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This study assesses the experiences of Internationally Recruited (IR) Consultant Psychiatrists focussing on the recruitment process and its adherence to the DH guidance.
Methods:
Eighty-eight IR consultant psychiatrists from different countries were mailed a 13-item questionnaire assessing their experiences regarding various aspects of the recruitment process.
Results:
48% IR psychiatrists responded; 97% were from India. The recruitment process was generally satisfactory with perceived gaps in support from various stakeholders. Inconsistent experiences were reported regarding induction, mentorship, clinical responsibilities, and racial discrimination.
Conclusions:
The recruitment process adhered to the good practice guidelines (DH) within the broad framework of clinical governance. It is important that any such future initiatives have in place appropriate supervision, mentorship, and a sufficient period of induction including exposure to the relevant systems and procedures to ensure good quality service with a view to minimise risk for patients as well as staff. There are limitations to the applicability of the results to the wider group of professionals.
We present a detailed analysis of the radio galaxy PKS
$2250{-}351$
, a giant of 1.2 Mpc projected size, its host galaxy, and its environment. We use radio data from the Murchison Widefield Array, the upgraded Giant Metre-wavelength Radio Telescope, the Australian Square Kilometre Array Pathfinder, and the Australia Telescope Compact Array to model the jet power and age. Optical and IR data come from the Galaxy And Mass Assembly (GAMA) survey and provide information on the host galaxy and environment. GAMA spectroscopy confirms that PKS
$2250{-}351$
lies at
$z=0.2115$
in the irregular, and likely unrelaxed, cluster Abell 3936. We find its host is a massive, ‘red and dead’ elliptical galaxy with negligible star formation but with a highly obscured active galactic nucleus dominating the mid-IR emission. Assuming it lies on the local M–
$\sigma$
relation, it has an Eddington accretion rate of
$\lambda_{\rm EDD}\sim 0.014$
. We find that the lobe-derived jet power (a time-averaged measure) is an order of magnitude greater than the hotspot-derived jet power (an instantaneous measure). We propose that over the lifetime of the observed radio emission (
${\sim} 300\,$
Myr), the accretion has switched from an inefficient advection-dominated mode to a thin disc efficient mode, consistent with the decrease in jet power. We also suggest that the asymmetric radio morphology is due to its environment, with the host of PKS
$2250{-}351$
lying to the west of the densest concentration of galaxies in Abell 3936.
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.
Mules and other equine species have been used in warfare for thousands of years to transport goods and supplies. Mules are known for ‘braying’, which is disadvantageous in warfare operations. This article explores the fascinating development of surgical techniques to stop military mules from braying, with particular emphasis on the key role played by the otolaryngologist Arthur James Moffett in devoicing the mules of the second Chindit expedition of World War II.
Method
The PubMed database (1900–2017) and Google search engine were used to identify articles related to devoicing mules in the medical and veterinary literature, along with information and images on the Chindit expedition.
Results
This paper reviews the surgical techniques aimed at treating braying in mules, ranging from ventriculectomy and arytenoidectomy to Moffett's approach of vocal cordectomy.
Conclusion
Moffett's technique of vocal cordectomy provided a quick, reproducible and safe solution for devoicing mules. It proved to be advantageous on the battlefield and demonstrated his achievements outside the field of medicine.
Immunoactivation depends upon the antigen potential to modulate T-cell repertoires. The present study has enumerated the effect of 61 kDa recombinant Leishmania donovani co-factor-independent phosphoglycerate mutase (rLd-iPGAM) on mononuclear cells of healthy and treated visceral leishmaniasis subjects as well as on THP-1 cell line. rLd-iPGAM stimulation induced higher expression of interleukin-1β (IL-1β) in the phagocytic cell, its receptor and CD69 on T-cell subsets. These cellular activations resulted in upregulation of host-protective cytokines IL-2, IL-12, IL-17, tumour necrosis factor-α and interferon-γ, and downregulation of IL-4, IL-10 and tumour growth factor-β. This immune polarization was also evidenced by upregulation of nuclear factor-κ light-chain enhancer of activated B cells p50 and regulated expression of suppressor of mother against decapentaplegic protein-4. rLd-iPGAM stimulation also promoted lymphocyte proliferation and boosted the leishmaniacidal activity of macrophages by upregulating reactive oxygen species. It also induced 1·8-fold higher release of nitric oxide (NO) by promoting the transcription of inducible nitric oxide synthase gene. Besides, in silico analysis suggested the presence of major histocompatibility complex class I and II restricted epitopes, which can proficiently trigger CD8+ and CD4+ cells, respectively. This study reports rLd-iPGAM as an effective immunoprophylactic agent, which can be used in future vaccine design.
Influenza A(H1N1) viruses of the 2009 pandemic (A(H1N1)pdm09) continue to cause outbreaks in the post-pandemic period. During January to May 2015, an upsurge of influenza was recorded that resulted in high fatality in central India. Genetic lineage, mutations in the hemagglutinin (HA) gene and infection by quasi-species are reported to affect disease severity. The objective of this study is to present the molecular and epidemiological trends during the 2015 influenza outbreak in central India. All the referred samples were subjected to qRT–PCR for diagnosis. HA gene sequencing (23 survivors and 24 non-survivors) and cloning were performed and analyzed using Molecular Evolutionary Genomic Analyzer (MEGA 5·05). Of the 3625 tested samples, 1607 (44·3%) were positive for influenza A(H1N1)pdm09, of which 228 (14·2%) individuals succumbed to death. A significant trend was observed in positivity (P = 0·003) and mortality (P < 0·0001) with increasing age. The circulating A(H1N1)pdm09 virus was characterized as belonging to clade-6B. Clinically significant mutations were detected. Patients infected with the quasi-species of the virus had a greater risk of death (P = 0·009). This study proposes a robust molecular and clinical surveillance program for the detection and characterization of the virus, along with prompt treatment protocols to prevent outbreaks.
Safflower is a traditional oilseed crop in the world. Its seed oil is a healthy edible oil containing high amount of unsaturated fatty acids. Genetically diverse exotic cultivars are valuable germplasm for introducing new diversity in safflower improvement programmes. In this study, we characterized safflower cultivars of India (30) and Mexico (23) comprising varieties, hybrids and advanced lines developed over 50 years for genetic distinctiveness using 38 simple sequence repeat (SSR) loci. Genetic diversity estimates across cultivar groups (total, India and Mexico) were as follows: mean number of alleles (3.2, 3.1, 2.6), expected heterozygosity (0.42, 0.37, 0.37) and polymorphism information content (0.36, 0.33, 0.32) respectively, which suggested narrow SSR allelic diversity within and between cultivar groups. However, distance-based cluster analysis (neighbour-joining tree) and model-based STRUCTURE analysis revealed that safflower cultivars of India and Mexico, with the exception of a few, form two genetically distinct groups. High level of genetic variation explained between the populations (40%) and Fst estimate (0.4) suggested that the cultivar groups were highly differentiated with limited gene flow supporting a strong genetic structuring. High oil (~38%) and high oleic (73–79%) contents of a subset of Mexican safflower varieties and advanced lines were confirmed in field trials in India. These exotic sources from Mexico are valuable for safflower breeding programmes in India to develop new cultivars with high oil yielding potential and high oleic acid content, which is the current market demand.
We assessed the effect of vitamin D supplementation on related biochemistry, infection and dentition of the infant. In a double-blind, placebo-controlled trial conducted in Lucknow, India (latitude 26°N), 230 mother –newborn pairs were randomised to receive, for 9 months, 3000µg/month oral vitamin D3 by the mother (group A) or 10µg/d by the infant (group B) or double placebo (group C). All babies received 15 min of sun exposure (unclothed) during massage. Infants’ median 25-hydroxyvitamin D (25(OH)D) was lower in group C (median 45·3; interquartile range (IQR) 22–59·5 nmol/l) than in groups A (median 60·8; IQR 41·3–80·5 nmol/l (P<0·01)) and B (median 61·3; IQR 41·3–75·3 nmol/l (P<0·05)) at 3·5 months. Infant 25(OH)D correlated negatively with infant parathyroid hormone (r −0·46, P<0·01). Elevated alkaline phosphatase (>7.5µkat/l) was significantly more frequent in group C babies (16 %) than in group A (4 %) or group B (0 %) babies. The number of days with respiratory or diarrhoeal infection by 9 months of age was higher in group C (median 46·5; IQR 14·8–73·3 d) than in group A (median 18·5; IQR 8·8–31·0 d (P<0·01)) or group B (median 13·0; IQR 7·0–28·5 (P<0·05)). We conclude that monthly maternal or daily infant supplementation with vitamin D along with sun exposure is superior to sun exposure alone in maintaining normal infant 25(OH)D at 3·5 months, and provide protection from elevated alkaline phosphatase and infectious morbidity.
Risk for depression is expressed across multiple levels of analysis. For example, parental depression and cognitive vulnerability are known markers of depression risk, but no study has examined their interactive effects on children's cortisol reactivity, a likely mediator of early depression risk. We examined relations across these different levels of vulnerability using cross-sectional and longitudinal methods in two community samples of children. Children were assessed for cognitive vulnerability using self-reports (Study 1; n = 244) and tasks tapping memory and attentional bias (Study 2; n = 205), and their parents were assessed for depression history using structured clinical interviews. In both samples, children participated in standardized stress tasks and cortisol reactivity was assessed. Cross-sectionally and longitudinally, parental depression history and child cognitive vulnerability interacted to predict children's cortisol reactivity; associations between parent depression and elevated child cortisol activity were found when children also showed elevated depressotypic attributions as well as attentional and memory biases. Findings indicate that models of children's emerging depression risk may benefit from the examination of the interactive effects of multiple sources of vulnerability across levels of analysis.
The choice of an appropriate cropping system is critical to maintaining or enhancing agricultural sustainability. Yield, profitability and water use efficiency are important factors for determining suitability of cropping systems in hot arid region. In a two-year field experiment (2009/10–2010/11) on loam sandy soils of Bikaner, India, the production potential, profitability and water use efficiency (WUE) of five cropping systems (groundnut–wheat, groundnut–isabgol, groundnut–chickpea, cluster bean–wheat and mung bean–wheat) each at six nutrient application rate (NAR) i.e. 0, 25, 50, 75, 100% recommended dose of N and P (NP) and 100% NP + S were evaluated. The cropping systems varied significantly in terms of productivity, profitability and WUEs. Averaged across nutrient application regimes, groundnut–wheat rotation gave 300–1620 kg ha−1 and 957–3365 kg ha−1 higher grain and biomass yields, respectively, than other cropping systems. The mean annual net returns were highest for the mung bean–wheat system, which returned 32–57% higher net return than other cropping systems. The mung bean–wheat and cluster bean–wheat systems had higher WUE in terms of yields than other cropping systems. The mung bean–wheat system recorded 35–63% higher WUE in monetary terms compared with other systems. Nutrients application improved yields, profit and WUEs of cropping systems. Averaged across years and cropping systems, the application of 100% NP improved grain yields, returns and WUE by 1.7, 3.9 and 1.6 times than no application of nutrients. The results suggest that the profitability and WUEs of crop production in this hot arid environment can be improved, compared with groundnut–wheat cropping, by substituting groundnut by mung bean and nutrients application.
Dengue is regarded as the most important arboviral disease. Although sporadic cases have been reported, serotypes responsible for outbreaks have not been identified from central India over the last 20 years. We investigated two outbreaks of febrile illness, in August and November 2012, from Korea district (Chhattisgarh) and Narsinghpur district (Madhya Pradesh), respectively. Fever and entomological surveys were conducted in the affected regions. Molecular and serological tests were conducted on collected serum samples. Dengue-specific amplicons were sequenced and phylogenetic analyses were performed. In Korea and Narsinghpur districts 37·3% and 59% of cases were positive, respectively, for dengue infection, with adults being the worst affected. RT–PCR confirmed dengue virus serotype 1 genotype III as the aetiology. Ninety-six percent of infections were primary. This is the first time that dengue virus 1 outbreaks have been documented from central India. Introduction of the virus into the population and a conducive mosquitogenic environment favouring increased vector density caused the outbreak. Timely diagnosis and strengthening vector control measures are essential to avoid future outbreaks.
Identification of climate-smart nutrient management practices will overcome the ill effects of extreme climate variability on agricultural production under projected climate change scenarios. The rice–wheat cropping system is the major system used in India: using long-term yield data from Integrated Nutrient Management experiments on this system, the present study analysed trends in weather parameters and grain yield under different nutrient management practices. Twelve treatments with different combinations of inorganic (chemical fertilizer) and organic (farmyard manure (FYM), green manure (GM) and crop residue) sources of nutrients were compared with farmers’ conventional practices. A significant increasing trend was noticed for rainfall during the rice season at Kalyani and Navsari, of the order of 137·7 and 154·2 mm/decade, respectively. The highest increase in maximum temperature was seen at Palampur (1·62 °C/decade) followed by Ludhiana (1·14 °C/decade). At all the sites except Ludhiana and Kanpur, the yield of the rice–wheat system showed an increasing trend ranging from 0·08 t/ha/year in Jabalpur to 0·011 t/ha/year in Navsari, under the recommended dose of inorganic fertilizer application. A significant decreasing trend of 0·055 t/ha was found in Ludhiana. For most of the sites, a combination of half the recommended dose of inorganic fertilizer and either FYM or GM to provide the remainder of the N required was sufficient to maintain productivity. The top three climate-resilient integrated nutrient management practices were identified for all the study sites. Thus, the present study highlights the adaptive capacity of different integrated nutrient management practices to rainfall and temperature extremes under rice–wheat cropping system in distinctive agro-ecological zones of India.
We calculated mass attenuation coefficients, effective atomic numbers and Kerma relative to air for human organ and tissue substitutes
(i.e. wax, plastic and polymer materials). The effective atomic numbers of the tissue substitutes were calculated by the direct method, interpolation method, Auto-Zeff software and single value XMuDat program and then compared. The calculated effective atomic numbers were also compared with available experimental data and a good agreement was observed. A large difference in effective atomic numbers calculated by the direct and interpolation methods was observed in photoelectric and pair-production regions. The direct method was found to be appropriate for effective atomic number computation in low-(>10 keV) and medium-(0.1 ≤ E ≤ 10 MeV) photon energy regions. Kerma relative to air of the selected tissue substitutes was found to be dependent upon the atomic number and element compositions, which show a sharp peak due to K-edge absorption.
Smallholder dairy production represents a promising income generating activity for poor farmers in the developing world. Because of the perishable nature of milk, marketing arrangements for collection, distribution and sale are important for enhanced livelihoods in the smallholder dairy sector. In this study we examined the relationship between market quality and basic feeding and breeding practices at farm level. We define market quality as the attractiveness and reliability of procurement channels and associated input supply arrangements. We took as our study countries, India with its well-developed smallholder dairy sector, and Ethiopia where the smallholder dairy industry has remained relatively undeveloped despite decades of development effort. We conducted village surveys among producer groups in 90 villages across three States in India and two Regions in Ethiopia. Producer groups were stratified according to three levels of market quality – high, medium and low. Data showed that diet composition was relatively similar in India and Ethiopia with crop residues forming the major share of the diet. Concentrate feeding tended to be more prominent in high market quality sites. Herd composition changed with market quality with more dairy (exotic) cross-bred animals in high market quality sites in both India and Ethiopia. Cross-bred animals were generally more prominent in India than Ethiopia. Herd performance within breed did not change a great deal along the market quality gradient. Parameters such as calving interval and milk yield were relatively insensitive to market quality. Insemination of cross-bred cows was predominantly by artificial insemination (AI) in India and accounted for around half of cross-bred cow inseminations in Ethiopia. Data on perceptions of change over the last decade indicated that per herd and per cow productivity are both increasing in high market quality sites with a more mixed picture in medium and low-quality sites. Similarly dairy-derived income is on the increase in high market quality sites. This is accompanied by a strong increase in stall feeding at the expense of grazing. The study indicates that the first constraint to intensification of dairy production in Ethiopia is the genetic quality of the herd. There is less scope for improved AI provision in India since the cross-bred herd is mainly serviced by AI already. However, as for Ethiopia, there is considerable scope for closing yield gaps in India through improved feed use and supply. Results strongly show that well-developed markets with good procurement arrangements are key for sustainable dairy intensification.
We report on the effect of the International Nosocomial Infection Control Consortium's (INICC) multidimensional approach for the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 21 intensive-care units (ICUs), from 14 hospitals in 10 Indian cities. A quasi-experimental study was conducted, which was divided into baseline and intervention periods. During baseline, prospective surveillance of VAP was performed applying the Centers for Disease Control and Prevention/National Healthcare Safety Network definitions and INICC methods. During intervention, our approach in each ICU included a bundle of interventions, education, outcome and process surveillance, and feedback of VAP rates and performance. Crude stratified rates were calculated, and by using random-effects Poisson regression to allow for clustering by ICU, the incidence rate ratio for each time period compared with the 3-month baseline was determined. The VAP rate was 17·43/1000 mechanical ventilator days during baseline, and 10·81 for intervention, showing a 38% VAP rate reduction (relative risk 0·62, 95% confidence interval 0·5–0·78, P = 0·0001).
Two dimensional Er3+-TeO2 thin film photonics crystals (PhCs) are fabricated. These PhCs demonstrate broadband enhancement of PL emission at near Infrared (NIR). The PhC structures are written by dual beam focused ion beam (FIB). Highly uniformed patterns with smooth surfaces are observed. A pattern resolution better than hundred nanometers is achieved. PhCs arrays with photonic lattice constants from 350 nm to 1700 nm are examined in order to optimize the PL extraction efficiency. Strong photoluminescence around 1530 nm is observed by 488-532 nm lasers pumping. A confocal microscopy with spectrometer is used to capture the broadband PL signals from individual PhC array.
The emission enhancement factor and spectral dependent extraction ratio are analyzed to find the interaction between PL lightwave and PhC structures. By optimize the PhC structures, 1500 um-1560 um broadband PL is successfully converted between the PL emission layer and the external cavity. A 60 % enhancement of surface extraction efficiency is achieved when PhC with periodicity a=800 nm is applied. When photonic lattice constants a are smaller than the critical periodicity 600 nm, the PL light becomes confined inside the thin film layer. Simulation is also performed by two dimensional finite difference time domain (FDTD) calculation in order to explain the experimental observed anisotropic PL enhancements.
The broadband PL enhancement enables Er3+-TeO2 PhCs thin film as a potential light source for three dimensional integrated photonic circuits.
Prior to 2009 dengue fever had not been reported in the Andaman and Nicobar archipelago. In 2009, a few patients with dengue fever-like illness were reported, some of whom tested positive for dengue antibodies. In 2010, 516 suspected cases were reported, including some with dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS); 80 (15·5%) were positive for dengue antibodies. DENV RNA was detected in five patients and PCR-based typing showed that three of these belonged to serotype 1 and two to serotype 2. This was confirmed by sequence typing. Two clones of dengue virus, one belonging to serotype 1 and the other to serotype 2 appeared to be circulating in Andaman. Emergence of severe diseases such as DHF and DSS might be due to recent introduction of a more virulent strain or because of the enhancing effect of sub-neutralizing levels of antibodies developed due to prior infections. There is a need to revise the vector-borne disease surveillance system in the islands.