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Piezoelectric materials have secured a significant place in the field of structural health monitoring (SHM) and energy harvesting over the past two decades. These materials are available in several forms and configurations, the efficacy of especially curved configurations is still unexplored. This article investigates, both experimentally and numerically, the potency of the curved configuration of the piezo transducers over the straight configuration when embedded in reinforced concrete (RC) structures for energy harvesting and SHM. The study consists of the comparative analysis of (a) open-circuit voltage generated across the piezo transducers; (b) the power developed under the impedance matching conditions; and (c) the potential of power storage into capacitors for both configurations. The article also experimentally examines the hitherto unexplored damage detection capability of the curved piezo transducers by the electro-mechanical impedance (EMI) technique. Results clearly demonstrate that curved piezo transducers exhibit better performance in comparison to straight configurations for both structural health monitoring and energy harvesting. A finite element (FE) analysis is also performed through a 3-D model of the real-life-sized RC beam with straight and curved piezo transducers embedded inside to evaluate the various parameters such as the angle of bend, the thickness, the number of elements and the position of placement of the curved transducers for energy harvesting. The FE simulations reveal an optimum range of the angle of bend as 130 to 160 degrees. There is a substantial impact of the increase in thickness of the transducers for energy harvesting in terms of its open-circuit voltage. The numerical analysis also suggests that the optimum position of placement of the piezo transducers is towards the top or bottom of the beam cross-section. The outcomes of the experimental and numerical investigations are very pivotal for the implementation of curved piezo transducers in real-life RC structures for improved energy harvesting and structural health monitoring.

Protein kinase C (PKC) is a diverse enzyme family crucial for cell signalling in various organs. Its dysregulation is linked to numerous diseases, including cancer, cardiovascular disorders, and neurological problems. In the brain, PKC plays pivotal roles in synaptic plasticity, learning, memory, and neuronal survival. Specifically, PKC’s involvement in Alzheimer’s Disease (AD) pathogenesis is of significant interest. The dysregulation of PKC signalling has been linked to neurological disorders, including AD. This review elucidates PKC’s pivotal role in neurological health, particularly its implications in AD pathogenesis and chronic alcohol addiction. AD, characterised by neurodegeneration, implicates PKC dysregulation in synaptic dysfunction and cognitive decline. Conversely, chronic alcohol consumption elicits neural adaptations intertwined with PKC signalling, exacerbating addictive behaviours. By unravelling PKC’s involvement in these afflictions, potential therapeutic avenues emerge, offering promise for ameliorating their debilitating effects. This review navigates the complex interplay between PKC, AD pathology, and alcohol addiction, illuminating pathways for future neurotherapeutic interventions.

To help meet its near-term NDC goals and long-term net-zero 2070 target, the Government of India has planned to establish a Carbon Credit Trading Scheme (CCTS), i.e. a domestic emission trading scheme (ETS). An ETS is an inherently cost-effective policy instrument for emission reduction, providing the greatest flexibility to reduce emissions from within and across sectors. An effective ETS requires design features that consider country-specific challenges and reflect its role within the larger policy package to achieve long-term emission reduction. Within the Indian context and in this study we therefore investigate—(i) what might be the role of the ETS in achieving India’s long-term mitigation targets? (ii) How might the various sectors interact under an emissions cap? (iii) How might the ETS interact with existing energy and climate policies? We do this analysis by running four main scenarios using the integrated assessment model GCAM (v6.0), adapted to India-specific assumptions and expectations. These scenarios are—(i) NZ (net-zero), (ii) NZ + ETS, (iii) NZ + CC (command and control), and (iv) NZ + RPO (renewables purchase obligations) + ETS. The NZ scenario assumes India’s near-term and long-term climate commitments of net zero by 2070. Scenarios with ETS (ii) and (iv) apply an emissions cap on four sectors—electricity, iron and steel, cement, and fertilizer. The scenario with CC applies a homogenous emission cap on each of the chosen sectors but does not allow cross-sectoral trading. The last scenario includes renewables purchase obligations (RPOs along with an ETS. We show that under a specific ETS emissions cap: (i) the electricity sector emerges as the largest source of cost-effective greenhouse gas (GHG) reduction options; (ii) ETS with trading across sectors is around 24% more cost-effective than ETS with trading only within sectors, (iii) RPOs can be complementary to an ETS although the impact of RPOs on GHG reductions in the electricity sector would need to be considered when setting the level of the ETS cap (or emissions intensity targets) or the RPO targets to avoid low carbon prices, and (iv) the direction and volume of financial transfers across sectors depends on allocation targets set by the government. Based on these results we provide design recommendations for India’s ETS.

Purpose: To study the correlation between choroidal thickness (CT) and IOP control in primary angle-closure glaucoma (PACG). Methods: In total, 61 patients (102 eyes) with PACG underwent subfoveal CT (SFCT) scanning using enhanced depth imaging–optical coherence tomography. The subjects with PACG were further grouped as controlled IOP (≤21 mm Hg on maximal medical therapy) and uncontrolled IOP (>21 mm Hg on maximal medical therapy). The average CT of the PACG eyes was calculated and compared between both groups. A correlation analysis was done between CT and intereye difference in CT with the disease parameters. Results: The mean CT was 274.38 ± 42.10 μm in 102 PACG eyes. SFCT was significantly increased in the uncontrolled IOP group as compared with the controlled IOP group. The mean SFCT was 245.57 ± 62.10 μm in the controlled group and 294.46 ± 51.05 μm in the uncontrolled group (P < 0.01). Factors associated with a thicker choroid were younger age, high IOP, and higher optic nerve head cupping (P < 0.001). Neither the visual field-mean deviation (VF-MD) nor pattern standard deviation (PSD) was found to be associated with overall CT. The intereye asymmetry between CT was significantly associated with poor VF-MD and PSD. Conclusion: PACG eyes with thicker choroid may be a risk factor for poor IOP control on medical anti-glaucoma therapy. Thicker choroid as compared to the fellow eye is a poor prognostic sign and these eyes should be monitored closely.

Objectives: Sputum culture conversion at the end of the intensive phase of multidrug-resistant tuberculosis (MDR-TB) treatment is a key predictor for successful treatment outcome. This observational study was undertaken to assess the interim microbiological outcome of a cohort of rifampicin-resistant (RR)-TB patients with variable resistance to second-line drugs. Methods: During Jan–Apr 2018, we consecutively enrolled 100 RR-TB patients, who underwent phenotypic drug susceptibility testing (DST) to assess baseline resistance to second-line drugs. Following RR-TB diagnosis, these patients were started on MDR-TB treatment. After 6 months of treatment, sputum culture conversion status was determined. Data were analysed to assess the impact of resistance to second-line drugs on culture conversion. Results: DST of 100 RR-TB patients showed a high resistance to fluoroquinolones (FQs; levofloxacin 56%; moxifloxacin 44%) followed by kanamycin (8%) and capreomycin (6%). None of the patients were resistant to the other drugs tested (amikacin, clofazimine and linezolid). At 6-month treatment follow-up, 28 patients had been lost to follow-up and eight had died. Microbiological outcome was obtained from the remaining 64 patients, but successful culture conversion was achieved in only 62.5% of the patients. FQ resistance was found to be a strong predictor (P

Background: Predictors of survival for interstitial lung disease (ILD) in the Indian population have not been studied. The primary objective of the study was to assess the Modified-Gender Age and Physiology (M-GAP) score to predict survival in patients with ILD seen in clinical practice. We also analyzed the role of demographic and radiological characteristics in predicting the survival of patients with ILD. Materials and Methods: In the ILD India registry, data were collected from 27 centers across 19 cities in India between March 2012 and June 2015. A single follow-up was conducted at 18 centers who agreed to participate in the follow-up in 2017. M-GAP score (range 0–5) was calculated with the following variables: age (≤60 years 0, 61–65 years 1, and >65 years 2), gender (female 0, male 1), and forced vital capacity% (>75% 0, 50%–75% 1, and >75% 2). A score of 0–3 and score of 4 and 5 were classified into Stage 1 and 2, respectively. Other predictors of survival, such as the history of tuberculosis, smoking, and the presence of honeycombing on computed tomography scan, were also evaluated. Results: Nine hundred and seven patients were contacted in 2017. Among them, 309 patients were lost to follow-up; 399 were alive and 199 had died. M-GAP was significantly associated with survival. Similarly, other predictors of survival were ability to perform spirometry (hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.34–0.72), past history of tuberculosis (HR: 1.57, 95% CI: 1.07–2.29), current or past history of smoking (HR: 1.51, 95% CI: 1.06–2.16), honeycombing (HR: 1.81, 95% CI: 1.29–2.55), a diagnosis of connective tissue disease -ILD (HR: 0.41, 95% CI: 0.22–0.76), and sarcoidosis (HR: 0.24, 95% CI: 0.08–0.77). Conclusion: In a subgroup of patients with newly diagnosed ILD enrolled in ILD India registry and who were available for follow-up, M-GAP score predicted survival. Honeycombing at the time of diagnosis, along with accurate history of smoking, and previous history of tuberculosis were useful indices for predicting survival.

The severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) causes coronavirus disease 2019 (COVID-19) and emerged as a new public health crisis. This RNA virus, which has an origin in bats, is phenotypically and genotypically diverse. The source of transmission is by direct inhalation or contact with infected droplets or indirect through fomites. The disease shows an average incubation period of 2 to 14 days. The general symptoms include fever, cough, sore throat, breathlessness, fatigue, and malaise, although in a few it is found to be asymptomatic. The immune response shows variation from individual to individual, which varies from pneumonia, chest pain, acute respiratory distress syndrome, and multiorgan failure leading to death. The cytokine and chemokine responses play a major role in the severity of the infection. Laboratory diagnosis is done by molecular investigations. The socioeconomic conditions of individuals also play a role in disease manifestation. Treatment is supportive with symptomatic management. Preventive measures include social distancing, use of face masks, and contact tracing. This review will present a general overview of coronavirus and describe the clinical and socioeconomic features of the COVID-19 patients. It will also introduce comprehensive data of symptomatic and asymptomatic patients among different Asian and Western countries during the current pandemic. Furthermore, it also focuses on the most up-to-date information on effective management and prevention of COVID-19.

Objective The objective of this subanalysis of data from centres across urban areas in India of the Global Asthma Network (GAN) was to study 1) the prevalence of symptoms of asthma in children and adults, 2) the change in prevalence of asthma and its trigger factors since the International Study of Asthma and Allergies in Childhood (ISAAC), and 3) current asthma treatment practice. Methods In this cross-sectional, multicentre, school-based and self-administered questionnaire, responses from children aged 6–7 years and 13–14 years, and their respective parents, were analysed. Results The GAN Phase I study included 20 084 children in the 6–7-year age group, 25 887 children in the 13–14-year age group and 81 296 parents. The prevalence of wheeze in the previous 12 months was 3.16%, 3.63% and 3.30% in the three groups, respectively. In comparison to the ISAAC studies, there was a significant reduction in the prevalence of current wheeze (p

Background: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. Methods: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. Results: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. Conclusion: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias.

Background: Respiratory disorders are important contributors to disease burden across the world. The aim is to assess the proportionate burden of types of respiratory diseases and their seasonal patterns in India we are performing a field study. The present report describes methodological aspects of a respiratory disease point prevalence survey from India. Methods: A total of 4108 chest physicians were invited. Acceptance was received from 420 sites. Chest physicians were classified according to location of practice one as medical college, district government hospital, private hospital, and private clinics. Qualifications of practicing chest physicians were postgraduate in chest medicine, including Doctorate of Medicine (68.4%), diploma in chest medicine (22.1%), and Postgraduate in Medicine (9.5%). The study questionnaire was designed to record demographic data, comorbidities, risk factors, and respiratory conditions based on ICD-10. Results: A total of 366 sites provided baseline data, and the response rate of recruitment of the study sites was 8.9% in the baseline phase. However, government and private medical colleges, as well as government and private hospitals across India, were part of recruitment of respiratory patients for this survey. Conclusions: It is feasible to conduct a large multisite study to assess respiratory disease burden. Challenges include low response rate and logistic issues.

BackgroundThe Global Burden of Disease data suggest that respiratory diseases contribute to high morbidity in India. However, the factors responsible for high morbidity are not quite clear. Therefore, the Seasonal Waves Of Respiratory Disorders (SWORD) study was planned to estimate the point prevalence due to respiratory diseases in Indian OPD services and its association with risk factors and change in seasons.MethodsIn this point prevalence observational multicenter study conducted during 2017-18, participating physicians recorded information of consecutive patients in response to a questionnaire. The study was conducted on four predetermined days representing transition of Indian seasons i.e., February (winter), May (summer), August (monsoon), and November (autumn).ResultsThe eligible number of patients from across 302 sites in India was 25,177. The mean age of study population was 46.1±18.1 years, 14102(56.0%) were males and 11075(44.0%) females. The common diagnoses were: asthma(29.8%), chronic obstructive pulmonary disease (COPD),15.6%, respiratory tract infections (RTIs),11.3%, and tuberculosis(8.7%). All these conditions showed significant seasonal trends (Asthma 31.4% autumn vs. 26.5% summer, COPD 21.1% winter vs. 8.1% summer, RTIs 13.3% winter vs. 4.3% summer, and tuberculosis 12.5% autumn vs. 4.1% summer, pConclusionsThe SWORD study showed wide seasonal variations in outpatient attendance of patients with common respiratory conditions. Novel risk-factors associated with respiratory diseases were also identified.

Context: Multiple environmental factors are associated with development of hypersensitivity pneumonitis (HP), and diagnostic algorithms for the diagnosis of HP have been proposed in recent perspectives. Aims: We analyzed the data of patients with HP from interstitial lung disease (ILD)-India registry. The analysis was performed to (1) find the prevalence of HP, (2) reclassify HP as per a recently proposed classification criterion to assess the level of diagnostic certainty, and (3) identify the causative agents for HP. Setting and Designs: This was a prospective multicenter study of consecutive, consenting adult patients with new-onset ILD from 27 centers across India (March 2012–April 2015). Materials and Methods: The diagnoses were based on prespecified working clinical criteria and multidisciplinary discussions. To assess strength of diagnosis based on available clinical information, patients with HP were subclassified into definite HP, HP with high level of confidence, and HP with low level of confidence using a recent classification scheme. Results: Five hundred and thirteen of 1084 patients with new-onset ILD were clinically diagnosed with HP and subclassified as HP with high level of confidence (380, 74.1%), HP with low level of confidence (106, 20.7%), and definite HP (27, 5.3%). Exposures among patients with HP were birds (odds ratios [OR]: 3.52, P < 0.001), air-conditioners (OR: 2.23, P < 0.001), molds (OR: 1.79, P < 0.001), rural residence (OR: 1.64, P < 0.05), and air-coolers (OR: 1.45, P < 0.05). Conclusions: About 47.3% of patients with new-onset ILD in India were diagnosed with HP, the majority of whom were diagnosed as HP with a high level of confidence. The most common exposures were birds, cooling devices, and visible molds.

AIM: To study the factors affecting residual exotropia (>10 PD) at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus (LR) recession or unilateral recess resect procedure]. METHODS: A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia (>10 PD) and successful outcome (within 10 PD of orthotropia) at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount (mm) of muscle surgery done. RESULTS: One hundred and fifty-seven patients with mean age of 14y (range 3-53y) were included. Twenty-seven patients (17.2%) had residual exotropia at 4-6wk postoperative follow up. Age at surgery (P=0.009) and preoperative deviation for distance (P≤0.001) and near (P=0.001) were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done (recess-resect or bilateral LR recession). The effect/dose ratio was more in deviations >40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group (1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery). CONCLUSION: Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.

Aims and Objectives: Environmental pollens are known to cause exacerbation of symptoms of patients with allergic rhinitis (AR) and asthma. During pollen months, number of patients visiting hospital has been shown to increase in some studies. However, in India, such studies are lacking. Therefore, we aimed to study pollen counts and to find its correlation with number of new patients attending Asthma Bhawan for 2 years. Materialsx and Methods: Aerobiological sampling was done using Burkard 24 h spore trap system. The site selected for the entrapment of the air spore was the building of Asthma Bhawan situated at Vidhyadhar Nagar, Jaipur. New patients coming with problems of respiratory allergy such as AR or asthma were recruited in the study. Skin prick tests (SPTs) were carried out after obtaining consent in these patients. Monthly pollen counts of trees, weeds and grasses were correlated with the number of new patients. Pollen calendar was prepared for 2 years. Results: Average annual pollen count during 2011 and 2012 were 14,460.5. In the analysis, 37 types of species or families were identified. Pollen count showed two seasonal peaks during March–April and from August to October. January and June showed the lowest pollen counts in 2 years. Average monthly count of grass pollens showed significant correlation with number of new patients (r = 0.59). However, monthly pollen count of trees and weeds did not correlate. The correlation of the pollen count of individual pollen with the SPT positivity to that pollen showed significant correlation with Chenopodium album only. Conclusions: It can be concluded that there were two peaks of pollen count in a year during March–April and August–October. Average monthly pollen counts of grass were significantly correlated with the number of hospital visits of new patients.

Context: A number of local dialects and languages exist in India, which leads to a single disease being addressed by a number of names which may overlap with other disease names also. This creates misunderstanding and is a hindrance to effective patient–doctor communication. Aims: The paper aims to find out how effectively the name of the respiratory disease is communicated to the patient. The terminology used by patients to describe their disease was also noted at limited level. Settings and Design: The study was conducted in the form of parallel cross-sectional surveys, among pulmonologists and patients. Methods: Among the members of the Indian Chest Society and those attending the National Conference on Pulmonary Diseases (NAPCON-2015), 1028 pulmonologists participated in the online survey which was the first part of the study. The term used to address the common respiratory disease was inquired in the survey. To find the response of patients, a questionnaire was given to the patients attending four respiratory disease clinics of a city. They were inquired about the name of respiratory disease they were suffering from. Results: Pneumonia was the disease which was communicated with exact terminology by 898 (87.4%) doctors to their patients. In contrast, idiopathic pulmonary fibrosis was communicated with precise terminology by only 171 (16.6%) doctors. Pulmonary tuberculosis was exactly told by 708 (69%), asthma by 731 (71.1%), and chronic obstructive pulmonary disease by 593 (57.7%) doctors. However, only 17.6% of the 1122 patients participating in the survey had a knowledge of the name of disease they were suffering from. Conclusions: The exact terminology of the common respiratory diseases is not effectively used by many doctors and most of the patients. The study identifies an important gap in patient–doctor communication, and therefore, highlights the need of effective patient education.

Context: Respiratory diseases are a common problem in our country and these are associated with significant morbidity and mortality. Aims: The aim of the paper was to analyze the pattern of diagnostic tests used and treatment prescribed for common respiratory diseases. Settings and Design: A total of 1028 pulmonologists, either member of Indian Chest Society or delegate attending the National Conference of Pulmonary Diseases (NAPCON) 2015, participated in the online survey. Subjects and Methods: The survey included questions pertinent to common respiratory diseases such as pulmonary tuberculosis (PTB), bronchial asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and pneumonia. Results: Investigation used for severity assessment and diagnosis of PTB, was sputum for acid-fast bacilli (83.5%), for IPF was high-resolution computed tomography chest (85.6%), for severe pneumonia was arterial blood gas analysis (69.3%), for asthma was spirometery and peak flow (96.8%) and for COPDs was spirometry (87.2%). The most popular choice of treatment for PTB was directly observed treatment short course (55.7%), for bronchial asthma, it was long-acting beta agonist with inhaled corticosteroids (LABA + ICSs) (41.1%), for COPD, it was LABA, ICS, and long-acting muscarinic antagonist (LABA + ICS + long-acting muscarinic antagonist) (32.4%) and for IPF, it was pirfenidone and N acetyl cysteine (38.3%). About 67.5% of doctors preferred hospitalization for patients with severe pneumonia. About 84.5% pulmonologists ordered diagnostic tests and 55.5% prescribed treatment as per current guidelines. Conclusions: The majority of doctors (70.1%) in our survey followed recommended guidelines for respiratory disease diagnosis and treatment. However, there is a need for upgradation of treatment strategies currently used by doctors.

Cough is often a distressing feature and may be caused due to varied reasons. A 39-year-old man presented with complaints of cough and had significant pigeon exposure. His chest X-ray revealed mediastinal enlargement and computed tomography chest revealed air trapping and mediastinal lymphadenopathy. Both endobronchial and transbronchial biopsies revealed granulomas. Thus, the patient was diagnosed as a case of sarcoidosis and started on steroids. Hypersensitivity pneumonitis may often mimic sarcoidosis; however, the presence of endobronchial granulomas will diagnose the latter condition.

Swine flu influenza had spread the world over in 2009. The main pathology was bilateral pneumonia. Majority of these cases recovered from pneumonia fully. Though in some cases, pulmonary fibrosis was reported as a sequel. However, long-term progression of such pulmonary fibrosis is uncertain. We are hereby reporting two cases of swine flu that showed residual pulmonary fibrosis. The clinical and laboratory parameters were also recorded. In both the cases, radiological shadows and spirometric values did not show deterioration. We conclude that swine flu pulmonary fibrosis is not a progressive condition.

Trans-mediastinal herniation of lung is seen occasionally but herniation of bulla across the mediastinum is rare. We report two cases with trans-mediastinal herniation of bullae leading to an unusual line appearing near the mediastinum. We propose the name 'Semilunar sign'for this radiological sign because of its resemblance to the half-moon shape.