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Introduction: Orthopaedic surgeons are among the most frequent users of radiation and are often exposed to X-Ray radiation regularly. There is an overall unsatisfactory level of knowledge, attitude, and practices regarding the same among surgeons. This study aimed to assess the practices among orthopaedic surgeons regarding radiation and its hazards in India. Methodology: This questionnaire-based survey was conducted between March and September 2022. The questionnaire broadly assessed the knowledge, awareness, and practices among orthopaedic surgeons regularly exposed to X-ray radiation. The questionnaire consisted of objective and Likert scale questions which were distributed to the respondents electronically using publicly available contact information. A qualitative review of interpretations obtained from the responses and available evidence in the literature was then performed. Results: The response rate for the survey was 36.4%. 65.9% reported using trunk protection all the time during procedures. 57.1% of respondents reported not using thyroid protection during procedures. 92.3% reported not using protective goggles and 100% did not use appropriate gloves. 76.9% were not issued dosimeters, and only 5.5% of those who had been issued one wore it during radiation procedures. 58.2% reported having a dedicated employee to operate the machine. 86.8% of respondents did not have formal training and 81.3% were not aware of institutes offering formal training. Conclusion: There is very high compliance with the use of protection aprons among the respondents however, the use of other apparel like thyroid shields, protection goggles and gloves was poor. The awareness regarding radiation exposure was also poor as most respondents were not issued dosimeters, however, those issued with one were well aware of their exposure. It is imperative to prioritize both surgeons' and patients' safety where radiation exposure is concerned. [ABSTRACT FROM AUTHOR]

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more costeffective manner. [ABSTRACT FROM AUTHOR]

X-class solar flares, which occurred in the daytime from 2008 to 2016 during solar cycle 24, were studied for their influence on the lower ionosphere over the lowequatorial Indian region. To understand the D-region behaviour during flare events, we used the very low frequency (VLF) navigational transmitter NWC (19.8 kHz) signal recorded at Pryagraj, Uttar Pradesh, India. A total of seven parameters were estimated: (i) the magnitude of X-ray flux, (ii) VLF signal rising amplitude perturbation (SRAP), (iii) X-ray flux and NWC signal start time difference (STD), (iv) peak time difference (PTD), (v) Wait’s ionospheric parameters h′ (reference height), (vi) β (sharpness factor) and (vii) D-region electron density difference (EDD) to determine the overall effect of solar flares on the D-region. The results suggest that three parameters (X-ray flux, SRAP and h′) show a decreasing trend through the linear fit line, two parameters (β and EDD) show an increasing trend, while the remaining two parameters show a mixed trend (decrease during low activity and increase during high activity). Further, the trend line during the diurnal variation shows an increasing trend for X-ray flux, PTD and h′, and a decreasing trend for SRAP, STD, β and EDD. Deviation in the case of individual events may indicate the dependence of these parameters on the seasons as well. The present study will provide the base for more robust analysis and modelling work in the future to understand the complexity of ionospheric change during flare events, and to develop a predictive model for space weather mitigation. [ABSTRACT FROM AUTHOR]

Introduction: The Posterior Tibial Slope (PTS) is an angle formed by the tibial plateau and supports the biomechanics of the knee joint. This slope is found to be a factor in differentiating ACL tear injuries. Earlier studies have shown the association of PTS with Anterior Cruciate Ligament (ACL) tears but have not evaluated the PTS values for different gradings. Aim: To evaluate the PTS on X-ray and Magnetic Resonance Imaging (MRI), for patients with different grades of ACL tears, and patients identified with meniscal tears. Materials and Methods: This cross-sectional study was conducted from April 2020 to March 2021 at the Department of Radiodiagnosis and Imaging, KS Hegde hospital, Mangaluru, Karnataka, India. A total of 30 patients were studied, in which 20 patients with ACL tears underwent both X-ray and MRI, while the 10 patients with meniscal tears were only subjected to MRI. The PTS was evaluated for different grades of ACL tears on X-ray and MRI by an experienced Radiologist. The number of patients with grade I, grade II, and grade III ACL tears were 7, 6 and 7, respectively. Paired t-test was used to evaluate the mean PTS for the identified grade of the ACL tear. One-way Analysis of Variance (ANOVA) and Bonferroni post hoc test was used to analyse the difference between grades of the ACL tear. Results: The mean age of the study population was 32.50±16.363 years, and the male-to-female ratio was 4:1. Both right, as well as the left knee, were included in the study, and the left-to-right knee ratio was 3:2. There was a significant difference in PTS between Grades of ACL tears (p-value-0.001). The PTS was observed to increase as the severity of the ACL injury increased. The mean PTS value obtained on x-ray for grade I, grade II, and grade III ACL tears were 10.85±0.54, 14.18±0.62, and 16.46±1.56, respectively. While the mean PTS value obtained on MRI for grade I, grade II, and grade III ACL tears were 10.85±0.53, 14.19±0.60, and 16.47±1.55, respectively. There was no significant difference in the PTS measured for ACL tears between the X-ray and MRI (p-value>0.05). Further, the results did not show any difference of significance in the PTS measured on MRI between ACL tears and meniscal tears (p-value>0.05). Conclusion: The PTS can be used as an aid in the identification of the severity of the ACL injury. The PTS could also be used as a tool to recognise the presence of ACL tears on X-ray and this could be an important prognostic factor towards the functional outcome. [ABSTRACT FROM AUTHOR]

X-rays are the primary tools in examining the suspected fractures in humans in this era. Manual examination of X rays is a time-consuming process, which requires expert radiologists or trained orthopaedic surgeons. The demanding workloads, unavailability of radiologists in small setups and at primary/community health centres results in the inability to diagnose and delay in the treatment due to unnecessary referrals by the primary care clinicians. Moreover, the shortage of expert radiologists and orthopaedic surgeons in medically under-resourced areas such as rural areas in India have motivated us to develop an automated fracture detection model. We have developed a deep neural network to detect, localize and divide the wrist region into segments to identify fractures around wrist joint in radiographs. The orthopaedic surgeon has manually annotated the fractures by drawing a bounding box and segmented mask. We have utilized two different domains of datasets for the better convergence of the model. There is a similarity in the crack patterns of the surface crack image dataset and the wrist fracture dataset, which consists of 3000 and 315 images. A part of the dataset is made publicly available for research purposes to overcome data collection and labelling barriers for identifying wrist fractures. The crack patterns in the wrist bone samples are learned by effectively transferring the knowledge or weights obtained from surface crack datasets. The proposed architecture utilizes Feature Pyramid Network as the backbone architecture where the last-level max pool layer of the architecture is replaced with the concatenation of AdaptiveConcatPool, AdaptiveAvgPool, AdaptiveMaxPool layers. Additionally, the concept of freezing and unfreezing the network during two phases of transfer learning is utilized for better model convergence. Every radiograph is assigned a ground truth label for evaluating the accuracy of the model. The performance measure for fracture detection and localization is evaluated using the Average precision value using the concept of Intersection over Union. The result of the proposed model is compared against the ground truth label annotated by the radiologists and related studies. The average precision of 92.278 on 50° and 79.003 on a strict scale of 75° was reported for fracture detection. Similarly, the average precision of 77.445 on 50° and 52.156 on a strict scale of 75° was reported for fracture segmentation. [ABSTRACT FROM AUTHOR]

Background: In India, raw peanuts are obtained by aggregators from smallholder farms in the form of whole pods and the price is based on a manual estimation of basic peanut pod and kernel characteristics. These methods of raw produce evaluation are slow and can result in procurement irregularities. The procurement delays combined with the lack of storage facilities lead to fungal contaminations and pose a serious threat to food safety in many regions. To address this gap, we investigated whether X-ray technology could be used for the rapid assessment of the key peanut qualities that are important for price estimation. Results: We generated 1752 individual peanut pod 2D X-ray projections using a computed tomography (CT) system (CTportable160.90). Out of these projections we predicted the kernel weight and shell weight, which are important indicators of the produce price. Two methods for the feature prediction were tested: (i) X-ray image transformation (XRT) and (ii) a trained convolutional neural network (CNN). The prediction power of these methods was tested against the gravimetric measurements of kernel weight and shell weight in diverse peanut pod varieties1. Both methods predicted the kernel mass with R2 > 0.93 (XRT: R2 = 0.93 and mean error estimate (MAE) = 0.17, CNN: R2 = 0.95 and MAE = 0.14). While the shell weight was predicted more accurately by CNN (R2 = 0.91, MAE = 0.09) compared to XRT (R2 = 0.78; MAE = 0.08). Conclusion: Our study demonstrated that the X-ray based system is a relevant technology option for the estimation of key peanut produce indicators (Figure 1). The obtained results justify further research to adapt the existing X-ray system for the rapid, accurate and objective peanut procurement process. Fast and accurate estimates of produce value are a necessary pre-requisite to avoid post-harvest losses due to fungal contamination and, at the same time, allow the fair payment to farmers. Additionally, the same technology could also assist crop improvement programs in selecting and developing peanut cultivars with enhanced economic value in a high-throughput manner by skipping the shelling of the pods completely. This study demonstrated the technical feasibility of the approach and is a first step to realize a technology-driven peanut production system transformation of the future. [ABSTRACT FROM AUTHOR]

Background: Drug resistant tuberculosis is a major public health threat that hinders progress in tuberculosis control worldwide. In 2019, India contributed highest cases of TB (27%) Worldwide. In 2019, 3.3% of new TB cases and 18% of previously treated cases had MDR/RRTB worldwide and India (27%) had the largest share of the global burden. This study was done to find out the sociodemographic and clinical profile of drug resistant TB patients. Methodology: It is an observational descriptive study with cross-sectional design, conducted at the drug resistant tuberculosis centre of R. G. Kar Medical College of Kolkata, West Bengal. Study Population consisted of the patients who were registered for the DR-TB regimen. Study duration was July 2016-March 2017. Pre-tested, semi-structured schedule was designed to capture their sociodemographic profile, treatment history, clinical findings and available medical records. Data were compiled in MS Excel and analyzed in IBM SPSS 23.0. Results: Out of 159 cases, 27% patients were between 21-30 years. Males were predominant (68.6%). Most patients (56.6%) were underweight (BMI<18.5kg/m2). HIV seropositivity was found in 4 (2.5%) cases. Among all cases, 81.1% had history of taking ATD and 34.4% was cured in previous episode of treatment. The commonest associated comorbidity was DM (15.7%). Rifampicin resistance (93.1%) was most common followed by Isoniazid (8.2%). Pallor was found among 94.3% patients. Most patients had bilateral (62.3%) and moderately extensive (57.2%) lesions in chest x-ray. Conclusion: DR-TB control should focus adequately on younger age group as numbers of resistance is increasing among them. Relapse in previously cured cases was found to be major contributor of DR-TB suspect cases. Though, Rifampicin resistance was so common but prevalence of resistance to 2nd line drugs is still low. Focus should be given on early detection of drug resistance in all TB cases and improvement of nutritional status of the TB patient. [ABSTRACT FROM AUTHOR]

The Mα and Mβ X-ray fluorescence cross sections, IMα/IMβ intensity ratio, M5 subshell fluorescence yield and M5 subshell Auger yield for gold, lead and bismuth elements were determined using Indus-2 synchrotron radiation available at the Raja Ramanna Center for Advanced Technology, India. A 7 keV synchrotron radiation was used to generate the characteristic M X-ray photons in gold, lead and bismuth and consequent X-ray photons were detected with Amptek silicon drift detector which has energy resolution of 129 eV at 5.9 keV. By measuring the area under Mα and Mβ X-ray peaks, Mα and Mβ X-ray fluorescence cross sections, IMα/IMβ intensity ratio, M5 subshell fluorescence yield and M5 subshell Auger yield were determined for gold, lead and bismuth. Experimentally determined values were compared with the theoretical and other experimental values available in the literature. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer in urban and second common in rural Indian women. In India, in spite of the best treatment available being given to the patients they lose their lives because of paucity of diagnostic aids and lack of an organized breast cancer screening program. Early detection, accurate staging, and initiation of appropriate therapy are the key factors for improving the treatment outcome and prognosis of the disease for the patients. Traditional staging methods include clinical examination, blood tests, chest X-ray, ultrasound of the abdomen, and/or skeletal survey. As these tests lack sensitivity and specificity, these are being scaled down. The hybrid positron emission tomography-computerized tomography (PET-CT) is a unique tool in the field of imaging modalities that combines the effectiveness of PET and CT. This study was undertaken to assess the efficacy and accuracy of PET-CT as a single-session staging modality in the very initial stage itself and if it can replace the conventional means of staging. Methods: This was a cross-sectional study conducted in the Radiotherapy department at GGS Medical College and Hospital Faridkot from March 2014 to October 2015. 52 patients with newly diagnosed and histopathologically proven carcinoma breast were staged by conventional modalities (clinical examination, blood tests, X-ray chest, mammography, ultrasonography abdomen, skeletal survey) and by 18F-fluorodeoxyglucose (18F FDG) PET/CT. PET-CT images were used for the detection, localization, staging of tumors and detection, evaluation, and diagnosis of metastatic lesions, disease burden and organ function along with treatment planning and planning therapeutic procedures. Following the completion of initial study, the results of 18F FDG PET-CT staging in comparison with conventional staging method were assessed. Along with this, the accuracy, changes in staging of cases of carcinoma breast and cost-effectiveness of 18F-FDG PET-CT were also studied. Results: All the pathologic entities identified by conventional imaging were also perceived with 18F-FDG PET/CT. Therefore, we recommend the use of PET/CT as an important imaging modality for initial diagnosis of carcinoma breast. [ABSTRACT FROM AUTHOR]

Euphorbia species are known for their diversity of terpenoid constituents. Euphorbia vajravelui is an endemic plant species distributed in the southern Western Ghats of India. Though conventional spectroscopic techniques are common in structure elucidation of secondary metabolites from plants, X-ray crystal structure analysis of a compound offers valuable information with minimum sample requirement. The present study reports the characterization of a new triterpene, 3,23-cycloglutin-5(10)-ene isolated from E. vajravelui, using single-crystal X-ray diffraction studies. Triclinic crystalline system was obtained for the compound, having P1 space group with unit cell parameters; a = 6.2907(8) Å, b = 7.4458(10) Å, c = 14.5802(18) Å, α = 94.899(6)°, β = 95.365(6)°, γ = 114.392(6)β, V = 613.43(14) ų and Z = 1. The triterpene has a glutinane skeletal structure containing a cyclopropane ring with a methyl group. [ABSTRACT FROM AUTHOR]

Dimethylformamidase (DMFase) catalyzes the hydrolysis of dimethylformamide, an industrial solvent, introduced into the environment by humans. Recently, we determined the structures of dimethylformamidase by electron cryo microscopy and X-ray crystallography revealing a tetrameric enzyme with a mononuclear iron at the active site. DMFase from Paracoccus sp. isolated from a waste water treatment plant around the city of Kanpur in India shows maximal activity at 54 °C and is halotolerant. The structures determined by both techniques are mostly identical and the largest difference is in a loop near the active site. This loop could play a role in co-operativity between the monomers. A number of non-protein densities are observed in the EM map, which are modelled as water molecules. Comparison of the structures determined by the two methods reveals conserved water molecules that could play a structural role. The higher stability, unusual active site and negligible activity at low temperature makes this a very good model to study enzyme mechanism by cryoEM. [ABSTRACT FROM AUTHOR]

Background: Changing trends of privatization and globalization of health care compel the hospitals to practice cost accounting for providing accurate information about the cost of patient care. Objectives: The objectives were to determine unit cost and to identify major cost areas of outpatient department (OPD) services provided by the community health center (CHC) of Bankura district, West Bengal. Materials and Methods: A cross-sectional study was conducted at Amarkanan CHC in 2016. Work sampling (WS) and time motion (TM) study were conducted for assessing the workforce cost, otherwise complete enumeration was done to assess the cost of different service areas such as medicine, logistic, maintenance, transport, electricity, building, equipment, and furniture. A predesigned pro forma and a questionnaire were used for WS and TM study and for interviewing the key informants for collection of information pertaining to different costs. Unit cost of different services as well as overall unit cost was estimated. Results: If a patient received injection, undergone dressing, and had electrocardiogram and X-ray both done in a day, then the total cost of OPD services for workforce was Rs. 85.33/. Cost of logistics per patient per day was maximum in X-ray room. Manpower exerted the maximum cost incurred by the government to conduct OPD in Amarkanan CHC. Overall, the unit cost in OPD incurred by the government was Rs. 44.53/-. Conclusion: Close monitoring is required by aligning the staffing pattern and patient activities and having adequate number of staff with right skill at right place and time for efficiency, productivity, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

The L1, L2 and L3 subshells of Hf, Ta and Re atoms have been excited selectively by using microprobe XRF beam line, Indus‐2, RRCAT, India. The consequent characteristic L X‐ray photons, emitted from the targets due to creations of vacancies in L subshells, are measured using silicon drift detector (X‐123) spectrometer. As the energy of synchrotron radiation increases, the contribution of characteristic L X‐ray intensity increases. The advantage of the increase in the intensity of the characteristic L X‐ray photons with an increase in the energy of synchrotron radiation has been used to determine the L subshell fluorescence yield ratios of Hf, Ta and Re atoms by adopting the selective excitation method. The measured ratios of L subshell fluorescence yield have been compared with theoretical and other experimental values. [ABSTRACT FROM AUTHOR]

The Solar X-ray Monitor (abbreviated as XSM) on board India's Chandrayaan-2 mission is designed to carry out broadband spectroscopy of the Sun from lunar orbit. It observes the Sun as a star and measures the spectrum every second in the soft X-ray band of 1 – 15 keV with an energy resolution better than 180 eV at 5.9 keV. The primary objective of the XSM is to provide the incident solar spectrum for the X-ray fluorescence spectroscopy experiment on the Chandrayaan-2 orbiter, which aims to generate elemental abundance maps of the lunar surface. However, observations with the XSM can independently be used to study the Sun as well. The Chandrayaan-2 mission was launched on 22 July 2019, and the XSM began nominal operations, in lunar orbit, from September 2019. The in-flight observations, so far, have shown that its spectral performance has been identical to that on the ground. Measurements of the effective area from ground calibration were found to require some refinement, which has been carried out using solar observations at different incident angles. It also has been shown that the XSM is sensitive enough to detect solar activity well below A class. This makes the investigations of microflares and the quiet solar corona feasible in addition to the study of the evolution of physical parameters during intense flares. This article presents the in-flight performance and calibration of the XSM instrument and discusses some specific science cases that can be addressed using observations with the XSM. [ABSTRACT FROM AUTHOR]

Introduction: Best radiography practice involves operational optimal machine performance, delivering costeffective healthcare services under appropriate safety conditions for workers and the public. The present study aimed to investigate the safety status of diagnostic X-ray installations in Mizoram, India. Material and Methods: Linearity of time (sec), linearity of current (mA), output reproducibility, table dose (μGy/mAs), peak voltage (kVp) accuracy, and 16 essential safety parameters of 135 X-ray machines were considered in this study. A battery-operated dosimeter and wide-range digital kVp meter were used to measure output radiation and effective peak potential of X-ray tube. Data analysis was performed using SPSS software to obtain the mean, standard deviation, and coefficient of variation. Results: Among different electronic parameters, 59.2% linearity of time, 82.6% linearity of current, 89.7% kVp accuracy, 35.1% output reproducibility, and 92.8% table dose were beyond the acceptable limits. Based on 16 essential safety parameters, it was observed that 98.7% of X-ray machines did not receive proper quality assurance test, 1.9% of the installations employed lead-line patient entrance doors, 46.8% of the machines were operated without any protective barriers and 83.1% of the units were operated without personnel monitoring service. Conclusion: The present study had concluded with more problems than the previous studies in different parts of the world in this regard. Due to the absence of proper quality control (QC) programs, many installations did not follow standard installation guidelines. The authors recommended that proper QC should be implemented by the frequent monitoring of each and every diagnostic X-ray installation. [ABSTRACT FROM AUTHOR]

Introduction: In early stage of disease of Corona Virus Disease 2019 (COVID-19) infection chest Computed Tomography (CT) imaging is considered as the most effective method for detecting lung abnormalities. A Brixia Chest X-ray (CXR) scoring system which uses an 18-point severity scale to grade lung abnormalities due to COVID-19 was developed to improve the risk stratification for infected patients. Aim: To ascertain the validity of Brixia scoring system and to measure the outcome in COVID-19 patients. Materials and Methods: A retrospective study was conducted from 1st April 2020 to 31st July 2020, at a tertiary care hospital in India. Baseline CXR of COVID-19 patients were scored based on Brixia scoring system. The lungs were divided into six equal zones. Subsequently, scores (from 0 to 3) were assigned to each zone, based on lung abnormalities. A group comparison was implemented using Chi-Square test for categorical variables. Whereas an independent t-test was applied for continuous variables that followed normal distribution. Results: The study included 130 patients. The mean age was 57.09±13.73 years, 70.8% patients included were males. Out of 130 patients, 79 patients died. Among patients who died the mean CXR score was calculated to be 12.13±2.50. The mean CXR score was calculated to be 11.18±2.30 in patients who recovered and got discharged. During the process of comparison of CXR scores with the outcomes, the t-value came out to be 2.20 and the resulting p-value was 0.03 (statistically significant). Conclusion: Brixia score more than 12 was associated with increased mortality due to COVID-19, with p-value of 0.03. [ABSTRACT FROM AUTHOR]

Background: India has the highest burden of tuberculosis (TB). Although most patients with TB in India seek care from the private sector, there is limited evidence on quality of TB care or its correlates. Following our validation study on the standardized patient (SP) method for TB, we utilized SPs to examine quality of adult TB care among health providers with different qualifications in 2 Indian cities.Methods and Findings: During 2014-2017, pilot programs engaged the private health sector to improve TB management in Mumbai and Patna. Nested within these projects, to obtain representative, baseline measures of quality of TB care at the city level, we recruited 24 adults to be SPs. They were trained to portray 4 TB "case scenarios" representing various stages of disease and diagnostic progression. Between November 2014 and August 2015, the SPs visited representatively sampled private providers stratified by qualification: (1) allopathic providers with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees or higher and (2) non-MBBS providers with alternative medicine, minimal, or no qualifications. Our main outcome was case-specific correct management benchmarked against the Standards for TB Care in India (STCI). Using ANOVA, we assessed variation in correct management and quality outcomes across (a) cities, (b) qualifications, and (c) case scenarios. Additionally, 2 micro-experiments identified sources of variation: first, quality in the presence of diagnostic test results certainty and second, provider consistency for different patients presenting the same case. A total of 2,652 SP-provider interactions across 1,203 health facilities were analyzed. Based on our sampling strategy and after removing 50 micro-experiment interactions, 2,602 interactions were weighted for city-representative interpretation. After weighting, the 473 Patna providers receiving SPs represent 3,179 eligible providers in Patna; in Mumbai, the 730 providers represent 7,115 eligible providers. Correct management was observed in 959 out of 2,602 interactions (37%; 35% weighted; 95% CI 32%-37%), primarily from referrals and ordering chest X-rays (CXRs). Unnecessary medicines were given to nearly all SPs, and antibiotic use was common. Anti-TB drugs were prescribed in 118 interactions (4.5%; 5% weighted), of which 45 were given in the case in which such treatment is considered correct management. MBBS and more qualified providers had higher odds of correctly managing cases than non-MBBS providers (odds ratio [OR] 2.80; 95% CI 2.05-3.82; p < 0.0001). Mumbai non-MBBS providers had higher odds of correct management than non-MBBS in Patna (OR 1.79; 95% CI 1.06-3.03), and MBBS providers' quality of care did not vary between cities (OR 1.15; 95% CI 0.79-1.68; p = 0.4642). In the micro-experiments, improving diagnostic certainty had a positive effect on correct management but not across all quality dimensions. Also, providers delivered idiosyncratically consistent care, repeating all observed actions, including mistakes, approximately 75% of the time. The SP method has limitations: it cannot account for patient mix or care-management practices reflecting more than one patient-provider interaction.Conclusions: Quality of TB care is suboptimal and variable in urban India's private health sector. Addressing this is critical for India's plans to end TB by 2025. For the first time, we have rich measures on representative levels of care quality from 2 cities, which can inform private-sector TB interventions and quality-improvement efforts. [ABSTRACT FROM AUTHOR]

As per latest Global TB Report (2018), an estimated 2.2 lakh children get tuberculosis (TB) each year in India and illness constitutes a very high global burden. Here we report an unusual case of a child aged 14 years (female), who presented to Emergency with complaints of cough and restlessness for the past 1 day. Working diagnosis of septic shock was kept and child was started on intravenous ionotropes, vasopressors, and an antibiotic. There was no significant history suggestive of TB. Patient was shifted to PICU and managed for shock accordingly. X-ray lung showed single right-sided cavitatory lesion. Bronchoalveolar lavage was positive for acid fast bacilli, confirming the diagnosis of pulmonary TB. The patient was started on antitubercular drug regimen (ATT) for 6 months and showed significant improvement with complete resolution. Literature was searched for association of septic shock in tubercular patients as a presenting complaint, which is a rare entity. [ABSTRACT FROM AUTHOR]

Purpose: To review the role of high resolution chest computed tomography (HRCT) in ocular sarcoidosis in a high TB endemic population.Methods: This was a retrospective study.Results: Out of 140 cases, 54 had ocular sarcoidosis, while 86 cases had ocular tuberculosis. Abnormal HRCT findings was noted in 52 cases (96.3%) of ocular sarcoidosis compared with 55 cases (64.7%) of ocular tuberculosis (p = 0.001). Mediastinal lymphadenopathy was the most common finding in both groups (p = 0.544). Hilar lymphadenopathy and fissural nodules were significantly seen in ocular sarcoidosis (p = 0.001). Necrosis was seen in three cases of ocular sarcoidosis. In nearly half of the cases, it was not possible to differentiate between sarcoidosis and tuberculosis on HRCT.Conclusions: HRCT is a useful diagnostic tool in ocular sarcoidosis. Bilateral hilar lymphadenopathy and fissural nodules are significant findings in ocular sarcoidosis. A confident diagnosis of ocular sarcoidosis is made by the amalgamation of results of clinical, radiologic, and other laboratory investigations. [ABSTRACT FROM AUTHOR]

Nearly half of the smear negative pulmonary TB in National TB Programme remain undetected in Haryana (north Indian state), probably due to poor access to chest radiography. A corporate hospital stepped into fill this infrastructure gap in Rewari district of Haryana by sending a mobile van with digital x-ray facilities and paramedic staff. The staff of the public health facility coordinated with the eligible patients and ensured that they visited on the designated day. The District TB Officer interpreted the x-ray and made decisions about diagnosis and treatment. The support was provided between May and Dec 2014 in seven public health centres (primary/secondary level) of the district. A total of 355 patie-nts were examined, of whom 122 (34.4%) were diagnosed as smear negative pulmonary TB and started on treatment according to programme guidelines. This public-private partnership needs to be scaled-up and better designed studies are required to assess community-level impact and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and radiological pattern in pulmonary and skeletal system of HIV infected children. Subjects and methods: Serologically positive 62 children between the age group of 18 months to 12 years were studied from October 2010 to March 2012 (1 1/2 years period) admitted to pediatric ward SNMC, Bagalkot. All children were taken chest x ray and knee radiographs irrespective of symptoms at the time of first presentation. A single radiologist experienced in the field analyzed the radiographs. Results: Number of HIV seropositive children admitted during study period was 62. Of the 62 children, 29 children had abnormal chest x-ray and 30 had abnormal knee x-ray. Among the abnormal chest x-ray, bronchopneumonia (41.38%) was most common followed by Pneumocystis Carinii Pneumonia (17.24%), and osteopenia (33.33%), osteoporosis (23.33%) and scurvy (36.67%) were more common findings on knee x-ray. Conclusion: Routine chest and knee x-ray, will help in early diagnosis and timely treatment and help in increase in life expectancy of these children and micronutrient correction. [ABSTRACT FROM AUTHOR]

Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH) cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India) during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients) to non-specific gastrointestinal complaints (5 patients). In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis) further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years). Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired. [ABSTRACT FROM AUTHOR]

Objective: Abdominal adiposity is an important risk factor for diabetes and cardiovascular disease in Indians. Dual energy Xray absorptiometry (DXA) can be used to determine abdominal fat depots, being more accessible and less costly than gold standard measures such as magnetic resonance imaging (MRI). DXA has not been fully validated for use in South Asians. Here, we determined the accuracy of DXA for measurement of abdominal fat in an Indian population by comparison with MRI. Design: 146 males and females (age range 18-74, BMI range 15-46 kg/m2) from Hyderabad, India underwent whole body DXA scans on a Hologic Discovery A scanner, from which fat mass in two abdominal regions was calculated, from the L1 to L4 vertebrae (L1L4) and from the L2 to L4 vertebrae (L2L4). Abdominal MRI scans (axial T1-weighted spin echo images) were taken, from which adipose tissue volumes were calculated for the same regions. Results: Intra-class correlation coefficients between DXA and MRI measures of abdominal fat were high (0.98 for both regions). Although at the level of the individual, differences between DXA and MRI could be large (95% of DXA measures were between 0.8 and 1.4 times MRI measures), at the sample level, DXA only slightly overestimated MRI measures of abdominal fat mass (mean difference in L1L4 region: 2% (95% CI:0%, 5%), mean difference in L2L4 region:4% (95% CI: 1%, 7%)). There was evidence of a proportional bias in the association between DXA and MRI (correlation between difference and mean 20.3), with overestimation by DXA greater in individuals with less abdominal fat (mean bias in leaner half of sample was 6% for L1L4 (95%CI: 2, 11%) and 7% for L2L4 (95% CI:3,12%). Conclusions: DXA measures of abdominal fat are suitable for use in Indian populations and provide a good indication of abdominal adiposity at the population level. [ABSTRACT FROM AUTHOR]

Background: Asbestos's production, processing, and consumption is on very high scale in India and it is increasing, and so do the related diseases. Asbestosis is such a disease which causes progressive respiratory disability. Aim: To find out perceptions and thinking about this disease and its risk among the patients which will help in constructing an effective community-based prevention and rehabilitation program. Materials and Methods: It was a community-based, qualitative study using a semi-structured interview schedule with 17 asbestosis patients from Mumbai, disgnosed by specialist with pulmonary function test and X-rays as per International Labour Organisation's recommandations. Results: The risk percived by the patients is very less and attitude toward the illness is bengine as there is no clear understanding about the causation. The prolong latent period appears to be the main cause. It suggests a need of very strong program for prevention of asbestosis with the incorporation of worker awareness and eduaction for safety. The socio-economical status and educational levels of the workers make this floating population more vulnarable for manipulation by the corporates. Conclusion: Apart from the radical step of ban on asbestos, there is a need of community-based sustainable, affordable, and accessible rehabilitation program with a component of palliative care which will consider the different needs of this marginalized group. The need for such a program is intense as the number of asbestisis patients will keep on increasing till 30 to 40 years of asbestos ban. [ABSTRACT FROM AUTHOR]

Long-term exposure to respirable dust containing silica leads to pneumoconiosis/silicosis. The disease is irreversible and incurable, and only preventive steps such as job rotation, use of personal protective equipment, etc., remain solutions to the problem. Under such a situation, early diagnosis or prediction may become very useful to control the disease. Biomarkers are biological parameters in blood serum that change their values with deposition of dust in the lung and onset of lung fi brosis. Since these biomarkers can help us to diagnose and in the prognosis of the disease before it is actually diagnosed by the conventional X-ray technique and lung function test used for diagnosis of silicosis. The present paper describes the various types of available biomarkers, their application and usefulness. The paper also suggests that further study of the behavior/level of these biomarkers on a specifi c subject with time may provide more useful information of a confi rmatory nature for prevention of dust-linked diseases. [ABSTRACT FROM AUTHOR]

Abstract: A Total Solar Eclipse (TSE) provides us with an exciting opportunity to study the VLF propagation effects under a controlled experimental condition where the extreme ultraviolet and the X-rays from the sun are totally blocked by the moon. During the total eclipse of July 22nd, 2009, the Indian Centre for Space Physics conducted a VLF campaign to obtain the signal from a dozen of places in the Indian sub-continent. Six of these locations gave very good and noise-free data. In some of these data, the signal amplitude is found to be higher than that at non-eclipse condition, while in some other places, it is lower. We present the results of our campaign and give an interpretation of the results using the Long Wavelength Propagation Capability (LWPC) code in a perturbed waveguide both for the easterly and westerly propagation paths. [Copyright &y& Elsevier]

Background: Patients suffering from drug-resistant tuberculosis (DR TB) avail of private care since Programmatic Management of DR TB (PMDT) is not universally available in India. Management of DR TB is challenging and involves great expertise. Chest physicians (CPs) play a major role in this area. The study was undertaken with the objective to see whether the practices of CPs comply with current guidelines and to identify areas where they could be involved to improve access to PMDT. Materials and Methods: For this cross-sectional study, CPs from Mumbai and Nagpur, Maharashtra, India, were given pretested questionnaires to be filled in and returned. Observations: Of 70 enlisted CPs, 29 (41%) responded. Twenty-six (89%) respondents used the drug susceptibility test (DST) for diagnosis: private labs and hospitals were preferred; 9 (31%) used standard treatment, 15 (51%) switched to individual treatment after starting standard therapy and 12 (41%) started empirical treatment later switched to individual treatment as per the WHO guidelines. Seven consultants (10%) used in addition drugs from alternative systems of medicine for immune modulation and adverse drug effects. Eighty-six per cent CPs monitored treatment by smear examination, 51% by culture and 93% used X-rays. Reported case holding in the form of regular follow-up consultation visits was around 70%, treatment success estimated to be between 30% and 70%, and deaths around 30%. Adverse drug reactions were reported in around 30% cases. Conclusion: This study shows that most private CPs generally comply with current guidelines for management of DR TB. Accreditation of private labs for DST, involving CPs in diagnosis, treatment and monitoring of patients through public private partnerships can improve access to PMDT [ABSTRACT FROM AUTHOR]

Background: There is a high prevalence of silicosis and other morbid conditions leading to early death among agate workers at Khambhat of Gujarat. Aims: The present study describes the prevalence of X-ray positive silicosis in a sample of a high-risk group visiting a clinic at Shakarpur of Khambhat. Settings and Design: A crosssectional study among 123 clinically suspected cases was conducted over 6 months. Materials and Methods: A chest physician and a radiologist independently evaluated the Chest X-rays of 123 clinically suspected patients of silicosis. Silicosis was confirmed if either of them rated the X-ray as positive. Statistical Analysis: Descriptive statistics and logistic regression were done using SPSS software version 14. Results: Out of 123 cases, 85 (69.1%) were confirmed as silicosis. There was no significant difference in the prevalence between males (70.3%) and females (69.4%). Workers with more than 10 years of exposure to silica had an odd ratio of 4.8, 95% CI (1.76, 13.60) compared to those with less than 10 years of exposure. A logistic regression analysis showed that for every extra year of exposure, the odds of getting silicosis increased by about 12%. Conclusions: This study highlights the catastrophic effects of exposures to silica in agate worker, which calls for urgent protective measures for this population. [ABSTRACT FROM AUTHOR]

We conducted a radiological safety and quality assurance (QA) audit of 118 medical X-ray diagnostic machines installed in 45 major hospitals in India. The main objective of the audit was to verify compliance with the regulatory requirements stipulated by the national regulatory body. The audit mainly covered accuracy check of accelerating potential (kVp), linearity of tube current (mA station) and timer, congruence of radiation and optical field, and total filtration; in addition, we also reviewed medical X-ray diagnostic installations with reference to room layout of X-ray machines and conduct of radiological protection survey. A QA kit consisting of a kVp Test-O-Meter (ToM) (Model RAD/FLU-9001), dose Test-O-Meter (ToM) (Model 6001), ionization chamber--based radiation survey meter model Gun Monitor and other standard accessories were used for the required measurements. The important areas where there was noncompliance with the national safety code were: inaccuracy of kVp calibration (23%), lack of congruence of radiation and optical field (23%), nonlinearity of mA station (16%) and timer (9%), improper collimator/ diaphragm (19.6%), faulty adjustor knob for alignment of field size (4%), nonavailability of warning light (red light) at the entrance of the X-ray room (29%), and use of mobile protective barriers without lead glass viewing window (14%). The present study on the radiological safety status of diagnostic X-ray installations may be a reasonably good representation of the situation in the country as a whole. The study contributes significantly to the improvement of radiological safety by the way of the steps already taken and by providing a vital feed back to the national regulatory body. [ABSTRACT FROM AUTHOR]

dvances in supramolecular chemistry and crystal engineering reported from India within the last decade are highlighted in the categories of new intermolecular interactions, designed supramolecular architectures, network structures, multi-component host-guest systems, cocrystals, and polymorphs. Understanding self-assembly and crystallization through X-ray crystal structures is illustrated by two important prototypes — the large unit cell of elusive saccharin hydrate, Na(sac) · 30HO, which contains regular and irregular domains in the same structure, and by the Aufbau build up of zinc phosphate framework structures, e.g. ladder motif in [CNH][Zn(HPO)] to layer structure in [CNH][Zn(HPO)] upon prolonged hydrothermal conditions. The pivotal role of accurate X-ray diffraction in supramolecular and structural studies is evident in many examples. Application of the bottomup approach to make powerful NLO and magnetic materials, design of efficient organogelators, and crystallization of novel pharmaceutical polymorphs and cocrystals show possible future directions for interdisciplinary research in chemistry with materials and pharmaceutical scientists. This article traces the evolution of supramolecular chemistry and crystal engineering starting from the early nineties and projects a center stage for chemistry in the natural sciences. [ABSTRACT FROM AUTHOR]

There are millions of working children worldwide. In gem polishing industry, exposure to occupational hazards of dust and chemicals used in polishing of gemstone may result in respiratory symptoms and respiratory disorders. The present study included 586 exposed and 569 comparison group subjects. Data was collected through personal interview, clinical examination, and chest radiography. The respiratory morbidity was diagnosed on the basis of clinical signs and symptoms and chest radiography. The study variables included age, sex, daily working hours, and duration of exposure. The mean age of the child laborers was 11.31 ± 5.34 years. Prevalence of respiratory morbidity was significantly high in the female child laborers. The other study variables namely age, duration of exposure, and daily working hours were found to be statistically non-significant. The prevalence of respiratory morbidity among child laborers of gem polishing industry in Jaipur was found to be 7%. [ABSTRACT FROM AUTHOR]

Abstract: Particle induced X-ray emission and particle induced γ-ray emission spectroscopic techniques have been carried out to analyse the elemental concentrations of human pigment gallstone samples from eastern region (Orissa) and southern region (Chennai) of India. It was observed that 18 minor/trace elements namely Na, Mg, Al, P, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br and Pb were present in the pigment gallstone samples of both the regions. Our study reveals that average concentration of all elements except Ni in south Indian pigment gallstone samples is higher than that of corresponding values in east Indian pigment gallstone samples whereas elements like Al, P, S, Cl and V did not show much variation between these two regions. Fourier transform infra-red analysis was carried out to identify the functional groups and the classification of the pigment type gallstones of both the regions. The thermal behaviour of pigment gallstones was carried out by thermogravimetry-derivative thermogravimetry analysis. [Copyright &y& Elsevier]

India has a large community of X-ray users and also has a good history of spectroscopy-related research using the ultraviolet, visible and infrared portions of the electromagnetic spectrum. The Raman effect is an example of this. Taking into account the need of the scientific community for having an in-house synchrotron radiation source, the Department of Atomic Energy, India decided to construct such a facility for the country. After a series of discussions with prospective users, it was decided to construct two such sources, one for the soft X-rays and vacuum ultra-violet rays, and the other for hard X-rays. These sources are named as Indus-1 and Indus-2, respectively.The construction of these sources started in the late 1980s after selection of the site at Indore. Indus-1 was commissioned in 1999 and is now operational with four beamlines working. Indus-2 is in an advanced stage of construction and is expected to be ready soon. Work on the beamlines is also in progress. In the future, it is proposed to install three insertion devices in this ring.In this paper, a brief historical development of this project, Indus-1 and Indus-2 and their beamlines, as well as future plans will be discussed. [Copyright &y& Elsevier]

A chondrodite from a marble from Ambasamudram near the Archankovil shear zone, Kerala Khondalite Belt, India, was characterized by powder X-ray diffraction (XRD), electron microprobe and Fourier Transform Infrared (FTIR) spectroscopic techniques. FTIR measurements were carded out in the range 400-10000 cm-1, to record both fundamental and overtone modes. A set of absorption peaks at 3393, 3411, 3561, 3571, 3650, and 3685 cm-1 were observed in the fundamental OH-stretching mode region. In the combination-mode region modes observed at 4103, 4328, and 4440 cm-1 indicate that the majority of M sites in this chondrodite are occupied by Mg. The modes at 3650 and 4520 cm-1 could be due to silanol (Si-OH) groups. A definite band was also observed at 5072 cm-1, whose origin presently is not clear. A weak overtone mode of the strongest OH stretching was observed at 6967 cm-1. [ABSTRACT FROM AUTHOR]

In recent years, Brain tumor detection and segmentation has created an interest on research areas. The process of identifying and segmenting brain tumor is a very tedious and time consuming task, since human physique has anatomical structure naturally. Magnetic Resonance Image (MRI) scan analysis is a powerful tool that makes effective detection of the abnormal tissues from the brain. Among different techniques, Magnetic Resonance Image (MRI) is a liable one which contains several modalities in scanning the images captured from interior structure of human brain. A novel hybrid energy-efficient method is proposed for automatic tumor detection and segmentation. The proposed system follows K-means clustering, integrated with Fuzzy C-Means (KMFCM) and active contour by level set for tumor segmentation. An effective segmentation, edge detection and intensity enhancement can detect brain tumor easily. For that, active contour with level set method has been utilized. The performance of the proposed approach has been evaluated in terms of white pixels, black pixels, tumor detected area, and the processing time. This technique can deal with a higher number of segmentation problem and minimum execution time by ensuring segmentation quality. Additionally, tumor area length in vertical and horizontal positions is determined to measure sensitivity, specificity, accuracy, and similarity index values. Further, tumor volume is computed. Knowledge of the information of tumor is helpful for the physicians for effective diagnosing in tumor for treatments. The entire experimentation was implemented in MATLAB environment and simulation results were compared with existing approaches. [ABSTRACT FROM AUTHOR]

We present a study on the secondary x-rays of energy band 2[?]100 keV emitted by the intruded principal pollutant components (gases and minerals) brought up in the lower atmosphere by dust storms, monsoon drift and the gravitational pull on meteoritic showers. On the ground we employed a 1.5 x 1 inch2 NaI crystal in a scintillation detector, suitable for the energy range 2[?]100 keV of secondary x-rays, providing better energy resolution than a larger sized crystal. In order to eliminate the radioactive background of the Earth, the detector was well shielded on all sides with the help of the lead (Pb) container, except with a small open window at the top to permit only vertically incident secondary radiation. The results from the data analysis obtained during the monsoon over Udaipur city (India) during the period from July to September (2006) have revealed a linear correlation between dust storm cum monsoon clouds and observed luminosities of secondary x-ray radiation from intruded pollutants. We found intense flux of secondary x-rays from the intruded pollutants when heavy dust and monsoon clouds were brought up by dust storms and monsoon drift in the lower atmosphere over Udaipur city as compared to normal days. Thus, secondary x-rays in the environment provide a tool for investigation of local intrusive pollutant components in the lower atmosphere. [ABSTRACT FROM AUTHOR]