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An authoritative account of the causes of infertility that fully explores the clinical assessment of patients and covers the decision-making behind treatment options. The content follows the MRCOG syllabus as well as delving deeper into subjects covered by the RCOG Advanced Training Skills Modules (ATSMs), leaving readers well prepared for their examinations. Written by nationally recognised leaders in the field, this volume concisely reviews contemporary clinical practice. Using an aetiology-based approach, chapters discuss ovulatory dysfunction, endometriosis, male infertility, uterine/tubal factors and unexplained infertility. The increasing use of third-party reproduction and surrogacy is explored, along with the psychosocial aspects of this type of treatment. Ethical dilemmas surrounding reproductive medicine and their management are covered in depth. With an emphasis on practical approaches to the delivery and organisation of clinical and laboratory services, readers learn how to ensure the support and care they offer is of the highest quality.
This study extends the extant literature on corporate philanthropy by exploring the indirect effect of physical attractiveness of CEOs on corporate philanthropy under conditional effects of family ownership and control. Recent empirical studies in psychology suggest that egalitarian values are negatively related to physical attractiveness. Based on these findings, we propose that physically attractive CEOs invest less in corporate philanthropic activities than less attractive peers as they have lower egalitarian values. Leveraging upper echelons and stewardship theory, we further consider the moderating impact of family ownership and control on the indirect relationship between the physical attractiveness of a CEO and philanthropy mediated through egalitarianism.
Magical realism is a world literary genre that stages and enables radical crossing of illicit boundaries. Intradiegetically, the mode explores questions of faith on the same ontological level as rationality. In the Arabic and Hebrew-Mizrahi contexts, magical realism serves to puncture the purportedly rational language of the state with the fantastic as a vehicle of minoritarian empowerment. These texts narrate subaltern histories without constantly reproducing the hegemonic language of Othering and subjugation. They disrupt dominant national, ethnic, religious, racial and gender historiographies and ontologies in their respective contexts, but this disruption is all the more powerful when Arabic and Hebrew texts are placed in relation extradiegetically. The networks of relationality created by this dual reading allow us to see ‘Arabness’ with the proverbial third eye – from the positions of minority and majority simultaneously, thereby allowing for a complex, textured and multifaceted understanding of its identitarian and performative meanings.
The progressions in the field of wireless technology can be highly attributed to the development of antennas, which can access high data rates, provide significant gain and uniform radiation characteristics. One such antenna called the Vivaldi antenna has attracted the utmost attention of the researchers owing to its high gain, wide bandwidth, low cross-polarization, and stable radiation characteristics. Over the years, different procedures have been proposed by several researchers to improve the performance of the Vivaldi antennas. Some of these different approaches are feeding mechanisms, integration of slots, dielectric substrate selection, and radiator shape. Correspondingly, the performance of a Vivaldi antenna can be increased by including dielectric lens, parasitic patch in between two radiators, corrugations, as well as metamaterials. This paper gives a systematic identification, location, and analysis of a large number of performance enhancement methods of Vivaldi antenna design depicting their concepts, advantages, drawbacks, and applications. The principal emphasis of this article is to offer an outline of the developments in the design of Vivaldi antennas over the last few years, where the most important offerings, mostly from IEEE publications, have been emphasized. This review work aims to reveal a promising path to antenna researchers for its advancement using Vivaldi antennas.
Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
Background: The multidrug-resistant fungus Candida auris is emerging as a major cause of healthcare-associated infection globally. Understanding the epidemiology of these infections in vulnerable groups such as cancer patients is important for hospital infection control and their effective management. In this report we present diagnostic, clinical, antifungal resistance and outcome data of 11 cases of C. auris infection from an oncology center in India. Methods:C. auris strains were identified by Sanger-based DNA sequencing of the internal transcriber spacer (ITS) gene. Antifungal susceptibility testing (AFST) was performed using the broth dilution method. Identification and AFST were checked by the WHO Collaborating Center for Reference & Research on Fungi of Medical Importance. Patients had both empirical as well as directed therapy with antifungal agents based on AFST results and clinical assessment. Results: Between November 2018 and March 2019, 11 cases of C. auris (8 from patients with solid-organ tumors and 3 from hematological malignancy) were detected. Two distinct genetic clusters were identified by ITS gene sequencing; one of these clusters showed 100% homology with a previously unknown C. auris isolate (GenBank accession no. MK881076) and the other cluster had a 100% identity score with isolates from Japan and South Korea (GenBank accession nos. MH071441, KY657027, and EU884189). All 11 strains were resistant to fluconazole. With voriconazole, 1 isolate was susceptible, 3 were resistant, and 7 showed dose-dependent susceptibility. Two isolates were resistant to amphotericin B. Resistance to caspofungin or anidulafungin was noted in 1 of 11 isolates (9%); most showed intermediate susceptibility (63% to caspofungin). Among all of the patients, 72% were from the intensive care unit (ICU) or the high-dependency unit. The 30-day all-cause mortality was 5 of 11 (45%) in the C. auris group and 4 of 11 (36%) the control group (ie, infections with other Candida spp during same period). Duration of ICU stay in the C. auris group was 12 days and in the control group it was 6 days. The median cost (in terms of hospital bill at the time of discharge or death) for management of Candida auris infection and the primary medical condition was US$10,121 for the C. auris groups and US$8,608 for the control group. Most cases (10 of 11) were detected in wards without isolation rooms, and 8 of the 11 C. auris cases (73%) were detected in patients in the intensive care unit. Conclusions: Morbidity, mortality, ICU stay, and healthcare costs are significant in C. auris infection.
Understanding the distribution of wildlife species and their response to diverse anthropogenic pressures is important for conservation planning and management of wildlife space in human-dominated landscapes. Assessments of anthropogenic impacts on mammals of the Indian Himalayan Region have mostly been limited to locations inside protected areas. We studied the occurrence of mammals in an unexplored landscape, the 7,586 km2 Bhagirathi basin, at an altitude of 500–5,200 m. The basin encompasses wilderness areas of various habitat types and protection status that are exposed to a range of anthropogenic pressures. Camera trapping at 209 locations during October 2015–September 2017 confirmed the occurrence of 39 species of mammals, nine of which are categorized as threatened (four Vulnerable, five Endangered) and four as Near Threatened on the IUCN Red List. We recorded five mammal species that were hitherto undocumented in Uttarakhand State: the argali Ovis ammon, Tibetan sand fox Vulpes ferrilata, woolly hare Lepus oiostolus, Eurasian lynx Lynx lynx and woolly flying squirrel Eupetaurus cinereus. In addition, we recorded two Endangered species, the dhole Cuon alpinus and tiger Panthera tigris. Threatened species such as the sambar Rusa unicolor, common leopard Panthera pardus and Asiatic black bear Ursus thibetanus occur in a wide variety of habitats despite anthropogenic disturbance. We recorded the snow leopard Panthera uncia in areas with high livestock density but temporally segregated from human activities. The musk deer Moschus spp. and Himalayan brown bear Ursus arctos isabellinus were recorded in subalpine habitats and appeared to be less affected by human and livestock presence. Our findings highlight the potential of the Bhagirathi basin as a stronghold for conservation of several threatened and rare mammal species.
Despite consistent public health efforts, the burden of viral disease in India remains high. The present study was undertaken to understand the aetiology, frequency and distribution of viral disease outbreaks in the state of Odisha between 2010 and 2019. This was a prospective study conducted at the Virology Research and Diagnostic Laboratory located at ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, wherein all the outbreaks of viral aetiologies were investigated and analysed to provide a comprehensive picture of the state of viral disease outbreaks in the region. A total of 191 suspected viral outbreaks were investigated by the team from VRDL during September 2010 and September 2019 reported from all the 30 districts of Odisha. Annual number of suspected cases ranged from 185 to 1002. The most commonly suspected outbreaks were of viral hepatitis (55 outbreaks; 1223 cases) followed by dengue (45 outbreaks; 1185 cases), chickenpox (30 outbreaks; 421 cases), viral encephalitis (27 outbreaks; 930 cases), measles (23 outbreaks; 464 cases), chikungunya (10 outbreaks; 593 cases) and rubella (1 outbreak; 60). The outbreaks peaked in frequency and intensity during the months of July and September. The epidemiology of viral disease outbreaks in the region is presented in the study. Health system preparedness based on evidence is essential for early detection and adequate response to such viral outbreaks.
To compare differences in clozapine doses and plasma levels between Bangladeshi and White British patients. Following ethical approval we identified all current Bangladeshi and White British patients on clozapine maintenance in an east London clinic. We carried out univariate and multivariate regression analyses to examine associations between clozapine doses and ethnicity, age, gender, smoking status and weight. We also compared plasma clozapine levels of the two groups.
On univariate analysis White British patients had on average 85 mg higher doses than Bangladeshi patients (P = 0.004). Older age, male gender and smoking were also associated with higher dose. On multivariate analysis only age and smoking status remained significant. A greater proportion of Bangladeshi patients had high plasma clozapine levels compared with White British (30.76% v. 20.75%), although the difference was not statistically significant.
Our findings point to the need for the broadening of data collection on ethnic differences in clozapine prescribing within big data-sets such as Prescribing Observatory for Mental Health (POM-UK). Ethnopharmacological variations can inform more person-centred guidance on prescribing.
To review the currently available data on the use of ketamine in the treatment of depression among older adults from randomized controlled studies.
Randomized controlled trials.
60 years and older with depression.
Change in Montgomery–Asberg Depression Rating Scale (MADRS) scores.
Two studies met the inclusion criteria. The first study showed a significant reduction in depression symptoms with use of repeated subcutaneous ketamine administration among older adults with depression. The second study failed to achieve significance on its primary outcome measure but did show a decrease in MADRS scores with intranasal ketamine along with a higher response and remission rates in esketamine group compared with the placebo group. The adverse effects from ketamine generally lasted only a few hours and abated spontaneously. No cognitive adverse effects were noted in either trial from the use of ketamine.
The current evidence for use of ketamine among older adults with depression indicates some benefits with one positive and one negative trial. Although one of the trials did not achieve significance on the primary outcome measure, it still showed benefit of ketamine in reducing depressive symptoms. Ketamine was well tolerated in both studies with adverse effects being mild and transient.
The word bhakti, as a common noun, means the intense love that one feels for one's god, the supreme attachment to a divinity. This god may be the formless Absolute, infinite, and eternal – nirguna, without attributes or qualities. The devotee may also address devotion towards a god made manifest in human form, with a name and a mythology. The god is then saguna, with attributes and qualities.
In Bengal, Vishnu's incarnation Krishna has always been the object of the deepest religious fervour. At the end of the twelfth century, the poet Jayadeva composed the Gita govinda in Sanskrit in honour of Krishna-Govinda. Jayadeva was the initiator of a devotion to Krishna that coloured the whole of eastern Indian Vaishnavism with its emotional quality and lyrical beauty. Later, Vaishnavite poetry of a very high order was also composed in Bengali and in Brajabuli, an artificial language mixing Maithili and Bengali. The poets mostly wrote about Krishna's love affair with Rādhā, his beloved, and his play with the other gopis, or cowherd women, on the banks of the Yamunā. The eroticism was imbued with spiritual and mystical meaning.
These love poems composed during the medieval period, mostly during and after the life of the great mystic Shrikrishna Chaitanya (1486–1534), did not fail to move the young Rabindranāth. As a young man, he was moved to joy on reading a collection of ancient lyric poems composed by the poets of the Vaishnav sect. He writes:
I was sure that these poets were speaking about the supreme Lover, whose touch we experience in all our relations of love – the love of nature's beauty, of the animal, the child, the comrade, the beloved, the love that illuminates our consciousness of reality.
At the age of sixteen, he composed a number of poems, in the same vein an language as the medieval Vaishnav lyrics, which were collected (along with a few later pieces) as Bhanusingha thākurer padābali (1884). He published eight of the poems anonymously in the family magazine Bhārati in 1877–8 (and a few later), giving the impression that they had been composed by an ancient poet named Bhānusingha.
Rabindranāth Tagore's writings on history cover three chief areas of interest. One is his philosophy of history, particularly in the context of free will and determinism. Here he basically asks the question: Is a human being and a citizen a free agent, or is he an instrument of the historical forces of his times? A second area covers issues arising out of historical narrative: events, personalities, and the long-term course of history. Here his chief focus of interest is the history of Indian civilization, but some of the most valuable discussions relate to global history, European civilization in particular. The third area extends beyond history to historiography: Tagore is critical of the colonial school of writing and offers his own interpretive approach. These three strands are interwoven and cannot be studied in isolation from each other. They are necessarily combined in the account that follows.
We must also bear in mind that Tagore was essentially a poet, and his perception of history finds expression not only in his discursive prose but also in his poetry, fiction, and literary criticism. There was a time in India when works of history were written in verse. In Tagore's poems based on historical annals and legends, most memorably collected in Kathā o kāhini (1908), one can discern traces of that centuries-old tradition. He sourced many verse-tales from Buddhist legends in texts such as the Avadānashataka, Bodhisattva-avadāna, Mahāvastu, and Divyāvad namālā. On another plane, he imbibed and extended the nascent nationalism that found soil in the history of the Sikhs and the Marāthās, and the historical legends and folk traditions of Rājasthān. Perhaps more importantly, he found a major source of inspiration for his poems and songs, with actual formal models, in the medieval saintly traditions associated with Kabir, Tulsidās, and others, and the Vaishnavite poetry and culture of Mithil and Bengal.
In an essay on the historical novel (‘Aitihāsik upanyās’), Tagore observes that a disconnect between actual history and fiction based on history is natural and inevitable. He quotes the English historian E. Augustus Freeman's comment that if anyone wishes to learn about European history at the time of the Crusades, he must studiously avoid reading Scott's Ivanhoe. Tagore recognized the educational value of historical tales and dramas.
Rabindranāth Tagore was born and brought up in a city: Calcutta, now Kolkata, the erstwhile second city of the British empire. He belonged to the third generation of a propertied family. His grandfather ‘Prince’ Dwārakānāth Tagore built up the family fortune in the modern sense of the term. Dwarakanath's eldest son, Debendran th, was Rabindranath's father. It is well known that Rabindranath never felt close to his grandfather in spirit. He felt greater affinity with his philosophic father: the two had a warm relationship over some forty years.
Young Rabi was brought up on disciplinarian but markedly unorthodox lines. The child's unusual nature made him resist institutional education. He was almost entirely taught at home in many fields – general education, science, music, painting – but in an unconventional way, neither ordered nor complete, nor even always rigorous. This recipe for disaster turned out wonderfully well in his case. It conditioned him to break conventions, as evident in all his creative work: poetry, music, painting, theatre, and even dance.
This chapter concerns his ideas on rural welfare and development in India. It may appear a strange concern for a literary personality of Rabindranath's stature; even more that he should pursue it with the zest of an activist. In fact, his engagement with such action-oriented projects was part of a grander design for a complete and harmonious life in society as a whole. This made village work as creative for Rabindranath as writing poetry and composing music. They all contributed to his project of wholeness.
THE ESSENCE OF SHRI
I have mentioned the related concepts of wholeness and harmony. Rabindranath's life's project took shape as a comprehensive endeavour towards those goals, absorbing almost anything that came his way – many strands of thought and practice, derived from both East and West. The spirituality of Upanishadic tradition, acquired from family sources, fed an aesthetic consciousness that was, at the same time, deeply rooted in sociopolitical reality. But his abiding concern all through was the notion of shri, which can be defined as grace, harmony, and well-being informed by a sense of inner truth. This commitment to truth made him look critically at the ritualistic aspects of not only religious practices but all spheres of social and political life. Instead of heeding the mystic call of an inner voice, he directed a rational, critical gaze at the reality around him.
Between 11–13 December 2018, local public health authorities in the West Midlands, England were alerted to 34 reports of diarrhoea with abdominal cramps. Symptom onset was ~10 h after diners ate Christmas meals at a restaurant between 7–9 December 2018. A retrospective case-control study, environmental and microbiological investigations were undertaken to determine the source and control the outbreak. An analytical study was undertaken with odds ratios (OR) and 95% confidence intervals (CI). Forty persons were recruited to the analytical study (28/40 cases). Multivariable analysis found that leeks in cheese sauce was the only item associated with illness (aOR 51.1; 95% CI 4.13–2492.1). Environmental investigations identified significant lapses in food safety, including lapses in temperature control during cooking and hot holding, likely cross-contamination between raw and cooked foods and the reuse of leftover cheese sauce for the next day's service. No food samples were taken during the exposure period. Two faecal samples were positive for Clostridium perfringens with one confirming the enterotoxigenic gene. Cheese sauce is an unusual vehicle for the organism and the first time this has been reported in England.
This chapter examines the ritual of Morning Assembly, the typical start to an Indian school day, which has long been ingrained within the Indian educational system, and, importantly, is considered to be “quite central in the approach to ethics education” (Duesund, 2013, p. 146). Constructed as a space for the inculcation of moral values regarding, among other aspects, citizenship and personal growth, this ritual typically entails dissemination of news, singing of patriotic and devotional songs in multiple languages, and edifying lectures. As part of a broader investigation of young boys at an orphanage in suburban New Delhi that entailed participant observation, audiovisual recordings, and interviews, the chapter focuses on two teachers’ lectures during the Morning Assembly to demonstrate how through the content, participation frameworks, and spatial and intercorporeal organization, the Morning Assembly is both a crucial institutional ritual and a dynamic site for socializing Indian children into specific dispositions and stances towards authority and knowledge. It argues that socialization into expected epistemic and moral stances is simultaneous and deeply entangled.