Testosterone therapy reduces insulin resistance in men with adult-onset testosterone deficiency and metabolic syndrome. Results from the Moscow Study, a randomized controlled trial with an open-label phase

AIMS

To describe changes in homeostasis model assessment of insulin resistance index (HOMA-IR) following testosterone therapy in men with hypogonadism and metabolic syndrome (MetS).

MATERIALS AND METHODS

A randomized, placebo-controlled, double-blind randomized controlled trial (RCT) comprising 184 men with MetS and hypogonadism (testosterone undecanoate [TU]: 113 men, placebo: 71 men) was conducted. This was followed by an open-label phase in which all men were given TU. We focused on men who were not receiving antiglycaemic agents (TU: 81 men; placebo: 54 men) as these could affect HOMA-IR. Inter-group comparison of HOMA-IR was restricted to the RCT (30 weeks), whilst intra-group comparison was carried out on men provided TU during the RCT and open-label phases (study cohort) and men given placebo during the RCT and then switched to TU during the open-label phase (confirmatory cohort). Regression analysis was performed to identify factors associated with change in HOMA-IR (∆HOMA-IR).

RESULTS

The median HOMA-IR was significantly reduced at almost every time point (after 18 weeks) compared to baseline in men receiving TU in both the study and confirmatory cohorts. There was a significant decrease in median values of fasting glucose (30 weeks: -2.1%; 138 weeks: -4.9%) and insulin (30 weeks: -10.5%; 138 weeks: -35.5%) after TU treatment. Placebo was not associated with significant ∆HOMA-IR. The only consistent predictor of HOMA-IR decrease following TU treatment was baseline HOMA-IR (r2 ≥ 0.64).

CONCLUSIONS

Baseline HOMA-IR predicted ΔHOMA-IR, with a greater percentage change in insulin than in fasting glucose. In men with MetS/type 2 diabetes (T2DM) not on antiglycaemic therapy, improvements in HOMA-IR may be greater than suggested by change in fasting glucose. Our results suggest that hypogonadism screening be included in the management of men with MetS/T2DM.

Atmospheric black carbon aerosol: Long-term characteristics, source apportionment, and trends

Black carbon (BC) aerosols play a very significant role in influencing air quality, climate, and human health. Large uncertainties still exist in BC emissions due to limited observations on the relative source contributions of fossil fuel (ff) combustion and biomass (wood fuel, wf) burning. Our understanding of long-term changes in BC emissions, especially their source apportionment, is sparse and limited. For the first time, BC characteristics, its source apportionment into ff and wf components, and their trends measured using a multi-wavelength aethalometer over an urban location (Ahmedabad) in India covering a 14 year period (2006-2019) are comprehensively investigated. The average contributions of eBCff and eBCwf concentrations to total eBC are 80 % and 20 %, respectively, which highlights dominance of emissions from fossil fuel combustion processes. A statistically significant increasing trend in eBC and eBCff mass concentrations at the rate of 11 % and 29%yr-1, respectively, and a decreasing trend in eBCwf concentration at the rate of 36%yr-1 are detected. The study reveals a significant decrease in biomass (wood fuel) burning emissions over past decade and an increase in emissions from fossil fuel combustion. However, rates of increase and decrease in eBCff and eBCwf are different, which indicate that rapid urbanization led to an increase in anthropogenic emissions, whereas an increase in usage of non-polluting fuel led to a decreasing trend in wood burning contribution. During weekdays and weekends, eBC and eBCff mass concentrations did not exhibit any statistically significant trends. However, eBCwf concentration shows a statistically significant decreasing trend during weekdays 34%yr-1 and weekends 38%yr-1. Globally, countries are adopting various strategies and mitigation policies on air quality; however, significant gaps exist in their implementation towards cleaner air. This comprehensive study is relevant for understanding the impact of urbanization and devising better BC emission control policies.

Macroprolactin over time: Is there any point in rechecking it in people with a persistently elevated serum prolactin?

OBJECTIVE AND DESIGN

Macroprolactinemia may influence the interpretation of serum prolactin levels-a recognised phenomenon since 1981. The degree of macroprolactinaemia over time is less well described. We determined how macroprolactin status (based on polyethylene glycol (PEG) precipitation) varied by analysing serial measurements in hyperprolactinaemic individuals over a period of 9 years.

PATIENTS AND MEASUREMENTS

Results from 1810 individuals were included. All serum total prolactin results (measured using Roche Cobas 8000 analyser) were extracted from the laboratory information system for the period 1 January 2012 to 1 April 2021, along with relevant patient demographic/test data. Samples with a macroprolactin screening test performed (on samples with prolactin > 700 miu/L) were included in the main analysis.

RESULTS

During the study period, 2782 macroprolactin checks were performed (12.5% of all prolactin tests) in 1810 individuals (599 males/2183 females, median-age: 35, interquartile range: 25-47, range: 16-93 years). Multiple macroprolactin checks were carried out on 465 patients (1437 measurements) with 94 patients (141 measurements) screening positive (<60% recovery). Only 19 patients (18 female) had at least one result above and one below the 60% screening cut-off, with 10 of these patients having results close to the 60% cut-off; in 9 patients, results were clearly different between repeat samples. In seven cases, the adjusted monomeric prolactin showed a potentially clinically significant difference.

CONCLUSIONS

In this study, only 19/465 patients appeared to change macroprolactin status based on a 60% PEG recovery cut-off. The majority of these 19 patients were on antipsychotic/antidepressant medication(s) or had a prolactinoma; in only 7 did monomeric prolactin change significantly. This suggests that once macroprolactin status has been determined, clinical decision making is rarely affected by repeating it.

Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men

PURPOSE

While testosterone therapy can improve the various pathologies associated with adult-onset testosterone deficiency (TD), Summary of Product Characteristics (SPC) of five testosterone preparations caution that treatment may be associated with hypertension. This paper evaluates the impact of testosterone undecanoate (TU) on blood pressure (BP) in men with adult-onset TD.

MATERIALS AND METHODS

Of 737 men with adult-onset TD in an on-going, observational, prospective, cumulative registry, we studied changes in BP using non-parametric sign-rank tests at final assessment and fixed time points. We used multiple regression analysis to establish factors (baseline BP, age, change/baseline waist circumference [WC] and hematocrit [HCT] and follow-up) potentially associated with BP change in men on TU.

RESULTS

TU was associated with significant reductions in systolic, diastolic BP and pulse pressure, regardless of antihypertensive therapy (at baseline or during follow-up), larger reductions were seen with concurrent antihypertensive therapy. In men never on antihypertensive agents, median changes (interquartile range [IQR]) in systolic BP, diastolic BP and pulse pressure were -12.5 (-19.0, -8.0), -8.0 (-14.0, -3.0), and -6.0 (-10.0, -1.0) mmHg, respectively at final assessment, with only baseline BP values inversely associated with these changes (HCT and WC were not significantly associated). In men not on TU, systolic BP, diastolic BP, and pulse pressure significantly increased. In the TU treated men only 1 of the 152 men (not on antihypertensive agents at baseline) were started on antihypertensives during follow-up. In contrast 33 of the 202 men on antihypertensives (at baseline or follow-up) had the antihypertensive agent discontinued by the end of the follow-up.

CONCLUSIONS

TU was associated with lowering of BP during follow-up irrespective of antihypertensive therapy, with greater reductions in men with higher baseline BP. In the context of SPC warnings, our long-term data provide reassurance on the effect of TU on BP.

Testosterone replacement therapy: association with mortality in high-risk patient subgroups

OBJECTIVES

We describe studies determining the association between testosterone therapy (TTh) and mortality.

MATERIALS & METHODS

We used a registry database of 737 men with adult-onset testosterone deficiency defined as presenting with low serum total testosterone (TT) levels ≤12.1 nmol/L and associated symptoms over a near 10-year follow-up. We compared associations between testosterone undecanoate (TU), cardio-metabolic risk factors and mortality using non-parametric statistics followed by separate Cox regression models to determine if any association between TU and morality was independent of age and cardio-metabolic risk factors. Finally, the association between TU and mortality was studied in men stratified by cardio-metabolic risk.

RESULTS

During a median follow-up interquartile range (IQR) of 114 (84-132) months, 94 of the 737 men died. TU (ref: non-treatment) was associated with mortality; hazard ratio = 0.23, 95% confidence intervals = 0.14-0.40. Cox's regression models showed the above association to be independent of baseline age, waist circumference, hemoglobin A1c, lipids, blood pressure, smoking, and type 2 diabetes. These variables remained associated with mortality. We finally stratified the men by the high-risk baseline variables and established that the association between mortality and TU was only evident in men at higher risk. A possible explanation could lie with the "law of initial value," where greater improvements are evident following treatment in patients with worse baseline values.

CONCLUSIONS

This study with long follow-up confirms that TTh is associated with lower mortality in men with adult-onset TD. This association was evident only in men with greater cardio-metabolic risk factors who demonstrated greater benefit.

Age and the Residual Risk of Cardiovascular Disease following Low Density Lipoprotein-Cholesterol Exposure

We believe that there is sufficient evidence from basic science, longitudinal cohort studies and randomised controlled trials which validates the low-density lipoprotein cholesterol (LDL-C) or lipid hypothesis. It is important that we can communicate details of the cardiovascular disease (CVD) risk reduction that the average patient could expect depending on the scale of LDL-C decrease following lipid lowering therapy. It is also essential that residual risk (ResR) of CVD be highlighted. To achieve this aim by using existing trial evidence, we developed mathematical models initially for relative risk reduction (RRR) and absolute risk (AR) reduction and then showed that despite optimising LDL-C levels, a considerable degree of ResR remains that is dependent on AR. Age is significantly associated with AR (odds ratio: 1.02, 95% confidence intervals: 1.01-1.04) as was previously demonstrated by analysing the Whickham study cohort using a logistic regression model (age remaining significant even when all the other significant risk factors such as sex, smoking, systolic blood pressure, diabetes and family history were included in the regression model). A discussion of a paper by Ference et al. provided detailed evidence of the relationship between age and AR, based on lifetime LDL-C exposure. Finally, we discussed non-traditional CVD risk factors that may contribute to ResR based on randomised controlled trials investigating drugs improving inflammation, thrombosis, metabolic and endothelial status.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.20 ppm

We present a new measurement of the positive muon magnetic anomaly, a_{μ}≡(g_{μ}-2)/2, from the Fermilab Muon g-2 Experiment using data collected in 2019 and 2020. We have analyzed more than 4 times the number of positrons from muon decay than in our previous result from 2018 data. The systematic error is reduced by more than a factor of 2 due to better running conditions, a more stable beam, and improved knowledge of the magnetic field weighted by the muon distribution, ω[over ˜]_{p}^{'}, and of the anomalous precession frequency corrected for beam dynamics effects, ω_{a}. From the ratio ω_{a}/ω[over ˜]_{p}^{'}, together with precisely determined external parameters, we determine a_{μ}=116 592 057(25)×10^{-11} (0.21 ppm). Combining this result with our previous result from the 2018 data, we obtain a_{μ}(FNAL)=116 592 055(24)×10^{-11} (0.20 ppm). The new experimental world average is a_{μ}(exp)=116 592 059(22)×10^{-11} (0.19 ppm), which represents a factor of 2 improvement in precision.

Aerosols heat up the Himalayan climate

The impact of aerosols, especially the absorbing aerosols, in the Himalayan region is important for climate. We closely examine ground-based high-quality observations of aerosol characteristics including radiative forcing from several locations in the Indo-Gangetic Plain (IGP), the Himalayan foothills and the Tibetan Plateau, relatively poorly studied regions with several sensitive ecosystems of global importance, as well as highly vulnerable large populations. This paper presents a state-of-the-art treatment of the warming that arises from these particles, using a combination of new measurements and modeling techniques. This is a first-time analysis of its kind, including ground-based observations, satellite data, and model simulations, which reveals that the aerosol radiative forcing efficiency (ARFE) in the atmosphere is clearly high over the IGP and the Himalayan foothills (80-135 Wm-2 per unit aerosol optical depth (AOD)), with values being greater at higher elevations. AOD is >0.30 and single scattering albedo (SSA) is ∼0.90 throughout the year over this region. The mean ARFE is 2-4 times higher here than over other polluted sites in South and East Asia, owing to higher AOD and aerosol absorption (i.e., lower SSA). Further, the observed annual mean aerosol-induced atmospheric heating rates (0.5-0.8 Kelvin/day), which are significantly higher than previously reported values for the region, imply that the aerosols alone could account for >50 % of the total warming (aerosols + greenhouse gases) of the lower atmosphere and surface over this region. We demonstrate that the current state-of-the-art models used in climate assessments significantly underestimate aerosol-induced heating, efficiency and warming over the Hindu Kush - Himalaya - Tibetan Plateau (HKHTP) region, indicating a need for a more realistic representation of aerosol properties, especially of black carbon and other aerosols. The significant, regionally coherent aerosol-induced warming that we observe in the high altitudes of the region, is a significant factor contributing to increasing air temperature, observed accelerated retreat of the glaciers, and changes in the hydrological cycle and precipitation patterns over this region. Thus, aerosols are heating up the Himalayan climate, and will remain a key factor driving climate change over the region.

Symptomatic benefits of testosterone treatment in patient subgroups: a systematic review, individual participant data meta-analysis, and aggregate data meta-analysis

BACKGROUND

Testosterone replacement therapy is known to improve sexual function in men younger than 40 years with pathological hypogonadism. However, the extent to which testosterone alleviates sexual dysfunction in older men and men with obesity is unclear, despite the fact that testosterone is being increasingly prescribed to these patient populations. We aimed to evaluate whether subgroups of men with low testosterone derive any symptomatic benefit from testosterone treatment.

METHODS

We did a systematic review and meta-analysis to evaluate characteristics associated with symptomatic benefit of testosterone treatment versus placebo in men aged 18 years and older with a baseline serum total testosterone concentration of less than 12 nmol/L. We searched major electronic databases (MEDLINE, Embase, Science Citation Index, and the Cochrane Central Register of Controlled Trials) and clinical trial registries for reports published in English between Jan 1, 1992, and Aug 27, 2018. Anonymised individual participant data were requested from the investigators of all identified trials. Primary (cardiovascular) outcomes from this analysis have been published previously. In this report, we present the secondary outcomes of sexual function, quality of life, and psychological outcomes at 12 months. We did a one-stage individual participant data meta-analysis with a random-effects linear regression model, and a two-stage meta-analysis integrating individual participant data with aggregated data from studies that did not provide individual participant data. This study is registered with PROSPERO, CRD42018111005.

FINDINGS

9871 citations were identified through database searches. After exclusion of duplicates and publications not meeting inclusion criteria, 225 full texts were assessed for inclusion, of which 109 publications reporting 35 primary studies (with a total 5601 participants) were included. Of these, 17 trials provided individual participant data (3431 participants; median age 67 years [IQR 60-72]; 3281 [97%] of 3380 aged ≥40 years) Compared with placebo, testosterone treatment increased 15-item International Index of Erectile Function (IIEF-15) total score (mean difference 5·52 [95% CI 3·95-7·10]; τ2=1·17; n=1412) and IIEF-15 erectile function subscore (2·14 [1·40-2·89]; τ2=0·64; n=1436), reaching the minimal clinically important difference for mild erectile dysfunction. These effects were not found to be dependent on participant age, obesity, presence of diabetes, or baseline serum total testosterone. However, absolute IIEF-15 scores reached during testosterone treatment were subject to thresholds in patient age and baseline serum total testosterone. Testosterone significantly improved Aging Males' Symptoms score, and some 12-item or 36-item Short Form Survey quality of life subscores compared with placebo, but it did not significantly improve psychological symptoms (measured by Beck Depression Inventory).

INTERPRETATION

In men aged 40 years or older with baseline serum testosterone of less than 12 nmol/L, short-to-medium-term testosterone treatment could provide clinically meaningful treatment for mild erectile dysfunction, irrespective of patient age, obesity, or degree of low testosterone. However, due to more severe baseline symptoms, the absolute level of sexual function reached during testosterone treatment might be lower in older men and men with obesity.

FUNDING

National Institute for Health and Care Research Health Technology Assessment Programme.

Erratum: Global Polarization of Ξ and Ω Hyperons in Au+Au Collisions at sqrt[s_{NN}]=200 GeV [Phys. Rev. Lett. 126, 162301 (2021)]

This corrects the article DOI: 10.1103/PhysRevLett.126.162301.

Insights into Changing Dermatophyte Spectrum in India Through Analysis of Cumulative 161,245 Cases Between 1939 and 2021

Dermatophytosis is one of the most common superficial infections of the skin affecting nearly one-fifth of the world population at any given time. With nearly 30% of worldwide terbinafine-resistance cases in Trichophyton mentagrophytes/Trichophyton interdigitale and Trichophyton rubrum reported from India in recent years, there is a significant burden of the emerging drug resistance epidemic on India. Here, we carry out a comprehensive retrospective analysis of dermatophytosis in India using 1038 research articles pertaining to 161,245 cases reported from 1939 to 2021. We find that dermatophytosis is prevalent in all parts of the country despite variable climatic conditions in different regions. Our results show T. rubrum as the most prevalent until 2015, with a sudden change in dermatophyte spectrum towards T. mentagrophytes/T. interdigitale complex since then. We also carried out an 18S rRNA-based phylogenetics and an average nucleotide identity-and single nucleotide polymorphism-based analysis of available whole genomes and find very high relatedness among the prevalent dermatophytes, suggesting geographic specificity. The comprehensive epidemiological and phylogenomics analysis of dermatophytosis in India over the last 80 years, presented here, would help in region-specific prevention, control and treatment of dermatophyte infections, especially considering the large number of emerging resistance cases.

The Extra-Islet Pancreas Supports Autoimmunity in Human Type 1 Diabetes

In autoimmune Type 1 diabetes (T1D), immune cells progressively infiltrate and destroy the islets of Langerhans - islands of endocrine tissue dispersed throughout the pancreas. However, it is unclear how this process, called 'insulitis', develops and progresses within this organ. Here, using highly multiplexed CO-Detection by indEXing (CODEX) tissue imaging and cadaveric pancreas samples from pre-T1D, T1D, and non-T1D donors, we examine pseudotemporal-spatial patterns of insulitis and exocrine inflammation within large pancreatic tissue sections. We identify four sub-states of insulitis characterized by CD8 ⁺ T cells at different stages of activation. We further find that exocrine compartments of pancreatic lobules affected by insulitis have distinct cellularity, suggesting that extra-islet factors may make particular lobules permissive to disease. Finally, we identify "staging areas" - immature tertiary lymphoid structures away from islets where CD8 ⁺ T cells appear to assemble before they navigate to islets. Together, these data implicate the extra-islet pancreas in autoimmune insulitis, greatly expanding the boundaries of T1D pathogenesis.

The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice

Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but its diagnosis and management can be challenging. A multi-disciplinary panel from BSSM reviewed the available literature on TD and provide evidence-based statements for clinical practice. Evidence was derived from Medline, EMBASE and Cochrane searches on hypogonadism, testosterone therapy (T Therapy) and cardiovascular safety from May 2017 to September 2022. This revealed 1,714 articles, including 52 clinical trials and 32 placebo-controlled randomised controlled trials. A total of twenty-five statements are provided, relating to five key areas: screening, diagnosis, initiating T Therapy, benefits and risks of T Therapy, and follow-up. Seven statements are supported by level 1 evidence, eight by level 2, five by level 3, and five by level 4. Recent studies have demonstrated that low levels of testosterone in men are associated with increased risk of incident type 2 diabetes mellitus, worse outcomes in chronic kidney disease and COVID 19 infection with increased all-cause mortality, along with significant quality of life implications. These guidelines should help practitioners to effectively diagnose and manage primary and age-related TD.

Radiative effects of absorbing aerosol types over South Asia

A comprehensive study on classifying the aerosol types and absorbing aerosol types, and quantifying the effect of absorbing aerosols on aerosol optical and radiative properties using four years (2015-2016, 2018-2019) of high-quality Aerosol Robotic Network (AERONET) datasets over Kanpur (urban) and Gandhi College (rural) in the Indo-Gangetic Plain (IGP) region is conducted on a seasonal scale, for the first time. Biomass burning (BB), urban-industrial, and mixed aerosol types are always present, whereas dust aerosol and mostly dust absorbing aerosol types are only present in pre-monsoon and monsoon seasons. During winter and post-monsoon seasons, BB aerosols and mostly black carbon (MBC) absorbing aerosols dominate, and the contribution of aerosol optical depth (AOD) and single scattering albedo (SSA) corresponding to MBC to total AOD and SSA are higher. SSA for MBC varies over a broader range due to mixing of BC with water-soluble aerosols. During pre-monsoon and monsoon seasons, mixing of dust with anthropogenic aerosols increases the amount of mixed aerosol type. Surface cooling and atmospheric heating efficiency for mixed aerosols are higher than MBC and dust aerosols due to enhancement in aerosol absorption over both locations. Seasonal analysis of aerosol radiative properties showed that during winter and post-monsoon, MBC absorbing aerosols are the major contributor in controlling/influencing the total aerosol radiative forcing (ARF) and heating rate (HR). During the other seasons, each absorbing aerosol type significantly influences ARF depending on their AOD and SSA values. In addition to Kanpur and Gandhi College, data from seven other AERONET sites located at Karachi, Lahore, Jaipur, Lumbini, Pokhara, Bhola, and Dhaka in South Asia are analysed to conduct a regional-scale examination of aerosol optical parameters and radiative effects due to different absorbing aerosol types. As the aerosol characteristics and trends are similar over these sites, the findings from such a regional-scale analysis can be an appropriate representative for the South Asian region. The regional analysis revealed that the annual mean atmospheric ARF (ARF_ATM) and ARF efficiency (ARFE_ATM), and HR are higher for MBC, followed by mixed and MD aerosols over South Asia due to higher AOD, and higher absorbing efficiency of MBC aerosols. In comparison, mixed aerosols exhibit higher ARF_ATM over East Asia. This quantification of absorbing aerosol types over a global aerosol hotspot will be useful for an accurate quantification of climate impacts of aerosols.

Black carbon flux in terrestrial and aquatic environments of Kodaikanal in the Western Ghats, South India: Estimation, source identification, and implication

Evolving Anthropocene epoch wields significant influence in altering atmospheric carbon, which affects the carbon cycle, leading to climate change. Understanding the carbon stock, fate, and transport across ecosystems are essential in determining India's carbon budget, hitherto, unavailable. In this study, we have analysed the stock, source, distribution, flux, and the relationship between terrestrial and aquatic black carbon over a high-altitude mountainous area in the Western Ghats region using the data collected from September 2019 to February 2021. Soil Organic Carbon (SOC) and Black Carbon (BC) are the highest in the forest region (SOC:23 ± 3 g of C/kg (dry weight (dw)), BC:6 ± 3 g/kg) and are the lowest in the urban region (SOC: 13 ± 2 g of C/kg (dw), BC:2 ± 1 g/kg). SOC is labile, whereas BC is non-labile. The BC/SOC ratio represents soil carbon lability. Topsoil BC/SOC ratios vary by land use and land cover, with urban areas having greater labile carbon pools than the forests. Dissolved BC (DBC) concentrations were most strongly correlated with bulk Dissolved Organic Carbon (DOC) concentrations in midstream (R = 0.6, p < 0.05), headwater streams (R = 0.3, p < 0.05) and to the soil bulk DBC (R = 0.3, p < 0.05), indicating the presence of transfer mechanism of soil to streams. The molecular associations revealed the presence of biolabile autochthonous compounds suggesting the crucial role land use and land cover play on watersheds. A positive relationship between DOC with seasonal hydrology and gradient significantly influences the DBC flux across regional streams. Intercomparison of observed terrestrial and aquatic carbon stocks with globally modelled data indicates an overestimation of regional-scale stock. These new findings have repercussions to policy framework on regional climate change. Further, the results suggest that a consistent quantification of BC and integration of regional, and global source-to-sink process are needed in order to understand and better quantify biogeochemical process cycles and associated climatic impacts.

Quantification of organic carbon and black carbon emissions, distribution, and carbon variation in diverse vegetative ecosystems across India

Black Carbon (BC) and Organic Carbon (OC) are the principal chemical aerosol components generated during combustion, both of which play a key role in air pollution, human health and climate change. Several studies of OC and BC have been conducted over India to assess the contribution from household and fossil fuel-based sources; however, studies on their emissions and their contribution from forest and cropland fires are quite limited. To address this issue, as part of this research, we derived a vegetation burning-based inventory of BC and OC aerosols over India at a resolution of 250 m × 250 m. Using a consumed biomass technique, we estimated emissions based on updated emission factor estimates. During the fire season in India (March-June), the mean OC and BC emissions were 2.1 ± 5.2 × 10¹³ kg per year and 1.8 ± 4.4 × 10¹² kg per year, respectively. Andhra Pradesh had the highest total carbonaceous aerosol emissions during the study period. Forest fires were prevalent in the northeastern states, while agricultural fires were prevalent in Gujarat, Chhattisgarh, Odisha, Madhya Pradesh, Bihar, Tripura, Uttar Pradesh, and Andhra Pradesh. The previous inventory, conducted at a coarser resolution (25 km × 25 km), overestimated open burning by 5 Mt. Our results were highly correlated with global bottom-up model values, especially the Fire Inventory (FINN). Our analysis showed that vegetative burning contributed 80.32% of the total carbon stock, with agricultural burning being the largest source of vegetative burning. Based on these findings, measures and strategies to control agricultural burning which would reduce significantly the total emissions of BC and OC with implications to improvement in air quality, human health and climate should be planned.

Trends in the types and absorption characteristics of ambient aerosols over the Indo-Gangetic Plain and North China Plain in last two decades

The sixth assessment report released by the Intergovernmental Panel on Climate Change (IPCC) in 2021 states that our inadequate understanding of magnitudes and trends of atmospheric aerosols, particularly over Asia, is a major source of uncertainty in climate change. In this study, the climatology and trends in different types of aerosols with focus on absorbing aerosols over Kanpur located in the Indo-Gangetic Plain (IGP) in South Asia and Beijing in the North China Plain (NCP) in East Asia are derived for the first time. We perform a first analysis of high-quality time series of columnar aerosols observations over a period of nearly two-decades, along with satellite observations to provide a broader regional perspective. The satellite retrieved aerosol Ångström exponent (AE) values have increased (10-20%) suggesting an increasing contribution of fine aerosols to aerosol optical depth (AOD) over Asia in last 2-decades. Among the three aerosol types [urban-industrial (UI), biomass burning (BB), and dust (DU)], only UI and BB aerosols are present over Kanpur throughout the year, while DU is present along with UI and BB aerosols only during pre-monsoon and monsoon. Overall, there is a positive trend in BB aerosols over both Kanpur and Beijing, a positive (negative) trend in UI aerosols over Kanpur (Beijing), and positive (negative) trend in dust over Beijing (Kanpur). However, only the positive trend in BB aerosol type over Kanpur is statistically significant. Further, among the three absorbing aerosol types [mostly black carbon (MBC), mostly dust (MDU), and mixed (MIX) containing BC and dust], only MBC and MIX are present in post-monsoon and winter over IGP, and MDU is present along with MBC and MIX only during pre-monsoon and monsoon, which is in agreement with aerosol types found. Trends in MBC, MIX and MDU over Kanpur in IGP and in MIX over Beijing are statistically significant. These trends are attributed mainly to the changes in anthropogenic aerosol emissions, and not to natural and climatic factors as their changes are relatively small. These findings on hitherto unavailable climatology and trends in aerosols and absorbing aerosols over two global aerosol hotspots and identified contrasts will be crucial in model simulations to better decipher the aerosol-climate interactions over Asia.

New Constraint on the Local Relic Neutrino Background Overdensity with the First KATRIN Data Runs

We report on the direct search for cosmic relic neutrinos using data acquired during the first two science campaigns of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity molecular tritium gas source are analyzed by a high-resolution MAC-E filter around the end point at 18.57 keV. The analysis is sensitive to a local relic neutrino overdensity ratio of η<9.7×10^{10}/α (1.1×10^{11}/α) at a 90% (95%) confidence level with α=1 (0.5) for Majorana (Dirac) neutrinos. A fit of the integrated electron spectrum over a narrow interval around the end point accounting for relic neutrino captures in the tritium source reveals no significant overdensity. This work improves the results obtained by the previous neutrino mass experiments at Los Alamos and Troitsk. We furthermore update the projected final sensitivity of the KATRIN experiment to η<1×10^{10}/α at 90% confidence level, by relying on updated operational conditions.

Assessment of the coronavirus disease 2019 (COVID-19) pandemic imposed lockdown and unlock effects on black carbon aerosol, its source apportionment, and aerosol radiative forcing over an urban city in India

A nationwide lockdown was imposed in India due to the Coronavirus Disease 2019 (COVID-19) pandemic which significantly reduced the anthropogenic emissions. We examined the characteristics of equivalent black carbon (eBC) mass concentration and its source apportionment using a multiwavelength aethalometer over an urban site (Ahmedabad) in India during the pandemic induced lockdown period of year 2020. For the first time, we estimate the changes in BC, its contribution from fossil (eBC ff ) and wood (eBC wf ) fuels during lockdown (LD) and unlock (UL) periods in 2020 with respect to 2017 to 2019 (normal period). The eBC mass concentration continuously decreased throughout lockdown periods (LD1 to LD4) due to enforced and stringent restrictions which substantially reduced the anthropogenic emissions. The eBC mass concentration increased gradually during unlock phases (UL1 to UL7) due to the phase wise relaxations after lockdown. During lockdown period eBC mass concentration decreased by 35%, whereas during the unlock period eBC decreased by 30% as compared to normal period. The eBC wf concentrations were higher by 40% during lockdown period than normal period due to significant increase in the biomass burning emissions from the several community kitchens which were operational in the city during the lockdown period. The average contributions of eBC ff and eBC wf to total eBC mass concentrations were 70% and 30% respectively during lockdown (LD1 to LD4) period, whereas these values were 87% and 13% respectively during the normal period. The reductions in BC concentrations were commensurate with the reductions in emissions from transportation and industrial activities. The aerosol radiative forcing reduced significantly due to the reduction in anthropogenic emissions associated with COVID-19 pandemic induced lockdown leading to a cooling of the atmosphere. The findings in the present study on eBC obtained during the unprecedented COVID-19 induced lockdown can provide a comprehensive understanding of the BC sources and current emission control strategies, and thus can serve as baseline anthropogenic emissions scenario for future emission control strategies aimed to improve air quality and climate.

Molecular Docking and Molecular Dynamic Studies, Synthesis, Characterisation of Thiazolidine-4-One Derivatives

Background: Antibacterial, antifungal, anticancer, antitubercular, anti-HIV, analgesic, anti-inflammatory, and ulcerogenic activities have all been documented for thiazolidine derivatives. Molecular docking has become a crucial step in the drug discovery process, with the goal of predicting the binding mechanism and affinity of the protein-ligand complex. AutoDock is a popular non-commercial docking tool that successfully docks ligands to their target proteins (accurate and computationally fast). The Discovery Studio Visualizer is a free viewer that may be used to open data produced by other Discovery Studio tools. Aim: The main aim of this study is: To study the molecular docking and molecular dynamic studies of the different thiazolidine derivatives. To synthesise the compound based on the results produced in the molecular dynamics and molecular studies. To Characterise the synthesised compounds using FTIR, 1H NMR, 13C NMR and Mass Spectral studies. Procedure: In two phases, a new series of Thiazolidine-4-one derivatives was created. The production of Schiff base is the first step, followed by the condensation of Schiff base with Chloro acetyl chloride and subsequent cyclisation steps. FTIR, 1H-NMR, 13C-NMR, and Mass Spectroscopy were used to characterise the chemical structures of the produced compounds. 1BVR protein that was taken from the protein database website The structures were drawn using Chem draw Ultra 8.0 and Biovia draw 2018. Using the Smiles Online Translator, it was stored in Mol format and then converted to PDB format. The Cygwin toolings were used to log all of the files. Conclusion: The conformation was computed using a ranking system. This indicates whether the molecule has strong ligand binding energy, hydrogen bonding, and hydrophobic interaction with the receptor. According to the findings, thiazolidine-4-one derivatives have antitubercular efficacy when used in conjunction with the Enoyl-acyl carrier protein (enoyl-ACP) reductase enzyme. For the docking analysis it indicates if the compound has strong ligand binding energy, hydrogen bonding, and hydrophobic binding with the receptor shows good activity. Using Auto dock 4.2 it was found out that among the above 20 compounds (including the control compound), C2, C5, C6, C8, C11. C13, C15 and C17 directly bind with the functional domain (Casein kinase II phosphorylation site) of the amino acid (252 to 255). The above compounds bind at the 252nd position of the Chain C, where Alanine is present (The target protein, 1BVR () contains ABCDEF chains).

Synthesis, Characterisation and Evaluation of Azetidine-2-One Derivative

Antibacterial, antifungal, anticancer, antitubercular, anti-HIV, analgesic, anti-inflammatory, and ulcerogenic activities have all been documented for azetidinone derivatives. The reaction of Schiff base((Z)-N (4-dimethylamino)benzylidene)pyrimidine-2-amine) with chloroacetyl chloride yielded a novel chemical called Azetdine-2-one derivative. Fourier Transform Infrared Spectroscopy and Proton Nuclear Magnetic Resonance Spectroscopy were used to confirm the chemical structures of the produced substances. The antimicrobial activity shows that the compound showed mild Antibacterial activity against Staphylococcus aureus and Escherichia coli.

Insights into recent aerosol trends over Asia from observations and CMIP6 simulations

Aerosols continue to contribute the largest uncertainty in climate change. Over Asia, a global aerosol hotspot, spatial patterns of aerosol emissions are changing mainly because of changes in anthropogenic emissions, producing a dipole in atmospheric aerosol loading between East (decrease in emissions) and South Asia (increase in emissions). The resultant aerosol radiative effects are expected to be different as compared to the last decades of the 20^th century because of this emerging Asian aerosol dipole. The projection and assessments of radiative and climate impacts of aerosols rely on simulating accurately the aerosol properties, thus, making it imperative that current climate models involved in climate assessments including the Intergovernmental Panel on Climate Change Assessment Reports, simulate well the magnitude and trends in changing aerosol properties. For the first time, in this study we analyze trends in aerosol properties over Asia from satellite and ground-based observations, and simulations from climate models in Coupled Model Intercomparison Project Phase 6 (CMIP6) experiment with state-of-the-art treatment of aerosol chemistry, physics and meteorology. The results reveal large inter-model differences in model estimates, and discrepancies between model simulations and observations as most models are not able to capture the recent observed magnitudes and trends in aerosol optical depth (AOD) and single scattering albedo (SSA) over Asia. The absolute and the relative (percent) trends (positive and/or negative) in AOD are significantly higher than the trends in SSA. The aerosol-induced effective radiative forcing within the atmosphere simulated with three CMIP6 models show a positive (increasing) trend over Asia. A positive trend in atmospheric heating due to aerosols in model simulations is consistent with model simulated trends in AOD (positive) and SSA (negative). These results on model-observations comparison need to be taken into account while examining the projected/expected future climate impacts due to aerosols, and potential value of various mitigation measures, in particular on regional and decadal climate change in Asia which is largely uncertain. MAIN FINDING: Our analysis of satellite and ground-based observations, and simulations from climate models in CMIP6 experiment with state-of-the-art treatment of aerosol chemistry, physics and meteorology reveal large difference in model calculations, and most models are not able to capture the recent observed trends in aerosol optical depth and single scattering albedo over Asia during 2000-2018.

Prevalence of forward neck posture and influence of smartphones in physiotherapy students

Introduction and Aim: InAsia, the prevalence of forward neck posture is 66%. Forward neck posture is the anterior positioning of cervical spine. This posture is sometimes called as “scholar’s neck. Forward neck posture can lead to musculoskeletal disorders such as injuries in muscles, tendons, and peripheral vessels, vascular vessels caused by repetitive or continuous use of certain body part. In forward neck posture, the sternocleidomastoid muscle and trapezius are largely responsible for turning and nodding the head. When the head moves front, the spine follows, pulling the shoulder blades forward as well.They make contact with the upper ribs and begin to drag it forward with them.Therefore, this study aims to quantify forward neck posture in prolonged smart phone users.   Methodology:An observational study was done in smartphone using student population comparing the control group students with forward neck posture studentsfor the duration of 3weeks. This study has included 100 students with forward neck posturewho were recruited fromDr. MGR Educational & Research Institute. Goniometer, Craniovertebral angle and Plumb line were used as the outcome measure.   Results:The findings of this research exhibit there is a statistically significant changes inforward neck posture studentscompared with control group and the mean difference is 14.97 in two groups students.   Conclusion:The present study concluded that 3 weeks after assessing the students. Forward neck posture students found to have decreased craniovertebral angle and range of motion compared to normal neck posture students and also found that forward neck posture students spent 5-6 hours using smart phones per day.

Observation of D_{s}^{±}/D^{0} Enhancement in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the first measurement of charm-strange meson D_{s}^{±} production at midrapidity in Au+Au collisions at sqrt[s_{NN}]=200  GeV from the STAR experiment. The yield ratio between strange (D_{s}^{±}) and nonstrange (D^{0}) open-charm mesons is presented and compared to model calculations. A significant enhancement, relative to a pythia simulation of p+p collisions, is observed in the D_{s}^{±}/D^{0} yield ratio in Au+Au collisions over a large range of collision centralities. Model calculations incorporating abundant strange-quark production in the quark-gluon plasma and coalescence hadronization qualitatively reproduce the data. The transverse-momentum integrated yield ratio of D_{s}^{±}/D^{0} at midrapidity is consistent with a prediction from a statistical hadronization model with the parameters constrained by the yields of light and strange hadrons measured at the same collision energy. These results suggest that the coalescence of charm quarks with strange quarks in the quark-gluon plasma plays an important role in D_{s}^{±}-meson production in heavy-ion collisions.

Measurement of e^{+}e^{-} Momentum and Angular Distributions from Linearly Polarized Photon Collisions

The Breit-Wheeler process which produces matter and antimatter from photon collisions is experimentally investigated through the observation of 6085 exclusive electron-positron pairs in ultraperipheral Au+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements reveal a large fourth-order angular modulation of cos4Δϕ=(16.8±2.5)% and smooth invariant mass distribution absent of vector mesons (ϕ, ω, and ρ) at the experimental limit of ≤0.2% of the observed yields. The differential cross section as a function of e^{+}e^{-} pair transverse momentum P_{⊥} peaks at low value with sqrt[⟨P_{⊥}^{2}⟩]=38.1±0.9  MeV and displays a significant centrality dependence. These features are consistent with QED calculations for the collision of linearly polarized photons quantized from the extremely strong electromagnetic fields generated by the highly charged Au nuclei at ultrarelativistic speed. The experimental results have implications for vacuum birefringence and for mapping the magnetic field which is important for emergent QCD phenomena.

Detectable respiratory SARS-CoV-2 RNA is associated with low vitamin D levels and high social deprivation

BACKGROUND

Accumulating evidence links COVID-19 incidence and outcomes with vitamin D status. We investigated if an interaction existed between vitamin D levels and social deprivation in those with and without COVID-19 infection.

METHODS

Upper or lower respiratory tract samples from 104 patients were tested for SARS-CoV-2 RNA in accordance with Public Health England criteria (January-May 2020) using RT-PCR. The latest serum total 25-hydroxyvitamin D(25-OHD) levels, quantified by LC-MS/MS, was obtained for each patient (September 2019-April 2020). Index of Multiple Deprivation (IMD) was generated for each patient. Univariate and logistic regression analyses examined associations between age, gender, 25-OHD, IMD score and SARS-CoV-2 result in the total cohort and subgroups.

RESULTS

In the total cohort, a positive SARS-CoV-2 test was significantly associated with lower 25-OHD levels and higher IMD. A positive test was associated with higher IMD in the male subgroup and with lower 25-OHD levels in those aged >72 years. Low 25-OHD and IMD quintile 5 were separately associated with positive COVID-19 outcome in the cohort. Patients in IMD quintile 5 with vitamin D levels ≤ 34.4 nmol/L were most likely to have a positive COVID-19 outcome, even more so if aged >72 years (OR: 19.07, 95%CI: 1.71-212.25; P = .016).

CONCLUSIONS

In this cohort, combined low vitamin D levels and higher social deprivation were most associated with COVID-19 infection. In older age, this combination was even more significant. Our data support the recommendations for normalising vitamin D levels in those with deficient / insufficient levels and in groups at high risk for deficiency.

Is a fasting testosterone level really necessary for the determination of androgen status in men?

BACKGROUND

As circulating testosterone may be suppressed in the post-prandial state, it has been recommended that measurements are carried out with the patient fasted.

OBJECTIVES

In this regard, we assessed the effect of fasting/non-fasting status on total testosterone (T) levels in men.

MATERIALS AND METHODS

Data was collected in a single UK Hospital in men with two serum T requests taken within a 6-month period of each other and sampled at a time of day ≤ 2 h apart. Three groups were established, with T levels compared via signed-rank test in men with both a fasting and non-fasting sample (Group 1; n = 69), and in men with paired non-fasting (Group 2; n = 126) and paired fasting (Group 3; n = 18) samples. The differences in T levels between the paired samples was compared between the three groups using the rank-sum test and also via multiple regression analysis with the groups factorised.

RESULTS

Median (Interquartile Range, IQR) age did not vary significantly between Groups 1, 2 and 3 at 49 (38-56), 51.5 (42-60) and 51.5 (40-59) years, respectively. No significant difference (p = 0.89) was found between the T levels in Group 1 with non-fasting (median (IQR) T = 11.1 (9.3-13.6) nmol/L) versus fasting samples T = 10.8 (8.9-14.1) nmol/L). Paired T levels did not significantly differ in each of the other two groups (2 and 3). There was no significant association between the differences in paired T levels between the three groups, even when the model was adjusted for age and time, with Group 1 (as reference) versus Group 2 (p = 0.79) and versus Group 3 (p = 0.63).

DISCUSSION

We found no significant differences between fasting and non-fasting T levels. A definitive confirmatory study is required to determine whether fasting status is necessary to diagnose hypogonadism.

CONCLUSION

Non-requirement of fasting status when checking testosterone levels would remove a major hurdle in the diagnosis of hypogonadism.

Converting noise into solitons: optical self-organization through intermodal nonlinearity

We experimentally demonstrate a pump-pulse-induced conversion of noise into solitons in multimode optical fibers. The process is based on the recently discovered phenomenon of soliton self-mode conversion, where a pump soliton in a higher-order spatial mode crafts another well-defined soliton, originating purely from noise, in a lower-order mode at a longer wavelength through intermodal Raman scattering. The lack of the need for any seed or cavity feedback demonstrates that soliton self-mode conversion is a fundamentally unavoidable, but nevertheless tailorable and hence useful, self-organizing nonlinear optical effect capable of turning noise into transform limited solitons.

Global Polarization of Ξ and Ω Hyperons in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

Global polarization of Ξ and Ω hyperons has been measured for the first time in Au+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements of the Ξ^{-} and Ξ[over ¯]^{+} hyperon polarization have been performed by two independent methods, via analysis of the angular distribution of the daughter particles in the parity violating weak decay Ξ→Λ+π, as well as by measuring the polarization of the daughter Λ hyperon, polarized via polarization transfer from its parent. The polarization, obtained by combining the results from the two methods and averaged over Ξ^{-} and Ξ[over ¯]^{+}, is measured to be ⟨P_{Ξ}⟩=0.47±0.10(stat)±0.23(syst)% for the collision centrality 20%-80%. The ⟨P_{Ξ}⟩ is found to be slightly larger than the inclusive Λ polarization and in reasonable agreement with a multiphase transport model. The ⟨P_{Ξ}⟩ is found to follow the centrality dependence of the vorticity predicted in the model, increasing toward more peripheral collisions. The global polarization of Ω, ⟨P_{Ω}⟩=1.11±0.87(stat)±1.97(syst)% was obtained by measuring the polarization of daughter Λ in the decay Ω→Λ+K, assuming the polarization transfer factor C_{ΩΛ}=1.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

The association of peak systolic velocity in the carotid artery with coronary heart disease: A study based on portable ultrasound

Cardiovascular disease (CVD) is the highest cause of death globally with more people dying annually from it than from any other cause. CVD is associated with modifiable risk factors (dyslipidaemia, hypertension and diabetes) and treating each of these factors lowers the risk of CVD. It is impossible to estimate the benefit of risk factor modification in the individual patient and extrapolating data from multiple trials is difficult. It would be useful to have a marker of risk that accurately estimates real time risk by measuring blood flow factors associated with the pathogenesis of atheroma. The aim of this preliminary study was to validate a low-cost measurement technique for obtaining blood flow velocity profiles and assess whether any of the measured and calculated factors, based on computational fluid dynamics (CFD) simulation, known to be associated with atheroma was associated with coronary heart disease (CHD), thus establishing its feasibility and acceptability as a clinical tool and suggesting areas for future research. Our study identified (i) that mean peak systolic (PS) velocity being associated with CHD; individuals without CHD: mean (SD) = 62.8 (16.1) cm/s, with CHD: mean (SD)  = 53.6 (17.3) cm/s, p = 0.042; and (ii) that low-cost, portable ultrasound, which is routinely available in general practice, is a suitable assessment tool.

Nonmonotonic Energy Dependence of Net-Proton Number Fluctuations

Nonmonotonic variation with collision energy (sqrt[s_{NN}]) of the moments of the net-baryon number distribution in heavy-ion collisions, related to the correlation length and the susceptibilities of the system, is suggested as a signature for the quantum chromodynamics critical point. We report the first evidence of a nonmonotonic variation in the kurtosis times variance of the net-proton number (proxy for net-baryon number) distribution as a function of sqrt[s_{NN}] with 3.1  σ significance for head-on (central) gold-on-gold (Au+Au) collisions measured solenoidal tracker at Relativistic Heavy Ion Collider. Data in noncentral Au+Au collisions and models of heavy-ion collisions without a critical point show a monotonic variation as a function of sqrt[s_{NN}].

Improved multiplex TaqMan qPCR assay with universal internal control offers reliable and accurate detection of Clavibacter michiganensis

AIM

Clavibacter michiganensis (Cm) is a seed-borne plant pathogen that significantly reduces tomato production worldwide. Due to repeated outbreaks and rapid spread of the disease, seeds/transplants need to be certified free of the pathogen before planting. To this end, we developed a multiplex TaqMan qPCR assay that can accurately detect Cm in infected samples.

METHODS AND RESULTS

A specific region of Cm (clvG gene) was selected for primer design using comparative genomics approach. A fully synthetic universal internal control (UIC) was also designed to detect PCR inhibitors and false-negative results in qPCRs. The Cm primers can be used alone or in a triplex TaqMan qPCR assay with UIC and previously described Clavibacter primers. The assay was specific for Cm and detected up to 10 fg of Cm DNA in sensitivity and spiked assays. Addition of the UIC did not change the specificity or sensitivity of the multiplex TaqMan qPCR assay.

CONCLUSION

The triplex TaqMan qPCR provides a specific and sensitive diagnostic assay for Cm.

SIGNIFICANCE AND IMPACT OF THE STUDY

This assay can be used for biosecurity surveillance, routine diagnostics, estimating bacterial titres in infected material and for epidemiological studies. The UIC is fully synthetic, efficiently amplified and multiplex compatible with any other qPCR assay.

Aerosol-induced atmospheric heating rate decreases over South and East Asia as a result of changing content and composition

Aerosol emissions from human activities are extensive and changing rapidly over Asia. Model simulations and satellite observations indicate a dipole pattern in aerosol emissions and loading between South Asia and East Asia, two of the most heavily polluted regions of the world. We examine the previously unexplored diverging trends in the existing dipole pattern of aerosols between East and South Asia using the high quality, two-decade long ground-based time series of observations of aerosol properties from the Aerosol Robotic Network (AERONET), from satellites (Moderate Resolution Imaging Spectroradiometer (MODIS) and Ozone Monitoring Instrument (OMI)), and from model simulations (Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2). The data cover the period since 2001 for Kanpur (South Asia) and Beijing (East Asia), two locations taken as being broadly representative of the respective regions. Since 2010 a dipole in aerosol optical depth (AOD) is maintained, but the trend is reversed—the decrease in AOD over Beijing (East Asia) is rapid since 2010, being 17% less in current decade compared to first decade of twenty-first century, while the AOD over South Asia increased by 12% during the same period. Furthermore, we find that the aerosol composition is also changing over time. The single scattering albedo (SSA), a measure of aerosol’s absorption capacity and related to aerosol composition, is slightly higher over Beijing than Kanpur, and has increased from 0.91 in 2002 to 0.93 in 2017 over Beijing and from 0.89 to 0.92 during the same period over Kanpur, confirming that aerosols in this region have on an average become more scattering in nature. These changes have led to a notable decrease in aerosol-induced atmospheric heating rate (HR) over both regions between the two decades, decreasing considerably more over East Asia (− 31%) than over South Asia (− 9%). The annual mean HR is lower now, it is still large (≥ 0.6 K per day), which has significant climate implications. The seasonal trends in AOD, SSA and HR are more pronounced than their respective annual trends over both regions. The seasonal trends are caused mainly by the increase/decrease in anthropogenic aerosol emissions (sulfate, black carbon and organic carbon) while the natural aerosols (dust and sea salt) did not change significantly over South and East Asia during the last two decades. The MERRA-2 model is able to simulate the observed trends in AODs well but not the magnitude, while it also did not simulate the SSA values or trends well. These robust findings based on observations of key aerosol parameters and previously unrecognized diverging trends over South and East Asia need to be accounted for in current state-of-the-art climate models to ensure accurate quantification of the complex and evolving impact of aerosols on the regional climate over Asia.

An audit of the measurement and reporting of male testosterone levels in UK clinical biochemistry laboratories

INTRODUCTION

A number of guidance documents have been published in recent years for the diagnosis and management of hypogonadism (HG). Laboratory practice has a major role in supporting guidelines with accurate and precise serum total testosterone (TT) methods and standardised pre- and post-analytical protocols. Our study investigated whether laboratory practice currently supports the management guidelines for HG.

METHODS

An internet-based questionnaire survey of senior laboratory biochemists (UK/Republic of Ireland) was conducted (April-May 2018). Questions reflected sampling, laboratory practice, reference ranges and reporting of results. The results were analysed in conjunction with data obtained from the UK National External Quality Assurance Service (UK NEQAS) on testosterone assay performance.

RESULTS

Analyses of 96 laboratory surveys returned the following: 74 laboratories stated that the optimal sampling time was communicated to users; 81 laboratories used immunoassays; 76 laboratories included reference ranges for adult men (31 had dual/multiple age-related intervals). Wide variability in lower/upper limits was evident in the common immunoassays; the majority of reference ranges were from manufacturers (50.0%) or historical (18.8%). Action limits based on TT levels were used by 64 laboratories, but 63 did not report a borderline range as suggested by the guidelines. Protocols for cascading tests based on TT were evident in 58 laboratories, with 50 laboratories offering estimated free testosterone; interpretative comments were provided by 67 laboratories, but no references were made to the management guidelines. Data from UK NEQAS demonstrated considerable variation in testosterone assay performance.

CONCLUSIONS

Our survey has highlighted inconsistencies that could lead to HG (and other conditions requiring measurement of TT) not being managed appropriately. The results from this survey and from UK NEQAS reinforce the requirement for action to be considered regarding the standardisation of testosterone assays and harmonisation of laboratory practice.

Fragility of a soliton's shot-to-shot coherence

We show that a soliton in a high-order spatial mode of a multi-mode fiber can completely lose its shot-to-shot coherence due to a noise seed with energy orders of magnitude below that of the soliton. The total degradation of shot-to-shot coherence is caused by a very strong recently demonstrated intermodal nonlinear effect, soliton self-mode conversion. The results indicate that the robustness of solitons against perturbations is not entirely applicable in the presence of intermodal nonlinearities, and, more generally, that certain single-mode results cannot be trivially extrapolated to multi-mode fibers.

Inter-annual and seasonal variations in columnar aerosol characteristics and radiative effects over the Pokhara Valley in the Himalayan foothills - Composition, radiative forcing, and atmospheric heating

This study reports comprehensive analysis of seasonal and inter-annual variations of aerosol properties (optical, physical and chemical) and radiative effects over Pokhara Valley in the foothills of central Himalayas in Nepal utilizing the high-quality multi-year columnar aerosol data observed recently from January 2010 to December 2017. This paper focusses on the seasonal and inter-annual variations of chemical (composition), and absorption properties of aerosols and their radiative effects. The single scattering albedo (SSA) either decreases as a function of wavelength or remains independent of wavelength. The seasonal mean aerosol absorption optical depth (AAOD) exhibits a behavior opposite to that of SSA. Carbonaceous aerosols (CA) dominate (≥60%) aerosol absorption during the whole year. Black carbon (BC) alone contributes >60% to AAOD_CA while brown carbon (BrC) shares the rest. The absorbing aerosol types are determined to be BC, and mixed (BC and dust) only. Dust as absorbing aerosol type is absent over the Himalayan foothills. The ARF_SFC is ≥ -50 Wm^-2 except in monsoon almost every year. The ARF_ATM is ≥ 50 Wm^-2 during winter and pre-monsoon in all the years. ARFE_SFC, ARFE_TOA and ARFE_ATM follow a similar pattern as that of ARF. High values of ARFE at SFC, TOA and ATM (except during monsoon when values are slightly lower) suggest that aerosols are efficient in significantly modulating the incoming solar flux throughout the year. The annual average aerosol-induced atmospheric heating rate (HR) over Pokhara is nearly 1 K day^-1 every year during 8-year observation, and is highest in 2015 (∼2.5 K day^-1). The HR is about 1 K day^-1 or more over all the locations in IGP during the year. These quantitative results can be used as inputs in global/regional climate models to assess the climate impact of aerosols, including on regional temperature, hydrological cycle and melting of glaciers and snowfields in the region.

Black carbon dominates the aerosol absorption over the Indo-Gangetic Plain and the Himalayan foothills

This study, based on new and high quality in situ observations, quantifies for the first time, the individual contributions of light-absorbing aerosols (black carbon (BC), brown carbon (BrC) and dust) to aerosol absorption over the Indo-Gangetic Plain (IGP) and the Himalayan foothill region, a relatively poorly studied region with several sensitive ecosystems of global importance, as well as highly vulnerable populations. The annual and seasonal average single scattering albedo (SSA) over Kathmandu is the lowest of all the locations. The SSA over Kathmandu is < 0.89 during all seasons, which confirms the dominance of light-absorbing carbonaceous aerosols from local and regional sources over Kathmandu. It is observed here that the SSA decreases with increasing elevation, confirming the dominance of light absorbing carbonaceous aerosols at higher elevations. In contrast, the SSA over the IGP does not exhibit a pronounced spatial variation. BC dominates (≥75%) the aerosol absorption over the IGP and the Himalayan foothills throughout the year. Higher BC concentration at elevated locations in the Himalayas leads to lower SSA at elevated locations in the Himalayas. The contribution of dust to aerosol absorption is higher throughout the year over the IGP than over the Himalayan foothills. The aerosol absorption over South Asia is very high, exceeding available observations over East Asia, and also exceeds previous model estimates. This quantification will be valuable as observational constraints to help improve regional simulations of climate change, impacts on the glaciers and the hydrological cycle, and will help to direct the focus towards BC as the main contributor to aerosol-induced warming in the region.

Circulation of Asian-I and Cosmopolitan genotypes of Dengue-2 virus in northeast India, 2016-2017

BACKGROUND & OBJECTIVES

Dengue is a major public health problem in northeast India where the majority of the cases go unreported and undiagnosed. Even though all four dengue serotypes are reported, there is a dearth of information on genetic diversity. The present cross-sectional study was undertaken during 2016-17 to determine the genetic variance of dengue virus serotype 2 (DENV-2) based on the envelope (E) glycoprotein gene.

METHODS

The serum samples collected from the northeast parts of India, as a part of hospital-based acute febrile illness surveillance, were serotyped. Viral RNA was extracted from DENV-2 serum samples using QIAquick® RNA Extraction Kit. The E gene was amplified by conventional reverse-transcriptase polymerase chain reaction (RT-PCR) and the PCR products were sequenced.

RESULTS

The E glycoprotein gene of nine serum samples with high viral RNA concentration (Ct <25) was sequenced. The E gene sequences of eight DENV-2 strains from Assam and Meghalaya aligned with genotype IV (Cosmopolitan) and one strain from Tripura segregated with Asian-I genotype.

INTERPRETATION & CONCLUSION

Ongoing laboratory-based surveillance is mandatory to understand the transmission dynamics of dengue in endemic countries. This study concluded that in northeast India, presently two distinct genotypes of DENV-2, namely genotype IVb (Cosmopolitan) and Asian-I genotype are in circulation.

A junior doctor's experience of critical illness: from treating patients to becoming a patient with COVID-19

When the coronavirus disease 2019 (COVID‐19) pandemic was declared, it was clear that severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) would have far‐reaching impacts on medicine, society and everyday life. As a junior doctor working closely with patients with SARS‐CoV‐2 infection, I was aware of my personal risk of exposure to the virus. I assumed that as a fit and well 26‐year‐old with no comorbidities, if I were to become infected, it was unlikely that COVID‐19 would be severe. However, I became critically unwell following a week of clinical work, necessitating hospital admission, tracheal intubation and mechanical ventilation. I remained mechanically ventilated for 6 days and was then transferred to a medical ward 2 days later. After two further days of rehabilitation, I was discharged home. This reflection is not a junior doctor’s view of how COVID‐19 was managed by the NHS, but a personal view of my illness from ‘the other side of the curtain’. My reflections focus upon the psychological aspects of my experiences, exploring the memories that I formed around the time of critical care, how the fears that I possessed were managed with exceptional communication, and the importance of the wider healthcare team in my recovery.

Testosterone replacement therapy: Pre-treatment sex hormone-binding globulin levels and age may identify clinical subgroups

BACKGROUND

Testosterone replacement therapy (TRT) improves health in some but not all men with type 2 diabetes (T2DM) and adult-onset testosterone deficiency (TD). Such heterogeneity is compatible with the concept of patient subgroups that respond differently to therapy.

OBJECTIVES

Use baseline SHBG and age to identify putative subgroups that demonstrate different responses in variables such as waist circumference and HbA1c following TRT.

MATERIALS AND METHODS

A randomized double-blind trial approach was used to recruit and randomize men with T2DM and adult-onset TD into placebo and TRT-treated groups. Multiple regression was used to study differences between groups.

RESULTS

Baseline SHBG and change in SHBG (∆SHBG) were inversely related in the TRT group. Both median values of SHBG and age mediated the effect of TRT on ∆SHBG depending on whether baseline values were ≤ or>median (28.1 nmol/L, 63 years, respectively). In men with both SHBG ≤ 28.1 nmol/L and age ≤ 63 years (subgroup 1), TRT was positively associated with ∆SHBG (c = 4.67, 95%CI 1.17-8.16, P = .010) while in those with SHBG > 28.1 nmol/L and age > 63.1 years (subgroup 4) the association was inverse (c = -7.07, 95%CI -11.64 to -2.49, P = .003). The association between TRT and change (∆) in waist circumference, HbA1c and International Index of Erectile Function (IIEF) score differed between subgroups; in subgroup 4 but not subgroup 1, the therapy was significantly associated with ∆waist circumference, ∆HbA1c and ∆IIEF.

DISCUSSION

Though the mechanism remains unclear, our finding of different responses to TRT in terms of change in waist circumference, HbA1c and IIEF score supports the concept of subgroups in men with T2DM and adult-onset TD.

CONCLUSION

Our approach may provide a basis for identifying men who will or will not derive benefit from TRT though a larger study is required.

First Measurement of Λ_{c} Baryon Production in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the first measurement of the charmed baryon Λ_{c}^{±} production at midrapidity (|y|<1) in Au+Au collisions at sqrt[s_{NN}]=200  GeV collected by the STAR experiment at the Relativistic Heavy Ion Collider. The Λ_{c}/D^{0} [denoting (Λ_{c}^{+}+Λ_{c}^{-})/(D^{0}+D[over ¯]^{0})] yield ratio is measured to be 1.08±0.16  (stat)±0.26  (sys) in the 0%-20% most central Au+Au collisions for the transverse momentum (p_{T}) range 3<p_{T}<6  GeV/c. This is significantly larger than the pythia model calculations for p+p collisions. The measured Λ_{c}/D^{0} ratio, as a function of p_{T} and collision centrality, is comparable to the baryon-to-meson ratios for light and strange hadrons in Au+Au collisions. Model calculations including coalescence hadronization for charmed baryon and meson formation reproduce the features of our measured Λ_{c}/D^{0} ratio.

Rapid Synthesis and Characterization of Pure and Cobalt Doped Zinc Aluminate Nanoparticles via Microwave Assisted Combustion Method

Zn_1-xCo_xAl₂O₄ (0 ≤ x ≤ 0.5) nanoparticles were synthesized employing L-alanine as fuel using MACT (microwave assisted combustion technique). The synthesized samples were characterized following methods such as X-ray Diffraction, high resolution scanning electron microscopy, Energydispersive X-ray spectroscopy; UV-visible diffused reflectance spectroscopy, FT-IR and VSM. The XRD confirmed the cubic spinel structure and the average crystallite size observed lying in the range of 12-19 nm deduced using the Debye Scherrer's equation. The morphology of the Zn_1-xCo_xAl₂O₄ (0 ≤ x ≤ 0.5) nanoparticles is observed using HR-SEM. EDX analysis is opted for the elemental mapping of pure and cobalt doped zinc aluminate nanoparticles. Further band gap value was calculated using Kubelka Munk function, which was seen lying within 3.73 to 5.45 eV. The strong absorption band at 669, 556 and 500 cm^-1 was associated with the vibrations of Zn-O, Al-O and Zn-O-Al of zinc aluminate nanoparticles. The hysteresis loops exhibited conversion from diamagnetic into super paramagnetic behaviour with increase in Co doping.