Percentage of patients shifting to another treatment modality: An experience-guided decision.

OBJECTIVE: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. MATERIAL AND METHODS: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). RESULTS: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. CONCLUSIONS: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

Plasmodium falciparum Alba6 exhibits DNase activity and participates in stress response.

Alba domain proteins, owing to their functional plasticity, play a significant role in organisms. Here, we report an intrinsic DNase activity of PfAlba6 from Plasmodium falciparum, an etiological agent responsible for human malignant malaria. We identified that tyrosine28 plays a critical role in the Mg2+ driven 5'-3' DNase activity of PfAlba6. PfAlba6 cleaves both dsDNA as well as ssDNA. We also characterized PfAlba6-DNA interaction and observed concentration-dependent oligomerization in the presence of DNA, which is evident from size exclusion chromatography and single molecule AFM-imaging. PfAlba6 mRNA expression level is up-regulated several folds following heat stress and treatment with artemisinin, indicating a possible role in stress response. PfAlba6 has no human orthologs and is expressed in all intra-erythrocytic stages; thus, this protein can potentially be a new anti-malarial drug target.

Correlation of oxygenation indices in invasive mechanical ventilated adult patients.

BACKGROUND: Mechanical ventilation is essential for managing acute respiratory failure, but traditional methods of assessing oxygenation, like the PaO2/FiO2 ratio, pose challenges due to invasiveness and cost. OBJECTIVE: This single-centre prospective observational study aimed to assess the potential of the non-invasive Oxygen Saturation Index (OSI), utilising SpO2 measurements, to diagnose hypoxemia in mechanically ventilated adults. The study sought to establish correlations between OSI, oxygenation index (OI), PaO2/FiO2 ratio and SpO2/FiO2 ratio. METHODS: From August 2022 to July 2023, data was collected from 1055 mechanically ventilated intensive care unit patients. Statistical analysis included correlation tests, receiver operating curve (ROC) analysis and cut-off value determination for hypoxemia diagnosis. RESULTS: We found that the P/F ratio had a statistically significant negative correlation with OI (correlation coefficient -0.832, P value: 0.000 in hypoxemic group and correlation coefficient -0.888, P value: 0.000 in the non-hypoxemic group), and OSI (correlation coefficient -0.746, P value: 0.000 in hypoxemic group and correlation coefficient -0.629, P value: 0.000 in non-hypoxemic group) and has a positive correlation with P/F ratio (correlation coefficient 0.92, P value: 0.000 in hypoxemic group and correlation coefficient -0.67, P value: 0.000 in non-hypoxemic group). OI and OSI had a statistically significant correlation (correlation coefficient 0.955, P value: 0.000 in hypoxemic group and correlation coefficient 0.815, P value: 0.000 in non-hypoxemic group). on ROC analysis P/F ratio was the most accurate in predicting hypoxia followed by OI and OSI. with a cut-off value, of OI being 7.07, and that for OSI being 3.90, at an 80% sensitivity level to diagnose hypoxemia. CONCLUSION: OSI can serve as a dependable surrogate for OI, simplifying ARDS severity assessment. The P/F ratio is the most accurate predictor of hypoxia. Further research, especially in larger multicentre studies, is needed to validate these findings and explore the long-term clinical implications of using OSI for oxygenation monitoring in mechanically ventilated patients.

Transboundary hazard and downstream impact of glacial lakes in Hindu-Kush Karakoram Himalayas.

Glacial Lake Outburst Floods (GLOFs) can generate catastrophic flash floods when the damming structure is breached or overtopped. Some of these glacial lakes are located in transboundary regions where floods originating from the lake in one country could inundate a neighboring country, devastating the population and infrastructure of both nations and influencing socio-political relationships. Therefore, assessing the lakes' hazard is crucial. This study investigates transboundary glacial lakes, considering their GLOF hazard, including potential mass movement intrusion, moraine's stability, upstream and downstream process cascades, downstream flood extents, and the exposure and vulnerability of the downstream infrastructure and affected population. GLOF exposure assessments were carried out to identify exposed buildings, bridges, and hydropower systems in transboundary regions. China currently has the highest number of transboundary lakes, with most of them potentially impacting India and Nepal. Most of the transboundary lakes in China, and many in India and Nepal, are susceptible to mass movements. Among the 230 transboundary glacial lakes in the Hindu Kush Karakoram Himalaya, 55 lakes can potentially impact other glacial lakes along their flow path, creating a cascade of events. Five transboundary lakes could potentially impact over 1000 buildings, and 16 lakes could impact over 500 buildings. A total of 35 lakes can impact at least one hydropower station along their flow path, and 4 lakes can impact two hydropower stations. This research emphasizes the critical importance of conducting comprehensive risk analyses of GLOFs in transboundary regions to inform policy-makers. It calls for investing in broad-scale assessments and data-driven decision-making for mitigating and adapting to GLOF risks effectively. Finally, by raising awareness among policy-makers, the study aims to drive actions that safeguard communities and infrastructure vulnerable to GLOF.

Characterizing the spatio-temporal distribution, detection, and prediction of aerosol atmospheric rivers on a global scale.

Aerosol Atmospheric Rivers (AARs) are elongated and narrow regions that carry high concentrations of aerosols (tiny particles suspended in the atmosphere) across large distances, exerting effects on both air quality and human health (Chakraborty et al., 2021, 2022). Monitoring and modeling these aerosols present distinct challenges due to their dynamic nature and complex interactions within the atmosphere. In this context, the present study detects and predicts the AARs using MERRA-2 reanalysis datasets with their seasonal climatology of key aerosol species, including Black Carbon (BC), Dust (DU), Organic Carbon (OC), Sea Salt (SS), and Sulphates (SU). The study employs an innovative Integrated Aerosol Transport (IAT) based AAR algorithm from 2015 to 2022. A total count of 44,020 BC AARs, 13,280 DU AARs, 21,599 OC AARs, 17,925 SS AARs, and 31,437 SU AARs were detected globally. The seasonal climatology of BC and OC AARs intensifies in areas such as the Amazon rainforest and Congo during AMJJAS (April-September) due to forest fires. Similarly, DU AARs are more frequent in regions near the Saharan desert, primarily around the equator during AMJJAS. SS AARs tend to predominate over the oceans, while SU AARs are predominantly found in the northern hemisphere, primarily due to higher anthropogenic emissions. Furthermore, convolutional autoencoder-based models were developed for key aerosol species, strengthening predictive accuracy by effectively capturing complex data relationships and delivering precise predictions for the last 5-time frames. During validation, the model evaluation parameters for image prediction such as the Structural Similarity Index ranged from 0.86 to 0.94, Peak Signal-to-Noise Ratio fluctuated between 1.14 and 42.25 dB, Root Mean Square Error varied from 2.39 to 296.4 mg/(m-sec), and Mean Square Error fell within the range of 1.55-17.22 mg/(m-sec). These collectively reflect image closeness, quality, dissimilarity, and accuracy in AAR prediction. This study demonstrates the effectiveness of advanced machine and deep learning models in predicting AARs, offering the potential for advanced forecasting and enhancing resilience in high-aerosol concentration regions.

Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Spatiotemporal-based automated inundation mapping of Ramsar wetlands using Google Earth Engine.

Wetlands are one of the most critical components of an ecosystem, supporting many ecological niches and a rich diversity of flora and fauna. The ecological significance of these sites makes it imperative to study the changes in their inundation extent and propose necessary measures for their conservation. This study analyzes all 64 Ramsar sites in China based on their inundation patterns using Landsat imagery from 1991 to 2020. Annual composites were generated using the short-wave infrared thresholding technique from June to September to create inundation maps. The analysis was carried out on each Ramsar site individually to account for its typical behavior due to regional geographical and climatic conditions. The results of the inundation analysis for each site were subjected to the Mann-Kendall test to determine their trends. The analysis showed that 8 sites exhibited a significantly decreasing trend, while 14 sites displayed a significantly increasing trend. The accuracy of the analysis ranged from a minimum of 72.0% for Hubei Wang Lake to a maximum of 98.0% for Zhangye Heihe Wetland National Nature Reserve. The average overall accuracy of the sites was found to be 90.0%. The findings emphasize the necessity for conservation strategies and policies for Ramsar sites.

The Effect of Difference in Word Order on Semantic Processing in Hindi-English Bilinguals.

Background: The typology of word order in Hindi (Subject-Object-Verb, SOV) differs from that of English (Subject-Verb-Object, SVO). Bilinguals whose two languages have conflicting word order provide a unique opportunity to understand how word order affects language processing. Earlier behavioural and event-related brain potential (ERP) studies with Spanish-Basque bilinguals showed longer reading times and more errors in the comprehension of OSV sentences than SOV sentences in Basque language, indicating that non-canonical word orders (OSV) were difficult to process than canonical word order (SOV). Purpose: This study was designed to explore how the difference in word order in Hindi and English languages affects N400 parameters in proficient Hindi-English bilinguals, using semantic congruity paradigm. Methods: Twenty-five proficient Hindi-English bilingual subjects were asked to silently read the congruent and incongruent sentences presented in one word at a time in both the languages. ERPs were recorded from midline frontal, central and parietal sites. Results: The mean amplitude of the N400 effect at the parietal sites in Hindi-English proficient bilinguals was larger for English than for Hindi but there was no significant difference in the N400 latencies. Conclusion: Hindi-English bilingual subjects processed SOV and SVO sentences with equal ease as evidenced by the N400 latencies. Higher amplitude of the N400 effect with English sentences indicate that placing 'Object' as the final word makes sentences more predictable than verb as the final word. Understanding the word order difference might help to unravel the neurophysiological mechanisms of language comprehension and may offer some insights in terms of functional advantage of a particular word order in bilinguals.

Exaggerated response to pattern reversal visual evoked potential among migraineurs.

OBJECTIVE: Visual evoked potential recording has reported ambiguous results among migraineurs, thus the present study explored the association of check-size and reversal rates on the latency and amplitude of pattern reversal VEP among migraineurs. METHOD AND MATERIAL: Monocular VEP responses for both eyes were recorded in 133 migraineurs and 111 controls. Checkerboard pattern with phase reversal frequency of 0.5, 1, 2 and 4 Hz and check-size of 16 × 16, 32 × 32, 64 × 64 and 128 × 128, i.e. spatial frequency of 0.475, 1.029, 2.056 and 4.112 cycle per degree (cpd) were used to record 100 responses each. Three-minutes gap was given after change of reversal frequency to a higher rate for next cycle of 4 check-size records. RESULT: A linear increase in latencies was observed with decreasing check-size in both groups, but migraineurs had significantly higher latencies at a given reversal rate. Amplitudes A1 and A2 were higher among migraineurs and amplitude A2 showed an inverted 'U' shaped trend with maximum amplitude at 32 × 32 check size (1.029 cpd) in both groups, with an exaggerated response among migraineurs. Check-size 32 × 32 i.e. spatial frequency of 1.029 behaves differently than other larger or smaller check-sizes. CONCLUSION: Variable VEP response for different visual stimuli may be due to differential activation of respective retinocortical pathways and cortical areas. The highest amplitude at modest check-size suggests a contributory role of foveal-parafoveal fibres in migraineurs. Exaggerated physiological response to visual stimuli may be responsible for higher amplitudes and prolonged latencies among migraineurs.

Exaggerated physiological VEP response as higher amplitudes and prolonged latencies, among migraineurs may be due to differential activation of respective retinocortical pathways and cortical areas.

Obstructive sleep apnea and epilepsy: understanding the pathophysiology of the comorbidity.

Obstructive sleep apnea (OSA) is a sleep disorder of significant health concern with a high prevalence in the general population. It has been found to exhibit a high incidence of comorbidity with epilepsy, the exact underlying pathophysiology of which still remains poorly understood. OSA is characterized by apnea/hypopnea spells and arousals, leading to intermittent hypoxemia and sleep deprivation. Both sleep deprivation and hypoxemia adversely affect the cortical excitability and favor epileptogenesis and worsening of pre-existing epilepsy, if any. In patients with OSA, deprivation of rapid eye movement sleep (REMS) phase (known for its strong antiepileptic influence) is relatively more than that non rapid eye movement sleep phase leading to postulation of REMS deprivation as a significant factor in the development of epilepsy as a comorbidity in patients with OSA. Furthermore, OSA and epilepsy both have shown to exercise a bidirectional influence on one another and are also likely to exacerbate each other through a positive feedback mechanism. This is especially based on the reports of improved control of epilepsy upon treatment of comorbid OSA. This brief paper attempts to present an underlying pathophysiological basis of the comorbidity of OSA and epilepsy based upon sleep deprivation and hypoxemia that are characteristic features observed in patients with OSA.

Heat waves characteristics intensification across Indian smart cities.

Indian cities have frequently observed intense and severe heat waves for the last few years. It will be primarily due to a significant increase in the variation in heat wave characteristics like duration, frequency, and intensity across the urban regions of India. This study will determine the impact of future climate scenarios like SSP 245 and 585 over the heat wave characteristics. It will present the comparison between heat waves characteristics in the historical time (1981 to 2020) with future projections, i.e., D1 (2021-2046), D2 (2047-2072), and D3 (2073-2098) for different climate scenarios across Indian smart cities. It is observed that the Coastal, Interior Peninsular, and North-Central regions will observe intense and frequent heat waves in the future under SSP 245 and 585 scenarios. A nearly two-fold increase in heat wave' mean duration will be observed in the smart cities of the Interior Peninsular, Coastal, and North Central zones. Thiruvananthapuram city on the west coast has the maximum hazard associated with heat waves among all the smart cities of India under both SSPs. This study assists smart city policymakers in improving the planning and implementation of heat wave adaptation and mitigation plans based on the proposed framework for heat action plans and heat wave characteristics for improving urban health well-being under hot weather extremes in different homogeneous temperature zones.

Understanding non-stationarity of hydroclimatic extremes and resilience in Peninsular catchments, India.

Climate change significantly impacts the global hydrological cycle, leading to pronounced shifts in hydroclimatic extremes such as increased duration, occurrence, and intensity. Despite these significant changes, our understanding of hydroclimatic risks and hydrological resilience remains limited, particularly at the catchment scale in peninsular India. This study aims to address this gap by examining hydroclimatic extremes and resilience in 54 peninsular catchments from 1988 to 2011. We initially assess extreme precipitation and discharge indices and estimate design return levels using non-stationary Generalized Extreme Value (GEV) models that use global climate modes (ENSO, IOD, and AMO) as covariates. Further, hydrological resilience is evaluated using a convex model that inputs simulated discharge from the best hydrological model among SVM, RVM, random forest, and a conceptual model (abcd). Our analysis shows that the spatial patterns of mean extreme precipitation indices (R1 and R5) mostly resemble with extreme discharge indices (Q1 and Q5). Additionally, all extreme indices, including R1, Q1, R5, and Q5, demonstrate non-stationary behavior, indicating the substantial influence of global climate modes on extreme precipitation and flooding across the catchments. Our results indicate that the random forest model outperforms the others. Furthermore, we find that 68.52% of the catchments exhibit low to moderate hydrological resilience. Our findings emphasize the importance of understanding hydroclimatic risks and catchment resilience for accurate climate change impact predictions and effective adaptation strategies.

Interactive Learning: Online Audience Response System and Multiple Choice Questions Improve Student Participation in Lectures.

Background and Objective Multiple Choice Questions (MCQs) are commonly used in medical education for formative and summative assessment. However, the use of MCQs as a pedagogical tool in lectures is an area that is yet to be fully explored. This study aimed to gather feedback on including MCQs in lectures using an Online Audience Response System (OARS). Methods This quasi-experimental study involved 114 first professional MBBS students. A lecture with strategically integrated MCQs was delivered in a traditional classroom setting. Students answered the ten MCQs and provided feedback via OARS using their mobile phones. The feedback included eleven questions about student engagement, attentiveness, and critical thinking skills. Students' perception of the advantages and limitations of OARS in lectures was also collected. Data are presented as percentages and median with an interquartile range. Results Higher levels of engagement were reported by 80% of students; 81% felt improvement in understanding of the learning objectives and lecture content; 5% felt that mobile phone usage caused distractions; 79% reported increased focus and concentration; 84% reported that MCQs promoted their critical thinking skills; 75% reported enhanced overall learning experience without causing any discomfort; 69% believed that asking questions individually by the instructor is less effective than MCQs with OARS; 83% felt motivated to come prepared with study material when MCQs were included in the lecture; 67% preferred an even distribution of MCQs throughout the lecture; 53% preferred six to ten MCQs per lecture. Conclusion This study suggests that integrating MCQs in lectures using OARS can be a valuable pedagogical strategy in medical education and can potentially improve the learning experience by enhancing student engagement, attentiveness, and critical thinking skills. However, educators should also be aware of the potential limitations and take steps to mitigate them.

Comparison of NLR (neutrophil/lymphocyte ratio) and PLR (platelet/lymphocyte ratio) as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study.

Background: There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state. Aim: This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1st episode mania. Materials and Methods: Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts. Results: A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania. Conclusion: Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1st episode mania group has a greater level of inflammation in comparison to bipolar mania.

Insights into the perceptual moment theory: Experimental evidence from simultaneity judgment.

The perception appears to flow in a continuous pattern but evidence suggest that perception may involve discrete temporal sampling of peripheral cues. Stroud's perceptual moment theory proposes that perception occurs in discrete moments; however, more experimental evidence is required to support this theory. The present study characterized the decision function for asynchrony detection using variable stimulus-onset asynchronies (SOAs). Fourteen healthy volunteers (twelve males and two females), ages 21.5 ± 3.8 years (mean ± SD) participated in the study. A microcontroller was used to randomly present 280 events of paired stimuli (two red LEDs) with varying SOAs from -65 to 65 ms in steps of 5 ms. Participants were asked to press the "L" or "R" response key based on whether the left or right LED lit up first and to press the "S" key if they could not perceive the order. Asynchrony detection does not exhibit a fixed threshold value; instead, its decision function shows a monotonic increase with increasing SOAs. The asynchrony detection was 50% at an SOA of 27.8 ± 1.7 ms (mean ± SE). The curve plateaued off near 100% at SOA of 57.2 ms, which may correspond to the duration of one perceptual moment for visual perception. Data from a separate group of ten volunteers was used to validate the results. Results indicate that perception is temporally discretized rather than continuous, and the estimated duration of one perceptual moment is around 57.2 ms. This simple experiment gives objective evidence for Stroud's perceptual moment theory.