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In 1700 the Mughals controlled much of the Indian subcontinent. By 1858 the British Crown ruled. Why did this transition occur? How did the relationship between the state and economic activity change? And how did the economy perform? This chapter provides an overview, discussing competing perspectives on the breakdown of the Mughal Empire, the rise of the East India Company, the increasing commercialization of the economy, and changes in the economic structure. The literature suggests that the East India Company’s political and military success partly came from more successful fiscal administration compared to its Indian rivals. After consolidating its rule, British policy favoured the export of Indian primary products and the import of manufactured goods, contributing to deindustrialization. In agriculture, the area cultivated increased with population, but technology stagnated. Per capita income, which was already low, may have fallen slightly. Conflicts between the state and local users of forests and other resources emerged, especially in conjunction with the introduction of a major technological innovation, the railways. Our period ends with the Mutiny, a formidable challenge to British rule, following which British policy became conservative, seeking to preserve the existing social order.
Developing countries experience both household air pollution resulting from the use of biomass fuels for cooking and industrial air pollution. We conceptualise and estimate simultaneous exposure to both outdoor and household air pollution by adapting the Total Exposure Assessment model from environmental health sciences. To study the relationship between total exposure and health, we collected comprehensive data from a region (Goa) in India that had extensive mining activity. Our data allowed us to apportion individuals’ exposure to pollution in micro-environments: indoor, outdoor, kitchen, and at work. We find that higher cumulative exposure to air pollution is positively associated with both self-reported and clinically- diagnosed respiratory health issues. Households in regions with higher economic (mining) activity had higher incomes and had switched to cleaner cooking fuels. In other words, household air pollution due to higher biomass use had been substituted away for outdoor air pollution in regions with economic activity.
In this study, we examine disparities in financial development at the regional level in India. The major research questions of the study are: how do we measure the level of financial development at the sub-national level? How unequal is financial development across the states? Does it vary by ownership of financial institutions? To explore these research questions, our study develops a composite banking development index at the sub-national level for three different bank groups – public, private and foreign for 25 Indian states covering 1996–2015. Our findings suggest that despite reforms, banking development is significantly higher in the leading high income and more developed regions compared to lagging ones. Furthermore, we find that all bank groups including public banks are concentrated more in the developed regions. Overall, over the years the position of top three and bottom three states in the aggregate banking index have remained unchanged reflecting lop-sidedness of regional development. We also note improvement in the ranking of some north-eastern states during the period 2009–15.
Climate change presents a particularly complex challenge in the context of flyway scale conservation of migratory bird species as it requires coordinated action by multiple countries along these species’ migratory routes. Coordinating conservation responses requires understanding the vulnerability of species and their habitats to climate change at the flyway scale throughout each species’ annual cycle. To contribute to such understanding, we used species distribution models to assess the exposure to climate change of waterbird species that are the focus of the Agreement on the Conservation of African-Eurasian Migratory Waterbirds (AEWA). We found that the species with the smallest proportion of their current range projected to be climatically suitable by 2050 (those whose distributions respond to changes in water availability but that do not perform synchronised migration) are dispersive species in the Afrotropical biogeographic realm, and migratory species in their breeding season, particularly Arctic breeding waders. These species also have the most limited availability of newly suitable areas. Projections for most other Palearctic migratory waterbird species suggest that losses of suitable areas in their current passage and wintering ranges may be largely offset by new areas becoming climatically suitable. The majority of migratory Palearctic waterbirds in the breeding season and Afrotropical waterbirds are widely dispersed with only a small proportion of their populations currently supported by ‘Critical Sites’ (i.e. sites that are either important for Globally Threatened Species or support 1% of the bioregional population of any waterbird species). This makes it unlikely that climate change adaptation measures focusing only on key sites will be sufficient to counter the predicted range losses. Therefore, climate change adaptation responses should also be implemented at the landscape scale for Afrotropical waterbirds and for breeding populations of Palearctic migrant waterbirds.
Aortopulmonary window is a rare congenital heart defect. Left main coronary artery extrinsic compression by an enlarged pulmonary artery is a rare complication and a potential cause for chest pain and sudden cardiac death in patients with pulmonary hypertension. Here, we present the case of a 14-year-old boy with a large aortopulmonary window who was planned for a device closure, but during the procedure, he developed ST-T segment changes while the device was being deployed, and hence the procedure was abandoned. The boy subsequently underwent a successful surgical closure thereafter.
Dictionary learning has emerged as a powerful method for data-driven extraction of features from data. The initial focus was from an algorithmic perspective, but recently there has been increasing interest in the theoretical underpinnings. These rely on information-theoretic analytic tools and help us understand the fundamental limitations of dictionary-learning algorithms. We focus on theoretical aspects and summarize results on dictionary learning from vector- and tensor-valued data. Results are stated in terms of lower and upper bounds on sample complexity of dictionary learning, defined as the number of samples needed to identify or reconstruct the true dictionary underlying data from noiseless or noisy samples, respectively. Many analytic tools that help yield these results come from information theory, including restating the dictionary-learning problem as a channel-coding problem and connecting analysis of minimax risk in statistical estimation to Fano’s inequality. In addition to highlighting effects of parameters on the sample complexity of dictionary learning, we show the potential advantages of dictionary learning from tensor data and present unaddressed problems.
The current investigation was conducted with the objective to develop an epidemiological case definition of possible severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) re-infection and assess its magnitude in India. The epidemiological case definition for SARS-CoV-2 re-infection was developed from literature review of data on viral kinetics. For achieving second objective, the individuals who satisfied the developed case definition for SARS-CoV-2 re-infection were contacted telephonically. Taking available evidence into consideration, re-infection with SARS-CoV-2 in our study was defined as any individual who tested positive for SARS-CoV-2 on two separate occasions by either molecular tests or rapid antigen test at an interval of at least 102 days with one negative molecular test in between. In this archive based, telephonic survey, 58 out of 1300 individuals (4.5%) fulfilled the above-mentioned definition; 38 individuals could be contacted with healthcare workers (HCWs) accounting for 31.6% of the cases. A large proportion of participants was asymptomatic and had higher Ct value during the first episode. While SARS-CoV-2 re-infection is still a rare phenomenon, there is a need for epidemiological definition of re-infection for establishing surveillance systems and this study contributes to such a goal.
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) re-infection is an emerging concern and there is a need to define it. Therefore, working epidemiological case definition for re-infection was developed and its magnitude was explored via archive-based, telephonic survey. Re-infection with SARS-CoV-2 was defined as two positive tests at an interval of at least 102 days with one interim negative test. Thirty-eight of the 58 eligible patients could be contacted with 12 (31.6%) being HCWs. Majority of the participants were asymptomatic and had higher Ct value during their first episode. To conclude, a working epidemiological case definition of SARS-CoV-2 re-infection is important to strengthen surveillance. The present investigation contributes to this goal and records reinfection in 4.5% of SARS-CoV-2 infected individuals in India.
ABSTRACT IMPACT: This study has implications for understanding early developmental mechanisms of ADHD and for guidelines regarding safe use of acetaminophen during pregnancy. OBJECTIVES/GOALS: Prenatal acetaminophen exposure has been associated with childhood attention-deficit hyperactivity disorder (ADHD), but the underlying mechanism is unknown. This prospective birth cohort study aims to identify linkages between specific metabolites in umbilical cord plasma and the association of prenatal acetaminophen exposure and ADHD. METHODS/STUDY POPULATION: The sample was a subset of the Boston Birth Cohort that included 583 mother-newborn dyads followed at Boston Medical Center from 1998 to 2018. Metabolites were measured from cord plasma collected at birth. Based on existing literature, the analyses focused on candidate metabolites involved in neuroendocrine, inflammation, and oxidative stress pathways. The outcome was physician-diagnosed ADHD between the ages of 3 and 16 years. Exploratory analyses and multiple logistic regressions were used to examine the association of these candidate metabolites with both unmetabolized cord plasma acetaminophen levels and with incident risk of ADHD, adjusting for covariates of maternal and child characteristics. RESULTS/ANTICIPATED RESULTS: Of the 583 children, 257 had ADHD and 326 had neurotypical development. Two promising results have been found thus far. 5-methoxytryptophol (5-MTX), a neuroendocrine molecule which also has antioxidant and immunomodulatory properties, was inversely associated with acetaminophen and ADHD risk. For children below the median cord 5-MTX level, the odds of ADHD were 3.29 (95% CI [1.56, 7.16], p=0.002) for the third tertile of acetaminophen compared to the first tertile. This association attenuated among those above the median 5-MTX level: 2.23 (95% CI [0.98, 5.21], p=0.059), suggesting a protective effect. Tryptophan, an essential amino acid and precursor of serotonin, was positively associated with acetaminophen and ADHD. Next steps include mediation analysis with tryptophan and analyses for other metabolites. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study identifies cord plasma metabolites as possible modifiers or mediators linking prenatal acetaminophen exposure and childhood ADHD, which may offer insight into a mechanistic pathway. The study findings have implications for FDA, clinical, and public health guidelines regarding safe use of acetaminophen during pregnancy.
This study details the intra-operative complications, and compares auditory scales post-implantation of either profoundly deaf young children with radiologically normal inner ears (group A) or children with Mondini dysplasia (group B).
A retrospective survey was carried out of 338 patients with severe to profound sensorineural hearing loss who underwent cochlear implant surgery from February 2015 to May 2017. Patients were divided into 2 groups of 27 patients each. Both groups were followed up to three years post-implantation.
Cerebrospinal fluid ooze developed in 12 patients, and 2 patients had a cerebrospinal fluid ‘gusher’, one of which had to be explored within 24 hours. After implant use for one year, both groups had similar speech perception scores.
The cerebrospinal fluid gusher in Mondini dysplasia should be anticipated and adequately managed intra-operatively. This study highlights the tailoring of a post-implantation rehabilitation programme according to individual needs.
Bipolar disorder (BD) is a major psychiatric illness which is thought to have strong biological underpinnings. A biological basis for BD is exemplified by a strong heritability of the disorder (1), occurrence of mood periods of mania (BPM), and depression (BPD), which may or may not be precipitated by environmental factors and dramatic improvement with specific medication treatment such as lithium(2). Therefore, with the augment of brain imaging techniques to study brain metabolism and task-induced activation there is an expectation that a brain state or trait abnormalities specific to BD will be identified.
Background: Infections caused by multidrug-resistant gram-negative bacilli (MDR GNB) are a therapeutic challenge to clinicians. Combination antimicrobial therapy with empirically selected antibiotics is often used to treat these infections. This approach is ill advised because the antibiotics selected may not be optimal because of different killing activity. We aimed to determine the in vitro efficacy of antibiotic combinations devoid of carbapenems to explore potential synergy between antibiotics of different chemical classes. Methods: Prospective, experimental descriptive study of 85 MDR GNB isolated from clinical samples. The minimum inhibitory concentrations (MICs) of ceftazidime, amikacin, imipenem, and ciprofloxacin were determined by broth microdilution. The in-vitro effects of CAZ–AMK, CAZ–CIPRO, IMP–AMK and IMP–CIPRO combinations were studied by checker-board assay. Results: ESBL, AmpC, and MBL production was observed among 62.35%, 27.05%, and 44.70% of the MDR GNB, respectively. Moreover, 27.05% coproduced multiple β-lactamases. The MIC90 ranges were 16 to ≥1028 μg/mL for CAZ; 0.25 to ≥256 μg/mL for Amk, 0.25 to 12 μg/mL for CIPRO; and 0.125 to 512 μg/mL for IMP. CAZ–AMK and IMP–AMK combinations showed synergistic effects in >85% of MDR-GNB, with a fractional inhibitory concentration index ≤0.5. Higher rates of indifference and antagonism were observed with combinations including fluroquinolones. Conclusions: The in vitro antimicrobial activity of antibiotic combinations having third- or fourth-generation cephalosporin with aminoglycosides was comparable to that of imipenem alone or in combination therapy. Combinations devoid of carbapenems should be advocated to prolong the clinical usefulness of this antibiotic group
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015–16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15–49 were included in the analysis of maternal health care indicators, and 8246 children aged 12–23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.
Our objective was to investigate associations of body size (birth weight and body mass index (BMI)) and growth in height, body fat (adiposity) and lean mass during childhood and adolescence, with risk markers for diabetes in young South Asian adults. We studied 357 men and women aged 21 years from the Pune Children’s Study birth cohort. Exposures were 1) birth weight, 21-year BMI, both of these mutually adjusted, and their interaction, and 2) uncorrelated conditional measures of growth in height and proxies for gain in adiposity and lean mass from birth to 8 years (childhood) and 8 to 21 years (adolescence) constructed from birth weight, and weight, height, and skinfolds at 8 and 21 years. Outcomes were plasma glucose and insulin concentrations during an oral glucose tolerance test and derived indices of insulin resistance and secretion. Higher 21-year BMI was associated with higher glucose and insulin concentrations and insulin resistance, and lower disposition index. After adjusting for 21-year BMI, higher birth weight was associated with lower 120-min glucose and insulin resistance, and higher disposition index. In the growth analysis, greater adiposity gain during childhood and adolescence was associated with higher glucose, insulin and insulin resistance, and lower disposition index, with stronger effects from adolescent gain. Greater childhood lean gain and adolescent height gain were associated with lower 120-min glucose and insulin. Consistent with other studies, lower birth weight and higher childhood weight gain increases diabetes risk. Disaggregation of weight gain showed that greater child/adolescent adiposity gain and lower lean and height gain may increase risk.
Recently, Kit Fine's (1994) view that modal truths are true in virtue of, grounded in, or explained by essentialist truths has been under attack. In what follows we offer two responses to the wave of criticism against his view. While the first response is pretty straightforward, the second is based on the distinction between, what we call, Reductive Finean Essentialism and Non-Reductive Finean Essentialism. Engaging the work of Bob Hale on Non-Reductive Finean Essentialism, we aim to show that the arguments against Fine's view are unconvincing, while we acknowledge the presence of a deep standoff between the two views.
To date, there have been no detailed reports of patients developing persistent psychotic symptoms following Coronavirus disease 2019 (COVID-19) infection. There have been reports of patients developing transient delirium (with and without hypoxia) after COVID-19 infection as well as other neurological manifestations. We report on a female patient who, post-COVID-19 infection, developed an initial delirium followed by persistent and florid psychotic symptoms consisting of persecutory delusion, complex visual and auditory hallucinations and Capgras phenomenon in the absence of hypoxia but elevated tumour necrosis factor (TNF)-α. The psychotic symptoms persisted for about 40 days. Her magnetic resonance imaging brain scan, electroencephalogram, cerebrospinal fluid examination and extensive autoimmune panel did not show any abnormalities. The cause of the psychotic symptoms in this patient were not ascertained but we propose either an inflammatory state, characterised by the patient's elevated TNF-alpha levels as a possible contributing mechanism for her psychosis in line with the proinflammatory changes observed in some cases of psychosis. Or, an alternative, but unproven, hypothesis is one of an antibody-mediated encephalitic event induced by viral infection.