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Abstract Case studies from global cities contribute to more focused analyses of global warming challenges and demonstrate the performance and effectiveness of mitigation and adaptation strategies to identify lessons about success at the city scale. The case studies were chosen to demonstrate aspects of the critical messages for action priorities in global warming mitigation and adaptation. This work focuses on best practices and initiatives for mitigation and adaptation approaches from developed and developing economies, including North American cities, European cities, Asian cities, and other global cities worldwide. The case studies were grouped to examine, identify, and emphasize important factors in various areas (e.g., local programs and alliances, governance, stakeholder engagement, community actions, and scientific research) that determined the success of adaptation strategies in various global cities. Many recent studies showcase mitigation approaches, particularly those relating to blue-green infrastructure and nature-based strategies. The case studies selected reflect vulnerable regions and demonstrate how increasing global warming significantly concerns individuals, societies, and their infrastructure. The selected studies include Amsterdam in Netherlands; Singapore, as a city in a garden; Boston in USA; Ahmedabad Heat Action Plan in India, aimed at implementing strategies with the objectives of climate adaptation planning; Copenhagen, as a coastal town, is more susceptible to flooding; Portland, the most progressive city in USA; Hamburg in Germany, one of the biggest harbours in Europe; and the 'Rain City Strategy', in Vancouver, Canada. Not all global cities respond the same way, but undertaking joint complex efforts helps mitigate the impacts.

Abstract Progress in understanding the impact of mesoscale variability, including gravity waves (GWs), on atmospheric circulation is often limited by the availability of global fine-resolution observations and simulated data. This study presents momentum fluxes due to atmospheric GWs extracted from four months of an experimental “nature run", integrated at a 1 km resolution (XNR1K) using the Integrated Forecast System (IFS) model. Helmholtz decomposition is used to compute zonal and meridional flux of vertical momentum from ~1.5 petabytes of data; quantities often emulated by climate model parameterization of GWs. The fluxes are validated using ERA5 reanalysis, both during the first week after initialization and over the boreal winter period from November 2018 to February 2019. The agreement between reanalysis and IFS demonstrates its capability to generate reliable flux distributions and capture mesoscale dynamic variability in the atmosphere. The dataset could be valuable in advancing our understanding of GW-planetary wave interactions, GW evolution around atmospheric extremes, and as high-quality training data for machine learning (ML) simulation of GWs.

Abstract Proper utilization of agricultural land is a big challenge as they often laid over as waste lands. Farming is a significant occupation in any country and improving it further by promoting more farming opportunities will take the country towards making a huge leap forward. The issue in achieving this would be the lack of knowledge of cultivable land for food crops. The objective of this work is to utilize modern computer vision technology to identify and map cultivable land for agricultural needs. With increasing population and demand for food, improving the farming sector is crucial. However, the challenge lies in the lack of suitable land for food crops cultivation. To tackle this issue, we propose to use sophisticated image processing techniques on satellite images of the land to determine the regions that are capable of growing food crops. The solution architecture includes enhancement of satellite imagery using sophisticated pan sharpening techniques, notably the Brovey transformation, aiming to transform dull satellite images into sharper versions, thereby improving the overall quality and interpretability of the visual data. Making use of the weather data on the location observed and taking into factors like the soil moisture, weather, humidity, wind, sunlight times and so on, this data is fed into a generative pre-trained transformer model which makes use of it and gives a set of crops that are suitable to be grown on this piece of land under the said conditions. The results obtained by the proposed fusion approach is compared with the dataset provided by the government for different states in India and the performance was measured. We achieved an accuracy of 80% considering the crop suggested by our model and the predominant crop of the region. Also, the classification report detailing the performance of the proposed model is presented.

Summary: Background: Transthoracic echocardiography (TTE) has traditionally been the primary method for coronary imaging in children with Kawasaki disease (KD). We aimed to evaluate coronary artery lesions (CALs) of the left circumflex artery (LCx) in KD on computed tomography coronary angiography (CTCA). Methods: Over a 9-year period (November 2013–December 2022), 225 children with KD underwent radiation-optimized CTCA on a 128-slice dual-source platform. TTE was performed on the same day, or a day prior or after CTCA. Findings: On CTCA, LCx CALs were seen in 41/225 (18.2%) patients. However, TTE detected CALs in only one third of these patients [15/41 (36.6%)]. CTCA showed 47 LCx CALs in 41 patients–aneurysms in 39 patients (40 fusiform, 2 saccular; 7 giant aneurysms), stenoses in 3, and thrombosis in 2. Thromboses and stenoses were both missed on TTE. Proximal LCx aneurysms were seen in 39 patients–of these, 12 had distal extension. Six patients had distal LCx aneurysms without proximal involvement and 2 non-contiguous multiple aneurysms. Four (9.75%) patients had isolated LCx involvement. Based on CTCA findings, treatment protocols had to be modified in 3/41 (7.3%) patients. Interpretation: This study highlights anatomical findings of LCx involvement in KD. Isolated LCx CALs were noted in 4/41 (9.75%) patients. TTE alone proved inadequate for LCx assessment in children with KD. With abnormalities detected in 18.2% of cases, including those missed by TTE, CTCA emerges as an essential imaging modality. The findings have implications for treatment planning and follow-up strategies in children with KD. Funding: None.

Abstract The study presents (a) a 44‐year wintertime climatology of resolved gravity wave (GW) fluxes and forcing in the extratropical stratosphere using ERA5, and (b) their composite evolution around gradual (final warming) and abrupt (sudden warming) transitions in the wintertime circulation, focusing on lateral fluxes. The transformed Eulerian mean equations are leveraged to provide a glimpse of the importance of GW lateral propagation (i.e., horizontal propagation) toward driving the wintertime stratospheric circulation by analyzing the relative contribution of the vertical versus meridional flux dissipation. The relative contribution from lateral propagation is found to be notable, especially in the Austral winter stratosphere where lateral (vertical) momentum flux convergence provides a peak climatological forcing of up to −0.5 (−3.5) m/s/day around 60°S at 40–45 km altitude. Prominent lateral propagation in the wintertime midlatitudes also contributes to the formation of belts of GW activity in both hemispheres.

This study uses a Systematic Literature Review (SLR) process to know the present status of research on urban Blue-Green Infrastructure (BGI) in the lower-middle-income countries of the South Asian region, specifically India, Bangladesh, Sri Lanka, Bhutan, Nepal, and Pakistan, which produced 77 relevant publications after detailed scanning published between 2013 and 2022. It was aimed to analyze variations on BGI's mentions in different regions, identify BGI components found in the literature and their uses to promote urban sustainability, research initiatives, and priorities, and identify knowledge gaps for future research. The review reveals significant differences in research distribution among countries, with the majority of the articles focusing on green spaces compared to bluescapes and concentrating on topics like local inhabitant's perception of urban green spaces, advantages of implementing nature-based solutions, the role of green infrastructures in minimizing the urban heat island effect, air pollution, etc. Articles highlighted the lack of governance and the challenges in implementing and designing a BGI network. However, articles discussing a holistic methodology to implement BGI for promoting urban sustainability were limited. Gaps still exist in determining the appropriate strategy for the scope identification, creation, management, and governance of BGI and integrating it with existing grey infrastructure. HIGHLIGHTS Blue-green infrastructure research in lower-middle-income South Asian countries is reviewed.; Research emphasizes global cities in lower-middle-income South Asian countries.; BGI research highlights geographical diversity, with fewer studies on provisioning services than regulatory and cultural services.; A framework for identifying, developing, managing, and governing BGI and its connection with grey infrastructure remains limited.; BGI benefits can be maximized through intergovernmental cooperation.;

This empirical study aims to explore the factors that impact job satisfaction among employees in private banks in Bangladesh, considering the prevailing atmosphere of intense competition in the country’s banking sector. Recognizing that employees are a crucial asset to any organization’s success, it is essential to explore the variables that contribute to their work contentment. The methodology adopted for this study follows a quantitative approach, employing regression analysis for scrutinizing the relationships between job satisfaction and selected variables. This study included a sample of 320 individuals employed in private banks in Bangladesh. This sample size was considered suitable for conducting a robust quantitative regression analysis. To collect the necessary data, the questionnaire was given to the bank personnel and employees via their email addresses. The survey instrument utilized in this investigation was modified from earlier research endeavors to ensure validity and reliability. To analyze the collected data, the researchers utilized the statistical software SPSS version 29.0. The regression analysis feature of SPSS was employed to test the model and hypotheses formulated for this study. The findings of the study reveal that green HR practices (β = 0.284), which encompass environmentally friendly policies and practices in human resource management, significantly contribute to employee job satisfaction. Additionally, remuneration (β = 0.224) emerges as another vital factor influencing job satisfaction. Furthermore, work environment (β = 0.298) was found to have a significant positive and highest effect among other two variables on job satisfaction levels.

Hexagonal close-packed (HCP) metals, particularly Zirconium (Zr), Titanium (Ti), and Magnesium (Mg) alloys, have attracted significant attention due to their unique properties and wide-ranging applications in the aerospace, biomedical, and energy industries. This review paper provides a comprehensive analysis of the microstructural and textural evolution in these HCP materials under various conditions, including rolling, extrusion, drawing, and annealing. The focus of the present work lies on the deformed microstructure and texture development in HCP metals, thus elucidating the fundamental mechanisms that govern their response to mechanical stress. The interaction between dislocation movements, twinning, and slip systems is discussed in detail, illustrating how these factors contribute to the anisotropic behavior characteristic of low-symmetry HCP structures. Unlike high-symmetry metals, deformation in Zr alloys depends on the activation of various slips and twin deformation modes, which are sensitive to crystallographic orientation and strain. Like Zr, Ti alloys present a more complex deformation behavior, heavily influenced by their crystallographic orientation. The most common deformation textures in Ti alloys include split-transverse direction (split-TD), split-rolling direction (split-RD), and normal direction (ND) symmetric basal fiber textures. These textures emerge due to the activation of multiple slip systems and twinning, which are dependent on external factors such as temperature, strain rate, and alloy composition. For Mg alloys, the poor formability and brittleness associated with the dominance of the basal slip system under ambient conditions is a critical material development challenge. The activation of non-basal slip systems introduces complexities in controlling texture and microstructure. However, their activation is crucial for optimizing mechanical properties such as strength and fatigue resistance. The tendency for twinning in Mg alloys further complicates their deformation behavior, leading to challenges in ensuring uniform mechanical performance. Modifying the alloy composition, grain size, and texture can additionally influence the activation of these deformation mechanisms. This review further explores the roles of dynamic recrystallization and grain growth in tailoring mechanical properties, with a particular focus on microstructure and texture evolution during annealing. Through this detailed review, we aim to present a thorough understanding of the microstructural and textural evolution in HCP materials, thereby guiding future research and industrial applications.

Thermal treatment of pine wood was carried out at 80, 120, 160, and 200 °C for 2, 4, and 6 hours. The highest mean values were, for specific gravity (0.492), moisture content (29.1%), and maximum moisture content (191%), whereas the lowest mean values were for specific gravity (0.418), moisture content (1.20%), and maximum moisture content (127%). The maximum mean values were for shrinkage in longitudinal plane (0.42%), radial plane (4.63%), volumetric shrinkage (9.28%), and maximum mean value tangential plane (3.67%). The minimum mean values were for shrinkage in longitudinal plane (0.04%), radial plane (2.22%), tangential plane (1.55%), and volumetric shrinkage (4.88%). Maximum mean values were for swelling in longitudinal (0.41%), radial (5.22%), and tangential plane (3.15%) and maximum mean volumetric swelling (7.71%), while minimum mean values were for swelling in longitudinal plane (0.08%), radial plane (2.26%), and tangential plane (1.29%) and minimum mean volumetric swelling (3.15%). The highest mean values were for tensile strength (57.3 MPa) and compression parallel to the grain (50.3 MPa), the maximum mean value of bending strength (84 MPa) and compression strength perpendicular to grain (27 MPa), whereas the lowest values were for tensile strength (42.7 MPa), bending strength (7.33 MPa), compression parallel to the grain (7.33 MPa) and compression strength perpendicular to grain (12.3 MPa).

This study aims to investigate the factors influencing consumers’ intention to adopt health fitness apps. The target population for this study were current users of health fitness apps. The data collection process was completed using a Google e-mail form with a cover letter for the convenience of customers, wherein 308 respondents were the final sample size. Data were collected from current members of health clubs and fitness centers in Dhaka, Bangladesh. Most of the respondents were males (56%, n = 308), whereas females were 44%, n = 134. Five-point Likert scale was used, where ‘1’ means ‘Strongly Disagree’ and ‘5’ ‘Strongly Agree’, to clarify the item-wise questionnaire. SPSS data analysis software for research purposes was used to evaluate the hypotheses. Cronbach Alpha (α) value was used to justify the reliability of the variables. Four items measure price value; perceived performance, health consciousness, facilitating condition, hedonic motivation are measured by two items; self-efficacy – by three. The results show that the selected six determinants positively and significantly affect consumers’ intention to use health fitness apps. Overall, these variables can explain 55.50% of the variance in predicting behavioral intentions to adopt health fitness apps. Furthermore, this results could provide significant clues to health fitness app developers that can severely influence users to adopt health fitness apps for their wellbeing.

Background: Vitamin D deficiency in inflammatory bowel disease (IBD) patients may have important clinical implications. Therefore, it is important to investigate the prevalence of vitamin D deficiency in patients with IBD to better understand its impact on disease management and outcomes. Objectives: To assess the prevalence of vitamin D deficiency in patients with IBD using a radioimmunoassay method. Material & Methods: This was a prospective, observational study conducted at the Department of Medicine, Government of Medical College Jammu, India for a year from 1 November 2021 to 31 October 2022. Adult patients from OPD and IPD with biopsy proven IBD were included. Results: A total of 40 patients were included in the study with mean age of 38.7 years. Majority of patients (70%) were male and 50% patients belonged to age group of 30-60 years. The mean vitamin D level was 25.6 ng/mL and 62.5% of patients observed with vitamin D deficiency. Both genders and age were affected, with a significant proportion of patients having abnormal vitamin D levels. The vitamin D level was found to be comparable between both genders (P>0.05) and age groups (0.229). Conclusion: The present study investigated the high prevalence of vitamin D deficiency among patients with IBD. Additionally, patients were supplemented with vitamin D and were followed for further monitoring and evaluation for their outcomes.

Effects of thermal modification were determined relative to chemical parameters of Pinus roxburghii. Thermal modification of wood was carried out at 80, 120, 160, and 200 °C for 2, 4, and 6 h. The chemical properties were different for different temperatures and different heating time. All parameters were similar except for cold water soluble extractives. Among the chemical properties studied, the maximum mean value of cold water extractives (8.20%), hot water soluble extractives (12.7%), holocellulose content (71.8%), and ash content (1.46%) were recorded at 120 °C, whereas the maximum mean values of alcohol benzene soluble extractives (13.9%) and lignin content (33.7%) were observed at 200 °C. The minimum mean value of cold water soluble extractives (5.82%), hot water soluble extractives (9.27%), holocellulose content (65.8%), and ash content (1.03%) were found to be at 200 °C, while the highest value of alcohol benzene soluble extractives 12.2% (control) and lignin content (28.0%) were found to be at 80 °C.

Employees are the most valuable part of every organization in the world, and the success of the organization depends on how well its employees do their jobs. Nowadays, commercial banks in Bangladesh are growing overwhelmingly, so the competition is enhancing one bank to another. Employee performance at the firm level and workplace productivity has not been empirically studied in the context of Bangladesh. The purpose of this study is to find out the variables that affect how well employees at banking institutions in Bangladesh do their jobs. People who worked in private banks in Bangladesh were the focus of this study and the final sample size was 250. The sample size was suitable for quantitative regression analysis. The questionnaire was sent to the e-mail ids of employees, and the questionnaires were adopted from the previous studies. To test the model and hypothesis, SPSS is used to analyze collected data in this study. The regression analysis was duly run with using the SPSS 26.0 version. The study shows that competence, compensation, leadership, and motivation have a big and good effect on how well employees do their jobs in regard to private commercial banks in Bangladesh. So, bank authorities should identify the factors influencing the improvement of the performance of bank employees, and they need to focus on employee productivity-enhancing activities.

Abstract The climate model hierarchy encompasses models of varying complexity along different axes, ranging from idealized models that elegantly describe isolated mechanisms to fully coupled Earth system models that aspire to provide useable climate projections. Based on the second Model Hierarchies Workshop, which took place in 2022, we present perspectives on how this field has evolved since the first Model Hierarchies Workshop in 2016. In this period, we have witnessed a dramatic increase in the use of (a) machine learning in climate modeling and (b) climate models to estimate risks and influence decision making under climate change. Here, we discuss the implications of these growing areas of research and how we expect them to become integrated into the model hierarchies framework.

The growth of the Internet of Things (IoT) has led to a massive upsurge in low-power radio research. Specifically, low-power receivers (RX) have been developed that efficiently receive data and extend the battery life for energy-constrained IoT systems. This has led to innovations in energy-detector (ED) first RXs which can achieve much lower power than traditional mixer-based heterodyne architectures. However, at such low-power levels, the RX performance is extremely limited. Oftentimes, low-power RXs have severe performance limitations, including lower data rate, limited blocker rejection, lower sensitivity, lower tolerance to PVT, limited modulation compatibility, and increased size and cost of off-chip components to achieve passive gain. This greatly limits the application of such RXs in real-world applications and prevents many of the low-power circuit techniques from translating to commercial standards. In this work, we look to motivate research into low-power heterodyne RX architectures which can support higher order modulation and have improved RX specifications while retaining low power.

Dislocation slips, twinning, shear banding (SBs), strain localization, and martensite formation are a few deformation modes that are activated in BCC metals and alloys. Strain, strain rate, and deformation temperature are other parameters that determine the activation of deformation modes in BCC alloys. This review focuses on several BCC alloys, such as beta-titanium (β-Ti), tantalum (Ta), and ferritic stainless steels (FSSs), all of which exhibit differences in deformation behavior. These alloys often undergo thermo-mechanical processing (TMP) to enhance their mechanical properties. TMP leads to the evolution of deformation-induced products, such as SBs, strain-induced martensite (SIM), strain localizations, and mechanical/deformation twins (DTs) during plastic deformation, while also influencing crystallographic texture. The deformation modes in β-Ti depend upon the stability of the β-phase (i.e., β-stabilizers); low-stability alloys show the formation of SIM along with slips and twins, whereas in highly stable β-Ti alloys, only slip+twin modes are observed as the primary deformation mechanisms. In the case of Ta, slip activity predominantly occurs on {110} planes, but it can also occur on planes with the highest resolved shear stress. The breakdown of Schmid’s law or non-Schmid behavior for Ta and Ta-W alloys has been discussed in detail. The cold rolling (CR) of FSSs results in the formation of ridges, which is an undesirable phenomenon leading to very low formability. The microstructures of the rolled sheets consist of elongated ferrite grains with in-grain SBs, which are preferentially formed in the γ-fiber-oriented grains. The formation of finer grains after recrystallization improves both the mechanical properties and ridging resistance in FSS. Therefore, this review comprehensively reports on the impact of TMP on the microstructural and crystallographic texture evolution during the plastic deformation and annealing treatment of β-Ti, Ta alloys, and FSSs in BCC materials, using results obtained from electron microscopy and X-ray diffraction.

Abstract While detection of malignancies on mammography has received a boost with the use of Convolutional Neural Networks (CNN), detection of cancers of very small size remains challenging. This is however clinically significant as the purpose of mammography is early detection of cancer, making it imperative to pick them up when they are still very small. Mammography has the highest spatial resolution (image sizes as high as 3328 × 4096 pixels) out of all imaging modalities, a requirement that stems from the need to detect fine features of the smallest cancers on screening. However due to computational constraints, most state of the art CNNs work on reduced resolution images. Those that work on higher resolutions, compromise on global context and work at single scale. In this work, we show that resolution, scale and image-context are all important independent factors in detection of small masses. We thereby use a fully convolutional network, with the ability to take any input size. In addition, we incorporate a systematic multi-scale, multi-resolution approach, and encode image context, which we show are critical factors to detection of small masses. We show that this approach improves the detection of cancer, particularly for small masses in comparison to the baseline model. We perform a single institution multicentre study, and show the performance of the model on a diagnostic mammography dataset, a screening mammography dataset, as well as a curated dataset of small cancers

Background: Transurethral resection of the prostate (TURP) has been the undisputed gold standard treatment for benign prostatic enlargement (BPE). However, morbidity after TURP remains significant with increased risk of bleeding and TUR syndrome. In recent years, the role of laser technology in endoscopic prostatic surgery has gradually increased. In our study, we evaluate the efficacy and safety of a novel technique of Thulium laser enucleation of prostate (THULEP) in the treatment of BPE. Materials and Methods: Five hundred and thirty-six patients with symptomatic benign prostatic hyperplasia (BPH) were treated with THULEP. The inclusion criteria were acute retention of urine with the failure of trial without catheter, dissatisfaction with medical treatment, maximum urinary flow rate (Qmax) 15. Patients were evaluated by Digital rectal examination (DRE), uroflowmetry, IPSS, prostate-specific antigen (PSA), blood and urine routine tests, abdominal ultrasonography, and trans-rectal ultrasonography (TRUS). Results: The efficacy of THULEP was assessed by comparing preoperative variables with postoperative data. IPSS score got reduced from 24 to 3.5, quality of life score improved to 0–1 from 4–5. Qmax improved from mean 7 to 20 ml/s, Postvoid residue reduced from a mean of 110 to 12 ml. Hospital stay was < 36 h in the majority of patients. The average operative time was 45 min. No postoperative blood transfusion was required. Conclusion: THULEP is a safe procedure and has a lesser number of complications. THULEP can replace monopolar TURP as a gold standard for the treatment of BPH.

There is a common belief among the laity and even physicians that sun exposure is a useful source of vitamin D. However, despite the fact that sun exposure occurs almost throughout the year in India, vitamin D deficiency is widely prevalent. Although several authors have reported on the duration of sun exposure required to synthesize adequate amounts of vitamin D in the human body, they have not followed a standard and uniform protocol for measurement of sun exposure and vitamin D synthesis. For these and many other reasons, the results are difficult to interpret. The American Academy of Pediatrics (AAP) has clearly stated that infants should be protected from the sun as much as possible and vitamin D requirements should be met through diet and fortified foods rather than deliberate sun exposure. However, this recommendation is frequently ignored in clinical practice. This review aims to summarize the available literature on benefits and harm of unprotected sun exposure in infants and children with a focus on skin phototype IV to VI. Dermatologists and pediatricians in India should counsel parents about the need for sun protection, especially in fair-skinned infants and children.

Abstract The atmospheric circulation response to global warming is important for accurate prediction of climate change on regional scales. For the midlatitudes, shifts in the extratropical jet streams have important consequences for precipitation, blocking, and extreme events. It has proven to be a challenge, however, to predict. For example, the North Atlantic jet stream plays a vital role in the climate of eastern North America and Europe; in the last intercomparison of state‐of‐the‐art climate models, the models did not even agree on the sign of its wintertime response to global warming. Perhaps this should not come as a surprise, as we also lack a comprehensive theory for the impact of warming on the midlatitude circulation. In a recent study, Tan et al. (2019, https://doi.org/10.1029/2018MS001492) constructed models of simpler atmospheres to explore the response of the midlatitude jet to global warming. Their idealized atmospheres highlight the difficulty of developing a comprehensive theory for the midlatitude circulation but also provide pathways to improve models of Earth's atmosphere. Models of simpler atmospheres allow one to isolate the impact of specific atmospheric processes and connect theoretical understanding with comprehensive climate prediction systems. Such models can also be used to explore very different atmospheric regimes, from Earth's past to distant planets.

Background: The impact of left ventricular ejection fraction (LVEF) changes after sudden cardiac arrest (SCA) on implantable defibrillator (ICD) utilization and long-term survival is not known. We therefore evaluated the influence of LVEF on these parameters in SCA survivors. Methods: Data were collected on consecutive SCA survivors who had ≥1 echocardiogram after SCA and who survived to hospital discharge (n = 655). The median time from baseline to first follow-up echocardiogram was 162 days. LVEF ≥50% was defined as normal. Patients were classified into 4 groups according to baseline (LVEFb) and follow-up (LVEFf) myocardial function: normal LVEFb and LVEFf (group1, n = 261); reduced LVEFb and normal LVEFf (group 2, n = 104); normal LVEFb but reduced LVEFf (group 3, n = 41); and reduced LVEFb and LVEFf (group 4, n = 249). All-cause mortality and time to ICD implantation were examined in all groups. Results: Over a median follow up of 4.3 years, death occurred in 279 (42%) of patients. Compared with patients in group 1, patients with any reduced LVEF at any time (groups 2–4) had significantly higher mortality, even after adjusting for unbalanced covariates (HR = 1.44, 95.0% CI 1.05–1.95, p = 0.022). ICDs were most commonly implanted in patients with persistently reduced LVEF (group 4: HR = 1.72, 95% CI = 1.26–2.35, p = 0.001). Conclusion: We demonstrate that, in survivors of SCA, a reduced LVEF at or after the index event is associated with higher mortality but that patients with persistently reduced LVEF were most likely to receive ICD therapy. These findings have implications on the management of SCA survivors. Keywords: Sudden cardiac arrest, Mortality, Myocardial function, Left ventricular ejection fraction, Implantable cardioveter-defibrillator

Background: Implantable cardioverter defibrillator (ICD) leads are considered as the ‘weakest link’ in defibrillator systems due to FDA recalls and advisories involving popular lead models from major manufacturers. The rate of electrical failure of ICD leads not implicated in a recall is however not well determined. Methods: Medical records of patients implanted with ICDs at hospitals of the University of Pittsburgh Medical Center between 2002 and 2014 were analyzed. Leads were classified as having electrically failed if removed or replaced for reasons other than infection or heart transplantation. Patients were followed to endpoint of death or electrical lead failure. Results: 2410 consecutive ICD recipients (mean age 66 ± 13 years, women 22%, single/dual/biventricular-ICD 20%/44%/36%) were included. During a mean follow-up of 3.9 ± 3.3 years, 1272 patients (53%) died, 55 patients (2.3%) had ICD lead electrical failure, and 1052 (44%) patients were alive with functional leads at the time of last follow-up. Patients with failed leads had higher BMI (p = 0.07), better functional status (p = 0.04), higher serum creatinine (p = 0.004), wider QRS complex (p = 0.01), higher number of implanted leads (p = 0.06) and were more likely to have ischemic cardiomyopathy (p = 0.03). After adjusting for these variables in a binary logistic regression model, only a lower BMI, presence of non-ischemic cardiomyopathy, and a better functional status remained independently predictive of electrical failure. Conclusions: Only 2.3% of non-recalled ICD leads experience electrical failure (annual failure rate of 0.6%). A higher patient functional status, lower BMI, and non-ischemic etiology of cardiomyopathy are independently associated with higher rates of ICD lead failure. Keywords: Defibrillator, Leads, Electrical failure, Recall, Predictors

The energy economy is continually evolving in response to socio-political factors in the nature of primary energy sources, their conversions to useful forms, such as electricity and heat, and their utilization in different sectors. Nuclear energy has a crucial role to play in the evolution of energy economy due to its clean and non-carbon-emitting characteristics. A techno-economic analysis was undertaken to establish the viability of selling heat along with electricity for an advanced 100 MWth small modular reactor (SMR) and four nuclear hybrid energy system (NHES) configurations featuring the SMR paired with chemical heat pump (ChHP) systems providing a thermal output ranging from 1 to 50 MWth. Net present value, payback period, discounted cash flow rate of return, and levelized cost of energy were evaluated for these systems for different regions of U.S. reflecting a range of electricity and thermal energy costs. The analysis indicated that selling heat to high temperature industrial processes showed profitable outcomes compared to the sale of only electricity. Higher carbon taxes improved the economic parameters of the NHES alternatives significantly. Providing heat to high temperature industries could be very beneficial, helping to cut down the greenhouse gases emission by reducing the fossil fuel consumption.

BackgroundChronic granulomatous disease (CGD) is an inherited defect in phagocytic respiratory burst that results in severe and life-threatening infections in affected children. Single center studies from India have shown that proportion of autosomal recessive (AR) CGD is more than that reported from the West. Further, affected patients have high mortality rates due to late referrals and difficulties in accessing appropriate treatment. However, there is lack of multicentric collaborative data on CGD from India.ObjectiveTo describe infection patterns, immunological, and molecular features of CGD from multiple centers in India.MethodsA detailed proforma that included clinical and laboratory details was prepared and sent to multiple centers in India that are involved in the care and management of patients with inborn errors of immunity. Twelve centers have provided data which were later pooled together and analyzed.ResultsOf the 236 patients analyzed in our study, X-linked and AR-CGD was seen in 77 and 97, respectively. Male female ratio was 172:64. Median age at onset of symptoms and diagnosis was 8 and 24 months, respectively. Common infections documented include pneumonia (71.6%), lymphadenitis (31.6%), skin and subcutaneous abscess (23.7%), blood-stream infection (13.6%), osteomyelitis (8.6%), liver abscess (7.2%), lung abscess (2.9%), meningoencephalitis (2.5%), splenic abscess (1.7%), and brain abscess (0.9%). Forty-four patients (18.6%) had evidence of mycobacterial infection. Results of molecular assay were available for 141 patients (59.7%)—CYBB (44.7%) gene defect was most common, followed by NCF1 (31.9%), NCF2 (14.9%), and CYBA (8.5%). While CYBA variants were documented only in Southern and Western parts of India, a common dinucleotide deletion in NCF2 (c.835_836delAC) was noted only in North Indian population. Of the 174 patients with available outcome data, 67 (38.5%) had expired. Hematopoietic stem cell transplantation was carried out in 23 patients, and 12 are doing well on follow-up.ConclusionsIn India, proportion of patients with AR-CGD is higher as compared to Western cohorts, though regional differences in types of AR-CGD exist. Clinical profile and mortality rates are similar in both X-linked and AR-CGD. However, this may be a reflection of the fact that milder forms of AR-CGD are probably being missed.

Introduction: Internet addiction (IA) is an emerging phenomenon among the youth of India. It has been found to be associated with mental health problems. This study was therefore conducted to find out the burden of IA among college students in Delhi, its risk factors and association with depression, anxiety, and stress. Methods: A cross-sectional study was conducted, with face-to-face interviews, among the nonprofessional college students of the University of Delhi. Simple random sampling was used to select the students from the list obtained from the three colleges. Young's IA test scale and depression, anxiety, and stress short scale were used to measure IA and the mental health correlates, respectively. Chi-square tests were applied for testing the association of IA with the sociodemographic variables, the variables related to internet usage patterns, and the mental health variables. Independent predictors were determined using logistic regression modeling. Results: The prevalence of IA was 25.3%. The mean (standard deviation) age of the participants was 19.1 (1.02) years and 62.1% were males. The median family income was INR 50,000. IA was significantly associated with higher family income, greater screen time, always online status, and greater duration of internet use per week. The independent predictors of IA were greater duration of internet use per week and always online status, depression, anxiety, and stress. Conclusion: The burden of IA among the college students was high. depression, anxiety, and stress were found to be independent predictors of IA.

Rosai Dorfman disease (RDD) commonly presents as bilateral cervical lymphadenopathy in children and young adults. We herein report a young girl with unilateral inguinal lymphadenopathy as a rare presentation of RDD. Keywords: Child, Rosai Dorfman disease, Unilateral lymphadenopathy

Kawasaki disease (KD) is a systemic vasculitis that mostly affects children below the age of 5. The vasculitis involves arteries of medium size, especially the coronaries. Various etiologies have been proposed including association with micro-organisms, bacterial superantigens, and genetic factors, however, the exact cause remains unknown. There is no specific laboratory test for KD. Diagnosis is clinical and depends upon the presence of fever for ≥5 days and 4 or more of five principal features, viz. polymorphous exanthem, extremity changes, mucosal changes involving the lips and oral cavity, bilateral bulbar conjunctival injection, and unilateral cervical lymphadenopathy. The term “incomplete KD” refers to the presence of fever and less than four principal clinical features. Recognition of this group of patients is important because it is usually seen in infants and risk of coronary abnormalities is increased probably because of delays in diagnosis. However, what appears to be “incomplete” at a given point of time may not actually be so because some of the features may have already subsided and others may evolve over time. Hence, a detailed dermatological examination is warranted in all cases, especially in incomplete KD, to ensure timely diagnosis. Although KD is a self-limiting disease in most patients, coronary artery abnormalities (CAAs) including coronary dilatations and aneurysms may develop in up to 25% of untreated patients. CAAs are the most common cause of morbidity and mortality in patients with KD. Treatment is aimed at reducing inflammation and consists of intravenous immunoglobulin (IVIG) along with aspirin. Despite treatment, some patients may still develop CAAs, and hence, long-term follow up is of utmost importance.

Osteomalacia in neurofibromatosis is a rare entity and distinct from more common dysplastic skeletal affections of this disease. As a rule, it is characterized by later onset in adulthood. There is renal phosphate loss with hypophosphatemia and multiple pseudofractures in the typical cases. The hypophosphatemic conditions that interfere in bone mineralization comprise many hereditary or acquired diseases, all of them sharing the same pathophysiological mechanism-reduction in phosphate reabsorption by the renal tubuli. This process leads to chronic hyperphosphaturia and hypophosphatemia, associated with inappropriately normal or low levels of calcitriol, causing rickets in children and osteomalacia in adults.

Individuals with HIV are at increased risk for coronary artery disease (CAD). Early detection of subclinical CAD by assessment of coronary artery calcium (CAC) may help risk stratify and prevent CAD events in these individuals. However, the current standard to quantify CAC i.e. Agatston scoring requires EKG-gated cardiac CT imaging.To determine if the assessment of CAC using non-EKG-gated chest CT and the Weston scoring system is a useful surrogate for Agatston scores in HIV-infected and HIV-uninfected individuals.CAC was assessed by both the Weston and Agatston score in 108 men enrolled in the Multicenter AIDS Cohort Study.Participants were 55.2 (IQR 50.4; 59.9) years old and 62 (57.4%) were seropositive for HIV. Inter-observer agreement (rs = 0.94, κ = 90.0%, p

Synchronous occurrence of two or more than two primary cancers of the urinary tract is quite rare, and poses a difficult treatment challenge. Here, we present a case of syn-chronous renal cell carcinoma, transitional cell carcinoma of urinary bladder and adenocarcinoma of prostate diagnosed within a short period. To the best of our knowledge, this is the first case reported from India and the youngest patient reported in the literature having this combination of urinary cancers.

Endoscopic incision is a good management option for orthotopic ureterocele. But most of the literature has shown its efficacy only in children. We have done this retrospective study to evaluate the safety and efficacy of endoscopic incision of orthotopic ureterocele in adults. From March 2004 to January 2008, at our center, 26 adults underwent transurethral, transverse incision of an ureterocele. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition in adults. Unilateral ureterocele was present in 24 patients and two patients had bilateral ureterocele. One patient had associated upper tract stones. Three patients had associated stones in ureterocele. Transurethral, transverse incision of ureterocele was given in all patients. The mean postoperative hospital stay was 50.5 h. Twenty-three patients were available for follow-up at three, six and 12 months. All patients were symptom free. At three months ultrasound and intravenous urography revealed no residual ureterocele but four patients showed residual hydronephrosis, but with a decrease in the grade indicating decompression. Micturating cystourethrography revealed vesico-ureteral reflux (VUR) in two patients and the reflux persisted in one patient even at 6 months. We conclude that in adults, management with endoscopic incision of orthotopic ureterocele is safe and effective. VUR may occur in a few cases.

Bladder exstrophy is rare and associated with an increased incidence of bladder cancer. Unreconstructed bladder extrophy presenting in an adult is very rare as most of the patients undergo repair in childhood. Most of the cancers are adenocarcinomas. We report a rare case of squamous cell carcinoma occurring in exstrophic unreconstructed bladder in a 58-year-old male patient.