Indian Institute of Management Amritsar

Background Migraine is a leading cause of disability worldwide, often complicated by cervical dysfunction and central sensitization. Non-phamacological strategies such as transcranial direct current stimulation (tDCS) and osteopathic manual therapy show promise, but their combined efficacy remains underexplored. This study aims to evaluate the effectiveness of combining active tDCS with physiotherapy compared to sham tDCS plus physiotherapy in patients with chronic migraine. Methods A single-center, single-blind randomized controlled trial was conducted at Sri Aurobindo University, India. A total of 160 participants with chronic migraine were randomized into two groups: Experimental Group A (Active tDCS + Cranio-cervical osteopathic therapy) and Control Group B (sham tDCS + Cranio-cervical osteopathic therapy). Interventions were delivered over six weeks (18 sessions). The outcomes were pain intensity measured by the Visual Analogue Scale (VAS), headache frequency and duration, pressure pain threshold (PPT), balance (MiniBESTest), quality of life (SF-36), Migraine Disability Assessment Score (MIDAS), Pittsburgh Sleep Quality Index (PSQI), Migraine Symptom Severity Score (MSSS). Statistical analyses employed ANCOVA and linear mixed-effects models with false discovery rate correction. Results Compared with controls, GroupA demonstrated significantly greater reduction in VAS (= 2.10, p < 0 . 001, d = 1.15), headache frequency (∆ = 1.85/week, p < 0 . 001) and duration (∆ =9.45 minutes/day, p < 0 . 001). Significant improvements were also observed in trapezius PPT, balance (+4.30 points, p < 0 . 001), quality of life, dsability and symptom severity. No between-group differences was noted for the sub-occipital PPT, anterior scalene PPT and PSQI. Conclusion Active tDCS combined with physiotherapy provides superior clinical benefits over sham stimulation, reducing migraine intensity, frequency, disability and improving function and qulaity of life. This multimodal approach addresses both central sensitization and peripheral dysfunction, support its role as an effective non-phamacological strategy in migrain management. Trial Registration Enrolled in the International Clinical Trials Registry on December 20, 2021 (CTRI/2021/12/038734). On July 18, 2020, the Sri Aurobindo Institute of Allied Health & Paramedical Sciences’ Research & Ethical Committee gave its approval.

This study examines the framework of globalization, evolution of technology and socio- political shifts. It analyzes how employment is affected by globalization, technology and government policies, it examines how labour supply and demand interact and also the role of education and skill development. Key findings reflect long standing challenges such as youth unemployment, gender disparities, informal work and ad-hock work. In this regard, the instant article proposes a policy recommendation to foster inclusive, sustainable employment growth.

The study evaluates the appropriateness and effectiveness of covariance-based, consistent and partial least squares structural equation modelling by comparing their outcomes on a proposed conceptual model while examining factors impacting customer loyalty in the Indian hotel industry. Using 382 responses collected through a structured survey, the model was evaluated using SmartPLS and AMOS software packages. The study underscores the superiority of partial least squares in handling non-normal data and small samples. At the same time, covariance-based method is more appropriate for larger samples and factor-based models. A consistent method demonstrates advantages in path coefficients and R ² values while examining the model. Managerial implications emphasize tailoring different analytical methods to a specific research context. At the same time, researchers are advised to consider study-specific characteristics, such as sample size and model complexity, in their respective research problems. The study has limitations pertaining to the moderate sample size, the absence of control variables and dependency on a specific software. Future research could explore more complex models, incorporate formative constructs and address cross-industry applications. This study contributes to the methodological rigour of structural equation modelling approaches, providing valuable guidance to academics and practitioners in selecting the most appropriate analytical tools.

Rapid industrialization and urbanization have exacerbated the accumulation of HMs (HMs) in the soil. Their greater mobility enables them to readily accumulate in the body of living organisms, which is referred to as bioaccumulation, thereby leading to their magnification in the biological systems. As a result, they have become an inevitable part of our food chain affecting the lives of organisms at all trophic levels; however, plants are at greater risk due to their sessile habitat. The bioaccumulation of HMs is affected by several factors like the type of plant species, its development stage and plant parts as well the environmental factors like temperature, pH, and composition of soil as well as the form of HM present in water and soil. Furthermore, the entry of noxious HMs into the plant system triggers several detrimental effects on the plants ROS burst, inhibition of enzymatic activities, reduced mineral nutrition, and many more resulting in reduced growth and development of plants. Therefore, in order to tolerate HMs in their system, plants incorporate several detoxification mechanisms like the efflux of HMs from the plant body, sequestration and compartmentalization through GSH (GSH), phytochelatins (PCs), and metallothionein (MTs), chelation of HMs with some organic compounds and activating antioxidant defense system to mitigate the deleterious effects produced by ROS generated due to HM stress. The role of miRNAs in helping the plants battle against the HMs and their toxicity has also been acknowledged. The bioaccumulation potential and detoxification mechanisms advocated by the plants enable them to become potential candidates for phytoremediation. This chapter will unveil the bioaccumulation potential of plants along with presenting detailed mechanisms underlying the detoxification of HMs that protects plants from their toxic effects.

BackgroundIn simultaneous bilateral total knee arthroplasty (bTKA), surgeons often encounter scenarios where femoral or tibial component sizes differ between limbs. While component sizing is routinely individualized, the functional and survivorship implications of such asymmetry remain insufficiently studied. A clearer understanding is clinically relevant, as patient anatomy, bone stock, and soft-tissue balance often necessitate asymmetric sizing, yet evidence guiding its safety and outcomes is limited. This prospective multicenter study evaluated whether inter-limb differences in component sizing influence postoperative function, patient-reported outcomes, or revision risk in bTKA.MethodsPatients undergoing cemented bTKA with standardized implants (metal femoral components, metal-backed tibial baseplates, and ultra-high-molecular-weight polyethylene inserts) were prospectively enrolled across 10 high-volume centers. Patients were stratified into Subset A (identical component sizes in both knees) and Subset B (different component sizes between knees). Clinical and functional outcomes were assessed preoperatively and postoperatively at regular intervals up to three years. Endpoints included range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short-Form Health Survey (SF-36). Radiographic assessment evaluated alignment, fixation, and implant stability. Minimal clinically important difference (MCID) thresholds were used to confirm the clinical relevance of improvements.ResultsA total of 166 patients (332 knees) were analyzed, with 140 in Subset A and 26 in Subset B. Baseline characteristics were comparable between groups. Both subsets demonstrated significant improvements in ROM and functional scores from baseline to three years (p<0.001 for within-group changes). Subset A achieved higher final ROM (123.6° vs. 118.1°; p<0.001) with less variability, and KSS were also significantly greater in this group (p<0.05).Subset B, despite inter-knee size differences, showed improvements similar to Subset A in WOMAC scores and demonstrated higher values in selected SF-36 domains, including physical functioning, role limitations, and emotional well-being (p<0.05). No implant-related complications, revisions, or radiographic failures were reported in either group during the three-year follow-up, and radiographs confirmed stable and well-aligned prostheses.ConclusionA one-size difference in femoral or tibial components between knees does not compromise clinical or functional outcomes in bTKA. While symmetric sizing may provide slightly greater ROM and KSS improvements, minor asymmetry is not detrimental and may even be associated with enhanced patient-reported quality-of-life domains. These findings support the practice of individualized component selection and reassure surgeons that small inter-limb differences in implant sizing do not negatively impact mid-term function or survivorship.