Background:Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine.Aim:The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population.Patients and Methods:We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis.Results:The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine.Conclusions:Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.

This paper proposes the use of Superconducting fault current limiter (SFCL), in conjunction with directional over current relays (OCRs) to solve the protection coordination problem in distribution systems equipped with distributed Generator (DG). The SFCL size and optimal directional OCR settings are determined in the grid connected mode. The proposed approach is tested on the IEEE 34 node distribution system in which 26 OCRs are placed. On the occurrence of fault, level of fault current changes which in turn changes the operating time of various OCRs. Therefore, it is important to calculate and suggest method of the relay setting in order to minimize the operating time of relays and also to avoid the mal-operation. SFCL reduces the magnitude of short circuit current on the occurrence of fault and ultimately retains the coordination among various directional over current relays.

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This paper proposes a novel hybrid approach that combines factor division algorithm and fuzzy c-means clustering technique for reducing the model order of high-order linear time invariant system. The process of clustering is used for finding the group of objects with similar nature that can be differentiated from the other dissimilar objects. The numerator of the higher order model is reduced using the factor division algorithm and the denominator of the higher order model is reduced using the fuzzy c-means clustering technique. The stability of the model is also verified using the pole zero stability analysis and it was found that the obtained reduced order model (ROM) is stable. Further, the steady state and transient response of the ROM is found to be better than the other existing techniques. The performance of the ROM is compared to other existing techniques in terms of integral square error, integral of time multiply squared error, integral absolute error and integral time-weighted absolute error.

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Abstract:In the presence of distributed generators (DGs) the fault current sensed by relay in the forward direction is larger than that in the reverse direction. Thus, it is required to have different relay settings for both forward and reverse directions. This paper investigates the impact of DG controller operating modes on the coordination of conventional and dual setting overcurrent relays (OCRs). The different DG control modes are voltage control mode (VCM) and current control mode (CCM). A comparative study of protection coordination is presented in both the operating modes of the DG. This scheme is tested on a 3-bus meshed system and the IEEE 34-node distribution system in which an electronically interfaced DG is connected. The protection coordination problem is formulated as a nonlinear programming problem and the optimal settings of OCRs are determined by using a genetic algorithm.

Context:High intracranial pressure is the most frequent cause of mortality and disability after severe traumatic brain injury (TBI) which is treated by first-line therapeutic measures. When these measures fail, second-line therapies are started. Among second-line therapies, decompressive craniectomy (DC) has been used. It improves the functional outcome in these patients.Aim:This study aims to analyze the clinicoradiological factors associated with the prognosis of severe TBI in patients undergoing DC.Settings and Design:It was a retrospective case series study from April 2014 to March 2016.Subjects and Methods:A total of 85 patients (admitted at Tata Main Hospital, Jamshedpur) with severe diffuse TBI with clinical and radiological evidence of intracranial hypertension who were refractory to first-tier therapies and required DC were included in our study. Cases excluded were patients with age <10 years and polytrauma patients.Results:Out of 85 cases, 55 were males, and thirty were females (male:female = 1.8:1) with the age ranging from 17 to 68 years. Road traffic accident was the leading cause of injury in 69.5% cases. A total of 49 (58%) patients were of Glasgow coma scale (GCS) 4–6 whereas 36 (42%) patients had GCS 7–8. Computed tomography (CT) scan brain was classified as per Marshall CT classification. Bifrontotemporal DC was done in 29% cases, and unilateral frontotemporoparietal craniectomy was done in 71%.Conclusions:Patients with younger age, early surgical intervention, better preoperative GCS score, and with low Marshall CT score have better prognosis.

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