The Rocker Technique for Atlantoaxial Dislocation With or Without Basilar Invagination: A Prospective Observational Study.

BACKGROUND AND OBJECTIVES: Atlantoaxial dislocation (AAD) poses a complex surgical challenge. Surgical approaches vary for reducible and irreducible cases. Challenges persist in reducing the atlantodental interval, especially in cases with oblique or vertical C1-C2 joints. The Rocker instrument (MJ Surgical), a less-explored technique, seeks to simplify instrumentation, reduce complexity, and enhance translation and retroflection reduction of AAD. METHODS: This prospective observational study was conducted from January 2022 to July 2023 at a tertiary neurosurgical center. Inclusion criteria covered all age groups with AAD, with or without basilar invagination. Exclusions included medically unstable patients and severe osteoporotic spine conditions. Preoperative assessments included dynamic X-rays, magnetic resonance imaging, and computed tomography scans. The Rocker technique was used, and patients were followed up for 6 to 12 months. RESULTS: Fifty-five patients (30 males, 25 females) underwent surgery. The mean age was 40.41 ± 15.01 years. Successful Rocker technique application was observed in 53 cases. Functional outcomes, assessed using Modified Ranawat grading, showed improvement postoperatively. Radiological outcomes revealed a significant reduction in the anterior atlantodental interval (7.21 ± 0.94 to 2.98 ± 0.78). Basilar invagination was reduced in all cases, whenever present. The technique exhibited versatility, applicability in various joint orientations, and cost-effectiveness. CONCLUSION: The Rocker technique is a safe and effective alternative for managing both reducible and irreducible AADs, with or without basilar invagination. It simplifies the reduction process, offering advantages over established techniques. Further trials, especially in rotational deformities, are warranted for validation.

A novel feature-level fusion scheme with multimodal attention CNN for heart sound classification.

BACKGROUND AND OBJECTIVE: Most of the existing machine learning-based heart sound classification methods achieve limited accuracy. Since they primarily depend on single domain feature information and tend to focus equally on each part of the signal rather than employing a selective attention mechanism. In addition, they fail to exploit convolutional neural network (CNN) - based features with an effective fusion strategy. METHODS: In order to overcome these limitations, a novel multimodal attention convolutional neural network (MACNN) with a feature-level fusion strategy, in which Mel-cepstral domain as well as general frequency domain features are incorporated to increase the diversity of the features, is proposed in this paper. In the proposed method, DilationAttenNet is first utilized to construct attention-based CNN feature extractors and then these feature extractors are jointly optimized in MACNN at the feature-level. The attention mechanism aims to suppress irrelevant information and focus on crucial diverse features extracted from the CNN. RESULTS: Extensive experiments are carried out to study the efficacy of the feature level fusion in comparison to that with early fusion. The results show that the proposed MACNN method significantly outperforms the state-of-the-art approaches in terms of accuracy and score for the two publicly available Github and Physionet datasets. CONCLUSION: The findings of our experiments demonstrated the high performance for heart sound classification based on the proposed MACNN, and hence have potential clinical usefulness in the identification of heart diseases. This technique can assist cardiologists and researchers in the design and development of heart sound classification methods.

Docosahexaenoic Acid Supplementation in Lactating Women Increases Breast Milk and Erythrocyte Membrane Docosahexaenoic Acid Concentrations and Alters Infant n-6:n-3 Fatty Acid Ratio.

Background: Low concentrations of docosahexaenoic acid (DHA) or high n-6 (ω-6):n-3 ratio in pregnant women is associated with poor fetal growth velocity and suboptimal neurodevelopment. However, there is a lack of data on levels of important n-6 and n-3 fatty acids (FAs) at different time points during pregnancy and lactation from India. Data on how much DHA is transferred during actual supplementation are also scarce. Objectives: We report the concentrations of n-6 and n-3 FAs in maternal and infant blood and in breast milk following maternal supplementation with DHA or placebo. Methods: A total of 957 pregnant women (≤20 wk) from Belagavi, Karnataka, were randomly assigned to receive either 400 mg/d of algal DHA or placebo through 6 mo postpartum. Blood samples were collected from the mother at recruitment/baseline, delivery, and 6 mo postpartum and from the infant at birth (cord) and 12 mo (venous). Breast milk samples were collected from a subsample at delivery, 1 mo and 6 mo postpartum. The FA profile was analyzed using gas chromatography. Results: The concentration of DHA appeared to be higher in erythrocyte and breast milk samples of the DHA-supplemented group at all subsequent time points. The n-6:n-3 ratio was lower among women in the DHA group at delivery [DHA: 4.08 (1.79); placebo: 5.84 (3.57); P < 0.001] and at 6 mo postpartum [DHA: 5.34 (2.64); placebo: 7.69 (2.9); P < 0.001]. Infants of DHA-supplemented mothers also had a lower n-6:n-3 ratio at delivery and 12 mo. The n-6:n-3 ratio of breast milk increased from delivery through 1 to 6 mo but remained lower in the DHA-supplemented group than in the placebo. Conclusions: Maternal DHA supplementation with 400 mg/d from early pregnancy through 6 mo postpartum significantly increased circulating DHA in breast milk and infant erythrocyte, whereas decreased erythrocyte and breast milk n-6:n-3 ratio. However, maternal supplementation did not get the ratio to the recommended levels.

Plant seed extract assisted, eco-synthesized C-ZnO nanoparticles: Characterization, chromium(VI) ion adsorption and kinetic studies.

This report attempts to elucidate the potential of plant seed extract assisted synthesis of graphite-based zinc oxide nanoparticles (C-ZnO NPs) towards removal of chromium(VI) ions from water samples. The graphite-based zinc oxide (C-ZnO) composites were characterized using thermogravimetric analysis (TGA), X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM). The C-ZnO nanocomposites have found to remove chromium from the sample through an adsorption process. The sensitivity of chromium removal through adsorption is found to be in the range of 40 to 240 mg. The adsorption behaviour was found to be fitting with Langmuir isotherm model and the adsorption reaction follows pseudo second-order kinetics.

Molecular detection of Salmonella isolated from commercial chicken.

Background: Salmonella in chicken, specially, the motile salmonellae, causes the food chain unsafe from farm to table and is considered a significant global threat to public health. Aims: The present study was carried out for molecular detection of Salmonellae in commercial poultry using PCR. Methods: The study was conducted for eight months, from July 2019 to February 2020, and a total of 26 poultry farms, including 15 broiler and 11-layer farms, were visited individually. Pooled faecal samples were obtained from the sheds. A total of 189 necropsy cases were examined for gastrointestinal lesions. Isolation and identification of the organism were done using microbe culture method, and the molecular characterization was performed via PCR targeting invA and ent genes. Results: The prevalence of salmonellosis in the broiler and layer farms was recorded at 20.0% and 45.4%, respectively, through the traditional gold standard culture method. From 189 necropsy birds, salmonellosis was recorded at 1.58% dead cases. Molecular detection of Salmonella isolates by PCR targeting invA gene was confirmed in 13.33% of the broiler farms and 36.3% of the layer farms. Further detection of Salmonella enteritidis was performed by PCR targeting ent gene by which 11.11% positivity was determined. Conclusion: This study, focused on the Salmonella prevalence, highlighted the zoonotic importance of the bacterium in the commercial poultry farms, which can subsequently be dispersed into the human food chain causing harmful health effects.

Epilepsy-Related Injuries in Children: An Institution-Based Study.

Background: Epilepsy carries a lifetime risk of seizure-related accidents. The risk varies according to the socioeconomic profile of a place. Sufficient data is lacking for epilepsy-related accidents in the pediatric population. Objective: We aimed to identify the proportion of pediatric epileptic patients who met with accidents and their associated factors. Methods: A prospective study was done. Patients of less than 18 years with epilepsy of more than 1-year duration were included and were given a questionnaire modified for the pediatric population. The demography of accidents during seizures and drugs taken were recorded. Results: 135 epileptic children were included. 70.4% of patients suffered seizure-related accidents ranging from 1-10 accidents in their epilepsy duration. Falls (83.15%) were the most common, 25.26% of them required hospitalization. Accidents due to missing of drug dosage were observed in 23% patients. Conclusion: Seizure-related accidents are common in the pediatric population, and may lead to major accidents. Better epilepsy management with extra care for high-risk epilepsy patients may decrease their incidents.

Prevalence of Polycystic Ovarian Syndrome, Phenotypes and their Ovulation Response to Sequential Letrozole Dose Escalation among Infertile Women at a Tertiary Care Centre in Southern India.

Background: Women with polycystic ovarian syndrome (PCOS) often have anovulatory infertility requiring ovulation induction with letrozole. Aims: This study aimed to determine the prevalence and phenotypic categorisation of infertile PCOS women and to assess ovulatory response and pregnancy rates of PCOS phenotypes with sequential letrozole dose escalation. Study Setting and Design: This was a prospective observational study. Materials and Methods: One hundred seventy-five infertile PCOS women were enrolled. One hundred fifty-six women received ovulation induction as per the protocol with sequential letrozole dose escalation in each subsequent cycle (2.5 mg, 5 mg and 7.5 mg). Responses were assessed by ovulation and/or pregnancy. Statistical Analysis Used: Descriptive statistics were elaborated by means, medians, frequencies and percentages. Group comparisons and linear correlation between two continuous variables were done using appropriate statistical tests. Results: Eighty-seven (49.7%) women were Phenotype A; 11 (6.3%) were Phenotype B; 20 (11.4%) were Phenotype C and 57 (32.6%) were Phenotype D in our study. After excluding the lost to follow up participants in each induction cycle, 33.3% (2.5 mg dose); 62.8% (5 mg dose) and 78.9% (7.5 mg dose) women responded to letrozole. A significant increase in ovulation to escalating letrozole doses was noted (Phenotype A: 35.1% to 2.5 mg, 53.7% to 5 mg and 72.7% to 7.5 mg; Phenotype B: 30% to 2.5 mg and 80% to 5 mg; Phenotype C: 35.3% to 2.5 mg and 87.5% to 5 mg and Phenotype D: 30.8% to 2.5 mg, 65.6% to 5 mg and 87.5% to 7.5 mg). Fifty-six of 156 (35.9%) infertile PCOS women achieved pregnancy; increase in pregnancy rates with escalated doses of letrozole was noted. Conclusion: All PCOS phenotypes show a similar response to escalating doses of letrozole. The role of phenotypic sub-categorisation for variable response to letrozole as an ovulation-inducing agent is uncertain.

Endoscope-controlled Access to Thalamic Tumors using Tubular Brain Retractor: An Alternative Approach to Microscopic Excision.

BACKGROUND: Surgery for thalamic lesions has been considered challenging due to their deep-seated location. Endoscopic excision of deep-seated brain tumors using tubular retractor has been shown to be safe and effective in prior studies; however, there are limited reports regarding its use for thalamic tumors. We present our experience of endoscope-controlled resection of thalamic tumors using a tubular retractor. MATERIAL AND METHODS: This was a prospective observational case series done at a tertiary center specialized for endoscopic neurosurgery during the period from 2010 to 2019. Surgeries were performed under the endoscopic control using a silicon tubular retractor. Lesions were approached transcortically or trans-sulcally. Data were collected for the extent of resection, amount of blood loss, operative time, need for conversion to microscopy, and complications. RESULTS: Twenty-one patients of thalamic masses of 14- to 60-year age underwent the surgeries. Pathologies ranged from grade I to IV gliomas. Gross total and near-total resection could be done in 42.85% of cases for each group. The average blood loss and operative time were164.04 ± 83.63 mL and 157.14 ± 28.70 minutes, respectively. Complications included a small brain contusion, two transient hemipareses, and one transient speech deficit. CONCLUSION: Endoscopic excision of thalamic tumors using a tubular retractor was found to be a safe and effective alternative to microscopic resection.

Image Denoising Based on Fractional Gradient Vector Flow and Overlapping Group Sparsity as Priors.

In this paper, a new regularization term in the form of L1-norm based fractional gradient vector flow (LF-GGVF) is presented for the task of image denoising. A fractional order variational method is formulated, which is then utilized for estimating the proposed LF-GGVF. Overlapping group sparsity along with LF-GGVF is used as priors in image denoising optimization framework. The Riemann-Liouville derivative is used for approximating the fractional order derivatives present in the optimization framework. Its role in the framework helps in boosting the denoising performance. The numerical optimization is performed in an alternating manner using the well-known alternating direction method of multipliers (ADMM) and split Bregman techniques. The resulting system of linear equations is then solved using an efficient numerical scheme. A variety of simulated data that includes test images contaminated by additive white Gaussian noise are used for experimental validation. The results of numerical solutions obtained from experimental work demonstrate that the performance of the proposed approach in terms of noise suppression and edge preservation is better when compared with that of several other methods.

Multi-Site Infant Brain Segmentation Algorithms: The iSeg-2019 Challenge.

To better understand early brain development in health and disorder, it is critical to accurately segment infant brain magnetic resonance (MR) images into white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF). Deep learning-based methods have achieved state-of-the-art performance; h owever, one of the major limitations is that the learning-based methods may suffer from the multi-site issue, that is, the models trained on a dataset from one site may not be applicable to the datasets acquired from other sites with different imaging protocols/scanners. To promote methodological development in the community, the iSeg-2019 challenge (http://iseg2019.web.unc.edu) provides a set of 6-month infant subjects from multiple sites with different protocols/scanners for the participating methods. T raining/validation subjects are from UNC (MAP) and testing subjects are from UNC/UMN (BCP), Stanford University, and Emory University. By the time of writing, there are 30 automatic segmentation methods participated in the iSeg-2019. In this article, 8 top-ranked methods were reviewed by detailing their pipelines/implementations, presenting experimental results, and evaluating performance across different sites in terms of whole brain, regions of interest, and gyral landmark curves. We further pointed out their limitations and possible directions for addressing the multi-site issue. We find that multi-site consistency is still an open issue. We hope that the multi-site dataset in the iSeg-2019 and this review article will attract more researchers to address the challenging and critical multi-site issue in practice.

Endoscopic Anterior Cervical Discectomy (Disc Preserving).

BACKGROUND AND INTRODUCTION: Endoscopic anterior cervical approach has several advantages compared to conventional anterior cervical discectomy and fusion (ACDF). OBJECTIVE: This video demonstrates a step-by-step procedure for endoscopic anterior cervical discectomy. PROCEDURE: The patient is placed supine with the neck extended. A standard anterior cervical approach using about 3 cm skin incision is made and under "Easy Go" (Karl Storz, Tuttlingen, Germany) endoscopic vision, the uncinate process and uncus are drilled. Only a small portion of the normal disc, posterior longitudinal ligament (PLL), and compressing disc is removed. The closure is done in a standard manner. RESULTS: In 240 patients, the average postoperative reduction in disc height, operating time, and blood loss were 1.1 ± 0.2 mm, 110 ± 17 min, and 30 ± 11 mL, respectively. The average postoperative VAS score and Nurick grading improved significantly. There were no permanent complications or any mortality. CONCLUSION: Endoscopic technique is an effective and safe alternative to ACDF after attaining the learning curve.

Anticancer efficacy of 6-thioguanine loaded chitosan nanoparticles with or without curcumin.

6-Thioguanine encapsulated chitosan nanoparticles (6-TG-CNPs) has formulated by the ionic-gelation method. Morphologically, the 6-TG-CNPs were spherical and showed mean size, PDI, zeta potential, and entrapment efficiency of 261.63 ± 6.01 nm, 0.34 ± 0.10, +15.97 ± 0.46 mV and 44.27%, respectively. The IR spectra confirmed the 6-TG complex with chitosan. The in vitro drug release profile of 6-TG-CNPs revealed an increase in sustained-release (91.40 ± 1.08% at 48 h) at pH 4.8 compared to less sustained-release (73.96 ± 1.12% at 48 h) at pH 7.4. The MTT assay was conducted on MCF-7 and PA-1 cell lines at 48 h incubation to determine % cell viability. The IC50 values of 6-TG, 6-TG-CNPs, and curcumin for MCF-7 were 23.09, 17.82, and 15.73 µM, respectively. Likewise, IC50 values of 6-TG, 6-TG-CNPs, and curcumin for PA-1 were 5.81, 3.92, and 12.89 µM, respectively. A combination of 6-TG-CNPs (IC25) with curcumin (IC25) on PA-1 and MCF-7 showed % cell viability of 43.67 ± 0.02 and 49.77 ± 0.05, respectively. The in vitro cytotoxicity potential in terms of % cell viability, early apoptosis, G2/M phase arrest, and DNA demethylating activity of 6-TG-CNPs alone and combination with curcumin proved to be more effective than that of 6-TG on PA-1 cells.

Tchebichef and Adaptive Steerable Based Total Variation Model for Image Denoising.

Structural information, in particular, the edges present in an image are the most important part that get noticed by human eyes. Therefore, it is important to denoise this information effectively for better visualization. Recently, research work has been carried out to characterize the structural information into plain and edge patches and denoise them separately. However, the information about the geometrical orientation of the edges are not considered leading to sub-optimal denoising results. This has motivated us to introduce in this paper an adaptive steerable total variation regularizer (ASTV) based on geometric moments. The proposed ASTV regularizer is capable of denoising the edges based on their geometrical orientation, thus boosting the denoising performance. Further, earlier works exploited the sparsity of the natural images in DCT and wavelet domains which help in improving the denoising performance. Based on this observation, we introduce the sparsity of an image in orthogonal moment domain, in particular, the Tchebichef moment. Then, we propose a new sparse regularizer, which is a combination of the Tchebichef moment and ASTVbased regularizers. The overall denoising framework is optimized using split Bregman-based multivariable minimization technique. Experimental results demonstrate the competitiveness of the proposed method with the existing ones in terms of both the objective and subjective image qualities.

Image denoising via overlapping group sparsity using orthogonal moments as similarity measure.

Recently, sparse representation has attracted a great deal of interest in many of the image processing applications. However, the idea of self-similarity, which is inherently present in an image, has not been considered in standard sparse representation. Moreover, if the dictionary atoms are not constrained to be correlated, the redundancy present in the dictionary may not improve the performance of sparse coding. This paper addresses these issues by using orthogonal moments to extract the correlations among the atoms and group them together by extracting the characteristics of the noisy image patches. Most of the existing sparsity-based image denoising methods utilize an over-complete dictionary, for example, the K-SVD method that requires solving a minimization problem which is computationally challenging. In order to improve the computational efficiency and the correlation between the sparse coefficients, this paper employs the concept of overlapping group sparsity formulated for both convex and non-convex denoising frameworks. The optimization method used for solving the denoising framework is the well known majorization-minimization method, which has been applied successfully in sparse approximation and statistical estimations. Experimental results demonstrate that the proposed method offers, in general, a performance that is better than that of the existing state-of-the-art methods irrespective of the noise level and the image type.

Antepartum Risk Assessment for Pregnant Women Visiting a Tertiary Care University Teaching Hospital in Southern India.

AIM: The study was conducted to assess the prevalence of high-risk pregnancy (HRP) cases among pregnant women visiting the Prabhakar Kore Hospital (PKH) at Belagavi, Karnataka for antenatal care (ANC) and determination of the level of risk in the identified cases. MATERIALS & METHODS: Data were collected as a part of a screening procedure of a nutrition supplement clinical trial on pregnant women [Study title: Maternal DHA Supplementation and offspring Neurodevelopment in India (DHANI)]. ANC case records including detailed notes on medical and obstetric history, physical examination, laboratory investigations of pregnant women with ≤ 20 weeks of gestational age were screened for known risk factors. RESULTS: A total of 11,686 new cases were registered for ANC between June 2016 through August 2017. Of these, 3379 (<20 weeks gestation) were screened out of 428 pregnant women, 12.6% pregnant women were found to be at risk, 40.2% (n=172) fell in the high-risk category. Most commonly reported risk factors were thyroid disorders (27.3%, hypothyroidism 17.3%; hyperthyroidism 10%), gestational diabetes (16.1%), bad obstetric history (12.6%) and anaemia (10.7%). CONCLUSION: Early identification of these at-risk mothers through a simple, practical, reliable and customized risk scoring schedule can ensure interventions either to control the risk causing factor or delivery of timely and appropriate care as and when needed. CLINICAL SIGNIFICANCE: Considering the disproportionate burden that high risk pregnancies pose on higher mortality rates and compromised quality of life for the cases which survive, early identification of these high risk cases (12.6% identified in this study) can have a significant impact on maternal and child health. The population negatively affected by at-risk pregnancies is only expected to increase in the near future in light of the rising trend of its known risk factors such as high blood pressure, diabetes, or being HIV-positive.

Compression of Steganographed PPG Signal with Guaranteed Reconstruction Quality Based on Optimum Truncation of Singular Values and ASCII Character Encoding.

OBJECTIVE: Extraction and analysis of various clinically significant features of photoplethysmogram (PPG) signals for monitoring several physiological parameters as well as for biometric authentication have become important areas of research in recent years. However, PPG signal compression; particularly quality-guaranteed compression, and steganography of patient's secret information is still lagging behind. METHOD: This paper presents a robust, reliable and highly-efficient singular value decomposition (SVD) and lossless ASCII character encoding (LL-ACE)-based quality-guaranteed PPG compression algorithm. This algorithm can not only be used to compress PPG signals but also do so for steganographed PPG signals that include the patient information. RESULT AND CONCLUSION: It is worth mentioning that such an algorithm is being proposed for the first time to compress steganographed PPG signals. The algorithm is tested on PPG signals collected from four different databases, and its performance is assessed using both quantitative and qualitative measures. The proposed steganographed PPG compression algorithm provides a compression ratio that is much higher than that provided by other algorithms that are designed to compress the PPG signals only. SIGNIFICANCE: (1) the clinical quality of the reconstructed PPG signal can be controlled precisely, (2) the patient's personal information is restored with no errors, (3) high compression ratio, and (4) the PPG signal reconstruction error is neither dependent on the steganographic operation nor on the size of the patient information data.

Profile of respiratory pathogens causing acute respiratory infections in hospitalised children at Rajasthan a 4 year's study.

Introduction: Various pathogens cause respiratory tract infections in children of <5 years of age causing severe morbidity and mortality. The profile of causative agents varies from place to place. Aims: The objectives of our study were to detect the profile and trends of respiratory pathogens causing acute respiratory tract infection in children using a custom multiplex real-time polymerase chain reaction (RT-PCR) and to develop a diagnostic algorithm. Materials and Methods: A total of 997 children with clinical manifestations of respiratory infections were included in the study. Their nasopharyngeal aspirate and throat swab samples were subjected to nucleic acid extraction followed by multiplex RT-PCR for eighteen viruses and six bacteria. Statistical Analysis Used: Chi-square test was employed to study the P value of different viruses and bacteria. Results: A total of 765 (76.73%) samples were found to be positive for one of the respiratory pathogens. Viruses were detected in 598 (59.98%) and bacteria in 167 (41.85%) samples, respectively. The prevalence of single and co-infections among viruses and bacteria were 77.76% and 22.24%, 81.44% and 18.56% each, respectively. Respiratory syncytial virus (RSV) A/B and Streptococcus pneumoniae were the most predominant pathogens detected in the study and were associated with lower respiratory tract infections. Conclusion: RSV and S. pneumoniae were the most common pathogens detected, higher prevalence was observed in children <1 year of age. Viruses were predominant during winter months. The study helped to prepare diagnostic algorithm which will help in reducing diagnostic costs. However, further studies are required to assess whether viruses are bystander or real pathogens and include larger panel of bacteria and viruses for diagnosis.

The impact of DocosaHexaenoic Acid supplementation during pregnancy and lactation on Neurodevelopment of the offspring in India (DHANI): trial protocol.

BACKGROUND: Evidence suggests a strong association between nutrition during the first 1000 days (conception to 2 years of life) and cognitive development. Maternal docosahexaenoic acid (DHA) supplementation has been suggested to be linked with cognitive development of their offspring. DHA is a structural component of human brain and retina, and can be derived from marine algae, fatty fish and marine oils. Since Indian diets are largely devoid of such products, plasma DHA levels are low. We are testing the effect of pre- and post-natal DHA maternal supplementation in India on infant motor and mental development, anthropometry and morbidity patterns. METHODS: DHANI is a double-blinded, parallel group, randomized, placebo controlled trial supplementing 957 pregnant women aged 18-35 years from ≤20 weeks gestation through 6 months postpartum with 400 mg/d algal-derived DHA or placebo. Data on the participant's socio-demographic profile, anthropometric measurements and dietary intake are being recorded at baseline. The mother-infant dyads are followed through age 12 months. The primary outcome variable is infant motor and mental development quotient at 12 months of age evaluated by Development Assessment Scale in Indian Infants (DASII). Secondary outcomes are gestational age, APGAR scores, and infant anthropometry. Biochemical indices (blood and breast-milk) from mother-child dyads are being collected to estimate changes in DHA levels in response to supplementation. All analyses will follow the intent-to-treat principle. Two-sample t test will be used to test unadjusted difference in mean DASII score between placebo and DHA group. Adjusted analyses will be performed using multiple linear regression. DISCUSSION: Implications for maternal and child health and nutrition in India: DHANI is the first large pre- and post-natal maternal dietary supplementation trial in India. If the trial finds substantial benefit, it can serve as a learning to scale up the DHA intervention in the country. TRIAL REGISTRATION: The trial is retrospectively registered at clinicaltrials.gov ( NCT01580345 , NCT03072277 ) and ctri.nic.in ( CTRI/2013/04/003540 , CTRI/2017/08/009296 ).

Coffee processing industrial wastewater treatment using batch electrochemical coagulation with stainless steel and Fe electrodes and their combinations, and recovery and reuse of sludge.

The efficiency of chemical oxygen demand (COD) and color removal from raw coffee processing wastewater (CPWW) using batch electrochemical coagulation (BECC) treatment process using stainless steel (SS) and iron (Fe) electrode combinations are investigated. Of the combinations: four SS, four Fe, Fe-Fe-SS-SS, Fe-SS-Fe-SS, SS-SS-Fe-Fe, and SS-Fe-SS-Fe; four SS electrodes operated at 23 V having 120 A/m2 current density was found as a good operating condition to achieve ∼87% COD removal from its initial COD of 1,984 mg/L and corresponding color removal of 97.1% (initial color 7,000 PCU). The second best electrode combination, SS-SS-Fe-Fe, had COD and color removals of 75% and 91%. When using polyaluminum chloride (PAC) as aid with different dosages of 20-100 mg/L, 50 mg/L PAC showed maximum COD and color removals of 80% and 92%. Comparison of proximate and ultimate analyses of various solid fuels with CPWW ECC sludge showed its usefulness as a soil supplement and as an adsorbent for reutilization. The solid residue obtained after BECC was characterized using energy dispersive X-ray spectroscopy and other analyses. Summarizing the results, it was concluded that BECC can be effectively used for maximum removal of organics from raw CPWW with clean water reclamations of up to ∼90% using ECC as a novel treatment technique.