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In August 2018, Kerala, India witnessed its worst flood in over a century. With the support of the national health mission, Operation Navajeevan, a public-private partnership between the district health administration and local hospitals was established in Kozhikode to provide medical aid to flood victims. This study identifies prerequisites, describes challenges, and depicts the epidemiology of patients seen in these camps.
1.Identify prerequisites and medical needs/challenges faced by medical relief camps in a flood-affected region
2.Formulate protocols to avoid duplication of services
3.Prepare an ideal PPP emergency medical camp model
A control center with drugs and a logistics unit was set up at the district administration to monitor and supervise various camps. A mobile medical documentation format was created to record the details of each camp. Cases of patients seen at these camps were compiled and later analyzed. The medical officer sent reports from each camp to the control center each day to specify the daily difficulties faced by each camp. Mobile ICUs were kept on standby to respond in the event of emergent circumstances or surge demands. Transfer protocol and treatment guidelines were formulated and standardized.
Over two weeks, approximately 40,000 patients were seen in 280 medical camps. Major medical issues included exacerbation of chronic illnesses due to loss of medications (18,490), acute respiratory infections (7,451), psychiatric illnesses (5,327), trauma (3,736), skin infection (792), tropical fever (498), acute gastroenteritis (394), and ACS (17). Of the cases of fever, 137 people had leptospirosis. Major challenges included a lack of training in disaster management and failure of documentation systems.
A well-organized control center, improved training in disaster medicine, and reliable documentation systems are crucial for coordinating medical camps in disaster areas. Public-private partnerships offer a model for providing medical relief in disaster settings.
Individuals with bipolar disorder (BD) show aberrant brain activation patterns during reward and loss anticipation. We examined for the first time longitudinal changes in brain activation during win and loss anticipation to identify trait markers of aberrant anticipatory processing in BD.
Thirty-four euthymic and depressed individuals with BD-I and 17 healthy controls (HC) were scanned using functional magnetic resonance imaging twice 6 months apart during a reward task.
HC, but not individuals with BD, showed longitudinal reductions in the right lateral occipital cortex (RLOC) activation during processing of cues predicting possible money loss (p-corrected <0.05). This result was not affected by psychotropic medication, mood state or the changes in depression/mania severity between the two scans in BD. Elevated symptoms of subthreshold hypo/mania at baseline predicted more aberrant longitudinal patterns of RLOC activation explaining 12.5% of variance in individuals with BD.
Increased activation in occipital cortex during negative outcome anticipation may be related to elevated negative emotional arousal during anticipatory cue processing. One interpretation is that, unlike HC, individuals with BD were not able to learn at baseline that monetary losses were smaller than monetary gains and were not able to reduce emotional arousal for negative cues 6 months later. Future research in BD should examine how modulating occipital cortical activation affects learning from experience in individuals with BD.
Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.
We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.
Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.
Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.
Mesophotic ecosystems have been relatively poorly studied in the Indo-Pacific and in particular within the Coral Triangle region. Here we used a mini-ROV to explore the changes in major benthic groups at two sites (~200 m apart) in the Wakatobi Marine National Park, SE Sulawesi, Indonesia spanning shallow water coral reefs (5 m) to deeper water mesophotic ecosystems (80 m). We found very similar patterns at both sites where coral cover peaked at 15 m, declined rapidly by 30 m, and was virtually absent at 50 m. As coral declined there was a marked increase in sponges, soft corals and other encrusting organisms (including ascidians, bryozoans, tubeworms, gorgonians and molluscs). Importantly, our results differ from most previous studies in other geographic locations where hard corals extend much deeper. It is unclear what drives this difference but it may be related to higher levels of turbidity and therefore reduced light penetration in the Wakatobi compared with other areas, which limits the vertical extent of coral development.
Trauma exposure is associated with development of depression and anxiety; yet, some individuals are resilient to these trauma-associated effects. Differentiating mechanisms underlying development of negative affect and resilience following trauma is critical for developing effective interventions. One pathway through which trauma could exert its effects on negative affect is reward-learning networks. In this study, we examined relationships among lifetime trauma, reward-learning network function, and emotional states in young adults.
One hundred eleven young adults self-reported trauma and emotional states and underwent functional magnetic resonance imaging during a monetary reward task. Trauma-associated neural activation and functional connectivity were analyzed during reward prediction error (RPE). Relationships between trauma-associated neural functioning and affective and anxiety symptoms were examined.
Number of traumatic events was associated with greater ventral anterior cingulate cortex (vACC) activation, and lower vACC connectivity with the right insula, frontopolar, inferior parietal, and temporoparietal regions, during RPE. Lower trauma-associated vACC connectivity with frontoparietal regions implicated in regulatory and decision-making processes was associated with heightened affective and anxiety symptoms; lower vACC connectivity with insular regions implicated in interoception was associated with lower affective and anxiety symptoms.
In a young adult sample, two pathways linked the impact of trauma on reward-learning networks with higher v. lower negative affective and anxiety symptoms. The disconnection between vACC and regions implicated in decision-making and self-referential processes may reflect aberrant regulatory but appropriate self-focused mechanisms, respectively, conferring risk for v. resilience against negative affective and anxiety symptoms.
When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.
We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.
We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.
Significance of results
Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.
The debates on Asian democracy began 30 years ago. Western countries have often promoted liberal democracy as being the genuine democracy, giving justice to the people and being able to meet the needs of their communities. However, at the same time, some Asian countries practice democracy that promotes Asian values, which are very different from Western values. Western countries describe Asian democracy as an excuse for some leaders to maintain power in their respective countries, for example Malaysia. Critics have pointed out that some Asian leaders have used authoritarianism or despotism in order to mitigate the weaknesses of their rule. Asian democracy is practiced in Kelantan where the PAS (Pan-Malaysian Islamic Party) continued to maintain power for 23 years, from 1990 to 2013. Factors that have contributed to the long rule of the PAS party include socio-political stability, including political parties who were clean and competent and leaders who are knowledgeable and pious.
The wandering of a wing-tip vortex in free-stream turbulence was documented by analysis of multi-probe hot-wire measurements in a wind tunnel and flow visualisation and particle image velocimetry measurements in a water tunnel. An error-minimisation approach was applied to the hot-wire measurements to estimate the time history of the location of the vortex axis, whereas flow visualisation from two orthogonal views permitted the reconstruction of relatively long sections of the vortex axis. The amplitude of the wandering motion was found to scale with the turbulence intensity, the core radius and the vortex turnover time; this amplitude was insensitive to changes in the integral length and time scales of the turbulence. The period of the vortex wandering was distributed in the range between 1 and 10 vortex turnover times. The wavelength of wandering was distributed at a relatively long value, which scaled with the vortex turnover time. The velocity of vortex wandering depended on the vortex turnover time, but also contained an additional contribution that was consistent with motion induced by bending waves. The prevalence of the vortex turnover time as the scale for vortex wandering was interpreted as evidence that vortex-induced straining of the free-stream eddies bounds the interaction time between the two, thus limiting the time available for linear and angular momentum transfer.
Despite global deterioration of coral reef health, not all reef-associated organisms are in decline. Bioeroding sponges are thought to be largely resistant to the factors that stress and kill corals, and are increasing in abundance on many reefs. However, there is a paucity of information on how environmental factors influence spatial variation in the distribution of these sponges, and how they might be affected by different stressors. We aimed to identify the factors that explained differences in bioeroding sponge abundance and assemblage composition, and to determine whether bioeroding sponges benefit from the same environmental conditions that can contribute towards coral mortality. Abundance surveys were conducted in the Wakatobi region of Indonesia on reefs characterized by different biotic and abiotic conditions. Bioeroding sponges occupied an average of 8.9% of available dead substrate and variation in abundance and assemblage composition was primarily attributed to differences in the availability of dead substrate. Our results imply that if dead substrate availability increases as a consequence of coral mortality, bioeroding sponge abundance is also likely to increase. However, bioeroding sponge abundance was lowest on a sedimented reef, despite abundant dead substrate. This suggests that not all forms of coral mortality will benefit all bioeroding sponge species, and sediment-degraded reefs are likely to be dominated by a few resilient bioeroding sponge species. Overall, we demonstrate the importance of understanding the drivers of bioeroding sponge abundance and assemblage composition in order to predict possible impacts of different stressors on reefs communities.
We have proposed a three-species hybrid food chain model with multiple time delays. The interaction between the prey and the middle predator follows Holling type (HT) II functional response, while the interaction between the top predator and its only food, the middle predator, is taken as a general functional response with the mutual interference schemes, such as Crowley–Martin (CM), Beddington–DeAngelis (BD) and Hassell–Varley (HV) functional responses. We analyse the model system which employs HT II and CM functional responses, and discuss the local and global stability analyses of the coexisting equilibrium solution. The effect of gestation delay on both the middle and top predator has been studied. The dynamics of model systems are affected by both factors: gestation delay and the form of functional responses considered. The theoretical results are supported by appropriate numerical simulations, and bifurcation diagrams are obtained for biologically feasible parameter values. It is interesting from the application point of view to show how an individual delay changes the dynamics of the model system depending on the form of functional response.
In 2015, a Pakistani court in the case of Leghari v. Federation of Pakistan made history by accepting arguments that governmental failures to address climate change adequately violated petitioners’ rights. This case forms part of an emerging body of pending or decided climate change-related lawsuits that incorporate rights-based arguments in several countries, including the Netherlands, the Philippines, Austria, South Africa, and the United States (US). These decisions align with efforts to recognize the human rights dimensions of climate change, which received important endorsement in the Paris Agreement. The decisions also represent a significant milestone in climate change litigation. Although there have been hundreds of climate-based cases around the world over the past two decades – especially in the US – past and much of the ongoing litigation focuses primarily on statutory interpretation avenues. Previous efforts to bring human rights cases have also failed to achieve formal success. The new cases demonstrate an increasing trend for petitioners to employ rights claims in climate change lawsuits, as well as a growing receptivity of courts to this framing. This ‘rights turn’ could serve as a model or inspiration for rights-based litigation in other jurisdictions, especially those with similarly structured law and court access.
The red panda Ailurus fulgens is categorized as Endangered on the IUCN Red List and is threatened by anthropogenic pressures such as livestock grazing. We surveyed people living in or near protected areas and people living away from protected areas in Nepal, to understand human attitudes towards red panda conservation. Given Nepal's participatory approach to managing protected areas, we hypothesized that local people living in or near protected areas would have more positive attitudes towards red panda conservation than those in non-protected areas. Ninety percent of the 142 respondents had positive attitudes, with people living in or near protected areas expressing less positive attitudes than those in non-protected areas. Despite this difference between protected and non-protected areas, people were generally positive towards red panda conservation. However, positive attitudes did not necessarily translate to sustainable resource-use behaviour. We found there was a high prevalence of both livestock grazing and livestock disease in red panda habitat. We suggest that alternative farming practices (e.g. stall-feeding of livestock) and awareness programmes (e.g. education on the conservation status and legal protection of red pandas, and livestock–wildlife disease transmission) could be important tools to improve conservation attitudes and protect red pandas in Nepal.