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Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
There is a paucity of scientific analysis that has examined spatial heterogeneities in the socioeconomic vulnerabilities related to coronavirus disease 2019 (COVID-19) risk and potential mitigation strategies at the sub-national level in India. The present study examined the demographic, socioeconomic, and health system-related vulnerabilities shaping COVID-19 risk across 36 states and union territories in India.
Using secondary data from the Ministry of Health and Family Welfare (MoHFW), Government of India; Census of India, 2011; National Family Health Survey, 2015-16; and various rounds of the National Sample Survey, we examined socioeconomic vulnerabilities associated with COVID-19 risk at the sub-national level in India from March 16, 2020, to May 3, 2020. Descriptive statistics, principal component analysis, and the negative binomial regression model were used to examine the predictors of COVID-19 risk in India.
There persist substantial heterogeneities in the COVID-19 risk across states and union territories in India. The underlying demographic, socioeconomic, and health infrastructure characteristics drive the vulnerabilities related to COVID-19 in India.
This study emphasizes that concerted socially inclusive policy action and sustained livelihood/economic support for the most vulnerable population groups is critical to mitigate the impact of the COVID-19 pandemic in India.
Economic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015–2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting (‘anthropometric failure’) across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive.
In this paper, a new design configuration has been proposed in which a prototype of resonant inductive power transfer-based contactless power transfer to wound rotor has been developed which provides field power to brushless alternating current (BLAC) or brushless direct current (BLDC) motors without the use of permanent magnets in the rotor. Further, wound field in the rotor of DC motor can be powered without carbon brushes. The proposed design facilitates motor performance improvement by adding an extra dimension of field flux control, while the armature circuit is conventionally fed from position detection and commutation schemes. It contains a primary multilayer concentrated coil fed with high-frequency resonating AC supply or switched mode supply. A single layer helical secondary coil coaxially fixed on the shaft receives high frequency wireless AC power transmitted from primary coil. Fast rectifier inside the hollow shaft and DC filter provides the transferred DC power to field terminals in the rotor. It has been verified that rotor power can be varied linearly with linear variation in input DC power with the highest efficiency at the resonant frequency. Available power to the rotor remains invariable with rotational speed and angle, which is a necessary requirement for rotor field. DC voltage on the rotor terminals can be effectively controlled during standstill as well as during rotation at any speed.
The relentless spread of Coronavirus Disease 2019 (COVID-19)1 has been exponential, with an alarming number of deaths2 putting health systems under severe strain. The World Health Organization (WHO) has declared COVID-19 a pandemic3 and health experts cannot predict when a vaccine may be available, or when the spread will slow.
The current study was undertaken to identify the sources of tolerance to bruchid in cowpea, by screening a set of germplasm accessions as a source for natural resistance. A total of 103 diverse accessions of cowpea were evaluated for resistance to Callosobruchus maculatus Fab. under no-choice artificial infestation conditions. Significant differences among the cowpea accessions were observed for oviposition, adult emergence, exit holes and per cent seed weight loss (PSWL) caused by the bruchid infestation. The accessions showed variation in physical seed parameters viz., colour, shape, testa texture, length, width and seed hardness. Among the seed biochemical parameters studied, per cent sugar content ranged from 0.322 (IC330950) to 1.493 (IC249137), and per cent phenol content ranged from 0.0326 (EC390261) to 1.081 (EC528423). Correlation studies indicated that PSWL had significant positive correlation (r = 0.335) with exit holes, oviposition (r = 0.219), adult emergence (r = 0.534) and seed roundness (r = 0.219). Adult emergence had a significant negative correlation with seed hardness (r = −0.332). Correlation with biochemical parameters indicated that PSWL had a significant positive correlation (r = 0.231) with sugar content and a significant negative correlation with phenol content (r = −0.219). None of the accessions were found to be immune to bruchid infestation. However, out of studied accessions, EC528425 and EC528387 were identified as resistant based on PSWL and moderately resistant based on adult emergence. These resistance sources of cowpea germplasm can be used as potential donors for development of bruchid tolerant/resistant cultivars.
Information about the stability of the diagnosis of the Adult ADHD, when made using standardized tools and diagnostic criteria remains unavailable from India.
To follow-up adults with ADHD after one year of diagnosis.
To study the stability of diagnosis and comorbidities at one year follow up of Adult ADHD.
20 subjects with adult ADHD (DSM-IV-TR 2000) were attempted to follow up after 1 year of the diagnosis. the diagnostic assessment was done using DSM-IV-TR and Wender Utah criteria wherever applicable. the symptoms were assessed on clinician rated ADHD-RS. the comorbidities and global functioning were also assessed at follow up.
19 (95%) of 20 subjects could be followed up. the diagnosis was stable in all the 19 (100%) subjects at the follow up according to DSM-IV-TR criteria. However, the symptoms declined over a period of one year. Diagnosis of 2(10.52%) subjects of ADHD - CT was changed to ADHD - IA. 2(10.52%) subjects went into partial remission. of the original 13 subjects diagnosed as adult ADHD as per Wender Utah criteria, 12 (92.30%) retained the diagnosis at follow up while 1 (7.7%) did not. Substance abuse was increased at the follow up from 26.32% to 47.37%. the rates of the rest of the comorbidities didn’t change over a period of one year.
Results suggest that the diagnosis of adult ADHD, when made using standardized tools and diagnostic criteria remains stable at 1 year follow-up. the rates of comorbidities increased at the follow up.
Considerable controversy exist regarding clinical presentation, diagnosis, and comorbidities specially Attention Deficit Hyperactivity Disorder (ADHD), in paediatric BPD.
To describe phenomenology and comorbidities of paediatric BPD.
To clinically study the Phenomenology and Comorbidity of Pediatric BPD and to clinically study the comorbidity of ADHD in Pediatric BPD.
78 Subjects (6–16 years) attending child and adolescent psychiatry services of C.S.M.M.U. Lucknow, who fulfilled DSM-IV-TR 2000 criteria for BPD were assessed using K-SADS-PL, child mania rating scale (CMRS),child depression rating scale (CDRS) ADHD-RS and C-GAS.
All the subjects were diagnosed as BPD-I. Their mean chronological age was 13.4 ± 2.1 years. the mean age at onset of BPD was 12.2 ± 2.3 years. the most common symptoms found in manic subjects were increased goal directed activities (100%), distractibility (100%), elation (98.7%), grandiosity (90.5%), physical restlessnesss (82.4%), poor judgment (82.4%) and decreased need for sleep (81.1%). 19 (24.5%) cases of BPD had other current comorbid disorders. the commonest comorbidities were MR (10.26%) and ADHD (10.26%), accompanied by Seizure disorders (2.56%), Oppositional Defiant Disorder (6.41%), substance abuse (3.85%), Anxiety Disorders (2.56%), and Enuresis (1.28).
In children and adolescents elation/grandiosity is more common presentation than Irritability. Comorbidities are rare in paediatric BPD-I. Differentiation of comorbid disruptive behaviour disorders especially ADHD from BPD is possible with respect to age of onset, quality of the disturbed mood, and the course of each disorder.
The community composition of zooplankton with an emphasis on copepods was assessed in the frontal zones of the Indian sector of the Southern Ocean (SO) during summer 2013. Copepods were the dominant group in both the bongo net and multiple plankton sampler across the entire region. High zooplankton abundance was recorded along each transect in the Polar Front (PF). Community structure in this front was dominated by common taxa, including Ctenocalanus citer, Clausocalanus spp., Calanoides acutus, Calanus propinquus, Calanus australis and Rhincalanus gigas, which together accounted for > 62% of the total abundance. Calocalanus spp., Neocalanus tonsus and C. propinquus were indicator species in the Sub-Tropical Front (STF), Sub-Antarctic Front and PF, respectively. A strong contrast in population structure and biovolume was observed between then PF and the STF. The community structure of smaller copepods was associated with the high-temperature region, whereas communities of larger copepods were associated with the low-temperature region. Thus, it seems probable that physical and biological characteristics of the SO frontal regions are controlling the abundance and distribution of zooplankton community structure by restricting some species to the warmer stratified zones and some species to the well-mixed zone.
For the first time in the literature, experimental determination of entire sets of exact interdiffusion coefficients in quaternary and quinary alloy systems is reported. Using the method of body-diagonal diffusion couple, a set of nine quaternary interdiffusion coefficients were evaluated in Fe–Ni–Co–Cr and a set of sixteen quinary interdiffusion coefficients were determined in a Fe–Ni–Co–Cr–Mn system, both at approximately equimolar compositions. Regions of uphill interdiffusion and zero flux planes were observed for nickel and cobalt in quinary couples, indicating the existence of strong diffusional interactions in Fe–Ni–Co–Cr–Mn alloys. The strong diffusional interactions were also manifested in the large magnitudes of cross coefficients in both the systems. The existence of strong diffusional interactions in high-entropy alloys (HEAs) as observed through experimentally determined interdiffusion coefficients in this study establishes beyond doubt the fact that cross interdiffusion coefficients cannot be ignored in HEAs.
While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings.
A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India.
Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed.
A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India.
This paper dwells upon investigating the effect of aspect ratio (AR) variation on the aerodynamic performance of unconventional control surfaces called grid fins by virtue of a series of subsonic experiments on a simplified grid fin variant called the cascade fin. Wind tunnel tests were performed for different AR (variable span) grid fins. The same had been investigated for different gap-to-chord ratio (g/c) variants. Results demonstrated a tangible increase in the aerodynamic efficiency as well as stall angle reduction for higher AR. Moreover, higher AR leads to increased pitching moment, which emphasizes elevated hinge moment requirements. The study ensued the presence of higher deviation between the low AR fins, that is
compared to the pertinent deviations between the high AR fins, that is
. The effect associated with these variations was termed as span effect in this paper. It was established that, the deviations arising due to this phenomena were lesser for higher g/c and higher AR. The analysis of AR variation for different g/c presented a limiting value of AR reduction for stall performance enhancement. Thus, optimised selection of the g/c and AR values can lead to enhanced aerodynamic efficiency alongside an improved stalling characteristic.
Cerebral malaria (CM) is the severe neurological complication causing acute non-traumatic encephalopathy in tropical countries. The mechanisms underlying the fatal cerebral complications are still not fully understood. Glutamate, a major excitatory neurotransmitter in the central nervous system of the mammalian brain, plays a key role in the development of neuronal cells, motor function, synaptic plasticity, learning and memory processes under normal physiological conditions. The subtypes of ionotropic glutamate receptor are N-methyl-D-aspartate receptors (NMDARs) which are involved in cellular mechanisms of learning and memory, synaptic plasticity and also mediate excitotoxic neuronal injury. In the present study, we found that glutamate level in synaptosomes, as well as expression of NMDAR, was elevated during the extreme condition of CM in C57BL6 mice. Arteether at 50 mg kg−1 × 1, 25 mg kg−1 × 2, days decreased the NMDAR expression and increased the overall survival of the experimental CM mice.
The present study investigated if the presence of encircling granulosa cells protected against di(2-ethylhexyl)phthalate (DEHP)-induced oxidative stress in rat oocytes cultured in vitro. Denuded oocytes and cumulus–oocyte complexes (COCs) were treated with or without various doses of DEHP (0.0, 25.0, 50.0, 100, 200, 400 and 800 μM) in vitro. Morphological apoptotic changes, levels of oxidative stress and reactive oxygen species (ROS), mitochondrial membrane potential, and expression levels of apoptotic markers (Bcl2, Bax, cytochrome c) were analyzed. Our results showed that DEHP induced morphological apoptotic changes in a dose-dependent manner in denuded oocytes cultured in vitro. The effective dose of DEHP (400 µg) significantly (P>0.05) increased oxidative stress by elevating ROS levels and the mitochondrial membrane potential with higher mRNA expression and protein levels of apoptotic markers (Bax, cytochrome c). Encircling granulosa cells protected oocytes from DEHP-induced morphological changes, increased oxidative stress and ROS levels, as well as increased expression of apoptotic markers. Taken together our data suggested that encircling granulosa cells protected oocytes against DEHP-induced apoptosis and that the presence of granulosa cells could act positively towards the survival of oocytes under in vitro culture conditions and may be helpful during assisted reproductive technique programmes.