Postpartum haemorrhage management: A randomized controlled trial comparing transvaginal uterine artery clamp, vacuum-assisted uterine contraction and condom tamponade.

OBJECTIVE: While there have been numerous innovations recently for the management of postpartum haemorrhage (PPH), a limited body of research supports their application during this critical complication, which contributes significantly to maternal mortality worldwide. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of three interventions - transvaginal uterine artery clamp (TVUAC), vacuum-assisted uterine contraction using a suction cannula (SC), and condom tamponade (CT) - in the management of atonic PPH. METHODS: An open-label RCT was conducted among women who delivered vaginally and developed atonic PPH at a tertiary care obstetric facility. Block randomization with sealed envelopes was used to allocate eligible participants into three interventional arms with a 1:1:1 ratio. The exclusion criteria were twin deliveries, haemodynamically unstable patients, and individuals who did not provide informed consent. The primary outcome variables assessed were blood loss post-application, total blood loss, time taken for application, and time required to achieve haemostasis within each trial arm. The secondary outcomes were the need for a second instrument or surgical intervention to control bleeding, and requirement for blood transfusion. Effectiveness outcomes were analysed as intention-to-treat, whilst safety outcomes were analysed as as-treated. RESULTS: Sixteen participants were randomized to each intervention group (n = 48). TVUAC and SC demonstrated comparable outcomes, while CT lagged in all examined parameters. Following device application, blood loss was similar in both the TVUAC (235 ± 187 ml) and SC (246.5 ± 189 ml) groups. However, following the use of CT, there was blood loss of 431 ± 427 ml, although this difference was not significant (p = 0.113). When considering total blood loss, the TVUAC group (903 ± 234 ml) showed slightly higher values than the SC group (887 ± 184 ml). However, the CT group exhibited notably higher total blood loss (1068 ± 455 ml) than the TVUAC and SC groups. In terms of application time, both TVUAC (1.8 ± 1.1 min) and SC (1.6 ± 0.9 min) significantly outperformed CT (3 ± 1.3 min) (p = 0.002). Furthermore, the time interval from the diagnosis of PPH to achieving haemostasis (defined as the time taken for active haemostasis) was significantly shorter in the TVUAC group (6 ± 4 min) and the SC group (5.7 ± 1.6 min) compared with the CT group (9.7 ± 3.8 min) (p = 0.002). CONCLUSIONS: TVUAC and SC are more effective for the management of PPH than CT. However, both TVUAC and SC have advantages and disadvantages. While these results suggest a potential preference for TVUAC and SC over CT for the management of PPH, further research is necessary to validate these findings.

Multimodal Brain Tumor Classification Using Convolutional Tumnet Architecture.

The most common and aggressive tumor is brain malignancy, which has a short life span in the fourth grade of the disease. As a result, the medical plan may be a crucial step toward improving the well-being of a patient. Both diagnosis and therapy are part of the medical plan. Brain tumors are commonly imaged with magnetic resonance imaging (MRI), positron emission tomography (PET), and computed tomography (CT). In this paper, multimodal fused imaging with classification and segmentation for brain tumors was proposed using the deep learning method. The MRI and CT brain tumor images of the same slices (308 slices of meningioma and sarcoma) are combined using three different types of pixel-level fusion methods. The presence/absence of a tumor is classified using the proposed Tumnet technique, and the tumor area is found accordingly. In the other case, Tumnet is also applied for single-modal MRI/CT (561 image slices) for classification. The proposed Tumnet was modeled with 5 convolutional layers, 3 pooling layers with ReLU activation function, and 3 fully connected layers. The first-order statistical fusion metrics for an average method of MRI-CT images are obtained as SSIM tissue at 83%, SSIM bone at 84%, accuracy at 90%, sensitivity at 96%, and specificity at 95%, and the second-order statistical fusion metrics are obtained as the standard deviation of fused images at 79% and entropy at 0.99. The entropy value confirms the presence of additional features in the fused image. The proposed Tumnet yields a sensitivity of 96%, an accuracy of 98%, a specificity of 99%, normalized values of the mean of 0.75, a standard deviation of 0.4, a variance of 0.16, and an entropy of 0.90.

Chronic kidney disease increases the susceptibility to negative effects of low and high potassium intake.

BACKGROUND AND HYPOTHESIS: Dietary potassium (K+) has emerged as a modifiable factor for cardiovascular and kidney health in the general population, but its role in people with chronic kidney disease (CKD) is unclear. Here, we hypothesize that CKD increases the susceptibility to negative effects of low and high K+ diets. METHODS: We compared the effects of low, normal, or high KChloride (KCl) diets and a high KCitrate diet for four weeks in male rats with normal kidney function and in male rats with CKD using the 5/6th nephrectomy model (5/6Nx). RESULTS: Compared to rats with normal kidney function, 5/6Nx rats on the low KCl diet developed more severe extracellular and intracellular hypokalemia and more severe kidney injury, characterized by nephromegaly, infiltration of T-cells and macrophages, decreased eGFR and increased albuminuria. The high KCl diet caused hyperkalemia, hyperaldosteronism, hyperchloremic metabolic acidosis and severe hypertension in 5/6Nx but not in sham rats. The high KCitrate diet caused hypochloremic metabolic alkalosis but attenuated hypertension despite higher abundance of the phosphorylated sodium chloride cotransporter (pNCC) and similar levels of plasma aldosterone and epithelial sodium channel (ENaC) abundance. All 5/6Nx groups had more collagen deposition than the sham groups and this effect was most pronounced in the high KCitrate group. Plasma aldosterone correlated strongly with kidney collagen deposition. CONCLUSIONS: CKD increases the susceptibility to negative effects of low and high K+ diets in male rats, although the injury patterns are different. The low K+ diet caused inflammation, nephromegaly and kidney function decline, whereas the high K+ diet caused hypertension, hyperaldosteronism and kidney fibrosis. High KCitrate attenuated the hypertensive but not the pro-fibrotic effect of high KCl, which may be attributable to K+-induced aldosterone secretion. Our data suggest that especially in people with CKD it is important to identify the optimal threshold of dietary K+ intake.

Crash Caesarean Delivery: How to Optimise Decision-to-Delivery Interval by Initiating a Novel Code? A Clinical Audit.

Background: Many resource-constrained centres fail to meet the international standard of 30 min of decision-to-delivery interval (DDI) of Category-1 crash caesarean deliveries. However, specific scenarios like acute foetal bradycardia and antepartum haemorrhage necessitate even faster interventions. Methods: A multidisciplinary team developed a "CODE-10 Crash Caesarean" rapid response protocol to limit DDI to 15 min. A multidisciplinary committee analysed a retrospective clinical audit of maternal-foetal outcomes over 15 months (August 2020-November 2021), and expert recommendations were sought. Results: The median DDI of twenty-five patients who underwent a "CODE-10 Crash Caesarean delivery" was 13 ± 6 min, with 92% (23/25) of DDIs falling below 15 min. Seven neonates required intensive care for more than 24 h with no maternal or neonatal mortality. DDIs during office and non-office hours were not significantly different (12.5 ± 6 min vs 13 ± 5 min, p = 0.911). Transport delays caused the two instances of DDI > 15 min. Conclusion: The novel "CODE-10 Crash Caesarean" protocol may be feasible for adoption in a similar tertiary-care setting with appropriate planning and training.

Complete transcatheter correction of variant scimitar syndrome-a case report.

Background: Scimitar syndrome (SS) comprises of an anomalously draining right pulmonary vein (APV), to the inferior vena cava (IVC), maldevelopment of the right pulmonary artery (RPA), and the right lung, with variable number of aorto-pulmonary collaterals (APC) to the right lung. It can cause pulmonary hypertension if left untreated. Surgical correction is the method of choice. We report a case of variant SS with dual drainage of the APV to the IVC and left atrium (LA) that was addressed with a transcatheter approach. Case summary: A 13-year-old child was evaluated for dyspnoea. Chest x-ray and transthoracic echo (TTE) were suggestive of SS with an additional central atrial septal defect (ASD). Cardiac computed tomography (CT) revealed dual drainage of the APV to the IVC and via a meandering vein to the LA and three APCs. The ASD was closed, and the APCs were coiled. The connection of the APV to the IVC was closed with a device, rerouting the pulmonary vein blood to the LA. The child is doing well on follow-up after 2 years. Discussion: Variant forms of SS are rare. Our case had ASD, multiple APCs, well-developed RPA and right lung and a dual drainage of the APV. This allowed for transcatheter management. Otherwise, surgery is the default choice. Multimodality imaging with TTE, CT, magnetic resonance imaging, and cardiac catheterization will help in diagnosis and anatomical delineation.

Arresting post-partum hemorrhage using the novel trans-vaginal uterine artery clamp.

OBJECTIVES: Post-partum hemorrhage (PPH) continues to be the leading cause of maternal mortality in low-resource settings. The commonest variant - Atonic PPH, is managed by additional pharmacological measures which may fail. Additional surgical interventions for hemostasis take time and are not universally available. Immediate arrest of bleeding was deemed essential and a novel Transvaginal Uterine Artery Clamp (TVUAC) was explored for its effectiveness in achieving immediate hemostasis in atonic and mixed post-partum hemorrhage. STUDY DESIGN: A retrospective chart review was performed for all patients, who underwent vaginal delivery and developed immediate post-partum atonic PPH, in a tertiary care center in South India, between 1st April 2015 and 31st December 2020. As soon as excess bleeding was observed, two TVUACs were applied trans-vaginally at 3' and 9'o clock position of the cervix to occlude the uterine arteries where it joins the isthmus of the uterus. RESULTS: Of 3999 vaginal deliveries, there were 251 patients who developed primary atonic PPH during the study period, of which 89 were managed by medical measures alone. Out of the remaining 162 patients, in 153 (94.4%) TVUAC helped to achieve hemostasis; with TVUAC alone in 120 patients (78.43%) and with an additional second line surgical intervention in 33 patients. In nine patients, TVUAC was not readily available and hence second line interventions alone were used. None required any third line surgical interventions (laparotomies) for hemostasis nor were there any incident of maternal mortality or consumptive coagulopathy. TVUAC was applied for a mean duration of 25 ± 10 min. Only 11.6% (29/251, 95% C.I 7.9-16.1%) of the patients required a blood transfusion with a median of 2 (1-4) units of packed RBC. No procedure related complications were reported up to a scheduled 6th week in-person follow-up. CONCLUSION: The novel TVUAC shows potential in limiting third line interventions, maternal morbidity and mortality. Its effectiveness and safety may be further explored as a first line surgical adjunct to medical measures, in PPH protocols in low-resource settings.

Immediate effects of 'Ujjayi Pranayama' on aerodynamic, acoustic and self perception parameters of voice in teachers.

BACKGROUND: Voice plays a major role in communication, and it reveals the speaker's physical and emotional health, personality, and identity. Professional voice users are dependent on their voice for their livelihood. A minimal change or deviation in their voice can interfere with their career. Since respiration is the source for voice production, good lung capacity and the inspiratory-expiratory ratio are very important in maintaining a good voice quality. Ujjayi Pranayama, an effective breathing technique is targeted in this study. OBJECTIVE: To investigate the immediate effects of Ujjayi pranayama on acoustic, aerodynamic and self-perception parameters of voice in teachers. METHOD: Twenty normophonic female teachers performed this breathing technique taught by yoga professional. Parameters of aerodynamic, acoustic, and self-perception were analyzed at pre and post-practice. RESULTS: Significant differences in the acoustic variables including intensity and jitter were observed. Aerodynamic parameters have shown significant improvements in the variables including Maximum phonation Duration (MPD), Estimated Subglottal Pressure (ESGP), Laryngeal Conductance (LAC), Laryngeal Resistance (LAR) and Sound Pressure Level (SPL). Among the study participants, 80% have rated the Ujjayi pranayama as useful in prepping their voice for the vocal loading tasks. CONCLUSION: In view of the better objective evidence and significant improvements in the study variables including the participant's self-perception, authors suggest that Ujjayi pranayama can also be used in voice rehabilitation as a vocal warm-up exercise.

Prevalence of overweight and obesity among school children in Mysuru, Karnataka.

Childhood obesity has become a major public health challenge in developing countries including India due to the changes in the lifestyle and food habits of children owing to the influence of urban culture and technological growth. The present study is a cross-sectional, school-based study conducted to assess the prevalence of obesity and to determine the demographic variables influencing the obesity among school children. METHODS: The study included 440 students (Boys: 240, Girls: 200) from two randomly selected schools of Mysuru city, Karnataka. WHO Standard Age and Sex specific Growth Reference charts were used for defining overweight and obesity. Modified Kuppuswamy's socioeconomic scale (2019) was adopted to assess the socioeconomic status of the family. RESULTS: Obesity prevalence among the study subjects was 3.86% and overweight was 12.27%. The mean body mass index (BMI) among boys was 18.13 and girls was 18.80. The difference in the distribution of BMI between male and female groups was statistically significant (P = 0.023). Age and obesity status of the children was found to have a significant association (P = 0.022). Prevalence of overweight and obesity was more among children from higher socioeconomic class (P = 0.01). CONCLUSION: Prevalence of obesity and overweight among school children is comparatively higher. The higher familial income, dietary patterns, parental history of obesity and diabetes and having urban residence were identified as the major factors which influenced the obesity status of the school children.

Comparing Approaches to Normalize, Quantify, and Characterize Urinary Extracellular Vesicles.

BACKGROUND: Urinary extracellular vesicles (uEVs) are a promising source for biomarker discovery, but optimal approaches for normalization, quantification, and characterization in spot urines are unclear. METHODS: Urine samples were analyzed in a water-loading study, from healthy subjects and patients with kidney disease. Urine particles were quantified in whole urine using nanoparticle tracking analysis (NTA), time-resolved fluorescence immunoassay (TR-FIA), and EVQuant, a novel method quantifying particles via gel immobilization. RESULTS: Urine particle and creatinine concentrations were highly correlated in the water-loading study (R2 0.96) and in random spot urines from healthy subjects (R2 0.47-0.95) and patients (R2 0.41-0.81). Water loading reduced aquaporin-2 but increased Tamm-Horsfall protein (THP) and particle detection by NTA. This finding was attributed to hypotonicity increasing uEV size (more EVs reach the NTA size detection limit) and reducing THP polymerization. Adding THP to urine also significantly increased particle count by NTA. In both fluorescence NTA and EVQuant, adding 0.01% SDS maintained uEV integrity and increased aquaporin-2 detection. Comparison of intracellular- and extracellular-epitope antibodies suggested the presence of reverse topology uEVs. The exosome markers CD9 and CD63 colocalized and immunoprecipitated selectively with distal nephron markers. Conclusions uEV concentration is highly correlated with urine creatinine, potentially replacing the need for uEV quantification to normalize spot urines. Additional findings relevant for future uEV studies in whole urine include the interference of THP with NTA, excretion of larger uEVs in dilute urine, the ability to use detergent to increase intracellular-epitope recognition in uEVs, and CD9 or CD63 capture of nephron segment-specific EVs.

Delayed presentation of partial anomalous systemic venous connection.

Anomalies of systemic venous connections are extremely rare. We describe the case of an asymptomatic 29-year-old woman who was found to have systemic desaturation in the peripartum period and referred to us for suspected cyanotic heart disease. She was diagnosed to have hemianomalous systemic venous connection of the inferior vena cava (IVC) into the left atrium (LA). Transesophageal echocardiogram with contrast diagnosed anomalous connection of the IVC to the LA, further confirmed by computed tomography and conventional angiography. The patient underwent successful surgical correction with an uneventful postoperative course.

Thiamine-responsive acute severe pulmonary hypertension in exclusively breastfeeding infants: a prospective observational study.

OBJECTIVES: Severe pulmonary hypertension (PH) causing right heart failure can occur due to thiamine deficiency in exclusively breastfeeding infants. This study describes the clinical profile and management of thiamine-responsive acute pulmonary hypertension. METHODS: A prospective observational study of infants presenting with severe PH without any other significant heart or lung disease. History of symptoms, clinical examination, echocardiography and basic investigations were performed. Dietary patterns of mothers were recorded. Thiamine was administered and serial echocardiography was performed. RESULTS: A total of 250 infants had severe PH and 231 infants responded to thiamine. The mean age was 3.2±1.2 months. Fast breathing, poor feeding, vomiting and aphonia were the main symptoms. Tachypnoea, tachycardia and hepatomegaly were found on examination. Echocardiogram revealed grossly dilated right heart with severe PH. Intravenous thiamine was administered to all the babies based on clinical suspicion. Clinical improvement with complete resolution of PH was noticed within 24-48 hours. Babies were followed up to a maximum of 60 months with no recurrence of PH. All the mothers consumed polished rice and followed postpartum food restriction. CONCLUSION: Thiamine deficiency is still prevalent in selected parts of India. It can cause life-threatening PH in exclusively breastfeeding infants of mothers who are on a restricted diet predominantly consisting of polished rice. It can contribute to infant mortality. Thiamine administration based on clinical suspicion leads to remarkable recovery. High degree of awareness and thiamine supplementation in relevant geographical areas is required to tackle this fatal disease.

Serum bicarbonate is associated with kidney outcomes in autosomal dominant polycystic kidney disease.

BACKGROUND: Metabolic acidosis accelerates progression of chronic kidney disease, but whether this is also true for autosomal dominant polycystic kidney disease (ADPKD) is unknown. METHODS: Patients with ADPKD from the DIPAK (Developing Interventions to halt Progression of ADPKD) trial were included [n = 296, estimated glomerular filtration rate (eGFR) 50 ± 11 mL/min/1.73 m2, 2.5 years follow-up]. Outcomes were worsening kidney function (30% decrease in eGFR or kidney failure), annual eGFR change and height-adjusted total kidney and liver volumes (htTKV and htTLV). Cox and linear regressions were adjusted for prognostic markers for ADPKD [Mayo image class and predicting renal outcomes in ADPKD (PROPKD) scores] and acid-base parameters (urinary ammonium excretion). RESULTS: Patients in the lowest tertile of baseline serum bicarbonate (23.1 ± 1.6 mmol/L) had a significantly greater risk of worsening kidney function [hazard ratio = 2.95, 95% confidence interval (CI) 1.21-7.19] compared with patients in the highest tertile (serum bicarbonate 29.0 ± 1.3 mmol/L). Each mmol/L decrease in serum bicarbonate increased the risk of worsening kidney function by 21% in the fully adjusted model (hazard ratio = 1.21, 95% CI 1.06-1.37). Each mmol/L decrease of serum bicarbonate was also associated with further eGFR decline (-0.12 mL/min/1.73 m2/year, 95% CI -0.20 to -0.03). Serum bicarbonate was not associated with changes in htTKV or htTLV growth. CONCLUSIONS: In patients with ADPKD, a lower serum bicarbonate within the normal range predicts worse kidney outcomes independent of established prognostic factors for ADPKD and independent of urine ammonium excretion. Serum bicarbonate may add to prognostic models and should be explored as a treatment target in ADPKD.

Isolated Partial Anomalous Pulmonary Venous Connection: Development of Volume Overload and Elevated Estimated Pulmonary Pressure in Adults.

OBJECTIVE: Partial anomalous pulmonary venous connection (PAPVC) is one of the rare congenital cardiac diseases with a prevalence of 0.4-0.7% of autopsies. The prevalence of a partial anomalous pulmonary venous connection is 0.2% in computed tomography (CT) among adults. We chose to study the association between isolated PAPVC and volume overload, estimated systolic pulmonary artery pressure in a tertiary care center for cardiovascular diseases. METHODS: CT report database was searched for keywords of partial anomalous pulmonary venous connection, pulmonary hypertension, dilated right atrium (RA), and right ventricle (RV). Both pediatric and adult population were considered. All the dedicated studies of non-coronary cardiac evaluation, pulmonary arteries, and thorax were included in the study. Echocardiography was performed in all the subjects. In adults, abnormalities searched were features of volume overload of RA and RV and estimated systolic pulmonary pressure of 45 mmHg. Biphasic studies were performed, and upper abdomen was included in the CT studies. RESULTS: Among the 110 subjects, 54 (49%) had isolated PAPVC. Of 54, 26 patients had volume overload of RA/RV or elevated estimated systolic pulmonary artery pressure. There is a significant association between drainage of anomalous veins to superior vena cava (SVC) and age >18 years (Chi-squared test P = 0.003). Among patients with isolated PAPVC, 18 had anomalous drainage to the SVC. Among isolated PAPVC cases, 38 were of the age >18 years. We found statistically significant association (P = 0.02) between isolated PAPVC in adults and pulmonary hypertension. CONCLUSION: Isolated PAPVC has association with the development of pulmonary hypertension in adults, approaching statistically significant p value. Because isolated PAPVC is a clinically significant independent risk factor, it should be actively treated to prevent the development of pulmonary hypertension later in life, which may result in severe clinical consequences.

Improved result on state estimation for complex dynamical networks with time varying delays and stochastic sampling via sampled-data control.

This paper investigates state estimation for complex dynamical networks (CDNs) with time-varying delays by using sampled-data control. For the simplicity of technical development, only two different sampling periods are considered whose occurrence probabilities are given constants and satisfy Bernoulli distribution, which can be further extended to the case with multiple stochastic sampling periods. By applying an input-delay approach, the probabilistic sampling state estimator is transformed into a continuous time-delay system with stochastic parameters in the system matrices, where the purpose is to design a state estimator to estimate the network states through available output measurements. By constructing an appropriate Lyapunov-Krasovskii functional (LKF) containing triple and fourth integral terms and applying Wirtinger-based single and double integral inequality, Jenson integral inequality technique, delay-dependent stability conditions are established. The obtained conditions can be readily solved by using the LMI tool box in MATLAB. Finally, a numerical example is provided to demonstrate the validity of the proposed scheme.

Comparative Evaluation of Water Sorption of Heat-Polymerized Polymethyl Methacrylate Denture Base Resin Reinforced with Different Concentrations of Silanized Titanium Dioxide Nanoparticles: An In vitro Study.

STATEMENT OF PROBLEM: Polymethyl methacrylate (PMMA) is the most regularly used material in denture fabrication. Water sorption of denture base PMMA denture base resin has negative effects on physical properties, may lead to harmful tissue reactions in patients, and also has detrimental effects on color stability of the denture base. PURPOSE: The purpose of this study was to evaluate the effect on water sorption of heat-cured PMMA denture base material after incorporation of 1%, 3%, and 5% by weight of silanized titanium dioxide (TiO2) nanoparticles. MATERIALS AND METHODS: For preparation of test samples, TiO2 nanoparticles (PCode: 700339, Sigma-Aldrich, USA) were coated with a layer of trimethoxysilylpropylmethacrylate (PCode: 440159, Sigma-Aldrich, USA) before sonicated in monomer (MMA) (DPI Heat Cure) with the percentages 1%, 3%, and 5% by weight; after sonication, it was mixed with PMMA powder using conventional denture fabrication procedure. Then, we prepared total 40 samples for study; 10 samples for each four groups, i.e. that is one control group and three experimental groups. The first group was prepared from PMMA without addition of TiO2 nanoparticles (control group), the second group with the addition of 1 wt% TiO2 nanoparticles, the third group with 3 wt% TiO2 nanoparticles, and the fourth one with 5 wt% TiO2 nanoparticles (experimental groups). Water sorption test was then conducted on each sample. RESULTS: Each group was evaluated for water sorption test, and it was found that increasing the wt% of nanoparticles, there was a significant decrease in water sorption of denture base resin from 1.74 to 1.46 mean wt%. P value suggested that the difference of mean percent increase across all groups was statistically significant with P = 0.034. CONCLUSION: The maximum decrease in water sorption was observed in denture base resin incorporated with 5 wt% TiO2 nanoparticles.

An In Vitro Study to Evaluate and Compare the Flow Property of Different Commercially Available Zinc Oxide Eugenol Impression Materials.

INTRODUCTION: Impression making is one of the most important steps in prosthodontic rehabilitation of edentulous patients. Zinc oxide eugenol (ZOE) impression paste is the most commonly used material for complete denture wash impression due to its cost-effectiveness and ease of manipulation, while providing the advantage of ability to record fine minute tissue details. Rheological property like flow is a critical factor influencing the success of any impression material, especially in intraoral conditions. Therefore, with so many brands of commercially available impression materials flooding the markets, the aim of this study was to evaluate and compare the flow property of four commercially available ZOE impression materials under simulated intraoral condition. MATERIALS AND METHODS: The testing method used was according to the American Dental Association (ADA) specification no. 16 for ZOE impression pastes. RESULTS: At room temperature, maximum flow was seen with Denzomix followed by Dental Product of India (DPI), Neogenate, and Cavex in descending order, respectively, at 30 s, 1 min, and 10 min of load application. At 37°C in saliva, maximum flow was seen with Denzomix followed by Neogenate, DPI, and Cavex in descending order, respectively, at 30 s, 1 min, and 10 min of load application. Of the four ZOE impression pastes, only the flow of Cavex was considerably less than ADA specified value. INTERPRETATION AND CONCLUSION: Results obtained from this study showed that there is considerable variation in the flow values of different commercially available ZOE impression materials. Change in temperature and presence of saliva had a significant influence on the flow of ZOE impression materials.

Nonemergency Acute Care: When It's Not the Medical Home.

The American Academy of Pediatrics (AAP) affirms that the optimal location for children to receive care for acute, nonemergency health concerns is the medical home. The medical home is characterized by the AAP as a care model that "must be accessible, family centered, continuous, comprehensive, coordinated, compassionate, and culturally effective." However, some children and families use acute care services outside the medical home because there is a perceived or real benefit related to accessibility, convenience, or cost of care. Examples of such acute care entities include urgent care facilities, retail-based clinics, and commercial telemedicine services. Children deserve high-quality, appropriate, and safe acute care services wherever they access the health care system, with timely and complete communication with the medical home, to ensure coordinated and continuous care. Treatment of children under established, new, and evolving practice arrangements in acute care entities should adhere to the core principles of continuity of care and communication, best practices within a defined scope of services, pediatric-trained staff, safe transitions of care, and continuous improvement. In support of the medical home, the AAP urges stakeholders, including payers, to avoid any incentives (eg, reduced copays) that encourage visits to external entities for acute issues as a preference over the medical home.

Objective Identification of Prepubertal Female Singers and Non-singers by Singing Power Ratio Using Matlab.

BACKGROUND: The field of music is increasingly gaining scope and attracting researchers from varied fields in terms of improvising the art of voice modulation in singing. There has been a lot of competition, and young budding singers are emerging with more talent. This study is aimed to develop software to differentiate a prepubertal voice as that of a singer or a non-singer using an objective tool-singing power ratio (SPR)-as an objective measure to quantify the resonant voice quality. METHOD: Recordings of singing and phonation were obtained from 30 singers and 30 non-singer girls (8-10 years). Three professional singers perceptually evaluated all samples using a rating scale and categorized them as singers or non-singers. Using Matlab, a program was developed to automatically calculate the SPR of a particular sample and classify it into either of two groups based on the normative values of SPR developed manually. RESULTS: Positive correlation for SPR of phonation or singing was found between perceptual and manual ratings, and objective values of SPR. Software could automatically give the SPR values for samples that are fed and could further differentiate them as singer or non-singer. CONCLUSION: Researchers need not depend on professional singers or musicians for the judgment of voice for research purposes. This software uses an objective tool, which serves as an instrument to judge singing talent using singing and phonation samples of children. Also, it can be used as a first line of judgment in any singing audition process, which could ease the work of professionals.

An evaluation of patient's decisions regarding dental prosthetic treatment.

INTRODUCTION: For fabricating dental prostheses that meet patients' demands and have good longevity and function, appropriate treatment planning and decision-making are required. Therefore, not only technical skills and clinical judgment of the dentist are needed, but also patients' attitude toward treatment plays a critical role in posttreatment satisfaction. AIM: The aim of this study is to investigate the factors affecting decision-making and the selection of dental prosthesis by the patients. MATERIALS AND METHODS: A cross-sectional survey to determine patients' attitudes about replacement of teeth was conducted. This survey was performed with the help of a prevalidated questionnaire, which contained the demographic data of every patient, whether or not they accept the treatment plan proposed by the dentist, and a close-ended multiple choice question stating the reasons cited by them if they decline the proposed treatment plan. RESULTS: The data were subjected to statistical analysis by Chi-square test at a significance level of P < 0.05. A relationship between the demographical information such as age, gender, educational status, marital status, and monthly income of each patient and the single best reason opted by them to not undergo the proposed treatment plan was established. CONCLUSIONS: In the sample of population studied, most of the patients declined the proposed treatment plan and accepted the alternate one. High expenditure is the most common reason for this rejection.