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The incidence of preterm birth (PTB), delivery before 37 completed weeks of gestation, is rising in most countries. Several recent small clinical trials of myo-inositol supplementation in pregnancy, which were primarily aimed at preventing gestational diabetes, have suggested an effect on reducing the incidence of PTB as a secondary outcome, highlighting the potential role of myo-inositol as a preventive agent. However, the underlying molecular mechanisms by which myo-inositol might be able to do so remain unknown; these may occur through directly influencing the onset and progress of labour, or by suppressing stimuli that trigger or promote labour. This paper presents hypotheses outlining the potential role of uteroplacental myo-inositol in human parturition and explains possible underlying molecular mechanisms by which myo-inositol might modulate the uteroplacental environment and inhibit preterm labour-onset. We suggest that a physiological decline in uteroplacental inositol levels to a critical threshold with advancing gestation, in concert with an increasingly pro-inflammatory uteroplacental environment, permits spontaneous membrane rupture and labour-onset. A higher uteroplacental inositol level, potentially promoted by maternal myo-inositol supplementation, might affect lipid metabolism, eicosanoid production, and secretion of pro-inflammatory chemocytokines, that overall dampen the pro-labour uteroplacental environment responsible for labour-onset and progress, thus, reducing the risk of PTB. Understanding how and when inositol may act to reduce PTB risk would facilitate the design of future clinical trials of maternal myo-inositol supplementation and definitively address the efficacy of myo-inositol prophylaxis against PTB.
The Miocene beds of Kutch in India are well known for their mammalian assemblages, including the extinct ape Sivapithecus, but far less is known about the fossil squamates from this area. Although India with its over 800 reptile species is recognized as one of the global biodiversity hotspots, knowledge of past diversity and paleobiogeography of squamates on this subcontinent is very limited. We here report on new lizard finds, which have been recovered from two stratigraphic levels: the older Palasava locality (dated to the middle Miocene, ca. 14 Ma) and the younger Tapar site (late Miocene, ca. 11–10 Ma). Although fragmentarily preserved, the material described here sheds important light on the composition and paleobiogeography of squamates during the Miocene in South Asia. The older Palasava locality contains cf. Uromastyx s.l. and Varanus sp., the latter representing the oldest record of this taxon in the region of India south of the Himalayas and its occurrence here suggests a mean annual temperature not less than 15°C. The material from the younger Tapar locality consists of an unidentified acrodontan lizard, here questionably placed in agamids, and a skink. The latter shows a resemblance to mabuyines, however, the fragmentary nature of the material does not allow a precise allocation without doubts. The cosmopolitan mabuyines have been suggested to have their origin in Asia, so the potential presence of mabuyines in the Tapar locality might represent the first, but putative, Asian evidence of the occurrence of this group in the Miocene.
Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England.
A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases.
Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage.
The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.
Cognitive impairment is frequently observed in patients suffering from depression. Cognitive dysfunction play a critical role in increasing the individual’s vulnerability for the first onset, maintenance and future recurrence of depressive episodes.
The objectiv was to assess the cognitive impairment in patient with depressive episode.
A cross sectional, hospital based study was conducted among 100 patients with depressive episodes diagnosed by International Classification of Diseases - 10 visiting outpatient and inpatient in Department of Psychiatry of Manipal Teaching Hospital, Pokhara, Nepal. The subjects were interviewed with Beck’s depression inventory, Perceived deficient questionnaire, Frontal assessment battery, Trail making test A and B and Forward and Backward Digit Span test. For the assessment of correlates, regression analyses were done using SPSS v 20.0.
The mean age of the participants was 32.47 years (SD±12.25), majority were female, married, Hindu and from urban population. Higher number of respondent were student. Most of them were educated till intermediate level and belonged to middle socioeconomic class family. Different domain of cognitive function according to severity of depression was found to be statistically significant (p<0.05). This study also found that age, sex, education, medication use and Becks depression inventory score predicted the cognitive function.
Cognitive impairment is not ucommon among patient with depressive episodes. The impairment is not only seen in severe cases but also in mild to moderate cases. The assessment of cognitive deficits should be the regular part of the assessment in depressive patients.
The COVID-19 pandemic has highlighted a need for engaging online resources to enrich psychiatry training for undergraduate medical students. Podcasting is a well-established digital communication platform utilised daily in a myriad of capacities, including education. A group of medical students were tasked with creating their own educational podcasts covering specific aspects of psychiatry.
Each pair was set a sub-topic of psychiatry and utilised software to produce educational resources. The objective of this project was to reflect upon production as well as explore the efficacy of podcasting as a tool within undergraduate training.
The medical students conducted research and contacted experts within the field to contribute to their podcasts. The majority of the students then conducted reviews of the literature surrounding podcasting within medical education, which informed the production of their own podcasts. From this, it was discussed how this project could impact future practice, and indicated that podcasts may become crucial asynchronous learning tools in medical education.
Literature review and first-hand experience of podcast production enabled the students to appreciate the advantages of podcasting and the potential for its widespread future applications. Their wider reading revealed that podcast-using study participants outperformed or matched their peers in assessments, and overwhelmingly enjoyed using podcasts over traditional teaching methods.
The use of podcasting can complement traditional psychiatry training and appeal to a generation of digital natives that prefer this learning style. Podcast production is also an excellent revision method, highlighting the advantages of peer-to-peer education in both learning and increasing engagement with psychiatry.
Social meaning has been shown to be richly produced within and among social groups (Eckert 2008a). In this study, I describe a different context in which social meaning routinely arises: personal biography. A person’s history of style acquisition and their dominant styles can become a frame of reference for inferred social meanings, referred to here as biographical indexicality. I examine two different scales – micro (individual lifespan) and macro (migration) – for evidence of how sequential biographical history factors into indexical meaning. In both cases, the indexical work achieved by certain linguistic forms derives primarily from inferences based on a person’s past history or default style rather than socially shared valuations of forms. In closing, I discuss three kinds of indexicality that run counter to the predictions of group-oriented models yet are well-attested. These can be explained if we allow meaning to additionally emerge out of an individual’s personal history. Biographical indexicality thus adds to the set of processes that generate social meaning; it also de-essentialises the link between ethnolectal features and their potential social meanings (Eckert 2008b).
Acceptance and willingness to pay for the COVID-19 vaccine are unknown.
We compared attitudes toward COVID-19 vaccination in people suffering from depression or anxiety disorder and people without mental disorders, and their willingness to pay for it.
Adults with depression or anxiety disorder (n = 79) and healthy controls (n = 134) living in Chongqing, China, completed a cross-sectional study between 13 and 26 January 2021. We used a validated survey to assess eight aspects related to attitudes toward the COVID-19 vaccines. Psychiatric symptoms were assessed by the 21-item Depression, Anxiety and Stress Scale.
Seventy-six people with depression or anxiety disorder (96.2%) and 134 healthy controls (100%) reported willingness to receive the COVID-19 vaccine. A significantly higher proportion of people with depression or anxiety disorder (64.5%) were more willing to pay for the COVID-19 vaccine than healthy controls (38.1%) (P ≤ 0.001). After multivariate adjustment, severity of depression and anxiety was significantly associated with willingness to pay for COVID-19 vaccination among psychiatric patients (P = 0.048). Non-healthcare workers (P = 0.039), health insurance (P = 0.003), living with children (P = 0.006) and internalised stigma (P = 0.002) were significant factors associated with willingness to pay for COVID-19 vaccine in healthy controls.
To conclude, psychiatric patients in Chongqing, China, showed high acceptance and willingness to pay for the COVID-19 vaccine. Factors associated with willingness to pay for the COVID-19 vaccine differed between psychiatric patients and healthy controls.
The demand for cobalamin (vitamin B12) and folate is increased during pregnancy, and deficiency during pregnancy may lead to complications and adverse outcomes. Yet, the status of these micronutrients is unknown in many populations. We assessed the concentration of cobalamin, folate and their functional biomarkers, total homocysteine (tHcy) and methylmalonic acid (MMA), in 561 pregnant women enrolled in a community-based randomised controlled trial in Bhaktapur, Nepal. Plasma concentrations of cobalamin, folate, tHcy and MMA were measured and a combined indicator of vitamin B12 status (3cB12) was calculated. We report mean or median concentrations and the prevalence of deficiency according to commonly used cut-offs, and assessed their association with indicators of socio-economic status, and maternal and dietary characteristics by linear regression. Among the women at gestational week less than 15, deficiencies of cobalamin and folate were seen in 24 and 1 %, respectively. Being a vegetarian was associated with lower plasma cobalamin, and a higher socio-economic status was associated with a better micronutrient status. We conclude that cobalamin deficiency defined by commonly used cut-offs was common in Nepalese women in early pregnancy. In contrast, folate deficiency was rare. As there is no consensus on cut-off points for vitamin B12 deficiency during pregnancy, future studies are needed to assess the potential functional consequences of these low values.
The local streamline topology classification method of Chong et al. (Phys. Fluids A: Fluid Dyn., vol. 2, no. 5, 1990, pp. 765–777) is adapted and extended to describe the geometry of infinitesimal vortex lines. Direct numerical simulation (DNS) data of forced isotropic turbulence reveals that the joint probability density function (p.d.f.) of the second ($q_\omega$) and third ($r_\omega$) normalized invariants of the vorticity gradient tensor asymptotes to a self-similar bell shape for $Re_\lambda > 200$. The same p.d.f. shape is also seen at the late stages of breakdown of a Taylor–Green vortex suggesting the universality of the bell-shaped p.d.f. form in turbulent flows. Additionally, vortex reconnection from different initial configurations is examined. The local topology and geometry of the reconnection bridge is shown to be nearly identical in all cases considered in this work. Overall, topological characterization of the vorticity field provides a useful analytical basis for examining vorticity dynamics in turbulence and other fluid flows.
Coronavirus disease 2019 (COVID-19) emerged from a city in China and has now spread as a global pandemic affecting millions of individuals. The causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is being extensively studied in terms of its genetic epidemiology using genomic approaches. Andhra Pradesh is one of the major states of India with the third-largest number of COVID-19 cases with a limited understanding of its genetic epidemiology. In this study, we have sequenced 293 SARS-CoV-2 genome isolates from Andhra Pradesh with a mean coverage of 13324X. We identified 564 high-quality SARS-CoV-2 variants. A total of 18 variants mapped to reverse transcription polymerase chain reaction primer/probe sites, and four variants are known to be associated with an increase in infectivity. Phylogenetic analysis of the genomes revealed the circulating SARS-CoV-2 in Andhra Pradesh majorly clustered under the clade A2a (20A, 20B and 20C) (94%), whereas 6% fall under the I/A3i clade, a clade previously defined to be present in large numbers in India. To the best of our knowledge, this is the most comprehensive genetic epidemiological analysis performed for the state of Andhra Pradesh.
Background: As the COVID-19 pandemic continues, special attention is focused on high-risk patients. In this study, we assessed the risk factors for COVID-19 mortality in nursing home patients. Methods: In this retrospective cohort study, we reviewed the electronic medical records of SARS-COV-2 PCR–positive nursing-home patients between March 8 and June 14, 2020. The primary outcome was in-hospital mortality. Risk factors were compared between those who were discharged or died using the Student t test, the Mann-Whitney U test, χ2 analysis, and logistic regression. Results: Among 169 hospitalized nursing-home patients, the case fatality rate was 43.2%. The mean age was 72.3 ± 13.8 years; 92 patients (54.4%) were male; and 112 patients (66.3%) were black. Within the first day of hospitalization, 83 (49%) patients developed fever. On admission, 24 (14.2%) patients were hypotensive. Leukopenia, lymphopenia, and thrombocytopenia were present in 20 (12%), 91 (53%), and 40 (23.7%) patients, respectively. Among the inflammatory markers, elevations in CRP and ferritin levels occurred in 79% and 24%, respectively. Intensive care admission was needed for 40 patients (23.7%). Septic shock occurred in 25 patients (14.8%). Patients over the age of 70 were more likely to die than younger patients (OR, 2.2; 95% CI, 1.2– 4.1; P = .20). Patients with a fever on admission were more likely to die than those who were afebrile (OR, 2.03; 95% CI, 1.08–3.8; P = .03). Also, 66.7% hypotensive patients died compared to 39.3% normotensive patients (OR, 3.1; 95% CI, 1.2–7.7 P = .01). Intubated patients died more often than those not intubated, 78.4% versus 33.3%, respectively (OR=7.3, p < 0.001, CI 3.1, 17.2) Factors significantly associated with death included higher mean qSofa (p < 0.001), higher median Charlson scores (0.02), thrombocytopenia (p = 0.04) and lymphocytopenia (0.04). From multivariable logistic regression, independent factors associated with death were Charlson score (OR=1.2, p=0.05), qSofa (OR=2.0, p=0.004), thrombocytopenia (OR = 3.0, p = 0.01) and BMI less than 25 (OR = 3.5, p=0.002). Conclusions: Our multivariable analysis revealed that patients with a greater burden of comorbidities, lower BMI, higher qSOFA sepsis score, and thrombocytopenia had a higher risk of death, perhaps because of severe infection despite a robust immune response.
Background: Carbapenem-resistant Enterobactericeae (CRE) has emerged as a global health threat with increasing incidence. It is a particular problem in India because control over antibiotics prescription is really poor; these agents can be easily bought over the counter and the antibiotic prescription threshold is low among Indian doctors. Also, even when administered, antibiotics are given in inappropriate dosages and durations. CRE infections are a healthcare challenge due to their difficulty to treat and high morbidity and mortality. Colonization requires infection prevention measures, and it should be prioritized. Methods: We sought to determine the prevalence rate of CRE colonization in the gastrointestinal tract in newly admitted ICU patients along with follow-up of any subsequent infection following colonization. A prospective observational study was carried out among ICU patients from January 2019 to August 2020 by collecting perirectal swabs from patients who gave consent. Clinical variables were identified, and the relationship between CRE colonization and subsequent systemic CRE infection was assessed. Processing was carried out by culturing on MacConkey agar plate with ertapenem disk and further identified using conventional microbiological techniques. The ertapenem MIC was determined using an Epsillometer (E) test. The modified carbapenem inactivation (mCIM) test and the EDTA carbapenem inactivation method (eCIM) were used to confirm carbapenem resistance using Clinical Laboratory Standards Institute 2020 guidelines (Figure 1). Results: Among 192 ICU patients, 37 (19.27%) were colonized with CRE (Table 1). Also, 13 (35.13%) CRE isolates showed metallo-β-lactamase resistance. Furthermore, 18 CRE isolates (48.64%) showed serine carbapenemase activity; 6 CRE isolates showed no carbapenemase activity. Klebsiella pneumoniae (n = 25 of 37, 67.56%) was the most common CRE isolated followed by Escherichia coli (n = 11 of 37, 29.72%) and 1 isolate of Enterobacter spp (n = 1 of 37, 0.02%). Of 37 patients, 33 (89.18%) developed CRE infection during their hospital stay. Pneumonia was the most common infection developed (36.36%), followed by surgical site infection (21.21%) and urinary tract infection (12.12%). Only 1 patient developed a bloodstream infection. However, 9 patients (27.27%) developed multiple-site infections. Of 37 CRE-colonized patients, 10 (27.02%) died during their hospital stay. Conclusions: Our study highlights the increased risk of CRE infection and mortality in patients with CRE colonization in ICU patients. Hence, CRE perirectal screening for detection of asymptomatic carriers should be conducted, and strict infection control measures, such as isolation and cohorting with barrier nursing of such patients, should be done to prevent further spread of CREs in hospital settings.
Intelligent manufacturing (IM) embraces Industry 4.0 design principles to advance autonomy and increase manufacturing efficiency. However, many IM systems are created ad hoc, which limits the potential for generalizable design principles and operational guidelines. This work offers a standardizing framework for integrated job scheduling and navigation control in an autonomous mobile robot driven shop floor, an increasingly common IM paradigm. We specifically propose a multi-agent framework involving mobile robots, machines, humans. Like any cyberphysical system, the performance of IM systems is influenced by the construction of the underlying software platforms and the choice of the constituent algorithms. In this work, we demonstrate the use of reinforcement learning on a sub-system of the proposed framework and test its effectiveness in a dynamic scenario. The case study demonstrates collaboration amongst robots to maximize throughput and safety on the shop floor. Moreover, we observe nuanced behavior, including the ability to autonomously compensate for processing delays, and machine and robot failures in real time.
There is controversy regarding management of the neck at salvage laryngectomy. The aim of this study was to perform an analysis to determine the incidence of occult node positivity in this group and analyse factors affecting it.
A retrospective analysis of 171 patients who underwent salvage total laryngectomy between 2000 and 2015 for recurrent or residual disease following definitive non-surgical treatment and were clinico-radiologically node negative at the time salvage laryngectomy was carried out.
A total of 171 patients with laryngeal or hypopharyngeal cancers underwent concurrent neck dissection at laryngectomy. There were 162 patients (94.7 per cent) who underwent bilateral neck dissection, and 9 patients (5.3 per cent) who underwent ipsilateral neck dissection. The occult lateral nodal metastasis rate was 10.5 per cent. Of various factors, initial node positive disease was the only factor predicting occult metastasis on univariable and multivariable analysis (p = 0.001).
Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.
This research aimed to study the short-term seizure outcomes following treatment with 8 mg/kg/day prednisolone in children with infantile spasms (IS) refractory to vigabatrin. We hypothesized that high-dose prednisolone may result in similar rates of electroclinical remission when compared to published ACTH rates.
All consecutive children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without IS, who had been treated with vigabatrin as first-line anti-seizure medication (ASM) followed by high-dose oral prednisolone (8 mg/kg/day; maximum 60 mg/day) in cases who did not respond to vigabatrin, were included. Clinical and electroclinical response (ECR) at 2 weeks following initiation of treatment and adverse effects were assessed.
Sixty-five children were included. A genetic etiology was seen in 38.5% cases. Complete ECR was seen in 30.8% (20/65) of the patients 2 weeks after vigabatrin. Complete ECR was noted in 77.8% (35/45) of the patients, 2 weeks after prednisolone initiation in children who failed vigabatrin, and this was sustained at 6 weeks in 66.7% (30/45) patients. Prednisolone was generally well tolerated.
High-dose (8 mg/kg/day) oral prednisolone resulted in sustained complete ECR (at 6 weeks) in two-thirds of the children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without parentally reported IS. It was generally well tolerated and found to be safe.
The coronavirus disease (COVID-19) pandemic has stressed the US health care system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here, we present a structured after-action report of a coalition of 9 EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth. We report our experience in 6 key areas using a framework built around lessons learned. This report represents the most salient concepts related to our institutional after-action report, and those seemingly most relevant to our peer institutions dealing with similar circumstances.