Eastern Indian Research Articles

Quality of life among type-2 Diabetes Mellitus Patients: A Cross-Sectional Study from Eastern Indian Medical Institute

Quality of life among type-2 Diabetes Mellitus Patients: A Cross-Sectional Study from Eastern Indian Medical Institute

Competency Mapping of Key Stakeholders in Procurement and Contracting of the National Tuberculosis Elimination Program Goods and Services in an Eastern Indian State

Abstract Background: The National Tuberculosis Elimination Program is a complex program, and the program officers are involved in the procurement and contracting of goods and services under it. A competency mapping was conducted to highlight the current capacity gaps in contract management at state and district levels under the program. Materials and Methods: A descriptive cross-sectional design was adopted with 15 participants involved in procurement and contracting in two districts of the state using a semi-structured questionnaire, and results were presented using the descriptive statistical analysis. Results: A total of 15 different stakeholders from the National Health Mission, State and District Tuberculosis (TB) Cell, State TB Training and Demonstration Centre, and State Medical Corporation participated in the study. The participants had an average of 10.3 years of experience in contracting, and 20% of them had received some training on contracting. The capacity of these respondents varied based on their involvement, previous training (s) received, and technical background. It was further observed that most of the respondents suggested an in-person physical training instead of virtual training. Most of the respondents requested to issue training certificate. Some of the topics that the participants requested for further training include Digital Signature Certification, Government e-Marketplace, General Financial Rule, Public Financial Management System, monitoring of performance indicators, and bid evaluation techniques. Moreover, 92% of the respondents felt that there is a training need on procurement and contracting. Conclusions: Many a time, the program officers come from a technical background not relevant to the contracting and procurement of goods and services and require regular on-the-job support and training to aid in effective program delivery.

Investigating linguistic and genetic shifts in East Indian tribal groups

South Asia is home to almost a quarter of the world's total population and is home to significant ethnolinguistic diversity. Previous studies of linguistic and genetic affiliations of Indian populations suggest that the formation of these distinct groups was a protracted and complex phenomenon involving multiple waves of migration, cultural assimilation, and genetic admixture. The evolutionary processes of migration, mixing and merging of populations thus impact the culture and linguistic diversity of different groups, some of which may retain their linguistic affinities despite genetic admixture with other groups, or vice versa. Our study examines the relationship of genetic and linguistic affinities between Austroasiatic and Indo-European speakers in adjacent geographical regions of Eastern India. We analyzed 224 mitogenomes and 0.65 million SNP genotypes from 40 unrelated individuals belonging to the Bathudi, Bhumij, Ho, and Mahali ethnic groups from the Eastern Indian state of Odisha. These four groups are speakers of Austroasiatic languages who have adopted elements from Indo-European languages spoken in neighbouring regions. Our results suggest that these groups have the greatest maternal genetic affinity with other Austroasiatic-speaking groups in India. Allele frequency-based analyses, genome-wide SNPs, haplotype-based methods and IBD sharing further support the genetic similarity of these East Indian groups to Austroasiatic speakers of South Asia rather than regional populations speaking Indo-European and Dravidian languages. Our study shows that these populations experienced linguistic mixing, likely due to industrialization and modernization that brought them into close cultural contact with neighbouring Indo-European-speaking groups. However, linguistic change in these groups is not reflected in genetic mixing in these populations, as they appear to maintain strict genetic boundaries while simultaneously experiencing cultural mixing.

Sexing of Dry Mandibles of Eastern Indian Population Using Discriminant Function Analysis

Sexing of Dry Mandibles of Eastern Indian Population Using Discriminant Function Analysis

Comparative analysis of pediatric rheumatic patient growth patterns against norms: A cross-sectional study conducted in an Eastern Indian hospital

Background. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease. Rheumatic diseases are a major cause of chronic illness in children around the world. SLE is a further prevalent inflammatory illness. Aims and objectives. To study different growth parameters of pediatric patients attending pediatric rheumatology clinic, to compare the growth parameters with age and sex matched controls and to compare growth among different types of pediatric rheumatic patients. Method. Different growth parameters and SMI (for children above 9 years) were recorded for patients attending pediatric rheumatology OPD having disease duration more than one year. Results. Among 121 patients, JIA was most common followed by SLE. Among JIA subtypes, SOJIA is most common. Mean age of presentation was earlier in SOJIA, late in JoAS. SLE patients had larger duration of illness prior to diagnosis than JIA patients. In JIA patients, mean height was significantly less than controls. SOJIA and polyarticular variety had significantly less weight and height compared to controls. SLE patients had significantly less weight and height compared to control. Anthropometric parameters were significantly more in SLE patients compared to JIA cohort. There was significantly more delayed puberty both in JIA and SLE patients compared to controls. Conclusion. JIA was most common, followed by SLE. Among JIA patients SOJIA variety was most common, JIA patients had significantly lower height than controls. SLE patients had significantly lower weight and height than controls. Delayed puberty was significantly more in both JIA and SLE patients compared to controls.

Correlation between Academic Procrastination and Self-Confidence among Medical Students at an Eastern Indian Institution: A Cross-Sectional Survey

Correlation between Academic Procrastination and Self-Confidence among Medical Students at an Eastern Indian Institution: A Cross-Sectional Survey

Sources of Southern Hemisphere Marine Aerosols: Insights From Carbonaceous Fraction Concentration and Stable Carbon Isotope Analysis

AbstractMarine carbonaceous aerosols, originating from marine and continental sources, are significant global aerosol components. The understanding of marine carbonaceous aerosols is currently limited, especially in the Southern Hemisphere. Furthermore, there is an ongoing debate regarding the contributions of marine fresh and ancient carbon to marine aerosols. To address these gaps, we conducted an extensive investigation utilizing a long‐term data set of aerosol samples collected during six Antarctic cruises (28°N–78°S) from 2013 to 2020. Our analysis revealed an average organic carbon (OC) concentration of 1.29 ± 1.15 μg/m3 and an element carbon (EC) concentration of 0.13 ± 0.18 μg/m3 in the samples. These concentrations varied within a range spanning from background marine samples to those impacted by substantial continental transport. Fossil fuel combustion remained the primary source of continental influence in the marine environment, as evidenced by the OC/EC ratio. The δ13CTC value for all samples range from −22.3‰ to −28.4‰, with a mean value of −26.3 ‰. Using a three‐endmember isotopic source model, we find that continental carbonaceous aerosols make substantial contributions in the Eastern Indian Ocean (81 ± 4%), while their prevalence is lower in the Southern Ocean (SO) (44 ± 20%). In contrast to mid‐latitudes, primary marine aerosol of the SO exhibits a significantly higher contribution from the fresh carbon pool (52 ± 19%). Furthermore, our study suggests that SO sea ice may play a potential role in driving emissions from the fresh carbon pool. These findings contribute to a comprehensive understanding of the effects of carbonaceous aerosols on climate change and the ocean‐atmosphere carbon cycle.

Genetic diversity analysis of native sheep population of Eastern Indian Himalayas using microsatellite DNA markers

Genetic diversity analysis of native sheep population of Eastern Indian Himalayas using microsatellite DNA markers

Variability of the Indian Ocean Dipole post-2100 reverses to a reduction despite persistent global warming

Previous examination of the Indian Ocean Dipole (IOD) response to greenhouse warming shows increased variability in the eastern pole but decreased variability in the western pole before 2100. The opposing response is due to a shallowing equatorial thermocline promoting sea surface temperature (SST) variability in the east, but a more stable atmosphere decreasing variability in equatorial zonal winds that weakens SST variability in the west. Post-2100, how the IOD may change remains unknown. Here we show that IOD variability weakens post-2100 in majority of models under a long-term high emission scenario to 2300. Post-2100, the atmosphere stability increases further and persistent ocean warming arrests or even reverses the eastern Indian Ocean shallowing thermocline. These changes conspire to drive decreased variability in both poles, reducing amplitude of moderate, strong and early-maturing positive IOD events. Our result highlights a nonlinear response of the IOD to long-term greenhouse warming under the high emission scenario.

Predicting suitable habitats for foraging and migration in Eastern Indian Ocean pygmy blue whales from satellite tracking data

BackgroundAccurate predictions of animal occurrence in time and space are crucial for informing and implementing science-based management strategies for threatened species.MethodsWe compiled known, available satellite tracking data for pygmy blue whales in the Eastern Indian Ocean (n = 38), applied movement models to define low (foraging and reproduction) and high (migratory) move persistence underlying location estimates and matched these with environmental data. We then used machine learning models to identify the relationship between whale occurrence and environment, and predict foraging and migration habitat suitability in Australia and Southeast Asia.ResultsOur model predictions were validated by producing spatially varying accuracy metrics. We identified the shelf off the Bonney Coast, Great Australian Bight, and southern Western Australia as well as the slope off the Western Australian coast as suitable habitat for migration, with predicted foraging/reproduction suitable habitat in Southeast Asia region occurring on slope and in deep ocean waters. Suitable foraging habitat occurred primarily on slope and shelf break throughout most of Australia, with use of the continental shelf also occurring, predominanly in South West and Southern Australia. Depth of the water column (bathymetry) was consistently a top predictor of suitable habitat for most regions, however, dynamic environmental variables (sea surface temperature, surface height anomaly) influenced the probability of whale occurrence.ConclusionsOur results indicate suitable habitat is related to dynamic, localised oceanic processes that may occur at fine temporal scales or seasonally. An increase in the sample size of tagged whales is required to move towards developing more dynamic distribution models at seasonal and monthly temporal scales. Our validation metrics also indicated areas where further data collection is needed to improve model accuracy. This is of particular importance for pygmy blue whale management, since threats (e.g., shipping, underwater noise and artificial structures) from the offshore energy and shipping industries will persist or may increase with the onset of an offshore renewable energy sector in Australia.

Racial/ethnic differences in incidence of squamous cell carcinoma in California.

11139 Background: Squamous cell lung carcinoma is strongly associated with a history of smoking. Typically, no actionable mutations are found, and treatment options are more limited. It is not known if race has any impact on the incidence of squamous cell cancers, especially for Asian ethnicities since most studies combine multiple Asian populations in an Asian/Pacific Islander (API) category. The purpose of this study was to compare the odds of squamous cell carcinoma versus adenocarcinoma in Hispanic, American Indian, Middle Eastern, and 7 Asian ethnicities when compared with both Black and White men and women. Methods: We accessed 211,987 cases of invasive lung cancer with either squamous cell or adenocarcinoma from the California Cancer Registry 2000-2020. Race was categorized as White, African American/Black, Hispanic, American Indian/Alaskan Native, Middle Eastern, Chinese, Japanese, Korean, Filipino, Southeast Asian (SEA), Pacific Islander, or Asian Indian. Separate logistic regression analyses were used to assess the odds of squamous cell versus adenocarcinoma for each race/ethnicity using White and Black as the reference categories. Analyses were conducted separately for males and females and adjusted for age, smoking status, socioeconomic status, marital status, and Charlson Comorbidity Score. Odds Ratios (OR) and 95% confidence intervals (CI) were computed. Results: When compared with White men, American Indian men had increased odds (OR: 1.39; 95% CI: 1.03, 1.88) and Black, Hispanic, Chinese, Filipino, SEA men had decreased odds of squamous cell carcinoma. Japanese women had increased odds (OR: 1.54; 95% CI: 1.15, 2.07) while Black, Hispanic, Middle Eastern, Filipino, and SEA women had decreased odds of squamous cell carcinoma when compared with White women. When compared with Black men, White men, (OR: 1.11; 95% CI: 1.01, 1.24) American Indian, (OR: 1.56; 95% CI: 1.13, 2.13) and Korean (OR: 1.35; 95% CI: 1.05, 1.73) men had increased odds and Chinese, Filipino, and SEA men had decreased odds of squamous cell carcinoma. White, (OR: 1.13; 95% CI: 1.01, 1.28) Japanese, (OR: 1.75; 95% CI: 1.28, 2.39) and Korean (OR: 1.63; 95% CI: 1.09, 2.42) women had increased odds and Southeast Asians had decreased odds when compared with Black women. Conclusions: Some Asian ethnicities have a higher risk for squamous cell lung cancer than both Black and White men and women even after adjusting for smoking. This is not apparent when the Asian ethnicities are classified as API. Examining individual Asian ethnicities is important since they have little to no shared genetic or cultural variables and are grouped together for convenience rather than any scientifically plausible reason.

A Decade-Long Cohort Analysis of Human Cytomegalovirus (HCMV)-Induced Early and Late Renal Rejection in Post-Transplant Patients in the Eastern Indian Population.

Background: HCMV causes severe clinical complications in transplant recipients and may lead to graft rejection. Successful renal transplantation heavily relies on the early prevention and diagnosis of CMV infections, followed by prompt prophylactic treatment before transplantation. Despite the majority of renal rejection cases with acute HCMV infections being asymptomatic and occurring one to two years later, the objective of this research was to comprehend the effect of late HCMV infection on renal rejection by examining specific clinical parameters in the Eastern Indian cohort. Method: In this study, 240 patients were studied for five years following transplantation, and their data were collected from the local metropolitan hospital in Eastern India. Both HCMV-positive and -negative post-transplant patients were investigated using the clinical parameters and viral loads for latent infection. Results: Within the studied population, 79 post-transplant patients were found to be HCMV positive. Among them, 13 (16.45%) patients suffered from renal rejection within less than 2 yrs. of transplantation (early rejection) and 22 (27.84%) patients suffered from renal rejection after 2 yrs. from the operation date (late rejection). Assessment of clinical parameters with respect to HCMV infection revealed that in early rejection cases, fever (p-0.035) and urinary tract infection (p-0.017) were prominent, but in late rejection, hematuria (p-0.032), diabetes (p-0.005), and creatinine level changes (p < 0.001) were significant along with urinary tract infection (p-0.047). Conclusions: This study provides valuable insights into monitoring latent CMV infections and highlights the understanding of reducing renal rejection rates and the need for further research in this field.

Are Indian mackerel (Rastrelliger kanagurta) populations in the eastern Indian Ocean truly homogeneous? Insights from geometric morphometric analysis

The boundaries of Indian mackerel (Rastrelliger kanagurta) populations/stocks in the three Large Marine Ecosystems (LMEs) in the eastern Indian Ocean (Arabian Sea, Bay of Bengal, and Andaman Sea) are not clearly discriminated or delineated, resulting in conflicting population boundaries. Inherent limitations of the methodologies adopted could be the major reason behind this lack clarity in the population boundaries. Geometric morphometric analysis (GMA) using landmarks has been found to be the most appropriate approach under these conditions. Thus, the present study aims to differentiate between the populations of R. kanagurta in the eastern Indian Ocean (Arabian Sea, Bay of Bengal, and Andaman Sea) by employing GMA of body shape. The results indicate significant differences in body shape between the populations of R. kanagurta inhabiting the eastern Indian Ocean. The variations are primarily observed in the relative sizes of body depth, head, dorsal and anal fins, and the position of eyes, mouth, pectoral, anal, and dorsal fins. The Bay of Bengal populations were mainly characterized with a deeper body, large heads, dorsally oriented eyes, posterior pectoral fins and longer anal and second dorsal fin. Andaman populations were characterized with a more streamlined body, anterior pectoral fins, ventral eyes and shorter anal and second dorsal fins. Arabian Sea population possess an intermediate shape between Bay of Bengal and Andaman populations. These observed variations confirm that R. kanagurta constitutes a discrete population in the eastern Indian Ocean. This study provides valuable information on the population structure of R. kanagurta in the Arabian Sea, Bay of Bengal, and Andaman Sea, which can be useful in fisheries management and conservation efforts.

Spatial distribution and environmental/biological co-regulation mechanism of dimethyl sulfur compounds in the eastern Indian Ocean

Dimethyl sulfur compounds including dimethylsulfoniopropionate (DMSP), dimethyl sulfide (DMS), and dimethyl sulfoxide (DMSO), play a crucial part in global sulfur cycling. The eastern Indian Ocean (EIO), characterized by its remarkable diversity of biomes and climate dynamics, is integral to global climate regulation. However, the regulation mechanism of DMS (P, O) in the EIO remains to be elucidated in detail. This paper presented a field survey aimed at investigating the spatial distribution of DMS (P, O) and their relationships with environmental and biological factors in the EIO. The surface concentrations of DMS, DMSPt, and DMSOt varied from 0.07 to 7.37 nmol/L, 0.14 to 9.17 nmol/L, and 0.15 to 3.32 nmol/L, respectively, and their distributions are attributed to high Chl-a concentration near Sri Lanka and the influence of ocean currents (Wyrtki jets, Bay of Bengal runoff). Higher concentrations of DMS (P) and DMSOt were predominantly observed in water columns shallower than 75m and deeper than 75m deep, respectively. The monthly DMS fluxes in the study area peaked in August. Temperature and Dissolved Silica Index (DSI) were the key environmental determinants for DMS distribution, while nitrate (NO3-) was the primary factor for both DMSPt and DMSOt. In terms of biological factors, Prochlorococcus and Synechococcus were significant contributors to DMS (P, O) dynamics. Synechococcus was the dominant influence on the DMS source and DMSPt sink, whereas Prochlorococcus primarily consumed DMSOt. Furthermore, the structural equation modeling (SEM) revealed the relationship between DMS, DMSPt, DMSOt, and the key environmental/biological factors, as well as among them, and together they formed a co-regulatory network in the EIO. This contributes significantly to the advancement of global ecosystem models for DMS (P, O).

Quasi-biennial oscillation modulation of stratospheric water vapour in the Asian monsoon

Abstract. The Asian monsoon (AM) plays a key role in the transport of water vapour to the lower stratosphere and contributes significantly to the wet phase of the annual global stratospheric water vapour cycle. Although it is known that the quasi-biennial oscillation (QBO) is one of the main drivers of the interannual variability in the AM water vapour, the physical mechanisms responsible for this variability remain unclear. Here we have used daily microwave limb sounder data for the period 2005–2020 to characterize the QBO signature on the lower stratosphere AM water vapour during the boreal summer. We show that the QBO has the strongest impact during August, when QBO westerly minus QBO easterly differences may reach 1 ppmv at 100 hPa, although a significant signature is also observed during July. We find that the region whose temperature controls the QBO signal on water vapour over the AM differs between July and August. In July, when the key region is over the tropical Indian Ocean, the QBO modulation of the AM water vapour occurs in phase with the signal over the Equator, whereas in August, when the key region is at the subtropics, over the southern edge of the monsoon, the signal over the AM is opposite to that over the Equator. Our results reveal that the QBO signal on the temperature on the south side of the AM anticyclone, which ultimately has an impact on AM water vapour, is, in turn, modulated by the QBO impact on tropical clouds. Thus, we find that the QBO signature on clouds over the eastern Indian Ocean gives rise to Rossby wave trains that produce variations in the circulation over the southern side of the AM anticyclone such that weaker anticyclone over this region generates an increase in water vapour, and vice versa.

Impacts of Atmospheric Internal Variations on the Variability of Sea Surface Temperature Based on the Hydra‐SINTEX Model

AbstractOcean–atmosphere interactions largely control the variabilities of the climate system on Earth. However, how much atmospheric internal signals contribute to climate variabilities remains uncertain over many parts of the globe. Here, we develop an interactive ensemble coupled model (called Hydra‐SINTEX) to investigate the influences of atmospheric internal variations (AIVs) on the mean‐states and variability of the climate system. The results show that, while climatological mean‐states are little affected, the AIVs can largely influence climate variabilities over the globe. We pay particular attention to two regions, that is, the tropical eastern Indian Ocean, which is the key area of the Indian Ocean Dipole (IOD), and the subtropical North Pacific. We found that sea surface temperature (SST) variabilities in these two regions are much reduced without the AIVs but with distinct mechanisms. Without the AIVs, the intensity of the IOD is largely reduced in association with weakened air–sea coupling in the tropics. This indicates the importance of atmospheric noise forcing on the development of the IOD. In contrast, the reduction of SST variability in the subtropical North Pacific is caused by the absence of the AIVs that are generated by both mid‐latitude atmospheric processes and weakened remote influence of the tropical SST in accordance with the reduced SST signals there.

Spatiotemporal Patterns and Environmental Drivers of Particulate Inorganic Carbon (PIC) Variability in the Southern Waters of Sumatra‐Java Islands

AbstractThe southern waters of the Sumatra‐Java Islands, within the Indo‐Pacific Warm Pool, are highly susceptible to global climate change impacts. Understanding particulate inorganic carbon (PIC) dynamics and environmental responses in this region is critical for assessing climate change effects on marine ecosystems. Utilizing two decades of remote sensing PIC data (2003–2022), we identified five sub‐regions via K‐means clustering: the Sunda Strait, southern coastal/offshore waters of Sumatra Island, and southern coastal/offshore waters of Java Island. Self‐Organizing Map explored interannual PIC variations, while Generalized Additive Models delineated driving factors. In the Sunda Strait, PIC dynamics are influenced by water exchanges between the Indonesian Seas (ISs) and eastern Indian Ocean (EIO). Seasonally, PIC concentrations peak during the east monsoon (boreal summer); decreasing during positive Indian Ocean Dipole (+IOD) and El Niño events. Along the southern Sumatra, PIC variations positively correlate with rainfall and photosynthetically active radiation (PAR). Along the southern Sumatra, upwelling drives PIC variations, with higher concentrations during mature summer monsoon induced upwelling periods. PIC increases during +IOD and decreases during El Niño. Our study highlights the nexus between nutrients, physical factors (e.g., rainfall), and climatic events (e.g., El Niño) on PIC concentrations. Climate‐induced changes in oceanic physical processes modulate nutrient concentrations, thereby governing PIC variations. We propose a mechanistic model to elucidate PIC variations in upwelling areas. Findings suggest that prospective climate variability, encompassing alterations in climate events, rainfall, and temperature, may escalate PIC concentrations within the study area, advocating PIC as a forward‐looking climate change indicator.

Contrasting physical mechanisms of yellowfin tuna fluctuations between the western and eastern Indian Ocean

Contrasting physical mechanisms of yellowfin tuna fluctuations between the western and eastern Indian Ocean

Prevalence of HPV in Oral Squamous Cell Carcinoma Through p16 IHC: A Hospital-Based Study in Eastern India

Abstract Context: Oral squamous cell carcinoma (OSCC), the third most prevalent solid cancer in India with 45% incidence, is associated with 20%–50% of cases having human papillomavirus (HPV) infection; however, the current role of HPV in managing OSCC remains unclear, particularly in high-incidence areas such as Eastern India. Aim: The study aims to determine the prevalence of HPV in OSCC patients and evaluate its role as an independent risk factor in the progression of OSCC. Settings and Design: This cross-sectional study, conducted in an Eastern Indian tertiary care hospital, involved 140 identified and treated OSCC patients. Materials and Methods: Immunohistochemistry (IHC) was used to determine HPV immunoreactivity using the marker p16. The data were analyzed using SPSS version 27.0 with a significance level of P &lt; 0.05. Results: Among 140 patients, 11 showed strong P16 positivity (&gt;70%) for HPV, resulting in a prevalence rate of 7.86%. However, no statistically significant association of HPV (p16 positivity) with any groups was found. Interestingly, all P16-positive patients in our study had a history of tobacco use (9.5%), suggesting that HPV may not be considered an independent factor for oral cancer. Conclusion: In our cases, p16 positivity is seen in 7.85% of cases. This finding suggests that further sub-analysis concerning p16 as a prognostic marker and its therapeutic implication is further required in oral cancer. Correlation with PCR is also required to substantiate TNM staging of p16 by the IHC method.

Burning Bright or Burning Out: A Cross-sectional Study on Burnout among Postgraduate Residents in an Eastern Indian Teaching Hospital

Introduction: Burnout is a concerning clinical syndrome comprising excessive stress, lack of satisfaction, and a feeling of being overworked. In India, postgraduate residents who shoulder the entire burden of patient care, are prone to suffer from burnout. Only a few Indian studies have been carried out to estimate the prevalence of burnout among postgraduate resident doctors. Our study, the first of its kind from eastern India, aims to address this lacuna. Materials and Methods: This was a single-institution cross-sectional observational study carried out using an online semi-structured form comprising demographic data and the Maslach Burnout Inventory. Appropriate statistical tests were carried out to analyze the data obtained. Results: The study received a response rate of 79.2%. Of the participants, 44.1% were females, 54.9% were males, and 1% identified as other gender. The mean age (standard deviation) of the participants was 28.02 (3.67) years. Overall, 75% of the participants experienced burnout. Younger participants, females, clinical residents, those in a relationship, and 2nd year of residency reported higher emotional exhaustion. Depersonalization was associated with lower age, being in a relationship, metropolitan upbringing, and 2nd year of residency. The lower personal accomplishment was seen in those coming from metropolitan and rural backgrounds. Conclusion: Burnout has serious implications on psychological and physical health of the residents. Interventions for effective management will greatly improve the overall mental health and work performance of the junior doctors.