe₆) and a silica supported cationic tungstentetramethyl complex [([triple bond, length as m-dash]Si-O-)WMe₄⁺ (C₆F₅)₃BMe^-] from a neutral silica supported tungstenpentamethyl complex [([triple bond, length as m-dash]Si-O-)WMe₅] is described. In both cases a direct demethylation using the B(C₆F₅)₃ reagent was used. The aforesaid complexes were characterized by liquid or solid state NMR spectroscopy. Interestingly, the homogeneous cationic complex [(WMe₅)⁺(C₆F₅)₃BMe^-] shows moderate activity whereas the supported cationic complex [([triple bond, length as m-dash]Si-O-)WMe₄⁺(C₆F₅)₃BMe^-] exhibits good activity in olefin metathesis reactions.

Single site silica supported tetramethyl niobium by the SOMC strategy: synthesis, characterization and structure–activity relationship in the ethylene oligomerization reaction

Facile synthesis of two SOMC-based niobium methyl complexes which showed different selectivity in ethylene oligomerization.

Ilioprofunda Endobypass Can Successfully Treat a Post-Operative Femoral Pseudo-Aneurysm

INTRODUCTION

A 75-year-old male patient with significant cardiopulmonary comorbidity presented with a 70-mm left femoral pseudoaneurysm 6 years after aortobifemoral bypass (and prior femoral endarterectomy).

REPORT

As the left superficial femoral artery was occluded, an ilioprofunda endobypass was undertaken following extraperitoneal exposure of the left limb of the bypass graft with subsequent deployment of four Viabahn endoprostheses via the left limb into the proximal left deep femoral artery with successful exclusion of the pseudoaneurysm. The endografts remain patent at 6 months with regression noted in the pseudoaneurysm itself.

DISCUSSION

Post-operative femoral pseudoaneurysm following anastomotic dehiscence has traditionally been treated by open surgical repair. Re-re-do open femoral vascular surgery has a high complication rate. Scarring and potential graft infection may necessitate ligation of involved arteries and extra-anatomic bypasses with an attendant risk of limb loss. Although the common femoral artery is conventionally contraindicated for endograft deployment because of the perceived high risk of stent fracture in a highly mobile zone, an endobypass can avoid the potential complications of open revision groin surgery in an unfit, high-risk patient.

Gallbladder Volume in Sikkimese Population

Background Gall bladder volume can have clinical and therapeutic implications and possibly affect certain pathophysiological mechanisms of many diseases affecting the gallbladder including gall stones. Objective The objective of the study was to establish baseline indices of gallbladder volume for the Sikkimese population and determine its correlation with age, sex and Body Mass Index. Method A prospective epidemiologic study on selected 100 patients (equal male to female ratio) over the age of 36 years, undergoing ultrasound scan of abdomen, was undertaken. Age, Sex, Body Mass Index and gall bladder volume for each subject were collected and analysed statistically. Spearman's correlation test was performed to look for significant variables. Result The overall mean gallbladder volume in the present study was 15.47±7.9 ml with 17.2±8.9 ml and 13.74±6.4 ml being average volumes in males and females respectively, which gives the baseline indices for the Sikkimese population. Gall bladder volume was strikingly increased in obese subjects. There was a positive correlation between gall bladder volume and age (r=0.114), gender (r=0.182) and BMI (r= 0.175) but the strength of correlation was weak and not statistically significant (p <0.001). Conclusion Ultrasonography is an easy and effective method for evaluation of gall bladder volume. Sikkimese males have a larger fasting gall bladder volume which is directly correlated with higher body mass index. Fasting gall bladder volume has a weak correlation with advancing age.

Cell-based gene therapy against HIV

The ability to integrate inside the host genome lays a strong foundation for HIV to play hide and seek with the host's immune surveillance mechanisms. Present anti-viral therapies, although successful in suppressing the virus to a certain level, fail to wipe it out completely. However, recent approaches in modifying stem cells and enabling them to give rise to potent/resistant T-cells against HIV holds immense hope for eradication of the virus from the host. In this review, we will briefly discuss previous landmark studies on engineering stem cells or T-cells that have been explored for therapeutic efficacy against HIV. We will also analyze potential benefits and pitfalls of some studies done recently and will share our opinion on emerging trends.

Striking difference between alkane and olefin metathesis using the well-defined precursor [Si–O–WMe5]: indirect evidence in favour of a bifunctional catalyst W alkylidene–hydride

Metathesis of linear alkanes versus olefins using supported multifunctional catalyst gives a very striking different distribution of metathesis products.

Biofilms on indwelling urologic devices: microbes and antimicrobial management prospect

BACKGROUND

Biofilms (BFs) are a potential source of highly resistant infections, frequently formed on devicesand pose problems for management.

AIM

This study was to develop rational approach for prevention of indwelling urologic device associated biofilm colonization.

SUBJECTS AND METHODS

From randomly selected patients visiting Department of Urology of a tertiary hospital in India 150 uro catheters and 31 used ureteric stents, in-situ for > 30, were collected aseptically. The organisms were isolated and identified from washed devices dipped in broth. Evidence of bacteriuria in each case was checked by semi-quantitative method of urine culture, on day 0 and 14 of device use. The BF statuses of the device-adhered organisms were confirmed by modified method of Christensen. The antibiotic susceptibility was determined by disc diffusion method. Data were analyzed using the Graphpad Prism version 5 statistical software.

RESULTS

Both single and multi-species BFs were formed on catheters, whereas mono-bacterial BFs were exclusive on stents. Predominant organisms were Pseudomonas aeruginosa (30.67%,69/225,) followed by Staphylococcus aureus (15.11%, 34/225), Escherichia coli (13.78%, 31/225), Klebsiella pneumoniae (12%, 27/225), Staphylococcus epidermidis (8.44%, 19/225). Of all strains, (89.33%, 201/225) were found to be BF positive and their colonizations were early indicated by the presence of insignificant bacteriuria in follow-up urine samples. All BF isolates were resistant to at least three antibiotics.

CONCLUSIONS

BF colonization was almost inevitable in prolonged used urinary devices and the most frequent organisms were Pseudomonas, Staphylococcus, and Escherichia spp. Their colonizations usually were indicated by insignificant bacteriuria from follow-up samples. Such BF dislodged organisms were multidrug resistant and could be a source of disseminated infection, yet were in-vitro preventable by many drugs.

Anaerobic culture on growth efficient bi-layered culture plate in a modified candle jar using a rapid and slow combustion system

Success for maximum isolation of anaerobes depends on maintaining critically low oxygen levels throughout and growth in a reduced medium with exclusion of inhibitory substances. Hence a dual system was used equipped with candle combustion for instant exhaustion of major part of oxygen from a sealed jar, along with acidified steel wool for residual oxygen purging. For inhibitory substances removal, test anaerobes were grown on anaerobic medium layered on buffer charcoal agar bed. After 48 hours incubation average colony sizes were compared with that of growths in conventional Gas-Pak system. Better growths were noted in the innovative system.

Effects of potassium iodide on low avid immunological reactions: probable mechanism of action on selective fungal infections

Background:

Selective in-vivo anti-fungal action of potassium iodide (KI) is an enigma, but circumstantial evidences strongly indicate some immune mechanism.

Aim:

Study was to demonstrate in-vitro immune-modulating role of KI.

Materials and Methods:

In identical test conditions keeping appropriate control, different immunological tests were performed with and without 0.1% effective concentration of KI. i) Sera from Coombs positive mothers were treated with O, Rh-positive erythrocyte suspensions along with Coombs’ sera (CS)/Bovine albumin (BA)/KI. ii) Amboceptor and complement (C) mixtures were titrated for hemolysis with or without KI. iii) Suspension of Salmonella Typhi with positive sera from enteric cases and C + KI was incubated at 37°C for 30 minutes, then sub-cultured on MacConkey Agar. iv) Positive serum from chronic muco-cutaneous candidiasis patient was treated with suspension of candida isolate and C + KI at 37°C for 30 minutes then sub-cultured to note variations in colony counts. The data was analyzed by Fishers exact test using Graphpad Prism 5 version 5.00 (California USA)

Results:

i) KI like BA or CS showed hemagglutination. ii) C-mediated hemolysis was inhibited in presence of KI. iii) C-mediated lysis of S. typhi was partially enhanced by KI showing reduced number of colonies; iv) while lysis of candida was reduced.

Conclusions:

KI increases avidity of some immune reactions including C-mediated cell lysis. An increase or decrease of cell-lysis resulted by KI probably mediates by altered access of C-binding receptors. Thus, hypothetically, a non-protective Splendore Hoeppli-like deposit around fungus may turn into protective immune mechanism by influence of KI.

Copper nanoparticle-catalyzed carbon-carbon and carbon-heteroatom bond formation with a greener perspective

The carbon-carbon and carbon-heteroatom bond formations constitute the backbone of organic synthesis and have been widely used in the synthesis of natural products and useful compounds. Because of growing environmental concern, more attention has been focussed on the development of greener methods. Copper is environment-friendly and comparatively inexpensive. Although the use of copper salts in catalysis has been known since the last century, this area of research has been less explored compared to other metals, such as palladium, magnesium, and zinc. This review highlights the general features of nanoparticles as catalysts with particular reference to copper and the recent developments in the copper(0) nanoparticle-catalyzed C(aryl)-C(aryl/alkynyl), C(aryl)-N, C(aryl)-O, C(aryl)-S, and C(aryl)-Se bond formations and related reactions. The mechanisms of the reactions have been outlined and discussed with respect to the active catalytic species and possible intermediates. The scope, limitations, and green aspects of the reactions have also been highlighted. The convenient methods of preparation of copper nanoparticles and their characterization are described.