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Background: Sleep state misperception (SSM) is seen among patients with obstructive sleep apnea (OSA) as well as those having insomnia. Moreover, OSA and insomnia can also be comorbid. This study aims at finding the proportion of SSM and “Comorbid Insomnia with OSA” (COMISA) among patients of OSA and chronic insomnia. Macroachitecture of sleep was also compared across groups. Methods: This study utilized the retrospective laboratory and medical records of two groups of patients: chronic insomnia and OSA. Sleep disorders were diagnosed according to standard criteria. Daytime sleepiness was examined using the Epworth Sleepiness Scale. Diagnosis of SSM was based on the difference between subjective and objective sleep onset latency (Subjective SOL > 1.5 × Objective SOL). Results: Sixteen adult subjects were included in each group. Based on the difference between subjective and objective sleep onset latency, SSM was reported by 62.5% subjects of chronic insomnia and 56.25% subjects having OSA (OR = 1.29; 95% CI = 0.31–5.33; P = 0.79). The proportion of COMISA in subjects with chronic insomnia was 18% and among subjects with OSA, it was 43%. Effect size for the proportion was calculated as odds ratio (33.96; 95% CI = 7.48–154.01; P < 0.0002). Thus, the odds for COMISA were higher among subjects with OSA than those with chronic Insomnia. The three groups (OSA, COMISA and Chronic Insomnia) were comparable with regard to the macro-architecture of sleep. Conclusion: SSM is common among subjects with OSA and chronic insomnia. COMISA was commoner among patients with OSA compared to those with chronic insomnia. Macro-architecture of sleep is comparable among groups.

Purpose: This study was aimed to assess knowledge regarding RLS among medical teachers and medical students. Method: ‘Knowledge about RLS (K-RLS)’ questionnaire was developed, validated and used to assess knowledge of study participants about RLS. It was applied to 50 medical teachers likely to get patients with RLS in addition to 324 undergraduate medical students. Results: Individual item validation ranged between 0.8 and 1. Average scale CVI (S-CVI/Ave) was 0.95 for the whole questionnaire and universal agreement (S-CVI/UA) scores for whole of the questionnaire was 0.75. K-RLS had good internal consistency (Cronbach’s alpha = 0.89). Results showed that knowledge regarding RLS was poor among students as well as medical teachers. Conclusion: K-RLS is a reliable tool to assess knowledge about RLS among health care professionals. Knowledge about RLS is poor among medical students as well as teachers.

Various research studies on hospital food services and patient satisfaction have been conducted globally. The quality of dietary services is one of the important aspects of health care. Indian studies in this field are very few, thus this pilot study was conducted as an insight for a similar future study on a large scale. A cross sectional study was carried out in Government Medical College and Hospital, sector 32, Chandigarh. Fifty-nine patients were selected randomly from private and general wards- mainly Obstetrics and Gynaecology, Oncology and Burn unit. A self-structured questionnaire was prepared for assessing satisfaction of the patients regarding food quality and food services. The data was collected and analyzed for all parameters of demographic profile of hospital patients selected, and their interview responses. Most patients (96.3%) were satisfied with the food and food service staff according to their responses. Correlations between most parameters were positive and highly significant at (p is less than 0.01) and (Pis less than 0.05) level. No impact of Age and BMI was seen on any of the variable at 95% confidence level as probability value greater than 0.05. Chi-square test of patient satisfaction responses showed asymptotic significance as p-value was 0.00. Effectiveness of results of this pilot study were understood as potential effectiveness. Focus was on feasibility and not on statistical significance. It also shows that the large-scale study will be feasible without changes in protocol. Confidence intervals showed that the pilot study testing can significantly reduce any flaws in the research approach. Amendments for future study are that the questions are properly framed to ensure that patients eat well, and leave the hospital with improved physical and mental health; and all aspects of dietary services should be well organized.

Objectives: Kabaddi is a commonly played sport in Asia and now it is getting recognition worldwide. With the emergence of this sport, concern related to injuries associated with this sport is also increasing. For uniform reporting of injuries and illness in the epidemiological study (Kabaddi), it desired to have standard definitions on Kabaddi-related injuries. Materials and Methods: After the initial review of various studies on other sports; the definitions and terms which can be valid for Kabaddi were selected and modified according to this sport. These definitions were then reviewed by experts, who have an abundance of experiences in the treatment of injuries related to this sport. After multiple meetings among the expert panel final definitions, terms, and methodology for injury surveillance studies were laid down. Results: Only new and modified definitions were used in this paper, therefore, it is advised to use this paper in conjunction with STROBE-SIS. Injury rates were defined per 1000 raids or 1000 tackles. Various definitions like match time loss, general time loss, match injury incidence, training injury incidence, match injury prevalence, etc. were included in this paper. Conclusion: These standard definitions will help inconsistent and better data collection in injury surveillance studies. This will also help in a better understanding of injury patterns.

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients’ homes.AimWe aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the model outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available.MethodsWe searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was conducted, and comparisons made between community-based and facility-based models, where within-study comparison was reported.Results5,335 unique studies were retrieved, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias.ConclusionEvidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA.

ImportanceClimate change is one of the most pressing global public health issues and is increasingly gaining attention from governments and researchers as a critical policy and research focus. While research on the effects of climate change on human health has grown significantly over the past few decades, there remain known gaps in research on non-physical health topics, like mental health, and in research on low-income countries.ObjectiveTo better understand the current state of research on the human health effects of climate change, including exposures, health conditions, populations, areas of the world studied, funding sources, and publication characteristics, with a focus on topics that are relevant for vulnerable populations.Evidence ReviewWe searched the National Institute of Environmental Health Sciences (NIEHS) Climate Change and Human Health Literature Portal, a curated bibliographic database of global peer-reviewed research and gray literature on the science of climate impact on human health, to identify peer-reviewed original research investigating the health effects of climate change published from 2012 to 2019. The database combines searches of multiple search engines including PubMed, Web of Science, and Google Scholar and includes added-value expert tagging of climate change exposures and health impacts. We filtered our search by year published, limited to original research articles published in English. After identifying all original research articles, we selected a 5% random sample to manually perform a detailed characterization of research topics and publication information.FindingsThere were 7082 original research articles published between 2012 and 2019, and the number of articles increased by 23% annually. In our random sample of 348 articles, we found that there were several gaps in research topics that are particularly relevant to vulnerable populations, such as those in the Global South (159; 45.7%) and the elderly (55; 15.8%). Additionally, fewer first authors were from the Global South (110; 31.6%), which may in part explain why there is disproportionally less research focusing on these countries.Conclusions and RelevanceOur results help elucidate gaps in research that, once addressed, may help us better understand and mitigate some of the most devastating effects of climate change on human health.

In Medical Science, Hoarseness is the term used to describe a change in normal quality of voice of a patient which is rough or harsh, lower in pitch and more or less discordant Depends on duration of illness, hoarseness can be divided into acute or chronic condition. The acute onset is more common and mainly caused by inflammation (acute laryngitis) chronic sinusitis acid reflux disease, excessive alcohol use, smoking and over use or misuse of voice whereas other cause may be, laryngeal trauma or thyroid surgery and systemic disease The aim of our study is to analyse clinical profile, assess different etiological factors and to find out common precipitating factors leading to hoarseness of voice.A total of 34500 patients visited OPD of Otolaryngology department from June 2017 to May2019. Out of these,253 cases presented with complaint of change in voice (Hoarseness). The incidence of hoarseness among total OPD patient was 0.73%. Among 253 cases ,165 (65.21%) were male and 88 (34.78%) were female. Male predominance was observed with Male: female ratio of 1.87:1 in this study. Majority of patients (22.13%) were reported in 51-60 years age group followed by 31-40 years age group (21.73%). Largest group of patients were housewives (19.76%), then farmer (19.36%%) and labour (18.57%). Rest was teacher (13.43%), singer (5.92%) politician (5.13%), policeman (1.97%) and sportsman (0.79%).Many predisposing factors were noted like tobacco chewing, smoking, alcohol drinking. Tobacco chewing (38.33%), smoking (33.99%) and alcohol consumption (15.81%) were most common predisposing factors in descending order. Functional disorder was reported in (5.13%) cases and vocal abuse in 2.37% cases. In present study most of the patients were referred for speech therapy and psychotherapy along with vocal conservation and maintenance of vocal hygiene.

On 14th June 2021, Philips Respironics issued a medical device recall notification (US only) and field-safety notice (International Markets) for mechanical ventilator devices including continuous positive airway pressure (CPAP), and bilevel positive airway pressure (bilevel PAP). This was in response to potential health risks related to the sound abatement foam component in these devices. The company had stated that they are working hard towards a resolution, which includes repair and replacement of the affected devices. The statement of Philips clearly declares that this is a recall notification for the US, and only a field-safety notice for the rest of the world. The advisory from Philips puts the ball in the court of the physician or Durable Medical Equipment (DME) provider to determine the most appropriate options for continued treatment of patients using the affected devices. Although the long-term effects of these recalled machines will continue to be a matter of concern for the patients, the patients must be supported by the providers with explanations, reassurances and hope.

Introduction With an increase in the number of total joint arthroplasties, the count of prosthetic joint infections (PJIs) is also increasing and has become a nightmare for an orthopaedic surgeon. Microbiological diagnosis is important for administering definitive antimicrobial treatment. Negative culture reports hamper patient management and prolonged incubation periods have increased the culture yield but at the risk of culture contamination in conventional microbiology settings. Thus, we aimed to optimize the best incubation time for culture and the aerobic bacterial profile of PJIs. Material and Methods Over a year, samples from clinically suspected PJI patients were collected and processed for culture using standard techniques. The samples were incubated for up to 10 days with daily subculturing on to solid media. The bacterial isolates were identified and antibiotic susceptibility was performed. Results Out of 200 patients, 105 were included in the study and samples were collected in triplicate. In 70 cases culture was positive and 35 were culture negative PJIs. Mean incubation days to culture positivity was 3.6 days with 97.14% culture positivity seen by the seventh day of incubation. Twenty-four percent methicillin-resistant Staphylococcus aureus, and more than 50% extended spectrum β lactamase producing Klebsiella pneumoniae and Escherichia coli were isolated. Discussion Culture positivity in PJIs provides definitive evidence of infection and guides the treatment. Increasing the incubation times can help in maximizing the culture yield, and we found that 97.14% pathogens grew within 7 days of incubation. Prolonging it further would not provide an added advantage especially in a resource-constraint setting.

The COVID-19 pandemic has revealed a range of disease phenotypes in infected patients with asymptomatic, mild, or severe clinical outcomes, but the mechanisms that determine such variable outcomes remain unresolved. In this study, we identified immunodominant CD8 T-cell epitopes in the spike antigen using a novel TCR-binding algorithm. The predicted epitopes induced robust T-cell activation in unexposed donors demonstrating pre-existing CD4 and CD8 T-cell immunity to SARS-CoV-2 antigen. The T-cell reactivity to the predicted epitopes was higher than the Spike-S1 and S2 peptide pools in the unexposed donors. A key finding of our study is that pre-existing T-cell immunity to SARS-CoV-2 is contributed by TCRs that recognize common viral antigens such as Influenza and CMV, even though the viral epitopes lack sequence identity to the SARS-CoV-2 epitopes. This finding is in contrast to multiple published studies in which pre-existing T-cell immunity is suggested to arise from shared epitopes between SARS-CoV-2 and other common cold-causing coronaviruses. However, our findings suggest that SARS-CoV-2 reactive T-cells are likely to be present in many individuals because of prior exposure to flu and CMV viruses.

Drought stress-induced crop loss has been considerably increased in recent years because of global warming and changing rainfall pattern. Natural drought-tolerant plants entail the recruitment of a variety of metabolites and low molecular weight proteins to negate the detrimental effects of drought stress. Dehydrin (DHN) proteins are one such class of proteins that accumulate in plants during drought and associated stress conditions. These proteins are highly hydrophilic and perform multifaceted roles in the protection of plant cells during drought stress conditions. Evidence gathered over the years suggests that DHN proteins impart drought stress tolerance by enhancing the water retention capacity, elevating chlorophyll content, maintaining photosynthetic machinery, activating ROS detoxification, and promoting the accumulation of compatible solutes, among others. Overexpression studies have indicated that these proteins can be effectively targeted to mitigate the negative effects of drought stress and for the development of drought stress-tolerant crops to feed the ever-growing population in the near future. In this review, we describe the mechanism of DHNs mediated drought stress tolerance in plants and their interaction with several phytohormones to provide an in-depth understanding of DHNs function.

The effect of high-grade preoperative pivot shift test on outcomes of anterior cruciate ligament (ACL) reconstruction surgery is not very well established. The present study was conducted to study the factors associated with high-grade pivot shift test and effect of high-grade preoperative pivot shift test on functional outcomes after ACL reconstruction surgery.Three hundred and sixty-two patients who underwent primary ACL reconstruction surgery were enrolled in the study. The pivot shift test was performed preoperatively under anesthesia in all patients. Side of the meniscal tear, if present at the time of ACL reconstruction, was documented. Patients were divided into two groups depending upon the grade of pivot shift test: group H, high-grade pivot shift (The presence of lateral meniscus tear (27/84 vs. 53/278) or both menisci tear (29/84 vs. 60/278) was associated with high-grade pivot shift (The high-grade pivot shift is associated with chronic ACL tear (6 months) and concomitant lateral meniscus tear. The presence of high-grade pivot shift preoperatively is associated with inferior clinical outcomes and lower rate of return to sports.Level IV, case-control study.

Many surgeons are still hesitant to do arthroscopic anterior cruciate ligament reconstruction (ACL) in patients above 40 years old. The effect of ACL reconstruction on functional outcomes in patients above 40 years of age. Patients of age > 40 years who underwent ACL reconstruction were enrolled in the study. Functional outcomes (Lysholm, WOMAC score, and Tegner activity scale), pain (VAS score), and knee stability (KT-1000) were assessed at final follow-up and compared with pre-operative scores. All patients were followed up for a minimum of 2 years. A total of 112 patients were included in the study. Eighty-eight were males and 24 were females. The mean age at the time of surgery was 44.8 ± 5.6 years (40–63 years). The mean Lysholm score was improved from 64.1 ± 11.7 to 87.2 ± 5.9 (p = 0.0001). Similarly, the WOMAC score was also improved from 8.8 ± 6.9 to 2.3 ± 1.9 (p = 0.0001). The mean side-to-side difference (KT-1000) also improved from 6.65 ± 2.25 mm to 2.32 ± 1.45 mm (p = 0.0001). More than 70% of the patients had excellent or good outcomes. Median pre-injury Tegner activity scale was 5 (3–8) and the median post-ACLR Tegner activity scale was 5 (3–7; p = 1). ACL reconstruction in patients > 40 years of age results in good functional outcomes and knee stability.

The optimization of device dimensions along with high-k gate dielectric is investigated in this work for improving RF/analog performance of double gate (DG) TFET device. Through simulation, it is seen that RF/analog performance of DG-TFET deteriorate by the use of high-k gate materials in place of SiO2 as gate oxide. It has been anticipated that this degradation (ΔFoM = FoM(k = 3.9) – FoM(k = 40)) can be abated by optimizing the device dimensions particularly the channel thickness (Tc) and length (Lc). It is seen that deprivation in intrinsic dc gain (ΔAV), cut –off frequency (ΔfT), maximum oscillation frequency (ΔfMAX), gain-frequency product (ΔGFP), transconductance-frequency product (ΔTFP), and gain-transconductance-frequency product (ΔGTFP) is 11.3%, 11.84%, 11.17%, 52.16%, 19.69% & 56.42% respectively for Tc = 12 nm and 32.6%, 10.96%, 12.8%, 59.58%, 14.61% & 61.24% respectively for Tc = 6 nm. Furthermore, it is seen that deprivation in RF/analog parameters as a result of high-k gate dielectrics varies with channel length (Lc). The ΔAV, ΔfT, ΔfMAX, ΔGFP, ΔTFP, and ΔGTFP is observed to be 32.6%, 10.96%, 12.8%, 59.58%, 14.61% & 61.24% respectively for Lc = 30 nm and 17.2%, 7.41%, 10.36%, 58.67%, 8.95% & 59.36% respectively for Lc = 15 nm. Consequently, high-k gate dielectrics-based DG-TFET should be designed at thicker Tc and lower Lc for improved analog/RF performance of TFET device.

Due to the rapid growth in sleep medicine's professional content, several countries have recognized sleep medicine as an independent specialty. The practice of sleep medicine and the demand for this service in Asian countries are expanding. At this point of growth, the accreditation of sleep medicine specialists is paramount to patient care and the training of physicians and technologists. The Asian Society of Sleep Medicine (ASSM) mandated a taskforce committee for the accreditation of sleep medicine practice. This taskforce developed Asian accreditation practice guidelines for sleep medicine physicians and technologists. This paper presents the newly approved Asian accreditation practice guidelines for sleep medicine physicians and technologists by the ASSM.

Objective:To determine the demographic pattern of juvenile-onset parkinsonism (JP, Materials and Methods:We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.Results:A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sleep-related issues more common in EOPD subjects. Overall, dyskinesias were documented in 32.8%. YOPD subjects had a higher frequency of dyskinesia than EOPD subjects (39.9% vs. 25.5%), but they were first noted later in the disease course (5.7 vs. 4.4 years).Conclusion:This large cohort shows differing clinical patterns in JP, YOPD, and EOPD cases. We propose that cutoffs of

Background Literature is controversial on femoral tunnel length as a risk factor for graft injury if the graft length in the tunnel is kept constant at ≥15 mm. Methods A total of 1079 sportspersons, meeting our inclusion criteria, were assessed for graft rupture. Patients with femoral tunnel length (FTL) ≤30 mm were labeled as Group 1, while those with FTL > 30 mm were labeled as Group 2. Both groups were compared for potential risk factors for graft injury keeping graft length in the tunnel at ≥15 mm and statistical analysis was performed to study whether the femoral tunnel length acted as an additional risk factor. Results Of 1079 sportspersons, 37 suffered from graft rupture. Patients with FTL > 30 mm were included in Group 1(n = 22) and patients with FTL ≤ 30 mm (n = 15) were included in Group 2. Both groups were comparable for risk factors for ACL injury: age (P = 0.37), gender (P = 0.53), mode of re-injury (P = 0.38), graft diameter (P = 0.71), level of sports activity (P = not significant), duration from injury to index surgery (P = 0.74), duration from index surgery to re-injury (P = 0.52), timing of return to sports after index surgery (P = 0.30), duration of sporting activity before second injury (P = 0.31), Tegner’s level (P = not siginificant), Notch width index (P = 0.12) posterior slope (P = 0.77) and height (P = 0.41). Conclusion Because the graft length in the tunnel was kept at optimum and the risk factors for ACL injury were comparable in both groups at a follow up period, we suggest that femoral tunnel length is not a risk factor for graft failure.

Leber congenital amaurosis (LCA) is a severe autosomal recessive retinal degenerative disease. The current study describes exome sequencing results for two unrelated Indian LCA patients carrying novel nonsense p.(Glu636*) and frameshift p.(Pro2281Leufs*63) mutations in the ALMS1 gene. Although ALMS1 gene mutations are associated with Alstrom syndrome (AS), the current patients did not exhibit typical syndromic features of AS. These data suggest that ALMS1 should be included in the candidate gene panel for LCA to improve diagnostic efficiency.

Background: Osteoarthritis (OA) in the anterior cruciate ligament (ACL)–deficient knee is seen in approximately 50% of affected patients. Possible causes include biochemical or biomechanical changes. Purpose: We sought to study the correlation between inflammatory cytokines and chondral damage in ACL-deficient knees. Methods: Seventy-six male patients who underwent ACL reconstruction were enrolled in a cross-sectional study. Synovial fluid was aspirated before surgery and analyzed for levels of the inflammatory cytokines tumor necrosis factor-α, interleukin-1 (IL-1), and interleukin-6 (IL-6). At the time of ACL reconstruction, the severity of chondral damage was documented as described by the Outerbridge classification. Results: Patients with grade 2 or higher chondral damage were observed to have elevated IL-6 levels when compared to patients who had no chondral damage. Interleukin-6 levels had no correlation with the duration of injury. Conclusion: Elevated levels of IL-6 in synovial fluid were associated with chondral damage in ACL-deficient knees. Further study is warranted to determine whether inflammatory cytokines contribute to the development of OA of the knee after ACL injury.

Background Literature shows that home confinement during coronavirus disease 2019 (COVID-19) pandemic has significantly affected sleep. However, such information regarding subjects having Parkinson’s disease (PD) is unavailable. Methods This cross-sectional study was conducted using a questionnaire, developed and validated by experts. PD subjects from nine centers across India were included. Questionnaire assessed presence as well as change in sleep-related parameters and PD symptoms during home confinement. Restless legs syndrome (RLS) and REM sleep behavior disorder (REMBD) was diagnosed using validated questionnaire. Additionally, changes in physical activity, adoption of new hobbies during home confinement and perceived quality of life were assessed. Results Of 832 subjects, 35.4% reported sleep disturbances. New-onset/worsening of sleep disturbances (NOWS) was reported by 23.9% subjects. Among those with sleep disturbances (n=295), insomnia symptoms worsened in half (51.5%) and nearly one-fourth reported worsening of RLS (24.7%) and REMBD (22.7%) each. NOWS was common in subjects lacking adequate family support during home confinement (P=0.03); home confinement > 60 days (P=0.05) and duration of PD > 7 years (P=0.008). Contrarily, physical activity > 1 hour/day and engagement in new hobbies during home confinement were associated with better sleep. NOWS was associated with worsening of motor as well as non-motor symptoms of PD (P 1 hour/day and adoption of new hobbies during home confinement were associated with better sleep., Highlights • New onset/worsening of sleep (NOWS) was reported by one-fourth subjects with Parkinson’s disease (PD) during home confinement. • While insomnia symptoms worsened in half, RLS and REMBD worsened in one-fourth of those with sleep disturbances. • Duration of PD >7 years, home confinement >60 days and absence of emotional support contributed to NOWS. • Adequate physical activity and adoption of hobbies during home confinement were protective factors.

Issues related to human factor – ergonomics influence the health of the students and contribute to their well-being. Human factor – ergonomics should be considered since the distinction between mind and body or mental and physical health is more artificial than actual. Perturbation in one affects the other; hence, simple steps to alter ergonomics can improve medical students' overall well-being and quality of life.

The current research work is based on the effects of walnut content on mechanical and wear property of ramie-glass fiber epoxy composites. Four different variations of hybrid polymer composites were fabricated by varying walnut content range from 0 wt% to 9 wt%, while keeping ramie and glass fibre fixed (at 5 wt%). Results predict that the addition of walnut content successfully enhances the mechanical properties, and higher values (62.59 MPa for tensile strength and 55.52 MPa for flexural strength), was attained at 6 wt% and 9 wt% respectively. While the maximum hardness (45.43 HV) was achieved at 9 wt% walnut content. Furthermore, the sliding wear behaviour of composites was examined by using a pin-on-disc setup and Taguchi optimization technique. Design of experiment (L16) was generated by selecting different control factors (sliding velocity, normal load, and sliding distance) and revealed that the sliding velocity and walnut content were attaining more significant as compared to other factors.

Introduction Bone-patellar tendon-bone (BPTB) and semitendinosus-gracilis (STG) are the commonest grafts used for ACL reconstruction. However even after having been debated for years, there is no consensus about the ideal graft. Moreover, the literature is deficient about STG graft with preserved tibial insertion (STGPI) which preserves the proprioception. Our aim is to compare the outcome of BPTB, free STG and STGPI grafts after ACL reconstruction in professional sports persons. We compared the outcome in terms of mechanical stability, functional outcome, return to sports activity and degenerative changes. Material and methods Professional sports persons aged between 16-50 years operated for ACL tear using BPTB, free STG and STGPI grafts with minimum follow-up of two years were identified from hospital records. Patients with associated knee injuries were excluded. Patients, divided in three groups according to graft used, were compared in terms of mechanical stability (arthrometric examination KT-1000 score), functional outcome (Lysholm Score), return to sports activity (Tegner score and difference in thigh circumference) and degenerative changes (KL grading). Results BPTB graft group was found to be better than free STG and STGPI graft groups in terms of KT-1000 score. There was no statistically significant difference among the groups in terms of Lysholm score, Tegner score, difference in thigh circumference and KL grading. Conclusion BPTB graft is better than free STG and STGPI grafts in terms of knee stability. When compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts.

Backgrounds: The graft tunnel mismatch is a well-known complication of bone-patellar tendon-bone (BPTB) graft in anterior cruciate ligament reconstruction (ACLR) surgery. In the present study, graft rotation technique is used to tackle this problem. Aim: The present study was conducted to study the effect of this technique on functional outcomes and graft failure rate.Methods: Ninety-nine patients who underwent ACL reconstruction using BPTB graft were enrolled in the study and depending upon the graft length these patients were divided into 2 groups. Group A-patients had no graft tunnel mismatch(n=67) and group B-patients had graft tunnel mismatch (n=32). In group B patients, the graft was rotated inside the tibial tunnel to manage the graft tunnel mismatch problem. Functional outcomes (Lysholm score and return to sports), knee laxity (KT-1000 difference), and graft rupture rate were compared between two groups. Results: The mean KT-1000 difference in group A was 2.11 mm and in group B was 2.03 mm (n.s.). There was no significant difference in mean Lysholm score (97 vs 97.3; p>0.05). 78% (49/67) of patients in group B and 73% (25/32) of patients in group A returned to the same or above level of pre-injury activity (n.s). The graft failure rate was 6% (4/67) in group A and 3% (1/32) in group B.Conclusions: Rotation of graft inside the tibial tunnel is an effective way to deal with graft tunnel mismatch.

In this work, we investigate the effect of transverse acoustic excitation on non-reacting swirling jets. The work is motivated by the azimuthal instabilities in annular gas turbine combustors which are one of the major challenges in aero-engines. Annular combustion chambers have a longer circumferential length in comparison to their length or height. As a result, thermoacoustic instabilities are driven by azimuthal acoustic modes. We have designed and fabricated a multi-nozzle (up to three nozzles) linear array combustor to simulate the flow conditions of an annular combustor. The nozzle features a dual co-rotating radial swirler, with a flow split of 44% and 56% between the primary and secondary swirlers. Two compression drivers (power 400 W each) placed on either side of the combustion chamber are used to generate acoustic fields in the direction transverse to the flow. Simultaneous 2D PIV and high-frequency pressure measurements are conducted to measure the time-averaged velocity field and the chamber acoustics, respectively. The time-averaged flow field of the quiescent swirling jet shows a typical low swirl number flow-field that features a narrow recirculation zone surrounded by a high-velocity annular jet. It is observed that once the swirling jet is excited with a transverse acoustic forcing, it instantaneously transitions to a conical type of vortex breakdown (CVB). However, this phenomenon is observed only above a threshold value of perturbation amplitude. In this condition, the flow moves radially outward and remains attached to the walls on either side of the nozzle, and is characterized by a recirculation zone with strong a negative axial velocity. It is a known phenomenon that swirling jets transition to a CVB upon transverse acoustic excitation. However, to the best of our knowledge, this is the first instance where it is shown that transverse acoustic excitation can lead to a bistable state in swirling flows. We investigated the acoustic response to low-amplitude forcing on the combustion chamber by performing a forced acoustic response analysis using COMSOL. It is observed that acoustic forcing leads to a peak response of the radial and azimuthal velocities at the flare of the swirler, which could induce an axisymmetric deflection of the jet shear layer pushing it into a CVB state. In the case of a multi nozzle array of three identical swirlers, we observed that the external acoustic forcing changes the time averaged base flow of the central nozzle.

Background: The majority of commercially insured individuals in the US are enrolled in high-deductible health plans (HDHPs). HDHPs aim to reduce healthcare spending by disincentivizing expensive care utilization and are associated with lower inpatient and outpatient care utilization. The association of HDHPs with healthcare utilization in patients with chronic cardiovascular (CV) disease is unclear. We studied the association of employer-mandated switching to HDHPs with inpatient and outpatient care utilization in patients with chronic CV disease. Methods: Data were extracted from a national commercial health insurance claims data set (Optum® Clinformatics® Data Mart). We identified employers that mandated switching from a traditional plan to an HDHP versus those that remained in traditional plans from 2011 to 2019 to reduce selection bias. We created a cohort of patients aged 18-64 with heart failure, coronary artery disease, peripheral artery disease, or stroke who were enrolled in these employer plans. Our primary outcomes were rates of all-cause hospitalizations and outpatient visits. We estimated the difference-in-differences in these outcomes between persons who switched to an HDHP after at least 1 year of enrollment in a traditional plan, compared to those who remained in a traditional plan, using a negative binomial regression model with inverse probability of treatment weighting to balance baseline patient characteristics. Results: A total of 1,038 individuals with chronic CV disease switched to an HDHP and 56,756 remained in a traditional plan. Switching to an HDHP was associated with a 10.4% (95% CI 4.3% to 16.2%; p=0.001) lower annual rate of outpatient visits, i.e., 0.66 (95% CI 0.25 to 1.05) fewer visits per person per year. The change in annual all-cause hospitalizations after switching to an HDHP was not statistically significant: -16.4% (95% CI -45.2% to 27.4%; p=0.41). Conclusion: Among patients with chronic CV disease, switching to an HDHP was associated with a significant reduction in outpatient visits and no significant change in all-cause hospitalizations. These findings suggest that HDHPs are associated with lower outpatient care utilization without significant change in utilization of inpatient services.

BACKGROUND: The effect of time interval between injury and surgery on outcomes of Bankart repair surgery has not been published previously. The purpose of this study was to assess the effect of surgical delay on functional outcomes after arthroscopic Bankart repair. METHOD: One hundred and five athletes who underwent arthroscopic Bankart repair ± remplissage were enrolled in the study. Patients were divided into 2 groups depending upon the injury to surgery time- < 12 months (n = 19), and ≥12 months (n = 86). Depending upon the number of episodes of dislocation, patients were further categorized into 2 groups