To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Several aspects of the COVID-19 pandemic remain ambiguous, including its transmission, severity, geographic and racial differences in mortality. These variations merit elaboration of local patterns to inform wider national policies.
In a retrospective analysis, data of patients treated at a dedicated COVID hospital with moderate and severe illness during eight weeks of the pandemic was reviewed with attention to mortality in a competing risks framework.
A total of 1147 patients were hospitalized, and 312 (27.2%) died in hospital. Those who died were older (56.5 vs 47.6 years; p, < 0.0001). Of these, 885 (77.2%) had tested positive on RT-PCR, with 219 (24.2%) deaths (incidence rate, 1.9 per 100 person-days). Median time from onset of symptoms to death was 11 days. A competing risks analysis for in-hospital death revealed an adjusted cause-specific hazard ratio of 1.4 for each decade increase in age.
This retrospective analysis provides broad patterns of disease presentation and mortality. Even COVID test negative patients will receive treatment at dedicated facilities and 33% presenting cases may die within the first 72 hours, most with comorbid illness. This should be considered while planning distribution of services for effective healthcare delivery
To determine the demographic pattern of juvenile-onset parkinsonism (JP, <20 years), young-onset (YOPD, 20–40 years), and early onset (EOPD, 40–50 years) Parkinson’s disease (PD) in India.
Materials and Methods:
We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.
A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sleep-related issues more common in EOPD subjects. Overall, dyskinesias were documented in 32.8%. YOPD subjects had a higher frequency of dyskinesia than EOPD subjects (39.9% vs. 25.5%), but they were first noted later in the disease course (5.7 vs. 4.4 years).
This large cohort shows differing clinical patterns in JP, YOPD, and EOPD cases. We propose that cutoffs of <20, <40, and <50 years should preferably be used to define JP, YOPD, and EOPD.
Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
Introduction: Emergency department (ED) patients with cellulitis that are treated with intravenous (IV) antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary objective of this study was to determine whether the implementation of an OPAT clinic results in decreased hospitalization and return ED visits for patients treated with IV antibiotics. Methods: We conducted a before-after implementation study involving adults (age >=18 years) that presented to two tertiary care EDs with cellulitis and were treated with IV antibiotics. The intervention was referral to an infectious disease physician within one week of the index ED visit at the newly created OPAT clinic. The primary outcomes were hospital admission and return ED visits within 14 days. Secondary outcomes were treatment failure (admission after 48 hours of OPAT) and adverse events (e.g. vomiting, diarrhea). We conducted an interrupted time series analysis from January to December both pre-intervention (2013) and post-intervention (2015), with 24 monthly data points. The year of clinic implementation (2014) was considered a transition period. A segmented non-linear regression autoregressive error model was used to aggregate the monthly data to evaluate the effectiveness of the intervention. Results: A total of 1,666 patients met inclusion criteria: 858 pre-intervention (mean age 59 years, 53.1% male) and 808 post-intervention (mean age 62 years, 54.5% male). Hospitalization rates were not significantly higher one year after clinic implementation (p = 0.53) although there was a non-statistically significant gradual increase of 0.8% per month (95%CI -0.3% to 1.9%). One year after introduction of the OPAT clinic, return ED visits were significantly lower (change in intercept -24.4%, 95%CI -34.2% to -14.6%; p < 0.001), followed by an additional drop of 1.4% per month (95%CI -2.1% to -0.6%; p = 0.002). By the end of the study, return visits were 40.7% lower (95%CI 25.6% to 55.9%) than if the intervention had not been introduced. Treatment failure rates were <2% and adverse events were <5% in both groups. Conclusion: Implementation of an OPAT clinic significantly reduced return ED visits for cellulitis, which is critically important given the current ED overcrowding crisis. There was no significant change in hospital admission rates. There were low rates of treatment failures and adverse events. An OPAT clinic should be considered to reduce ED crowding while maintaining safe patient care.
Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
Occurrence of drought under rainfed conditions is the foremost factor responsible for yield reduction in soybean. Developing soybean cultivars with an inherent ability to withstand drought would immensely benefit the soybean production in rainfed areas. In the present study, F2 derived mapping populations were developed by crossing drought tolerant (PK 1180, SL 46) and susceptible (UPSL 298, PK 1169) genotypes to investigate the inheritance of seedling survival drought mechanisms and to identify simple-sequence repeat (SSR) markers associated with them, using bulked segregant analysis. Parents as well as a F2 derived mapping population were screened for drought tolerance based on seedling survivability under controlled conditions. Segregation analysis of F2 population derived from a cross between PK 1180 × UPSL 298 was previously shown to have a 3:1 tolerant to susceptible ratio and a probability of 0.61 at a χ2(3:1) value of 0.258. This was confirmed in another F2 population derived from a cross between PK 1169 × SL 46 with a χ2(3:1) value of 0.145 obtained at a probability of 0.70. One SSR marker Satt277 showed polymorphism between contracting bulks (tolerant and susceptible) out of 50 polymorphic markers identified during parental polymorphism. Single marker analysis suggested that the marker, Satt277 is linked to seedling survival drought tolerance and is located on chromosome linkage group C2 (chr 6) with a map distance of 3.40 cM. The tolerant genotypes identified could be used as a donor in soybean improvement programs. The marker identified can be used in marker-assisted selection while screening large collection of germplasm.
Prostate cancer is one of the most common solid malignancies and has a high morbidity rate. The uncertainty of the prostate location compromises the overall treatment plan optimisation. To account for the location uncertainty, the radiation oncologist needs to expand the margin of the planning target volume (PTV), which may increase the radiation toxicity to organs in proximity.
Materials and methods:
In this study, we investigated the quality of treatment plans for a patient with different ring sizes (2 and 3 cm). A small ring-shaped structure circumferentially around the PTV helps in defining the location of PTV. Prostate and pelvic node plans were analysed with dose prescription to 99% of PTV.
Additional ring-shaped structures led to more conformal dose coverage for target with reduced radiation side effects to nearby organ at risk (OAR). Expected treatment time was slightly higher for 2 cm ring compared to 3 cm ring. In case of prostate, expected duration was 4% higher, while for node plan, expected duration for 2 cm ring was 16% higher compared to 3 cm ring plan.
It was observed that using a smaller size ring can lead to improved dose sparing to OAR with same target coverage as with larger dimension ring. The composite plans do not show any clinically significant difference in dose to OARs.
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.
The study area belongs to the Singhbhum metamorphic belt of Jharkhand, situated in the eastern part of India. The spatial distribution of the index minerals in the pelitic schists of the area shows Barrovian type of metamorphism. Three isograds, viz. garnet, staurolite and sillimanite, have been delineated and the textural study of the schists has revealed a time relation between crystallization and deformation. Series of folds with shifting values of plunges in the supracrustal rocks having axial-planar schistosity to the folds have been widely cited. Development of these folds could be attributed to the second phase of deformation. In total, two phases of deformation, D1 and D2, in association with two phases of metamorphism, M1 and M2, have been lined up in the study area. Chemographic plots of reactant and product assemblages corresponding to various metamorphic reactions suggest that the pattern of metamorphic zones mapped in space is in coherence with the temporal-sequential change during prograde metamorphism. The prograde P–T evolution of the study area has been obtained using conventional geothermobarometry, internally consistent winTWQ program and Perple_X software in the MnNCKFMASHTO model system. Our observations suggest that the progressive metamorphism in the area is not related to granitic intrusion or migmatization but that it was possibly the ascending plume that resulted in the M1 phase of metamorphism followed by D1 deformation. The second and prime metamorphic phase, M2, with its possible heat source generated by crustal overloading, was preceded by D1 and it lasted until late- to post-D2 deformation.
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
We present the study of horizontal branch morphology of the cluster NGC 6656. A blueward shift in temperature of about ~5000 K (nM-jump) in the color-color plot is detected.To explain this feature, we study the presence of stellar-mass black hole by plotting Projected density profile (PDP) in the central HST region. The PDP in the inner region (r < 10″) can be nicely reproduced by the king+BH model. The blue ward shift in temperature can be due the presence of stellar mass black holes in the centre.
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.
Nano-patterned surfaces have potential applications in the development of efficient solar cells through multiple internal reflections and may be used to fulfil the energy demand of rural India. Therefore, the basic understanding of growth mechanism of patterns under ion irradiation is much required. Here, the ripple patterns are grown on Si (100) surfaces for two specific ion irradiation conditions. First, the two set of samples (namely set-A and set-B) of Si (100) are irradiated by 50 keVAr+ ion beam at oblique (60°) and normal incidence, respectively, using ion fluence of 5×1016 ions/ cm2. The aim of this first stage irradiation at two different angles is the creation of different depth locations of amorphous/crystalline (a/c) interface while keeping the free surface similar in surface features, which is a crucial parameter in surface growth. Further, the sequential second stage irradiation is carried out at 60° for the same energy of Ar beam for the fluences 3×1017 to 9×1017 ions/cm2 to see the evolution of ripple patterns. Atomic force microscopy (AFM) study shows that the ripple pattern ordering is better in set-A rather than set-B. Lateral correlation length of each ripple structure surface is computed by autocorrelation function while roughness exponent is measured with height-height correlation function. Fractals behaviors of patterned on Si (100) surface are found to be sensitive to the two stage irradiation approach. The understanding of the mechanism of nano-patterns formation may be useful to develop efficient solar systems for the needs of energy in rural India.
Polyphenol oxidase (PPO) in red clover (RC) has been shown to reduce both lipolysis and proteolysis in silo and implicated (in vitro) in the rumen. However, all in vivo comparisons have compared RC with other forages, typically with lower levels of PPO, which brings in other confounding factors as to the cause for the greater protection of dietary nitrogen (N) and C18 polyunsaturated fatty acids (PUFA) on RC silage. This study compared two RC silages which when ensiled had contrasting PPO activities (RC+ and RC−) against a control of perennial ryegrass silage (PRG) to ascertain the effect of PPO activity on dietary N digestibility and PUFA biohydrogenation. Two studies were performed the first to investigate rumen and duodenal flow with six Hereford×Friesian steers, prepared with rumen and duodenal cannulae, and the second investigating whole tract N balance using six Holstein-Friesian non-lactating dairy cows. All diets were offered at a restricted level based on animal live weight with each experiment consisting of two 3×3 Latin squares using big bale silages ensiled in 2010 and 2011, respectively. For the first experiment digesta flow at the duodenum was estimated using a dual-phase marker system with ytterbium acetate and chromium ethylenediaminetetraacetic acid as particulate and liquid phase markers, respectively. Total N intake was higher on the RC silages in both experiments and higher on RC− than RC+. Rumen ammonia-N reflected intake with ammonia-N per unit of N intake lower on RC+ than RC−. Microbial N duodenal flow was comparable across all silage diets with non-microbial N higher on RC than the PRG with no difference between RC+ and RC−, even when reported on a N intake basis. C18 PUFA biohydrogenation was lower on RC silage diets than PRG but with no difference between RC+ and RC−. The N balance trial showed a greater retention of N on RC+ over RC−; however, this response is likely related to the difference in N intake over any PPO driven protection. The lack of difference between RC silages, despite contrasting levels of PPO, may reflect a similar level of protein-bound-phenol complexing determined in each RC silage. Previously this complexing has been associated with PPOs protection mechanism; however, this study has shown that protection is not related to total PPO activity.
Perforations of the tympanic membrane are treated with various surgical techniques and materials. This study aimed to determine the efficacy of platelet-rich plasma during underlay myringoplasty.
The study included 40 patients. Autologous platelet-rich plasma was applied in-between temporalis fascia graft and tympanic membrane remnant during underlay myringoplasty in group 1 (n = 20). The outcome was evaluated after three months and compared with group 2 (n = 20), a control group that underwent routine underlay tympanoplasty.
After three months’ follow up, graft uptake was 95 per cent in group 1 and 85 per cent in group 2 (p < 0.03). Mean hearing threshold gain was 18.62 dB in group 1 and 13.15 dB in group 2. This difference was statistically significant (p < 0.01).
Platelet-rich plasma, with its ease of preparation technique, availability, low cost, autologous nature and good graft uptake rate, justifies its use in tympanoplasty type I procedures.
Detailed numerical simulations have been carried out on a spiked blunt body with multiple hemispherical disks using a commercial CFD code in order to investigate their effectiveness in reducing the aerodynamic drag and heating. The base configuration is a hemispherical cylinder whose diameter is 40 mm with an overall length of 70 mm. The lengths of the aerospikes investigated are 1, 1.5, 2 and 2.5 times the base diameter of the cylinder and the radii of the aerodisks are varied between 0.05, 0.1, 0.15 and 0.2 times the diameter of the cylinder. Besides these, the position of the aerodisks is varied with the rearmost aerodisk placed at 25%, 50% and 75% along the length of the aerospike and the intermediate aerodisk for three-disk cases, positioned at 25%, 50% and 75% of the distance between the front and the rearmost disk. All the investigations have carried out at a freestream Mach number of 6.2 and Reynolds number of 2.64 × 107/m. It has been observed that the multidisk spikes are advantageous for the purpose of reduction of both aerodynamic drag and heating at hypersonic speed. The two aerodisk spiked configurations show better results in terms of aerodynamic heating and drag in comparison to the single-disk aerospikes while the three-disk spikes yield only a marginal reduction in aerodynamic drag over the two-disk configurations. For reduction of heat fluxes and heat transfer rates though, the three-disk configurations are extremely advantageous and give much larger reductions are compared to the two-disk configurations.
The National Iodine and Salt Intake Survey (NISI) 2014–2015 was undertaken to estimate household iodised salt coverage at national and sub-national levels in India.
Cross-sectional survey with multistage stratified random sampling.
India was divided into six geographic zones (South, West, Central, North, East and North-East) and each zone was further stratified into rural and urban areas to yield twelve distinct survey strata.
The target respondent from each household was selected as per predefined priority; wife of the household head, followed by women of reproductive age, followed by any adult available during the visit.
Households (n 5717) were surveyed and salt samples (n 5682) were analysed. Household coverage of iodised salt (iodine≥5 ppm) was 91·7 (95 % CI 91·0, 92·7) %. Adequately iodised salt (iodine≥15 ppm) was consumed in 77·5 (95 % CI 76·4, 78·6) % of households. Significant differences in coverage were seen across six geographic regions, with North and North-East zones on the verge of achieving the universal salt iodisation target of >90 % coverage. Coverage of households with adequately iodised salt (adjusted OR; 95 % CI) was significantly less in rural households (0·55; 0·47, 0·64), lower/backward castes (0·84; 0·72, 0·98), deprived households (0·72; 0·61, 0·85) as assessed by multidimensional poverty index, households with non-diverse diet (0·73; 0·62, 0·86) and households using non-packaged salt (0·48; 0·39, 0·59) and non-refined salt (0·17; 0·15, 0·20).
India is within striking reach of achieving universal salt iodisation. However, significant differentials by rural/urban, zonal and socio-economic indicators exist, warranting accelerated efforts and targeted interventions for high-risk groups.
The interstellar extinction law in 20 open star clusters namely, Berkeley 7, Collinder 69, Hogg 10, NGC 2362, Czernik 43, NGC 6530, NGC 6871, Bochum 10, Haffner 18, IC 4996, NGC 2384, NGC 6193, NGC 6618, NGC 7160, Collinder 232, Haffner 19, NGC 2401, NGC 6231, NGC 6823, and NGC 7380 have been studied in the optical and near-IR wavelength ranges. The difference between maximum and minimum values of E(B − V) indicates the presence of non-uniform extinction in all the clusters except Collinder 69, NGC 2362, and NGC 2384. The colour excess ratios are consistent with a normal extinction law for the clusters NGC 6823, Haffner 18, Haffner 19, NGC 7160, NGC 6193, NGC 2401, NGC 2384, NGC 6871, NGC 7380, Berkeley 7, Collinder 69, and IC 4996. We have found that the differential colour-excess ΔE(B − V), which may be due to the occurrence of dust and gas inside the clusters, decreases with the age of the clusters. A spatial variation of colour excess is found in NGC 6193 in the sense that it decreases from east to west in the cluster region. For the clusters Berkeley 7, NGC 7380, and NGC 6871, a dependence of colour excess E(B − V) with spectral class and luminosity is observed. Eight stars in Collinder 232, four stars in NGC 6530, and one star in NGC 6231 have excess flux in near-IR. This indicates that these stars may have circumstellar material around them.