Black carbon aerosols over Indian Ocean have unique source fingerprint and optical characteristics during monsoon season.

Effects of aerosols such as black carbon (BC) on climate and buildup of the monsoon over the Indian Ocean are insufficiently quantified. Uncertain contributions from various natural and anthropogenic sources impede our understanding. Here, we use observations over 5 y of BC and its isotopes at a remote island observatory in northern Indian Ocean to constrain loadings and sources during little-studied monsoon season. Carbon-14 data show a highly variable yet largely fossil (65 ± 15%) source mixture. Combining carbon-14 with carbon-13 reveals the impact of African savanna burning, which occasionally approach 50% (48 ± 9%) of the total BC loadings. The BC mass-absorption cross-section for this regime is 7.6 ± 2.6 m2/g, with higher values during savanna fire input. Taken together, the combustion sources, longevity, and optical properties of BC aerosols over summertime Indian Ocean are different than the more-studied winter aerosol, with implications for chemical transport and climate model simulations of the Indian monsoon.

Modeling the atmospheric refractive index structure parameter using macrometeorological observations.

The dynamic fluctuations in the atmospheric refractive index, commonly referred to as optical turbulence, cause phase distortions of the electromagnetic waves propagating through the atmosphere. The consequent scintillations have large implications for free-space optical communication, laser remote sensing, and directed energy applications. The refractive index structure parameter (C n2), quantifying the strength of these fluctuations, is usually estimated using high-frequency micrometeorological measurements, employing sonic anemometer-thermometers or scintillometers. Despite providing highly accurate information, these systems are immensely complex and costly, especially for frequent field applications and remote locations. In this study, we have developed an empirical multinomial model for estimating C n2 using three-year macrometeorological data and validated it against collocated and concurrent micrometeorological measurements, from a tropical semi-arid location. This simpler model would be handy for applications in remote locations having weather station measurements alone.

A method for noninvasive beat-by-beat visualization of His bundle signals.

BACKGROUND: Invasive recording of His bundle signals (HBS) in electrophysiological study (EPS) is important in determining HV interval, the time taken to activate the ventricles from the His bundle. Noninvasive surface measurements of HBS are attempted by averaging typically 100-200 cardiac cycles of ECG time series in body surface potential mapping (BSPM) and in magnetocardiography (MCG) which records weak cardiac magnetic fields by highly sensitive detectors. However, noninvasive beat-by-beat extraction of HBS is challenged by ramp-like atrial signals and noise in PR segment of the cardiac cycle. METHODS: By making use of a signal-averaged trace showing prominent HBS as a guide trace, we developed a method combining interval-dependent wavelet thresholding (IDWT) and signal space projection (SSP) technique to eliminate artifacts from single beats. The method was applied on MCG recorded on 21 subjects with known HV intervals based on EPS and noninvasive signal-averaging, including five subjects with BSPM recorded subsequently. The method was also applied on stress-MCG of a subject featuring autonomic dynamics. RESULTS: HBS could be extracted from 19 out of 21 subjects by signal-averaging whose timing differed from EPS between -8 and 11 ms as tested by 2 observers. HBS in single beats were seen as aligned patterns in inter-beat contours and were appreciable in stress-MCG and conspicuous than BSPM. The performance of the method was evaluated on simulated and measured MCG to be adequate if the signal-to-noise ratio was at least 20 dB. CONCLUSIONS: These results suggest the use of this method for noninvasive assessments on HBS.

[Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know]. / Espectro de coinfecciones pulmonares fúngicas oportunistas en COVID-19: lo que el radiólogo debe saber.

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

Enhanced optical pulse broadening in free-space optical links due to the radiative effects of atmospheric aerosols.

Propagation through turbulent media produces complex amplitude fluctuations and temporal spreading of narrow optical pulses. Light-absorbing aerosols present in the atmospheric transmission path will perturb the refractive index structure parameter (Cn2) through atmospheric heating. The consequent enhancement in broadening and attenuation of ultrashort (femtosecond) optical pulses has been calculated by combining multi-satellite observations, radiosonde profiles and computational radiative transfer. It is shown that narrower optical pulses are more vulnerable to aerosol-induced impairments while broader pulses are more resilient, notwithstanding three to four orders of enhanced optical scintillation.

Radiative effects of atmospheric aerosols on the average channel capacity of free-space optical communication systems.

Free-space optical (FSO) communication systems employ unguided light beams propagating through the atmosphere to carry a large volume of data. The reliability of such data transfer can be hampered by various atmospheric effects. Based on an analytical model of a differential phase-shift keying FSO system through exponentiated Weibull turbulence, we investigate the effectiveness of beam width optimization and improved beam alignment, along with aperture averaging on the average channel capacity. Our results show significant signal deterioration produced due to the aerosol-induced optical turbulence, which substantially shadows the performance gain achieved through beam width optimization. Strong aerosol-induced atmospheric heating and the consequent enhanced optical scintillations result in reduction of the channel capacity by as much as 50% of its value when these effects are not considered or negligible. FSO systems are more resilient to aerosol-induced optical turbulence when the normalized beam width is less, and the average channel capacity can be significantly improved by improved beam alignment. These variations are weakly dependent under poor transmitter-receiver alignment conditions. Furthermore, the receiver aperture has a strong control on the link performance. While FSO systems with higher magnitude of normalized beam width have improved performance under all aperture diameter conditions; for a given beam configuration, large aperture diameter ensures a significant improvement in the link performance due to reduction in effects of scintillations.

Entanglement of near-surface optical turbulence to atmospheric boundary layer dynamics and particulate concentration: implications for optical wireless communication systems.

Localized reduction in optical turbulence due to enhanced atmospheric heating caused by the solar absorption of aerosol black carbon (BC) is reported. Immediate response of atmospheric turbulence to BC-induced atmospheric warming strongly depends on the available solar radiation (time of the day), BC concentration, and atmospheric boundary layer dynamics. Besides the significant climate implications of a reduction in turbulence kinetic energy, a large reduction in the refractive index structure parameter (Cn2) resulting from BC-induced warming would affect the atmospheric propagation of laser beams. Interestingly, aerosols contribute significantly (up to 25%) to the signal deterioration in optical wireless communication systems during convectively stable atmospheric conditions when higher signal-to-noise ratios are expected otherwise due to the reduced thermal convection. Competing effects of the fractional contributions of aerosol extinction and scintillations on beam attenuation are reported; daytime being largely dominated by scintillation effects while the nighttime being dependent on the ambient aerosol concentration as well. We put forward the entanglement of optical turbulence to aerosol concentration, atmospheric boundary layer dynamics, and surface-reaching solar radiation, and discuss the possible implications for optical propagation.

Performance of free-space optical communication systems: effect of aerosol-induced lower atmospheric warming.

We report the effect of aerosol-induced local atmospheric heating and the resulting changes in the lower atmospheric optical turbulence on the performance of Free-Space Optical (FSO) communication links. A closed form mathematical expression is derived to estimate the influence of aerosol-induced warming on the Bit Error Rate (BER) of a Binary Phase Shift Keying FSO communication link through Gamma-Gamma modeled turbulence. Our results demonstrate a strong impact, with the aerosol-induced turbulence taking a toll on the signal-to-noise ratio of ~20 dB for a BER of 10-9. Aerosol-induced warming produces significant variations in BER compared to the clear atmospheric conditions and can subdue the benefits of improved beam alignment.

Outcome of pregnancies in women with pulmonary hypertension: a single-centre experience from South India.

OBJECTIVE: To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India. STUDY DESIGN: Retrospective observational study. SETTING: Tertiary centre in south India. POPULATION: Pregnant women with pulmonary hypertension. METHOD: Data regarding demographics, clinical course, medication received, and echocardiographic diagnosis regarding pulmonary hypertension and antenatal care received were collected from the records. Details of labour and delivery, and postpartum follow up were retrieved. We compared the outcome based on the presence or absence of cyanosis and right ventricular systolic pressure levels. MAIN OUTCOME MEASURES: Maternal mortality, occurrence of complications such as heart failure, fetal growth restriction. RESULTS: There were 81 pregnancies in 73 women with pulmonary hypertension. The majority of them had pulmonary hypertension secondary to congenital heart disease (80.8%); 17.8% had Eisenmenger syndrome. An advanced pulmonary artery hypertension (PAH) medication, sildenafil, was administered in 25 (31.3%) pregnancies. There were four maternal deaths, of which three had Eisenmenger syndrome. Heart failure complicated 6.3% and fetal growth restriction 26.3% of pregnancies. Morbidity was significantly increased in women with pulmonary hypertension associated with a cyanotic cardiac lesion or with right ventricular systolic pressure >70 mmHg. CONCLUSION: Despite advances in care, mortality in pregnant women with pulmonary hypertension is a matter of concern, especially in those with Eisenmenger syndrome. Multidisciplinary team management in tertiary centres and the use of advanced PAH medications even in low- to middle-income countries with limited resources, could lead to a reduction in morbidity and mortality related to pulmonary hypertension. TWEETABLE ABSTRACT: Multidisciplinary care and use of new medication may improve outcomes in pregnant women with pulmonary hypertension.

Distinctive roles of elevated absorbing aerosol layers on free-space optical communication systems.

The impact of enhanced local heating due to absorption of solar radiation by elevated layers of aerosol black carbon (BC) in the lower troposphere in the performance of free-space optical (FSO) communication links is investigated. It is seen that a strong elevated BC layer at an altitude around 4.5 km enhances the atmospheric stability locally and leads to a large reduction in the atmospheric refractive index structure parameter (Cn2), leading to improved performance of the FSO communication links. For layers in the tropical atmosphere with sufficiently high BC concentration, the signal attenuation due to BC absorption is alleviated by the large reduction in Cn2 due to BC-induced warming and brings down the link outage probability. Synergy between reduction in Cn2 and long wavelength transmission improves the link budget significantly by reducing the beam wander and number of adaptive optics units required.

Dependence of atmospheric refractive index structure parameter (Cn2) on the residence time and vertical distribution of aerosols.

Effects of absorbing atmospheric aerosols in modulating the tropospheric refractive index structure parameter (Cn2) are estimated using high resolution radiosonde and multi-satellite data along with a radiative transfer model. We report the influence of variations in residence time and vertical distribution of aerosols in modulating Cn2 and why the aerosol induced atmospheric heating needs to be considered while estimating a free space optical communication link budget. The results show that performance of the link is seriously affected if large concentrations of absorbing aerosols reside for a long time in the atmospheric path.

Elevated fibrinogen and lowered homocysteine-vitamin determinants and their association with left atrial thrombus in patients with rheumatic mitral stenosis.

Mitral stenosis (MS) causes stagnation of blood flow, leading to thrombus formation in the left atrium (LA), which may lead to systemic thrombo-embolic complications and stroke. We compared the alterations in echocardiographic and procoagulant parameters in patients with severe rheumatic MS with and without LA thrombus. The study was a cross-sectional study of patients with rheumatic MS, being evaluated for percutaneous mitral commisurotomy. Group 1 patients comprised of patients with rheumatic MS with LA thrombus (n=35) and Group 2 patients had rheumatic MS without LA thrombus (n = 45). Platelet aggregability, fibrinogen, homocysteine, vitamin B12 and folate; mitral valve area (MVA), mean mitral gradient and pulmonary artery pressure (PAP) were assessed in all study subjects. Significant increase in fibrinogen, homocysteine and platelet aggregation and fall in homocysteine-associated determinants were seen in Group 1, as compared with Group 2. Raised fibrinogen, lowered homocysteine-vitamin determinants and lowered mitral valve area were associated independently, with presence of LA thrombus in rheumatic MS. In this study, fibrinogen, vitamin B12 and folate were independently associated with the occurrence of thrombus in patients with rheumatic MS. Hence, our results suggest that increase in procoagulant mechanisms contribute to increased risk of thrombosis in the left atrium in patients with rheumatic MS.

Elevated levels of serum sialic acid and high-sensitivity C-reactive protein: markers of systemic inflammation in patients with chronic heart failure.

Heart failure (HF) is a common, debilitating disorder in which the heart is unable to pump an adequate blood supply to the tissues. Although it has been shown that inflammation occurs in HF, inflammatory markers have yet to be defined. Inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP), cytokines and serum sialic acid (SA) have been suggested as cardiovascular risk biomarkers. This study aims to assess the serum levels of inflammatory markers such as sialic acid and hs-CRP in chronic heart failure (CHF). Forty-eight patients with CHF and 30 healthy controls were recruited. Total sialic acid (TSA) and lipid-associated sialic acid (LASA), and the inflammatory marker hs-CRP, were assayed in all study subjects. N-terminal pro-brain natriuretic peptide (NT-proBNP) was assayed in the patient group only. Serum mean TSA and LASA were significantly higher in CHF patients when compared to healthy controls (P < 0.01). Mean hs-CRP levels in CHF patients showed a significant elevation compared with healthy controls (P < 0.01). There was a significant positive correlation between TSA and hs-CRP. Thus, TSA and hs-CRP would appear to be stable markers of systemic inflammation in chronic heart failure.

Toxicity assays and in silico approach to assess the impacts of chlorine dioxide on survival, respiration and some biochemical markers of marine zooplankton.

Chlorination is the common antifouling method in desalination and power plant water intake structures to control microbial and macrofouling growth. In this study, the impacts of chlorine dioxide on toxicity, metabolic activity and biochemical markers like glutathione S-transferase and catalase enzyme activity were tested using four zooplankton species (Centropages sp., Acartia sp., Oncaea sp., and Calanus sp.) collected from the Red Sea. The zooplankton species were treated with different concentrations (0.02, 0.05, 0.1, 0.2, and 0.5 mg L-1) of chlorine dioxide. Further, chlorite, the main decomposition product of chlorine dioxide, was used for molecular docking studies against glutathione S-transferase and catalase enzymes. The results indicated the LC50 range of 0.552-1.643 mg L-1 for the studied zooplankton species. The respiration rate of the zooplankton increased due to the chlorine dioxide treatment with a maximum of 0.562 µg O2 copepod h-1 in Acartia. The glutathione S-transferase and catalase enzyme activities showed elevated values in zooplankton treated with chlorine dioxide. Molecular docking of chlorite with enzymes involved in antioxidant defense activity, such as glutathione S-transferase and catalase enzyme showed weak interactions. Overall, this study yielded significant insights for understanding the effects of chlorine dioxide on the survival, metabolism, and biochemical composition of marine zooplankton.

Surgical outcomes of common arterial trunk repair beyond infancy.

Background: The aim of this study is to analyze the clinical outcomes of common arterial trunk repair beyond infancy in terms of both early- and long-term outcomes. Methods: Between January 2003 and December 2019, 56 patients underwent repair for common arterial trunk beyond infancy at our institute. Median age was 34.5 months, 51.8% were females, and 48.2% were males. Results: 48.2% were type 1, 46.4% were type 2, and 5.4% were type 3. 17.9% patients underwent direct connection technique for right ventricular outflow tract reconstruction; remaining received a conduit. The most common type of truncal valve anatomy was tricuspid (82.1%). Early mortality was 7%. Univariable analysis identified age (p = 0.003), weight (p = 0.04), duration of ventilation (p = 0.036), and pulmonary hypertensive crisis (p ≤ 0.001) as factors affecting early mortality. In our overall cohort of beyond infancy repair for common arterial trunk, at 10 years, the survival, freedom from reintervention for right ventricular outflow tract reconstruction, freedom from ≥ moderate conduit obstruction, freedom from impaired right ventricle function, and freedom from ≥ moderate truncal valve regurgitation were 76.7%, 89.7%, 74%, 88.6%, and 66.3%, respectively. Conclusion: Repair for common arterial trunk in patients presenting beyond 1 year of age is challenging; however, it can be done with satisfactory early and late outcomes in terms of mortality and reintervention.

Roles of water-soluble aerosol coatings for the enhanced radiative absorption of black carbon over south asia and the northern indian ocean.

Black Carbon (BC), formed by incomplete combustion, absorbs solar radiation and heats the atmosphere. We investigated the enhancement in optical absorption of BC due to coatings of water-soluble (WS) species in the polluted South Asian atmosphere. The BC Mass Absorption Cross-section (MAC; 678 nm) was estimated before and after removal of the WS components. Wintertime samples were collected from three South Asian receptor observatories intercepting large-footprint outflow: Bangladesh Climate Observatory Bhola (BCOB; integrating outflow of the Indo-Gangetic Plain), Maldives Climate Observatories at Hanimaadhoo (MCOH) and at Gan (MCOG), both reflecting outflow from the South Asian region. The ambient MAC observed at BCOB, MCOH and MCOG were 4.2 ± 1.4, 7.9 ± 1.9 and 7.1 ± 1.5 m2 g-1, respectively. The average enhancement of the BC MAC due to WS coatings (i.e., ws-EMAC) was identical at all three sites (1.6 ± 0.5) indicating that the anthropogenic aerosols had already evolved to a fully coated morphology at BCOB and/or that subsequent aging involved two compensating evolution processes of the coating. Inspecting the key coating component sulfate; the sulfate-to-BC ratio increased threefold when transitioning from BCOB to MCOH and by about 1.5 times from BCOB to MCOG. Conversely, both WS organic carbon (WSOC)/BC and water-insoluble OC (WIOC)/BC ratios declined with distance: WSOC/BC diminished by 84 % from BCOB to MCOH and by 80 % from BCOB to MCOG, while WIOC/BC dropped by about 63 % and 59 %, respectively. Such declines in WSOC and WIOC reflect a combination of photochemical oxidation and more efficient washout of OC compared to BC. The observed changes in the SO42-/BC and WSOC/BC ratios across South Asia highlight the significant impact of aerosol composition on the optical properties of Black Carbon (BC). These findings emphasize the need for detailed studies on aerosol composition to improve climate models and develop effective strategies for reducing the impact of anthropogenic aerosols on the climate.

Genetic polymorphisms of CYP2C19 influences the response to clopidogrel in ischemic heart disease patients in the South Indian Tamilian population.

BACKGROUND: The antiplatelet activity of clopidogrel is variable among patients suffering from ischemic heart disease. Variation in the cytochrome P450 2C19 (CYP2C19) gene coding for the CYP2C19 enzyme is one of the major determinants of this variable response to clopidogrel. The activity of the CYP2C19 enzyme, which plays a role in the conversion of the prodrug clopidogrel to its active metabolite, is genetically influenced by polymorphisms in its gene. The aim of our study was to evaluate the association of CYP2C19 polymorphisms and the antiplatelet effect of clopidogrel in the South Indian Tamilian population. MATERIALS AND METHODS: Genotyping and platelet aggregation results of 149 ischemic heart disease patients on clopidogrel maintenance therapy (75 mg daily dose) were analyzed in this study. CYP2C19 polymorphisms were genotyped by the PCR-restriction fragment length polymorphism method. We measured residual platelet activities in these patients on clopidogrel therapy in terms of impedance (expressed as ohms). The study subjects were divided into two metabolizer phenotype groups [group 1: poor/intermediate metabolizers (PM/IM); group 2: extensive/ultra-rapid metabolizers (EM/URM)] based on CYP2C19 genotype, and the residual platelet activities were compared. Higher values of impedance denote increased residual platelet activity. RESULTS: Poor/intermediate metabolizers had significantly higher impedance values than EM/URM [(median; range) 4.0; 0-13 vs. 2.0; 0-11, respectively; p = 0.04]. These higher impedance values denote higher residual platelet activities among the carriers of loss-of-function alleles (CYP2C19*2,*3) than among non-carriers. However, residual platelet activities were lower among the carriers of the gain-of-function allele (CYP2C19*17) than among non-carriers, although this difference was not significant. CONCLUSION: Patients with CYP2C19 (*2 or *3) genetic polymorphisms had higher residual platelet activities and were associated with a reduced antiplatelet response to clopidogrel. As the South Indian Tamilian population is characterized with higher frequencies of these genetic polymorphisms, our findings mandate further studies aimed at initiating genome-based personalized antiplatelet therapy.

Aerosol demasking enhances climate warming over South Asia.

Anthropogenic aerosols mask the climate warming caused by greenhouse gases (GHGs). In the absence of observational constraints, large uncertainties plague the estimates of this masking effect. Here we used the abrupt reduction in anthropogenic emissions observed during the COVID-19 societal slow-down to characterize the aerosol masking effect over South Asia. During this period, the aerosol loading decreased substantially and our observations reveal that the magnitude of this aerosol demasking corresponds to nearly three-fourths of the CO2-induced radiative forcing over South Asia. Concurrent measurements over the northern Indian Ocean unveiled a ~7% increase in the earth's surface-reaching solar radiation (surface brightening). Aerosol-induced atmospheric solar heating decreased by ~0.4 K d-1. Our results reveal that under clear sky conditions, anthropogenic emissions over South Asia lead to nearly 1.4 W m-2 heating at the top of the atmosphere during the period March-May. A complete phase-out of today's fossil fuel combustion to zero-emission renewables would result in rapid aerosol demasking, while the GHGs linger on.

Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know.

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

Ensemble Deep Learning and Internet of Things-Based Automated COVID-19 Diagnosis Framework.

Coronavirus disease (COVID-19) is a viral infection caused by SARS-CoV-2. The modalities such as computed tomography (CT) have been successfully utilized for the early stage diagnosis of COVID-19 infected patients. Recently, many researchers have utilized deep learning models for the automated screening of COVID-19 suspected cases. An ensemble deep learning and Internet of Things (IoT) based framework is proposed for screening of COVID-19 suspected cases. Three well-known pretrained deep learning models are ensembled. The medical IoT devices are utilized to collect the CT scans, and automated diagnoses are performed on IoT servers. The proposed framework is compared with thirteen competitive models over a four-class dataset. Experimental results reveal that the proposed ensembled deep learning model yielded 98.98% accuracy. Moreover, the model outperforms all competitive models in terms of other performance metrics achieving 98.56% precision, 98.58% recall, 98.75% F-score, and 98.57% AUC. Therefore, the proposed framework can improve the acceleration of COVID-19 diagnosis.