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Background: Levamisole is a commonly used steroid-sparing agent (SSA), but the reported incidence of antineutrophil cytoplasmic antibody (ANCA) positivity has been concerning. Methods: Observational cross-sectional study wherein children aged 2 to 18 years with frequently relapsing/steroid dependent nephrotic syndrome (FRNS/SDNS) on levamisole for ≥ 12 months were tested for ANCA. Results: A total of 210 children (33% female), median age of 7.3 (IQR: 5.6–9.6) years, and a median duration of levamisole exposure of 21 (IQR: 15–30) months were tested. ANCA was positive in 18% (n = 37): 89% (n = 33) perinuclear ANCA (pANCA), 3% (n = 1) cytoplasmic ANCA (cANCA), and 8% (n = 3) both. Of ANCA-positive children, none had reduced eGFR or abnormal urinalysis. The majority of these children were asymptomatic (81%, n = 30). Rash was more common among ANCA-positive children [6/37 (16%) vs. 3/173 (2%), p = 0.0001]. On multivariate analysis, higher age (OR = 1.02, [95th CI: 1.01 to 1.03], p = 0.007) and longer duration of levamisole exposure (OR = 1.05, [95th CI: 1.02 to 1.08], p = 0.0007) were associated with ANCA positivity. Levamisole was stopped in ANCA-positive children with the resolution of any clinical manifestations if present. Repeat ANCA testing was performed in 54% (20/37), and all were ANCA negative by 18 months. Conclusions: Children with FRNS/SDNS on longer duration of levamisole were associated with increasing prevalence of ANCA positivity, but most of these children were clinically asymptomatic. Prospective studies are required to determine the chronology of ANCA positivity and its clinical implication. [ABSTRACT FROM AUTHOR]

Background: Levamisole is less expensive and has a better toxicity profile compared to other steroid sparing agents used in nephrotic syndrome. It has a plasma half-life of 2.0 to 5.6 hours, but is conventionally administered on alternate days. We aimed to assess whether daily levamisole is safe and more effective than standard alternate-day therapy in maintaining remission in children with frequently relapsing or steroid-dependent nephrotic syndrome (FR/SDNS). Methods: An open-label randomized controlled trial was conducted in children with FR/SDNS. Group A received daily while Group B received alternate-day levamisole (2–3 mg/kg/dose) for 12 months. Prednisolone was tapered off by 3 months. Patients were monitored for relapses, further steroid requirement, and adverse effects. Results: A total of 190 children with FR/SDNS (94 in Group A and 96 in Group B) were analyzed. Sustained remission for 12 months was observed in 36% of Group A and 27% of Group B patients (p = 0.18). Numbers completing 12 months in the study were 67% in Group A and 56% in Group B (p = 0.13). Time to first relapse, persistent FR/SDNS, and withdrawal due to poor compliance were statistically similar in both groups, while relapse rate and cumulative steroid dosage were significantly lower in Group A compared to Group B (p = 0.03 and p = 0.02, respectively). The incidence of adverse effects was comparable in both groups, with reversible leucopenia and hepatic transaminitis being the commonest. Conclusions: Daily levamisole therapy was not superior to alternate-day therapy in maintaining sustained remission over 12 months. Nevertheless, relapse rate and cumulative steroid dosage were significantly lower without increased adverse effects. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

The impact of ecosystem conservation and restoration activities are rarely monitored from a global, multidimensional and multivariable perspective. Here we present an approach to quantify the environmental impact of landscape restoration using long-term and high-resolution satellite observations. For two restoration areas in Tanzania, we can likely attribute an increase in the amount of water retained by the soil (∼0.01 m³ m⁻³, ∼13% average increase), a soil temperature drop (∼-0.5°C) and an increase in surface greenness (∼50% average increase) in 3.5 years. These datasets illuminate the impact of restoration initiatives on the landscape and support the reporting of comprehensive metrics to donors and partners. Satellite observations from commercial providers and space agencies are now achieving the frequency, resolution, and accuracy that can allow for the effective evaluation of restoration activities. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to obtain the morphological and morphometric variations of the glenoid cavity of the scapula in the population of Bihar and compare it to that of the study done in different races by the previous author. Method: A total of 120 dry adult human scapulae of unknown age and sex in which 60 belong to the right side and 60 belonging to the left side were obtained from the Department of Anatomy and forensic medicine of Indira Gandhi Institute of Medical Sciences, Patna and also from other medical colleges of Bihar. Results: The most common shape of the glenoid cavity recorded in this study was pearshaped followed by inverted comma-shaped. The least common shape was oval. The mean scapular length was observed as 137.11±8.72 mm, the mean breadth of scapula was 98.73±10.92 mm, the mean supero-inferior glenoid diameter was 36.34±3.91 mm, the mean anteroposterior glenoid diameter was 24.95±4.58 mm and mean glenoid cavity index was 68.82±10.33. Conclusion: Morphological and morphometric analysis of the glenoid cavity of the scapula is very important during designing and fitting of glenoid components in total shoulder arthroplasty and its associated shoulder pathology. [ABSTRACT FROM AUTHOR]

The isotopic composition (δ18O and δ2H) of precipitation is widely used as a moisture source tracer. In north‐west India, the δ18O, δ2H and D‐excess values of precipitation correlate mainly with air temperature; however, the moisture sources of water vapour are unclear. Therefore, we collected daily precipitation isotope data (n = 425) from 13 rain gauge stations in northwest India in 2013. We established a regional meteoric water line (MWL) for northwest India and local MWLs for all 13 rain gauge stations separately. We observed an altitudinal gradient of about 0.11‰/100 m in slope and about 1.22‰/100 m in intercept from the western to the northeast part of the study area. The isotopic composition of precipitation shows spatial and temporal variability across the study area. We found higher Deuterium excess values during winter (December–February) and lower during the monsoon season (July–September), which may be associated with the different moisture sources, namely, the Bay of Bengal, Arabian Sea and Westerly disturbances. Our results suggest local moisture recycling may also occur during the study period. The present study can enhance the knowledge of the isotopic evolution of precipitation and moisture sources in northwest India. [ABSTRACT FROM AUTHOR]

Background: We present clinical, biochemical, and histopathological characteristics and treatment outcomes of biopsy proven childhood lupus nephritis (LN) from a low/middle income setting treated in the current era of increased use of Mycophenolate Mofetil (MMF) and biologics. Methods: Retrospective observational study of children (1–18 years) with biopsy proven LN treated from 01.01.2010 to 31.01.2020. Results: 60 children met our inclusion criteria (80%, n = 48 were females). The median age at diagnosis was 11 (IQR: 9–12) years. The most common extra-renal manifestation was mucocutaneous (n = 54, 90%) and the most common kidney manifestation was edema (n = 50, 83.3%). The median 24-h urinary protein excretion was 1117.8 (IQR: 795.4–1941.7) mg/m2/day with 67% (n = 40) having nephrotic range proteinuria (>1000 mg/m2/day). 75% (n = 45) children had eGFR <90 mL/min/1.73 m2 (median eGFR = 71; IQR: 56–90 mL/min/1.73 m2). Anti-Nuclear Antibody was positive in all, both complement three and four were low in 82% (n = 49) and anti-double stranded DNA antibodies were positive in 63% (n = 38). 85% (n = 51) had proliferative LN with majority being class IV (57%, n = 34). All children received steroids for induction therapy. MMF was given as the sole induction agent in 48% (n = 29) and cyclophosphamide in 27% (n = 16). Rituximab was added in 17% (n = 10) as a rescue agent. Median follow up duration was 50 (IQR: 28–82) months. Six children (10%) died as a result of serious infections and none of them had shown complete response (CR). Out of the 52 children who had a follow up duration of at least 2 years, CR was achieved in 46 children (88%) and partial response (PR) or no response (NR) in three children (6%) each. Although children who were in CR/PR at last follow up had lower proteinuria, higher eGFR, and lower histopathology activity index at onset; low numbers in the NR group precluded us from subjecting them to any statistical correlation tests. 36% (n = 22) of children developed 36 episodes of renal flares with overall incidence of 0.14/person-year. Conclusion: Our study on a contemporary cohort of childhood LN highlights the importance of achieving CR and its feasibility. [ABSTRACT FROM AUTHOR]

The Kosi River, draining through Nepal and north Bihar, India, has been known for excessive sediment (commonly called silt) deposition—a primary cause of several hazards. However, there are still no good estimates of the volume of silt accumulated in the Kosi River channel, which makes removal and utilization of silt a major challenge, both technically as well as economically. In this work, we first present a novel method to estimate sediment volume on a reach scale using hydrological and channel planform data mapped from satellite images. We then identify various commercial uses of the Kosi River sediments such as embankment construction, backfilling, land reclamation, landscaping, agricultural applications, industrial applications, and geotextile silt walls. In consultation with various stakeholders, backfilling and embankment construction were identified as potentially the best solutions shortlisted for the development of a business case and investment model. Therefore, we prepared an investment model based on economic viability, cost-to-benefit ratio, and stakeholder consultations for two districts. We performed a SWOT analysis by breaking down the opportunities and risks into political, economic, social, technological, environmental, and legal (PEST-EL) factors to identify the pros and cons within the sector and of the ecosystem in which the stakeholders operate. [ABSTRACT FROM AUTHOR]

Understanding the spatiotemporal dynamics of river water chemistry from its source to sinks is critical for constraining the origin, transformation, and "hotspots" of contaminants in a river basin. To provide new spatiotemporal constraints on river chemistry, dissolved trace element concentrations were measured at 17 targeted locations across the Ramganga River catchment. River water samples were collected across three seasons: pre-monsoon, monsoon, and post-monsoon between 2019 and 2021. To remove the dependency of trace element concentrations on discharge, we used molar ratios, as discharge data on Indian transboundary rivers are not publicly available. The dataset reveals significant spatiotemporal variability in dissolved trace element concentrations of the Ramganga River. Samples collected upstream of Moradabad, a major industrial city in western Uttar Pradesh, are characterized by ~ 1.2–2.5 times higher average concentrations of most of the trace elements except Sc, V, Cr, Rb, and Pb, likely due to intense water–rock interactions in the headwaters. Such kind of enrichment in trace metal concentrations was also observed at sites downstream of large cities and industrial centers. However, such enrichment was not enough to bring a major change in the River Ganga chemistry, as the signals got diluted downstream of the Ramganga-Ganga confluence. The average river water composition of the Ramganga River was comparable to worldwide river water composition, albeit a few sites were characterized by very high concentrations of dissolved trace elements. Finally, we provide an outlook that calls for an assessment of stable non-traditional isotopes that are ideally suited to track the origin and transformation of elements such as Li, Mg, Ca, Ti, V, Cr, Fe, Ni, Cu, Zn, Sr, Ag, Cd, Sn, Pt, and Hg in Indian rivers. [ABSTRACT FROM AUTHOR]

Recent years have seen a rapid rise in the generation of high-resolution topographic data using custom-built or commercial-grade Unmanned Aerial Vehicles (UAVs). Though several studies have demonstrated the application potential of UAV data, significant knowledge gaps still exist in terms of proper documentation of protocols for data acquisition, post-flight data processing, error assessments, and their mitigation. This work documents and provides guidelines for UAV data acquisition and processing from several years of field experience in diverse geomorphic settings across India, including undulating topography (~17 km2), alluvial plains (~142 km2), lowland-river basin (~66 km2), and a highly urbanized area (~5 km2). A total of 37,065 images with 16 and 20 Megapixels and 604 ground control points (GCPs) were captured with multiple UAV systems and processed to generate point clouds for a total area of ~230 km2. The Root Mean Square Error (RMSE) for each GCP for all sites ranged from 6.41 cm to 36.54 cm. This manuscript documents a comprehensive guideline for (a) pre-field flight planning and data acquisition, (b) generation and removal of noise and errors of the point cloud, and (c) generation of orthoimages and digital elevation models. We demonstrate that a well-distributed and not necessarily uniformly distributed GCP placement can significantly reduce doming error and other artifacts. We emphasize the need for using separate camera calibration parameters for each flight and demonstrate that errors in camera calibration can significantly impact the accuracy of the point cloud. Accordingly, we have evaluated the stability of lens calibration parameters between consumer-grade and professional cameras and have suggested measures for noise removal in the point cloud data. We have also identified and analyzed various errors during point cloud processing. These include systematic doming errors, errors during orthoimage and DEM generation, and errors related to water bodies. Mitigation strategies for various errors have also been discussed. Finally, we have assessed the accuracy of our point cloud data for different geomorphic settings. We concluded that the accuracy is influenced by Ground Sampling Distance (GSD), topographic features, and the placement, density, and distribution of GCPs. This guideline presented in this paper can be extremely beneficial to both experienced long-term users and newcomers for planning the UAV-based topographic survey and processing the data acquired. [ABSTRACT FROM AUTHOR]

Introduction: Invasive urodynamics (UDS) is a standard investigation in children. Studies measuring voiding pressures in children use varied nomenclatures and quote a wide range of voiding pressures. Thus, voiding pressures in children are not considered reliable and they do not find any place in the pediatric diagnostic armamentarium. On the contrary, adult studies have well-defined nomograms and standard values which make voiding studies indispensable in the diagnosis of voiding dysfunctions in adults. The difference primarily lies in the uniformity of parameters assessed in adults and the contrasting heterogeneity in the pediatric literature. Objective: The objective of this study was to study the voiding parameters observed during UDS in boys. Study Design: We retrospectively reviewed the pressure flow data obtained during conventional invasive UDS in 106 neurologically normal boys (6 months-16 years) who had different indications for urodynamics. The values of Pdetmax and PdetQmax were analyzed and compared with the existing data of pressure flow studies in children. Results: Pdetmax decreased with age whereas PdetQmax was independent of age. The difference between the values of Pdetmax and PdetQmax was more in the younger kids. The wide range of voiding detrusor pressure (Pdet) in the existing pediatric literature is similar to the values of Pdetmax observed in our study, whereas the value of PdetQmax is much lower. Discussion: The values of Pdetmax observed in this study are similar to the values of "maximum Pdet during voiding" documented in previous studies and are determined by detrusor contractility and functional/dynamic contraction of outflow during voiding. PdetQmax has been documented in very few pediatric studies and is significantly less than Pdetmax. Further prospective studies are needed to corroborate UDS findings with radiologic/cystoscopic findings to create nomograms of voiding parameters in children. Conclusion: Existing literature on pediatric voiding studies mentions voiding pressures during variable phases of void (usually Pdetmax) and the values have been very heterogeneous, making voiding pressure-flow studies unreliable in children. PdetQmax values are much lower than values quoted as "standard" pressures and are age independent. The use of PdetQmax instead of PdetMax may make voiding pressures in children more reproducible and informative. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a known independent risk factor for morbidity/mortality but there is scarcity of robust data on it among childhood nephrotic syndrome (NS). We assessed the incidence of AKI among hospitalized children with NS as well as looked for any significant risk factors. Prospective observational study conducted across two tertiary pediatric hospitals in Eastern India from September 2020 to August 2021. Children aged 1–18 years admitted with NS and without any nephritic features or pre-existing chronic kidney disease (CKD) were included. In 200 admissions (n = 176; 63% female, median age 4 years [IQR: 3–7]), AKI occurred in 36 (18%; 95% CI 13 to 36%). Two children required kidney replacement therapy and one death was recorded. In 27/36 (75%), AKI resolved within 48 h, 4 had persistent AKI, 3 acute kidney disease, and two progressed to CKD. On multivariate regression analysis: fractional excretion of sodium ≤ 0.2% (OR 12.77; 95% CI 3.5–46.4), male gender (OR 6.38; 95% CI 2.76–14.74), underlying infection (OR 5.44; 95% CI 2.4–11.86), nephrotoxic drugs (OR 4.83; 95% CI 2.21–10.54), and albumin ≤ 1.4 g/dl (OR 4.35; 95% CI 1.55–12.8) were associated with AKI. A predictive equation using these five variables on admission had high AUC (0.86) in correctly identifying 17 children who subsequently developed AKI. Conclusion: In a low resource setting, AKI is common among hospitalized children with NS. Larger multi-center prospective studies are needed to refine prediction equations and test its utility in preventing AKI development. What is Known: • Acute Kidney Injury is a known independent risk factor for increased morbidity and mortality. • There are few studies to assess the incidence of Acute kidney injury in hospitalised cases of childhood nephrotic syndrome.. What is New: • This is the largest prospective cohort of children suffering from nephrotic syndrome, in India, proposing a novel algorithm for predicting the risk of AKI among hospitalised cases of childhood nephrotic syndrome. [ABSTRACT FROM AUTHOR]

Background: Despite its utility, uncertainty exists on the feasibility of acute peritoneal dialysis (PD) and optimal PD catheter type for very low birth weight (VLBW < 1500 g) and extremely low birth weight (ELBW < 1000 g) infants. We hereby report our experience of acute PD among these high-risk infants and compare the outcome between stylet-based rigid catheter (SRC) and Cook Mac-Loc Multipurpose Drainage catheters® (CMMDC). Methods: Case notes of infants < 1500 g undergoing PD between 2012 and 2021 in a network of five participating neonatal units supported by a tertiary paediatric nephrology centre in Kolkata, India, were retrospectively reviewed. PD was conducted either with SRC or after 2018 with CMMDC. Outcome parameters included complications, survival during PD, and survival to discharge. Results: 24 infants (VLBW: n = 13 and ELBW: n = 11) underwent PD at median age 4.5 days (IQR 3–6) with either CMMDC (n = 14) or SRC (n = 10). Significant improvement in biochemical parameters and fluid removal was seen in both ELBW and VLBW infants. CMMDC was associated with significantly fewer PD-related complications 7/14 (50%) vs. 9/10 (90%) (p = 0.04) and higher survival during PD 13/14 (93%) vs. 5/10 (50%) (p = 0.02), without significant difference in survival to hospital discharge 8/14 (57%) vs. 3/10 (30%) (p = 0.25). CMMDC also enabled longer duration of PD, higher ultrafiltration, and better control of acidosis. Consumable cost was higher for CMMDC (USD$60) than SRC (USD$14). Conclusions: In a low resource setting, CMMDC had lower PD complications and superior short-term survival among ELBW/VLBW infants. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

The Ganga River is one of the largest river systems in the world that has built extensive alluvial plains in northern India. The stretch of the Lower Ganga River is vulnerable to siltation because of: (a) the naturally low slope in the alluvial stretch; (b) the confluence of several highly sediment‐charged rivers such as the Ghaghra, Gandak, and Kosi; and (c) the reduction in non‐monsoon flows because of upstream abstractions of both surface and groundwater. Additionally, the Farakka barrage has impacted the morphology of the Ganga River significantly, both upstream and downstream of the barrage. Large‐scale siltation in several reaches has reduced the channel capacity, leading to catastrophic floods in this region even at low discharges. This work has utilized historical remote sensing data and UAV surveys to reconstruct channel morphodynamics and compute sediment volumes accumulated in the channel belt along the Lower Ganga River between Buxar and Farakka. The work was carried out by dividing the total length of the river into four continuous stretches: (a) Buxar–Gandhighat (GW1, 160 km); (b) Gandhighat–Hathidah (GW2, 106 km); (c) Hathidah–Azmabad (GW3, 182 km); and (d) Azmabad–Farakka (GW4, 132 km). We document that major 'hotspots' of siltation have developed in several reaches of the Lower Ganga during the last four to five decades. Sediment budgeting using planform maps provides estimates of 'extractable' volumes of sediment in GW1, GW2, GW3, and GW4 as 656 ± 48, 706 ± 52, 876 ± 71, and 200 ± 85 Mm3, respectively. These estimates are considerably lower than those computed from the hydrological approach using observed suspended sediment load data, which assumes uniform sedimentation between two stations. Further, our approach provides reach‐scale hotspots of aggradation and estimates of extractable sediment volumes, and this can be very useful for river managers to develop a strategic sediment management plan for the given stretch of the Ganga River. [ABSTRACT FROM AUTHOR]

The wetland cover is defined as the spatially homogenous region of a wetland attributed to the underlying biophysical conditions such as vegetation, turbidity, hydric soil, and the amount of water. Here, we present a novel method to derive the wetland-cover types (WCTs) combining three commonly used multispectral indices, NDVI, MNDWI, and NDTI, in three large Ramsar wetlands located in different geomorphic and climatic settings across India. These wetlands include the Kaabar Tal, a floodplain wetland in east Ganga Plains, Chilika Lagoon, a coastal wetland in eastern India, and Nal Sarovar in semi-arid western India. The novelty of our approach is that the derived WCTs are stable in space and time, and therefore, a given WCT across different wetlands or within different zones of a large wetland will imply similar underlying biophysical attributes. The WCTs can therefore provide a novel tool for monitoring and change detection of wetland cover types. We have automated the proposed WCT algorithm using the Google Earth Engine (GEE) environment and by developing ArcGIS tools. The method can be implemented on any wetland and using any multispectral imagery dataset with visible and NIR bands. The proposed methodology is simple yet robust and easy to implement and, therefore, holds significant importance in wetland monitoring and management. [ABSTRACT FROM AUTHOR]

Floodplain wetlands are critical for sustaining various ecological and hydrological functions in a riverine environment. Severe anthropogenic alterations and human occupation of floodplains have threatened these wetlands in several parts of the world. A major handicap in designing sustainable restoration and monitoring strategies for these wetlands is the lack of scientific process-based understanding and information on the basin-scale controls of their degradation. Here, we offer a novel approach to integrate the connectivity of the wetlands with the surrounding landscape along with other attributes such as stream density, hydrometeorological parameters, and groundwater dynamics to explain their degradation and then to prioritise them for restoration and monitoring. We hypothesise that the best possible connectivity scenario for the existence of a wetland would be if (a) the wetland has a high connectivity with its upslope area, and (b) the wetland has a low connectivity with its downslope region. The first condition ensures the flow of water into the wetland and the second condition allows longer water residence time in the wetland. Accordingly, we define four connectivity-based wetland health scenarios—good, no impact, bad, and worst. We have implemented the proposed method in 3226 wetlands in the Ramganga Basin in north India. Further, we have applied specific selection criteria, such as distance from the nearest stream and stream density, to prioritise the wetlands for restoration and monitoring. We conclude that the connectivity analysis offers a quick process-based assessment of wetlands' health status and serves as an important criterion to prioritise the wetlands for developing appropriate management strategies. [ABSTRACT FROM AUTHOR]

The article discusses a case of a child with abdominal pain, arthralgia, palpable skin rash, hepatosplenomegaly, and pancytopenia. It mentions the etiology of the child's symptoms, which initially presented as Henoch-Schonlein purpura (HSP)/IgA vasculitis but was later diagnosed as Wilson disease. It also delves into the possible pathogenesis of IgA vasculitis and discusses the treatment approach for this condition in the context of Wilson disease.

The concept of cardiorenal syndrome (CRS) is derived from the crosstalk between the heart and kidneys in pathological conditions. Despite the rising importance of CRS, there is a paucity of information on the understanding of its pathophysiology and management, increasing both morbidity and mortality for patients. This review summarizes the existing conceptual pathophysiology of different types of CRS and delves into the associated therapeutic modalities with a focus on pediatric cases. Prospective or retrospective observational studies, comparative studies, case reports, case--control, and cross-sectional studies that include pediatric patients with CRS were included in this review. Literature was searched using PubMed, EMBASE, and Google Scholar with keywords including "cardio-renal syndrome, type," "reno-cardio syndrome," "children," "acute kidney injury," and "acute decompensated heart failure" from January 2000 to January 2021. A total of 14 pediatric studies were ultimately included and analyzed, comprising a combined population of 3608 children of which 32% had CRS. Of the 14 studies, 57% were based on type 1 CRS, 14% on types 2 and 3 CRS, and 7% were on types 4 and 5 CRS. The majority of included studies were prospective cohort, although a wide spectrum was observed in terms of patient age, comorbidities, etiologies, and treatment strategies. Commonly observed comorbidities in CRS type 1 were hematologic, oncologic, cardiology-related side effects, muscular dystrophy, and pneumonia/bronchiolitis. CRS, particularly type 1, is prevalent in children and has a significant risk of mortality. The current treatment regimen primarily involves diuretics, extracorporeal fluid removal, and treatment of underlying etiologies and comorbidities. [ABSTRACT FROM AUTHOR]

Background: Inherited tubulopathies are a heterogeneous group of genetic disorders making whole-exome sequencing (WES) the preferred diagnostic methodology. Methods: This was a multicenter descriptive study wherein children (< 18 years) with clinically suspected tubular disorders were recruited for molecular testing through WES. Multiplex ligation-dependent probe amplification (MLPA) and Sanger sequencing were done when required. Variants were classified as per American College of Medical Genetics 2015 guidelines and pathogenic (P)/likely pathogenic (LP) variants were considered causative. Results: There were 77 index cases (male =73%). Median age at diagnosis was 48 months (IQR 18.5 to 108 months). At recruitment, the number of children in each clinical group was as follows: distal renal tubular acidosis (dRTA) = 25; Bartter syndrome = 18; isolated hypophosphatemic rickets (HP) = 6; proximal tubular dysfunction (pTD) = 12; nephrogenic diabetes insipidus (NDI) = 6; kidney stone/nephrocalcinosis (NC) = 6; others = 4. We detected 55 (24 novel) P/LP variants, providing genetic diagnoses in 54 children (70%). The diagnostic yield of WES was highest for NDI (100%), followed by HP (83%; all X-linked HP), Bartter syndrome (78%), pTD (75%), dRTA (64%), and NC (33%). Molecular testing had a definite impact on clinical management in 24 (31%) children. This included revising clinical diagnosis among 14 children (26% of those with a confirmed genetic diagnosis and 18% of the overall cohort), detection of previously unrecognized co-morbidities among 8 children (sensorineural deafness n = 5, hemolytic anemia n = 2, and dental changes n = 1) and facilitating specific medical treatment for 7 children (primary hyperoxaluria n = 1, cystinosis n = 4, tyrosinemia n = 2). Conclusion: WES is a powerful tool in the diagnosis and management of children with inherited tubulopathies in the Indian population. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

The article describes the case of a six-year old girl with e Beta thalassemia on regular blood transfusion and iron chelation therapy. Further investigations on the patient included evaluation of metabolic acidosis, conformation on the underlying cause of acute kidney injury and acute liver failure as well as indications of underlying tubulopathy of proximal variant. The patient was treated with oral deferiprone after deferasirox was withdrawn. Adverse effects of deferasirox were identified.

Wetlands are dynamic ecosystems that require continuous monitoring and assessment of degradation status to design strategies for their sustainable management. While hydrology provides the primary functional control for the wetland ecosystem, the loss of landscape connectivity influences wetland degradation in a major way as it leads to fragmentation. This article aims to integrate hydrogeomorphic and ecological concepts for the assessment of degradation status and its causal factors for a large wetland in the western Ganga plains, India, the Haiderpur, using a wetlandscape approach. We have used a remote‐sensing‐based approach, which offers a powerful tool for assessing and linking cross‐scale structures, functions, and controls in a wetlandscape. The Haiderpur, a Ramsar site since December 2021, is an artificial wetland located on the right bank of the Ganga River wherein the inflows are controlled by a barrage constructed on the Ganga River apart from smaller tributaries flowing in from the north. A novel aspect of this work is the integration of river dynamics and its connectivity to the wetlandscape to understand the spatiotemporal variability in the waterspread area in the wetland. In this work, we have developed an integrated wetlandscape assessment approach by evaluating wetland's geomorphic and hydrological connectivity status for the period 1993–2019 (25 years) across three different spatial scales – regional, catchment, and wetland. We have highlighted the ecological implications of connectivity and patch dynamics for developing sustainable wetland management plans. [ABSTRACT FROM AUTHOR]

Summary: PREDNOS 2 was a double blind placebo controlled trial done to investigate the use of daily low-dose prednisolone for the treatment of upper respiratory tract infection—related relapses. It evaluated 365 children with relapsing steroid-sensitive nephrotic syndrome with and without background immunosuppressive treatment at 122 pediatric departments in the UK from February 1, 2013, to January 31, 2020. At the beginning of an upper respiratory tract infection, children received 6 days of prednisolone, 15 mg/m2 daily, or matching placebo preparation. Those already taking alternate-day prednisolone rounded their daily dose using trial medication to the equivalent of 15 mg/m2 daily or their alternate-day dose, whichever was greater. The primary outcome was the incidence of first upper respi-ratory tract infection-related relapse. The modified intention-to-treat analysis population comprised 271 children (mean (SD) age, 7.6 (3.5) years; 64.2% male), with 134 in the prednisolone arm and 137 in the placebo arm. The number of patients experiencing an upper respiratory tract infection-related relapse was 56 (42.7%) in the predniso-lone arm and 58 (44.3%) in the placebo arm (adjusted risk difference, 0.02; 95% CI, 0.14 to 0.10; P =0.70). No evidence was found that the treatment effect differed according to background immuno-suppressive treatment. A post hoc subgroup analysis assessing the primary outcome in 54 children of South Asian ethnicity (risk ratio, 0.66; 95% CI, 0.40–1.10) vs 208 children of other ethnicity (risk ratio, 1.11; 95% CI, 0.81–1.54) found no difference in efficacy of intervention in those of South Asian ethnicity (test for interaction P=0.09). The authors concluded that, results of PREDNOS 2 suggest that administering 6 days of daily low-dose prednisolone at the time of an upper respiratory tract infection does not reduce the risk of relapse of nephrotic syndrome in children in the UK and further work is needed to study the inter-ethnic differences in the study response. [ABSTRACT FROM AUTHOR]

Recent developments in passive microwave remote sensing have provided an effective tool for monitoring global soil moisture (SM) observations on a spatiotemporal basis, filling the gap of uneven in-situ measurement distribution. In this paper, four passive microwave SM products from three bands (L, C, and X) are evaluated using in-situ observations, over a dry–wet cycle agricultural (mostly paddy/wheat cycle crops) critical zone observatory (CZO) in the Central Ganga basin, India. The L-band and C/X-band information from Soil Moisture Active Passive (SMAP) Passive Enhanced Level 3 (SMAP-L3) and Advanced Microwave Scanning Radiometer 2 (AMSR2), respectively, was selected for the evaluation. The AMSR2 SM products used here were derived using the Land Parameter Retrieval Model (LPRM) algorithm. Spatially averaged observations from 20 in-situ distributed locations were initially calibrated with a single and continuous monitoring station to obtain long-term ground-based data. Furthermore, several statistical metrices along with the triple collocation (TC) error model were used to evaluate the overall accuracy and random error variance of the remote sensing products. The results indicated an overall superior performance of SMAP-L3 with a slight dry bias (−0.040 m3·m−3) and a correlation of 0.712 with in-situ observations. This also met the accuracy requirement (0.04 m3·m−3) during most seasons with a modest accuracy (0.059 m3·m−3) for the entire experimental period. Among the LPRM datasets, C1 and C2 products behaved similarly (R = 0.621) with a ubRMSE of 0.068 and 0.081, respectively. The X-band product showed a relatively poor performance compared to the other LPRM products. Seasonal performance analysis revealed a higher correlation for all the satellite SM products during monsoon season, indicating a strong seasonality of precipitation. The TC analysis indicated the lowest error variance (0.02 ± 0.003 m3·m−3) for the SMAP-L3. In the end, we introduced Spearman's rank correlation to assess the dynamic response of SM observations to climatic and vegetation parameters. [ABSTRACT FROM AUTHOR]

The understanding of spatiotemporal dynamics of Earth's hydrological components and their controls is critical for efficient water resource management, especially in the agriculture-dominated landscapes. In this study, we utilize the empirical orthogonal function (EOF), random combination, and temporal stability approach on the soil moisture (SM) and depth to groundwater table (DTGT) observations from the Critical Zone Observatory in the Ganga basin to understand their spatiotemporal variability and optimal sampling strategies. Around 91% of the observed DTGT spatial variation are explained by the first two spatial EOF whereas the first five EOFs explains only 67% of the total SM variability. Topography and soil texture (% clay) are considered to be the leading factors that drive the spatial pattern of both the attributes. Furthermore, we noted that four SM sampling locations and two monitoring well, selected randomly can capture the mean spatial variability with an accuracy of 3% vol/vol and 0.90 mgbl (meter below ground level) respectively. Moreover, four temporally stable SM sites and a single observation well are identified, which provide the spatial mean with an absolute error of ±2% vol/vol and 0.36 mgbl respectively. Overall, this study provides an insight to spatiotemporal hydrological controls in an intensively managed landscape and has important implications for water resource management in such regions. [ABSTRACT FROM AUTHOR]

The world is rapidly losing its wetlands. To contain the loss, the first and foremost requirement is to prepare an inventory of wetlands based on historical datasets. Individual wetlands in a catchment system are not standalone entitites, and together, they control the hydrological processes of the catchment. Therefore, it is essential to map the wetlands at the catchment scale to understand their relationship with the adjoining water bodies. This will further help to develop sustainable strategies for their revival and management. In the present work, we have formulated a simple yet robust method to (a) map the wetlands and (b) document surface dynamics of wetlands by applying pixel-scale binary logic (wet/not-wet) to the time-series Landsat dataset. We have applied this method to a large basin in the Ganga Plains and mapped a total of 3226 wetlands in the basin. The method can also be applied to map wetlands at a pixel scale to a basin scale. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a well-known life-threatening systemic effect of snake envenomation which commonly happens secondary to snake bites from families of Viperidae and Elapidae. Enzymatic toxins in snake venom result in injuries to all kidney cell types including glomerular, tubulo-interstitial and kidney vasculature. Pathogenesis of kidney injury due to snake envenomation includes ischaemia secondary to decreased kidney blood flow caused by systemic bleeding and vascular leakage, proteolytic degradation of the glomerular basement membrane by snake venom metalloproteinases (SVMPs), deposition of microthrombi in the kidney microvasculature (thrombotic microangiopathy), direct cytotoxic action of venom, systemic myotoxicity (rhabdomyolysis) and accumulation of large amounts of myoglobin in kidney tubules. Clinical features of AKI include fatigue, loss of appetite, headache, nausea, vomiting, oliguria and anuria. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Early initiation of anti-snake venom and early diagnosis of AKI are always desirable. Biomarkers which will help in early prediction of AKI are being explored, and current studies suggest that urinary clusterin, urinary neutrophil gelatinase-associated lipocalin, and serum cystatin C may play an important clinical role in the future. Apart from fluid and electrolyte management, kidney support including early and prompt initiation of kidney replacement therapy when indicated forms the bedrock in managing snake bite-associated AKI. Long-term follow-up is important because of chances of progression towards CKD. [ABSTRACT FROM AUTHOR]

Rituximab is a chimeric monoclonal antibody capable of depleting B cell populations by targeting the CD20 antigen expressed on the cell surface. Its use in oncology, initially in B cell lymphoma and post-transplant lymphoproliferative disorders, predates its current utility in various fields of medicine wherein it has become one of the safest and most effective antibody-based therapies. It was subsequently found to be effective for rheumatological conditions such as rheumatoid arthritis and antineutrophil cytoplasmic antibody-associated vasculitis. Over the past decade, rituximab has generated a lot of interest in nephrology and has become an emerging or accepted therapy for multiple renal conditions, including systemic lupus erythematosus, lupus nephritis, vasculitis, nephrotic syndrome and in different scenarios before and after kidney transplantation. This review outlines its current use in paediatric nephrology practice, focusing on the knowledge required for general paediatricians who may be caring for children prescribed this medication and reviewing them on a shared care basis. [ABSTRACT FROM AUTHOR]

The Indian Summer Monsoon (ISM) characterizes the hydrometeorological variability across the north Indian region and contributes more than 75% of the annual rainfall during the monsoon (June–September) season. In the present study, we analysed the long-term monsoon rainfall for the Ganga River basin to investigate its spatio-temporal variability. A statistically increasing (10 to 17 mm/year; p < 0.05) trend has been observed in ISM rainfall for the mountainous region since 1980, accompanied by increased temperature. We further note that high, very high and extreme rainfall events are also increasing, enhancing the flash flood risk in the mountainous region. In contrast, the ISM rainfall in the alluvial region is observed to be statistically decreasing (−5 to −20 mm/year; p < 0.05) with the combined influence of reduced vegetation. These findings provide valuable insights into the variations in regional hydrology of the Ganga River basin caused by natural and anthropogenic factors. [ABSTRACT FROM AUTHOR]

Background: Transplantation is the optimal modality for children with ESRD. High risk of disease recurrence and graft loss with FSGS, and its financial implications, may result in families refusing transplantation. Deceased donation is often preferred for FSGS, but access is limited in many low‐ and middle‐income group countries (LMIC; per capita gross national income between $1026 and $3995). As FSGS secondary to an underlying genetic etiology has low recurrence risk, we hypothesized that in LMIC such as India, families with children in ESRD secondary to FSGS with proven pathogenic mutation are more likely to consent for transplantation than those with unknown etiology. Methods: Prospective cross‐sectional study with retrospective chart review was undertaken (March 2011 and February 2019) to identify children with ESRD from FSGS. The objective was to ascertain NGS uptake and findings, parental decision for transplantation, and transplant outcome. Results: 28 children with FSGS started transplant workup, and 15 (54%) families agreed for NGS testing. Pathogenic mutation (NPHS1 x 2, WT1 x 2, COL4A3 x 2, CD2AP, CRB2, COL4A5, INF 2, ACTN4, NPHP4: 1 each) was identified in 12 (80%). 92% (11/12) agreed to proceed with transplantation in contrast to 13% (2/16) who either did not undergo NGS testing or had no pathogenic mutation identified (P =.001). No disease recurrences were noted in those with a known pathogenic mutation. Conclusion: In LMIC, NGS results are useful in transplant discussions with families for children with ESRD secondary to FSGS. [ABSTRACT FROM AUTHOR]

This commentary is designed to highlight the recent contributions on Indian geomorphology that have been published in Earth Surface Processes and Landforms (ESPL). A large number of papers included in this commentary have been published as part of the special issue on Indian geomorphology. However, I have taken the liberty of including a few others that appeared in ESPL in the last couple of years. These papers have covered a variety of topics ranging from erosion rates in Himalayan basins, miliolites in peninsular India, flood risk, connectivity concept, socio‐hydrology, and paleoclimatic reconstruction from lake sediments. They have also utilized a wide range of methodologies and tools including fractals, remote sensing, cosmogenic nuclides, and modelling. It is hoped that this commentary will put the diversity of Indian geomorphology in the correct perspective and will encourage geomorphologists across the world to continue their excellent research. [ABSTRACT FROM AUTHOR]

Geomorphological study of some of the just more than 200 known terrestrial impact structures has demonstrated that despite extensive degradation, important geomorphological keys, such as drainage pattern, topographic signatures, erosional landforms, and depositional features, can still be assessed. They can provide possible indicators to assist in the recognition of further impact structures, especially on Precambrian shields and cratonic landmasses. This study documents the surface features and landforms of the Paleoproterozoic, about 11 km diameter Dhala impact structure in India. The Dhala structure has an estimated age that is constrained stratigraphically between 1.7 and 2.5 Ga. This structure is deeply eroded, and barely has a morphological resemblance to other known terrestrial or extraterrestrial impact structures. We have analyzed the operative surface‐forming processes for the Dhala area. We demand to continue the in‐depth study of all terrestrial impact structures, especially the pre‐Paleozoic ones, so that geomorphological criteria can be rigorously constrained and applied in conjunction with a priori remote sensing and field data to support the identification of new structures prior to their ultimate confirmation using diagnostic evidence of shock metamorphism. [ABSTRACT FROM AUTHOR]

Although Acute Kidney Injury (AKI) has been described among childhood diabetes ketocidosis (cDKA) there is scarcity of literature on the role of concomitant rhabdomyolysis. A retrospective chart review was undertaken (2014–2018) to identify cDKA who developed AKI and had evidence of rhabdomyolysis defined by serum creatine phosphokinase (CPK) > 5 times upper limit of normal. 46 cDKA were identified. Ten (22%) developed AKI with 6/10 reaching peak AKI Stage 3 and 8/10 had co-current rhabdomyolysis. In comparison to non rhabdomyolysis group, cDKA with rhabdomyolysis were at presentation significantly more likely to be hypotensive and have higher corrected sodium and calculated osmolality. Subsequently they were more likely to develop lower trough potassium levels during treatment. Five patients, all with rhabdomyolysis, needed dialysis: median duration 9 days (range 4–35). Three children in our cohort died, all from infection complications during treatment, one in AKI only group who did not receive dialysis and two in AKI with rhabdomyolysis on dialysis. Rhabdomyolysis was common among our cohort of cDKA with AKI and was associated with high morbidity and mortality. Rapid flux in electrolytes and osmolality may be important precipitating factors. We recommend larger prospective studies exploring the importance of rhabdomyolysis among cDKA with AKI. [ABSTRACT FROM AUTHOR]

We propose an innovative methodology to estimate the formative discharge of alluvial rivers from remote sensing images. This procedure involves automatic extraction of the width of a channel from Landsat Thematic Mapper, Landsat 8, and Sentinel-1 satellite images. We translate the channel width extracted from satellite images to discharge using a width–discharge regime curve established previously by us for the Himalayan rivers. This regime curve is based on the threshold theory, a simple physical force balance that explains the first-order geometry of alluvial channels. Using this procedure, we estimate the formative discharge of six major rivers of the Himalayan foreland: the Brahmaputra, Chenab, Ganga, Indus, Kosi, and Teesta rivers. Except highly regulated rivers (Indus and Chenab), our estimates of the discharge from satellite images can be compared with the mean annual discharge obtained from historical records of gauging stations. We have shown that this procedure applies both to braided and single-thread rivers over a large territory. Furthermore, our methodology to estimate discharge from remote sensing images does not rely on continuous ground calibration. [ABSTRACT FROM AUTHOR]

The groundwater crisis in northwestern India is the result of over-exploitation of groundwater resources for irrigation. The Government of India has targeted a 20 percent improvement in irrigation groundwater use efficiency. In this perspective, and using a regional-scale calibrated and validated three-dimensional groundwater flow model, this article provides the first forecasts of water levels in the study area up to the year 2028, both with and without this improvement in use efficiency. Future water levels without any mitigation efforts are anticipated to decline by up to 2.8 m/year in some areas. A simulation with a 20 percent reduction in groundwater abstraction shows spatially varied aquifer responses. Tangible results are visible in a decade, and the water-level decline rates decrease by 36–67 percent in over-exploited areas. Although increasing irrigation use efficiency provides tangible benefits, an integrated approach to agricultural water management practice that incorporates use efficiency along with other measures like water-efficient cropping patterns and rainwater harvesting may yield better results in a shorter period. [ABSTRACT FROM AUTHOR]

Introduction: Recently, prolonged intermittent renal replacement therapies (PIRRT) have emerged as cost‐effective alternatives to conventional CRRT and their use in the pediatric population has started to become more prominent. However, there is a lack of consensus guidelines on the use of PIRRT in pediatric patients in an intensive care setting. Methods: A literature search was performed on PubMed/Medline, Embase, and Google Scholar in conjunction with medical librarians from both India and the Cleveland Clinic hospital system to find relevant articles. The Pediatric Continuous Renal Replacement Therapy workgroup analyzed all articles for relevancy, proposed recommendations, and graded each recommendation for their strength of evidence. Results: Of the 60 studies eligible for review, the workgroup considered data from 37 studies to formulate guidelines for the use of PIRRT in children. The guidelines focused on the definition, indications, machines, and prescription of PIRRT. Conclusion: Although the literature on the use of PIRRT in children is limited, the current studies give credence to their benefits and these expert recommendations are a valuable first step in the continued study of PIRRT in the pediatric population. [ABSTRACT FROM AUTHOR]

Introduction: Body stores of vitamin D are measured as "total" serum 25-hydroxy vitamin D (25(OH)D). Its largest component is protein bound and lost in urine in nephrotic syndrome (NS). Our study investigates whether "free" 25(OH)D levels are a better guide to bone health and need for vitamin D supplementation in patients with steroid-sensitive NS (SSNS). Methods: A cross-sectional study was performed in children with SSNS and healthy controls. Blood was tested for albumin, creatinine, calcium, phosphate, ALP, total and free (by direct ELISA) 25(OH)D, iPTH, and urine for protein–creatinine ratio. Results: Seventy-nine NS patients (48 in relapse, 31 in remission) and 60 healthy controls were included. The levels of total 25(OH)D were significantly different (lowest in NS relapse and highest in controls) (p < 0.001). Corrected calcium and phosphate levels were normal, and there were no differences in free 25(OH)D, ALP, or iPTH levels between groups. Only total and not free 25(OH)D correlated significantly and negatively with urinary protein creatinine ratios (rs = − 0.42 vs. 0.04). Free 25(OH)D values of 3.75 and 2.85 pg/ml corresponded to total 25(OH)D levels of 20 and 12 ng/ml, respectively, in healthy controls. Conclusion: These results confirm that total 25(OH)D levels are low in NS and related to degree of proteinuria. However levels of free 25(OH)D, ALP, and iPTH did not change in relapse or remission in comparison with healthy controls. Our results suggest that in proteinuric renal diseases, free 25(OH)D rather than total 25(OH)D levels should be used to diagnose vitamin D deficiency and guide therapy. [ABSTRACT FROM AUTHOR]

Unsustainable exploitation of groundwater in northwestern India has led to extreme but spatially variable depletion of the alluvial aquifer system in the region. Mitigation and management of groundwater resources require an understanding of the drivers behind the pattern and magnitude of groundwater depletion, but a regional perspective on these drivers has been lacking. The objectives of this study are to (1) understand the extent to which the observed pattern of groundwater level change can be explained by the drivers of precipitation, potential evapotranspiration, abstraction, and canal irrigation, and (2) understand how the impacts of these drivers may vary depending on the underlying geological heterogeneity of the system. We used a transfer function-noise (TFN) time series approach to quantify the effect of the various driver components in the period 1974–2010, based on predefined impulse response functions (θ). The dynamic response to abstraction, summarized by the zeroth moment of the response M 0, is spatially variable but is generally large across the proximal and middle parts of the study area, particularly where abstraction is high but alluvial aquifer bodies are less abundant. In contrast, the precipitation response is rapid and fairly uniform across the study area. At larger distances from the Himalayan front, observed groundwater level rise can be explained predominantly by canal irrigation. We conclude that the geological heterogeneity of the aquifer system, which is imposed by the geomorphic setting, affects the response of the aquifer system to the imposed drivers. This heterogeneity thus provides a useful framework that can guide mitigation efforts; for example, efforts to decrease abstraction rates should be focused on areas with thinner and less abundant aquifer bodies. [ABSTRACT FROM AUTHOR]

The music industry has widely viewed digital rights management (DRM) as an effective strategy for reducing digital piracy. Digital rights management systems aim to prevent unauthorized copying and to reduce the overall rate of piracy. Therefore, the recent move toward offering DRM-free music by some major online music sellers appears paradoxical. In this article, the authors propose a model that conceptualizes and estimates the concept of hardcore piracy in an attempt to resolve this apparent paradox. Based on two large empirical studies and a validation exercise with a large sample of more 2000 college students, the model results indicate that the music industry can benefit from removing DRM because such a strategy has the potential to convert some pirates into paying consumers. In addition, a DRM-free environment enhances both consumer and producer welfare by increasing the demand for legitimate products as well as consumers' willingness to pay for these products. The authors find that producers could benefit by lowering prices from currently observed levels. The article concludes with a discussion of the practical implications of the findings for managers within the music industry. [ABSTRACT FROM AUTHOR]

Brand communities have been cited for their potential not only to enhance the loyalty of members but also to engender a sense of oppositional loyalty toward competing brands. However, the impact of brand community membership on actual new product adoption behavior has yet to be explored. This study examines the effects of brand community participation and membership duration on the adoption of new products from opposing brands as well as from the preferred brand. Longitudinal data were collected on the participation behavior, membership duration, and adoption behavior of 7506 members spanning four brand communities and two product categories. Using a hazard modeling approach, the authors find that higher levels of participation and longer-term membership in a brand community not only increase the likelihood of adopting a new product from the preferred brand but also decrease the likelihood of adopting new products from opposing brands. However, such oppositional loyalty is contingent on whether a competitor's new product is the first to market. Furthermore, in the case of overlapping memberships, higher levels of participation in a brand community may actually increase the likelihood of adopting products from rival brands. This finding is both surprising and disconcerting because marketing managers usually do not know which other memberships their brand community members possess. The authors discuss how managers can enhance the impact of their brand community on the adoption of the company's new products while limiting the impact of opposing brand communities. [ABSTRACT FROM AUTHOR]

The emergence of dramatically innovative, or radical, new manufacturing technologies can force pivotal and life-threatening decisions for industry competitors. These technologies can represent a huge cost for adopting firms, but may also offer the chance to achieve competitive advantage through superior manufacturing. While prior research has considered a range of production process decisions (e.g., JIT, mass customization) and outcomes for end-product technologies, little attention has been given to adoption decisions relative to core manufacturing technologies. This study examines an industry's adoption of major manufacturing technologies over several decades and demonstrates that two groups of contingencies related to adoption (e.g., timing and cumulative effects) have a significant impact on firm performance. Based on a sample of over 1,000 firms, the results provide insights into the effects of adoption timing and ‘manufacturing technology bundles’ on firm survival. We also find that adoption of manufacturing technologies prior to the inflection point of the estimated Bass diffusion curve for each technology leads to significant reduction in firm mortality. Thus, we are able to demonstrate the ability of the Bass model to predict the survival outcomes of firms facing manufacturing technology adoption decisions. The strategic implications of these pivotal decisions are considered. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The goal of this article is to ascertain the factors that govern consumers' willingness to pirate a digital product, such as a digital music track. The authors assess the tendency to pirate with both indirect measures (e.g., willingness to pay for the legal alternative) and direct measures (e.g., piracy preference). Whether measured indirectly or directly, the tendency to pirate depends, to different extents, on three key factors: positive incentives (e.g., improved functionality of the legal Web site), negative incentives (e.g., perceived risk of piracy), and consumer characteristics. Based on three studies, the results suggest that negative incentives are a strong deterrent for certain consumers but can actually increase piracy tendencies for others. Conversely, positive incentives, such as improved functionality, can significantly reduce the tendency to pirate among all the consumer segments studied. The authors conclude by discussing prescriptive recommendations for the recording industry. [ABSTRACT FROM AUTHOR]

Although the merits of maintaining a market orientation have been extensively discussed in the literature, studies examining the empirical link between market orientation and performance have shown mixed results. The authors explore the relative performance effects of various dimensions of market orientation using a longitudinal approach based on letters to shareholders in corporate annual reports. Furthermore, the authors examine the relative effects of alternative strategic orientations that reflect different managerial priorities for the firm. The authors also extend previous work by considering the mediating effects of organizational learning and innovativeness on the orientation-performance relationship. The results show that firms possessing higher levels of competitor orientation, national brand focus, and selling orientation exhibit superior performance. [ABSTRACT FROM AUTHOR]

The article reports a case of a 10-year-old boy with fever, body swelling, painless gross hematuria, abdominal and knee joint pain, and rashes on both lower limbs. It is reported that the child was diagnosed with glomerulonephritis with mesangial depositions of IgA and C3, despite treatment with corticosteroids showing no significant improvement in kidney parameters.

A multicenter retrospective study was conducted to assess the clinical spectrum of 30 severe acute respiratory syndrome coronavirus (SARS-CoV-2)-positive children with idiopathic nephrotic syndrome. Difficult to treat nephrotic syndrome was found to be a high-risk group with a high incidence of acute kidney injury and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Kidney Disease (CKD) is a major and global health problem. In majority of cases patients die before reaching End Stage Renal Disease (ESRD) due to cardiovascular complications which arise due to altered lipoprotein compositions. Present study was designed to evaluate and compare the serum lipid profile in CKD patient with healthy controls. Materials and Method: In this study 50 CKD patients as cases and 50 healthy patients as control had been included randomly. Serum lipid profile, urea creatinine, Fasting Blood Sugar, Post Prandial Blood Sugar, total protein and albumin were tested in all the cases and controls. The results were analyzed and compared with the controls using Graph Pad Instat software. Results: Mean and standard deviation of Total cholesterol, Triglyceride Level (TGL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL), High Density Lipoprotein (HDL) in CKD group and control group was 128.2±53.57 and 142.53±31.44, 157.88±61.82 and 96.98±37.52, 63.23±46.47 and 77.35±26.81, 31.58±12.36 and 19.39±7.50, 33.40±9.06 and 45.95±10.35 respectively. Very Low Density Lipoprotein (VLDL) of CKD group was marginally elevated and High Density Lipoprotein (HDL) of CKD group was significantly reduced in the patient group as compared to the controls and the results were statistically highly significant with p-value<0.001. Total cholesterol and LDL were lower in the patient group as compared to the controls, however the difference was statistically not significant (p value 0.09 and 0.059 respectively). Conclusion: Increased TGL and reduced HDL, rather than increased total cholesterol and increased LDL are responsible for the high incidence of cardiovascular complications in CKD patients. Hypolipidemic drugs and low fat diet may be helpful in impeding the progression of cardiovascular complications and decrease mortality and morbidity in such patients. [ABSTRACT FROM AUTHOR]