Archives-December 

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the only treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEF. Larger fistulae and those situated lower down e.g. supra cardinal cannot be managed by this technique.

Having a child with disability in a family is not the same as having a child without a disability. Parents of disabled children after knowing that their children have disability, develop highly ambivalent feelings towards their babies. Parent’s social life becomes restricted, and feelings of social rejection and isolation may follow. Parents having a child with mental retardation experience a variety of stressors and stress reactions related to the child’s disability and the parents have the feelings of guilt, anxiety, hostility, and insecurity. Having a child with autism also found to be a significant financial burden to the family. Parents of children with autism are more likely to use avoidant coping strategies that may have a negative impact on the marital relationship. Parents may feel self-conscious about taking a child with autism out into the community. An attempt has been made to present a critical analysis of a preliminary review of epidemiological studies on psychological distress in parents of children with mental retardation and autism.

The outline of the determined boundary of the Iranian snowflake was formed in the previous chapter. Now, another quadrangle rotation around whose axis perfects the main context of the architecture is introduced: the fancy of the work. The mind of the architect is required to have an imagination based on the subject of the design in regards to the users to create the initial embryo in the scope of the first stage’s conditions to create the entire work. This is the most sensitive part of the designing and leads to the fundamental difference in the works of designers because as we mentioned, chaotic systems are extremely sensitive to initial conditions and any slight difference in initial conditions of the formation of the system can lead to fundamental transformations in the final product. This stage is the stage of patterning or creation of fancy. The term fancy is chosen to define the mental pattern founding the design because it simultaneously covers cogitation, concept, imagination and fantasy.

People affected with Diabetes Mellitus use Continuous Glucose Monitoring (CGM) devices for monitoring of their blood glucose level. The currently available CGM devices show the current glycemic level of the user and produce alarm whenever the glycemic level exceeds the normal range or is in increasing or decreasing trend. Some devices do prediction of the glucose value some time slots ahead and give an alarm of the impending Hypo/ Hyper glycemia situation. But the true scenario is that the success is only 50% due to false alarms or missing alarms. With the understanding that CGM data do have errors when the rate of change is high, in our study, we have tried the prediction of glucose levels ahead in time without intervention through Auto Regressive Integrated Moving Average (ARIMA) Model with its parameters optimized with Differential Evolution. The Method is validated with Simulated data obtained from the web based Diabetes Educator. First half of the data set is used for training and the remaining half is used for testing. Mean Absolute Difference (MAD) between the predicted and actual glucose values is used as the performance metric. The experiments conducted showed promising results with MAD in the range of 6 to 10.3. The prediction accuracy can be improved by increasing the number of iterations and the optimum selection of scaling factor.

A developing nation like ours has been suffering with a tremendous cases of tuberculosis nationwide, in all forms expected. We here highlight a case of Tuberculosis of breast tissue in an adolescent girl which is rare as a presentation and was mis-lead and treated as a breast abscess of other origin. Confirmatory findings with use of tools like ultrasonography and biopsy made us to final the diagnosis and put the patient on anti-tubercular drugs.

Biogas, a clean and renewable form of energy could very well substitute (especially in the rural sector) for conventional sources of energy (fossil fuels, oil, etc.) which are causing ecological–environmental problems and at the same time depleting at a faster rate. Despite its numerous advantages, the potential of biogas technology could not be fully harnessed or tapped as certain constraints are also associated with it. Most common among these are: the large hydraulic retention time of 30–50 days, low gas production in winter, etc. Therefore, efforts are needed to remove its various limitations so as to popularize this technology in the rural areas. Researchers have tried different techniques to enhance gas production. This paper reviews the various techniques, which could be used to enhance the gas production rate from solid substrates.

The industrial/military power of any nation is attributed to its ability to produce steel. Alloys are as a result of the combination of a base material with other constituent elements. It is therefore interesting to note that for this well researched paper metallic alloys are a combination of a base metal and other constituents. The main constituents here are the carbon. It is the addition of carbon that change metals to an engineering material, thus, various constituents of carbon carbides can be constituted to give different categories of steel alloys which can be used to produce different spare parts. With various production methods, these steel alloys can be better appreciated by what it can be used to accomplish.

The analog speech signal can be used for interacting with machines, computers or robots. In this case, speech algorithm is capable to recognize the voice commands that are given as inputs to a mobile robot through wireless XBee modules. It is actually a form of Word Recognition. In this presented paper, a voice command recognition system is going to be developed by using Artificial Neural Network (ANN). The Commands that used here are all in Nepali Languages (used in North East India). Linear predictive coding (LPC) has been applied to represent speech signal in frames in early stage. Features from the selected frames are used to train multilayer perceptrons (MLP) using back-propagation. The same routine is applied to the speech signal during the recognition stage and unknown test patterns are classified to the nearest patterns. In short, the selected frames represent the local features of the speech signal and all of them contribute to the global similarity for the whole speech signal. The analysis, design and development of the automation system are done in MATLAB, in which an isolated word speaker independent digits recogniser is developed.

The aim of this paper is to develop a methodology for solving matrix games with fuzzy payoffs. Here, a fuzzy matrix game has been considered and its solution method has been proposed using interval parametric technique. This technique is based on parametric representation of interval number. In this technique, the fuzzy number has been converted into interval number using interval approximation of fuzzy number and the interval number has been presented to its parametric interval functional form. Then the corresponding matrix game has been converted into crisp game using the said technique. The value of the matrix game for each player is obtained by solving corresponding crisp game problems using the existing method. Finally, a numerical example has been considered and solved in support of the solution method.

Retirement is of the categories, which contains widely range in studies and involves scientific and legislative societies of each country to itself. In numerous discussions with pension matters; discussion about mandatory retirement age, because of its closeness with employment; more than other retirement issues is important and it more worthy to pay attention. Also, the mandatory retirement age increase or decrease due to its different effects on different domains (such as job or income and social security organization losses) is quite a challenging and reviewable matter. Accordingly, we have tried to engage to the subject of compulsory retirement age and factors affecting its determination and to provide a good model for legislation in this field.