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The Indian Pulsar Timing Array (InPTA) employs unique features of the upgraded Giant Metrewave Radio Telescope (uGMRT) to monitor dozens of the International Pulsar Timing Array (IPTA) millisecond pulsars (MSPs), simultaneously in the 300-500 MHz and the 1260-1460 MHz bands. This dual-band approach ensures that any frequency-dependent delays are accurately characterized, significantly improving the timing precision for pulsar observations, which is crucial for pulsar timing arrays. We present details of InPTA’s second data release that involves 7 yrs of data on 27 IPTA MSPs. This includes sub-banded Times of Arrival (ToAs), Dispersion Measures (DM), and initial timing ephemerides for our MSPs. A part of this dataset, originally released in InPTA’s first data release, is being incorporated into IPTA’s third data release which is expected to detect and characterize nanohertz gravitational waves in the coming years. The entire dataset is reprocessed in this second data release providing some of the highest precision DM estimates so far and interesting solar wind related DM variations in some pulsars. This is likely to characterize the noise introduced by the dynamic inter-stellar ionised medium much better than the previous release thereby increasing sensitivity to any future gravitational wave search.
We evaluate data on choices made from convex time budgets (CTB) in Andreoni and Sprenger (Am Econ Rev 102(7):3333–3356, 2012a) and Augenblick et al. (Q J Econ 130(3):1067–1115, 2015), two influential studies that proposed and applied this experimental technique. We use the weak axiom of revealed preference (WARP) to test for external consistency relative to pairwise choice, and demand, wealth and impatience monotonicity to test for internal consistency. We find that choices made by subjects in the original Andreoni and Sprenger (Am Econ Rev 102(7):3333–3356, 2012a) paper violate WARP frequently; violations of all three internal measures of monotonicity are concentrated in subjects who take advantage of the novel feature of CTB by making interior choices. Wealth monotonicity violations are more prevalent and pronounced than either demand or impatience monotonicity violations. We substantiate the importance of our desiderata of choice consistency in examining effort allocation choices made in Augenblick et al. (Q J Econ 130(3):1067–1115, 2015), where we find considerably more demand monotonicity violations, as well as many classical monotonicity violations which are associated with time inconsistent behavior. We believe that the frequency and magnitude of WARP and monotonicity violations found in the two studies pose important confounds for interpreting and structurally estimating choice patterns elicited through CTB. We encourage researchers employing CTB in present and future experiments to include consistency tests in their design and pre-estimation analysis.
We present the Okinawa Institute of Science and Technology – Taylor–Couette set-up (OIST-TC), a new experimental set-up for investigating turbulent Taylor–Couette (TC) flow. The set-up has independently rotating inner and outer cylinders, and can achieve Reynolds numbers up to $10^6$. Noteworthy aspects of its design include innovative strategies for temperature control and vibration isolation. As part of its flow-measurement instrumentation, we have implemented the first ‘flying hot-wire’ configuration to measure the flow velocity whilst either or both cylinders are rotating. A significant challenge for obtaining reliable measurements from sensors within the inner cylinder is the data distortion resulting from electrical and electromagnetic interference along the signal pathway. Our solution involves internal digitization of sensor data, which provides notable robustness against noise sources. Additionally, we discuss our strategies for efficient operation, outlining custom automation tools that streamline both data processing and operational control. We hope this documentation of the salient features of OIST-TC is useful to researchers engaged in similar experimental studies that delve into the enchanting world of turbulent TC flow.
Rastelli surgery is used for the correction of several CHDs. Although late-onset cardiac arrhythmias have emerged as a major complication after corrective surgeries, there is a paucity of data on arrhythmias after Rastelli surgery.
Methods:
This retrospective cohort study was conducted on patients who had undergone Rastelli surgery and have been followed at the adult CHD clinic at our hospital.
Results:
A total of 55 patients (36.4% female, age 22.2 ± 6.4 years) were followed for a median period of 24.2 (20.6–31.0) years. Tachyarrhythmias occurred in 21 (38.4 %) patients (n = 15 for atrial tachycardia, 5 for ventricular tachycardia, and 1 for both atrial and ventricular tachycardia). Older age at surgery was significantly associated with the risk of tachyarrhythmias (P = 0.022). Bradyarrhythmia occurred in 12 (21.8%) patients and consisted of perioperative AV block (n = 5), late AV block (n = 1), and sinus node dysfunction (n = 6). Nine (16.4%) patients underwent catheter ablation. The mechanisms of atrial arrhythmias include cavotricuspid isthmus-dependent and surgical scar-dependent intra-atrial reentrant tachycardias. Among the three patients who underwent ablation for ventricular tachycardia, all circuits were dependent on the scar at the base of the right ventricle to pulmonary artery conduit. Median survival free from any event (arrhythmia, death, or heart failure) was 31.6 (28.1–35.1) years after Rastelli surgery.
Conclusions:
The prevalence of arrhythmias late after Rastelli surgery is substantial and increases in the second decade after surgery. Older age at surgery is associated with a higher prevalence of arrhythmias.
Ecuador has a high prevalence of household food insecurity (HFI) and is undergoing nutritional and epidemiologic transition. Evidence from high-income countries has reported negative or null associations between HFI and physical activity (PA) in children. It remains uncertain whether the same is true of those from low- and middle-income countries like Ecuador whose environmental and socio-demographic characteristics are distinct from those of high-income countries. We aimed to investigate the association of HFI with PA, sedentary behaviour (SB) and anthropometric indicators in children.
Design:
Cross-sectional analysis of data from the nationally representative 2018 Ecuadorian National Health and Nutrition Survey. Data were collected on HFI, PA, SB, socio-demographic characteristics and measured height and weight. Unadjusted and adjusted linear, log-binomial and multinomial logistic regression analyses assessed the relationship of HFI with PA, SB, stunting and BMI-for-age.
Setting:
Ecuador.
Participants:
23 621 children aged 5–17 years.
Results:
Marginal and moderate-severe HFI was prevalent in 24 % and 20 % of the households, respectively. HFI was not associated with PA, SB, stunting nor underweight. Moderate-severe HFI was associated with a lower odds of overweight and obesity. However, adjustment for household assets attenuated this finding for overweight (adjusted OR:0·90, 95 % CI: 0·77, 1·05) and obesity (adjusted OR: 0·88, 95 % CI: 0·71, 1·08).
Conclusion:
HFI is a burden in Ecuadorian households, but is not associated with PA, SB nor anthropometric indicators in children aged 5–17 years. However, a concerning prevalence of insufficient PA was reported, emphasising the critical need for evidence-based interventions aimed at promoting PA and reducing SB.
Background: Objective markers of disease progression are needed for patients with multiple sclerosis (MS). Increased randomness in neural networks is hypothesized to be an important cause of morbidity that can be objectified using graph theory. Methods: We use voxel-based structural similarity determined from T1-weighted MRI scans of 23 patients with MS receiving autologous stem cell transplant (ASCT) to compute cortical covariance network parameters. We examine associations between measures of cortical integration or segregation and biochemical/clinical measures of cortical health or function using Spearman correlation coefficients. P<0.05 was considered significant. Results: Path length increase was associated with markers of greater inflammation (ρ=0.56,P<.046) at baseline and reduced Naa/Cr ratio (P<.041) at 12 months. Reduced lambda was associated with markers of greater grey matter atrophy (ρ=0.55,P<.019) after 12 months and lower cognition (ρ=0.56,P<.008) at 12 months. Reduced clustering was associated with higher neurofilament (ρ=-0.68,P<.010) at baseline, greater white matter atrophy (ρ=0.62,P<.006) after 12 months, lower 2-second PASAT performance (ρ=0.56,P<.011) at baseline, and reduced Naa/Cr ratio (P<.001) at 12 months. Conclusions: Reduced cortical integration and segregation (random network features) co-occur with unfavourable markers of cortical health and function in patients with MS receiving ASCT. Network features show promise as important longitudinal markers of patient status and progression.
With increasing demand for large numbers of testing during the coronavirus disease 2019 pandemic, alternative protocols were developed with shortened turn-around time. We evaluated the performance of such a protocol wherein 1138 consecutive clinic attendees were enrolled; 584 and 554 respectively from two independent study sites in the cities of Pune and Kolkata. Paired nasopharyngeal and oropharyngeal swabs were tested by using both reference and index methods in a blinded fashion. Prior to conducting real-time polymerase chain reaction, swabs collected in viral transport medium (VTM) were processed for RNA extraction (reference method) and swabs collected in a dry tube without VTM were incubated in Tris–EDTA–proteinase K buffer for 30 min and heat-inactivated at 98 °C for 6 min (index method). Overall sensitivity and specificity of the index method were 78.9% (95% confidence interval (CI) 71–86) and 99% (95% CI 98–99.6), respectively. Agreement between the index and reference method was 96.8% (k = 0.83, s.e. = 0.03). The reference method exhibited an enhanced detection of viral genes (E, N and RNA-dependent RNA polymerase) with lower Ct values compared to the index method. The index method can be used for detecting severe acute respiratory syndrome corona virus-2 infection with an appropriately chosen primer–probe set and heat treatment approach in pressing time; low sensitivity constrains its potential wider use.
To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women).
Design:
We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed.
Setting:
Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included.
Participants:
All eligible participants from the original datasets were included.
Results:
The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61–0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight.
Conclusions:
MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.
Ethics are important in psychiatry since psychiatrydeals mainly with human conduct and behaviour. Ethics are principles, notlaws but standards of conduct, which define the essentials of honourablebehaviour for the physician. Indian Psychiatric Society approved ethical guideline in 1989Cuttack conference.
Hypothesis-
Ethical issues depend on the following theories –
Utilitarian Theory– A fundamental obligation in making decision and is to try to producethe greatest possible happiness for the greatest benefit.
Parentalism-A person performing actions for another benefit without the person's consent.
Autonomy Theory –It is based on writing of Imanuel Kant. Relationship between a physician and anadult patient is conceived as relationship between two responsible persons.
Observation –
Some common causes of malpractice in psychiatry seen in India arei) Negligence in diagnosis ii) Overlooking basic human rights iii) Consent nottaken from patient iv) Risk of suicide v) Experimentation by doctor vi)Negligence in physical methods of treatment vii) Seaxual relation with clientand Exploitation.
Conclusion –
Now a days following forces are to be considered as new ethical challenges a)Rapidly increasing cost of mental health care b) Influence of new technologies likeMRI, CT SCAN Brain c) Societal reengineering for better mental health d)Increasing pressure by patient party e) Current market forces are demandinghigh quality health care.
Discussion–
Apracticing psychiatrist has to take more responsibility in management of mentaldisorders. One has to take it as normal inevitable professionalhazards.
An improved understanding of diagnostic and treatment practices for patients with rare primary mitochondrial disorders can support benchmarking against guidelines and establish priorities for evaluative research. We aimed to describe physician care for patients with mitochondrial diseases in Canada, including variation in care.
Methods:
We conducted a cross-sectional survey of Canadian physicians involved in the diagnosis and/or ongoing care of patients with mitochondrial diseases. We used snowball sampling to identify potentially eligible participants, who were contacted by mail up to five times and invited to complete a questionnaire by mail or internet. The questionnaire addressed: personal experience in providing care for mitochondrial disorders; diagnostic and treatment practices; challenges in accessing tests or treatments; and views regarding research priorities.
Results:
We received 58 survey responses (52% response rate). Most respondents (83%) reported spending 20% or less of their clinical practice time caring for patients with mitochondrial disorders. We identified important variation in diagnostic care, although assessments frequently reported as diagnostically helpful (e.g., brain magnetic resonance imaging, MRI/MR spectroscopy) were also recommended in published guidelines. Approximately half (49%) of participants would recommend “mitochondrial cocktails” for all or most patients, but we identified variation in responses regarding specific vitamins and cofactors. A majority of physicians recommended studies on the development of effective therapies as the top research priority.
Conclusions:
While Canadian physicians’ views about diagnostic care and disease management are aligned with published recommendations, important variations in care reflect persistent areas of uncertainty and a need for empirical evidence to support and update standard protocols.
Vortex-induced vibration (VIV) is an important physical phenomenon as one design a riser or a cylindrical structure in ocean. As the riser or the cylindrical structure is adjacent to a seabed, the boundary effect on VIV is not fully understood yet. The direct-forcing immersed boundary (DFIB) method is used to investigate a two-degree-of-freedom VIV of a flexible supported circular cylinder adjacent to a plane boundary in this study. Furthermore, the effect of the VIV of cylinder on skin friction of the plane boundary is investigated. The effects of varying reduced velocity and gap ratio on VIV are discussed. Only a single vortex street is found when the cylinder is close to plane boundary. Hydrodynamic coefficients of the freely vibrating cylinder are analyzed in time and spectral domains. Furthermore, nearly round oval-shaped motion is observed as the so-called lock-in phenomenon occurs. The skin friction of the plane boundary is predicted by the DFIB model. Results show that the vibrating cylinder in the boundary layer flow can reduce the friction effectively. This proposed DFIB model can be useful for the investigation of VIV of the structures under the plane boundary effect even for a small gap between the cylinder and the boundary.
Rotavirus (RV) infection causes acute infantile diarrhoea in humans and animals and remains a major concern for vaccine development. The close proximity of humans to animals may foster cross-species infection resulting in the emergence of novel/unusual strains by genetic reassortment. In this study, we characterized 500 diarrhoeal samples for group A rotaviruses (RVA) from children (n = 290), piglets (n = 95) and calves (n = 115) in Northeast India during 2012–2013. The data showed that 142/500 (28·4%) faecal samples were positive for RVA with the highest level of infection detected in piglets (57/142, 40·1%) followed by children (51/142, 35·9%) and calves (34/142, 23·9%). Sequence-based G- and P-typing showed G1P[8] (25%) and G1P[7] (35%) were the prevailing genotypes in both humans and animals. Single cases of unusual genotypes, i.e. G9P[8], G5P[8] in humans and G1P[13], G1P[23] and G3P[7] in animals were also identified. Cluster analyses of the sequences showed regional strains were genetically closer to their homologous strains. However, human G5P[8] and porcine G1P[8] strains showed homology to heterologous hosts of their prototype strains. The subsequent global spread of unusual RV strains may result in their establishment over time, presenting challenges to future vaccine evaluation programmes. More studies on emerging genotypes are required to elucidate how RVA strains evolve post-vaccination. This study supports the need for continuous surveillance of RVA infections after detecting from diverse hosts in a common setting.
Drinking raw date palm sap is the primary route of Nipah virus (NiV) transmission from bats to people in Bangladesh; subsequent person-to-person transmission is common. During December 2010 to March 2011, we investigated NiV epidemiology by interviewing cases using structured questionnaires, in-depth interviews, and group discussions to collect clinical and exposure histories. We conducted a case-control study to identify risk factors for transmission. We identified 43 cases; 23 were laboratory-confirmed and 20 probable. Thirty-eight (88%) cases died. Drinking raw date palm sap and contact with an infected person were major risk factors; one healthcare worker was infected and for another case transmission apparently occurred through contact with a corpse. In absence of these risk factors, apparent routes of transmission included drinking fermented date palm sap. For the first time, a case was detected in eastern Bangladesh. Identification of new epidemiological characteristics emphasizes the importance of continued NiV surveillance and case investigation.
Background: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
The West Virginia University Hot hELIcon eXperiment (HELIX) provides variable density and ion temperature plasmas, with controllable levels of thermal anisotropy, for space relevant laboratory experiments in the Large Experiment on Instabilities and Anisotropy (LEIA) as well as fundamental studies of helicon source physics in HELIX. Through auxiliary ion heating, the ion temperature anisotropy (T⊥/T∥) is variable from 1 to 20 for parallel plasma beta (β = 8πnkTi∥/B2) values that span the range of 0.0001 to 0.01 in LEIA. The ion velocity distribution function is measured throughout the discharge volume in steady-state and pulsed plasmas with laser induced fluorescence (LIF). The wavelengths of very short wavelength electrostatic fluctuations are measured with a coherent microwave scattering system. Operating at low neutral pressures triggers spontaneous formation of a current-free electric double layer. Ion acceleration through the double layer is detected through LIF. LIF-based velocity space tomography of the accelerated beam provides a two-dimensional mapping of the bulk and beam ion distribution functions. The driving frequency for the m = 1 helical antenna is continuously variable from 8.5 to 16 MHz and frequency dependent variations of the RF coupling to the plasma allow the spontaneously appearing double layers to be turned on and off without modifying the plasma collisionality or magnetic field geometry. Single and multi-species plasmas are created with argon, helium, nitrogen, krypton, and xenon. The noble gas plasmas have steep neutral density gradients, with ionization levels reaching 100% in the core of the plasma source. The large plasma density in the source enables the study of Aflvén waves in the HELIX device.
Socio-behavioural factors and pathogens associated with childhood diarrhoea are of global public health concern. Our survey in 696 children aged ⩽2 years in rural West Bengal detected rotavirus as sole pathogen in 8% (17/199) of diarrhoeic stool specimens. Other organisms were detected along with rotavirus in 11% of faecal specimens. A third of the children with rotavirus diarrhoea, according to Vesikari score, had severe illness. The top four rotavirus genotypes were G9P[4] (28%), G1P[8] (19%), G2P[4] (14%) and G8P[4] (8%). In the multivariate model, the practice of ‘drawing drinking water by dipping a pot in the storage vessel’ [adjusted odds ratio (aOR) 2·21, 95% confidence interval (CI) 1·03–4·74, P = 0·041], and ‘children aged ⩽6 months with non-exclusive breastfeeding’ (aOR 2·07, 95% CI 1·1–3·82, P = 0·024) had twice the odds of having diarrhoea. Incidence of rotavirus diarrhoea was 24/100 child-years in children aged >6–18 months, 19/100 child-years in children aged >18–24 months and 5/100 child-years in those aged ⩽6 months. Results have translational implications for future interventions including vaccine development.