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Study-specific data quality testing is an essential part of minimizing analytic errors, particularly for studies making secondary use of clinical data. We applied a systematic and reproducible approach for study-specific data quality testing to the analysis plan for PRESERVE, a 15-site, EHR-based observational study of chronic kidney disease in children. This approach integrated widely adopted data quality concepts with healthcare-specific evaluation methods. We implemented two rounds of data quality assessment. The first produced high-level evaluation using aggregate results from a distributed query, focused on cohort identification and main analytic requirements. The second focused on extended testing of row-level data centralized for analysis. We systematized reporting and cataloguing of data quality issues, providing institutional teams with prioritized issues for resolution. We tracked improvements and documented anomalous data for consideration during analyses. The checks we developed identified 115 and 157 data quality issues in the two rounds, involving completeness, data model conformance, cross-variable concordance, consistency, and plausibility, extending traditional data quality approaches to address more complex stratification and temporal patterns. Resolution efforts focused on higher priority issues, given finite study resources. In many cases, institutional teams were able to correct data extraction errors or obtain additional data, avoiding exclusion of 2 institutions entirely and resolving 123 other gaps. Other results identified complexities in measures of kidney function, bearing on the study's outcome definition. Where limitations such as these are intrinsic to clinical data, the study team must account for them in conducting analyses. This study rigorously evaluated fitness of data for intended use. The framework is reusable and built on a strong theoretical underpinning. Significant data quality issues that would have otherwise delayed analyses or made data unusable were addressed. This study highlights the need for teams combining subject-matter and informatics expertise to address data quality when working with real world data.

# Background Since the 1980’s, the state has opened up the healthcare sector to private investors, which has encouraged the emergence of health training institutions, resulting in the creation of private healthcare establishments (Etablissements de soins et services de santé - ESS). # Methods The aim of this study was to investigate the managerial factors of private entrepreneurship in healthcare that determine the level of activity of healthcare ESS. Econometric and statistical analysis was used to measure the relationship between the entrepreneur's profile and that of the ESS, on the one hand, and the latter's level of activity, on the other. This was an analytical cross-sectional study conducted in 57 first-contact private ESS in the N'sele ZS. # Results Each of the activity indicators was associated with bed capacity and occupancy rate; then, the number of beds per nurse and per doctor were associated with the average length of stay in the ESS and also with the share of stay in minor surgery; finally, the presence of an emergency department was associated with the share of stay in internal medicine. # Conclusions There is a relationship between bed utilization and capacity in private ESS, on the one hand, and the level of activity in private ESS in urban-rural areas, on the other. It also shows that the efficient organization of production factors influences the level of ESS activity.

Background: Despite the University of California San Francisco, the American Academy of Pediatric Dentistry (AAPD), and the Food and Drug Administration having approved the use of silver diamine fluoride (SDF) in arresting dentinal caries, literature available on its systemic absorption is limited. Aim: This study aimed to assess any systemic absorption of fluoride ion following the topical application of SDF in young children. Materials and Methods: Children aged between 3 and 6 years who were diagnosed with severe early childhood caries and required rehabilitation were recruited for the study. Before the onset of treatment for the arrest and control of caries, a baseline urine sample as a control was collected from the patient. In accordance with the manufacturer's instructions and AAPD guidelines, SDF was topically applied on a minimum of five carious teeth, following which additional urine samples were collected after 2 h and after 24 h, respectively, of application of SDF. The urine samples were stored at −20°C, and the estimation of fluoride ion concentrations in urine was then ascertained using a fluoride ion selective electrode. Results: The results revealed that the fluoride concentration in urine before application of SDF was 0.66 mg/L ± 0.25 mg/L, and following 2 h of application, it was 1.13 mg/L ± 0.23. However, 24 h postapplication, the urinary fluoride concentration was reduced to 0.63 mg/L ± 0.20, which is close to the baseline value of the control sample. Conclusion: There was no significant systemic absorption of fluoride following the application of SDF, and it could be adopted as an effective and safe agent in the armamentarium for managing caries in young children.

Background: A decision tree is a popular predictive modeling technique used to classify observations based on their properties and can also be used for numeric or categorical predictions. A logistic regression model estimates the relationship between a dependent categorical variable and one or more independent variables. Objective: To compare the performances of logistic regression and decision tree models for predicting mortality in patients with oral cavity cancer. Materials and Methods: This was a retrospective study on de-identified records of patients with oral cavity cancer who received treatment at Jawaharlal Institute of Post Graduate Medical Education and Research, a tertiary healthcare hospital in Puducherry, South India, from 2011 to 2017. The models were built by incorporating potential predictive variables such as stage of the cancer, tumor and node categories, and margin status. The performances of the classification models were compared using sensitivity, specificity, predictive accuracy, and by plotting the area under the receiver operating characteristic (ROC) curves. Results: Among the 427 patients who received treatment for oral cavity cancer between 2011 and 2017, we included 275 who had undergone surgery and whose histopathology details were available. There were 180 (65.5%) male patients. The median age was 55 years (range, 26-87). The tumor stage and margin status of the cancer were found to be significant predictors of mortality in a multiple logistic regression model. The predictive accuracies and the areas under the ROC curves of logistic regression and decision tree models were found to be similar. Conclusion: A decision tree method along with other machine learning algorithms could be an innovative alternative to statistical models for the prediction of outcomes when the assumptions of these models fail. The application of these machine learning algorithms can help risk stratify patients with oral cavity cancer and thus aid in their treatment planning.

This article examines the effects of combining silica-rich Halloysite Nano Tube (HNT) and Molybdenum di Sulphide (MoS _2 ) as hybrid reinforcements, dispersed at volumes of 2, 4, and 6%, on the surface of AZ31 alloy through the application of the friction stir process (FSP). The prepared composites were analysed to evaluate their microstructure, mechanical properties, wear resistance, and corrosion characteristics. Microstructural observations indicate the occurrence of rapid recrystallization, resulting in reduced grain size and uniform dispersion. The surface composite demonstrates an increasing trend in hardness with the addition of HNT, while hardness decreases with the inclusion of MoS _2 . The micro tensile test results exhibits that the composite exhibits an increasing trend in strength, while the micrograph of the fractured surface of the micro tensile specimens reveals reduced ductility. The composite displays enhanced wear behaviour with the increasing volume percentages of HNT and MoS _2 particles. Solid lubricant nature of the secondary reinforcement and enhanced hardness due to HNT addition and FSP leads to higher wear resistance of the developed hybrid composite. Additionally, the corrosion rate decreases with the addition of HNT, whereas higher concentrations of MoS _2 lead to increased corrosion.

Introduction: Achieving a correct occlusion depends heavily on the axial inclination of the teeth, particularly the maxillary anteriors, which have the longest crowns. This study, which expanded the use of angular measures to the mandible, was created to determine the prevalence of adversely angulated canines using orthopantomograms. Methods: A sample of 200 people between the ages of 18 and 25 was chosen and separated into two groups based on the degree of crowding; one group served as the control group while the other, which experienced severe, crowding, served as the study group. All of the individuals had their Orthopantomogram and study models taken. Results: While canine angulation in controls typically ranges from 85 to 95 degrees, cases of crowding were observed to have angulation as low as 67 degrees and as high as 105 degrees. Conclusion: Orthopantomogram can be used to predict canine angulation, with distally and mesially angulated canines occurring at rates of roughly 18% and 37%, respectively.

In most sexually reproducing organisms crossing over between chromosome homologs during meiosis is essential to produce haploid gametes. Most crossovers that form in meiosis in budding yeast result from the biased resolution of double Holliday junction (dHJ) intermediates. This dHJ resolution step involves the actions of Rad2/XPG family nuclease Exo1 and the Mlh1-Mlh3 mismatch repair endonuclease. Here, we provide genetic evidence in baker's yeast that Exo1 promotes meiotic crossing over by protecting DNA nicks from ligation. We found that structural elements in Exo1 that interact with DNA, such as those required for the bending of DNA during nick/flap recognition, are critical for its role in crossing over. Consistent with these observations, meiotic expression of the Rad2/XPG family member Rad27 partially rescued the crossover defect in exo1 null mutants, and meiotic overexpression of Cdc9 ligase reduced the crossover levels of exo1 DNA-binding mutants to levels that approached the exo1 null. In addition, our work identified a role for Exo1 in crossover interference. Together, these studies provide experimental evidence for Exo1-protected nicks being critical for the formation of meiotic crossovers and their distribution.

Introduction: During the initial phase of COVID-19 pandemic crisis, the schools and educational institutions were closed countrywide. Hence, more than 90% of students admitted to educational institutions worldwide are affected as 188 countries have implemented COVID restrictions. Hence, this study focuses on the health status of adolescent students during the shutdown of educational institutions during the COVID-19 pandemic. Aim and Objective: This study assesses mental health, dental health, eye health, physical activity, immunization, and nutrition in adolescents during the COVID-19 pandemic among adolescent boys and girls. Materials and Methods: The current cross-sectional study was done among school-going adolescent children. One hundred and eighty students from different syllabus systems and urban and rural parts of north Kerala participated. The data collected were entered into an excel sheet and analyzed using the SPSS software. Results: 59.4% of students have gained weight due to sedentary behaviour. Students spend more time in front (95%) of a digital screen, leading to computer vision syndrome. Loss of social interactions adversely affected students' mental health by 37.8%. Thirty percentage of physically active students were involved in indoor physical activities such as Zumba and aerobics. In addition, 77% of students have not taken their routine immunization. Conclusion: The newer learning methods have impacted the students' knowledge. There is no uniformity in the form of teaching. Multiple factors have played a role in improving the lockdown situation, including the families, schools, local authorities, government, digital media, and newspapers.

BACKGROUND: Vasovagal reactions to blood donation though generally mild and account for about 1% of donations, causes embarrassment/injury to the donors, lower likely return rates for future donations etc. The workforce hours devoted to attending to those who reacted can also affect the efficiency of the blood centre. There are various factors, both modifiable and nonmodifiable, involved in the causation of such reactions. OBJECTIVES: This study sought to identify the factors associated with vasovagal donor reactions in a case–control study. MATERIALS AND METHODS: This was a descriptive comparative study between donors who had VVRs (cases) and those who did not (controls) during or after blood donation from a single center in southern India. All the biophysical and demographic variables were collected from the donor records. In addition, a questionnaire was administered to the donors after donation within half an hour, addressing the psychosocial variables. All the data were captured in Microsoft Excel and analyzed using SPSS for Windows version 20. RESULTS: A total of 178 donors who had donor reactions were included in the study with an equal number of controls who were age and sex-matched. Donors who had VVRs had an odds of 4.1 (95% confidence interval [CI]: 2.4–7.7) of admitted anxiety for blood donation. They also had an odds of 4.4 (95% CI: 2.8–6.9) of disturbed sleep the night before blood donation. Having an accompanying person to the blood center was detrimental, with an odds of 0.32 (95% CI: 0.2–0.6). Donors with local complications such as hematoma, double prick, or delayed collection had an odds of 21.2 (95% CI: 1.8–159.8) of developing VVR. CONCLUSION: The psychosocial factors such as fear of the needle, the sight of the blood, state of mind, and quality and duration of sleep seem to have an association, adversely impacting the donors resulting in VVRs after/during blood donation.

Background: In pediatric daycare surgery, I gel has been used safely and effectively in anesthetized children. I-gel size is determined routinely by the manufacture's recommended weight-based method. The dimension of thenar eminence can help in determining I-gel size. The aim of this study was to compare the weight-based method and thenar eminence dimension method in the selection of I gel. Subjects and Methods: The prospective, randomized, single-blind study included 80 patients of the age group 6 months to 12 years, the American Society of Anesthesiologists class I, II, and III of either gender who were undergoing surgery under general anesthesia. Group 1– (n = 40) recommended weight-based method and group 2 – (n = 40) thenar eminence-based method. Parameters observed were proper placement, adequate ventilation, leak fraction (LF), and number of attempts. Results: Proper placement and adequate ventilation were comparable between two groups. LF is statistically higher in group 1 compared to group 2 (P = 0.003). The mean insertion time was 17 s in each group. The number of attempts, hemodynamic parameters, and ease of insertion were all comparable between two groups. Conclusions: Thenar eminence dimension can be the better method for the recommended weight-based method, especially in the emergency situations when the weight cannot be determined.

Background: Mental illnesses are becoming a major health issue across the world. The availability of inpatient facilities for mentally ill patients is very much limited in developing countries such as India. Aim: This study was aimed to explore the pattern of psychiatric admissions at a general hospital psychiatry unit (GHPU) in South India. Methodology: The study was conducted at a multispecialty tertiary care hospital in South India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the department of psychiatry, the medical records department, and the electronic hospital information system of the institute were reviewed between April 2006 and March 2016. Results: A total of 3082 patients were admitted as psychiatry inpatients during the 10-year study period, representing an average of 308.2 admissions per calendar year. The majority of inpatients were male (n = 1824; 59.2%). Concerning diagnostic categories, mood disorders were accounted for 33.6% of admissions, followed by psychotic disorders (26.4%) and substance use disorders (19.3%), respectively. The median length of hospital stay was 14 days (range 0–163 days). A statistically significant seasonality pattern was noticed for mood disorders (December to February) and anxiety and neurotic disorders (August to October). Conclusion: It is obvious that treatment-seeking attitude among individuals with mental illnesses is increasing and the awareness regarding treatment aspects is also increasing among the general public. Hence, there is a need to improve the existing resources to facilitate intensive management for better treatment outcomes and this, in turn, will enhance the quality of life of mentally ill individuals.

We describe here nesting biology of Hoplonomia westwoodi, a common ground nesting solitary bee in India. A typical nest consisted of a straight main tunnel with the cells arranged horizontally at the end. Number of cells per nest ranged from 2 to 4 (x̄ = 2.67). Polypropylene bag and pot culture studies, to evaluate soil types preferred by the bees for nesting, showed that red soil + FYM (1:1) was the most preferred substrate with an average of 12.67 nests/bag. Maximum foraging activity was between 8:00 -13:00 hours. Though H. westwoodi bees were active throughout the year, higher foraging activity was observed between March to June. The species being polylectic, foraged on flowers of several families including Myrtaceae, Lamiaceae, Portulacaceae, Convolvulaceae, Lythraceae, Meliaceae, Rubiaceae, Solanaceae, Cucurbitaceae, Asteraceae, Fabaceae and Malvaceae. A cleptoparasite, Eupetersia sp. was observed in the nests of H. westwoodi, which is the first record of Eupetersia sp. parasitisation on the genus Hoplonomia.

Snake bite is an important cause for acute kidney injury (AKI) in the tropics and the victims are often otherwise healthy young adults without conventional risk factors for chronic kidney disease (CKD). Available literature on long-term outcomes of AKI –snake envenomation is limited, with only two small retrospective studies with follow-up periods of two years or less. In a hospital-based prospective and retrospective follow-up study, all consecutive adult patients who developed AKI and discharged alive were recruited in the prospective group and for retrospective analysis, we retrieved medical records of patients hospitalized with snake bite from the digitized medical records. Clinical and biochemical characteristics during hospitalization and on follow-up were collected. We recruited 193 patients with snake bite and AKI in a prospective (140) and a retrospective (53) group. Of the 193 AKI patients, 162 (84%) had estimated glomerular filtration rate (eGFR)

Autoimmune hemolytic anemia (AIHA) is a very rare presentation of COVID-19, and AIHA due to COVID-19 alone (i.e., in the absence of an associated underlying disorder) is extremely rare. Warm agglutinin disease accounts for the majority of AIHA in general. Here, we report a case of a 23-year-old male with bronchial asthma who was referred to our hospital with SARS-COV-2 infection and severe anemia presenting as acute immune-mediated hemolytic crisis due to warm autoimmune hemolytic anemia (AIHA). Extensive laboratory testing was performed, including polyspecific direct antiglobulin test, complete autoimmune workup and common infections leading to AIHA were ruled out by serology and molecular methods. The patient required multiple blood transfusions and other therapeutic interventions before clinical stabilization. Treatment of new-onset AIHA is always challenging in the presence of an active viral replication; combining immunosuppression with active COVID-19 infection creates extremely difficult diagnostic and management settings, as this case illustrates.

INTRODUCTION: Gamma Irradiation of blood products accentuates biochemical changes in the blood stored at 4°C. This study tried to compare the changes in potassium, sodium, glucose, lactate, and lactate dehydrogenase (LDH) levels in packed red blood cell (PRBC) units irradiated at various time points and then stored versus those stored for a particular period then irradiated.METHODOLOGY: One hundred and eighty units of RBCs were randomly assigned equally to be irradiated or not. Eighteen units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on day 1, 7, 14, 21, and 28 of their storage, respectively, in the irradiation group. All the units were assessed for their plasma levels of potassium, sodium, glucose, LDH, and lactate by clinical chemistry auto analyzer Beckman coulter AU680 weekly. The values were documented and analyzed by SPSS.RESULTS: Baseline values on day 1 for studied biochemical parameters were comparable between irradiated and nonirradiated groups. Mean values of potassium, lactate and LDH were higher in irradiated than nonirradiated PRBC bags. In contrast, Sodium and Glucose mean values were lower than baseline values. Maximum cumulative mean values were noted in day-21 irradiated bags when the parameters were measured on day-28 for potassium and lactate levels. This was followed by day 14 irradiated bags, followed by day 7 irradiated bags.CONCLUSION: The study indicates that irradiation of red cells later in their storage period had comparatively more detrimental changes in relation to potassium and lactate than irradiation in earlier days. Consideration of irradiation to be performed as close to the issue as possible to reduce a lesser number of days of storage postirradiation is to be explored.

BACKGROUND AND OBJECTIVES: The curve of Spee is a naturally occurring phenomenon in the human dentition. Leveling the curve of Spee can affect the Frankfort-mandibular plane (FMP) Angle and thus the lower anterior facial height. This study examined the degree of change in FMP angle after leveling the curve of Spee in different malocclusion groups. METHODS: In this study, 75 patients who were aged >14 years and had undergone fixed appliance therapy using a 0.022-slot MBT bracket system were included. The pre- and post-treatment casts and lateral cephalograms of the patients were divided into three groups, namely Class I, II, and III malocclusions, with 25 patients in each group. The curve of Spee and FMP angle were measured before and after orthodontic treatment, and their correlation was evaluated. RESULTS: After leveling the curve of Spee, the FMP angle decreased in Class I and II groups and increased in Class III group. These results were statistically significant except in Class I malocclusion group. A mild positive correlation was observed between the curve of Spee and FMP angle in Class I and III malocclusion groups and a negative correlation in Class II malocclusion group. CONCLUSION: The change in FMP angle, following the leveling of the curve of Spee, in Class II and III malocclusion group, is attributed to alterations in lower anterior facial height. The study observed a mild positive correlation between the curve of Spee and FMP angle in Class I and III malocclusion groups and a negative correlation in Class II malocclusion group.

Context: Dental fear is a common and imperative emotion that develop as a response to the stressful situation, which raises children's anxiety level and resulting in avoidance behavior. Aims: The aim of this study is to evaluate and compare the tell-show-do technique with and without the aid of a virtual tool in the management of pediatric dental patients. Settings and Design: Department of Pediatric and Preventive Dentistry, nonrandomized clinical trial. Subjects and Methods: A total of 90 children of the age group of 6–9 years who were in the need of restorative treatment without using local anesthesia were assigned into two groups: Control group, where tell-show-do was applied as behavior management technique and intervention group in which tell-show-do with the aid of a virtual tool was applied. Child anxiety level was assessed using a combination of anxiety rating parameters before and after the procedure. Three physiological parameters (heart rate, oxygen saturation, and respiratory rate) and two behavioral parameters (Wright's modification of Frankl' behavior Rating Scale and Facial Image Scale) were recorded. Statistical Analysis Used: Physiological parameters were analyzed using the independent sample t-test and behavioral parameters using the Mann–Whitney U-test (P < 0.05). Results: A significant difference in all five parameters was observed between the control group and intervention group. Conclusions: Virtual tool offers a new concept of virtual distraction aid in pediatric dentistry, and it was found to be very effective in managing anxious pediatric patients. This promising method diminishes the unpleasantness often associated with dental procedures and offers a relaxed state in children.

Introduction: Oral cavity contains a plethora of microorganisms. These microorganisms have shown both beneficence and maleficence. The most common disease affecting the oral cavity not only to the human being but also for the animals was dental caries that are proved to have multi-bacterial origin. Bacterial species such as Streptococcus mutans (S.mutans), S.sanguis and Lactobacillus fermentum plays a major role in the pathogenesis of this disease. In this study, the crude extract of sargassum wightii is tested for its antibacterial efficacy against the S.mutants. Materials and Methods: The brown seaweed S. wightii was collected from the Gulf of Mannar. The samples were cut into small pieces and shade dried for five days. After drying, the samples were grounded and stored. Stock solution was prepared using soxhlet apparatus. The organic extract of the seaweed S. wightii was assayed for the antimicrobial activity against S. mutans using agar diffusion method and the result was compared with the positive control sample (Ampicillin). Results: Stock solution of S.wightii used in this study was prepared in the following grades 500, 750, and 1000 μg. It was found that zone of inhibition increased steadily as the concentration of the extract increased. Highest inhibition zone of about 23 mm was found out at the concentration of 1000 μg, whereas the control showed 38 mm. Result showed the definite antibacterial activity of S.wightii even with the crude extract. Conclusion: Majority of the treatment and preventive approaches for dental caries are based on the use of synthetic antibiotics and chemicals. Their excessive use leads to alterations in the oral and intestinal microbiome, development of resistance and other undesirable side effects. The use of natural resources or products has proven to be copious source of biologically active compounds.

HCV infection treatment regimens are viewed from positions of HCV life cycle and replication, effects of NS3/4A protease inhibitors and NS5A/NS5B inhibitors on HCV strain replication. Evolution of HCV treatment regimens from its discovery to modern DAA agents had led to substantial progress although drug resistance poses a new issue to be addressed.

Most commonly, skin grafts are used to resurface the raw areas resulting after the release of postburn contractures but in the extensively burned patient, donor sites may be limited. There is no accurate technique described in literature for the assessment of the true defect preoperatively. We describe a technique to accurately assess the true defect which helps to determine the amount of skin graft required preoperatively.

Prevalence of gastrointestinal (GI) parasites in native Tibetan sheep (Ovis aries), a critically endangered small ruminant of North district of Sikkim, India was studied during July 2014 to June 2015. Of the 213 animals examined, 71 (33.33%) were found positive for different GI parasites. The overall prevalence of different parasites recorded was strongyles (67, 31.46%), coccidia (52, 24.41%), Strongyloides spp. (41, 19.24%), Moniezia spp. (37, 17.37%), Nematodirus spp. (25, 11.73%), amphistomes (12, 5.63%), Dicrocoelium spp. (9, 4.22%) and Trichuris spp. (8, 3.76%). The faecal egg counts (eggs per gram of faeces, epg) of nematodes ranged from 100 to 2700 with higher load during rainy and post rainy seasons. A higher infection rate was recorded in animals above 2 years of age (39.29%) followed by 1 to 2 year (24.14%) while those below 1 year of age showed only 13.33% prevalence and the parasites mostly recorded were Haemonchus spp., Eimeria spp. and Moniezia spp. The seasonal distribution of parasitism indicated a higher percentage of infestation in autumn (44.26%) and summer (37.74%) as compared to spring (31.92%) and winter (17.31%).

Microgrids have gathered a significant amount of attention within the past decade and becoming an essential asset in the energy industry. The ability to integrate sustainable energy generation methods into the distribution network is one of the main reasons for microgrids popularity. A wide variety of Distributed Generation (DG) including wind and other micro-turbine generation, photovoltaic generation along with energy storage, makes the microgrid viable in both grid-connected and islanded modes while reducing the power losses. There are various technical challenges to be tackled in order to harvest the full potential of microgrids, and protection is one of them. Various solutions were introduced, driven by the development of protection techniques. One of the most promising approaches for microgrid protection is adaptive protection. This paper contains a systematic review on adaptive protection of microgrids, including a wide range of applicability variants, their strengths, and drawbacks. It also explores the state-of-the-art researches that utilize computational intelligence to achieve adaptive protection. These solutions are currently at the verge of totally redefining protection solutions with a more flexible and reliable system that will be applied globally.

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.