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Statistical learning (SL) is the ability to detect and learn regularities from input and is foundational to language acquisition. Despite the dominant role of SL as a theoretical construct for language development, there is a lack of direct evidence supporting the shared neural substrates underlying language processing and SL. It is also not clear whether the similarities, if any, are related to linguistic processing, or statistical regularities in general. The current study tests whether the brain regions involved in natural language processing are similarly recruited during auditory, linguistic SL. Twenty-two adults performed an auditory linguistic SL task, an auditory nonlinguistic SL task, and a passive story listening task as their neural activation was monitored. Within the language network, the left posterior temporal gyrus showed sensitivity to embedded speech regularities during auditory, linguistic SL, but not auditory, nonlinguistic SL. Using a multivoxel pattern similarity analysis, we uncovered similarities between the neural representation of auditory, linguistic SL, and language processing within the left posterior temporal gyrus. No other brain regions showed similarities between linguistic SL and language comprehension, suggesting that a shared neurocomputational process for auditory SL and natural language processing within the left posterior temporal gyrus is specific to linguistic stimuli., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The majority of trauma-related deaths occur in low- and middle-income countries; however, limited data exists in these settings related to injury types and severity. The prevalence of trauma similar to our setting was less estimated. This study aimed to find the prevalence of traumatic injury among patients presented to the department of emergency medicine of a tertiary care centre., Methods: This is a descriptive cross-sectional study conducted among patients presented to the Department of Emergency Medicine from 15 September 2021 to 14 September 2022. Ethical approval was taken from the Institutional Review Committee. World Health Organization trauma minimum data set, injury mechanism, types and patient disposition data were collected and injury severity scores were calculated. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval., Results: Among 47,825 patients, 1,524 (3.19%) (3.03-3.34, 95% Confidence Interval) patients presented with a traumatic injury. A total of 967 (63.45%) were males and had a median age of 30 years (Interquartile range: 25). Most injuries were caused by falls 650 (42.65%), followed by road traffic accidents 411 (26.97%). A majority had minor Injury Severity Scores 1280 (83.99%)., Conclusions: The prevalence of traumatic injury among patients presenting to emergency was found to be lower than other studies done in similar settings., Keywords: emergency care; injuries and wounds; injury severity score; trauma unit.

This study quantified the organic carbon (C org ) stocks in Thalassia hemprichii meadows that are (i) adjacent to mangroves (MG), and (ii) without mangroves (WMG), in tropical Andaman and Nicobar Islands (ANI) of India. In the top 10 cm of the sediment, C org content was 1.8-fold higher at the MG sites than the WMG sites. The total C org stocks (sediment + biomass) in the 144 ha of seagrass meadows at MG sites (988.74 ± 138.77 Mg C) was 1.9-fold higher than in 148 ha of WMG sites. Protection and management of T. hemprichii meadows of ANI can lead to emission avoidance of around 5447.33 (MG; 3595.12 + WMG: 1852.21) tons of CO 2 . The social cost of the carbon stocks in these T. hemprichii meadows is around US$ 0.30 and 0.16 million at the MG and WMG sites, respectively, showcasing the importance of ANI's seagrass ecosystems as nature-based solutions for climate change mitigation., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Amrit Kumar Mishra reports financial support was provided by Science and Engineering Research Board. Amrit Kumar Mishra reports a relationship with Indian Institute of Technology Bhubaneswar that includes: employment. I have no conflict of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Cnemaspis gracilis is a poorly known species that has been reported from across southern India, with 11 named species within the clade. The species is known only from the type series, as many other records from areas outside the type locality have turned out to represent distinct species. We provide an expanded morphological description of the species based on topotypic material and other samples that were assigned using genetic data. Cnemaspis gracilis is now known with certainty from three localities in the vicinity of Palakkad, Palakkad District, Kerala, and Valparai town, Coimbatore district, Tamil Nadu, besides from an introduced population in the Timber Market, Kolhapur city, Kolhapur district, Maharashtra, India. The species is 7.6-15.8 % divergent on the ND2 gene from described members of the gracilis clade and can be diagnosed by a combination of morphological characters including body size, number of paravertebral tubercles between limb insertions, number of dorsal tubercle rows, number of ventral scale rows across the belly, number of femoral and precloacal pores and poreless scales separating these series in males, and the presence of a single central black ocellus on the neck and a smaller one on the occiput. The assignment of extant populations to the species, a detailed morphological description and genetic data will allow the description of many more species from within this diverse clade of diurnal geckos.

Background: Lung ultrasound (LUS) is an effective tool for diagnosing pneumonia; however, this has not been well studied in resource-limited settings where pneumonia is the leading cause of death in children under 5 years of age., Objective: The objective of this study was to evaluate the diagnostic accuracy of bedside LUS for diagnosis of pneumonia in children presenting to an emergency department (ED) in a resource-limited setting., Methods: This was a prospective cross-sectional study of children presenting to an ED with respiratory complaints conducted in Nepal. We included all children under 5 years of age with cough, fever, or difficulty breathing who received a chest radiograph. A bedside LUS was performed and interpreted by the treating clinician on all children prior to chest radiograph. The criterion standard was radiographic pneumonia, diagnosed by a panel of radiologists using the Chest Radiography in Epidemiological Studies methodology. The primary outcome was sensitivity and specificity of LUS for the diagnosis of pneumonia. All LUS images were later reviewed and interpreted by a blinded expert sonographer., Results: Three hundred and sixty-six children were enrolled in the study. The median age was 16.5 months (IQR 22) and 57.3% were male. Eighty-four patients (23%) were diagnosed with pneumonia by chest X-ray. Sensitivity, specificity, positive and negative likelihood ratios for clinician's LUS interpretation was 89.3% (95% CI 81-95), 86.1% (95%CI 82-90), 6.4, and 0.12 respectively. LUS demonstrated good diagnostic accuracy for pneumonia with an area under the curve of 0.88 (95% CI 0.83-0.92). Interrater agreement between clinician and expert ultrasound interpretation was excellent (k = 0.85)., Conclusion: Bedside LUS when used by ED clinicians had good accuracy for diagnosis of pneumonia in children in a resource-limited setting., (© 2023. The Author(s).)

We report the rediscovery of Oligodon melaneus 112 years after its original description and document the third, and only non-type, specimen for the species. The new specimen was found 267 km east of the type locality (Tindharia, West Bengal state) from Assam state, India. We designate a lectotype for the species, and provide an extended description of a freshly collected male specimen. Phylogenetic analyses of 16s and cytb mitochondrial genes provide support for O. melaneus being closely related to the widespread South Asian endemic O. arnensis.

Seagrasses have the ability to contribute towards climate change mitigation, through large organic carbon (C org ) sinks within their ecosystems. Although the importance of blue carbon within these ecosystems has been addressed in some countries of Southeast Asia, the regional and national inventories with the application of nature-based solutions are lacking. In this study, we aim to estimate national coastal blue carbon stocks in the seagrass ecosystems in the countries of Southeast Asia including the Andaman and Nicobar Islands of India. This study further assesses the potential of conservation and restoration practices and highlights the seagrass meadows as nature-based solution for climate change mitigation. The average value of the total carbon storage within seagrass meadows of this region is 121.95 ± 76.11 Mg ha -1 (average ± SD) and the total C org stock of the seagrass meadows of this region was 429.11 ± 111.88 Tg, with the highest C org stock in the Philippines (78%). The seagrass meadows of this region have the capacity to accumulate 5.85-6.80 Tg C year -1 , which accounts for $214.6-249.4 million USD. Under the current rate of decline of 2.82%, the seagrass meadows are emitting 1.65-2.08 Tg of CO 2 year -1 and the economic value of these losses accounts for $21.42-24.96 million USD. The potential of the seagrass meadows to the offset current CO 2 emissions varies across the region, with the highest contribution to offset is in the seagrass meadows of the Philippines (11.71%). Current national policies and commitments of nationally determined contributions do not include blue carbon ecosystems as climate mitigation measures, even though these ecosystems can contribute up to 7.03% of the countries' reduction goal of CO 2 emissions by 2030. The results of this study highlight and promote the potential of the southeast Asian seagrass meadows to national and international agencies as a practical scheme for nature-based solutions for climate change mitigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea., Methods: A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training., Results: Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively., Conclusions: Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.

Marine cone snails are predatory gastropods characterized by a well-developed venom apparatus and highly evolved hunting strategies that utilize toxins to paralyze prey and defend against predators. The venom of each species of cone snail has a large number of pharmacologically active peptides known as conopeptides or conotoxins that are usually unique in each species. Nevertheless, venoms of only very few species have been characterized so far by transcriptomic approaches. In this study, we used transcriptome sequencing technologies and mass spectrometric methods to describe the diversity of venom components expressed by a worm-hunting species, Conus bayani . A total of 82 conotoxin sequences were retrieved from transcriptomic data that contain 54 validated conotoxin sequences clustered into 21 gene superfamilies including divergent gene family, 17 sequences clustered to 6 different conotoxin classes, and 11 conotoxins classified as unassigned gene family. Seven new conotoxin sequences showed unusual cysteine patterns. We were also able to identify 19 peptide sequences using mass spectrometry that completely overlapped with the conotoxin sequences obtained from transcriptome analysis. Importantly, herein we document the presence of 16 proteins that include five post-translational modifying enzymes obtained from transcriptomic data. Our results revealed diverse and novel conopeptides of an unexplored species that could be used extensively in biomedical research due to their therapeutic potentials.

Background: Clinicians in resource-limited settings commonly use the World Health Organization criteria to diagnose pneumonia in children., Aim: The aim of this study was to prospectively evaluate the diagnostic accuracy of the WHO criteria compared with chest radiograph for the diagnosis of pneumonia in children under 5 years of age presenting to an emergency department (ED) in Nepal., Methods: A prospective cross-sectional study of children presenting to an ED with respiratory complaints in Nepal was conducted. It included all children under 5 years of age with cough or difficulty breathing who received a chest radiograph. Paediatric pneumonia was diagnosed according to WHO criteria when a child presented with a cough or difficulty breathing and met the age-related WHO-defined respiratory rate for tachypnoea. The criterion standard was radiographic pneumonia. The primary outcome was the sensitivity and specificity of the WHO criteria for diagnosis of pneumonia., Results: Of 324 patients enrolled, 72 had radiographic pneumonia. The median (IQR) age was 17 (23) months. Overall, WHO criteria had a sensitivity of 71% (95% CI 59-81) and specificity of 57% (95% CI 50-63). Respiratory rate had poor diagnostic accuracy for pneumonia with an area under the curve of 0.65., Conclusion: The WHO criteria had poor sensitivity and specificity for the diagnosis of pneumonia in children presenting to the ED in a resource-limited setting.

Introduction: High-fidelity medical simulation is widely used in emergency medicine training because it mirrors the fast-paced environment of the emergency department (ED). However, simulation is not common in emergency medicine training programs in lower-resourced countries as cost, availability of resources, and faculty experience are potential limitations. We initiated a simulation curriculum in a low-resource environment., Methods: We created a simulation lab for medical officers and students on their emergency medicine rotation at a teaching hospital in Patan, Nepal, with 48,000 ED patient visits per year. We set up a simulation lab consisting of a room with one manikin, an intubation trainer, and a projector displaying a simulation cardiac monitor. In this environment, we ran a total of eight cases over 4 simulation days. Debriefing was done at the end of each case. At the end of the curriculum, an electronic survey was delivered to the medical officers to seek improvement for future cases., Results: All eight cases were well received, and learners appreciated the safe learning space and teamwork. Of note, the first simulation case that was run (the airway lab) was more difficult for learners due to lack of experience. Survey feedback included improving the debriefing content and adding further procedural skills training., Discussion: Simulation is a valuable experience for learners in any environment. Although resources may be limited abroad, a sustainable simulation lab can be constructed and potentially play a supportive role in developing an emergency medicine curriculum., (© 2020 Wang et al.)

Conopeptides are neurotoxic peptides in the venom of marine cone snails and have broad therapeutic potential for managing pain and other conditions. Here, we identified the single-disulfide peptides Czon1107 and Cca1669 from the venoms of Conus zonatus and Conus caracteristicus , respectively. We observed that Czon1107 strongly inhibits the human α3β4 (IC 50 15.7 ± 3.0 μm) and α7 (IC 50 77.1 ± 0.05 μm) nicotinic acetylcholine receptor (nAChR) subtypes, but the activity of Cca1669 remains to be identified. Czon1107 acted at a site distinct from the orthosteric receptor site. Solution NMR experiments revealed that Czon1107 exists in equilibrium between conformational states that are the result of a key Ser 4 -Pro 5 cis-trans isomerization. Moreover, we found that the X-Pro amide bonds in the inter-cysteine loop are rigidly constrained to cis conformations. Structure-activity experiments of Czon1107 and its variants at positions P5 and P7 revealed that the conformation around the X-Pro bonds ( cis-trans ) plays an important role in receptor subtype selectivity. The cis conformation at the Cys 6 -Pro 7 peptide bond was essential for α3β4 nAChR subtype allosteric selectivity. In summary, we have identified a unique single-disulfide conopeptide with a noncompetitive, potentially allosteric inhibitory mechanism at the nAChRs. The small size and rigidity of the Czon1107 peptide could provide a scaffold for rational drug design strategies for allosteric nAChR modulation. This new paradigm in the "conotoxinomic" structure-function space provides an impetus to screen venom from other Conus species for similar, short bioactive peptides that allosterically modulate ligand-gated receptor function., Competing Interests: The authors declare that they have no conflicts of interest with the contents of this article., (© 2020 Mohan et al.)

In September 2019, a dengue outbreak was observed in many non-endemic areas of Nepal. The emergency department of Patan Academy of Health Sciences also received febrile patients exceeding usual daily numbers. This surge of the patient was managed by epidemic triage and activation of surge capacity. A part of the surge plan was to activate an epidemic emergency unit. An observation ward adjacent to the emergency was used for the epidemic emergency unit. The febrile patients who were triaged yellow and green were treated in this unit. The patients who were triaged as Red were treated in the emergency department.

Background: Lung ultrasound is an effective tool for the evaluation of undifferentiated dyspnea in the emergency department. Impact of lung ultrasound on clinical decisions for the evaluation of patients with dyspnea in resource-limited settings is not well-known. The objective of this study was to evaluate the impact of lung ultrasound on clinical decision-making for patients presenting with dyspnea to an emergency department in the resource-limited setting of Nepal., Methods: A prospective, cross-sectional study of clinicians working in the Patan Hospital Emergency Department was performed. Clinicians performed lung ultrasounds on patients presenting with dyspnea and submitted ultrasounds with their pre-test diagnosis, lung ultrasound interpretation, post-test diagnosis, and any change in management., Results: Twenty-two clinicians participated in the study, completing 280 lung ultrasounds. Diagnosis changed in 124 (44.3%) of patients with dyspnea. Clinicians reported a change in management based on the lung ultrasound in 150 cases (53.6%). Of the changes in management, the majority involved treatment (83.3%) followed by disposition (13.3%) and new consults (2.7%)., Conclusions: In an emergency department in Nepal, bedside lung ultrasound had a significant impact on physician clinical decision-making, especially on patient diagnosis and treatment.

Objective: Natural disasters have a significant impact on the health sector. On April 25, 2015, Nepal was struck by a 7.8 magnitude earthquake. The aim of the study was to compare patient volumes and clinical conditions presenting to the emergency department pre- and post-earthquake., Methods: A retrospective study was done at Patan Hospital Emergency Department in Kathmandu, Nepal. Volume, demographics, and patient diagnoses were collected for 4 months post-disaster and compared with cases seen the same months the year before the disaster to control for seasonal variations., Results: After the 2015 Nepal earthquake, 12,180 patients were seen in the emergency department. This was a significant decrease in patient volume compared with the 14,971 patients seen during the same months in 2014 (P=0.04). Of those, 5496 patients (4093 pre-disaster and 1433 post-disaster) had a chief complaint or diagnosis recorded for analysis. An increase in cardiovascular and respiratory cases was seen as well as an increase in psychiatric cases (mostly alcohol related) and cases of anemia. There was a decrease in the number of obstetrics/gynecology, infectious disease, and poisoning cases post-earthquake., Conclusions: Understanding emergency department utilization after the earthquake has the potential to give further insight into improving disaster preparedness plans for post-disaster health needs. (Disaster Med Public Health Preparedness. 2019;13:211-216).

Viruses are unique biological agents that infect living host cells through molecular delivery of a genomic cargo. Over the past two decades advancements in genetic engineering and bioconjugation technologies have allowed the unprecedented use of these "unfriendly" biological molecules, as nanoscopic platforms for the advancement of an array of nanotechnology applications. This mini-review focuses on providing a brief summary of key demonstrations leveraging the versatile characteristics of Tobacco mosaic virus (TMV) for molecular assembly and bio-device integration. A comprehensive discussion of genetic and chemical modification strategies along with potential limiting factors that impact the assembly of these macromolecules is presented to provide useful insights for adapting TMV as a potentially universal platform toward developing advanced nanomaterials. Additional discussions on biofabrication techniques developed in parallel to enable immobilization, alignment, and patterning of TMV-based functional particles on solid surfaces will highlight technological innovations that can be widely adapted for creating nanoscopic device components using these engineered biomacromolecules. Further exploitation in the design of molecular specificity and assembly mechanisms and the development of highly controllable and scalable TMV-device integration strategies will expand the library of nanoscale engineering tools that can be used for the further development of virus-based nanotechnology platforms., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Lizards of the genus Calotes are geographically restricted to South Asia, Indo-China and parts of Southeast Asia. The greatest diversity of the genus is from the biodiversity hotspots in South Asia: Western Ghats (Peninsular India), Sri Lanka and Indo-Burma. Here, we present a systematic revision of members of the genus Calotes from Peninsular India using a combination of molecular phylogeny, geographical distribution and morphological characters. We show that Calotes from the Western Ghats is paraphyletic and consists of three major clades, one of which is widely distributed in South and Southeast (SE) Asia, while the others are restricted to Peninsular India. The Peninsular Indian clade is composed of two sister clades: Psammophilus, with a wider distribution and a second clade, composed of two extant species, Calotes rouxii and Calotes ellioti and two new species, all restricted to the Western Ghats region. Based on morphological differences, we retain the generic status of Psammophilus and assign its sister clade to a new genus Monilesaurus gen. nov. and transfer the following species, C. rouxii and C. ellioti, to this new genus. We also provide diagnoses and descriptions for two new species recognized within Monilesaurus gen. nov. In addition, Calotes aurantolabium from the Western Ghats was observed to be deeply divergent and to share a sister-relationship with the clade composed of Calotes, Monilesaurus gen. nov., and Psammophilus. Based on its phylogenetic position and morphological attributes, we assign this species to a new genus Microauris gen. nov. These new discoveries highlight the evolutionary significance of the Western Ghats in housing novel lizard diversity.

Background: Lung ultrasound is an effective tool for diagnosing pneumonia in developed countries. Diagnostic accuracy in resource-limited countries where pneumonia is the leading cause of death is unknown. The objective of this study was to evaluate the sensitivity of bedside lung ultrasound compared to chest X-ray for pneumonia in adults presenting for emergency care in a low-income country., Methods: Patients presenting to the emergency department with suspected pneumonia were evaluated with bedside lung ultrasound, single posterioranterior chest radiograph, and computed tomography (CT). Using CT as the gold standard, the sensitivity of lung ultrasound was compared to chest X-ray for the diagnosis of pneumonia using McNemar's test for paired samples. Diagnostic characteristics for each test were calculated., Results: Of 62 patients included in the study, 44 (71%) were diagnosed with pneumonia by CT. Lung ultrasound demonstrated a sensitivity of 91% compared to chest X-ray which had a sensitivity of 73% (p = 0.01). Specificity of lung ultrasound and chest X-ray were 61 and 50% respectively., Conclusions: Bedside lung ultrasound demonstrated better sensitivity than chest X-ray for the diagnosis of pneumonia in Nepal., Trial Registration: ClinicalTrials.gov, registration number NCT02949141 . Registered 31 October 2016.

Background: Resuscitation of a critically-ill child requires an accurate weight for fluids and medication dosing; however, weighing children on a scale while critically ill is not always practical. The objective of this study is to determine the accuracy of three different weight estimation methods (Broselow, PAWPER XL and Mercy tape) of children presenting to Patan Hospital, Nepal., Methods: This was a prospective, cross-sectional study that included children presenting to the emergency department and under-fourteen outpatient clinic at Patan Hospital. Measured weight was compared to estimated weight of Broselow, PAWPER XL, and Mercy tapes. The mean percentage error and percentage of estimated weights that were within 10% (PW10) and 20% (PW20) of actual weight were calculated. Acceptable accuracy was determined as a PW10>70% and PW20>95%. A Bland-Altman analysis was done to determine agreement between each weight estimation method and actual weight., Results: The study included 813 children. The mean age was 4.2 years (ranging from 4 days to 14 years) with 60% male. The mean percentage error (MPE) for Broselow, PAWPER XL and Mercy were -1.0% (SD 11.8), 0.7% (10.5) and 4.2% (11.9) respectively. The predicted weight within 10% was highest for the PAWPER XL (71.5%) followed by Broselow (63.2%) and Mercy (58.1%). The predicted weight within 20% of actual weight was 95.2%, 91.5% and 91.3% for PAWPER XL, Broselow and Mercy respectively., Conclusion: The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children., Competing Interests: Conflicts of interest: The authors declare that there are no conflicts of interest regarding the publication of this paper.

Background: For children worldwide, diarrhea is the second leading cause of death. These deaths are preventable by fluid resuscitation. Nasogastric tubes (NGs) have been shown to be equivalent to intravenous fluids for rehydration and recommended by the World Health Organization (WHO) for use in severe dehydration. Despite this, NGs are rarely used for rehydration in Kenya. Our objective was to evaluate clinicians' adherence to rehydration guidelines and to identify barriers to the use of NGs for resuscitating dehydrated children., Methods: A case-based structured survey was administered to pediatric care providers in western Kenya to determine their choices for alternative rehydration therapies when oral rehydration and intravenous fluids fail. Providers then participated in a qualitative, semi-structured interview to identify barriers to using nasogastric tubes for rehydration. Analysis included manual, progressive coding of interview transcripts to identify emerging central themes., Results: Of 44 participants, only four (9%) followed WHO guidelines that recommend quickly switching to NG for rehydration in their case responses. Participants identified that placing intravenous lines in dehydrated children is a challenge. However, when discussing NG use, many believed NGs are not effective for rehydration. Other participants' concerns surrounded knowledge and training regarding guidelines as well as not having NGs available., Discussion: Healthcare providers in western Kenya do not report using NGs for rehydration in accordance with WHO guidelines for diarrheal illness with severe dehydration. Barriers to the use of NG tubes were lack of knowledge and availability. Education and implementation of guidelines using NG tubes for rehydration may improve outcomes of children suffering from diarrheal illness with severe dehydration., Competing Interests: The authors declare there are no competing interests.

Study Design: Descriptive study., Objectives: To describe the epidemiological features of spinal cord injury (SCI) following the 2015 earthquakes in Nepal., Setting: Spinal Injury Rehabilitation Centre, Kavre, Nepal., Methods: Data were collected from the medical records of all earthquake-related patients seen from 25 April 2015 through to 16 June 2016. Data collected included patient demographics, mechanism of injury, initial medical treatment, neurological assessment, complications, neurological/functional outcomes and length of stay., Results: Data from 117 earthquake-related SCI patients were evaluated, with a female-to-male ratio of 1.3:1. In total, 108 patients (92%) sustained vertebral fracture and/or dislocation. Seventy-seven patients had undergone surgical fixation. The majority of patients (81%) presented with paraplegia, of whom most (60%) were incomplete. Thirty-eight (33%) patients had documented pressure ulcers upon admission; six (5%) patients developed new pressure ulcers during their rehabilitation stay. Urinary tract infection was seen in 34 (29%) patients. Seven (6%) patients were diagnosed with deep vein thrombosis. One patient developed clinically significant heterotopic ossification. Significant improvements were seen in patients' functional outcomes before discharge. Two deaths occurred in this patient population., Conclusions: The Nepal earthquakes resulted in a significant number of SCIs, the majority occurring in women. Incomplete paraplegia was the most common presentation. Pressure ulcer, the most frequent complication, primarily occurred before rehabilitation admission. Continued efforts focused on comprehensive planning, and preparedness for SCI-specific interdisciplinary care following earthquakes, particularly in resource-limited settings, is critical to ensuring survival, preventing complications and optimizing functional outcomes in this patient population.

Objectives: Vocal fry is a voice register often used by young adult women for sociolinguistic purposes. Some acoustic correlates of lexical stress, however, appear incompatible with the use of vocal fry. The objective of this study was to systematically examine the role of lexical stress in the use of vocal fry by young adult women., Study Design: This is a semi-randomized controlled laboratory study., Methods: Fifty female undergraduate students were recorded repeating one-, two-, three-, and four-syllable nonwords that conformed to English phonotactics. Nonwords were presented in order from shorter to longer lengths, with stimuli randomized within syllable length. Perceptual analyses of recordings were augmented by acoustic analyses to identify each syllable in which vocal fry occurred., Results: Eighty-six percent of participants produced at least one episode of vocal fry. Vocal fry was more likely to occur in unstressed than stressed position, and the likelihood increased as distance from the stressed syllable increased. There was considerable variability in the use of vocal fry. Frequent and infrequent users varied on the degree to which they used vocal fry in single-syllable nonwords., Conclusions: Vocal fry use persists among young adult women even in the absence of syntactic and pragmatic influences. Lexical stress appeared to dramatically reduce the use of vocal fry. Patterns of vocal fry use appeared to be different for frequent and infrequent users of this vocal register., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

A new species of Cyrtodactylus (Geckoella) from the C. collegalensis complex is described based on a series of specimens from western and central India. Morphological and molecular data support the distinctiveness of the new form, which can be diagnosed from other Cyrtodactylus (including other Geckoella) species by its small body size (snout to vent length to 56 mm), the absence of precloacal and femoral pores, no enlarged preanal or femoral scales, and a dorsal scalation consisting wholly of small, granular scales. The new species is most closely related to C. collegalensis, C. speciosus and C. yakhuna, from which it differs by the presence of a patch of enlarged roughly hexagonal scales on the canthus rostralis and beneath the angle of jaw, its relatively long limbs and narrow body, and a dorsal colour pattern of 4-6 pairs of dark spots.

While considerable attention has been focused on understanding the myriad of ethical analysis in international research in low and middle income countries, new issues always arise that have not been anticipated in guidelines or studied extensively. The disruption of medical care arising as a direct result of political actions, including strikes, postelection violence and related activities, is one such issue that leaves physician-researchers struggling to manage often conflicting professional responsibilities. This paper discusses the ethical conflicts that arise for physician-researchers, particularly when disruption threatens the completion of a study or completion is possible but at the expense of not addressing unmet medical needs of patients. We review three pragmatic strategies and the ethical issues arising from each: not starting research, stopping research that has already started, and continuing research already initiated. We argue that during episodes of medical care disruption, research that has been started can be continued only if the ethical standards imposed at the beginning of the study can continue to be met; however, studies that have been approved but not yet started should not begin until the disruption has ended and ethical standards can again be assured., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

As policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems., (© 2013 by the Society for Academic Emergency Medicine.)

Drug-evoked synaptic plasticity in the mesolimbic system reshapes circuit function and drives drug-adaptive behavior. Much research has focused on excitatory transmission in the ventral tegmental area (VTA) and the nucleus accumbens (NAc). How drug-evoked synaptic plasticity of inhibitory transmission affects circuit adaptations remains unknown. We found that medium spiny neurons expressing dopamine (DA) receptor type 1 (D1R-MSNs) of the NAc project to the VTA, strongly preferring the GABA neurons of the VTA. Repeated in vivo exposure to cocaine evoked synaptic potentiation at this synapse, occluding homosynaptic inhibitory long-term potentiation. The activity of the VTA GABA neurons was thus reduced and DA neurons were disinhibited. Cocaine-evoked potentiation of GABA release from D1R-MSNs affected drug-adaptive behavior, which identifies these neurons as a promising target for novel addiction treatments.

Examination of type material and new collections from Goa, southern Maharashtra and northern Karnataka, leads to the conclusion that Gegeneophis nadkarnii Bhatta & Prashanth, 2004 is a subjective junior synonym of Gegeneophis danieli Giri, Wilkinson & Gower, 2003. The purported differences between these species are very minor and attributable to nor-mal individual variation, except for some features of the dentition that are peculiar to the exceptionally abnormal paratype of G. nadkarnii. This taxonomic revision extends the known geographic range of G. danieli and suggests it could be trans-ferred from Data Deficient to Least Concern status in the IUCN Red List.

Study Objective: Validated methods for weight estimation of children are readily available in developed countries; however, their utility in developing countries with higher rates of malnutrition and infectious disease is unknown. The goal of this study is to determine the validity of a height-based estimate, the Broselow tape, compared with age-based estimations among pediatric patients in Western Kenya., Methods: A prospective cross-sectional study of all sick children presenting to the emergency department of a government referral hospital in Eldoret, Kenya, was performed. Measured weight was compared with predicted weights according to the Broselow tape and commonly used advanced pediatric life support (APLS) and Nelson's age-based formulas. A Bland-Altman analysis was used to determine agreement between each method and actual weight. The method for weight prediction was determined a priori to be equivalent to the actual weight if the 95% confidence interval for the mean percentage difference between the predicted and actual weight was less than 10%., Results: Nine hundred sixty-seven children were included in analysis. The overall mean percentage difference for the actual weight and Broselow predicted weight was -2.2%, whereas APLS and Nelson's predictions were -5.2% and -10.4%, respectively. The overall agreement between Broselow color zone and actual weight was 65.5%, with overestimate typically occurring by only 1 color zone., Conclusion: The Broselow tape and APLS formula predict the weights of children in western Kenya. According to its better performance, ease of use, and provision of drug dosing and equipment size, the Broselow tape is superior to age-based formulas for estimation of weight in Kenyan children., (Copyright © 2012. Published by Mosby, Inc.)

Sensory experience drives robust plasticity of sensory maps in cerebral cortex, but the role of inhibitory circuits in this process is not fully understood. We show that classical deprivation-induced whisker map plasticity in layer 2/3 (L2/3) of rat somatosensory (S1) cortex involves robust weakening of L4-L2/3 feedforward inhibition. This weakening was caused by reduced L4 excitation onto L2/3 fast-spiking (FS) interneurons, which mediate sensitive feedforward inhibition and was partially offset by strengthening of unitary FS to L2/3 pyramidal cell synapses. Weakening of feedforward inhibition paralleled the known weakening of feedforward excitation. As a result, mean excitation-inhibition balance and timing onto L2/3 pyramidal cells were preserved. Thus, reduced feedforward inhibition is a covert compensatory process that can maintain excitatory-inhibitory balance during classical deprivation-induced Hebbian map plasticity., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Market power among dental insurance carriers is a carrier's ability to reimburse dentists at rates below what would exist in more competitive areas. Competition among carriers for dentists' participation in their networks protects dentists from highly discounted fees. The authors examined the extent to which dental insurance carriers facing less competition increase fee discounts., Methods: The authors selected a sample of dentists from listings of general practitioners. They identified 219 metropolitan areas and contacted 11,542 dentists in those areas by mail, telephone or both. A total of 8,017 dentists completed surveys (a response rate of 69.46 percent). The authors' key focus was the possible relationship between carrier market power and the size of the fee discount. The authors compared discounts across metropolitan areas with their differing levels of insurance coverage and carrier market shares., Results: Carrier market power was directly related to the sizes of fee discounts. The larger discounts were found where there was significant dental insurance coverage and few carriers providing this coverage. Dentists' net incomes were significantly less in areas with larger fee discounts., Conclusions and Practice Implications: Dental insurance carrier market power leads to increased fee discounts. These higher discounts reduce dentists' earnings. Although the larger discounts may result in lower overall patient costs, this patient benefit is temporary. Ultimately, the number of practicing dentists in these communities will decrease as dentists seek improved practicing conditions elsewhere. This reduction will lead to overall fee increases until the earning potential of dentists is restored.

This article discusses the problem of iron and manganese contamination, the adverse effects and available control methods. The presence of iron and manganese in water causes serious commercial and health problems. Various treatment methods are available to treat water contaminated with these elements. However, catalytic media is an excellent choice particularly increasing given the preference for non-chemical water treatment. INDION ISR and BIRM are the most popularly used synthetically manufactured catalytic media.

The following article has been prepared by the American Dental Association (ADA) at the request of the Minnesota Dental Association (MDA). The article is the culmination of a rigorous national study by the ADA to measure the concentration of dental insurance in major dental marketplaces around the country. Five Metropolitan Statistical Areas (MSA's)from Minnesota were compared to other MSA's around the country. The results of this study are very significant for dentists and dental patients in Minnesota. Minnesota' practicing dental community may find the results of the study to be somewhat disturbing. Nevertheless, the MDA believes that it is important to share the results of this study with MDA members and others in the Minnesota dental community. It is important to consider both the study's short-term ramifications, as well as its long-term implications, as we attempt to better understand Minnesota's dental marketplace. It is also important for MDA members to know that the ADA brought the results of this study as they relate to the Minnesota Dental Marketplace to the appropriate federal agencies. The ADA believed that these agencies might choose to develop it into an anti-trust case. After reviewing the matter and working with the ADA over a long period of time, these agencies decided that they would not proceed with a Minnesota-based anti-trust case; additional information beyond what the ADA was legally able to provide was needed by the federal agencies in order for them to proceed. The MDA will continue to analyze and respond to these dental marketplace developments.

Background: The goal of the authors' research was to determine the national economic impact of expenditures arising from the provision of dental services., Methods: The authors used a well-known and accepted methodology in economics known as input-output analysis to measure the economic impact. These models describe--among other things--the interrelationships between businesses, government, households and the foreign sector with regard to where inputs come from and where outputs go., Results: For 2000, national expenditures attributable to the provision of dental services were calculated at dollar 203.6 billion. Dentistry accounted for more than two million jobs nationwide. Taxes generated directly or indirectly from dental activity totaled more than dollar 33 billion. The annual impact of one additional dentist on the economy was estimated at dollar 1,278,253., Conclusions: Dentistry provides substantial local and national economic benefits, including increased economic activity, employment and tax revenues. For small counties, an additional dentist provides a significant boost to the local economy.

Previous studies have shown that overexpression of the protein PSD-95 (postsynaptic density-95) selectively enhances AMPA receptor-mediated synaptic responses in hippocampal pyramidal cells. To determine whether this effect is related to synaptic plasticity at these synapses, we examined whether PSD-95 expression mimics long-term potentiation (LTP), and also whether it influences LTP and long-term depression (LTD) in hippocampal slice cultures. Using simultaneous recording from transfected or infected cells and control pyramidal cells, we found that PSD-95, similar to LTP, increases the amplitude and frequency of miniature EPSCs. It also converts silent synapses to functional synapses, as does LTP. In addition, LTP is completely occluded in cells expressing PSD-95, whereas LTD is greatly enhanced. These results suggest that common mechanisms are involved in controlling synaptic AMPA receptors by PSD-95 and synaptic plasticity.

Insurance now pays for slightly less than 50% of America's dental bill. The explosive growth in dental insurance in the 1970s and 1980s is traced to the tax effect (coverage paid for with pre-tax dollars offsets fees up to a point) and the insurance effect (costs for care can be projected, although improvements in oral health status are leading to lower projected costs). An equilibrium point appears to have been reached. Dentists must weigh the trade-offs between discounted fees and increased number of patients, and carriers must weight the trade-offs between smaller discounts and wider participation by dentists. There are no market forces forecast that will substantially change this equilibrium in the near future.

Policy initiated in the 1970s follows the contention that competitive forces do not work and new types of regulation are warranted. This article presents an expanded demand-supply theory introducing patient waiting time as a component of full price. Equilibrium is reached through adjustments in both fee levels and waiting time. Competitive markets require unequal fee levels among providers in the same community and differing provider-to-population ratios across communities. The evidence from dentistry presented supports this expanded theory. Fees and waiting time are inversely related and full price is apparently insensitive to dentist density. Communities seeking higher fees and shorter waits attract more dentists per capita. Two additional studies cited further support this expanded approach. Patient waiting time is an important component of price.