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‘Upendra Baxi’, the name, I read for the first time in or about 1968 just below the title ‘“The Little Done, the Vast Undone”: Some Reflections on Reading Granville Austin's The Indian Constitution’, published in the Journal of the Indian Law Institute. Impressed not only by the title and the size of the paper—107 pages—but also by its writing style, I continued to be confused about the nationality of the author until quite a few persons confirmed that he was very much an Indian who also worked at the Indian Law Institute for some time, even in the editorial team of the Journal of the Indian Law Institute. Confusion also persisted because around that time some foreign scholars like A. R. Blackshield had written quite long articles running into more than one issue of the journal, while no Indian scholar had ventured to do so until then. Later, I had the opportunity to read one of his articles, perhaps in the Jaipur Law Journal, on the issue of compensation for acquisition of property as decided in the Shantilal case, which in his opinion amounted to ‘paying peanuts for the gold coin’. The two writings showed similarity in his concern for sustaining traditional civil rights with little regard to the constitutional philosophy represented in the Directive Principles of State Policy. It was much later, perhaps after the 1975–1977 Emergency, when the Supreme Court shifted its emphasis from haves to have-nots that Professor Baxi also came up with ‘taking suffering seriously’ and removing weapons of impoverishment of people.
After shifting from the small-town Meerut College to Delhi University in 1970, sometime in late 1971 or early 1972 I heard that Professor Baxi had also been appointed as professor of law where I was a junior lecturer. I got the first opportunity to see him in person after he joined as Professor-in-Charge of Law Centre II of the Faculty of Law in 1973. Given the difference between his and my position at the university as well as the daunting impression left by his writings on me, I was always hesitant about introducing myself and talking to him.
Deinotheriidae Bonaparte, 1845 is a family of browsing proboscideans that were widespread in the Old World during the Neogene. From Miocene deposits in the Indian subcontinent, deinotheres are known largely from dental remains. Both large and small species have been described from the region. Previously, only small deinothere species have been identified from Kutch in western India. In the fossiliferous Tapar beds in Kutch, dental remains have been referred to the small species Deinotherium sindiense Lydekker, 1880, but the specimens are too fragmentary to be systematically diagnostic. Here, we describe a large p4 of a deinothere from the Tapar beds and demonstrate that it is morphologically most similar to Deinotherium indicum Falconer, 1845, a large species of deinothere, thereby confirming the identity of deinotheres at Tapar. Deinotherium indicum from Tapar is larger than other deinotheres identified from Kutch and is the first occurrence of the species in the region. This new specimen helps constrain the age of the Tapar beds to the Tortonian and increases the biogeographic range of this species—hitherto only known from two localities on the subcontinent. This specimen also highlights the morphological diversity of South Asian deinothere p4s and allows us to reassess dental apomorphies used to delimit Indian deinothere species. Lastly, we argue that by the late Miocene, small deinotheres in Kutch were replaced by the large Deinotherium indicum.
Deep learning using convolutional neural networks represents a form of artificial intelligence where computers recognise patterns and make predictions based upon provided datasets. This study aimed to determine if a convolutional neural network could be trained to differentiate the location of the anterior ethmoidal artery as either adhered to the skull base or within a bone ‘mesentery’ on sinus computed tomography scans.
Coronal sinus computed tomography scans were reviewed by two otolaryngology residents for anterior ethmoidal artery location and used as data for the Google Inception-V3 convolutional neural network base. The classification layer of Inception-V3 was retrained in Python (programming language software) using a transfer learning method to interpret the computed tomography images.
A total of 675 images from 388 patients were used to train the convolutional neural network. A further 197 unique images were used to test the algorithm; this yielded a total accuracy of 82.7 per cent (95 per cent confidence interval = 77.7–87.8), kappa statistic of 0.62 and area under the curve of 0.86.
Convolutional neural networks demonstrate promise in identifying clinically important structures in functional endoscopic sinus surgery, such as anterior ethmoidal artery location on pre-operative sinus computed tomography.
The eastern Arabian Sea is influenced by both the advection of upwelled water from the western Arabian Sea and winter convective mixing. Therefore, sediments collected from the eastern Arabian Sea can help to understand the long-term seasonal hydrographic changes. We used the planktonic foraminifera census and stable isotopic ratio (δ18O) from sediments drilled during the International Ocean Discovery Program Expedition 355 to reconstruct surface hydrographic changes in the eastern Arabian Sea during the last 350 kyr. The increased abundance of Globigerina bulloides suggests enhanced advection of upwelled water during the latter half of MIS7 and the beginning of MIS6, as a result of a strengthened summer monsoon. A large drop in upwelling and/or advection of upwelled water from the western Arabian Sea is inferred during the subsequent interval of MIS6, based on the rare presence of G. bulloides. The comparable relative abundance of Neogloboquadrina dutertrei, G. bulloides and Globigerinoides ruber suggests that during the early part of MIS5, hydrographic conditions were similar to today. The upwelling decreased and winter convection increased with the progress of the glacial interval. A good coherence between planktonic foraminiferal assemblage-based monsoon stacks from both the eastern and western Arabian Sea suggests a coeval response of the entire northern Arabian Sea to the glacial–interglacial changes. The glacial–interglacial difference in δ18Osw-ivc was at a maximum with 4–5 psu change in salinity during Termination 2 and 3, and a minimum during Termination 4. The significantly reduced regional contribution to the glacial–interglacial change in δ18Osw-ivc during Termination 4 suggests a lesser change in the monsoon.
Mycetoma is a chronic granulomatous, suppurative and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. In India, actinomycotic mycetoma is prevalent in south India, south-east Rajasthan and Chandigarh, while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. The objective was to determine the epidemiological profile and spectrum of eumycetoma from a tertiary care hospital in Delhi, North India. Thirty cases of eumycetoma were diagnosed by conventional methods of direct microscopy, culture and species-specific sequencing as per standard protocol. The spectrum of fungal pathogens included Exophiala jeanselmei, Madurella mycetomatis, Fusarium solani, Sarocladium kiliense, Acremonium blochii, Aspergillus nidulans, Fusarium incarnatum, Scedosporium apiospermum complex, Curvularia lunata and Medicopsis romeroi. Eumycetoma can be treated with antifungal therapy and needs to be combined with surgery. It has good prognosis if it is timely diagnosed and the correct species identified by culture for targeted therapy of these patients. Black moulds required prolonged therapy. Its low reporting and lack of familiarity may predispose patients to misdiagnosis and consequently delayed treatment. Hence health education and awareness campaign on the national and international level in the mycetoma belt is crucial.
To determine the impact of a passive, prescriber-directed, electronic best-practice advisory coupled with prescriber education on the rate of antibiotic prescribing for acute, uncomplicated bronchitis in ambulatory adults across a large health system.
This study was a quasi-experiment examining antibiotic prescribing for ambulatory adults with acute bronchitis from January 1, 2016 through December 31, 2018. The intervention was implemented in December 2016 for emergency departments and urgent care clinics followed by ambulatory clinics in September 2017.
Outpatient settings across a health system, including 15 emergency departments, >30 urgent care clinics, and >150 ambulatory clinics.
All adults with a primary diagnosis of acute bronchitis who were seen and discharged from a study site were included.
A passive, prescriber-directed, best-practice advisory for treatment of acute bronchitis in the electronic health record and an optional, online education module regarding acute bronchitis.
The study included 81,975 ambulatory adults with a primary diagnosis of acute bronchitis during the preintervention period (19.8% >65 years of age; 61.9% female) and 89,571 ambulatory adults during the postintervention period (16.5% >65 years of age; 61.1% female). Antibiotic prescribing rates decreased from 60.8% (49,877 of 81,975 patients) preintervention to 51.4% (46,018 of 89,571 patients) postintervention (absolute difference, 9.4%; P < .001). The largest reduction occurred in the emergency departments.
An electronic best practice advisory combined with prescriber education was associated with a statistically significant reduction in antibiotic prescribing for adults with acute bronchitis. Future studies should incorporate patient education and address prescriber-reported barriers to appropriate antibiotic prescribing.
This paper describes and analyzes a new technique used in Q-slot antenna to generate circular polarization (CP). The CP characteristics were investigated carefully by studying the surface current distribution, the phase difference between the left hand circular polarization (LHCP) and right hand circular polarization (RHCP) at some resonant frequencies, and the measured values of the axial ratio bandwidth (ARBW). Normal arms (E1 and E2) were cut in the upper elliptical feeding strip line to form an open-mouth structure. The arms E1 and E2 were made equal in length and set perpendicular to each other to have normal electric fields, leading to the generation of CP radiation. A formula was modified for the dual resonant frequencies f1, f2 of the modes TM010 and TM001. The measured values of the ARBW indicated that the antenna has a wide ARBW of 4.8–5.93 GHz, which is approximately 52% of the 3rd operating band of 4.7–6.8 GHz. The wide ARBW in a small size indicated that the design of the Q-slot antenna overcame the limits of designing antennas with wide ARBW in small size and low profile. A formula for normalized field was driven according to the complementary of the Q-slot antenna.
A novel flexible radio frequency (RF) sensor is designed to facilitate the accurate testing of various samples used in the biomedical industry at the industrial, scientific and medical (ISM) frequency band. The proposed RF biosensor comprises a liquid channel-loaded interdigitated capacitor, which is integrated on a coplanar waveguide structure. The prototype of the sensor is fabricated on a 0.13 mm thin biodegradable polyethylene terephthalate polyester film to perform the testing of various bio-graded samples by recording the corresponding resonant frequency. It is observed that there is a noticeable change between the measured resonant frequencies of these samples, which primarily occurs due to the difference in their dielectric properties. The designed sensor was used to monitor and investigate the quality of glycerol, which is the most commonly used raw ingredient in the biomedical and food industry. The determination of glucose concentration in base fluids is considered to ease the challenges faced by doctors and biochemists regarding the monitoring of glucose concentration. It is found that the proposed sensor can quantify the glycerol purity up to the minimum specified adulteration level of 2 and 1% corresponding to toxic contaminants diethylene glycol and ethylene glycol, respectively, and the glucose concentration of 0.5 mg/ml.
Personality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders.
To calculate the worldwide prevalence of personality disorders and examine whether rates vary between high-income countries and low- and middle-income countries (LMICs).
We systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from January 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094).
A total of 46 studies (from 21 different countries spanning 6 continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8% (95% CI 6.1–9.5). Rates were greater in high-income countries (9.6%, 95% CI 7.9–11.3%) compared with LMICs (4.3%, 95% CI 2.6–6.1%). In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage v. one-stage assessment), county income (high-income countries v. LMICs) and interview administration (clinician v. trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of cluster A, B and C personality disorders were 3.8% (95% CI 3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%).
Personality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations.
Introduction: Children diagnosed with medulloblastoma (MB) who are refractory to upfront therapy or experience recurrence have very poor prognoses. Although phase I and phase II trials exist, these treatments bear significant treatment-related morbidity and mortality. Methods: A retrospective review of children diagnosed with a recurrence of MB from 2002 to 2015 at McMaster University was undertaken. Results: Recurrent disease in 10 patients involved leptomeningeal dissemination, with 3 experiencing local recurrence. In three recurrent patients the disease significantly progressed, and the children were palliated. The remaining 10 children underwent some form of salvage therapy, including surgical re-resection, radiation, and chemotherapy, either in isolation or in varying combinations. Of the 13 children experiencing treatment-refractory or recurrent disease, 4 are currently alive with a median follow-up of 38.5 months (75.5 months). Of the eight patients with molecular subgrouping data, none of the Wnt MB experienced recurrence. Conclusion: Recurrent MB carried a poor prognosis with a 5-year overall survival (OS) of 18.2% despite the administration of salvage therapy. The upfront therapy received, available treatment, and tolerability of the proposed salvage therapy resulted in significant heterogeneity in the treatment of our recurrent cohort.
A single-centre, single-blinded prospective experimental study was conducted to determine the effectiveness of autologous platelet-rich plasma applied to the tonsillar bed post-operatively in reducing post-operative pain and haemorrhage.
Platelet-rich plasma, prepared prior to surgery, was applied with calcium gluconate to one randomly chosen tonsillar fossa. Pain and haemorrhage were analysed, using a visual analogue scale and a pre-defined grading scale respectively, four times on the day of surgery at 2-hourly intervals, and thrice on the following day.
The pain score and haemorrhage grade on the test side were lower than on the control side. These findings were statistically significant.
This pilot study, conducted in India, revealed valid positive results for a promising new technology. The manual preparation of platelet-rich plasma could be automated in the future to allow a larger sample size.
Introduction: Controversy exists in antiepileptic drug (AED) prophylaxis prescribing in patients with aneurysmal subarachnoid hemorrhage (SAH). We undertook the Use of Antiepileptic Drugs in Aneurysmal Subarachnoid Hemorrhage (ALIBI) study to identify factors associated with prescribing practices. Methods: A retrospective chart review of all consecutive patients requiring Level 1 care with aneurysmal SAH admitted between 2012 and 2014 to the intensive care unit at Toronto Western Hospital, Ontario, Canada, was conducted. Data were collected on clinical and imaging characteristics. Primary and secondary outcomes were AED prophylaxis and clinical seizure activity during hospitalization. Data were compared using chi-square or Mann–Whitney U-tests. Those variables found to be significant, or trending toward significance, on univariate analysis were fitted to multivariate regression. Results: Sixty-eight patients were included. Mean age was 62 ± 12.2, and 42.6% of patients were male. Of these, 21 patients (30.9%) received AED prophylactically, while 18 (26.5%) had reported seizures at some point during hospitalization. Female gender and presence of midline shift (MLS) were significantly associated or approached significance with AED prophylaxis in univariate analysis (p = 0.036 and p = 0.062, respectively). In multivariate analysis, only MLS was an independent predictor (odds ratio 5.09, p = 0.04). Conclusion: The presence of MLS was an independent predictor of seizure activity in patients with aneurysmal SAH. AED prophylaxis prescribing patterns seemed arbitrary and was not informed by identifiable clinical factors or true risk factors for seizure. A current lack of evidence guiding AED prescribing practice highlights the need for larger studies in this patient population.
To propose a new classification of inner-ear anomalies that is more clinically oriented and surgically relevant: the SMS (Sawai Man Singh) classification of cochleovestibular malformations.
A retrospective multicentric study was conducted of 436 cochlear implantations carried out in 3 Indian tertiary care institutes. Patients with anomalous anatomy were included and classified, as per the new SMS classification, into cochleovestibular malformation types I, II, III and IV, based on cochlear morphology, modiolus and lamina cribrosa.
There were 19, 23, 8 and 4 patients with cochleovestibular malformation types I, II, III and IV, respectively. Two-year post-operative Meaningful Auditory Integration Scale scores were statistically analysed.
This new classification for inner-ear anomalies is a simpler, more practical, outcome-oriented classification that can be used to better plan the surgery. These merits make it a more uniform classification for recording results.
Background: Urinary tract infection (UTI) is a common diagnosis in children presenting to the Emergency Department (ED) and often leads to empiric antibiotic treatment prior to culture results. A recent study at our centre found that 47% of children diagnosed with a UTI and discharged on antibiotics had a negative urine culture. None of these patients were notified of the negative result or to discontinue antimicrobial treatment. Aim Statement: The aim of this study was to improve UTI diagnostic accuracy by 50% while promoting antimicrobial stewardship through timely antibiotic discontinuation and standardized antimicrobial treatment for uncomplicated UTIs over the next 12 months. Measures & Design: Three interventions were developed using plan-do-study-act (PDSA) cycles. In collaboration with the hospital's Choosing Wisely campaign and antimicrobial stewardship program, an evidence-based empiric UTI diagnostic algorithm was created to aid with diagnostic decision-making and reduce practice variation. A daily call-back system was also implemented for urine cultures where patients who had a negative urine culture were contacted to stop antibiotics. Lastly, a practice alert was integrated in the EMR as a reminder of appropriate antimicrobial prescription duration. The main outcome measures were the percentage of inappropriately diagnosed UTIs and percentage with timely antimicrobial discontinuation. Process measures included antibiotic days saved, treatment duration, and physician adherence to the algorithm. As a balancing measure, positive urine cultures were reviewed to assess accuracy of the algorithm to detect UTIs and potential harm from delayed UTI diagnoses. Evaluation/Results: Early results from the 530 children included in the analysis demonstrated a 14% reduction in inappropriate UTI diagnoses. With the initiation of the call-back system, the antibiotic days saved increased from 0 to 495 days. Call-backs for negative cultures increased from 0% to 68% of the time. Of those positive cultures with a missed UTI diagnosis, only 5 patients in 5 months had a return visit within 72 hours and none required admission. Discussion/Impact: Appropriate diagnosis and treatment of UTIs in our ED has improved with the implementation of a diagnostic algorithm. A larger impact is anticipated once the algorithm is embedded in the EMR as a form of decision support, but these changes take time to implement. Although labour intensive, the call-back system has greatly impacted the antimicrobial days saved and reduced risk for harm in this population.
Cardiopulmonary exercise testing has been used to measure functional capacity in children who have undergone a heart transplant. Cardiopulmonary exercise testing results have not been compared between children transplanted for a primary diagnosis of CHD and those with a primary diagnosis of cardiomyopathy despite differences in outcomes. This study is aimed to compare cardiopulmonary exercise testing performance between these two groups.
Patients who underwent heart transplant with subsequent cardiopulmonary exercise testing at least 6 months after transplant at our institution were identified. They were then divided into two groups based on primary cardiac diagnosis: CHD or cardiomyopathy. Patient characteristics, echocardiograms, cardiac catheterisations, outcomes, and cardiopulmonary exercise test results were compared between the two groups.
From the total of 35 patients, 15 (43%) had CHD and 20 (57%) had cardiomyopathy. Age at transplant, kidney disease, lung disease, previous rejection, coronary vasculopathy, catheterisation, and echocardiographic data were similar between the groups. Mean time from transplant to cardiopulmonary exercise testing, exercise duration, and maximum oxygen consumption were similar in both groups. There was a difference in heart rate response with CHD heart rate response of 63 beats per minute compared to cardiomyopathy group of 78 (p = 0.028). Patients with CHD had more chronotropic incompetence than those with cardiomyopathy (p = 0.036).
Primary diagnosis of CHD is associated with abnormal heart rate response and more chronotropic incompetence compared to those transplanted for cardiomyopathy.
International Ocean Discovery Program Expedition 355 drilled Sites U1456 and U1457 in Laxmi Basin (eastern Arabian Sea) to document the impact of the South Asian monsoon on weathering and erosion of the Himalaya. We revised the chronostratigraphic framework for these sites using a combination of biostratigraphy, magnetostratigraphy and strontium isotope stratigraphy. The sedimentary section at the two sites is similar and we divided it into six units bounded by unconformities or emplaced as a mass-transport deposit (MTD). Unit 1 underlies the MTD, and is of early–middle Miocene age at Site U1456 and early Paleocene age at Site U1457. An unconformity (U1) created by emplacement of the MTD (unit 2) during the late Miocene Epoch (at c. 9.83–9.69 Ma) separates units 1 and 2 and is identified by a marked change in lithology. Unit 3 consists of hemipelagic sediment with thin interbeds of graded sandstone of late Miocene age, separated from unit 4 by a second unconformity (U2) of 0.5–0.9 Myr duration. Unit 4 consists of upper Miocene interbedded mudstone and sandstone and hemipelagic chalk deposited between c. 8 and 6 Ma. A c. 1.4–1.6 Myr hiatus (U3) encompasses the Miocene–Pliocene boundary and separates unit 4 from unit 5. Unit 5 includes upper Pliocene – lower Pleistocene siliciclastic sediment that is separated from unit 6 by a c. 0.45 Myr hiatus (U4) in the lower Pleistocene sediments. Unit 6 includes a thick package of rapidly deposited Pleistocene sand and mud overlain by predominantly hemipelagic sediment deposited since c. 1.2 Ma.
A cross-sectional study on six dairy farms was conducted to ascertain the occurrence of carbapenem-resistant Escherichia coli in calves. Two-hundred and seventy-nine isolates of E. coli were recovered from 90 faecal samples from apparently healthy (45) and diarrhoeal (45) calves. The isolates were screened for phenotypic susceptibility to carbapenems and production of metallo β-lactamase, as well as five carbapenemase resistance genes by PCR, and overexpression of efflux pumps. Eighty-one isolates (29.03%) were resistant to at least one of three carbapenem antibiotics [meropenem (23.30%), imipenem (2.15%) and ertapenem (1.43%)], and one isolate was positive for the blaVIM gene which was located on an Incl1 plasmid of a novel sequence type (ST 297) by multilocus sequence typing. The majority (83.95%) of isolates had an active efflux pump. Calves housed on concrete floors were approximately seven times more likely to acquire meropenem-resistant isolates than those housed on earthen floors (95% CI 1.27–41.54). In India, carbapenem drugs are not used in food animal treatment, hence carbapenem-resistant strains in calves possibly originate from the natural environment or human contact and is of public health importance. To our knowledge, this is the first report of blaVIM carbapenemases gene in calves from India.
Depression frequently co-occurs with disorders of glucose and insulin homeostasis (DGIH) and obesity. Low-grade systemic inflammation and lifestyle factors in childhood may predispose to DGIH, obesity and depression. We aim to investigate the cross-sectional and longitudinal associations among DGIH, obesity and depression, and to examine the effect of demographics, lifestyle factors and antecedent low-grade inflammation on such associations in young people.
Using the Avon Longitudinal Study of Parents and Children birth cohort, we used regression analyses to examine: (1) cross-sectional and (2) longitudinal associations between measures of DGIH [insulin resistance (IR); impaired glucose tolerance] and body mass index (BMI) at ages 9 and 18 years, and depression (depressive symptoms and depressive episode) at age 18 years and (3) whether sociodemographics, lifestyle factors or inflammation [interleukin-6 (IL-6) at age 9 years] confounded any such associations.
We included 3208 participants. At age 18 years, IR and BMI were positively associated with depression. These associations may be explained by sociodemographic and lifestyle factors. There were no longitudinal associations between DGIH/BMI and depression, and adjustment for IL-6 and C-reactive protein did not attenuate associations between IR/BMI and depression; however, the longitudinal analyses may have been underpowered.
Young people with depression show evidence of DGIH and raised BMI, which may be related to sociodemographic and lifestyle effects such as deprivation, smoking, ethnicity and gender. In future, studies with larger samples are required to confirm this. Preventative strategies for the poorer physical health outcomes associated with depression should focus on malleable lifestyle factors.