bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of electroless copper plating with high plating coverage in small BVH for next generation fine pattern SAP
Authors: Yoshida Shinichiro , Nakayama Tomoharu , Yamamoto Hisamitsu
Published: May 2023

Printed wiring board (PWB) used for package substrates are required to have higher circuit densities. We

anticipate that PWB circuit patterns and blind via hole (BVH) will continue to be miniaturized due to higher

density requirements. The electroless copper plating solution generally used has less chemical material

supply to the inside of the BVH than the surface of the substrate. As a result, the copper thickness at the

bottom of the BVH tends to be thinner than that on the surface of the substrate. It is difficult to uniformly

deposit the electroless copper plating in the BVH on the package substrate by the semi-additive process

(SAP), especially when the BVH are becoming smaller. Therefore, we investigated additives that suppress

the electroless copper plating deposition on the surface of the substrate and additives that improve the

permeability of the plating solution into the BVH. Two additives have been discovered that dramatically

improve the plating uniformity in the small BVH compared to the conventional bath. In addition, we used

this plating solution with the new additives to evaluate the internal stress and peel strength of the electroless

copper plating film. As a result, it was confirmed that both internal stress and peel strength were improved

compared to the conventional bath.
A Closed Form Method Combined with the Steinberg’s Solution to Estimate Number of Fatigue Cycles for Lead-Free Solders
Authors: Nguyen Tuan H.
Published: May 2023

Solder joints of components are normally the most susceptible to the vibration loading conditions.

The Steinberg’s closed form solution has been widely used in industries to identify high risk components to

be candidates for detailed finite element (FE) durability analysis under vibration loads. Unfortunately, the

Steinberg’s closed form solution is only applicable to the SnPb, not the lead-free materials (SAC);

therefore, it would be troublesome to identify high risk SAC components, especially if there are numerous

SAC components in the BOM.

This paper is to present a method that would be able to combine with the Steinberg’s closed form solution

to identify high risk SAC components. This method is developed from comparison between SnPb and SAC

fatigue vs. strain range relationship using the high and low cycles of fatigue Coffin Manson closed form

equation. In addition, this method can also predict solder joint fatigue cycles of one material using the

already-derived fatigue cycles from another material without re-running detailed FE analysis. This

additional feature would help, for example, to make prediction if re-ball from SAC to SnPb or vice versa

would pose any risks. It is strongly recommended to utilize this method when assessing lead-free

components under vibration as currently it is only available method to serve this purpose.
Reconfigurable NEMS based Advance Packaging for Anti Reverse Engineering and Counterfeiting
Authors: Khan Aslam A. , Sahebkar Keon , Need Ryan F. , Tehranipoor Mark M. , Asadizanjani Navid
Published: May 2023

The chips used in modern electronic devices are mainly manufactured and packaged by Outsourced Semiconductor

Assembly and Test (OSAT) facilities and are potentially vulnerable to hardware attacks. Due to the complexity of the

global supply chain, it is difficult to track the full fabrication process by the foundries or the intellectual property (IP)

owners. Additionally, the design for fabricating and packaging the chip made by IP owners remains the same and

visible throughout the process. Hence, this design can be seen by every entity in the supply chain using physical

inspection techniques, making it vulnerable if any adversaries are present in the supply chain. Security threats such as

IP piracy, overbuilding, reverse engineering, and counterfeiting are thus possible by potential adversaries in the supply

chain. These attacks have become an increasing concern in the world of trusted microelectronics as supply chain

globalization continues to develop. Several security methods have already been developed to protect and detect such

threats until they become embedded into sensitive systems, such as logic locking, obfuscating, physically unclonable

functions (PUF), and hardware metering. However, these existing prevention methods have their limitations or are not

applicable to all devices. In general, only a few existing methods make use of the inherent characteristics of electronic

devices and materials to provide reliable security. Hence, novel security and assurance strategies with minimal changes

or modifications in the fabrication of the system circuit are urgently required. This paper proposes a novel technique of

obfuscation and locking using a reconfigurable nano-electromechanical system (NEMS) based advanced package

throughout the supply chain. Using this novel technique, the netlist/golden design for heterogeneously integrated

devices will be hidden from malicious adversaries, and the IP designer will have control of its design until it reaches

the end-user.
Optimization of the Copper Microstructure to Improve Copper-to-Copper Direct Bonding
Authors: Schmidt Ralf , Schwarz Christian , Tamer Erkin , Dieter Sascha
Published: May 2023

Advanced packaging solutions and heterogeneous integration are key technologies to enable devices with

improved operating characteristics, including higher performance, increasing power efficiency, and

decreasing form factor. Packages with high interconnect densities are required to efficiently combine, e.g.,

processing and memory units but impose restrictions to the pitch of the interconnects. Conventional

technologies, including wire bonds and flip chip bonds are limited to larger pitches and, therefore, not suitable

to meet the requirements of upcoming packaging technologies with respect to interconnect densities. Direct

copper-to-copper interconnects are supposed to allow such small pitches of 10 µm or even below. However,

formation of such bonds usually requires high temperatures and pressures. Temperature-sensitive devices

like DRAM components restrict the maximum temperature that can be applied to the package. Thus, copper

material is required, which allows bond formation at relatively low temperatures. In this context, hybrid

bonding processes were discussed that involve initial bond formation via the usually oxide-based dielectric

at room temperature followed by copper-to-copper bonding at elevated temperatures. The copper material is

usually prepared by electrolytic deposition and the properties of the respective deposits may be modified by

properly designed organic additives as well as process parameters. Strong bond formation of the copper

should be obtained upon grain growth over the interface of the two deposits, which are brought into contact

during the bonding step. In order to facilitate such growth at relatively low temperatures, suitable

microstructures need to be prepared. Ideally, morphologies should be chosen in a way that they can be

maintained throughout all process steps after the electrolytic deposition but, at the same time, allow grain

growth over the interface during copper-to-copper bonding. Various strategies to enable improved seamless

grain growth but maintain a metastable microstructure throughout the preceding process steps and the

corresponding unique copper microstructures will be compared. In this context, different electrolytic copper

deposition processes, the resulting microstructures, as well as their respective advantages and challenges with

regards to copper-to-copper bond formation will be discussed.
Algorithm for Ultrasonic Wire Bond Outlier Classification
Authors: Villa Pedro , Seppänen Henri
Published: May 2023

Wedge bonders use ultrasonic energy to bond metal wires onto metal substrates in a process that takes

milliseconds. In high-volume production, failures cause downtime and costs. On-line monitoring systems

are used to reduce the failures and determine the root cause. We developed and tested an algorithm to

classify outliers in ultrasonic wire bond production. The algorithm is used in large wire wedge bonders to

measure and analyze process signals and detect and classify bond outliers. It helps bonder operators,

production supervisors and process engineers to detect process deviations and fix the underlying root

causes. The algorithm measures bond signals, such as deformation, ultrasonic current, and ultrasonic

frequency. Bonds are automatically divided into subgroups based on bond order and process parameters,

and the signals within a subgroup are then normalized. For outlier classification, the features are extracted

from the normalized signals and combined into failure class values. The failure classes such as

contamination, no wire, high deformation, misaligned wire, and unstable substrate, are calculated

independently. We measured the detection rates for large wire aluminum bond failure classes and

demonstrate how the algorithm calculates failure class values from the signals. Additionally, we show how

new signal features and failure classes can be defined to detect production-specific or rare failure classes.
A preliminary camera trapping study of mammals of Monti Lepini (Central Italy)
Authors: Angelini Claudio , Corsetti Luigi , Faustinella Luca , Martellato Reuccio , Mastrobuoni Giovanni , Mastrodomenico Daniela , Marozza Luigi , Petra Stefano , Pietrocini Venusta , Proietti Massimiliano
Published: May 2023

We used 52 camera traps to survey mammal species in the Lepini Mountains (Lazio, Central Italy) during three trapping sessions. Thirteen mammal species have been recorded. Compared to data based on previous opportunistic observations (2000-2018), camera trapping has quickly increased knowledge about the distribution of species, especially for elusive ones. We modelled species and average community occupancy also considering habitat covariates in a hierarchical modelling framework. Occupancy at community level was positively impacted by woods and negatively impacted by open habitats, indicating that the ongoing reforestation of the area may favour mammal diversity. Open surfaces have a negative effect on the presence of Sciurus vulgaris, a species for which our study confirms extensive recolonization of the area. We have also shown that woods increase the probability of occupation by Canis lupus and Felis silvestris, confirming that these species could be negatively impacted by increased deforestation.
The Bac(chus) experiment: blood alcohol concentrations after wine tasting
Authors: Van de Wiel Albert , Moolenaar David , Wielders Jos
Published: May 2023

Blood alcohol concentrations (BACs) were measured in ten volunteers after a wine tasting event with and without the swallowing of 15 mL of each wine. In case ten wines were tasted within one hour without swallowing, buccal mucosa absorption did not result in problematic BAC’s; however in case 15 mL of each wine was swallowed, BAC’s may exceed the legal driving limit of most countries. It is recommended to eat beforehand, but also to wait at least one hour after the session before driving back home.
Introducing renewable energy in vineyards and agricultural machinery: A way to reduce emissions and provide sustainability
Authors: Carroquino Javier , García-Casarejos Nieves , Gargallo Pilar
Published: May 2023

Climate change, depletion of nonrenewable resources in the current energies, pollution from them and the greater ecological awareness of the population, are factors that suggest the change of energy sources in business. The wine industry is concerned about sustainability and with a clear awareness of what climate change may mean for it. This sector is supposed to have a high receptivity to the implementation of clean energy, as this favours not only the environment but also the essence of its business. This work shows how the use of renewable energy, on a small scale, can be profitable in both vineyards and wineries. For this purpose, the European project LIFE REWIND (Renewable energy in the wine industry) has developed several actions, including the installation and operation of a prototype in a Spanish winery. This paper shows how to introduce renewable energy in wineries and vineyards in a profitable way, reducing the emissions of CO2 associated to the activity and the product, without changing the processes of cultivation or production.
Uneven Donor Engagement and Fraught Transboundary Conservation Approaches
Authors: Kachena Lameck , Spiegel Samuel J.
Published: May 2023

Mainstream environmental literature has often presented the initiation of transfrontier conservation areas (TFCAs) in southern Africa as progress, obscuring the influences of geopolitics and capitalist power relationships that shape TFCA initiatives. Recognising the need to explore trajectories that threaten the very core of what TFCA approaches, in theory, stand for, we undertook an ethnographic study in the Chimanimani TFCA along the Zimbabwe-Mozambique border to examine outcomes of uneven funding commitments associated with geopolitics and neoliberal conservation initiatives. We discuss how on the Mozambique side, access to donor funding linked to neoliberal programming has been associated with unfulfilled promises of ‘conservation-based enterprises’ and the grabbing of livelihood resources, while constricted access to conservation funding has been instrumentalised as a rationale for coercive ‘fortress conservation’ approaches in Zimbabwe, shaping tensions between park authorities and buffer communities. Communities on both sides of the TFCA experience unintended socio-ecological trajectories associated with economic inequalities and systems of exploitation, in turn leading to fraught conservation in the TFCA. Considering how these inequalities in TFCA management have also been worsened by shocks, including extreme climatic events and the COVID-19 pandemic, we conclude that more attention is warranted to the impact of uneven donor engagement driven by neoliberal principles and geopolitics on conservation.
A Phantom Study on Feasibility of Manual Field-in-Field Clinical Implementation for Total Body Irradiation and Comparison of Midplane Dose with Different Bilateral TBI Techniques
Authors: Pandu Bharath , Khanna D. , Mohandass P. , Elavarasan Rajadurai , Ninan Hima , Vivek T. R. , Jacob Saro
Published: May 2023

Objective:

The aim of this study is to implement a new treatment technique in total body irradiation (TBI) using the manual field-in-field-TBI (MFIF-TBI) technique and dosimetrically verifying its results with respect to compensator-based TBI (CB-TBI) and open field TBI technique.

Materials and Methods:

A rice flour phantom (RFP) was placed on TBI couch with knee bent position at 385 cm source to surface distance. Midplane depth (MPD) was calculated for skull, umbilicus, and calf regions by measuring separations. Three subfields were opened manually for different regions using the multi-leaf collimator and jaws. The treatment Monitor unit (MU) was calculated based on each subfield size. In the CB-TBI technique, Perspex was used as a compensator. Treatment MU was calculated using MPD of umbilicus region and the required compensator thickness was calculated. For open field TBI, treatment MU was calculated using MPD of umbilicus region, and the treatment was executed without placing compensator. The diodes were placed on the surface of RFP to measure the delivered dose and the results were compared.

Results:

The MFIF-TBI results showed that the deviation was within ± 3.0% for the different regions, except for the neck for which the deviation was 8.72%. In the CB-TBI delivery, the dose deviation was ± 3.0% for different regions in the RFP. The open field TBI results showed that the dose deviation was not within the limit ± 10.0%.

Conclusion:

The MFIF-TBI technique can be implemented for TBI treatment as no TPS is required, and laborious process of making a compensator can be avoided while ensuring that the dose uniformity in all the regions within the tolerance limit.
Monte Carlo Modeling of Dynamic Tumor Tracking on a Gimbaled Linear Accelerator
Authors: Carpentier Emilie E. , Mcdermott Ronan L. , Su Shiqin , Rostamzadeh Maryam , Popescu I. Antoniu , Bergman Alanah M. , Mestrovic Ante
Published: May 2023

Purpose and Aim:

The Vero4DRT (Brainlab AG) linear accelerator is capable of dynamic tumor tracking (DTT) by panning/tilting the radiation beam to follow respiratory-induced tumor motion in real time. In this study, the panning/tilting motion is modeled in Monte Carlo (MC) for quality assurance (QA) of four-dimensional (4D) dose distributions created within the treatment planning system (TPS).

Materials and Methods:

Step-and-shoot intensity-modulated radiation therapy plans were optimized for 10 previously treated liver patients. These plans were recalculated on multiple phases of a 4D computed tomography (4DCT) scan using MC while modeling panning/tilting. The dose distributions on each phase were accumulated to create a respiratory-weighted 4D dose distribution. Differences between the TPS and MC modeled doses were examined.

Results:

On average, 4D dose calculations in MC showed the maximum dose of an organ at risk (OAR) to be 10% greater than the TPS’ three-dimensional dose calculation (collapsed cone [CC] convolution algorithm) predicted. MC’s 4D dose calculations showed that 6 out of 24 OARs could exceed their specified dose limits, and calculated their maximum dose to be 4% higher on average (up to 13%) than the TPS’ 4D dose calculations. Dose differences between MC and the TPS were greatest in the beam penumbra region.

Conclusion:

Modeling panning/tilting for DTT has been successfully modeled with MC and is a useful tool to QA respiratory-correlated 4D dose distributions. The dose differences between the TPS and MC calculations highlight the importance of using 4D MC to confirm the safety of OAR doses before DTT treatments.
Assessment of abnormal involuntary movements in psychiatric patients: A cross-sectional study
Authors: Jaitpal Varun , Faye Abhijeet , Tadke Rahul , Gawande Sushil , Kirpeker Vivek , Bhave Sudhir
Published: May 2023

Context:

Movement disorders can be hyperkinetic or hypokinetic. They can be further classified as involuntary, semi-voluntary, voluntary, and automatic. These disabling and distressing disorders can be attributed largely to either neurological dysfunction or adverse effects of medications. Uncommon presentations of these disorders are often missed. It is important to study this aspect in psychiatric patients to plan appropriate measures and help improve the quality of life in these patients.

Aims:

The aim of this study was to estimate the prevalence and nature of abnormal involuntary movements in psychiatric patients.

Settings and Design:

This was a cross-sectional study that was conducted in an outpatient department/inpatient department (OPD/IPD) of tertiary-health care setting.

Materials and Methods:

After the institutional ethics committee’s permission, 50 patients attending the psychiatry OPD/IPD were enrolled and interviewed after taking their written informed consent. A semi-structured-proforma, questionnaire prepared for the study, and the AIMS scale were administered for the assessment. Data were analyzed statistically and results were obtained. Epi-info 7 software was used and prevalence rates were calculated.

Results:

Approximately 22% of cases of abnormal movements were identified by AIMS criteria, whereas 64% of cases were identified by questionnaire criteria. Significantly more (42%) cases were picked up by questionnaire method over AIMS-criteria. Tremors of hands and feet were the most common abnormal involuntary movement seen in 54% of participants as per the questionnaire, and, they were seen mostly in patients on antipsychotics.

Conclusions:

Abnormal involuntary movements are common among psychiatric patients, more commonly in patients on antipsychotics. Many cases often go undiagnosed, which suggests that better assessment modalities should be adopted for appropriate detection and management besides standard scales like AIMS.
Introducing Electives in the Undergraduate Medical Training Period
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2023

The period of undergraduate medical training is fully packed owing to the extensive amount of information and skills that needs to be passed on to the medical students. This calls for the need to incorporate an elective within the curriculum that gives an opportunity to the students to not only opt for their preferences but also to suit their career likings. While designing an elective course, it is a must that the organizers should state the specific learning objectives, the duration of the course with scheduling and timetabling of the sessions, the course organizer, resource materials, and prerequisites for joining the elective. Moreover, due consideration has to be given toward carrying out the evaluation of the elective course. In conclusion, electives represent an important aspect of the medical training and prepare the students for their future career by increasing vocational opportunities. The need of the hour is that all the medical institutions should sensitize the faculty members and initiate a series of elective courses for the benefit of students.
Ameloblastoma, a Tumor with an Infamous Notoriety for Recurrence
Authors: Jagtap Miheer Milind , Shukla Samarth , Nair Dhanushree
Published: May 2023

Ameloblastoma is a locally invasive epithelial tumor of odontogenic origin comprising 1% or less of the cystic lesions and tumors arising in the jaws. It is a lesion most commonly seen in the molar region of the mandibular ramus. Ameloblastomas can be both benign and malignant and this can be differentiated by certain unique morphological features. In the older histology nomenclature, the term “adamantinoma” was used instead of ameloblastoma. The chances of recurrence can be high or low depending upon the surgical management. Curettages are associated with high recurrence rates while wide local excision tends to reduce recurrences.
Maximal Medical Therapy in Extensive Subdural Empyema of the Brain and Spinal Cord
Authors: Souslian Fotis G. , Janjua Tariq , Moscote-Salazar Luis Rafael
Published: May 2023

Severe subdural empyema (SDE) involving both the brain and spinal cord can be a life-threatening condition if not treated properly. We describe a malnourished patient with extensive spinal and intracranial SDE, whose poor prognosis prompted palliative care consultation. Surgical options were not possible. However, following maximal medical therapy, the patient's condition resolved completely in 1 year. This case highlights the important relationship between neurocritical care medical management and infection when surgical options are not possible.
Implementing Foundation Course for Medical Undergraduates in India
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2023

The delivery of medical education to the undergraduate medical students and producing a competent medical graduate is a complex task, especially considering the wide range of domains, in which a medical student has to be trained. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of four studies similar to the current study objectives were identified initially and all were selected based on the suitability with the current review objectives. In an effort to make the newly joined students get familiar with the campus environment and the general structure of the academic program, a month-long foundation course has been proposed. The regulatory body emphasized the need to evaluate the foundation course at institutional level so that it can be improved based on the received feedback for the upcoming batches of students. To conclude, the introduction of foundation course as a part of the competency-based medical education for undergraduate students is a welcome step. The foundation course has the potential to offer multiple benefits to the students, and thus it is the need of the hour that a thorough planning goes in the background, and all the available resources and logistics are utilized well for the effective implementation of the course.
Elder Abuse in Rural Belagavi
Authors: Malhotra Nishtha , Shivaswamy M. S.
Published: May 2023

Background:

Elder abuse is defined by the WHO as: “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.” Elder abuse has always been considered a western problem and its existence in India has never been acknowledged seriously. The present study aimed to find the prevalence of elder abuse and assess the sociodemographic determinants for the same.

Materials and Methods:

A cross-sectional, questionnaire-based study was conducted among 400 in elderly population of age ≥60 years, residing for at least 1 year in rural field practice areas of primary health-care Vantamuri in Belagavi taluka and district, Karnataka state, India, by systematic random sampling from January 1, to December 30, 2020. A set of pretested standardized questionnaires consisting of three parts, including “Modified Geriatric Mistreatment Scale” to assess the elder abuse prevalence, were used. Statistical analysis was done by using rates, proportions, and percentages, and the association was tested with Chi-square test and binary logistic regression.

Results:

Among the 400 elderly participants, the overall prevalence of elder abuse was found to be 68 (17%). Among all these cases, maximum number of them were facing psychological abuse (59, 52%), followed by economic exploitation (24, 21%), neglect (23, 20%), and physical abuse (8, 7%). None of the participants had experienced sexual abuse. Statistically significant association was present between the occurrence of abuse and sociodemographic characteristics such as age ≥70 years, illiteracy, elderly living with family/spouse, and living in a house owned by spouse/others or a rented place.

Conclusion:

The prevalence of elder abuse was found to be low (17%) as compared to what was expected (35%). Elder abuse exists in India in various forms, and it is imperative to form new policies and strategies by the government, police, health administration, and NGOs to prevent abuse of elderly population in rural India.
Introducing the Component of Telemedicine in the Undergraduate Medical Education Training Period
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2023

The field of telemedicine has shown exponential growth across the last few decades and has opened gateways for people living in distant geographical locations to access health care. The purpose of the current review was to explore the introduction of telemedicine during the medical education training period. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 13 articles were selected based upon the suitability with the current review objectives and analyzed. It is a fact that for the successful implementation of a telemedicine unit, the medical personnel plays a defining role. This calls for an indispensable need to expose the medical students to telemedicine during their training period, so that they are not only aware of the same but even prepared to use it in their future clinical practice. The need of the hour is to systematically introduce the telemedicine-related competencies in a standardized manner without stretching the overall duration of the medical training. In conclusion, telemedicine has emerged as an important aspect of the health-care delivery system, and thus it is quite essential that we expose medical students to telemedicine during their undergraduate period of training. We must remember that a lot of effort is required to ensure that the training of medical students in telemedicine remains meaningful, relevant, and holistic.
Predisposing Factors of Mycotic Infections in Covid-19 Patients
Authors: Singh Satyam , Acharya Sourya , Shukla Samarth , Muneshwar Komal
Published: May 2023

The coronavirus disease 2019 pandemic (COVID-19) has led to considerable hike in hospitalizations for pneumonia with multiorgan disease requiring immediate hospital care, maintenance of oxygen saturation level, and severe cases requiring mechanical ventilation. This opens the window of opportunity to microscopic organisms such as different species of fungus including Candida, Aspergillus, Rhizopus, and Cryptococcus adding other fungi causing opportunistic invasive fungal infections (OIFIs), and other bacteria to cause concurrent infections in COVID-19-diseased patients which on occasion not promptly diagnosed and are mostly diagnosed after death, which get chance due to invasive procedures such as intubation and immunosuppressant drugs which mostly consists of corticosteroids, patient with diabetes mellitus or any other chronic disease causing immunosuppression, patient having a history of chronic obstructive airway disease, development of antibiotic resistance, and vulnerability of pulmonary tissues regarding developing colony for mycotic infections. In this review, we talk over the character of mycotic concurrent infections in aggravation of COVID-19 disease severity and focus on arising trends associated with fungal infections in coronavirus-diseased (COVID-19 diseased) cases. In addition, this review impart the view on the risky component for concurrent mycotic infections in COVID-19 diseased patients who are hospitalized and focuses the possible task of extended immunemodulatory treatments in managing concurrent mycotic infections, comprising COVID-19-associated pulmonary aspergillosis, COVID-19-associated Candidiasis, and mucormycosis. This article restates the demand for prompt detection regarding presumed COVID-19-related systematic mycosis in the health-care settings which could empower fast OIFI diagnosis, treatment, and lowers the mortality rate.
Integrating Geriatric Competencies in the Undergraduate Medical Education
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2023

With the advancements in science and the field of medicine, it has become a reality that people are living longer in contrast to the earlier trends of life expectancy. The current review was carried out to explore the integration of geriatric competencies in the medical education curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of five articles were selected based upon the suitability with the current review objectives and analyzed. As it is quite obvious that in the years to come all the medical doctors will encounter a large number of elderly patients with physical, psychological, and other social concerns, it becomes indispensable to expose them to different geriatric competencies during the undergraduate period of training. We must also accept that elderly population requires a different approach and the better and long-term approach will be to expose the undergraduate medical students in this domain and prepare them for their future clinical practice. This integration into the existing curriculum has to start with the formulation of geriatric competencies that need to be covered in the undergraduation period followed by curriculum mapping. In conclusion, regardless of the rise in the number of the elderly, the medical education imparted to undergraduate medical students lacks alignment. This calls for the need to expose the medical students to different learning experiences in geriatrics and prepare them to not only meet the specific needs of the elderly but also address the concern of shortage of geriatricians.
A Cross-sectional Study to Evaluate Hand Preferences from Performance Measures Namely Work Done, Nerve Conduction Velocity, and Bimanual Coordination among Phase I Medical Students
Authors: Bagi Jaysheela , Kour Harpreet
Published: May 2023

Background and Objective of the Study:

Most of the individuals classify themselves as right or left handed but it is not entirely clear whether handedness should be determined based on preference inventories, hand performance tasks, or a combination of both. The strength and significance of the relationship between hand preference and performance asymmetries have always been contested.

Materials and Methods:

This cross-sectional study has evaluated different performance measures to predict hand preference among a total of 150 1st year medical students. The performance measures included work done by ergography, nerve conduction velocity test, and bimanual coordination test.

Results:

A statistically significant correlation was found between hand performance and preference measures (P < 0.05 was considered as significant).

Conclusion:

This study helps to understand the degree of hand dominance on various performance tasks. In particular to medical profession, this study may help in the modifications of the instruments and training given to medical students in improving their bimanual dexterity.
Prevalence, Clinical Profile, and Maternal and Perinatal Outcomes of Hyperglycemia in Pregnancy in a Tertiary Care Hospital in South India
Authors: Khursheed Romana , Shivalingappa Jayanth , Maldar Arif , Dalal Anita
Published: May 2023

Background:

Hyperglycemia in pregnancy (HIP) is an umbrella term for any degree of carbohydrate intolerance in pregnancy which carries risk of transgenerational transfer of metabolic disorders. The present observational study was carried out to know the prevalence, clinical profile, and maternal and perinatal outcome in different categories of HIP, in a South Indian setup.

Materials and Methods:

The study was carried out for 1 year at KAHER's Dr Prabhakar Kore Charitable Hospital, Belagavi in South India. The HIP was diagnosed by Diabetes in Pregnancy Study Group of India criteria and further categorized into gestational diabetes mellitus (GDM), gestational glucose intolerance (GGI), and diabetes in pregnancy (DIP). The prevalence, clinical profile, and maternal and perinatal outcome were analyzed in three groups.

Results:

The prevalence of HIP among pregnant population was found to be 17.47% in 1 year. 222 women (75.5%) had GDM, followed by 49 (17%) and 23 women (8%) presented with GGI and DIP, respectively. The maternal outcomes among HIP were cesarean delivery 230 (78.2), preterm labor 53 (18.02%), preeclampsia 50 (17.01%), premature rupture of membranes 34 (11.56%), and infections 33 (11.22%). The perinatal outcome recorded were neonatal intensive care unit admissions in 107 neonates (36.39%), hyperbilirubinemia in 44 neonates (15%), hypoglycemia in 79 neonates (26.8%), respiratory distress syndrome in 43 neonates (14.46%), and macrosomia in 44 fetuses (15%).

Conclusion:

Degree of hyperglycemia affects pregnancy outcomes. Continued surveillance of women in preconceptional, antenatal, and postnatal period ensures early diagnosis and management of glucose intolerance and helps in delaying the onset of overt diabetes.
Research and Development Priorities in the Coronavirus Disease 2019 Pandemic
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2023

The number of cases reported in the ongoing coronavirus disease-2019 (COVID-19) pandemic continues to rise across the world. The primary reason due to which the disease is able to produce so much disastrous impact is its novel nature, as the virus was detected for the first time and even now there are many epidemiological, clinical and virological characteristics which are not known about the disease. All the available facts clearly suggest the need that we have to strengthen the research and development sector immensely, otherwise the disease will continue to claim lives of thousands of more people and will eventually break the health system of each and every nation and negatively impact the economy of the nations as well. In conclusion, research and development is a primary focus of interest for all the stakeholders involved in the fight against COVID-19 pandemic. The need of the hour is to expedite the entire process and utilize the research findings in ensuring better prevention and effective treatment of the cases of the disease.
To Study the Association between Daytime Sleepiness and Cognition as Tested by Stroop Test in Indian Medical Students
Authors: Khullar Shilpa , Singh Mitasha , Das Suman , Kamya
Published: May 2023

Context:

Human populations have undergone a steady constant decline in sleep hours attributable to changes in environmental and social circumstances. Excessive daytime sleepiness has been associated with a decreased capacity to perform daily activities and cognitive decline all over the world particularly among students.

Aim:

The aim of our study was to see the association between excessive daytime sleepiness and cognitive function in Indian medical students.

Settings and Design:

It was a cross-sectional study conducted in a Government Medical College located in the Delhi/NCR region. Materials and Methods: The study included 60 healthy young volunteers in the 18–30 years age group of both sexes. The students were assessed for daytime sleepiness using the Epworth Sleepiness Scale (ESS). Color–Word Stroop Test was used to assess cognition in both the groups. Statistical Analysis: Data were expressed as mean ± standard deviation and analyzed using SPSS Software Version 21.

Results:

The average score of the ESS scale of the participants was 7.33 ± 2.20. In the Stroop Test, the reaction time of congruent trial and incongruent trial was 24.81 ± 7.76 and 31.15 ± 8.03 s, respectively. No significant correlation was seen between the ESS score and parameters of the “Stroop Test.”

Conclusion:

The reaction time of the incongruent trial was significantly higher as compared to the congruent trial (P < 0.05) in the Stroop Task. No significant correlation was seen between the ESS score and Stroop Test results.
A Single-Center Detection of Adult Patients with Advanced Periodontal Disease using Surgical Assessment and Cone-Beam Computed Tomography
Authors: Chandran Ajay , Preethanath Reghunathan S. , Gufran Khalid , Khan Mohammad Shoyab , Alqahtani Abdullah Saad , Chikkanna Meenakumari , Swarnalatha C , Babu J Suresh , Nayyar Abhishek Singh
Published: May 2023

Context:

One of the major limitations of conventional radiological procedures is presence of considerable overlapping and lack of clear, three-dimensional information. Cone-beam computed tomography (CBCT) has emerged as an effective imaging modality in such situations offering high-quality images and lower radiation exposure to patients.

Aim:

The aim of the present study was to assess the role of CBCT in detection of intra-bony defects in patients with advanced periodontal disease.

Settings and Design:

The present study was designed as a prospective, observational study wherein patients aged between 35 and 55 years with advanced periodontal disease who were indicated for periodontal treatment in the form of periodontal surgeries were selected from the outpatient department based on defined inclusion and exclusion criteria.

Materials and Methods:

Sixty patients with chronic periodontitis with 12 teeth each including 6 anterior and 6 posterior teeth were selected for making measurements pre- and perioperatively while bone defects were measured first with the help of CBCT software installed in an individualized system devised to be used for storing and analyzing CBCT images and then during surgical intervention using standardized UNC-15 periodontal probe and compared.

Statistical Analysis Used:

Statistical analysis was done using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). The measurements obtained with the help of CBCT software installed in the personalized system and those obtained on surgical exploration were compared in each anterior and posterior tooth with the help of paired-sample t-test while Pearson's correlation® was used to test the correlation between the observed values. Level of statistical significance was set at P < 0.05.

Results:

The results were found to be highly significant both in terms of statistical (P value) and clinical® significance for various sites in the anterior and posterior teeth in all instances.

Conclusions:

From the observations made from the present study, it could be concluded that CBCT provided a highly precise assessment of bone topography equivalent to the judgment obtained during surgical exposure at the sites of interest preoperatively which helped in assessing the exact type and depth of defect present and helped optimizing surgical treatment planning.
Information and Communication Technology in Medical Education
Authors: Ferdoush Jannatul , Roy Biswas Rajat Sanker Roy , Khan Ikram Ullah , Momtaz Tashfia , Alam Jahangir , Morshed Md. Masud , Chowdhury Abhijit , Parveen Kohinoor , Ata Maliha , Jeenia Fathiha Tasmin
Published: May 2023

Background:

Bangladesh is declared as “Digital Bangladesh” however, medical students are least acquainted with the necessary information and communication technology (ICT) knowledge in the context of medical education. We have conducted a survey to know about digital equipment ownership, therefore, carried out a self-reported assessment of knowledge and utilization of ICT in relation to educational and clinical development.

Materials and Methods:

A cross-sectional, multi-centered questionnaire survey was conducted among the medical students during the period of October 2019.

Results and Discussions:

In total 467 medical students responded to the questionnaire in which 92% of the students owned a Google android smartphone and accessed the Internet on their devices. Sixty-nine percent of students have (1–5) medical-related apps in their device and drug formulary apps most commonly used 43%. Fifty-nine percent of students have gained their present computer knowledge through self-learning. For study work with fellow student, 90% of students preferred Facebook group, WhatsApp, and Viber. While there was a range of variation in the usage of nonacademic search engines 72% of Google and no usages were found for more dedicated academic services such as PubMed and Medscape. According to 74% of students, inadequate integration of ICT knowledge into their syllabus culminated in insufficient future professional skills. All students were keen on a basic ICT learning program at the beginning of their medical courses.

Conclusion:

The study revealed that to prepare medical students for using ICT in their academic work adequately, introducing ICT training at the initial stage of the undergraduate program and designing the curriculum to develop a multiplicity of skills is essential in addition to an integrated teaching method.
COPD and glycopyrronium responsiveness assessment: An appraisal
Authors: Bhattacharyya Parthasarathi , Saha Dipanjan , Chatterjee Moumita , Sengupta Sayoni , Dey Debkanya , Banerjee Rajat
Published: May 2023

Background:

Glycopyrronium bromide (a long-acting antimuscarinic agent: LAMA) appears pharmacokinetically suitable for testing bronchodilator responsiveness as salbutamol (short-acting β2-agonist: SABA). Exploring the feasibility, acceptability, degree of reversibility with glycopyrronium, and its comparison with that of salbutamol may be intriguing.

Methods:

New, consecutive, and willing outpatient attendees in the same season of the two consecutive years with chronic obstructive pulmonary disease (FEV1/FVC <0.07; FEV1 <80% of predicted) were subjected to serial responsiveness with inhalation of salbutamol first followed by 50 μg dry powder glycopyrronium [Salbutamol- Glycopyrronium] (phase-1) in the first year and glycopyrronium followed by salbutamol [Glycopyrronium- Salbutamol] (phase-2) in the following year. We looked for the acceptability, adverse reactions, and degree of changes in FEV1, FVC, FEV1/FVC, and FEF25-75 with comparison between the two groups.

Results:

The [Salbutamol- Glycopyrronium] group (n = 86) were similar in age, body mass index, and FEV1 to the [Glycopyrronium- Salbutamol] group (n = 88). Both the agents could make a significant (P <.0001) improvement in the parameters independently or as add-on when used serially in alternate orders. The intergroup difference at no stage was significant. The sensitive patients to salbutamol (n = 48), glycopyrronium (n = 44), and both (n = 12) have improvement of 165, 189, and 297 mL while a both-insensitive group (n = 70) had barely 44 mL of improvement. The protocol was universally accepted without any adverse events.

Conclusion:

Serial testing of salbutamol and glycopyrronium responsiveness in alternate orders provides an insight regarding the independent and the add-on effects of these two agents. About 40% of our chronic obstructive pulmonary disease patients had no clinically appreciable difference in FEV1 with the salbutamol + glycopyrronium combination inhalation.

Clinical Trial Registration:

ECR/159/Inst/WB/2013/RR-20
Systemic inflammatory response syndrome criteria (SIRS) and sepsis 3 criteria for assessing outcomes in sepsis: A prospective observational study
Authors: Chand Siddharth , Kumar Naresh , Mawari Govind , Sarkar Sayan , Daga Mradul Kumar , Raghu RV , Aarthi J. , Fatima Arisha
Published: May 2023

Background:

Sepsis is a major cause of death in hospitalised patients worldwide. Most studies for assessing outcomes in sepsis are from the western literature. Sparse data from Indian settings are available comparing the systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) (sepsis 3 criteria) for assessing outcomes in sepsis. In this study, we aimed to compare the SIRS criteria and sepsis 3 criteria to assess disease outcome at day 28 (recovery/mortality) in a North Indian tertiary care teaching hospital.

Methods:

A prospective observational study was performed in the Department of Medicine from 2019 to early 2020. Patients admitted to the medical emergency with clinical suspicion of sepsis were included. Systemic inflammatory response syndrome, qSOFA and SOFA scores were calculated at the time of presentation to the hospital. Patients were followed through the course of their hospital stay.

Results:

Out of 149 patients, 139 were included in the analysis. Patients who died had significantly higher mean SOFA, qSOFA scores and mean change in SOFA score than patients who survived (P value <0.01). There was no statistical difference between recovery and deaths at similar SIRS scores. A 40.30% fatality rate was recorded. Systemic inflammatory response syndrome had low Area Under Curve (AUC) (0.47) with low sensitivity (76.8) and specificity (21.7). SOFA had the maximum AUC (0.68) compared to qSOFA (0.63) and SIRS (0.47). SOFA also had the maximum sensitivity (98.1) while the qSOFA score had the maximum specificity (84.3).

Conclusion:

SOFA and qSOFA scores had superior predictive ability as compared to the SIRS score in assessing mortality in sepsis patients.