Instrumental Assessment of Aero-Resistive Expiratory Muscle Strength Rehabilitation Devices

PURPOSE

Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians' ability to assess which model is best suited to a particular client's needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making.

METHOD

We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation.

RESULTS

All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived.

CONCLUSIONS

Systematic testing of several commercially available expiratory resistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.

Largest Real-World Data of Regional Nodal Irradiation Using Ultra-Hypofractionated 5-Fraction Adjuvant Radiation Therapy for Breast Cancer from a Single Institute in India

PURPOSE/OBJECTIVE(S)

Safety data for ultra-hypofractionated (UHFRT) 5-daily fractions of the supraclavicular fossa (SCF) radiation therapy (RT) have been reported only on 384 patients treated in trial setting in UK-FAST-Forward (n = 286) and HYPORT study (n = 98). Internal Mammary nodal (IMN) RT has been reported only in 6 patients from HYPORT study. We report acute and late toxicities in largest real world regional nodal irradiation (RNI) cohort of not only with 5-daily but also with 5-weekly once RT regimen.

MATERIALS/METHODS

Of 1435 patients (1463 breasts) who received 5-fraction RT in an IEC approved registry and prospectively followed, we report 999 consecutive cases receiving RNI with a median age of 49 years (IQR:42-56years). During pandemic all patients were treated with 5-fr regimens only to limit hospital visits whereas prior to and subsequently only in patients with advanced age or with issues precluding daily 15-20 treatments. Of these, 431 (43.1%) had locally advanced BC, and 280 (28%) patients presented with ≥cN2 disease. Median cT and pT sizes were 4cm (IQR:3-6cm) and 2.8cm (IQR:1.5-4cm) respectively. Tumor was Her2 positive in 290(29%) and TNBC in 220(22%). Of these 999 cases, 611 received NACT, 647 had mastectomy and 351 had breast conserving surgery (BCS). Simultaneous integrated tumor bed boost (SIB) was given in 341 (97.1%) of BCS cases.

RESULTS

The fractionation used was 26 Gy/5-daily fractions (SIB = 32 Gy) in 762 and 28.5 Gy/ 5 once weekly fractionation (SIB = 33 Gy) in 232 cases. RNI included SCF in all 999 and IMN in 168 patients. Of the 831 cases not requiring IMN RT, 573 (70.4%) had 3D conformal RT (n = 573/831,70.4%) whereas Inverse-planned intensity modulated RT was used in 152/168 (90.4%) patients requiring IMN RT. All Mono-isocentric technique was used for all RNI cases treated with 3D CRT. Nearly half of the patients treated with SIB received additional boost dose with electrons (50.5%) and the remaining with IMRT. In these 999 patients treated with UHFRT the peak RTOG grade ≥II skin and pharyngeal toxicity was 7.2% and 8.1% respectively. Among the 341 BCS cases who received SIB with UHFRT, the RTOG acute grade II and III skin toxicity was seen in 6.6% and 0.3% cases respectively. The maximum skin toxicity at 2 weeks after completion of RT of grade ≥II was significantly higher with 5-weekly compared to daily regimen (16.1 vs 4.6, p<0.01). In contrast, the maximum pharyngeal toxicity of grade ≥II was significantly higher with 5-daily compared to weekly fractionation (8.8% vs 5.2%, p = 0.04). At median follow-up of 25 months (CI:23.6-26.3 months), none of our patients had developed symptomatic radiation pneumonitis, brachial plexopathy or any major cardiac event.

CONCLUSION

Five-fraction adjuvant breast cancer RT is well tolerated with low acute toxicity burden even among patients requiring regional nodal irradiation. No brachial plexopathy was observed in cases treated with mono-isocentric RNI but longer follow-up is required to inform about the late toxicities and locoregional control rates.

Videofluoroscopy Practice in India: A Survey of Speech-Language Pathologists

Owing to differences in clinical approaches toward videofluoroscopic swallowing studies (VFSS), professional and governing bodies in some countries have implemented guidelines for performing VFSS. However, in India, the establishment of such practice guidelines is in initial stages of acceptance and there are no uniform guidelines. The aim of the current study was to investigate and describe the clinical practice patterns related to VFSS assessments among Speech-Language Pathologists (SLPs) in India. An electronic survey consisting of 34 questions categorized into four main sections (demographic details and education; current practice; instrumental and technical considerations; protocol and assessment methods) was sent to SLPs registered with the Indian Speech and Hearing Association (ISHA) through email and social media from August 2020 to January 2021. A total of 129 eligible responses were received. More than 50% of the participants used a standard assessment and analysis protocol. Barium and water-soluble contrasts were mostly used, and 97% of participants did not know what percent weight to volume (w/v) or volume to volume (v/v) contrast to fluid were used. Considerable amount of variability was observed in the responses of our participants, which was consistent with international surveys of VFSS practice patterns. Lack of adequate radiation safety measures was also observed. Our findings suggest a need to increase awareness and training among Indian SLPs in technical and procedural aspects of VFSS, and more sensitization toward radiation safety. ISHA should consider forming a committee to develop and adopt uniform nationwide practices in VFSS. Future studies exclusively investigating barriers and facilitators to VFSS practice in the Indian scenario are necessary.

Cervical Vestibular-Evoked Myogenic Potentials in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Vestibular evoked myogenic potentials (VEMPs) in individuals with diabetes mellitus (DM) provide evidence as how diabetes can bring about changes in the peripheral nervous system. Cervical VEMP (cVEMP) evaluates the function and integrity of the sacullo- collic pathway and ocular VEMP (oVEMP) evaluates the utriculo-collic pathway. cVEMP is an ipsilateral inhibitory response of the sternocleidomastoid muscle. cVEMP is recorded at higher intensity above 80-85 dBnHL with biphasic waveforms having initial peak positivity P13 followed by a negativity N23. We performed a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to evaluate cVEMP in diabetes mellitus. The search was conducted in the databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Cochrane library using the keywords "diabetes mellitus" and "vestibular evoked myogenic potential" or "cVEMP." A two-phase selection process was used for the final inclusion of studies, and the methodological quality of these studies was assessed using the Newcastle Ottawa scale (NCOS). Meta-analysis was performed using a random-effects model. For comparisons between DM and healthy controls, a significant difference was observed for cVEMP amplitude (P = 0.01). Our meta-analysis's results suggest peripheral vestibular dysfunction can be observed in DM. It appears that cVEMPs may be useful in the early detection of neuropathy in DM.

Validation and Psychometric Evaluation of the Kannada Version of the Speech Handicap Index in Individuals with Oral and Oropharyngeal Cancer

The current study aimed to adapt and validate the speech handicap index into the Kannada language, and also to investigate its psychometric properties in Kannada speaking individuals with oral and oropharyngeal cancers. This is a cross-sectional study and it was carried out in two phases. The first phase dealt with the translation of the English version of SHI into the Kannada language, and its validation on 95 healthy individuals and 25 individuals with oral or oropharyngeal cancer. The second phase dealt with the investigation of speech-related quality of life among 50 Kannada speaking individuals with oral and oropharyngeal cancers. The SHI-K has very good internal consistency (Cronbach's Alpha is 0.98) and exhibited good test-retest reliability (ICC = 0.94). The mean scores of the disordered group, for the psychosocial scores (t (118) = 25.87, p < 0.01), for speech scores (t (118) = 19.74, p < 0.01), for total SHI scores (t (188) = 26.45, p < 0.01), for overall rating (t (118) = 16.81, p < 0.01) were statistically significant and greater than the healthy group (p < 0.01). A statistically significant association was found between clinical-stage, total SHI scores, and rating [χ2 (4, N = 50) = 3.82, p = 0.02], but not for sex, tumor site, and type of treatment received. SHI-K is a valid and reliable tool to assess the speech-related quality of life of individuals with speech disorders. This tool can allow clinicians to plan better rehabilitation, and it can be used as an outcome tool for any treatment studies. The findings of the study emphasize the importance of considering patient priorities before commencing surgical or therapeutic interventions.

Systematic Review and Meta-Analysis of Dysphagia and Associated Pneumonia in Patients With Stroke From India: A Call to Arms

OBJECTIVES

This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India.

METHOD

We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle-Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the I² index.

RESULTS

A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], p < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], p < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], p < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented.

CONCLUSIONS

Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022.

The Test of Masticating and Swallowing Solids (TOMASS): Reliability, Validity and Normative Data for the Adult Indian Population

The Test of Masticating and Swallowing Solids (TOMASS) is a reliable and well-validated tool to assess the effectiveness of solid bolus ingestion. Previous studies have established normative values for 4 to 80+ years across a range of commercially available crackers and countries. The current study aimed to establish normative data for the TOMASS across age and gender groups for a commercially available biscuit (cracker) for the adult Indian population. A total of 300 typical individuals in the age range of 21 to 80 years grouped by age and sex participated in the study. Participants were instructed to eat a commercially (locally) available biscuit 'as quickly and comfortably as possible,' and the task was video recorded. The recorded video samples were analyzed to obtain measures of the number of bites, number of masticatory cycles, number of swallows, and total time taken to complete the ingestion of biscuit. Cronbach's α values revealed a moderate to good (0.71 to 0.82) test-retest reliability; ICC values were suggestive of a high level (> 0.76) of interrater reliability for all the measures of TOMASS. The results of the one-way ANOVA revealed a significant main effect of age (F = 3.12, p < 0.01) and gender (F = 4.37, p < 0.01), but not an interaction between the two. Normative data stratified by age and gender were also generated. The TOMASS assessment procedure was feasible, reliable, and valid. In the current study, we observed that males took fewer bites, took less time, chewed less, and swallowed fewer times than females. A definitive age effect was observed for the number of bites, masticatory cycles, and total time. The normative data generated by the current study can serve as clinical benchmarks to assess the ingestion of solid bouls in the adult Indian population.

Effects of dual-task interference on swallowing in healthy aging adults

A wide body of literature has demonstrated that the neural representation of healthy swallowing is mostly bilateral, with one hemisphere dominant over the other. While several studies have demonstrated the presence of laterality for swallowing related functions among young adults, the data on older adults are still growing. The purpose of this paper is to investigate potential changes in hemispheric dominance in healthy aging adults for swallowing related tasks using a behavioral dual-task paradigm. A modified dual-task paradigm was designed to investigate the potential reduction in hemispherical specialization for swallowing function. Eighty healthy right-handed participants in the study were divided into two groups [Group 1: young adults (18–40 years) and Group 2: older adults (65 and above)]. All the participants performed a timed water swallow test at baseline and with two interference conditions (silent word repetition, and facial recognition). The results of the study revealed the following 1) a statistically significant effect of age on swallow performance; 2) statistically significant effect of each of the interference tasks on two of the swallow measures (VPS and VPT) in younger adults; and 3) no significant effect of the interference tasks on the swallowing performance of older adults. These findings suggest that aging substantially affects swallowing in older individuals, and this potentially accompanies a reduction in the hemispheric specialization for swallowing related tasks.

The Test of Masticating and Swallowing Solids (TOMASS): Normative data for the adult Indian population

This data article accompanies the manuscript titled 'The Test of Masticating and Swallowing Solids (TOMASS): reliability, validity and normative data for the adult Indian population.' TOMASS is a widely used procedure to assess the effectiveness of solid bolus ingestion. Previous studies have established normative values for 4 to 80+ years across a range of commercially available crackers and countries. In this data set we report normative TOMASS data for the adult Indian population. Data was recorded from 300 typical individuals in the age range of 21 to 80 years grouped by age and sex. Participants were instructed to eat a commercially (locally) available biscuit 'as quickly and comfortably as possible,' and the task was video recorded. The recorded video samples were analyzed to obtain measures of the number of bites, number of masticatory cycles, number of swallows, and total time taken to complete the ingestion of biscuit.

The timed water test of swallowing: Reliability, validity, and normative data from Indian population

OBJECTIVES

Dysphagia post-stroke represents a substantial health issue. The rates of pneumonia are lesser among those individuals who have passed a dysphagia screening test. Only few among the existing screening tests meet the required standards; the timed water swallow test (TWST) is one among them. The purpose of the study was to establish normative data for the TWST in Indian population.

METHODS

The present study involved 480 typical individuals in the age range of 8-80.11 years. All the participants performed TWST and indices of volume per swallow, time per swallow, and swallow capacity were obtained for the tasks of normal and rapid swallow across age and gender.

RESULTS

In the first phase of the study, normative data were obtained and summarized by age and gender. The second phase of the study dealt with additional analyses on measures of reliability and validity. Two-way mixed ANOVA was performed with age and gender as the between-group variables, and normal and rapid swallowing as the within-group variables.

CONCLUSION

Normative values for the performance of Indian population on TWST were obtained. The results revealed a significant difference for all the three indices of swallow performance across age, gender, and type of swallowing. These norms can be used as a screening tool for identifying swallowing dysfunction.

A Delphi survey based construction and validation of test for oropharyngeal dysphagia in Indian neonates

BACKGROUND

SLPs have a crucial need to depend on comprehensive clinical swallowing assessments to determine the presence of dysphagia in neonates. A comprehensive clinical swallowing assessment that is ethnoculturally sensitive may help to identify the presence and severity of swallowing problems in neonates.

OBJECTIVE

The study aimed to construct and validate the contents of a test for oropharyngeal dysphagia in Indian neonates (TOD-IN).

METHOD

The test for oropharyngeal dysphagia in Indian neonates (TOD-IN) was developed using the Delphi process. Five expert panelists served as participants; two rounds of electronic questionnaire-based survey was carried out to develop and validate the contents of TOD-IN.

RESULTS

Round one rendered descriptive data that was analyzed quantitatively and qualitatively. At the end of round one, panelists unequivocally agreed on the need for research to develop a validated assessment tool for dysphagia in Indian neonates. The second round dealt with establishing the face and content validity of the final version of TOD-IN. A unanimous consensus was obtained regarding the format, scoring system, and the construct of the final version of the tool.

CONCLUSION

Practicing clinicians in India are met with several challenges such as resource constraints, limited infrastructure, increasing caseload, and a lack of trained workforce. We believe that inexperienced clinicians will benefit from the structured guidance provided by TOD-IN in a restrained resource context where prioritization of patients is the key. Further studies investigating the psychometric properties of TOD-IN are in progress.

Two step convolutional neural network for automatic glottis localization and segmentation in stroboscopic videos

Precise analysis of the vocal fold vibratory pattern in a stroboscopic video plays a key role in the evaluation of voice disorders. Automatic glottis segmentation is one of the preliminary steps in such analysis. In this work, it is divided into two subproblems namely, glottis localization and glottis segmentation. A two step convolutional neural network (CNN) approach is proposed for the automatic glottis segmentation. Data augmentation is carried out using two techniques :  1) Blind rotation (WB), 2) Rotation with respect to glottis orientation (WO). The dataset used in this study contains stroboscopic videos of 18 subjects with Sulcus vocalis, in which the glottis region is annotated by three speech language pathologists (SLPs). The proposed two step CNN approach achieves an average localization accuracy of 90.08% and a mean dice score of 0.65.

Aerodynamic and acoustic characteristics of voice in children with down syndrome-A systematic review

PURPOSE

The anatomical, physiological, and phenotypic characteristics of children with Down Syndrome results in deviated acoustic and aerodynamic measures in their voice. These deviant vocal presentations may negatively affect the quality of life of children with Down syndrome. The present study aimed to systematically review the available literature on acoustic and aerodynamic voice characteristics of children with Down syndrome.

METHOD

A systematic review of studies on acoustic and aerodynamic measures of voice in children with Down Syndrome (using PubMed/MEDLINE, CINAHL, Scopus, ProQuest, Cochrane, Ovid, Science Direct) was carried out. Keywords based on Population-Investigation-Outcome were used to develop search strings. Two authors screened titles and abstracts independently, and appropriate studies were analyzed in detail for data extraction.

RESULTS

Out of the 1432 studies, two studies met the inclusion criteria. Different acoustic and aerodynamic measures were employed, such as fundamental frequency, intensity, phonation time, jitter, shimmer and ESGP, MAFR, and LAR.

CONCLUSION

Overall, there was a lack of standardized criteria for the evaluation of acoustic and aerodynamic characteristics in the Down syndrome population. Acoustically, there was no significant difference between children with DS and typically developing children. However, aerodynamic studies suggest that there is a significant impairment of glottal valving in children with Down syndrome.

Evaluating the Psychometric Properties of the Kannada Version of EAT 10

BACKGROUND

Eating Assessment Tool 10 is a symptom survey and has several advantages over other existing questionnaires. The instrument has also proven to be useful in establishing initial dysphagia symptom severity and to aid in measuring treatment outcomes. Due to its wide applicability, the instrument has been translated into several languages. The aim of the present study was to translate and validate the Kannada version of Eating Assessment Tool 10.

METHOD

88 individuals with dysphagia and equal number of healthy individuals filled the Kannada version of Eating Assessment Tool. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was also established by comparing the scores of dysphagia patients and healthy controls.

RESULTS

The overall Cronbach's α for the tool was 0.9 indicating a good internal consistency. The internal consistency of each of the items was also high, and ranged 0.88 to 0.9. Twenty patients filled the questionnaire after a span of 48 h, and the ICC coefficient was found to be 0.89 indicating a high reliability. The control group has significantly lower scores for all scales when compared to the dysphagia group [t(174) = 78.41, p < 0.001].

CONCLUSION

The present study demonstrates that the Kannada version of EAT 10 has good internal consistency, test retest reliability, and concurrent validity. The results of the study also reveal that it is a reliable and valid tool for screening dysphagia population.

Translation and Validation of Kannada Version of the Dysphagia Handicap Index

Background The Dysphagia Handicap Index (DHI) is a 25-item questionnaire that assesses the quality of life among individuals with dysphagia. The aim of this study was to translate and validate the Kannada version of DHI (DHI-K). Method Eighty-eight individuals with dysphagia and an equal number of healthy individuals filled out the DHI-K. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI-K scores of patients with dysphagia and healthy controls. Results The overall Cronbach's α for DHI-K was .81, indicating good internal consistency. Cohen's κ agreement for test-retest reliability of self-perceived severity was found to be .9. Correlation between subscales of DHI and self-perceived severity was analyzed using Spearman correlation coefficient and was found to very high. The control group has significantly lower scores for all scales when compared to the dysphagia group (physical: t(174) = 31.74, p < .001; functional: t(174) = 32.65, p < .001; emotional: t(174) = 36.3, p < .001; total: t(174) = 34.08, p < .001). Conclusions This study demonstrates that DHI-K has good internal consistency, test-retest reliability, and concurrent validity. The results of the study also reveal that it is a reliable and valid tool for assessment of handicap in Kannada-speaking dysphagia population.

Assessment of genetic diversity in Colletotrichum falcatum Went accessions based on RAPD and ISSR markers

Sugarcane is susceptible to red rot disease caused by phytopathogenic fungus Colletotrichum falcatum Went which ultimately affect the economy of farmers as well as sugar based industry. One of the various ways to control this devastating disease is to develop disease resistance sugarcane cultivar and this requires the complete understanding of genetic makeup of pathogen. Although South Gujarat is well known sugarcane cultivating area, less published data can be found about PCR-based genetic diversity in prevalent C. falcatum accessions. So, present investigation aims at finding molecular variation among the ten accessions of C. falcatum using RAPD and ISSR molecular markers. A total of 35 RAPD and 39 ISSR primers were screened across 10 C. falcatum accessions, of which 15 RAPD and 21 ISSR primers have showed consistent amplification. Statistics related to genetic variation were estimated using NTSYS-PC by means of Dice's coefficient. The results revealed 80.6% and 68.07% polymorphism and similarity coefficient ranged from 0.43 to 0.91 and 0.73 to 0.93 in RPAD and ISSR analysis respectively. The dendrogram generated using RAPD, ISSR and combined RAPD-ISSR grouped accessions into different clusters which reveal considerable level molecular variation among the C. falcatum accessions. It is also evident from PCA plots that accessions are rather dispersed with tested marker systems indicating good genetic base. So, in nut shell, we found considerable genetic variation and relatedness within C. falcatum accessions collected from different areas of south Gujarat, India using RAPD and ISSR markers.

Separation Dynamics of Air-to-Air Missile and Validation with Flight Data

<p class="p1">Prediction of flight characteristics of a store in the vicinity of an aircraft is vitally important for ensuring the safety of the aircraft and effectiveness of the store to meet the mission objective. Separation dynamics of an agile air-to-air-Missile from a fighter aircraft is numerically simulated using an integrated store separation dynamics suite. Chimera cloud of points along with a grid-free Euler solver is used to obtain aerodynamic force on the missile and the force is integrated using a rigid body dynamics code to obtain the missile position. In the present work, the suite is applied to a flight test case and sensitivity of trajectory variables on launch parameters is studied. Further, the results of the suite are compared with the flight data. The predicted body rates and Euler angles of missile compare well with the flight data.<span class="Apple-converted-space"> </span></p><p class="p2"><span class="Apple-converted-space"> </span></p>

Assessment of genetic diversity in Costus pictus accessions based on RAPD and ISSR markers

Costus pictus, belonging to the family Costaceae, is one of the valuable medicinal plants with its anti-diabetic property. Despite ever-increasing demand from the pharmaceutical industry, this species is being less exploited at molecular level. Hence, an effort has been made in the present study to characterize the 15 accessions of C. pictus collected from different geographical regions of India through random amplified polymorphic DNA (RAPD) and inter-simple sequence repeats (ISSR) markers. A total of 25 RAPD and 20 ISSR primers were used in the present study. The RAPD analysis generated 343 loci, of which 124 were polymorphic with an average of 4.96 loci per primer. While, ISSR primers produced 177 loci, of which 77 were polymorphic with an average of 3.85 loci per primer. The similarity coefficients ranged from 0.86-0.99, 0.84-0.95 and 0.86-0.96 for RAPD, ISSR and combined RAPD-ISSR, respectively. The UPGMA dendrogram generated using these data showed low level of divergence among the accessions from South and West regions. Further, accession-specific bands were also revealed by RAPD and ISSR markers which might be contributed to specific trait. This investigation was an understanding of genetic variation within the C. pictus accessions. The present finding indicates that both the marker tools RAPD and ISSR combined or individually can be used in determining the genetic relationship between the accessions. It may be concluded that data of hereditary differences appeared among the C. pictus accessions could be utilized for their conservation and reproducing programs.

An experimental assessment on the performance of different lubrication techniques in grinding of Inconel 751

The application of emulsion for combined heat extraction and lubrication requires continuous monitoring of the quality of emulsion to sustain a desired grinding environment; this is applicable to other grinding fluids as well. Thus to sustain a controlled grinding environment, it is necessary to adopt an effectively lubricated wheel-work interface. The current study was undertaken to assess experimentally the ​ effects of different grinding environments such as dry, minimum quantity lubrication (MQL) and Cryo-MQL on performance, such as grinding force, temperature, surface roughness and chip morphology on Inconel 751, a higher heat resistance material posing thermal problems and wheel loading. The results show that grinding with the combination of both liquid nitrogen (LN₂) and MQL lowers temperature, cutting forces, and surface roughness as compared with MQL and dry grinding. Specific cutting energy is widely used as an inverse measure of process efficiency in machining. It is found from the results that specific cutting energy of Cryo-MQL assisted grinding is 50–65% lower than conventional dry grinding. The grindability of Inconel 751 superalloy can be enhanced with Cryo-MQL condition.

Neutrophil-lymphocyte ratio, pain perception, and disease activity score may serve as important predictive markers for sustained remission in rheumatoid arthritis

The implementation of new treatment strategies based on current recommendations has enabled a greater number of patients with rheumatoid arthritis (RA) to achieve remission. However, there are no definite predictors of sustained remission. Moreover, the absence of clear consensus on the time of withdrawal or reduction of treatment further adds to the treatment burden. This pilot study was intended to evaluate the prognostic potential of various RA-related parameters. All the enrolled subjects (n=124) were clinically evaluated on the basis of various parameters including age, gender, duration of illness before the initiation of disease-modifying anti-rheumatic drugs, tender and swollen joints (28 joints), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin percentage, lymphocyte count, total white-blood cell counts, and neutrophil to lymphocyte ratio (NLR). Student's t-test and discriminant function analysis were performed. The specificity of all parameters and their best possible cut-off to predict relapse were calculated using the receiver operating characteristic (ROC) analysis. A significant difference in terms of pain perception, NLR, tendency to have a significant tender joint count and absolute lymphocyte counts was identified between the patients in sustained remission and those in relapse. The ROC analysis indicated that NLR was consistent in predicting remission. CRP, ESR, and/or disease activity score may not be very effective in differentiating patients with sustainable remission/low disease activity. NLR along with patient's perception of pain may assist in predicting sustained remission.

Road Traffic Related Injury Research and Informatics. New Opportunities for Biomedical and Health Informatics as a Contribution to the United Nations' Sustainable Development Goals?

The United Nations has recently adopted 17 sustainable development goals for 2030, including ensuring healthy lives and promoting well-being for all at all ages, and making cities and human settlements inclusive, safe, resilient and sustainable. Road injuries remain among the ten leading causes of death in the world, and are projected to increase with rapidly increasing motorisation globally. Lack of comprehensive data on road injuries has been identified as one of the barriers for effective implementation of proven road safety interventions. Building, linking and analysing electronic patient records in conjunction with establishing injury event and care registries can substantially contribute to healthy lives and safe transportation. Appropriate use of new technological approaches and health informatics best practices could provide significant added value to WHO's global road safety work and assist Member States in identifying prevention targets, monitoring progress and improving quality of care to reduce injury-related deaths. This paper encourages the initiation of new multidisciplinary research at a global level.

Synthesis of orotidine by intramolecular nucleosidation

An intramolecular nucleosidation approach, using orotate as a leaving group, provides easy access to orotidine in high yields.

Effect of L-aspartic acid on the growth, structure and spectral studies of Zinc (tris) Thiourea Sulphate (ZTS) single crystals

Single crystals of pure and L-aspartic acid doped Zinc (Tris) Thiourea Sulphate (ZTS) were grown from aqueous solution by solution growth method. The cell parameters and structure of the grown crystals were determined by X-ray diffraction studies. The presence of functional group in the compound has been confirmed by FTIR and FT-Raman analysis. The optical transparency range has been studied through UV-Vis spectroscopy. TGA/DTA studies show thermal stability of the grown crystals. Microhardness study reveals that the hardness number (Hv) increases with load for pure and doped ZTS crystals. Dielectric studies have been carried out and the results are discussed. The second harmonic generation was confirmed for l-aspartic acid doped ZTS which is greater than pure ZTS.

Microwave-assisted preparation of nucleoside-phosphoramidites

Microwave-assisted phosphitylation of nucleosides is an efficient method for the preparation of phosphoramidites.

Growth and characterization of KDP crystals doped with L-aspartic acid

Potassium Dihydrogen Phosphate (KDP) doped with L-aspartic acid has been grown by solvent slow evaporation technique from a mixture of aqueous solution of KDP and 0.7% of L-aspartic acid at room temperature. The grown crystals were characterized by powder X-ray diffraction, UV-visible, FTIR analysis. The doping of aspartic acid was confirmed by FTIR spectrum. The Nonlinear optical property (SHG) of L-aspartic acid doped KDP has been confirmed. Microhardness studies were carried out on the grown crystal.

The utility of ultrasound and magnetic resonance imaging versus surgery for the characterization of müllerian anomalies in the pediatric and adolescent population

STUDY OBJECTIVE

To evaluate the utility of transabdominal ultrasound and magnetic resonance imaging in the evaluation of American Society for Reproductive Medicine (†)(ASRM)-classified müllerian anomalies compared to surgical findings in the pediatric and adolescent population.

DESIGN

Retrospective chart review.

SETTING

Tertiary academic center.

PARTICIPANTS

Thirty-eight patients with müllerian anomalies seen in our pediatric and adolescent gynecology clinic were identified both on the basis of ICD-9 codes and having magnetic resonance imaging at Texas Children's Hospital between 2004 and 2009.

INTERVENTIONS

None.

MAIN OUTCOMES MEASURE

Correlation among transabdominal ultrasound and magnetic resonance imaging findings with surgical findings.

RESULTS

Mean age was 12.2 (± 4.1) years. Twenty-eight patients underwent magnetic resonance imaging and required surgical intervention, and 88.5% demonstrated correlative consistency with surgical findings. Twenty-two patients underwent ultrasound, magnetic resonance imaging, and surgery, which revealed consistency among ultrasound and surgical findings (59.1%) and consistency among magnetic resonance imaging and surgical findings (90.9%). In ASRM diagnoses evaluated by magnetic resonance imaging, surgical findings correlated in 92% (Pearson 0.89). Overall, 55.2% of patients had a renal malformation.

CONCLUSIONS

Magnetic resonance imaging is the gold standard imaging modality for müllerian anomalies and is an effective technique for noninvasive evaluation and accurate classification of the type of anomaly in the pediatric and adolescent population. Magnetic resonance imaging should be considered as an adjunct to transabdominal ultrasound to evaluate müllerian anomalies.

Exenatide decreases hepatic fibroblast growth factor 21 resistance in non-alcoholic fatty liver disease in a mouse model of obesity and in a randomised controlled trial

AIMS/HYPOTHESIS

Systemic fibroblast growth factor (FGF)21 levels and hepatic FGF21 production are increased in non-alcoholic fatty liver disease patients, suggesting FGF21 resistance. We examined the effects of exenatide on FGF21 in patients with type 2 diabetes and in a diet-induced mouse model of obesity (DIO).

METHODS

Type 2 diabetes mellitus patients (n = 24) on diet and/or metformin were randomised (using a table of random numbers) to receive additional treatment consisting of pioglitazone 45 mg/day or combined therapy with pioglitazone (45 mg/day) and exenatide (10 μg twice daily) for 12 months in an open label parallel study at the Baylor Clinic.

RESULTS

Twenty-one patients completed the entire study and were included in the analysis. Pioglitazone treatment (n = 10) reduced hepatic fat as assessed by magnetic resonance spectroscopy, despite a significant increase in body weight (Δ = 3.7 kg); plasma FGF21 levels did not change (1.9  ±  0.6 to 2.2  ±  0.6 ng/ml [mean ± SEM]). However, combined pioglitazone and exenatide therapy (n = 11) was associated with a significant reduction of FGF21 levels (2.3  ±  0.5 to 1.1  ±  0.3 ng/ml) and a greater decrease in hepatic fat. Besides weight gain observed in the pioglitazone-treated patients, lower extremity oedema was observed as a side effect in two of the ten patients. Three patients who received pioglitazone and exenatide combination therapy complained of significant nausea that was self-limiting and did not require them to leave the study. In DIO mice, exendin-4 for 4 weeks significantly reduced hepatic triacylglycerol content, decreased hepatic FGF21 protein and mRNA, and enhanced phosphorylation of hepatic AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase, although no significant difference in weight and body fat was observed. Hepatic FGF21 correlated inversely with hepatic AMPK phosphorylation

CONCLUSIONS/INTERPRETATION

In type 2 diabetes mellitus, combined pioglitazone and exenatide therapy is associated with a reduction in plasma FGF21 levels, as well as a greater decrease in hepatic fat than that achieved with pioglitazone therapy. In DIO mice, exendin-4 treatment reduces hepatic triacylglycerol and FGF21 protein, and enhances hepatic AMPK phosphorylation, suggesting an improvement of hepatic FGF21 resistance.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT 01432405.

Successive explosions in Mumbai the economic center of India

Terrorist activities in India are increasing day by day with sophistication in modus operandi. Mumbai the economic center of India was attacked by a series of bomb blasts at twelve different places within a span of an hour on 12th March 1993. The main explosive used was RDX [Krishnamurthy R, Malve MK, Shinde BM. J Indian Acad Forensic Sci 1996;35(1& 2):46-61.]. After about 10 years, terrorist activity of late has again erupted taking a toll on innocent lives, with the use of explosives causing death and destruction. On 2.12.02 a public bus at Ghatkopar was blown up by an improvised explosive device (IED) with two casualties. On 27.1.03 the public vegetable market at Vileparle was targeted causing heavy damage and panic among common people. On 13.3.03 a fully packed local train compartment at Mulund railway station was blown up by an improved explosive device and the casualties ranged up to 10. In most of the explosions the explosives used were RDX, NC-NG, etc. The blasts that occurred at the Zaveri bazaar and the gateway of India on 25/8/03 showed the presence of big craters at the blast site and on analysis the presence of RDX and petroleum oil.

Pentopyranosyl oligonucleotide systems. Part 11: Systems with shortened backbones: (D)-beta-ribopyranosyl-(4'-->3')- and (L)-alpha-lyxopyranosyl-(4'-->3')-oligonucleotides

The (L)-alpha-lyxopyranosyl-(4'-->3')-oligonucleotide system-a member of a pentopyranosyl oligonucleotide family containing a shortened backbone-is capable of cooperative base-pairing and of cross-pairing with DNA and RNA. In contrast, corresponding (D)-beta-ribopyransoyl-(4'-->3')-oligonucleotides do not show base-pairing under similar conditions. We conclude that oligonucleotide systems can violate the 'six-bonds-per-backbone-unit' rule by having five bonds instead, if their vicinally bound phosphodiester bridges can assume an antiperiplanar conformation. An additional structural feature that seems relevant to the cross-pairing capability of the (L)-alpha-lyxopyranosyl-(4'-->3')-oligonucleotide system is its (small) backbone/basepair axes inclination. An inclination which is similar to that in B-DNA seems to be a prerequisite for an oligonucleotide system's capability to cross-pair with DNA.

Isolation of group A beta-hemolytic streptococci in the tonsillopharynx of school children in Madras City and correlation with their clinical features

Today, rheumatic fever is the most common cause of heart disease in children and young adults, and it accounts for about half of all cardiovascular diseases causing death in the first four decades of life, in India. In the present study, conducted during 1991-1992 at Chennai, India, a total of 666 school girls aged 5-15 years were examined clinically for one or more of the following signs and symptoms: repeated sore throat, joint pain/swelling, epistaxis, chest pain, breathlessness, palpitation, abdominal pains, etc. Out of the 666 children screened, 124 were recruited for the present study, based on their meeting one or more of the above mentioned clinical criteria. They were screened for the presence of group A beta-hemolytic streptococci, and for antistreptolysin O and C-reactive protein. Thus, the aim of the present study was to reduce the load of streptococcal infection and the consequent risk of developing rheumatic fever and rheumatic heart disease. In the present study group, 89.5% of the children indicated a history of repeated sore throat. However, only 4.0% of the children in the study group were positive for group A beta-hemolytic streptococci. The antistreptolysin O and C-reactive protein levels were higher in 11- to 15-year-old patients than in 5- to 10-year-old patients in the study group.

Drosophila transcription factor AP-2 in proboscis, leg and brain central complex development

We report loss- and gain-of-function analyses that identify essential roles in development for Drosophila transcription factor AP-2. A mutagenesis screen yielded 16 lethal point mutant alleles of dAP-2. Null mutants die as adults or late pupae with a reduced proboscis, severely shortened legs (~30% of normal length) lacking tarsal joints, and disruptions in the protocerebral central complex, a brain region critical for locomotion. Seven hypomorphic alleles constitute a phenotypic series yielding hemizygous adults with legs ranging from 40–95% of normal length. Hypomorphic alleles show additive effects with respect to leg length and viability; and several heteroallelic lines were established. Heteroallelic adults have moderately penetrant defects that include necrotic leg joints and ectopic growths (sometimes supernumerary antennae) invading medial eye territory. Several dAP-2 alleles with DNA binding domain missense mutations are null in hemizygotes but have dominant negative effects when paired with hypomorphic alleles. In wild-type leg primordia, dAP-2 is restricted to presumptive joints. Ectopic dAP-2 in leg discs can inhibit but not enhance leg elongation indicating that functions of dAP-2 in leg outgrowth are region restricted. In wing discs, ectopic dAP-2 cell autonomously transforms presumptive wing vein epithelium to ectopic sensory bristles, consistent with an instructive role in sensory organ development. These findings reveal multiple functions for dAP-2 during morphogenesis of feeding and locomotor appendages and their neural circuitry, and provide a new paradigm for understanding AP-2 family transcription factors.

An evaluation of the effects of Rorschach EB style on the diagnostic utility of the Depression Index

Several empirical studies have found the Rorschach Depression Index (DEPI) to have questionable diagnostic utility. Studies using adolescent samples suggest that the DEPI has limited sensitivity and fails to differentiate effectively between adolescents with and without depression diagnoses. The present study was conducted to evaluate Viglione, Brager, and Haller's suggestion that the DEPI may have better discriminative ability for individuals with extratensive problem-solving styles, measured by the Rorschach EB (Erlebnistypus) variable, compared to those with introversive and ambitent styles. Comparisons were conducted between adolescents with depression-related diagnoses and adolescents with other diagnoses for each of the three EB groups. The results failed to support the hypothesized greater discriminative power of DEPI for depressed extratensives, and suggest caution in using the DEPI to evaluate adolescent depression.

Chemical etiology of nucleic acid structure: the alpha-threofuranosyl-(3'-->2') oligonucleotide system

TNAs [(L)-alpha-threofuranosyl oligonucleotides] containing vicinally connected (3'-->2') phosphodiester bridges undergo informational base pairing in antiparallel strand orientation and are capable of cross-pairing with RNA and DNA. Being derived from a sugar containing only four carbons, TNA is structurally the simplest of all potentially natural oligonucleotide-type nucleic acid alternatives studied thus far. This, along with the base-pairing properties of TNA, warrants close scrutiny of the system in the context of the problem of RNA's origin.