Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

FINDINGS

The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

INTERPRETATION

Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.

FUNDING

Bill & Melinda Gates Foundation.

Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios.

METHODS

To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline.

FINDINGS

During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction.

INTERPRETATION

Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world.

FUNDING

Bill & Melinda Gates Foundation.

N-Hydroxyalkanamide Based Organo/hydrogels as Novel Scaffolds for pH-Dependent Metronidazole and Theophylline Release

The traditional delivery of metronidazole and theophylline presents challenges like bitter taste, variable absorption, and side effects. However, gel-based systems offer advantages including enhanced targeted drug delivery, minimized side effects, and improved patient compliance, effectively addressing these challenges. Consequently, a cost-effective synthesis of N-hydroxyalkanamide gelators with varying alkyl chain lengths was achieved in a single-step reaction procedure. These gelators formed self-assembled aggregates in DMSO/water solvent system, resulting in organo/hydrogels at a minimum gelation concentration of 1.5% w/v. Subsequently, metronidazole and theophylline were encapsulated within the gel core and released through gel-to-sol transition triggered by pH variation at 37 °C, while maintaining the structural-activity relationship. UV-vis spectroscopy was employed to observe the drug release behavior. Furthermore, in vitro cytotoxicity assays revealed cytotoxic effects against A549 lung adenocarcinoma cells, indicating anti-proliferative activity against human lung cancer cells. Specifically, the gel containing theophylline (16HAD+Th) exhibited cytotoxicity on cancerous A549 cells with IC50 values of 19.23 ± 0.6 µg/mL, followed by the gel containing metronidazole (16HAD+Mz) with IC50 values of 23.75 ± 0.7 µg/mL. Moreover, the system demonstrated comparable antibacterial activity against both gram-negative (E. coli) and gram-positive bacteria (S. aureus).

Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication

BACKGROUND

The purpose of this study is to provide comprehensive and efficient pre-anesthesia counseling (PAC) utilizing audiovisual aids and to examine their effect on parental anxiety.

METHODS

For this prospective, controlled study, 174 parents were recruited and randomized into three groups of 58 (Group A: video, Group B: brochure, and Group C: verbal). During pre-anesthesia counseling, the parent was provided with a detailed explanation of preoperative preparation, fasting instructions, transport to the operating room, induction, the emergence of anesthesia, and nursing in the post-anesthesia care unit based on their assigned group. We evaluated parental anxiety using Spielberger's State-Trait Anxiety Inventory before and after the pre-anesthesia counseling.

RESULTS

The results of our study show a statistically significant difference in the final mean STAI scores among the three groups (Group A: 34.69 ± 5.31, Group B: 36.34 ± 8.59, and Group C: 43.59 ± 3.39; p < .001). When compared to the brochure and verbal groups, the parents in the video group have the greatest difference in mean baseline and final Spielberger's State-Trait Anxiety Inventory scores (12.207 ± 5.291, p .001).

CONCLUSION

The results of our study suggest that pre-anesthesia counseling by video or a brochure before the day of surgery is associated with a higher reduction in parental anxiety when compared to verbal communication.

DFT and TDDFT exploration on electronic transitions and bonding aspect of DPA and PTDC ligated transition metal complexes

CONTEXT

In this study, we have investigated the structure, reactivity, bonding, and electronic transitions of DPA and PDTC along with their Ni-Zn complexes using DFT/TD-DFT methods. The energy gap between the frontier orbitals was computed to understand the reactivity pattern of the ligands and metal complexes. From the energies of FMO's, the global reactivity descriptors such as electron affinity, ionization potential, hardness (η), softness (S), chemical potential (μ), electronegativity (χ), and electrophilicity index (ω) have been calculated. The complexes show a strong NLO properties due to easily polarization as indicated by the narrow HOMO-LUMO gap. The polarizability and hyperpolarizabilities of the complexes indicate that they are good candidates for NLO materials. Molecular electrostatic potential (MEP) maps identified electrophilic and nucleophilic sites on the surfaces of the complexes. TDDFT and NBO analyses provided insights into electronic transitions, bonding, and stabilizing interactions within the studied complexes. DPA and PDTC exhibited larger HOMO-LUMO gaps and more negative electrostatic potentials compared to their metal complexes suggesting the higher reactivity. Ligands (DPA and PDTC) had absorption spectra in the range of 250 nm to 285 nm while their complexes spanned 250 nm to 870 nm. These bands offer valuable information on electronic transitions, charge transfer and optical behavior. This work enhances our understanding of the electronic structure and optical properties of these complexes.

METHODS

Gaussian16 program was used for the optimization of all the compounds. B3LYP functional in combination with basis sets, such as LanL2DZ for Zn, Ni and Cu while 6-311G** for other atoms like C, H, O, N, and S was used. Natural bond orbital (NBO) analysis is carried out to find out how the filled orbital of one sub-system interacts with the empty orbital of another sub-system. The ORCA software is used for computing spectral features along with the zeroth order regular approximation method (ZORA) to observe its relativistic effects. TD-DFT study is carried out to calculate the excitation energy by using B3LYP functional.

Groundwater quality assessment using water quality index and principal component analysis in the Achnera block, Agra district, Uttar Pradesh, Northern India

The qualitative and quantitative assessment of groundwater is one of the important aspects for determining the suitability of potable water. Therefore, the present study has been performed to evaluate the groundwater quality for Achhnera block in the city of Taj, Agra, India, where groundwater is an important water resource. The groundwater samples, 50 in number were collected and analyzed for major ions along with some important trace element. This study has further investigated for the applicability of groundwater quality index (GWQI), and the principal component analysis (PCA) to mark out the major geochemical solutes responsible for origin and release of geochemical solutes into the groundwater. The results confirm that, majority of the collected groundwater samples were alkaline in nature. The variation of concentration of anions in collected groundwater samples were varied in the sequence as, HCO3- > Cl- > SO42- > F- while in contrast the sequence of cations in the groundwater as Na > Ca > Mg > K. The Piper diagram demonstrated the major hydro chemical facies which were found in groundwater (sodium bicarbonate or calcium chloride type). The plot of Schoellar diagram reconfirmed that the major cations were Na+ and Ca2+ ions, while in contrast; major anions were bicarbonates and chloride. The results showed water quality index mostly ranged between 105 and 185, hence, the study area fell in the category of unsuitable for drinking purpose category. The PCA showed pH, Na+, Ca2+, HCO3- and fluoride with strong loading, which pointed out geogenic source of fluoride contamination. Therefore, it was inferred that the groundwater of the contaminated areas must be treated and made potable before consumption. The outcomes of the present study will be helpful for the regulatory boards and policymaker for defining the actual impact and remediation goal.

Birth Asphyxia among Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital

Introduction

Birth asphyxia causes significant morbidity and mortality among neonates, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to find the prevalence of birth asphyxia among neonates admitted to the neonatal intensive care unit of a tertiary care hospital.

Methods

This descriptive cross-sectional study was conducted among neonates at a tertiary care hospital between 15 January 2022 to 14 January 2023 after obtaining ethical approval from the Institutional Review Committee. Neonates with gestational age ≥35 weeks were included and those with major congenital anomalies were excluded. A convenience sampling method was used. A point estimate was calculated at a 95% Confidence Interval.

Results

Among 902 neonates, 120 (13.30%) (11.08-15.52, 95% Confidence Interval) had birth asphyxia. A total of 108 (90%) were outborn, and 84 (70%) were males. HIE stage-I, II and III were seen in 47 (39.17%), 64 (53.33%) and 9 (7.50%) of the asphyxiated neonates respectively. Poor suck 92 (76.67%), seizures 73 (60.83%) and lethargy 70 (58.33%) were common abnormal neurological findings. Death occurred in 15 (12.50%) neonates in the hospital.

Conclusions

The prevalence of birth asphyxia was found to be similar to other studies done in similar settings. The high burden underscores an urgent need to implement better perinatal care and delivery room management practices.

Keywords

hypoxic-ischemic encephalopathy; neonates; prevalence.

Unveiling a robust and high-temperature-stable two-dimensional ZnAl layered double hydroxide nanosheet based flexible triboelectric nanogenerator

Triboelectric nanogenerators have the ability to harvest low- and mid-frequency vibrational energy from the environment; however, achieving stable performance of the nanogenerator device in high-temperature conditions remains challenging. In this work, a flexible and temperature-stable polyvinyl alcohol (PVA)/layered double hydroxides (LDH) nanocomposite-based triboelectric nanogenerator was developed to harvest unexploited vibrational energy for the first time. Crystalline ZnAl LDH nanosheets grown by a hydrothermal route are used to fabricate the high-performance flexible nanogenerator. The ZnAl LDH exhibits fire-retardancy and high-temperature stability (∼500 °C). A triboelectric nanogenerator based on the ZnAl LDH-PVA nanocomposite generated a very high output voltage of 60 V even under a low vertical pressure of 1 kgf. Surprisingly, the developed device shows ultra-stable output performance even up to a temperature of 200 °C. In addition, a ZnAl LDH-nanosheet-reinforced PVA nanocomposite film shows very high dielectric constant of about 5 × 105 at the low-frequency side. The tremendous increase in the output voltage and stable performance are discussed in terms of the high dielectric constant and synergistic effect of the LDH nanosheets and PVA. Furthermore, the device was also used to monitor human body movements such as finger and wrist bending to develop self-powered sensors.

National and regional prevalence of gestational diabetes mellitus in India: a systematic review and Meta-analysis

BACKGROUND

Gestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India.

METHODS

We conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India.

RESULTS

Two independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0-13.0%, I2=96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0-16.0%, I2 = 99%].

CONCLUSIONS

This review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country.

C-H bond activation by high-valent iron/cobalt-oxo complexes: a quantum chemical modeling approach

High-valent metal-oxo species serve as key intermediates in the activation of inert C-H bonds. Here, we present a comprehensive DFT analysis of the parameters that have been proposed as influencing factors in modeled high-valent metal-oxo mediated C-H activation reactions. Our approach involves utilizing DFT calculations to explore the electronic structures of modeled FeIVO (species 1) and CoIVO ↔ CoIII-O˙ (species 2), scrutinizing their capacity to predict improved catalytic activity. DFT and DLPNO-CCSD(T) calculations predict that the iron-oxo species possesses a triplet as the ground state, while the cobalt-oxo has a doublet as the ground state. Furthermore, we have investigated the mechanistic pathways for the first C-H bond activation, as well as the desaturation of the alkanes. The mechanism was determined to be a two-step process, wherein the first hydrogen atom abstraction (HAA) represents the rate-limiting step, involving the proton-coupled electron transfer (PCET) process. However, we found that the second HAA step is highly exothermic for both species. Our calculations suggest that the iron-oxo species (Fe-O = 1.672 Å) exhibit relatively sluggish behavior compared to the cobalt-oxo species (Co-O = 1.854 Å) in C-H bond activation, attributed to a weak metal-oxygen bond. MO, NBO, and deformation energy analysis reveal the importance of weakening the M-O bond in the cobalt species, thereby reducing the overall barrier to the reaction. This catalyst was found to have a C-H activation barrier relatively smaller than that previously reported in the literature.

Microbiology proficiency testing in fish and fishery products: detection of Listeria monocytogenes and Salmonella spp

This paper presents the results of two proficiency testing (PT) rounds conducted by the Export Inspection Agency (EIA) Chennai laboratory in 2021 for food testing laboratories in India. The PT program was designed in accordance with ISO/TS 22117, a standard for proficiency testing in food microbiology, and targeted Listeria monocytogenes and Salmonella spp as the organisms of focus. The samples were found to be stable and recoverable during the analysis, and all PT sample packages were delivered to participant laboratories in good condition. The participant laboratories reported high sensitivity rates of 100% for PT round 061021 M and 96.49% for PT round 050721 M. The accuracy rate in PT round 061021 M was 91.89% and 92.10% in case of PT round 050721 M. However, there were some false positive and false negative results reported by some participant laboratories in both PT rounds, which may have been caused by operational errors or inconsistencies in analysis. During the PT round 061021 M, out of a total of 38 participant laboratories, five laboratories reported false positive results and one laboratory reported a false negative result. Similarly, during the PT round 050721 M, six laboratories reported false positive results which resulted in their results being deemed unsatisfactory.

Variability of groundwater fluoride and its proportionate risk quantification via Monte Carlo simulation in rural and urban areas of Agra district, India

This study quantifies the groundwater fluoride contamination and assesses associated health risks in fluoride-prone areas of the city of Taj Mahal, Agra, India. The United States Environmental Protection Agency (USEPA) risk model and Monte Carlo Simulations were employed for the assessment. Result revealed that, among various rural and urban areas Pachgain Kheda exhibited the highest average fluoride concentration (5.20 mg/L), while Bagda showed the lowest (0.33 mg/L). Similarly, K.K. Nagar recorded 4.38 mg/L, and Dayalbagh had 1.35 mg/L. Both urban and rural areas exceeded the WHO-recommended limit of 1.5 mg/L, signifying significant public health implications. Health risk assessment indicated a notably elevated probability of non-carcinogenic risk from oral groundwater fluoride exposure in the rural Baroli Ahir block. Risk simulations highlighted that children faced the highest health risks, followed by teenagers and adults. Further, Monte Carlo simulation addressed uncertainties, emphasizing escalated risks for for children and teenagers. The Hazard Quotient (HQ) values for the 5th and 95th percentile in rural areas ranged from was 0.28-5.58 for children, 0.15-2.58 for teenager, and 0.05-0.58 for adults. In urban areas, from the range was 0.53 to 5.26 for children, 0.27 to 2.41 for teenagers, and 0.1 to 0.53 for adults. Physiological and exposure variations rendered children and teenagers more susceptible. According to the mathematical model, calculations for the non-cancerous risk of drinking water (HQ-ing), the most significant parameters in all the targeted groups of rural areas were concentration (CW) and Ingestion rate (IR). These findings hold relevance for policymakers and regulatory boards in understanding the actual impact and setting pre-remediation goals.

DFT and TDDFT exploration on the role of pyridyl ligands with copper toward bonding aspects and light harvesting

CONTEXT

Schiff base-containing metal complexes have been the subject of extensive research. In this work, a coordination polymer-derived complex called [Cu(L)] that is solution-stable (L = 2-(2-hydroxybenzylidene-amino)phenol) has been explored theoretically with five different pyridyl-based ligands using DFT/TDDFT in order to understand the structural-functional and electronic transitions of these five complexes. Frontier molecular orbital (FMO) analysis was carried out to assess the reactivity behavior of all five complexes. For the purpose of studying the charge energy distribution over complexes, electrostatic potential maps were also drawn. Furthermore, in order to identify any stabilizing interactions that may be present in the given complexes, an NBO analysis was studied. To learn more about any potential correlations between the properties of these five complexes, a comparative analysis was explored. Our calculations demonstrate that complex 3 having pyridine-4-carboxamide as a ligand has a lower energy gap and a higher negative electrostatic potential which may indicate its higher reactivity and this may be due to the electron withdrawing group (carboxamide). TDDFT results show that the highest light harvesting efficiency (LHE) of all the studied complexes is found in the range of 440-448 nm. Complexes 1, 2, and 4 show the higher light harvesting efficiency as compared to complexes 3 and 5. Our findings are in good accordance with the available experimental data.

METHODS

All DFT computations were performed using the Gaussian16 with unrestricted B3LYP-D2 functional with the basis sets 6-31G(d,p) for O, N, C, and H while LanL2DZ for Cu. The polarized continuum model (PCM) was used for the solvation. The software GaussView6.1 was utilized for the modeling of initial geometries and the plotting of MEP maps. The NBO6.0 program which is incorporated in Gaussian16 was utilized to investigate the bonding nature and stabilization energies of the complexes. The ORCA program was used to simulate the absorption spectra.

Effectiveness of ayurvedic formulation, NAOQ19 along with standard care in the treatment of mild-moderate COVID-19 patients: A double blind, randomized, placebo-controlled, multicentric trial

BACKGROUND

Medicines in indigenous systems such as Ayurveda have strong antimicrobial activity but double-blind randomized control trials are infrequent in this system of medicine. The efficacy of a new ayurvedic formulation was evaluated during the pandemic.

METHODS

150 mild-moderate COVID-19 patients were enrolled and randomized in 1:1 to NAOQ19 and placebo group. RT-PCR was done on Day 3, 5 and 7. CBC, CRP, LFT, and KFT were assessed at baseline and exit. Duration of hospital stay was noted and clinical assessment was also performed.

RESULT

The results demonstrated more people turning RT-PCR negative in the NAOQ19 group compared to the placebo group on day 3 (p-value = 0.033). The mean time duration to turn RT-PCR negative was significantly lower in the NAOQ19 group (4.6 days) compared to placebo group (5.2 days) (p-value = 0.018). There was significant reduction in hospital stay among patients in the NAOQ19 arm who were discharged earlier (5.6 days) compared to placebo group (6.4 days) (p-value = 0.046). Patients in NAOQ19 arm did not show any adverse life-threatening events.

CONCLUSION

The ayurvedic preparation given along with standard of care therapy reduced the duration of hospital stay and there was earlier conversion to RT-PCR negative.The integrated approach can help to reduce patient workload in the hospitals as well as limit the transmission of the virus in the community.

STUDY REGISTRATION

CTRI/2021/05/033790.

Theoretical study of the formation of metal-oxo species of the first transition series with the ligand 14-TMC: driving factors of the "Oxo Wall"

Terminal metal-oxo species of the early transition metal series are well known, whereas those for the late transition series are rare, and this is related to the "Oxo Wall". Here, we have undertaken a theoretical study on the formation of metal-oxo species from the metal hydroperoxo species of the 3d series (Cr, Mn, Fe, Co, Ni, and Cu) with the ligand 14-TMC (1,4,8,11-tetramethyl-1,4,8,11-tetraazacyclotetradecane) via O⋯O bond cleavage. DFT calculations reveal that the barrier for O⋯O bond cleavage is higher with the late transition metals (Co, Ni, and Cu) than the early transition metals (Cr, Mn, and Fe), and the formed late metal-oxo species are also thermodynamically less stable. The higher barrier may be due to electronic repulsion because of the pairing of d electrons. In the late transition metal series, the electron goes into an antibonding orbital, which decreases the bond order and hence decreases the possibility of metal-oxo formation. Computed structural parameters and spin densities suggest that valence tautomerism occurs in the late transition metal-oxo species which remain as a metal-oxyl. Our findings support the concept of the "Oxo Wall".

Programmed cell death ligand 1 (PD-L1) expression in non-small cell lung cancer: Findings from a tertiary care institute in western part of India

BACKGROUND

Immune checkpoint inhibitors targeting either programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1) have been established as a novel target for immunotherapy in non-small cell lung cancer (NSCLC). Prevalence of PD-L1 expression in NSCLC varies from 13% to 70%, with sparse data from the Indian subcontinent. In this study, we looked at PD-L1 expression and its association with demographic, clinical, radiologic and pathologic parameters in NSCLC patients.

METHODS

This was an observational study carried over a period of 18 months in which 65 patients of NSCLC were included. Immunohistochemistry (IHC) for PD-L1 was done using an automated IHC stainer and testing was performed using PD-L1 IHC CAL10. For statistical analysis, unpaired t test, Chi square test, Fisher's exact test and binomial logistic regression were used. P < 0.05 was taken to be statistically significant.

RESULTS

Mean age of the patients was 62.9 ± 9.2 years, and majority (87.3%) of them were males. Seventeen (26.2%) patients expressed PD-L1, among whom 10 had high PD-L1 expression (≥50%) and 7 had low PD-L1 expression (1-49%). PD-L1 expression was seen in 13 out of 43 cases of squamous cell carcinoma (SCC) and 4 out of 15 cases of adenocarcinoma. On applying binomial logistic regression analysis, association between smoking and PD-L1 expression was found to be insignificant.

CONCLUSION

Almost a quarter of NSCLC cases were PD-L1 positive without any difference in expression between SCC and adenocarcinoma. PD-L1 status was not associated with any specific demographic, clinical or radiologic parameter including the histologic subtype.

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

INTRODUCTION

The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.

METHODS

Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.

RESULTS

Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).

CONCLUSION

Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

The role of DNA methylation in personalized medicine for immune-related diseases

Epigenetics functions as a bridge between host genetic & environmental factors, aiding in human health and diseases. Many immune-related diseases, including infectious and allergic diseases, have been linked to epigenetic mechanisms, particularly DNA methylation. In this review, we summarized an updated overview of DNA methylation and its importance in personalized medicine, and demonstrated that DNA methylation has excellent potential for disease prevention, diagnosis, and treatment in a personalized manner. The future implications and limitations of the DNA methylation study have also been well-discussed.

Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak

We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.

Estimating the weight of consumed tobacco product waste in various Indian states: a novel method to assess the potential burden of tobacco product waste

INTRODUCTION

The direct morbidity and mortality caused by tobacco are well documented, but such products also contribute to a range of environmental pollutants resulting from tobacco product waste. No previous studies have yet quantified tobacco product waste in a low-income and middle-income country (LMIC). This study estimates the potential annual waste generated due to consumption of smoked and smokeless tobacco products in India and its states.

METHODOLOGY

We systematically collected samples of smoked and smokeless tobacco products from 33 districts of 17 Indian states/union territories. Stratified weights of plastic, paper, foil and filter packaging components, and gross empty package weights were recorded. Prevalence of smoking and smokeless tobacco use at national and state-level estimates was derived from the Global Adult Tobacco Survey (2016-2017) to quantify waste potentially generated by tobacco products.

RESULTS

We included 222 brands of tobacco products (70 cigarette, 94 bidi and 58 smokeless tobacco brands) in the final analysis. A total of 170 331 (±29 332) tonnes of waste was estimated to be generated annually, out of which 43.2% was plastic, 3.6% was foil and 0.8% was filter. Two-thirds of the overall waste was contributed by smokeless products alone. Maximum waste was generated in Uttar Pradesh (20.9%; 35 723.7±6151.6 tonnes), Maharashtra (8.9%; 15 116.84±2603.12 tonnes) and West Bengal (8.6%; 14 636.32±2520.37 tonnes).

CONCLUSION

This study provides first of its kind national-level evidence on the types (plastic, paper, foil and filter) and quantity of waste potentially generated by use of tobacco products in India. Similar studies from other LMICs can serve to raise consciousness about many negative environmental impacts of tobacco products and need for policies to address them.

Determining the Clinical Value of Routine Post Operative follow up in Common Paediatric Surgical Conditions: A Prospective Observational Study

Background

The traditional postoperative visit consists of an in-person hospital visit at a predetermined date which requires the investment of time and resources. This implies a need to prioritize visits rather than mandating them, which can be assessed by the requirement of clinical intervention at the time of follow-up. The purpose of this study is to determine the clinical value of routine postoperative physical follow-up in common pediatric surgery conditions, to identify factors determining follow-up, and to estimate the cost of routine follow-up.

Materials and Methods

Surgical data of 226 patients admitted for routine pediatric surgical procedures were collected. The postoperative period was documented in detail and interventions done either physically or telephonically at the time of follow-up were used as a proxy measure of clinical value.

Results

There were 226 patients enrolled, of which 64.60% followed up physically in outpatient department and 35.40% followed up telephonically. Maximum percentage of patients with postoperative complications belonged to the group of laparotomy at 22.22%, followed by complicated appendicitis at 15.62%. 13.27% of patients required clinical intervention at the time of follow-up.

Conclusion

Patients undergoing simpler procedures such as inguinal hernia, hydrocele, and orchidopexy have lesser rate of complications which translates to requirement of fewer clinic visits, whereas those undergoing procedures such as appendectomy and laparotomy require a physical visit after discharge since they are more susceptible to develop complications requiring interventions. By selecting patients for physical visit, we can potentially eliminate unnecessary visits in patients who have low chance of developing complications.

A systematic review of the techniques for automatic segmentation of the human upper airway using volumetric images

The human upper airway is comprised of many anatomical volumes. The obstructions in the upper airway volumes are needed to be diagnosed which requires volumetric segmentation. Manual segmentation is time-consuming and requires expertise in the field. Automatic segmentation provides reliable results and also saves time and effort for the expert. The objective of this study is to systematically review the literature to study various techniques used for the automatic segmentation of the human upper airway regions in volumetric images. PRISMA guidelines were followed to conduct the systematic review. Four online databases Scopus, Google Scholar, PubMed, and JURN were used for the searching of the relevant papers. The relevant papers were shortlisted using inclusion and exclusion eligibility criteria. Three review questions were made and explored to find their answers. The best technique among all the literature studies based on the Dice coefficient and precision was identified and justified through the analysis. This systematic review provides insight to the researchers so that they shall be able to overcome the prominent issues in the field identified from the literature. The outcome of the review is based on several parameters, e.g., accuracy, techniques, challenges, datasets, and segmentation of different sub-regions. Flowchart of the search process as per PRISMA guidelines along with inclusion and exclusion criteria.

Exploring internet addiction and its associated factors among college students in Western Rajasthan, India: A mixed-methods study

Background

With near universal use of internet by college students, there is propensity for internet addiction (IA) among them. This study aimed to estimate the prevalence and predict the factors for internet addiction among college students in Jodhpur, Rajasthan, India, and qualitatively explore the factors associated with internet addiction.

Materials and Methods

Explanatory sequential (QUAN-QUAL) mixed-methods design was used. A cross-sectional questionnaire-based survey was conducted among three streams of undergraduate colleges (health, engineering, and others). Survey instruments included Young's internet addiction test (IAT), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety, and Stress Scale-21 (DASS-21) Items. Focus group discussions (FGDs) and in-depth interviews (IDIs) among the students with mild-to-moderate levels of addiction were conducted to understand the reasons for excessive internet use.

Results

The prevalence of internet addiction (IA) among the college students was 51% and the rates for mild, moderate, and severe addiction were 31.8%, 18.5%, and 0.7%, respectively. Predictors of IA were male gender, age in years, age of first internet use in years, urban origin, accessing internet at college, mobile internet use, using internet to make online friendship, sleep disturbance, depression, anxiety, and stress. Qualitative study identified five major themes related to situations initiating internet use for nonacademic purpose, content of internet use, triggers for internet overuse/addiction (IA), perceived impact of IA, and measures to overcome IA.

Conclusions

Internet addiction was found to be highly prevalent in college students across various streams. Qualitative results provide deeper insights into IA among college students. It is imperative to screen for IA among the students and devise suitable preventive interventions, which can be easily implemented at community level.

Psychosocial well-being and quality of life in women with breast cancer in foothills of North India

Introduction

Breast cancer remains a leading cause of unintended death among Indian women. Cancer treatment-induced pain, fatigue, nausea/vomiting, body image, and sexual problems could affect the patient psychosocial well-being and quality of life (QOL). The study aims to determine the QOL and psychosocial well-being among women with breast cancer.

Materials and Methods

A cross-sectional survey completed by 244 women with breast cancer at a tertiary level teaching hospital. The European Organisation for Research and Treatment of Cancer QOL Questionnaire C30, the Breast Module (QLQ-BR23), and the Hospital Anxiety and Depression Scale (HADS) is used to measure the QOL, and psychological well-being, respectively. Appropriate descriptive and inferential statistics are applied to compute the results.

Results

The total number of women with breast cancer interviewed was 244, with a mean age of 45.06 (standard deviation ± 11.17) years. The mean global health score was 70.97 ± 15.63. As per the QLQ-C30 scale, "physical functioning" scored the highest (70.54 ± 22.00), and "role functioning" reported the lowest (49.45 ± 36.15) mean score. Further, on the QLQ-C30 symptoms scale, "appetite loss" (45.09 ± 35.09) was the worst reported symptom, followed by "nausea and vomiting" (34.97 ± 38.39). On the BR-23 scale, body image said (68.42 ± 22.28) higher score than other domains and experience of arm-related problems (43.80 ± 26.06) were more frequently reported symptom in women. As per the HADS scale, 24.6% and 36.1% of women were in moderate anxiety and depression, respectively. The mean HADS score was 14.39 ± 5.82. Findings on predictors for the individual patient remained the same as that earlier published literature.

Conclusions and Recommendations

Women with breast cancer have an overall good QOL and poor psychosocial well-being. However, using a holistic approach, including identifying psychological problems and their time management, signifies the need for the studied population.

Assessment of the Effect of Phototherapy and PRP on the Immediate Implants: An Original Research

Immediate implants have been gaining popularity in recent times. There are many adjuvant techniques that are followed before implant placement, which have recently shown hopeful results. For this reason, the current comparative study analyzes the effectiveness of platelet-rich plasma (PRP) and photofunctionalization (PF) at a tertiary care dental hospital. In the current clinical trial, 30 subjects were grouped equally to receive immediate dental implants, with one group in which pretreatment of the extraction site was done with the auto-PRP and PF, while the control group received no pretreatment. For 12 months after the placement of the implant, the subjects were observed for alterations in the parameters. The variables analyzed were survival, esthetics, biological integration, and finally the success of the implants in each group. Values were noted and compared using the appropriate statistical tools, while keeping the level of significance at P < 0.05. For the variables of esthetics and survival, no substantial differences were observed in the PRP and PF groups. There was no difference between these experimental groups and the control group. However, there were significant differences for the biological variable as there was more marginal bone loss in the experimental groups. On the whole, the success was greater for the experimental groups than the control group, though not significant. The pretreatment protocols using PRP and PF have shown to improve some characteristics of the immediate implants in the anterior regions. However, further studies are suggested.

Comparison of the efficacy of ultrasound guided pectoralis-II block and intercostal approach to paravertebral block (proximal intercostal block) among patients undergoing conservative breast surgery: A randomised control study

Background and Aims

Regional anesthesia techniques have attributed a multimodal dimension to pain management after breast surgery. The intercostal approach to paravertebral block has been gaining interest, becoming an alternative to conventional paravertebral block, devoid of complexities in its approach, being recognized as the proximal intercostal block. Parallel to the widespread acceptance of fascial plane blocks in breast surgery, pectoralis II block has emerged as being non-inferior to paravertebral block. The aim of this study was to evaluate the efficacy of two independent fascial plane blocks, proximal intercostal block and pectoralis II block, in breast conservation surgery.

Material and Methods

This prospective, randomized control, pilot study included 40 patients, randomly allocated among two groups: proximal intercostal block and pectoralis II block.

Results

The pectoralis II block group had significantly lower pain scores at rest in the immediate postoperative period but became comparable with the proximal intercostal block group in the late postoperative period. Pain scores on movement though were lower at 0 h postoperatively and became comparable with the proximal intercostal block group subsequently. Although the pectoralis II group had earlier recovery in the post-anesthesia care unit, the overall time to discharge from the hospital was comparable and not influential. Both groups had high patient satisfaction scores and similar perioperative opioid consumption. Sedation, time to first rescue analgesia, and postoperative nausea vomiting scores were comparable.

Conclusion

Fascial plane blocks in the form of pectoralis II and proximal intercostal block facilitate pain alleviation, early return to shoulder arm exercise, and enhanced recovery, which should render them to be incorporated into multimodal interdisciplinary pain management in breast conservation surgery.

Paddy-Straw-Derived Graphene Quantum Dots Reinforced Vertical Aligned Zinc Oxide Nanosheet-Based Flexible Triboelectric Nanogenerator for Self-Powered UV Sensors and Tribotronics Application

Herein, we report the paddy-straw-derived graphene quantum dots (GQDs)-reinforced vertical-aligned two-dimensional (2D) ZnO nanosheet-based flexible triboelectric nanogenerator (FTNG) for scavenging mechanical energy for the first time. The GQDs (diameter ∼5-7 nm) and ZnO nanosheets were grown using a hydrothermal method and seed-assisted chemical route, respectively. The X-ray diffraction and electron microscopy results confirmed the formation of a hexagonal wurtzite crystal structure and vertical-aligned morphology of 2D ZnO nanosheets. The GQD-reinforced ZnO-nanosheet-based FTNG device generated an output voltage of 40 V and current density of 2 μA/cm², respectively, whereas pristine vertical-aligned ZnO-nanosheet-based device produced an output voltage of only 16 V and a current density of 0.36 μA/cm², respectively. The performance of the GQD-ZnO nanosheet FTNG device was also measured under illumination of the UV light, and a drastic increase in the output voltage is observed as compared to a pristine ZnO-nanosheet-based device. The GQD-reinforced ZnO nanosheets exhibited very high dielectric constant of 40 at low frequency side. The current finding suggested a novel approach to efficiently harvest mechanical energy and a novel method to fabricate the self-powered UV sensors and tribotronics devices using agrowaste-derived GQDs and ZnO nanosheets.

Musculoskeletal disorders among doctors and nursing officers : an occupational hazard of overstrained healthcare delivery system in western Rajasthan, India

BACKGROUND

The present study was conducted to estimate the prevalence and distribution of MSDs in different anatomical regions among Doctors and NO and to determine their ergonomic risk factors and predictors.

METHODS

This cross-sectional study was conducted in an apex institution in Western India. The socio-demographic information, medical and occupational history, and other personal and work-related attributes were captured using a semi-structured questionnaire, which was developed and finalized by piloting on 32 participants (who were not part of the study). Nordic Musculoskeletal and International Physical Activity Questionnaires were used to assess MSDs and Physical activity. Data were analyzed using SPSS v.23. Prevalence of Musculoskeletal Symptoms (M.S.), Multisite Musculoskeletal Symptoms (MMS), and Widespread Musculoskeletal Symptoms (WMS) were calculated. A comparison was made to estimate the burden and distribution of MSD among Doctors and Nursing officers. Logistic regression was applied to identify the predictors of MSDs and pinpoint the risk factors associated with MSDs.

RESULTS

A total of 310 participants, of which 38.7% were doctors, and 61.3% were Nursing Officers (NOs) were included in the study. The mean age of the respondents was 31.63 ± 4.9 years. Almost 73% (95%CI: 67.9-78.1) of participants had MSD in the last 12 months, with approximately 41.6% (95%CI: 36.1-47.3) suffering from MSDs in the previous seven days of the survey. The lower back (49.7%) and the neck (36.5%) were the most affected sites. Working in the same position for a long time (43.5%) and not taking adequate breaks (31.3%) were the highest self-reported risk factors. Females had significantly higher odds of having pain in the upper back [aOR:2.49(1.27-4.85)], neck [aOR:2.15(1.22-3.77)], shoulder [aOR:2.8 (1.54-5.11)], hips [aOR:9.46 (3.95-22.68)] and knee [aOR:3.8(1.99-7.26)].

CONCLUSIONS

Females, who are NOs, work for > 48 h per week, and fall in the obese category were significantly at more risk of developing MSDs. Working in an awkward position, treating an excessive number of patients in a day, working in the same position for a long period, performing repeated tasks, and not having enough rest breaks were significant risk factors for MSDs.

HIF 1 α - a promising target for the treatment of meningiomas

Background

Meningiomas are the most frequent tumors of the brain and spinal cord with a potency to recur in around one third of the cases and and invade surrounding tissue. Hypoxia driven factors like HIFs (Hypoxia inducible factors) are implicated in tumor cell growth and proliferation.

Aim

This study aims at determining the association of HIF 1 α with different histopathological grades and types of meningiomas.

Methods

This prospective study was conducted on 35 patients. The patients presented with headache (65.71%), seizures (22.86%) and neurological deficits (11.43%). They underwent surgical excision and surgical tissue samples of these patients were histopathologically processed and microscopically graded and typed. Immunohistochemistry was performed using anti-HIF 1α monoclonal antibody. The nuclear expression of HIF 1 α was graded as <10%: negative, 11-50%: mild to moderate positive, >50%: strong positive.

Results

Of the 35 cases so examined 20% were recurrent; 74.29% were WHO grade I with meningothelial type (22.86%), being the commonest; 57.14 % revealed mild to moderate positivity for HIF 1α, while strong positivity was noted in 28.57%. Significant association was found between WHO grade and HIF 1α (p=0.0015) and between histopathological types and HIF 1α (p=0.0433). Furthermore, HIF 1α was also significantly associated with the recurrent cases (p=0.0172).

Conclusion

HIF 1α appears to be a marker and a promising target for effective therapeutics in meningiomas.

An efficient approach to extract nanocrystalline cellulose from sisal fibers: Structural, morphological, thermal and antibacterial analysis

Nanocellulose has been proposed by many researchers as a suitable bio-reinforcement material for the development of sustainable bio-nanocomposites in advanced applications due to its excellent properties. Conventional techniques for extracting nanocellulose from plant biomass are time-consuming and involve chemical wastage. This study aims to extract nanocellulose using simple processes with minimal consumption of chemicals in a minimum time. In the present work, cellulose nanocrystalline has been extracted from sisal fibers efficiently by chemical treatment assisted with steam explosion and mechanical grinding. The morphology of extracted sisal cellulose nanocrystalline (CNC-S) was analyzed by FESEM, whereas the DLS, TEM and AFM confirmed its nanosize. The average aspect ratio and zeta potential (ζ) of CNC-S were measured as 7.4 and -14.3 mV, respectively. The XRD analysis indicated that the crystallinity of the fibers considerably improved from 48.74 % for untreated fibers (UT-S) to 74.28 % for CNC-S. The chemical structure of the fibers was changed as hemicellulose and lignin were found to be eliminated after the chemical treatment which FTIR confirmed. From TGA-DTG results, it was observed that CNC-S has good thermal stability. It was also noticed that CNC-S did not show any antibacterial properties against E. coli and S. aureus due to the complete removal of lignin. This study suggests that the present extraction process can be considered as an efficient process to convert fibers into high performance nanocellulose to be used as potential reinforcing material in advanced applications.

Does change in the shape of intrauterine contraceptive device Cu 375 and Cu T 380A affect the expulsion after post-partum insertion - a prospective randomized control trial

PURPOSE

The objective of the study was to see the difference in expulsion rates of two types of Copper containing intrauterine contraceptive devices (IUCDs): Cu 375 & CuT 380 A, within or at 6 weeks after insertion.

METHODS

It was a randomised control trial. A total of 396 pregnant women were recruited. Ultrasonography was done to look for the position of the IUCD at the time of discharge and at six weeks follow-up and the expulsion rate was calculated.

RESULTS

Amongst 396 participants, 22 PPIUCDs were expelled completely at 6 weeks (modified intention to treat analysis [ITA]), 10 (5.3%) and 12 (6.7%) in the Cu 375 and CuT 380 A groups respectively. The expulsion rate was 6.02%. However, this difference was not statistically significant. When ultrasonologically assessed partial expulsions were also considered, the total expulsion rate in both groups (14.3% and 14.1% respectively) was also not significantly different. The expulsion rate was higher in the vaginal delivery group (10.7%) than in the caesarean section (3.6%) group (p = 0.007) and early postpartum insertion 12.3% than in the immediate post-placental insertion group, 3.7% (p = 0.002).

CONCLUSIONS

The study concluded that the altered shape of Cu 375 has effectively no role in decreasing the expulsion rate. Placement of IUCD at or near the uterine fundus immediately after delivering the placenta (post-placental) decreases the expulsion rate, thereby increasing the contraceptive efficacy.SHORT CONDENSATIONThe altered shape of Cu 375 has effectively no role in decreasing the expulsion rate. Placement of IUCD at or near the uterine fundus immediately after delivering the placenta (post-placental) decreases the expulsion rate, thereby increasing the contraceptive efficacy.

Is telemedicine a holy grail in healthcare policy: clinicians' and patients' perspectives from an Apex Institution in Western India

BACKGROUND

This study aimed to explore the perception of doctors regarding telemedicine consultations and the level of patient satisfaction with the services received through teleconsultations.

METHODS

This cross-sectional study was conducted on clinicians who provided teleconsultations and patients who received teleconsultations in an Apex healthcare institution in Western India. Semi-structured interview schedules were used to record the quantitative and qualitative information. Clinicians' perceptions and patients' satisfaction were assessed using two different 5-point Likert scales. Data were analyzed using SPSS v.23 using non-parametric tests (Kruskal Wallis and Mann-Whitney U).

RESULTS

A total of 52 clinicians who delivered teleconsultations and 134 patients who received teleconsultations from those doctors were interviewed in this study. For 69% of doctors, telemedicine was feasible to implement, and for the rest, it was challenging. Doctors believe telemedicine is convenient for patients (77%) and prevents the transmission of infection (94.2%). Difficulty in clinical evaluation (73%), communication (55.7%), network connectivity (34%), diagnosis and investigations (32%), and patients' e-illiteracy (32%) were the most common challenges faced by clinicians. Patients' experiences were positive in terms of ease of registration (82.1%), audio quality (100%), freedom to discuss medicine (94.8%), and comprehension of the diagnoses (88.1%). Patients expressed satisfaction with the length of the teleconsultation (81.4%), the advice and care they received (78.4%), and the manner and communication of the clinicians (78.4%).

CONCLUSIONS

Though there were some challenges in the implementation of telemedicine, the clinicians perceived it quite helpful. The majority of the patients were satisfied with teleconsultation services. Difficulty in registration, lack of communication, and a deep-rooted mindset of physical consultations were the primary concerns from the patient side.

Integration of Pre-Treatment with UF/RO Membrane Process for Waste Water Recovery and Reuse in Agro-Based Pulp and Paper Industry

This recent study aims to evaluate the efficacy of membrane filtration on recovery of water resource from agro-waste such as bagasse, crop-based pulp and paper mill waste. A mini pilot scale membrane system having a combination of pre-treatment filter unit (pre-filter, sediment filter and pre-carbon filter), ultra-filtration and reverse osmosis with spiral wound configuration were employed to evaluate the water reuse efficacy of effluent coming from the secondary clarifier of the conventional treatment plant of the mill. The operational conditions were optimized using Taguchi method at pH 8, temperature 32 °C, and pressure 2 bar and a flow rate of 60 l/hr. The qualities of the effluent from the secondary clarifier, and the permeate from both the combination, viz. Combination 1 (pre-treatment + ultra-filtration) and Combination 2 (pre-treatment + ultra-filtration+ reverse osmosis) were analyzed and the percentage reduction in pH, TDS, TSS, BOD, COD, Color, Lignin, Potassium and Sodium were calculated. The elimination of TDS, COD and BOD with Combination 1 was not promising (<22%). However, the installation of a RO membrane greatly reduced (>88%) the contaminants in both paper mill effluents. The obtained qualities of water from all the combinations were compared with the tolerance standard for reuse as process water. The quality of effluent from the secondary clarifier did not agree with any class of water quality. The permeate from the combination of pre-treatment and UF sufficiently reduced the TSS to reach the requirement. However, the combination of (pre-treatment + UF + RO) adequately complied with the quality standard required for reuse in the making of all grades of paper.

Pathological and molecular studies on elephant endotheliotropic herpesvirus haemorrhagic disease among captive and free-range Asian elephants in India

In the present research pathology and molecular diagnosis of elephant endotheliotropic herpes virus-haemorrhagic disease (EEHV-HD) among Asian elephants was studied. Out of 76 cases, 20 were positive for EEHV infection in PANPOL and POL1 based semi-nested PCR. Out of 20 samples, 10 samples were fatal cases of EEHV-HD while 10 were of either subclinical or latent infection. Acute onset haemorrhagic disease with EEHV-HD had anorexia, facial and neck swelling, cyanotic buccal mucosa and tongue, nasal and ocular discharge, and colic. The hallmark of gross finding in all cases were severe haemorrhagic lesions in the internal organs viz. cyanosis of tongue with multifocal petechial haemorrhages, diffuse epicardial and endocardial haemorrhages, swollen liver (rounded edges) with parenchymal haemorrhages, serosal and mucosal haemorrhages in gastrointestinal tract, congested kidneys with corticomedullary haemorrhages, highly congested meninges, and brain capillaries with haemorrhages. Microscopic findings in all the cases had severe vascular changes in the visceral organs. Microthrombi was present in the vasculature of tongue, heart, lung, liver, kidney, and brain. The endothelial lining of most of the blood vessels were swollen with apoptotic changes. Amphophilic to basophilic intranuclear inclusion bodies were observed in the endothelial cells. Immunostaining using anti-EEHV DNAPOL hyperimmune sera revealed intense positive signals in the endothelium of blood vessels and their walls. Quantification of viral load in necropsy tissue samples revealed highest in the heart (7.4 × 10⁶/μg of sample) and least in the brain (9 × 10³/μg of sample). The PCR amplicons from EEHV1 specific genes (POL1(U38) and TER were subjected to partial genome sequencing which had 99.9% similarity with the EEHV1A subtype. It was concluded that Asian elephants in India are latently infected for EEHV1 and in all the fatal EEHV-HD cases, EEHV1A subtype was the causative agent with characteristic pathomorphological changes in visceral organs.

Next-generation development and application of codon model in evolution

To date, numerous nucleotide, amino acid, and codon substitution models have been developed to estimate the evolutionary history of any sequence/organism in a more comprehensive way. Out of these three, the codon substitution model is the most powerful. These models have been utilized extensively to detect selective pressure on a protein, codon usage bias, ancestral reconstruction and phylogenetic reconstruction. However, due to more computational demanding, in comparison to nucleotide and amino acid substitution models, only a few studies have employed the codon substitution model to understand the heterogeneity of the evolutionary process in a genome-scale analysis. Hence, there is always a question of how to develop more robust but less computationally demanding codon substitution models to get more accurate results. In this review article, the authors attempted to understand the basis of the development of different types of codon-substitution models and how this information can be utilized to develop more robust but less computationally demanding codon substitution models. The codon substitution model enables to detect selection regime under which any gene or gene region is evolving, codon usage bias in any organism or tissue-specific region and phylogenetic relationship between different lineages more accurately than nucleotide and amino acid substitution models. Thus, in the near future, these codon models can be utilized in the field of conservation, breeding and medicine.

Exploring frailty and its domains - Systematic mapping of the literature

Background

'Frailty' has no consensual definition till date, although the term occupies a pivotal role in geriatric medicine. A bibliometric analysis of the literature serves to capture the keyword cooccurrences and linkages, co-citations, author collaborations, research trends and to present the extant research in a nutshell.

Objective

To explore the usage of frailty, its domains in medical research and the evolution of the term to other disciplines through systematic mapping by bibliometric analysis.

Methods

Literature search was done in the Scopus database using a pre-formed search strategy. 2629 documents were retrieved. Co-occurrence citation analysis using keywords and link strength was obtained using the VOSviewer ver.1.6.16. A three-field plot was constructed using 'biblioshiny' package of the R-studio to identify the various domains of frailty. Descriptive statistics were applied to identify the trends in frailty research, number of contributions from countries, fields of research involving frailty.

Results

Total of 3739 publications were observed, with the USA having most number of contributions (740, 20%) as single country, while India has only 19 contributions (0.5%) in the past 20 years. As a region, Europe and Central Asia contributed to the maximum (1714, 46.4%), most of them being from the high-income countries. Research on frailty has steadily increased over the past two decades, with most of the researches being conducted in the fields of Medicine, Biochemistry and Genetics. Cooccurrence citations and three-field plots indicate the evolving usage of frailty in other domains, such as cognition, mental health, indicators of survival, risk assessment, mortality, and quality of life.

Conclusion

Upon exploring frailty, it also makes one wonder if frailty could be the cause for what is known as death due to 'natural causes' or 'old age'. The implementation of extension codes in the ICD-11 related to 'Ageing' (XT9T) and 'Old Age' (MG2A), paves way for researchers to further explore 'frailty' as a cause of mortality.

Application of Indian Diabetic Risk Score (IDRS) and Community Based Assessment Checklist (CBAC) as Metabolic Syndrome prediction tools

BACKGROUND

Indian Diabetic Risk Score (IDRS) and Community Based Assessment Checklist (CBAC) are easy, inexpensive, and non-invasive tools that can be used to screen people for Metabolic Syndrome (Met S). The study aimed to explore the prediction abilities of IDRS and CBAC tools for Met S.

METHODS

All the people of age ≥30 years attending the selected rural health centers were screened for Met S. We used the International Diabetes Federation (IDF) criteria to diagnose the Met S. ROC curves were plotted by taking Met S as dependent variables, and IDRS and CBAC scores as independent/prediction variables. Sensitivity (SN), specificity (SP), Positive and Negative Predictive Value (PPV and NPV), Likelihood Ratio for positive and negative tests (LR+ and LR-), Accuracy, and Youden's index were calculated for different IDRS and CBAC scores cut-offs. Data were analyzed using SPSS v.23 and MedCalc v.20.111.

RESULTS

A total of 942 participants underwent the screening process. Out of them, 59 (6.4%, 95% CI: 4.90-8.12) were found to have Met S. Area Under the Curve (AUC) for IDRS in predicting Met S was 0.73 (95%CI: 0.67-0.79), with 76.3% (64.0%-85.3%) sensitivity and 54.6% (51.2%-57.8%) specificity at the cut-off of ≥60. For the CBAC score, AUC was 0.73 (95%CI: 0.66-0.79), with 84.7% (73.5%-91.7%) sensitivity and 48.8% (45.5%-52.1%) specificity at the cut-off of ≥4 (Youden's Index, 2.1). The AUCs of both parameters (IDRS and CBAC scores) were statistically significant. There was no significant difference (p = 0.833) in the AUCs of IDRS and CBAC [Difference between AUC = 0.00571].

CONCLUSION

The current study provides scientific evidence that both IDRS and CBAC have almost 73% prediction ability for Met S. Though CBAC holds relatively greater sensitivity (84.7%) than IDRS (76.3%), the difference in prediction abilities is not statistically significant. The prediction abilities of IDRS and CBAC found in this study are inadequate to qualify as Met S screening tools.

Death, Disability, and Premature Life Years Lost Due to Cigarettes, Bidis, and Smokeless Tobacco in India: A Comparative Assessment

BACKGROUND

Due to the staggering number of tobacco users in India, it is important to determine the exact mortality and morbidity rates due to tobacco use. This study aimed to estimate deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) attributable to cigarettes, bidis, and smokeless tobacco (SLT) in India.

METHODS

Data pooling and meta-analysis were done using case-control studies available on the three types of tobacco products. Health burden was estimated by applying the population attributable fraction (PAF) value to the total disease burden.

FINDINGS

A total of 33 studies were included. PAF was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT. Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 deaths; bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths, and SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually.

CONCLUSION

Evidence of measurable health burden and methodology for calculation for individual states was provided in the study. The generated evidence could be utilized for policy recommendations and revision of the existing taxation norms.

Forensic tool for sex prediction- hand dimensions

Background: Determination of sex from mutilated body fragments can perform vital role for identification of departed soul.Forensic authority pacts with human identification from the hand measurements which is of prodigious assessment during tragedies, terror attacks and in criminality. Objective: Present study explored the analytical role of the anthropometric measurements of hand dimensions, find demarking points for male and female, check percentage exactitude of sex determination in Western Indian population. Methods: The study was piloted on a sample of 504 individuals. All the measurements were taken by standard procedure. Discriminant analysis and demarking points were created for all hand measurements. Results: Males have a significantly higher values of all measurements than females. The left-hand length measurement unveiled  noteworthy sexual dimorphism index (110.80). The higher value of the demarking point labelled as males. The best sexually dimorphic hand dimensions showed the utmost precision left hand length (95% in the male), followed by right hand length (76.1%). Conclusion: All hand measurements like length, breadth and index are displaying sexual dimorphism, hence they can be used for determination of sex when isolated hand is found.Keywords: Hand measurements; sexual dimorphism; demarking point; discriminant analysis.

Assessing attitude towards condom use among truck drivers at transhipment location, Meerut District, India, using multidimensional condom attitude scale

Background: In India, unsafe sex has been documented among truck drivers. This study explores the factors influencing their attitude of trucker towards condom use.Methods: A cross-sectional study design was adapted for this study in which 25 factors were chosen to assess attitude toward condom use on 7 point validated Likert scale UCLA Multidimensional Condom Attitude Scale on 5 subcomponents –Reliability, Pleasure, Stigma associated with condom use, embarrassment about negotiation and use of condom and about purchasing condom. Hundred truck drivers were recruited using convenient sampling and Mann-Whitney U and Kruskall Wallis Test were used to validate the subcomponents among those practicing unsafe sex. Results: Positive attitudes regarding reliability and effectiveness of condom were significantly higher among adult entrants and those resting more than 10 hours during journey whereas positive attitude regarding pleasure associated with condoms and stigma towards it is significantly higher among truck drivers travelled long distances and resting more than 10 hours. Conclusion: Adolescent entrants, those who have not travelled long distances and not rested more than 10 hrs requires improvement in the attitude towards condom use. Keywords: Unsafe sex; condom use; India.

An overview of One and Two Carbon Homologation and Homologation-Functional Group Interconversion Reactions in Organic Synthesis

Abstracts:

The extension of carbon chains, known as homologation, is one of the most fundamental operations of organic synthesis. One and two-carbon homologation reactions are of immense importance because they can be used for synthesizing members of a homologous series by iterative operations. Homologation reactions produce higher analogues of the same functional group, whereas homologation-functional group interconversion (FGI) generates higher analogues with a change in functionality. This general synthesis strategy may be counted for a number of reasons, such as higher accessibility to the successive homologs, a chance for the introduction of additional functionality, or solely to create a regular series of homologs. The advantages of homologation reactions could be measured by the efficiency, technical simplicity, and regio- and/or stereo-selectivity of the overall operations in a synthetic plan. Homologation reactions constitute powerful and versatile tools for preparative chemistry which uses different concepts underpinning the use of homologating reagents in addition to their applications in organic synthesis. A compilation and comparison of diverse methods available for homologation cum functional group interconversion will empower synthetic chemists to undertake studies that require a series of analogues. In this review, we have categorized and summarized such methods and synthetic applications of one and two-carbon homologation-functionalization of various functional groups in organic synthesis.

Challenges in the Implementation of the Rajasthan Pneumoconiosis Policy

OBJECTIVES

"Silicosis" is a leading cause of occupational morbidity globally. In Rajasthan, India silicosis has been recognized as an epidemic, resulting in the development of a new pneumoconiosis policy in 2019. This study was conducted to provide an overview of the policy implementation regarding the detection, prevention, and control of silicosis.

METHODS

A qualitative study was carried out in the Jodhpur district of Western Rajasthan in which stakeholders were interviewed. Themes were identified regarding prevention, detection, diagnosis, and certification, and organized by stakeholder role. Data were retrieved from the Silicosis Grant Disbursement Portal of the Government of Rajasthan to present an overview of the existing system for detection, prevention, and control of silicosis and to determine the delays in various aspects.

RESULTS

A total of 35 stakeholders were interviewed. There was low awareness regarding the prevention, detection, diagnosis, and rehabilitation of silicosis amongst multiple stakeholders. There is a need for robust enforcement in mining units regarding silicosis prevention and screening. Unregistered mining activities and migration of mineworkers are major challenges in the detection of silicosis cases. Misdiagnosis and low notification rates prevent workers from accessing resources. There are myriad reasons for delays in workers receiving diagnosis and benefits, which have systemic roots but can be uprooted through rigorous implementation of the legislative provisions.

CONCLUSION

There are several well-established pieces of legislation to protect the rights of mineworkers; however, there are gaps in the effective implementation of various provisions that require immediate attention to address the challenges faced during the prevention, detection, diagnosis, and rehabilitation of workers with silicosis.

Extremely Reduced Dielectric Constant and Band Gap Enhancement in Few-Layered Tungsten Disulfide Nanosheets

Highly crystalline few-layered tungsten disulfide (WS₂) nanosheets were synthesized via a cost-effective, low-temperature hydrothermal route. X-ray diffraction and HR-TEM analysis confirmed the formation of hexagonal nanosheets with thickness of ∼6-8 nm. Raman analysis and AFM results confirmed the few-layered 2H phase of WS₂ nanosheets. The UV-vis study shows absorption peaks at 219 and 271 nm with large band gap value of ∼3.12 eV for WS₂ nanosheets. Surprisingly, WS₂ nanosheets show a dielectric constant of approximately ε' ≈ 5245, whereas bulk WS₂ material exhibits a dielectric constant of 7482373. An almost 1426-fold decrease in the value of dielectric constant for the WS₂ nanosheet is observed. Such an extreme reduction in dielectric constant and observance of large band gap in WS₂ nanosheet were observed for the first time. The present study reveals the excellent and unusual optical and dielectric properties for their potential application in optoelectronic, dielectric, solar, phosphor, and various nanoelectronic devices.

Targeted proteomics identifies circulating biomarkers associated with active COVID-19 and post-COVID-19

The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the highly infectious Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). There is an urgent need for biomarkers that will help in better stratification of patients and contribute to personalized treatments. We performed targeted proteomics using the Olink platform and systematically investigated protein concentrations in 350 hospitalized COVID-19 patients, 186 post-COVID-19 individuals, and 61 healthy individuals from 3 independent cohorts. Results revealed a signature of acute SARS-CoV-2 infection, which is represented by inflammatory biomarkers, chemokines and complement-related factors. Furthermore, the circulating proteome is still significantly affected in post-COVID-19 samples several weeks after infection. Post-COVID-19 individuals are characterized by upregulation of mediators of the tumor necrosis (TNF)-α signaling pathways and proteins related to transforming growth factor (TGF)-ß. In addition, the circulating proteome is able to differentiate between patients with different COVID-19 disease severities, and is associated with the time after infection. These results provide important insights into changes induced by SARS-CoV-2 infection at the proteomic level by integrating several cohorts to obtain a large disease spectrum, including variation in disease severity and time after infection. These findings could guide the development of host-directed therapy in COVID-19.

Investigating the effect of density variation on pitch angle scattering events of runaway electrons as observed through electron cyclotron emission diagnostic at Aditya-upgrade tokamak

Nascent observations about the influence of kinetic instabilities on electron cyclotron emission (ECE) from runaway electrons (REs) have been detected and explored at the Aditya-Upgrade (Aditya-U) tokamak. The developed broadband ECE radiometer system offers wideband measurements by integrating several radio frequency units with a fixed intermediate frequency receiver with multiple channels, which is a novel approach to meet the needs of the localized measurements at various toroidal fields and extend the system dynamic range. The low density (n_e ≤ 1 × 10^-19 m^-3) plasma discharges at Aditya-U are consistently accompanied by a 20%-40% increase in the ECE radiometer signal amplitude within 100 µs and sporadic step-like modulations. The Pitch Angle Scattering (PAS) of REs induced by kinetic instabilities is a potential candidate for their occurrence. This steep jump in the radiometer signals was detected due to its high temporal resolution of 10 µs. A "PREDICT" code that employs the relativistic test particle model validates these experimental findings of the radiometer diagnostic for the first time for Aditya-U tokamak. Preliminary observations of the ECE radiometer signals also show that additional gas puffs can be used to vary the trigger timings of such PAS events or even lead to their complete avoidance.

Barriers and facilitators to COVID-19 screening at Jaipur International Airport, India

Background

Airports pose a possible threat in facilitating global disease transmission within the community which may be prevented by rigorous systematic entry-exit screening. This study captures the perception of stakeholders on barriers and facilitators of coronavirus disease 2019 (COVID-19) screening. Further, key outcomes viz. total passengers screened, suspected cases, and confirmed cases were assessed.

Methods

An inductive-deductive mix-method thematic analysis was conducted to capture qualitative data of key stakeholders on COVID-19 disease screening at Jaipur International Airport. Additionally, secondary data retrieved from Rajasthan Medical & Health Department team deployed for COVID-19 airport screening were analyzed.

Results

Jaipur International Airport screened 4565 passengers (Males = 4073 and Females = 492) with 23 suspected cases during an outlined period of declaration of Pandemic to Lockdown in India (11 to 24 March 2020). Total 65 passengers had travel history from China (3 from Wuhan). The mean average age of passengers was 40.95 ± 7.8 years. The average screening time per passenger was 2-3 min with a load of 25-90 passengers per team per flight. Fishbone analysis of screening challenges revealed poor cooperation of passengers, masking symptoms, apprehension, and stigma related to quarantine. Moreover, inadequate human resources and changing guidelines overburdened healthcare providers. But, perception of risk, and social responsibility of travelers together with supportive organization behavior act as facilitators. Overall, groundwork on airport screening was insightful to propose key action areas for screening.

Conclusions

Globally, COVID-19 has an impact on health infrastructure and international travel. International coordination with streamlined screening will go an extended way in virus containment.