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Introduction: Postoperative DVT remains one of the formidable challenges for the surgeon. It is associated with a significant risk of associated morbidity and mortality. Diagnosis of DVT is usually established by the combination of symptoms and imaging, which is most commonly performed noninvasively by color Doppler. However, in multiple instances, the patient may remain asymptomatic, and hence, the diagnosis may be missed. Aim and Methodology: This study was performed at tertiary care to study the incidence of asymptomatic DVT in postoperative patients across various specialties. All postoperative patients were subjected to color Doppler on the 1st, 7th, and 30th postoperative days. Results: Out of 300 patients who were part of the study over 1 year, 31 patients developed DVT, of which eight were symptomatic. They all were managed as per any other patient of DVT by anticoagulants, class II stockings, and limb elevation. We had no mortality. Conclusion: DVT may develop in postoperative cases. It may be fatal if not recognized and treated in time. Timely diagnosis and adequate management remain key in avoiding morbidity and mortality. Data related to postoperative patients developing asymptomatic DVT are limited. There seems to be ambiguity in its etiology, prognosis, management protocol, and follow-up.

Introduction: The study was aimed at identifying the incidence of unreported probable hypoglycaemia in individuals with type 2 diabetes (T2DM) on anti-diabetic medications, using the screening Stanford Hypoglycemia Questionnaire (SHQ) in real-world situations. Methods: It was a multicentre cross-sectional study on consecutive individuals attending 10 diabetes care centres in Lucknow, Uttar Pradesh, India. The inclusion criteria were as follows: known individuals with T2DM, literate, age greater than or equal to 18 years, on at least one anti-diabetic agent for more than a month and not engaged in regular self-monitoring of blood glucose (SMBG). Results: This study was conducted from August 2017 to April 2018, involving 1198 participants. The mean age of the individuals enrolled was 53.45 years (±10.83), with males comprising 55.3% of the population. It was found that 63.6% of patients were on sulphonylurea (SU), 14.5% were on pioglitazone, 92.2% on metformin, 62.3% on Dipeptidyl peptidase (DPP4i) and 12.8% on Sodium-glucose cotransporter (SGLT2i). The mean SHQ score was 1.81 (±1.59). Probable hypoglycaemia was mild in 57.59%, moderate in 14.69% and severe in 1.41%. Those with diabetic neuropathy (P =

This study aimed to assess the potential of soil organic carbon (SOC) production through organic amendments. SOC sequestration would help to achieve the net-zero emissions targets set by the Intergovernmental Panel on Climate Change (IPCC). Given the urgency to reduce greenhouse gas emissions, traditional methods that estimate SOC over 100 years must be revised. Hence, a novel fate transport numerical model was developed to forecast SOC levels relevant to individual countries’ net-zero targets in various time frames. The simulation results revealed that most countries had sufficient organic amendment to mitigate the CO2 emission of that country for a year if the organic amendment was applied on 20% of the arable land. However, if a significant fraction of the total CO2 emissions needs to be mitigated before reaching the net zero target, the requirements of organic amendments need to be increased several folds. All the available agricultural land should also be brought under the organic amendment regime. Later, the dynamic LCA approach was undertaken for estimating Global Warming (GWP) from land-applied organic residue. It was observed that, depending on the dynamic LCA model, the estimated GWP was different. However, the estimated dynamic GWP was very close to the residual SOC calculated through the fate transport model. The mass of organic residues generated from a biorefinery was examined by employing a waste biorefinery model to explore further the routes of acquiring additional organic amendment. Simulated results showed that while a waste biorefinery could not provide additional organic residue compared to the original organic waste input, it was highly efficient for nutrient recovery and its uses. This study demonstrated that organic amendment-based carbon sequestration adequately mitigated residual GHG at the net-zero target.

Abstract Deglaciation has led to the transformation of glaciers into rock glaciers in various mountainous regions worldwide. However, the science of permafrost and rock glaciers remains under‐researched in the Himalayan region. This study presents a detailed inventory, dynamics, and permafrost distribution map for the Jhelum basin in the Kashmir Himalaya. The Permafrost Zonation Map (PZM) is created using a Logistic Regression Model based on topographic and climatic variables. High‐resolution satellite images are used to identify rock glaciers as visual indicators. Active and relic rock glaciers are classified based on surface topography and geomorphology. Results reveal 207 rock glaciers in the Jhelum basin, covering ∼50 km2, with over 100 falling into the active category. The PZM aligns well with the global permafrost zonation index map. Slope, aspect, and elevation of rock glaciers are computed using the ASTER Digital Elevation Model. The average elevations range from 3,700 m to 4,550 m, and the average surface slope ranges from 12° to 26°, with maximum slopes from 25° to 65°. Most rock glaciers are oriented toward the south or southeast. Field investigations confirm that these rock glaciers occur in highly elevated regions with steep slopes. This study provides valuable information on the high areal abundance of permafrost in the Himalayan region and suggests increased risks of thawing permafrost due to climate warming in the future. The findings contribute to the understanding of permafrost and rock glaciers, filling knowledge gaps in the Himalayan context.

Ground deformation is a widespread phenomenon that accelerates due to anthropogenic land development. Thus reclaimed/created land is more vulnerable to deformation and subsidence, especially in mountain areas. Advanced Differential Synthetic Aperture Radar Interferometry (A-DInSAR) can be used to monitor such projects. The Pakyong Airport is an engineering feat, constructed by cutting a mountain and converting it into a tabletop in a landslide-prone zone and seismically active region of the Sikkim Himalayas. The cutting of hill slopes for airport construction and other anthropogenic activities has increased slope instability in the region. This paper studies the slow-moving landslides in the airport neighbourhood using A-DInSAR on Sentinel-1 time series data consisting of 64 images of ascending track and 82 images of the descending track. The time period of monitoring was from October 2014 to April 2018 (43 months). The images have been connected using the Minimum Spanning Tree graph for interferogram generation for estimating deformation. The atmospheric noise was removed, and the results enabled the identification of deformation (in line-of-sight) on the airstrip as well as in the neighbouring area, both the upslope and downslope of the airport. The deformation rates estimated were up to ±90 mm/year in Pakyong from both tracks. We could successfully capture such land movement associated with the Pakyong Airport construction and help assess the impacts of infrastructure construction on the slope stability of the area. The controlling factors such as precipitation, seismicity, geology and others were analysed with respect to the deformation obtained. This study helps in assessing the land deformation after construction (cutting and filling of the slope) in the area. The deformation detected in this study needs to be addressed for the safety of the residents as well as for the infrastructure present in the area.

Human error (HE) is an important concern in safety-critical systems such as nuclear power plants (NPPs). HE has played a role in many accidents and outage incidents in NPPs. Despite the increased automation in NPPs, HE remains unavoidable. Hence, the need for HE detection is as important as HE prevention efforts. In NPPs, HE is rather rare. Hence, anomaly detection, a widely used machine learning technique for detecting rare anomalous instances, can be repurposed to detect potential HE. In this study, we develop an unsupervised anomaly detection technique based on generative adversarial networks (GANs) to detect anomalies in manually collected surveillance data in NPPs. More specifically, our GAN is trained to detect mismatches between automatically recorded sensor data and manually collected surveillance data, and hence, identify anomalous instances that can be attributed to HE. We test our GAN on both a real-world dataset and an external dataset obtained from a testbed, and we benchmark our results against state-of-the-art unsupervised anomaly detection algorithms, including one-class support vector machine and isolation forest. Our results show that the proposed GAN provides improved anomaly detection performance. Our study is promising for the future development of artificial intelligence based HE detection systems.

The nuclear industry’s economic viability is challenged by significant operations and maintenance (O&M) costs. Although maintenance strategies are often risk-averse, many maintenance programs rely on schedule-based strategies that perform repairs and replacements regardless of the asset’s condition, leading to unnecessary repairs and high costs. Predictive maintenance can help alleviate these costs through condition monitoring and risk-informed decision-making. In this article, we show that the use of improved reliability models can help reduce the total cost of ownership (TCO) for a high-value repairable asset. Current risk-informed methods used in the industry today rely on mean-time-between-failure (MTBF) models that may oversimplify failure likelihood estimation. Improvements can be made by integrating condition monitoring, operational history, and maintenance effectiveness into a hybrid reliability model. In contrast with conventional MTBF methods, the generalized renewal process uses recurrent event analysis and historical repair data to quantify the effectiveness of maintenance repairs and estimate the likelihood of failure. During a case study on a nuclear power plant’s circulating water system, a hybrid reliability model was fitted to the historical data and shown to have improved likelihood estimations when compared to a MTBF model. Monte Carlo simulations were then used to simulate and compare TCO for various maintenance strategies, showing that an extended replacement interval can reduce overall costs by upwards of 10.7%. The successful results of the improved reliability models showcase the ability to aid decision-making and reduce overall operations and maintenance costs in the nuclear power industry.

Transfemoral access for neurointerventions has been a time-tested technique of entering the vascular network of the body and reaching the intended targets. However, it has its own share of shortcomings in the form of long admission times leading to increased costs, patient inconvenience and local (though infrequent) adverse affects. Transradial route has taken the interventional cardiology domain by storm and is staring now at other vascular domains especially neurointervention. It has shown better outcomes than the transfemoral route in many aspects. The current article discusses the vascular access perspectives with an exhaustive overview of the transradial route concerning its historical perspectives, its requirement in the current clinical scenario, the procedure per se including the adverse effects and whether it has the real world charm to displace the transfemoral route into the backseat. Transradial access in neurointervention is here to stay, however it would require training, certain modifications in the standard catheters that one currently uses for cerebral procedures and constant practice by the operator to cross the learning curve and attain a certain level of competence before he becomes comfortable with the technique.

Abstract Background Primary tuberculous otitis media is rare in the paediatric age group, and its neuro-otogenic complication of involvement of cerebellopontine angle in a child is very unusual. Tuberculosis should always be considered as a rare but possible aetiology for such neuro-otogenic lesions. Case presentation We report a case of a 13-year-old female patient who presented with left ear discharge and mass-like lesion on otoscopy. High-resolution computed tomography (HRCT) temporal bone showed erosion of petrous temporal bone, external auditory canal and ossicles. Contrast-enhanced MRI (CEMRI) revealed peripherally enhancing hetero-intense lesion epicentred in the petrous and mastoid part of left temporal bone extending into the left cerebellopontine angle and external auditory canal. Homogenously enhancing soft tissue was seen in the left occipital condyle with sigmoid sinus thrombosis and cervical lymphadenopathy. There was also a single enhancing left temporal lobe lesion. Radiological and clinical assessment was suggestive of malignant aetiology. However, biopsy revealed tuberculosis and anti-tubercular therapy (ATT) was initiated. Interval imaging showed an adequate response to treatment. Conclusions Tuberculous otitis media often masquerades as malignancy on clinical and imaging assessment.

Abstract Background Hemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis. Case presentation We report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Conclusions BAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy.

Background: There had been an increasing incidence of mucormycosis during the COVID-19 pandemic. Aim: This study evaluates the pattern of radiological imaging, endoscopic and histopathological features of rhino-orbital cerebral mucormycosis in patients with COVID-19 infection. Materials and Methods: The study included 31 patients with culture/biopsy-proven mucormycosis and COVID-19 infection from November 1, 2020, to December 31, 2021, in a single tertiary care centre. This study was approved by institutional ethics committee. Computed tomography (CT)/magnetic resonance imaging (MRI) images, endoscopic, and histopathological findings were retrospectively analyzed to look for the extent and pattern of disease. Statistical analysis was performed through descriptive statistics. Results: The imaging spectrum showed paranasal sinus involvement (n = 31; 100%), nasal involvement (n = 14; 45.16%), oral and palatal involvement (n = 6; 19.3%), deep neck/face space involvement (n = 25; 80.6%), orbital involvement (n = 20; 64.5%), vascular complications (n = 9; 29%), skull base involvement (n = 12; 38.7%), and cerebral involvement (n = 10; 32.2%). Endoscopy showed black necrotic tissue and slough mostly affecting middle turbinate, maxillary, and sphenoid sinuses. CT showed 100% sensitivity and specificity for the detection of sinonasal osseous erosion. Histopathology examination revealed mucormycosis as broad aseptate, predominantly 90° branching hyphae with macrophage and neutrophilic infiltration in 93.5%, granuloma in 61.3%, cavity formation in 48.4%, and angioinvasion in 77.4%. Diabetes mellitus was the predominant coexisting morbidity for mucormycosis. The mean time interval between COVID-19 diagnosis and mucormycosis was 18 days. Conclusion: CT revealed hyperdense contents within sinuses with osseous erosion; while MRI showed T2 hypointense, heterogeneously enhancing lesions with adjacent structural infiltration, orbital inflammation, cavernous sinus and internal carotid artery thrombosis, and intracranial complications such as infarct, hemorrhage, meningitis, and abscess. Neutrophilic infiltration and angioinvasion were predominant histopathological characteristics while necrosis with eschar formation was demonstrated through endoscopy.

Inspection-based techniques are being widely used for aging management of passive structures in nuclear power plants (NPPs). This paper presents a condition-based maintenance approach to detect corrosion in NPPs secondary piping structures using distributional features extracted from the total unwrapped phase signal of accelerometers. To demonstrate a condition-based maintenance approach, a scaled-down experimental testbed and data-driven methodology are developed and validated for detecting surrogate corrosion processes in a piping structure. The surrogate corrosion process is emulated by removing different levels of mass from the pipe-bend section and measuring the vibration of the pipe bend using five tri-axial accelerometers. The data collected are processed using the Hilbert-Huang transform. Distributional features of the total unwrapped phase from each accelerometer are used to develop a binary classifier to predict a degraded pipe against baseline pipes (healthy state). The binary classification model is extended to a multiclass classification to predict the level of mass removal. Binary and multiclass classification are performed using traditional machine learning algorithms such as logistic regression, neural networks, random forest, and support vector machine. All the algorithms achieved at least 99% prediction accuracy in each direction of the tri-axial accelerometer and significantly outperformed intrinsic mode function-based prediction methods. Performance of classification algorithms were evaluated using data for different number of the tri-axial accelerometers, including a single sensor. The overall prediction accuracy for all these cases was over 99%. Also, the models were interpreted using Shapley additive explanation values to understand the contribution of each input feature in diagnosing the percentage of mass removal. Finally, the performance of a transfer learning model is demonstrated to adopt a machine learning model on to an another elbow, and the prediction performance over 99% is achieved with partial retraining.

Context: There is a dearth of studies on the risk of gaming addiction (GA) in children and adolescents with disruptive behavior disorders (DBDs) and its comorbidity with attention-deficit hyperactivity disorder (ADHD). Methods: Seventy participants aged 6–16 years diagnosed with ADHD and DBD were included in this cross-sectional, observational study and compared with 40 healthy controls. They were assessed for clinical details of gadget type, duration of use, and purpose on a semi-structured questionnaire. The intensity of video gaming was assessed using Game Addiction Scale (GAS). Behavioral symptoms were assessed on Child Behavior Checklist (CBCL). Descriptive statistics with t-test, analysis of variance, and Pearson's correlational analysis were used as applicable. Results: Use of gadgets for video games for ≥ 4 hours was found to be significantly higher (P = 0.001) in cases (61.5%) than in controls (10%). Most of the cases used Internet for communication (69.4%) and entertainment (58.3%). A significantly higher number of cases (37.1%) fulfilled criteria for video game addiction and the numbers were significantly higher in ADHD + DBD groups as compared to only ADHD or only DBD group. Children with GA had significantly higher scores in all domains of CBCL as compared to those without GA. The GAS score had a significant positive correlation with aggressive behavior, social problems, rule breaking, and attention problem domains of CBCL. Conclusions: GA was significantly higher in ADHD and/or DBD than normal children and adolescents. Comorbidity of ADHD and DBD further increases the risk of GA. Therefore, children with these disorders should be screened routinely for GA.

Aim: The study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. Method: Total 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. Results: Majority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. Conclusion: Factors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.

Abstract Background Pneumopericardium is a rare complication in patients with bacterial necrotizing pneumonia and proven to be lethal with a high incidence of mortality due to cardiopulmonary failure. Case presentation This is a rare case of broncho-pericardial fistula in a 21 year old, who was a known case of T-cell acute lymphoblastic leukemia status post-chemotherapy, presented with relapse of acute lymphoblastic leukemia. He was evaluated for febrile neutropenia. Further investigation showed features of necrotizing pneumonia and follow-up chest X-ray during the hospital stay showed evidence of pneumopericardium. To localize the cause, computed tomography chest was performed, further confirming the etiology of bronchopericardial fistula. Conclusions Our case illustrates broncho-pericardial fistula as a rare complication of necrotizing pneumonia and the utility of multimodality imaging in its diagnosis and determination of tension pneumopericardium.

The capacity of aquifers to store water and the stability of infrastructure can each be adversely influenced by variations in groundwater levels and subsequent land subsidence. Along the south bank of the River Thames, the Battersea neighbourhood of London is renovating a vast 42-acre (over 8 million sq ft) former industrial brownfield site to become host to a community of homes, shops, bars, restaurants, cafes, offices, and over 19 acres of public space. For this renovation, between 2016 and 2020, a significant number of bearing piles and secant wall piles, with diameters ranging from 450 mm to 2000 mm and depths of up to 60 m, were erected inside the Battersea Power Station. Additionally, there was considerable groundwater removal that caused the water level to drop by 2.55 ± 0.4 m/year between 2016 and 2020, as shown by Environment Agency data. The study reported here used Sentinel-1 C-band radar images and the persistent scatterer interferometric synthetic aperture radar (PSInSAR) methodology to analyse the associated land movement for Battersea, London, during this period. The average land subsidence was found to occur at the rate of −6.8 ± 1.6 mm/year, which was attributed to large groundwater withdrawals and underground pile construction for the renovation work. Thus, this study underscores the critical interdependence between civil engineering construction, groundwater management, and land subsidence. It emphasises the need for holistic planning and sustainable development practices to mitigate the adverse effects of construction on groundwater resources and land stability. By considering the Sustainable Development Goals (SDGs) outlined by the United Nations, particularly Goal 11 (Sustainable Cities and Communities) and Goal 6 (Clean Water and Sanitation), city planners and stakeholders can proactively address these interrelated challenges.

Crucial changes in urban climate can be witnessed due to rapid urbanisation of cities across the world. It is important to find a balance between urban expansion and thermal environment quality to guarantee sustainable urban development. Thus, it is a major research priority to study the urban heat island (UHI) in various fields, i.e., climate change urban ecology, urban climatology, urban planning, mitigation and management, urban geography, etc. The present study highlighted the interrelationship between land surface temperature (LST) and the abundance of impervious cover and green cover in the Varanasi city of Uttar Pradesh, India. For this purpose, we used various GIS and remote-sensing techniques. Landsat 8 images, land-use–land-cover pattern including urban/rural gradients, and grid- and metric-based multi-resolution techniques were used for the analysis. From the study, it was noticed that LST, density of impervious cover, and density of green cover were correlated significantly, and an urban gradient existed over the entire city, depicting a typical UHI profile. It was also concluded that the orientation, randomness, and aggregation of impervious cover and green cover have a strong correlation with LST. From this study, it is recommended that, when planning urban extension, spatial variation of impervious cover and green cover are designed properly to ensure the comfort of all living beings as per the ecological point of view.

As integral components of any power plant, transformers sup-ply the generated electricity to the grid. However, the trans-former’s cellulose-based paper insulation and the mineral oilin which it is immersed break down over time under stan-dard operating conditions—or more rapidly due to potentialfaults within the system. This technical brief exhibits a col-lection of diagnostic and prognostic techniques that utilitiescan adopted in lieu of labor-intense periodic preventive main-tenance routines. Furthermore, prognostic models have beenincorporated using the latest version of the Institute of Elec-trical and Electronics Engineers (IEEE) standard (IEEE StdC57.104TM-2019) for dissolved gas analysis (DGA), thusexpanding it to include estimation of the time to maintenance.Overall, four different methodologies are explained, each ofwhich aid in determining a transformer’s state of health. Thesemethodologies include the Chendong model, the IEEE C57.91-2011 thermal life consumption model, a diagnostic model forDGA, and a prognostic model for DGA that uses an autore-gressive integrated moving average (ARIMA) model. An ad-ditional improvement for estimating missing system parame-ters from monitoring data (i.e., a tool for parameter estimationutilizing Powell’s method) is presented, enabling the IEEEthermal life consumption model to benefit not only the col-laborating power plant, but also the power industry at large.

Background and Importance Intracranial textilomas are retained surgical sponges presenting as pseudomass lesions in postoperative patients usually with surrounding inflammatory reaction. Though rare, these are commonly misdiagnosed as postoperative hemorrhagic collections, abscesses, radionecrosis, or residual/recurrent mass lesions. We describe the imaging findings of intracranial textilomas diagnosed in four patients on follow-up postoperative imaging along with their characteristic imaging findings to help radiologists/neurosurgeons make accurate diagnosis. Clinical Presentation One patient had chronic headache without any focal neurological deficits. Rest of the patients were asymptomatic at the time of presentation Conclusion In postoperative scans, possibility of textilomas should be considered apart from residual/recurrent lesions, postoperative abscesses, or radionecrosis. Correct and timely diagnosis is important for further treatment planning and patient care.

Because of the growing concerns regarding climate change and energy sustainability, a transition toward a modern energy sector that reduces environmental effects while promoting social and economic growth has gained traction in recent years. Sustainable energy solutions, which include renewable and low-carbon sources such as nuclear energy and natural gas, could minimize emissions of greenhouse gases, enhance air and water quality, and encourage energy independence. Yet, the shift to a sustainable energy industry is fraught with difficulties, including governmental and regulatory obstacles, technological and economic limits, and societal acceptability hurdles. Addressing these issues would necessitate the development of long-term, durable, and cost-effective energy systems containing nuclear energy and associated with the generation of both electricity and other by-products required by industry. Integrated energy systems (IES) are a novel way to maximize the use of various energy resources and technologies in order to deliver dependable, efficient, and sustainable energy services. IES entail the integration of various energy systems, such as electricity, heating, cooling, and transportation, in respect to energy sustainability and a system’s resilience and flexibility. Their development and implementation require the cooperation of several parties, including energy providers and policymakers. This study provides a state-of-the-art literature review of the most creative nuclear-driven hybrid energy system applications and methodologies, from which the research challenges and prospects for effective IES implementation emerge.

Objective Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis. The aim of the study was to quantitatively evaluate blood–brain barrier (BBB) perfusion changes in TBM patients using dynamic contrast-enhanced (DCE) MR perfusion. Methods and Material Thirty untreated patients of TBM and 10 healthy controls were prospectively evaluated by conventional imaging and DCE MR perfusion. Mean permeability indices—Ktrans and Ve—were calculated from multiple regions of interest (ROIs) placed in basal cisterns and comparison was done between the patients and controls. Results The permeability indices were significantly higher (where p < 0.001) in cisterns of TBM patients who showed basal meningeal enhancement when compared with healthy controls. Significant differences in permeability were observed between “enhancing” cases and controls as well as in “enhancing” cases when compared with the “non-enhancing” cases. However, no significant difference was observed in the mean cisternal value between “non-enhancing” cases and the controls. Ktrans with a cutoff value of > 0.0838 had 81.6% sensitivity and 78.6% specificity in differentiating cases and controls while Ve mean value with a cutoff value of 0.0703 showed 86.8% sensitivity and 91.4% specificity in predicting the permeability difference between the cases and controls. Conclusion DCE MR perfusion is useful in the quantitative measurement of disruption of BBB and perfusion alterations in patients of TBM.

Background: Exposure to dichlorodiphenyltrichloroethane (DDT), a potent lipophilic organochlorine pesticide, has long been linked as a risk factor for type 2 diabetes mellitus (T2DM). However, its presence in the adipose tissues of the T2DM subjects has not been explored in the Indian population, where this long-banned pesticide is still in use. The present study was conducted to evaluate the possible association of DDT and its metabolites in obese and non-obese T2DM subjects. Methods: Subjects with normal glucose tolerance (n = 50) and T2DM (n = 50) were divided into equal numbers in obese and non-obese groups. Their plasma glucose levels, HbA1c, and lipid profile were measured. The adipose tissues were collected intraoperatively, and DDT and its metabolites were measured using a gas chromatograph equipped with an electron capture detector. Results: Obese subjects, irrespective of their glycemic status, and T2DM subjects had higher concentrations of DDT. p, p′ DDT was found to increase the odds for diabetes, and o, p′ DDT for central obesity. p, p′ DDD was also strongly correlated with central obesity, glycemic parameters, and triglycerides. Conclusion: The excess deposition of p, p′ DDD, o, p′ DDT, and p, p′ DDT in obese subjects may proceed to T2DM by disrupting triglycerides and glycemic parameters.

The Corona Virus Disease (COVID)-19 pandemic led to the death of countless lives worldwide, which forced most countries and cities to impose a shutdown, bringing a halt to major human activities. While this shutdown caused a significant economic crisis, resulting in loss of livelihood to many people, it caused relief to the environment. Delhi in India is amongst the highest air-contaminated cities worldwide, and the COVID-19 shutdown helped improve air quality. This paper studied the variation in air quality for Wazirpur, Delhi, during shutdown in 2020 and a similar time-period in 2019. The data was acquired from the Central Pollution Control Board (CPCB) open-access portal for six air contaminants viz. Carbon-monoxide (CO), Nitrogen-dioxide (NO2), Ozone (O3), Particulate Matter (PM10 and PM2.5), and Sulphur-dioxide (SO2). Inferential statistical analysis was done to determine the trend in air quality variation during the shutdown compared to the previous year. Mean, standard deviation, percentage difference, linear regression and correlation analysis were made, and variable reduction in most air contaminants was noted. It was noted that for most of our observed time, the concentration of NO2, O3, PM10, PM2.5 and SO2 in 2020 is lower than in 2019, while the concentration of CO is greater in 2020 than the corresponding time in 2019. The maximum decline was observed for PM10 (70.5%) during phase-1, while the maximum increase was observed in CO (32.3%) during phase-1. As the shutdown restrictions were eased out, an increase in the air contaminants was also noted.

Background and Purpose: Haemophilus influenzae type b (Hib) infection occurs mostly in children and is transmitted from person to person through the respiratory pathway. Hib strain is associated with meningitis or encephalitis. It is not an uncommon infection, particularly, in the developing world. This prospective cohort study was done with the aim of describing imaging findings in patients with Hib meningoencephalitis. Materials and Methods: In a prospective cohort study, consecutive children admitted in the pediatric emergency unit with acute febrile encephalopathy were enrolled. The clinical details, CSF analysis, and microbiological and serological investigations were recorded on a case record proforma. Children with confirmed Hib meningoencephalitis were included in this study. Clinicoradiological features were assessed. Results: A total of 16 patients with acute febrile encephalopathy, in whom CSF latex agglutination, CSF culture, or CSF multiplex PCR were positive for H. influenzae were included in this study. All these children were investigated with magnetic resonance imaging (MRI) brain. Important imaging findings were meningitis, predominantly around frontoparietal lobes (43%), cerebritis (28%), ventriculitis (14%), and subdural collections (21.5%). One patient had features consistent with acute disseminated encephalomyelitis (ADEM) while four patients had normal MRI scan. Conclusions: H. influenzae is still a common cause of meningitis in infants and children in the developing world. We have tried to study the most common MRI features associated with Hib infection to help radiologists alert the treating clinicians to further investigate these patients for appropriate prognostication.

Nuclear power plants collect and store large volumes of heterogeneous data from various components and systems. With recent advances in machine learning (ML) techniques, these data can be leveraged to develop diagnostic and short-term forecasting models to better predict future equipment condition. Maintenance operations can then be planned in advance whenever degraded performance is predicted, thus resulting in fewer unplanned outages and the optimization of maintenance activities. This enables lower maintenance costs and improves the overall economics of nuclear power. This paper focuses on developing a short-term forecasting process that leverages a feature selection process to distill large volumes of heterogeneous data and predict specific equipment parameters. A variety of feature selection methods, including Shapley Additive Explanations (SHAP) and variance inflation factor (VIF), were used to select the optimal features as inputs for three ML methods: long short-term memory (LSTM) networks, support vector regression (SVR), and random forest (RF). Each combination of model and input features was used to predict a pump bearing temperature both 1 and 24 hours in advance, based on actual plant system data. The optimal inputs for the LSTM and SVR were selected using the SHAP values, while the optimal input for the RF consisted solely of the response variable itself. Each model produced similar 1-hour-ahead predictions, with root mean square errors (RMSEs) of roughly 0.006. For the 24-hour-ahead predictions, differences could be seen between LSTM, SVR, and RF, as reflected by model performances of 0.036 +- 0.014, 0.0026 +- 0, and 0.063 +- 0.004 RMSE, respectively. As big data and continuous online monitoring become more widely available, the proposed feature selection process can be used for many applications beyond the prediction of process parameters within nuclear infrastructure.

Underground coal mining activities and ground movement are directly correlated, and coal mining-induced ground movement can cause damage to property and resources, thus its monitoring is essential for the safety and economics of a city. Fangezhuang coal mine is one of the largest coalfields in operation in Tangshan, China. The enormous amount of coal extraction has resulted in significant ground movement over the years. These phenomena have produced severe damages to the local infrastructure. This paper uses the finite difference method (FDM) 3D model and the stacking interferometric synthetic aperture radar (InSAR) method to monitor the ground movement in Fangezhuang coalfield during 2016. The FDM 3D model used calibrated Fangezhuang geological parameters and the satellite InSAR analysis involved the use of ascending C-band Sentinel-1A interferometric wide (IW) data for 2016. The results show that the most prominent subsidence signal occurs in mining panel 2553N and the area between panel 2553N and fault F0 with subsidence up to 57 cm. The subsidence observed for the FDM 3D model and stacking InSAR to monitor land deformation under the influence of fault are in close agreement and were verified using a two-sample t-test. It was observed that the maximum subsidence point shifted towards the fault location from the centre of the mining panel. The tectonic fault F0 was found to be reactivated by the coal mining and controls the spatial extent of the observed ground movement. The impact of dominant geological faults on local subsidence boundaries is investigated in details. It is concluded that ground movement in the study area was mainly induced by mining activities, with its spatial pattern being controlled by geological faults. These results highlight that the two methods are capable of measuring mining induced ground movement in fault dominated areas. The study will improve the understanding of subsidence control, and aid in developing preventive measures in Fangezhuang coalfield with fault reactivation.

Background: Dissociative disorder is a common neurotic disorder. Patients with dissociative disorder experience significant psychological distress and have deficits in various domains of neurocognitive functions. Objective: To assess the neurocognitive functioning of adolescents diagnosed with dissociative disorder and compare it with that of healthy controls. Materials and Methods: This is a cross-sectional observational study conducted on adolescents diagnosed with dissociative disorder, attending child and adolescent specialty clinic of a tertiary care hospital of North India from October 2016 to February 2017. Healthy control subjects were also recruited for comparison on study variables. Malin's Intelligence Scale for Indian children and standardized neuropsychological tools were administered for the assessment of intellectual functioning and neurocognitive functioning. Results: A total of 50 participants with dissociative disorder and 50 healthy controls completed the study. Participants of both the groups had an average level of intellectual functioning. Participants with dissociative disorder showed poorer performance on tasks of attention and executive functions. After the Bonferroni correction, deficits were detected in the domains of coding (P = 0.0012), maze (P = 0.0001), and mathematics (P = 0.0016). Conclusions: Adolescents with dissociative disorder have impaired neurocognitive functions in comparison to healthy controls.

Background: The lifelong responsibility of the autistic children along with the lack of knowledge, lack of treatment, and if treatment is available, it is unaffordable leads to deterioration of quality of life of the parents in several domains. Objectives: The objective is to study the quality of life of principal caregivers of autistic children and adolescents visiting health facilities in Lucknow city. Materials and Methods: The sample included 90 principal caregivers (aged < 60 years) of autistic children and adolescents aged 3–19 years and diagnosed with autism, attending government and private health facilities providing treatment for autism in Lucknow, Uttar Pradesh, India. Results: The quality of life of principal caregivers was found to be influenced most in the physical health domain (with least score). The predictors of quality of life of principal caregivers were type of family and knowledge regarding child's problem. Conclusion and Recommendations: Thus, there is an immense need of increasing awareness through information, education, and communication materials, mass media, and discussions regarding autism.

Background: Autism is extraordinarily difficult for families to cope with for various reasons. Perceived burden and care for the child with autism, available forms of social support, and the interactions between the autistic child and other family members are areas of significant concern for families. Objective: The objective of this study was to determine the burden of care perceived by the principal caregivers of autistic children or adolescent visiting health facilities in Lucknow city. Methods: The cross-sectional study was conducted from October 2016 to September 2017 with a sample of 90 principal caregivers (aged

Objective: To assess the effect of nationwide lockdown and its associated repercussion on the self-care management of Type 2 Diabetes Mellitus (T2D). Methods: Response from 1406 diabetic patients was collected against a 16 item questionnaire. Data was collected on diabetic self-management practices, behavioral aspects, psychological implications, drug availability and awareness towards the pandemic. Emphasis was on choices made by patients in the absence of guidance from physicians and impact of stress and blood sugar levels on other variables. The data was analyzed using Chi-square tests at P

In this paper, a new seventeen level inverter topology is proposed for single-phase grid-connected renewable energy applications. The proposed inverter topology can provide seventeen levels in the output voltage while using a lesser number of power devices. This proposed inverter topology comprises nine power switches, five power diodes, and two sets of DC sources (two 3 V and two V) which are in the ratio of 1:3. By properly arranging the input DC sources, power switches, and power diodes through different possible combinations the seventeen voltage levels are generated. The main advantage of this seventeen level inverter is that a maximum of six power devices conducts in any mode. Thus, conduction losses are lesser compared to existing seventeen level inverter topologies which results in a highly efficient system. Further, the detailed comparison of proposed inverter topology with the existing multilevel inverter (MLI) topologies shows that the number of required power devices count is considerably lower. The possible extension of the proposed inverter topology for the three-phase application is also discussed. Further, a level-shifted based pulse modulation strategy is proposed to control the output of the proposed inverter. To verify the operation, the proposed inverter topology is simulated in MATLAB/Simulink for a 500 W grid-connected system. All the major results are included in the paper. The experiments are performed to validate the proposed inverter topology for a 500 W grid-connected system and all the key results are included in the paper.

The increasing prevalence and severity of wildfires, severe storms, and cyberattacks is driving the introduction of numerous microgrids to improve resilience locally. While distributed energy resources (DERs), such as small-scale wind and solar photovoltaics with storage, will be major components in future microgrids, today, the majority of microgrids are backed up with fossil-fuel-based generators. Small modular reactors (SMRs) can form synergistic mix with DERs due to their ability to provide baseload and flexible power. The heat produced by SMRs can also fulfill the heating needs of microgrid consumers. This paper discusses an operational scheme based on distributed control of flexible power assets to strengthen the operational resilience of SMR-DER integrated-energy microgrids. A framework is developed to assess the operational resilience of SMR-DER microgrids in terms of system adaptive real-power capacity quantified as a response area metric (RAM). Month-long simulation results are shown with a microgrid developed in a modified Institute of Electrical and Electronics Engineers (IEEE)-30 bus system. The RAM values calculated along the operational simulation reflect the system resilience in real time and can be used to supervise the microgrid operation and reactor’s autonomous control.

Treating a Class II patient has always been a challenge to orthodontist, especially in noncompliant adolescents. An appliance that minimizes the dependence on patient cooperation, reduces the treatment duration, and is esthetically less visible offers a potential solution to some compliance problems encountered in orthodontic practice. This article presents a case report of a 13-year-old male with a Class II division 1 malocclusion treated with a modified Churro jumper, by inserting it on an auxiliary wire (consisting of a molar segment, a posterior vertical segment, a vestibular segment, and an anterior vertical segment) placed on the mandibular arch, instead of directly placing on the main arch wire, to improve its efficiency. The patient responded well to the fixed functional appliance and saved the treatment time spent in aligning the bicuspids later.

Aim: The aim of the present study was to explore the adjunctive use of Acacia arabica gel in the treatment of chronic periodontitis. Methods: Single centre, randomised, triple blind, controlled trial on mild to moderate chronic periodontitis patients; Group I (SRP + Acacia arabica, n = 40) and Group II (SRP + placebo, n = 40); were analysed for clinical improvements in periodontal pocket depth (PPD) and clinical attachment levels (CAL) at baseline, 15 and 90 days on application of gels. Gingival index and plaque index were assessed as secondary parameters. Results: Statistically significant PPD reduction (p

Groundwater variation can cause land-surface movement, which in turn can cause significant and recurrent harm to infrastructure and the water storage capacity of aquifers. The capital cities in the England (London) and India (Delhi) are witnessing an ever-increasing population that has resulted in excess pressure on groundwater resources. Thus, monitoring groundwater-induced land movement in both these cities is very important in terms of understanding the risk posed to assets. Here, Sentinel-1 C-band radar images and the persistent scatterer interferometric synthetic aperture radar (PSInSAR) methodology are used to study land movement for London and National Capital Territory (NCT)-Delhi from October 2016 to December 2020. The land movement velocities were found to vary between −24 and +24 mm/year for London and between −18 and +30 mm/year for NCT-Delhi. This land movement was compared with observed groundwater levels, and spatio-temporal variation of groundwater and land movement was studied in conjunction. It was broadly observed that the extraction of a large quantity of groundwater leads to land subsidence, whereas groundwater recharge leads to uplift. A mathematical model was used to quantify land subsidence/uplift which occurred due to groundwater depletion/rebound. This is the first study that compares C-band PSInSAR-derived land subsidence response to observed groundwater change for London and NCT-Delhi during this time-period. The results of this study could be helpful to examine the potential implications of ground-level movement on the resource management, safety, and economics of both these cities.

ObjectivesThe National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS.DesignMultisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage.SettingConducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology.ParticipantsA total of 34 802 adults (>18 years) were interviewed.Main outcome measurePrevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0.ResultsThe weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40–59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD.ConclusionAround 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.

Groundwater-induced land movement can cause damage to property and resources, thus its monitoring is very important for the safety and economics of a city. London is a heavily built-up urban area and relies largely on its groundwater resource and thus poses the threat of land subsidence. Interferometric Synthetic Aperture Radar (InSAR) can facilitate monitoring of land movement and Gravity Recovery and Climate Experiment (GRACE) gravity anomalies can facilitate groundwater monitoring. For London, no previous study has investigated groundwater variations and related land movement using InSAR and GRACE together. In this paper, we used ENVISAT ASAR C-band SAR images to obtain land movement using Persistent Scatterer InSAR (PSInSAR) technique and GRACE gravity anomalies to obtain groundwater variations between December 2002 and December 2010 for central London. Both experiments showed long-term, decreasing, complex, non-linear patterns in the spatial and temporal domain. The land movement values varied from −6 to +6 mm/year, and their reliability was validated with observed Global Navigation Satellite System (GNSS) data, by conducting a two-sample t-test. The average groundwater loss estimated from GRACE was found to be 9.003 MCM/year. The ground movement was compared to observed groundwater values obtained from various boreholes around central London. It was observed that when large volumes of groundwater is extracted then it leads to land subsidence, and when groundwater is recharged then surface uplift is witnessed. The results demonstrate that InSAR and GRACE complement each other and can be an excellent source of monitoring groundwater for hydrologists.

Renal artery pseudoaneurysm is a very rare complication after blunt trauma. Congenital anomalies like horseshoe kidney, ectopic kidney, pelvi-ureteric junction obstruction, etc., make it more vulnerable to trauma. We report a case of a 21-year-old male admitted to our hospital 3 days after blunt abdominal trauma with complaints of lower abdominal pain, hematuria, and hypotension. The diagnosis of ectopic right kidney with interlobar laceration was established by ultrasonography. Computed tomography angiography showed interlobar renal artery pseudoaneurysm in ectopic right kidney. Successful superselective endovascular coil embolization of the pseudoaneurysm was performed.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.

Aim: To evaluate the role of virtual cystoscopy (VC) comparing it with cystopanendoscopy (CPE) for detecting bladder tumor(s). Material and Methods: Ethical clearance was obtained from the Institutional ethics committee. After an informed consent 30 patients fulfilling the inclusion criteria were enrolled in the prospective non-randomized clinical study and were evaluated as per protocol with VC performed by a qualified radiologist who was blinded to the findings of CPE performed by a qualified urologist. The results so obtained were analyzed using appropriate statistical tools. Results: The mean age of the patients was 56 years. Sensitivity of VC in detecting bladder lesions was 92%. However, when axial images were also interpreted along with VC, the sensitivity increased to 96% for detecting bladder lesions. The specificity of VC with axial CT was 40% in respect of detecting bladder lesions.VC with axial CT was 85.7% sensitive in identifying multiple bladder tumors. There were no complications on account of performing VC. Minor problems were encountered with VC and CPE in 16.7% and 13.3% patients respectively. Conclusions: VC with axial CT is 96% sensitive in detecting bladder lesions and 85.7% sensitive in detecting the multiplicity of the tumors. VC may be a useful complementary diagnostic tool for the workup of select patients with suspected bladder lesions. However, larger randomized controlled studies are needed to better define the precise clinical and diagnostic role of VC in routine practice. Settings and Design: Prospective Clinical Comparative Non Randomized Clinical Study.

Orthodontic treatment is based on the premise that when force is delivered to a tooth and thereby transmitted to the adjacent investing tissues, certain mechanical, chemical, and cellular events take place within these tissues, which allow for structural alterations and contribute to the movement of that tooth. Molecules present in drugs and nutrients consumed regularly by patients can reach the mechanically stressed paradental tissues through the circulation and interact with local target cells. The combined effect of mechanical forces and one or more of these agents may be inhibitory, additive, or synergistic. Current orthodontic research aims to develop methods of increasing the tissue concentration of molecules promoting tooth movement, while simultaneously decreasing the concentration of unwanted elements which can produce harmful side effects. This article discusses in detail the various possible drugs that can bring about alterations in the desired orthodontic tooth movement.

This paper presents the development of diagnostic and prognostic capabilities for active assets in nuclear power plants (NPPs). The research was performed under the Advanced Instrumentation, Information, and Control Technologies Pathway of the Light Water Reactor Sustainability Program. Idaho National Laboratory researched, developed, implemented, and demonstrated diagnostic and prognostic models for generator step-up transformers (GSUs). The Fleet-Wide Prognostic and Health Management (FW-PHM) Suite software developed by the Electric Power Research Institute was used to perform diagnosis and prognosis. As part of the research activity, Idaho National Laboratory implemented 22 GSU diagnostic models in the Asset Fault Signature Database and two wellestablished GSU prognostic models for the paper winding insulation in the Remaining Useful Life Database of the FW-PHM Suite. The implemented models along with a simulated fault data stream were used to evaluate the diagnostic and prognostic capabilities of the FW-PHM Suite. Knowledge of the operating condition of plant asset gained from diagnosis and prognosis is critical for the safe, productive, and economical long-term operation of the current fleet of NPPs. This research addresses some of the gaps in the current state of technology development and enables effective application of diagnostics and prognostics to nuclear plant assets.