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Prolonged survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on environmental surfaces and personal protective equipment may lead to these surfaces transmitting this pathogen to others. We sought to determine the effectiveness of a pulsed-xenon ultraviolet (PX-UV) disinfection system in reducing the load of SARS-CoV-2 on hard surfaces and N95 respirators.
Chamber slides and N95 respirator material were directly inoculated with SARS-CoV-2 and were exposed to different durations of PX-UV.
For hard surfaces, disinfection for 1, 2, and 5 minutes resulted in 3.53 log10, >4.54 log10, and >4.12 log10 reductions in viral load, respectively. For N95 respirators, disinfection for 5 minutes resulted in >4.79 log10 reduction in viral load. PX-UV significantly reduced SARS-CoV-2 on hard surfaces and N95 respirators.
With the potential to rapidly disinfectant environmental surfaces and N95 respirators, PX-UV devices are a promising technology to reduce environmental and personal protective equipment bioburden and to enhance both healthcare worker and patient safety by reducing the risk of exposure to SARS-CoV-2.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
The combination of clozapine and other potentially leukopenic drugs may pose a greater risk for neutropenia. However, neutropenia may not always be due to clozapine. When adding potentially leukopenic drugs, clinicians should look for possible alternatives especially as clozapine is often a drug used as the last resort in treatment refractory schizophrenia.
Childhood trauma and aggressive traits are considered risk factors for suicidal behavior. The hypothesis we aimed to test in this study was the existence of an association between childhood trauma and aggression in two distinct samples of Italian and French suicide attempters.
Study participants comprise 587 subjects with different psychiatric diagnoses according to DSM-IV-TR criteria. Three different samples were analyzed and compared: a group of French suicide attempters (N = 396; mean age 40.47 SD = 13.52; M/F: 110/286); a group of Italian suicide attempters (N = 103; mean age 38.60 SD = 12.04; M/F 27/76) and an Italian psychiatric comparison group (N = 88; mean age: 41.49 SD = 12.05; M/F; 37/51). Patients were interviewed with the Brown–Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Childhood Trauma Questionnaire (CTQ) 34-items for Italian data and 28-items for French data.
When compared with the comparison group, Italian suicide attempters had significantly higher scores on the BGLHA scale and reported higher scores on the CTQ scores for physical abuse, sexual abuse and emotional abuse. Significant correlations between childhood trauma and aggression were found in both groups, Italian and French, of suicide attempters.
The hypothesis tested was supported as psychiatric patients who had attempted suicide reported significantly more childhood trauma and aggression. Significant correlations were found between aggressive behavior, and childhood trauma in suicidal patients. This finding was replicated in two independently recruited samples in two countries with different prevalence of suicidal behavior.
The goal of this randomly-assigned placebo-controlled double-blind study was to determine if the addition of buspirone, a widely available 5-HT1A partial agonist, would enhance cognitive function, in subjects with schizophrenia treated with atypical antipsychotic drugs (AAPDs). Seventy-three patients with schizophrenia, who had been treated with an AAPD for at least three months, were randomly assigned to receive either buspirone, 30 mg/day, or matching placebo. All other medications remained unchanged. Attention, verbal fluency, verbal learning and memory, verbal working memory, and executive function, as well as psychopathology, were assessed at baseline, and 6 weeks, and 3 and 6 months after baseline. A significant Time x Group interaction effect was noted on the Digit Symbol Substitution Test, a measure of attention/speeded motor performance, due to better performance of the buspirone group compared to the placebo group at 3 months. No significant interaction effects were noted for other domains of cognition. Scores on the Brief Psychiatric Rating Scale (Total, Positive) were improved during treatment with buspirone but not placebo, but the effects did not reach statistical significance.
The results of this study showed a possible benefit of buspirone augmentation of AAPDs to enhance attention. However, we did not replicate the results of the previous study with tandospirone that improved executive function and verbal learning and memory, which may be due to the differences between tandospirone and buspirone, between typical antipsychotics and AAPDs, or a combination of the above. Further study to determine the usefulness of 5-HT1A agonist treatment in schizophrenia is indicated.
Every year 4,000 to 5,000 adolescents reside in Quebec Youth Protection Centers (YPCs). Many youth have risky behaviours and mental health issues that put them at risk for sexually transmitted infections (STIs).
Document the prevalence of STIs (chlamydia and gonorrhoeae) among adolescents aged 14-17 years old entering Quebec residential YPCs and identify associated risk factors.
In 2008–2009, adolescents residing in six YPCs completed a questionnaire covering sexual and substance use behaviours, as well as other health issues affecting their well-being. Urine samples were collected for Chlamydia trachomatis (CTGI) and Neisseria gonorrhoea (NGGI) genital infections.
Among 578 participants, 14-17 years old, 89% were sexually active. Risk behaviours included: early sexual initiation (66% < 14 years); multiple partners (median: girls 5, boys 8); group sex (girls 38%, boys 43%); sex for money or goods (girls 27%, boys 8%). Half of sexual relations were under the influence of drugs/alcohol. Regular substance use (3x weekly and +) was: tobacco: 75.0%; cannabis: 63.1%; alcohol: 24.2%; amphetamines: 16.7%; and cocaine: 7.4%. Prevalence of CTGI: 9.3% girls, 1.9% boys; NGGI: 1.7% girls, 0% boys. In multivariate analysis, factors significantly associated with chlamydia infection among girls were: alcohol intoxication hospitalisation or history of suicide ideation with plan.
Serious alcohol misuse or mental distress were significantly associated with STI infections among adolescents. Mental health professionals are encouraged to provide sexual health and substance use counselling with adolescent patients given the highly woven interaction between mental distress and risk of sexually transmitted infections.
In a study conducted in the database of a large commercial healthcare insurer, we previously demonstrated that use of a commercial pharmacogenetic assay for individuals with mood disorders was associated with decreased resource utilization and cost in the 6 month period following use compared to propensity-score matched controls. We conducted a post hoc analysis to understand variables associated with high cost savings.
The results and methods of the initial study have previously been described. Cases were individuals with mood and anxiety disorders who received a commercial pharmacogenetic assay (Genomind, King of Prussia PA) to inform pharmacotherapy. 817 tested individuals (cases) with mood and/or anxiety disorders were matched to 2745 controls. Overall costs were estimated to be $1,948 lower in the tested group. The differences were largely the result of lesser emergency room and inpatient utilization for cases. In the present analysis, cost difference for cases compared to their matched controls was rank ordered by decile. High cost savers were arbitrarily defined a priori as the top 20% of savers. Using multivariable modeling techniques, an ordinal logistic regression model was generated in which baseline or follow-up variables were statistically tested for independent associations with high, low, and no cost savings.
606 (74%) of cases were net cost savers compared to their controls (cost difference <0). High cost savers (n=121) saved on average $10,690 compared to their matched controls. They were statistically more likely to have been diagnosed with bipolar disorder (n=33/121) than low cost savers (n=57/485) or non-savers (n=31/211), and had a lower Charlson Comorbidity index. High cost savers had fewer mean number of antidepressants in the baseline period (mean=3.16) compared to non-savers (3.73) but more than low cost savers (2.72) (p<0.05 across groups). In a multivariable model, bipolar, count of antidepressants, outpatient visits, and inpatient visits were statistically associated with being a high cost saver; antidepressant count and all-cause inpatient and outpatient visits in the baseline period were inversely associated with cost savings.
Use of a pharmacogenetic assay was associated with cost-savings in the database of a large commercial insurer. Patients with bipolar disorder were more likely to be high cost savers than individuals with other mood and anxiety disorders.
Travelling across the Deccan Plateau of India, one encounters a somewhat confusing environment. On entering the region, say crossing the steep Sahyadri Mountains on the Mumbai–Pune Expressway, the landscape changes only slowly and gradually. Even if not as monotonous as the great Gangetic Plains of north India, the terrain remains relatively uniform for long distances. Yet, within this vast plateau, cultural markers change sharply and rapidly. For one, the region hosts some of India's shiniest IT centres, most notably in Hyderabad and Pune, alongside of some of India’s most impoverished rural communities. Beyond this cliche of India's economic disparities, the cultural and linguistic diversity of the region is easily noticeable. When crossing almost invisible state borders, which do not usually follow natural features, the script on the road signs changes immediately and one enters a visibly different linguistic domain. However, these seemingly uninterrupted linguistic spaces are not as even as they look. The region is dotted with towns where the dominant signage is in a language (and script) other than that of the state. In certain places, Urdu in Nastaliq and Hindi in Devanagari are predominant. Even these are not simply islands in the wider space. On the contrary, spaces are shared between all linguistic markers. They are occupied and visualised by scripts that link them to separate traditions. Even the Char Minar, the most recognisable landmark of the Muslim history of Hyderabad, shares its space with the Sri Bhagyalaksmi Temple, decorated by saffron flags and with signage in English, Devanagari and Telugu but (strategically) not in Nastaliq.
Linguistic diversity not only marks separated places, but also indicates connections. In certain settlements around the Deccan, for example, in sites in Aurangabad (Maharashtra), Hyderabad (Telangana) or Gulbarga (Karnataka), one is likely to see signs in Nastaliq, creating visual links between those places. Another level of cross-border linguistic connectivity is created by the use of English, and to some degree Hindi, both visible everywhere even if not spoken by all. If we tried to map the Deccan according to language use, then each language would demonstrate a distinct geography.
On the opposite side from the Deccanis in terms of their association with the Deccan as a region and with the sultanates as its dominant political organisation, stand the self-styled Foreigners. In a sense, they represent a paradox in the region. On the one hand, they placed themselves at the very centre of political life in the local sultanates. On the other hand, working according to non-localised lines, they were the least related to the Deccan of all elite groups. While some settled permanently in the region and gradually became identified as Deccanis, others preferred to emphasise their foreign origin and orientations. Many continued to rely on their association with trans-regional networks that linked them to their ancestral lands rather than immersing themselves in local society. In that, the Foreigners represent an elite element that at the same time contributed to the sultanates where they settled and preferred to adhere to transient over settled life.
Albeit widely discussed in the scholarship, the analysis of these foreign elites remains limited. Previous historiography tended to treat them either as a group of loosely linked individuals, or as a united political agglomeration, overlooking their social complexity and inner workings. This partial understanding was carried further into the analysis of the Foreigners’ position in the region, limiting their engagement only to either monolithic contradiction with the Deccanis or to individual contribution to the states. This chapter aims at analysing the Foreigners as a composite and diverse group, and, furthermore, to understand them within the political and social system of the Deccan. Examining their political structures, identities and sensitivities, the Foreigners will be introduced as a somewhat problematic political element, which not only contributed to the running of local institutions, but which was also disruptive, in action or in perception. As such, the chapter will highlight the duality they presented to the Deccan and their form of engagement that was different from that demonstrated by local actors.
Migration to India in Context
Migration from West Asia and the lands around the Indian Ocean into the Deccan was by no means a new phenomenon in early modern times. Possibly as early as Mauryan times (fourth–second centuries BCE) maritime links connected India to West Asia and East Africa.
In the previous chapters we examined the Deccan as the stage on which a unique state system emerged, characterised by parallel contradictory trajectories and the relative weakness of the centre. Elite groups were struggling and reformulating themselves in relation to one another and to the locality, on the one hand, and, on the other hand, to international identities and trans-regional networks. The emphasis on these aspects of political and social life on the Deccan Plateau has clear limitations. First and foremost, the narrative is heavily linked to the Islamic identity of the sultanates, whereas non-Muslims are pushed to the margins. This emphasis is not merely the outcome of modern imagination. Persian and, to some degree, Dakhani sources only seldom discuss non-Muslims. The region as a whole was imagined as an Islamic space, even if carrying its own brand of Islam.
The Deccan, however, was not solely an imagined Islamic space. The political system of all sultanates did not erase centuries of history. From imperial formations with their all-Deccani ideas to vernacular kingdom and their local sensitivities, the establishment of Muslim dynasties did not wipe off all pasts to start from a clean slate. Not only history, locality and memory, but also people, including elites, remained in place. Non-Muslims continued to be the majority of the population, and many non-Muslim elite groups maintained power bases and privilege. In the competitive environment of the early modern Deccan, the sultans did not have any choice but to rely on local expertise and its agents to maintain their military and administrative systems and to successfully position themselves vis-à-vis predatory neighbours. Considering the power relations between relatively weak rulers and powerful ruled, the sultans could not simply force locals into their system. Rather, they had to gain elite cooperation, and to do so quickly, if they wished to keep afloat in the com-bative environment of the sixteenth century. The collapse of Vijayanagara in 1565 and the opportunities it provided the sultans beyond their core regions only intensified the need to appeal to increasingly diverse groups.
The result was an ever-growing effort on behalf of the ruling dynasties to incorporate ideas and forms of expression into their political language that would appeal to local elites. These elements did not come to replace Islamic reasoning and legitimacy. Yet local, non-Muslim voices had a growing impact on the image and direction the sultanates took.
The engagement of the Deccan sultanates with the locality, be it as part of a state-acknowledged vernacularisation process or in the shape of non-particular localisation, achieved considerable success. The sultan-ates were able to gain the support of substantial elite groups, Muslim and non-Muslim alike, with whose backing they secured their rule for many years. Particularly in their core regions on the Deccan Plateau, the rule of the Qutb Shahi and ᑦAdil Shahi sultans remained unchallenged until the mid-seventeenth century. Even in shaky Ahmadnagar, where the Nizam Shahi rulers faced continuous internal instability and Mughal aggression, the dynasty maintained its monopolistic position of legitimacy.
The success of the sultanates, however, had evident limitations. In certain places, substantial gaps separated the sultans, the ideology they projected, and their ability to enforce it, on the one hand, and the willingness of local elites to accept their message, on the other hand. Regions not under firm sultanate rule, beyond the core region of a sultanate or under weakening authority, were particularly problematic. From the second quarter of the seventeenth century, more general upheaval put the system to the test. The events started with a historical coincidence. In 1626–7, a whole generation of rulers died. Sultan Muhammad Qutb Shah of Golkonda was succeeded by his son, ᑦAbdullah (r. 1626–72). Malik Ambar died the same year, throwing Nizam Shahi domains back into confusion. In 1627, Ibrahim ʿAdil Shah II of Bijapur was succeeded by his son Muhammad (r. 1627–56). No less important was the death of the Mughal Emperor Jahangir in late 1627, to be succeeded by his son Shah Jahan (r. 1628–58). The combination of sweeping changes in leadership in the Deccan and the expansionist ambitions of the new Mughal emperor was bound to have a major effect on the region. The decade that followed was tense, not the least due to the Mughal invasion. A peace treaty in 1636 seemingly secured the northern border of the sultanates, allowing them to expand considerably. This expansion, however, brought the internal tensions and questions of control back to the surface, shaking the ruling dynasties. With renewed Mughal aggression in the mid-1650s the situation seemed ever grimmer; the sultanates only barely survived the war.
The history of the early modern Deccan reveals parallel trends which were seemingly contradictory. The region was unified in many respects: geographically, politically, historically and culturally. The various factors of unity came together to define the Deccan as a discrete space, distinct from both Vijayanagara to the south and the Mughal Empire to the north. Accordingly, early modern sources, as well as modern historiography, have treated the Deccan as a single, coherent historical and geopolitical entity. This unity, however, was limited to only certain aspects. In other respects, the Deccan has been a composite and diverse space, divided according to numerous lines. The most easily traceable division was along political lines: the region was home to simultaneous dynasties, closely linked to one another yet who perceived themselves as independent. Most prominent of these were the Nizam Shahs, ᑦAdil Shahs and Qutb Shahs, by the side of the significantly weaker ᑦImad Shahs, Baridis and numerous local potentates. While the Deccan sultanates saw prolonged periods of conflict, in particular, in the western Deccan, their core regions remained stable throughout the period, limiting shifts to their border regions only.
Politics was only one aspect of intra-regional divisions. Elite society itself was far from homogeneous. On the contrary, at the very heart of each sultanate stood a complex elite which was diverse in terms of religion, language, class, caste and occupation. Both local and foreign groups took part in various aspects of the political, military, economic and cultural life of the sultanates. Most identified with the local political system were the group known as Deccanis, a term broadly referring to those Muslims who saw the Deccan as their home. The Deccanis hailed from diverse backgrounds: some were local converts, others, the descendants of migrants from north India, yet others were new migrants who struck roots in the region. By their side, in all sultanates, members of trans-regional communities, self-styled Foreigners, became a crucial part of the elites. Organised in locality- or family-based networks, many Foreigners combined personal interests in trade, scholarly pursuits, and administrative and military positions. Those Muslims from Iran and elsewhere in West and Central Asia presented a rejection of the locality in favour of a continuously itinerant lifestyle.