Technology: Saving and Enriching Life During COVID-19

The pandemic of COVID-19 has arrested the life of 7.8 million people living on this earth. However, some people are more vulnerable to the risk of this deadly virus. The frailty of senior citizens put them at the top of this list. The past 6 months have not only presented a threat to their physical health but to mental health also. Although lockdown was necessary to check the spread of the coronavirus it culminated in an exponential rise in the problems of loneliness, anxiety, fear, helplessness, and depression. The present paper reviews the role of social networking sites, apps, and other digital platforms in saving and enriching the lives of the elderly, especially those who spent the lockdown alone and were devoid of a regular support system due to unavailability of transport and administrative restrictions on the movement of people. It also analyzes the efficiency of the virtual world in reducing their anxiety of being alone by connecting them with others and also make them feel empowered. The review is based on the online data collected about the insurgence in the percentage of elderly people using such platforms, recent studies analyzing the effects of the COVID 19 pandemic on senior citizens. Besides this personal telephonic discussions were conducted with some elderly people who spent their lockdown alone in their homes. The study was primarily focused on three objectives. Firstly it attempts to understand the ways in which senior citizens made use of social networking sites and various digital platforms for managing life better. Secondly, it analyses the process of adopting technology, and finally, it examined the width and depth of the impact technology created in their life and also the permanence of this change. The analysis clearly suggests an increase in the digital life of elderly people. The process moved in distinct stages from utter confusion to relative ease in using technology, thereby significantly reducing the loneliness, and bringing relatively stable change in the way they lead their life.

Surgical management of the odontogenic keratocyst: A 20-year experience

The objective of this study was to describe the authors' long-term experience with the management of odontogenic keratocysts (OKCs). All OKC cases treated at the study centre between 1999 and 2015, with a minimum of 5 years of follow-up by December 2019, were reviewed retrospectively. Operative procedures including decompression/marsupialization, enucleation (E), E+Carnoy's solution (CS), E+CS+peripheral ostectomy (PO), and resection were assessed for complete resolution, partial resolution, and recurrence rates. In the parakeratinized non-syndromic group, E+CS+PO resulted in the lowest recurrence rate among the minimally invasive procedures (4.3%), while enucleation resulted in the highest rate (60%). Regarding the other modalities, recurrence was 12.5% for decompression, 11.5% for marsupialization, 16.7% for E+CS, 26.7% for E+PO, and 0% for resection. In the syndromic group, marsupialization resulted in a significantly higher recurrence (23.1%), while E+CS+PO cases showed no recurrence. No recurrence was observed in the orthokeratinized group patients treated with marsupialization or with E+CS. Based on clinico-radiographic features and observed results, it is concluded that OKC, although having a high recurrence rate, is a benign lesion and responds well to conservative procedures in most cases. Radical procedures should be reserved for unresponsive lesions and those with extensive tissue destruction.

A catalog of associations between rare coding variants and COVID-19 outcomes

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease-19 (COVID-19), a respiratory illness that can result in hospitalization or death. We investigated associations between rare genetic variants and seven COVID-19 outcomes in 543,213 individuals, including 8,248 with COVID-19. After accounting for multiple testing, we did not identify any clear associations with rare variants either exome-wide or when specifically focusing on (i) 14 interferon pathway genes in which rare deleterious variants have been reported in severe COVID-19 patients; (ii) 167 genes located in COVID-19 GWAS risk loci; or (iii) 32 additional genes of immunologic relevance and/or therapeutic potential. Our analyses indicate there are no significant associations with rare protein-coding variants with detectable effect sizes at our current sample sizes. Analyses will be updated as additional data become available, with results publicly browsable at https://rgc-covid19.regeneron.com.

Care of People with Epilepsy in Rural Medical Centre of Developing Countries with Limited Resources: During the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) has become a pandemic disease globally. This extraordinary situation is posing an enormous burden on the healthcare systems worldwide and is reshaping the way in which chronic disorders are managed. Pandemic has made epilepsy care even more demanding in rural part of developing countries. We outline the adverse circumstances in epilepsy care induced by the pandemic; propose emergency management and follow up care of people with epilepsy. There is a requirement for public health systems in resource poor countries to improve awareness, implement proper strategies of triage, acute treatment, telemedicine services and virtual check-ins.

Possible treatment and strategies for COVID-19: review and assessment

The coronavirus disease 2019 (COVID-19) is declared as an international emergency in 2020. Its prevalence and fatality rate are rapidly increasing but the medication options are still limited for this perilous disease. The emergent outbreak of COVID-19 triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) keeps propagating globally. The present scenario has emphasized the requirement for therapeutic opportunities to relive and overcome this latest pandemic. Despite the fact, the deteriorating developments of COVID-19, there is no drug certified to have considerable effects in the medical treatment for COVID-19 patients. The COVID-19 pandemic requests for the rapid testing of new treatment approaches. Based on the evidence, hydroxychloroquine is the first medicine opted for the treatment of disease. Umifenovir, remdesivir, and fevipiravir are deemed the most hopeful antiviral agent by improving the health of infected patients. The dexamethasone is a first known steroid medicine that can save the lives of seriously ill patients, and it is shown in a randomized clinical trial by the United Kingdom that it reduced the death rate in COVID-19 patients. The current review recapitulates the existing evidence of possible therapeutic drugs, peptides, humanized antibodies, convulsant plasma, and vaccination that has revealed potential in fighting COVID-19 infections. Many randomized and controlled clinical trials are taking place to further validate these agent's safety and effectiveness in curing COVID-19.

Expression of MTNR1A, steroid (ERα, ERβ, and PR) receptor gene transcripts, and the concentration of melatonin and steroid hormones in the ovarian follicles of buffalo

High ambient temperature exhibits a retrograde effect on buffalo reproduction because of heat stress. Moreover, melatonin is known to regulate reproductive changes in seasonally reproductive animals by binding to high affinity, G protein-coupled receptors. The MTNR1A gene is a prime receptor, mediating the effect of melatonin at the neuroendocrine level to control seasonal reproduction. In sheep, the role of melatonin is well known; however, studies have not been conducted in buffalo to determine its effect during favorable and unfavorable breeding seasons. Therefore, the present study aimed to (1) determine the expression of MTNR1A, ERα, ERβ, and PR gene transcripts in the ovarian follicles of buffalo during the summer and winter seasons and (2) analyze melatonin, 17β-estradiol, and progesterone concentrations in the follicular fluid of buffalo during both seasons. Murrah buffalo ovaries were collected during both the summer (May-June) and winter (December-January) seasons. All visible ovarian follicles were allocated into one of three groups: (1) small (8-9.9 mm); (2) medium (10-11.9 mm); and (3) large (12-14 mm). Follicular fluid was aspirated from each group of follicles for hormone analyses. The granulosa cells were processed for RNA extraction. Furthermore, they were subjected to real-time quantitative PCR to analyze the expression (relative quantification) of MTNR1A, ERα, ERβ, and PR in each follicular group. The expression of MTNR1A gene transcript decreased with the increasing size of the follicle and intrafollicular melatonin concentration. Expression of ERα and PR remained unaffected by the season and was similar (P > 0.05) in all groups. Expression of ERβ was higher (P < 0.05) in summer than winter; nevertheless, small-sized follicles from the summer exhibited higher (P < 0.05) expressions than medium- and large-sized follicles. The overall intrafollicular melatonin concentration was positively correlated (P < 0.05) with 17β-estradiol and progesterone concentrations. In conclusion, the decreased expression of MTNR1A and increased concentration of intrafollicular melatonin with the increasing size of the follicle indicates a probable role in folliculogenesis and ovulation in buffalo.

P1409Effectiveness of atrial fibrillation ablation using a contact force stability module with contact force or non-contact force catheter

Funding Acknowledgements

This study was funded by Biosense Webster, Inc.

Background

Catheter ablation is a mainstream treatment option for atrial fibrillation (AF). Recently, contact force (CF) enabled ablation catheters and a stability module were developed to allow for real-time CF sensing and improvement of catheter-tissue stability, which is important for achieving an optimal clinical outcome.  We assessed the relative effectiveness of these new technologies, as well as the optimal CF stability parameters, in a real-world setting.

Purpose

To compare the clinical effectiveness of AF ablations performed with a CF catheter using location stability settings of 2.5 mm maximum distance for 12 s minimum (2.5/12) vs. a non-CF catheter with settings of 3 mm for 7 s (3/7).

Methods

Within 1/14–4/18, 176 de novo AF ablations using either a CF catheter with stability settings of 2.5/12 (n = 92, 5/16–4/18) or a non-CF catheter with stability settings of 3/7 (n = 84, 1/14–3/14) were performed by a single operator at a Canadian medical center. Patients routinely wore 48 hour Holter monitors every three months through the first year. The primary measures of effectiveness were Kaplan-Meier (KM) survival estimates of freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) recurrence after a 3-month blanking period and reablation.

Results

The CF group was 62.9 ± 10.0 years old, 57.6% male, and 66.3% paroxysmal (PAF). The non-CF group was 61.6 ± 9.9 years old, 63.1% male, and 76.2% PAF. Procedural complications consisted of a single vascular access complication in the non-CF group. The 12-month estimate of freedom from AF/AT/AFL recurrence was 79.4% in the CF group vs. 64.8% in the non-CF group (p = 0.058 for difference in survival over time). 12-month freedom from reablation was 90.4% in the CF group vs. 70.5% in the non-CF group (p = 0.002).

Conclusion

CF ablation with more stringent stability settings of 2.5/12 was more effective than non-CF ablation with stability settings of 3/7, likely attributable to the CF catheter enabling visualization of catheter-tissue contact and the stability module facilitating maintenance of CF stability during ablation.

Abstract Figure.

Preparation of Nanofungicides Based on Imidazole Drugs and Their Antifungal Evaluation

In spite of modern crop protection measures, the overall crop losses due to pests and pathogens are huge. Rhizoctonia solani, Macrophomina phaseolina, Sclerotium rolfsii, and Fusarium oxysporum are one of the most devastating soil-borne fungi and cause numerous plant diseases. Therefore, the present study aimed to systematically design and develop new nanofungicides based on imidazole drugs, clotrimazole, econazole nitrate, and miconazole nitrate, for effective and efficient management of plant diseases. The assessment of these antifungal medicines for their fungicide likeness using Hao's rule and their enzyme inhibitory potential by molecular docking was helpful in ensuring their utility as antifungal agents in managing phytopathogenic fungi. Nanotechnological strategies were used to develop nanoformulations of test compounds in poly(ethylene glycol) 300 for further augmenting their bioactivity. Transmission electron microscopy studies confirmed the nanosize of the prepared products. Analysis of their in vitro and in vivo antifungal properties revealed their usefulness in controlling the test fungi, R. solani, M. phaseolina, S. rolfsii, and F. oxysporum. Excellent in vitro antifungal activities were displayed by the clotrimazole nanoformulation with a median effective dose (ED₅₀) of 1.18 μg/mL against R. solani, the econazole nitrate nanoformulation with an ED₅₀ of 5.25 μg/mL against S. rolfsii, and the miconazole nitrate nanoformulation with an ED₅₀ of 1.49 and 1.82 μg/mL against M. phaseolina and F. oxysporum. Furthermore, in vivo studies against test fungi demonstrated the antifungal potency of all the nanoformulations with disease incidences ranging from 11.11 to 27.38% in plants treated with nanoformulations of test chemicals as compared to the inoculated control (39.68-72.38%).

Effect of yoga practices on general mental ability in urban residential school children

Introduction Mental ability of children represents functioning of brain in different aspects of competency including verbal, mathematical, logical reasoning and spatial, which is of prime importance for academic performance. Objective The objective of this study was to assess the effect of yoga on general mental ability of urban residential school children. Methods Sixty-six urban school children aged 11-15 years were selected as participants. All the selected participants were staying in a residential school in Pune District. A stratified random sampling method was used to divide the students into experimental and control groups. There were 32 students in experimental group and 29 students in control group. Both experimental and control groups were assessed for general mental ability by using standard questionnaire at the baseline and at the end of 12 weeks of yoga training. The study participants of experimental group underwent yoga training for 12 weeks, for 1 h in the morning for a period of 12 weeks. The control group did not undergo any yoga training during this time period. Results The experimental group participants showed significant improvement in general mental ability as compared to control group. Conclusion The findings of this study indicate that yoga practices could improve general mental ability of urban residential school children.

Thermionic microwave gun for terahertz and synchrotron light sources

Conventional thermionic microwave and radio frequency (RF) guns can offer high average beam current, which is important for synchrotron light and terahertz (THz) radiation source facilities, as well as for industrial applications. For example, the Advanced Photon Source at Argonne National Laboratory is a national synchrotron-radiation light source research facility that utilizes thermionic RF guns. However, these existing thermionic guns are bulky, difficult to handle and install, easily detuned, very sensitive to thermal expansion, and due for a major upgrade and replacement. In this paper, we present the design of a new, more stable, and reliable gun with optimized electromagnetic performance, improved thermal engineering, and a more robust cathode mounting technique, which is a critical step to improve the performance of existing and future light sources, industrial accelerators, and electron beam-driven THz sources. We will also present a fabricated gun prototype and show results of high-power and beam tests.

Tobacco use among school going children

Background

Despite increasing awareness of harmful effects of tobacco, its use in various forms continues to be significant health risk factors among children.

Aim

To assess the prevalence, pattern, and age of initiation of tobacco consumption, various factors influencing the habit of tobacco consumption, correlation between the educational status of children and their habit of tobacco consumption, and evaluation of any tobacco-induced oral lesion among 8-14 years of school going children in Central Delhi zone.

Methods and Materials

Total sample of 500 students aged 8-14 years from two schools in Central Delhi were studied using a structured, close ended, prevalidated questionnaire after taking prior permission and inform consent from the school authority. In the end, intraoral examination was done and health educational session was conducted to make students aware of health hazards of tobacco products.

Results

Prevalence of tobacco consumption among students was 16.4%. Out of total 82 tobacco users, 89% were male, whereas 11% were female. Smokeless tobacco consumption was predominant with Gutka being most preferred. Mean age of initiation of smoking form of tobacco was 9.57 ± 1.13 year, whereas for smokeless form, it was 9.25 ± 1.16 years. Friends (78.04%) were most common influencing factors, followed by family member (12.2%) and media (9.7%).

Conclusion

The rate of tobacco use was high, considering very young age group of this study. Consumption of tobacco among children is an emerging health problem in Central Delhi zone. Mandatory health education sessions against tobacco should be held regularly for students, teachers, and parents.

Measuring health and well-being with the help of the community

Issue

The Well North Programme is a multi-centre study focused on reducing inequalities in deprived communities through locally-led interventions and activities. As a locally driven project where the local stakeholders were involved in the programme of work, it was important to involve the community when deciding what to measure.

Description

As part of the evaluation there was a need to produce a tool to capture health and wellbeing information that was relevant to the specific communities involved in the project. In order to do this, we established that we needed local people to define what they wanted to measure, and we would use evidence synthesis techniques to identify tools that could be used to measure it within the community.

Results

We formulated the Well North Star, a bespoke spider diagram designed to capture individual level data. The Star is a quantitative tool used to collect individual-level data at an individual, organisational and geographical level. Each arm of the star represents an important theme, selected for measurement by local people. Identified local stakeholders (including residents, voluntary sector, police and councillors) were invited to workshops in order to decide what issues were important locally. After group discussions and thematic analysis, up to seven issues were highlighted as the most important in the community. Two of the main issues highlighted within local communities were aspiration and access to local information. After extensive literature search, tools to measure these were insufficient (e.g. aspiration tools focused on aspiration to become famous) and so bespoke tools needed to be created.

Lessons

When conducting community driven research, it is important to involve representatives from the community in identifying issues that are important to them. There is a gap between what academics and researchers consider important in local communities and what the communities themselves consider important.

1207Pulsed Field Ablation: Acute and Chronic Safety and Lesion Efficacy

Introduction

Thermal ablation methods are the cornerstone of treatment for atrial fibrillation. However, they pose a risk to extra-cardiac structures and may result in inadequate efficacy. Nonthermal, pulsed-field ablation (PFA) delivery to cardiac tissues may create durable, efficacious lesions while avoiding collateral damage.

Purpose

The purpose of this preclinical GLP study was to assess acute and chronic electrical isolation combined with a pathology assessment of chronic lesion extent in response to PFA delivery to cardiac tissue, and to document any collateral damage.

Methods

Six pigs were treated with biphasic, bipolar PFA doses through a circular multi-electrode catheter. PFA was delivered at four locations at specified voltages: superior vena cava (SVC at 700V), right atrial appendage (RAA at 1500V), left atrial appendage (LAA at 1200V), and right pulmonary vein (RPV at 1500V). Phrenic nerve pacing thresholds and electrical block at SVC, RPV, and RAA sites were investigated acutely, and electrical block at the SVC sites chronically. Pigs were survived for 4 weeks. After euthanasia, necropsies and histopathological assessments documented the findings at the lesion sites and collateral tissues.

Results

Post PFA, entrance block was achieved in all SVC, RPV, and RAA sites. Histopathology showed characteristic replacement fibrosis of the myocardium at all ablation sites. The PFA lesions in the SVC and RPV were all continuously circumferential and histopathology did not detect any remaining myofiber conduits across the post-ablation fibrosis (consistent with the electrical assessments). PFA of the appendages caused wide-ranging fibrosis in the RAA, and limited fibrosis in the LAA. Histologically, the atrial fibrosis was almost exclusively transmural in both, with the RAA lesions overall diagnosed as circumferentially complete in all but one case. The right phrenic nerve (RPN) pacing thresholds were unchanged from baseline to the end of the procedure and were all <1.0V. The examined juxtaposed RPN segments exposed to PFA at the SVC and RPV sites were normal. None of the ablated targets was associated with stenosis, aneurysms, luminal thrombus or collateral damage on the abluminal side.

Continuous lesion sites

Conclusions

This limited preclinical study evaluated the acute and chronic safety and efficacy of PFA in multiple cardiac and vascular treatment sites. In this porcine model, PFA results in acute and chronic electrical isolation, confirmed by pathology data, for all of the RPV and SVC targets. Pathology findings of the RAA revealed the ability to achieve chronic transmural lesions in highly trabeculated cardiac tissue. No collateral damage was seen to the adjacent RPN.

Acknowledgement/Funding

Medtronic

P3753Does empagliflozin modulate the autonomic system among patients with type 2 diabetes and coronary artery disease? Insights from the Holter sub-study of the EMPA-Heart CardioLink-6 Randomised Trial

Introduction

The mechanism behind how empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces all-cause and cardiovascular mortality among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) is unknown. Autonomic tone, as reflected by changes in heart rate variability (HRV), is an established prognosticator in patients with CAD and/or heart failure.

Purpose

To assess if empagliflozin treatment changes HRV in subjects with T2DM and CAD.

Methods

In the double-blind EMPA-Heart trial, 97 subjects with T2DM and CAD were randomised to empagliflozin 10 mg/day or placebo for 6 months and underwent 24-hour Holter monitoring at baseline and 6 months. Using automated algorithms, time and frequency HRV domain measures were obtained (standard deviation of NN intervals (SDNN); SD of the average NN intervals for each 5-minute segment (SDANN); root mean square of successive RR interval differences (rMSSD); % interval differences of successive NN intervals >50 ms (pNN50); ratio of low to high frequency (LF/HF)). Changes of these HRV parameters were calculated over 6 months. Between-group differences in HRV parameters were compared using ANCOVA.

Results

Complete Holter data (baseline and 6-month) were available for 68% (n=66) of the cohort. The average heart rate (HR) at baseline/6 months was 69.5±9.8 bpm/72.8±8.1 bpm and 76±10.4 bpm/76.5±10.6 in the placebo group and empagliflozin group, respectively. Both groups had similar changes in average HR over 6 months. Key Holter data are summarised in the table. SDNN and SDANN were higher in the placebo vs. empagliflozin group at 6 months; no significant difference was noted for all other measures.

Empagliflozin 10 mg/day (n=33) Placebo (n=33) Adjusted difference between Empagliflozin and Placebo (ANCOVA) Baseline, Mean (SD) 6-month, Mean (SD) Baseline, Mean (SD) 6-month, Mean (SD) Mean, (95% CI) P-value SDNN (ms) 100.49 (43.74) 98.05 (38.86) 109.35 (30.02) 125.08 (43.83) −18.55 (−34.28, −2.82) 0.022 SDANN (ms) 86.84 (39.34) 83.76 (35.53) 94.70 (28.52) 118.28 (77.41) −20.24 (−37.27, −3.21) 0.021 rMSSD (ms) 27.00 (11.84) 27.22 (13.48) 28.00 (11.58) 27.17 (9.38) −1.23 (−6.02, 3.55) 0.608 pNN50 (%) 7.81 (7.59) 8.32 (9.51) 8.26 (7.8) 6.93 (5.35) 0.51 (−2.61, 3.62) 0.746 LF/HF ratio 1.63 (0.52) 1.65 (0.51) 1.53 (0.43) 1.83 (0.82) −0.08 (−0.38, 0.22) 0.602

Conclusions

Among subjects with T2DM and CAD, changes in HRV over 6 months were similar in the empagliflozin and placebo arms suggesting that the mortality benefit conferred by empagliflozin is not associated with positive modulation of autonomic tone.

Acknowledgement/Funding

This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.

Vitamins for Cancer Prevention and Treatment: An Insight

Over a few decades a strong interlink between oxidative damage and cancer has been investigated by various scientists across the world on the basis of epidemiological observations of the effects of fruits and vegetables used in the diet for cancer patients. Primarily, Vitamin C, Vitamin D and Vitamin E are reported to be involved in the amelioration of side effects which occur in chemotherapy and radiation therapy of lungs, stomach, prostate, colorectal, gastric head and neck cancers. The vitamins acting as antioxidant adjuvants are found to have apoptotic and antiangiogenesis potential as well as inhibitory effects against metastasis in cancer cells. This chapter explicitly discusses the key aspects concerned with the vitamins in relation to cancer prevention and treatment. It describes vitamins and their natural resources, role of vitamins in the body, and vitamins as prime ingredients in the diet and their effects on cancer biology with reference to recent research reports. Moreover, this paper also includes the emerging potential of pharmaceutical advances to enhance bioavailability of the vitamins to cancer patients with improved safety and efficacy. Clinicians and researchers must mull over the nutritional requirements of individual cancer patient so as to treat cancer and increase life expectancy.

Association of Socio-Demographic Profile with Prevalence of Multi Drug Resistant Tuberculosis among Retreated Pulmonary Tuberculosis Patients in North India

Methods: An observational cross sectional study, which includes 116 patients of sputum smear positive pulmonary TB of age 18 or above. Further, detailed history taking regarding different demographic profile was done. Also, they were subjected to CB-NAAT and rifampicin resistant cases were considered as MDR-TB. Results: Proportion of MDR-TB was 31.89% among retreatment TB cases. 56.75 % (n=21) of MDR-TB cases were between the age group of 21-40 years. Proportion of MDR-TB was higher among males (75.67%), married (59.45%) and rural dwellers 59.45%. Proportion was 61.76% among patients with BMI <16; 31.57% with BMI 16-16.99, 28.57% with BMI 17-18.49 and 5.7% with BMI 18.50-24.99. MDRTB proportion was less 29.72% (n=11) in patients with history of TB contact in family. Pulmonary TB including MDR-TB was more common among illiterates (37.83% among MDR). Conclusion: Proportion of MDR-TB was high among retreatment cases in north India. Among them low BMI and education status are modifiable factor and this study signifies that MDR-TB burden can be reduced by improving health and education status of patient.

Role of Serum Osteoprotegerin as a Diagnostic Indicator of Primary Osteoporosis in Perimenopausal and Postmenopausal Women: An Indian Perspective

Introduction: Osteoporosis (OP) is a major health problem in the older population. The aim of the study was to assess the role of serum osteoprotegerin (OPG) as a diagnostic indicator of primary osteoporosis in peri- and post-menopausal women in an Indian population.

Materials and Methods: After ethical approval, 90 cases (45 cases and 45 controls) of peri- and post-menopausal females above 40 years of age presenting to our outpatient department were included in the study. It was a case controlled study conducted between July 2014 to July 2015. Based on the clinical features, t-score and radiological evidence from the DEXA scan, they were equally divided into two groups (cases and controls). Serum osteoprotegerin (OPG) levels were measured amongst cases and controls.

Results: The total calcium (mg/dl) level was lower among the cases and the difference was significant (p-Value= <0.001). Similarly, alkaline phosphatase (u/l), osteoprotegerin (u/ml) levels were higher in the cases as compared to controls and the difference was significant (p-Value= <0.001). The mean osteoprotegerin level showed a slight increase with increase in severity of the grading of BMD of spine. The results suggested a cut-off value of ≥10.5 u/ml (86.7% sensitive and 80% specific with accuracy of 84.5%) between normal and osteoporosis.

Conclusion: From the present study, we conclude that osteoprotegerin is a valid biomarker to diagnose postmenopausal women with low bone mineral density.

Text-document clustering-based cause and effect analysis methodology for steel plant incident data

The purpose of this study is to develop a text clustering-based cause and effect analysis methodology for incident data to unfold the root causes behind the incidents. A cause-effect diagram is usually prepared by using experts' knowledge which may fail to capture all the causes present at a workplace. On the other hand, the description of incidents provided by the workers in the form of incident reports is typically a rich data source and can be utilized to explore the causes and sub-causes of incidents. In this study, data were collected from an integrated steel plant. The text data were analysed using singular value decomposition (SVD) and expectation-maximization (EM) algorithm. Results suggest that text-document clustering can be used as a feasible method for exploring the hidden factors and trends from the description of incidents occurred at workplaces. The study also helped in finding out the anomaly in incident reporting.

Collecting standardized urban health indicator data at an individual level for school-aged children living in urban areas: methods from EURO-URHIS 2

Background

Measuring health and its determinants in urban populations is essential to effectively develop public health policies maximizing health gain within this context. Adolescents are important in this regard given the origins of leading causes of morbidity and mortality develop pre-adulthood. Comprehensive, accurate and comparable information on adolescent urban health indicators from heterogeneous urban contexts is an important challenge. EURO-URHIS 2 aimed to develop standardized tools and methodologies collecting data from adolescents across heterogenous European urban contexts. Questionnaires were developed including (i) comprehensive assessment of urban health indicators from 7 pre-defined domains, (ii) use of previously validated questions from a literature review and other European surveys, (iii) translation/back-translation into European languages and (iv) piloting. Urban area-specific data collection methodologies were established through literature review, consultation and piloting. School-based surveys of 14-16-year olds (400-800 per urban area) were conducted in 13 European countries (33 urban areas). Participation rates were high (80-100%) for students from schools taking part in the surveys from all urban areas, and data quality was generally good (low rates of missing/spoiled data). Overall, 13 850 questionnaires were collected, coded and entered for EURO-URHIS 2. Dissemination included production of urban area health profiles (allowing benchmarking for a number of important public health indicators in young people) and use of visualization tools as part of the EURO-URHIS 2 project. EURO-URHIS 2 has developed standardized survey tools and methodologies for assessing key measures of health and its determinants in adolescents from heterogenous urban contexts and demonstrated the utility of this data to public health practitioners and policy makers.