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Coronavirus disease 2019 (COVID-19) has posed formidable challenges, including overwhelming biomedical waste management. Guidelines have been rapidly changing along with the mounting pressure of waste generation.
These challenges were managed by smart re-engineering of structure and processes for the desired outcomes. Dedicated staff, in personal protective equipment with appropriate training, were deployed to collect waste using dedicated trolleys. A dedicated route plan was drawn with a dedicated elevator meant for COVID-19. A new temporary holding area was created. Dedicated trucks with requisite labels were deployed to transport COVID-19 waste to a common biomedical waste treatment facility. Communication challenges were addressed through timely circulars, which were further reinforced and reiterated during various on-going training programs.
Before the onset of COVID-19 pandemic, the amount of biomedical waste generated was 1.93 kg/bed/day; currently, the quantity of COVID-19 biomedical waste generated is 7.76 kg/COVID bed/day. Daily COVID-19 waste generation data are maintained and uploaded in an android application monitored by Central Pollution Control Board, Government of India. To date, none of the workers handling COVID-19 waste has acquired health-care associated COVID-19 infection, which reflects on the soundness of the new system and the infection control practices in the institute.
A responsive leadership harmonizing with a robust communication and training system has augmented timely re-engineering of structure and processes for better outcomes in the war on waste.
Bell's palsy is a lower motor neurone facial weakness of unknown aetiology, although reactivation of a virus within the facial nerve has been proposed.
A prospective study was conducted of Bell's palsy cases presenting to our paediatric ENT unit over a 19-week period, from February to June 2020. Patients were invited for severe acute respiratory syndrome coronavirus-2 antibody testing. A text-message questionnaire was sent to other ENT centres to determine their observational experience.
During the study period, 17 children presented with Bell's palsy, compared with only 3 children in the same time period in the previous year (p < 0.0001). Five patients underwent severe acute respiratory syndrome coronavirus-2 antibody testing, the results of which were all negative. Four out of 15 centres questioned perceived an increased incidence in paediatric Bell's palsy.
Clinicians are encouraged to be vigilant to the increase in paediatric Bell's palsy seen during the coronavirus disease 2019 pandemic, which may represent a post-viral sequela of coronavirus disease 2019.
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 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.
The aim of our study was to compare the cognitive distortions in learning-disabled male sex-offenders before and after the administration of full 52-weeks Sex-Offenders Treatment Programme(SOTP).
As a part of the CBT-based Sex-Offenders Treatment Programme, 17 male adults were referred for therapy(over a period of 2 years) out of which 12 were accepted for SOTP. Mean age of the subjects was 32.5 years(Range: 22-50 years) and mean IQ was 65.16(Range: 53-75).
SOSAS(Sexual-Offenders Self-Appraisal Scale) was administered both pre and post treatment. This instrument consists of 20 statements from four sub-scales: Denial, Victim Blaming, Minimization and Realism to which each respondent was asked to indicate his degree of agreement or disagreement.
We noticed an improvement in Denial and Minimization scores in 58% of cases, Victim Blame scores in 25% of cases and Realism scores in 67% of cases.There was a little (< 5%) or no change in 25% of Denial scores, 17% of Victim Blame scores and 9% of Minimization and Realism scores.A deterioration in 17% of Denial scores, 58% of Victim Blame scores, 33% of Minimization scores and 24% of Realism scores.
Our results reveal beneficial effect of SOTP on the cognitive distortions of Denial, Minimization and Realism in more than half of the patients but deterioration in the cognitive distortion of Blame.
While the results suggest CBT-based Sex Offenders Treatments are beneficial in modifying cognitive distortions, further research is needed to validate the effectiveness of this approach, especially in long-term follow up studies.
To assess the effect of tranexamic acid in head and neck surgical procedures.
A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients’ group allocation (case or control).
Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant.
Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.
Background: Biallelic variants in POLR1C are associated with POLR3-related leukodystrophy (POLR3-HLD), or 4H leukodystrophy (Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism), and Treacher Collins syndrome (TCS). The clinical spectrum of POLR3-HLD caused by variants in this gene has not been described. Methods: A cross-sectional observational study involving 25 centers worldwide was conducted between 2016 and 2018. The clinical, radiologic and molecular features of 23 unreported and previously reported cases of POLR3-HLD caused by POLR1C variants were reviewed. Results: Most participants presented between birth and age 6 years with motor difficulties. Neurological deterioration was seen during childhood, suggesting a more severe phenotype than previously described. The dental, ocular and endocrine features often seen in POLR3-HLD were not invariably present. Five patients (22%) had a combination of hypomyelinating leukodystrophy and abnormal craniofacial development, including one individual with clear TCS features. Several cases did not exhibit all the typical radiologic characteristics of POLR3-HLD. A total of 29 different pathogenic variants in POLR1C were identified, including 13 new disease-causing variants. Conclusions: Based on the largest cohort of patients to date, these results suggest novel characteristics of POLR1C-related disorder, with a spectrum of clinical involvement characterized by hypomyelinating leukodystrophy with or without abnormal craniofacial development reminiscent of TCS.
Agriculture in the Central Himalayan Region depends on the availability of suitable germplasm as well as natural conditions. Due to extreme weather conditions, food and nutrition security is a major issue for communities inhabiting these remote and inaccessible areas. Millets are common crops grown in these areas. Foxtail millet (Setaria italica (L.) P. Beauv) is an important crop and forms a considerable part of the diet in this region. The aim of the present study was to explore, collect, conserve and evaluate the untapped genetic diversity of foxtail millet at the molecular level and discover variability in their nutritional traits. A total of 30 accessions having unique traits of agronomic importance were collected and molecular profiling was performed. A total of 63 alleles were generated with an average of 2.52 alleles per locus and average expected heterozygosity of 0.37 ± 0.231. Significant genetic variability was revealed through the genetic differentiation (Fst) and gene flow (Nm) values. Structure-based analysis divided whole germplasm into three sub-groups. Rich variability was found in nutritional traits such as dietary fibre in husked grains, carbohydrate, protein, lysine and thiamine content. The collected germplasm may be useful for developing nutritionally rich and agronomically beneficial varieties of foxtail millet and also designing strategies for utilization of unexploited genetic diversity for food and nutrition security in this and other similar agro-ecological regions.
Mental health and wellbeing, including addressing impacts of historical trauma and substance use among young people, has been identified as a key priority by Indigenous communities and leaders across Canada and globally. Yet, research to understand mental health among young Indigenous people who have used drugs is limited.
To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs.
The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress.
Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men.
Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.
Introduction: A previous Canadian emergency department (ED) model determined predictors of increased workload using a manual chart review to elucidate comorbidities. We designed an electronic algorithm to capture all comorbidities based on the Charlson Comorbidity Index (CCI) for a 5 year period preceding the ED visit from the regional inpatient database. Our objective was to identify predictors correlating with physician time require to treat patients and thus develop a multivariable model to predict physician workload. Methods: From May to September 2015, two research assistants (RAs) shadowed a random sample of physicians from the six urban EDs in a single health region. They documented time spent performing clinical and non-clinical functions for patient visits. A linkage with the previously validated regional ED database was used to obtain triage acuity, age, gender, mode of arrival, and CCI scores. Multiple linear regression was used to describe the associations between predictor variables and total physician time per patient visit as well as time spent on history and physical exam and to derive an equation for physician workload. RA inter-rater reliability was assessed on 107 MD-patient interactions. Results: Over the 4-month period, 873 patient encounters were documented. Data from 599 completed encounters were included in the model. The median age was 49.4 (SD 22.8) and 52.2% were female. Overall, 16.0% were admitted to hospital, 64.9% of patients were CTAS 1-3, 19.6% of patients arrived by ambulance, and 15.5% of patients had a CCI score of ≥ 1. The mean time spent on history and physical was 7.0 minutes (SD 4.73) and mean total time was 19.4 minutes (SD 11.6). Using a linear regression model with total time as the dependent and EMS arrival, CTAS, and age as the independent variables, having any CCI score is a significant predictor of total time (p = 0.03). with a difference of 2.9 minutes between CCI positive versus negative patients. Higher acuity was the most significant factor associated with time spent with a mean difference of 4.4 minutes per CTAS category. The intraclass correlation coefficient value was 0.99 (95% CI 0.97-1.00) indicating excellent reliability. Conclusion: The electronically derived CCI does have value in the development of a physician workload model and can replace the use of manual chart review to define patient comorbidities.
Introduction: ED patient comorbidity is difficult to ascertain for research. Traditional surrogates such as triage acuity, admission rate, and age have been used to approximate patient complexity. Differences between EDs for the management of similar conditions are nevertheless difficult to reconcile. The Charlson Comorbidity Index (CCI) contains 19 categories and is a validated predictor of the ten-year mortality for a patient who may have a range of comorbid conditions. CCI is based on the International Classification of Diseases (ICD) diagnosis codes found in administrative data such as the Discharge Abstract Database (DAD). The DAD collects this, and other inpatient information, for all Canadian hospitals. We sought to develop a linkage between the regional ED database and the regional inpatient DAD in order to derive a CCI score for each ED patient as a surrogate of comorbidity. Methods: We used regional data from Vancouver Coastal Health (VCH) over a 2.5 year period from April 2013 - September 2015. An algorithm was created to identify CCI conditions in the regional DAD. Whenever a patient visited the ED a query was made to the DAD going back for 5 years to acquire CCI relevant diagnoses and enter these diagnoses as well as the CCI weighting into the ED database. Patient DAD records from VCH were utilized no matter in which ED a patient presented. No information from admissions outside the region was available. Results: There were 931,596 regional ED visits made by 446,579 unique patients in a total of 11 EDs (6 urban and 5 rural). In total there were 127,233 patients with a CCI score (13.7% of total visits). The average CCI was 0.40 (SD 1.31) with a range of 0.12 at the urban urgent care centre to 0.52 at the urban tertiary care centre. More isolated rural EDs tended to have higher percentages of patients with CCI scores than community urban EDs. Higher acuity, age, and ambulance arrival, ED death, all correlated to higher CCI scores. The most common CCI conditions were “diabetes with complications” (10/11 EDs) and was present in 35,816 (3.8%) visits and “cancer” (10/11 EDs) present in 34,624 (3.7%) ahead of COPD (26,451 visits) and CHF (25,233 visits). Conclusion: Use of the CCI is a novel way to passively capture patient comorbidities without reliance on a data entry technician. Limitations include the inability to link to hospitalization data outside a specific health region.
The binary X-ray source GX 1 + 4 was observed during a balloon flight in 1986, November. The source was in a relatively high intensity state. Time analysis of the data shows that the pulsation period was 111.8 ± 1.0 s indicating that one or more episodes of spin-down occurred between 1980 and 1986. Folded pulse profiles are very broad with an indication of a notch at the peak. Evidence has been found for a correlation between hard X-ray intensity and phase of the proposed 304 day orbital period. The time averaged intensity since 1980 is an order of magnitude lower than during the 1970’s. A survey of the post 1980 data shows that several reversals of the period derivative have occurred. Spin-up at the rates typical of the 1970’s has been followed by a dramatic spin-down episode with dP/dt>2.4 × 10−7 s/s.
Expressed sequence tag-simple sequence repeat (EST-SSR) markers were used to analyse genetic diversity among three Lens species. The SSR loci amplified successfully in wild species, with 94·82% transferability in Lens culinaris subsp. orientalis, 95·4% in Lens nigricans, 98·81% in L. culinaris subsp. odemensis, 94·82% in L. culinaris subsp. tomentosus and 96·55% in Lens ervoides. Ninety-nine alleles (average 3·41 alleles/locus) were detected by 29 SSR markers. Based on the unweighted pair group method with arithmetic mean cluster analysis, all the genotypes were grouped into three clusters at a similarity level of 0·30. The diversity analysis indicated no species-specific clustering of the wild and cultivated species. Wild species L. nigricans and L. culinaris subsp. odemensis, L. culinaris subsp. orientalis and L. ervoides were grouped in Cluster I, whereas the Mediterranean land races of L. culinaris subsp. culinaris and L. culinaris subsp. tomentosus formed a separate group in Cluster II A. Cluster II B comprised L. ervoides, L. culinaris subsp. orientalis and L. culinaris subsp. culinaris. Clusters II C, II D and II F included cultivated Indian lentil genotypes. Cluster II E comprised Indian and Mediterranean germplasm lines. Cluster II F included three early maturing germplasm lines, whereas Cluster III included only two germplasm lines. The functional annotation of SSR-containing unigenes revealed that a majority of genes were involved in an important transport-related function or were a component of metabolic pathways. A high level of polymorphism of EST-SSRs and their transferability to related wild species indicated that these markers could be used for molecular screening, map construction, comparative genomic studies and marker-assisted selection.
Lower and middle income countries (LMICs) are home to >80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional ‘hubs’ established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs.
The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants.
Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful.
The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding.
Aspiration pneumonia is an important cause of death in head and neck cancer patients. This study therefore aimed to evaluate the risk factors associated with aspiration pneumonia in head and neck cancer patients.
Hospital death records from 12 years (2000–2012) were reviewed to obtain the number of deaths. Treatment details and cause of death were analysed. Statistical analysis was performed to identify the risk factors for aspiration pneumonia.
The records revealed that aspiration pneumonia was the cause of death in 51 out of 85 patients. Primary tumour site (oropharynx and hypopharynx, odds ratio 3.3; 95 per cent confidence interval 1.17–9.4, p = 0.02) and advanced tumour stage (odds ratio 4.2, 95 per cent confidence interval 1.16–15.61, p = 0.02) had significant negative impacts on aspiration pneumonia related mortality.
Advanced pharyngeal cancer patients are at an increased risk of aspiration pneumonia related death. Investigations for the early detection of this condition are recommended in these high-risk patients.
There is increasing evidence that Mars may have once been a habitable environment. Gypsum is targeted in the search for Martian biosignatures because it can host extensive cryptoendolithic communities in extreme terrestrial environments and is widespread on Mars. In this study the viability of using different spectroscopy-based techniques to identify the presence of gypsum endolithic communities was investigated by analysing various cryptoendoliths collected from the Lake St. Martin impact crater (LSM), a Mars analogue site found in Manitoba, Canada. Concurrently, the cryptoendolithic microbial community structure present was also analysed to aid in assigning spectroscopic features to microbial community members. Two main morphologies of endolithic communities were collected from gypsum deposits at LSM: true cryptoendolithic communities and annular deposits on partially buried boulders and cobbles <1 cm below the soil surface. Endolithic communities were found to be visibly present only in gypsum with a high degree of translucency and could occur as deep as 3 cm below the exterior surface. The bacterial community was dominated by a phylum (Chloroflexi) that has not been previously observed in gypsum endoliths. The exterior surfaces of gypsum boulders and cobbles are devoid of spectroscopic features attributable to organic molecules and detectable by reflectance, Raman, or ultraviolet-induced fluorescence spectroscopies. However, exposed interior surfaces show unique endolithic signatures detectable by each spectroscopic technique. This indicates that cryptoendolithic communities can be detected via spectroscopy-based techniques, provided they are either partially or fully exposed and enough photon–target interactions occur to enable detection.
Plant genetic resources are raw materials and their use in breeding is one of the most sustainable ways to conserve biodiversity. The ICRISAT has over 120,000 accessions of its five mandate crops and six small millets. The management and utilization of such large diversity are greatest challenges to germplasm curators and crop breeders. New sources of variations have been discovered using core and minicore collections developed at the ICRISAT. About 1.4 million seed samples have been distributed; some accessions with specific attributes have been requested more frequently. The advances in genomics have led researchers to dissect population structure and diversity and mine allelic variations associated with agronomically beneficial traits. Genome-wide association mapping in sorghum has revealed significant marker–trait associations for many agronomically beneficial traits. Wild relatives harbour genes for resistance to diseases and insect pests. Resistance to pod borer in chickpea and pigeonpea and resistance to rust and late leaf spot in groundnut have been successfully introgressed into a cultivated genetic background. Synthetics in groundnut are available to broaden the cultigen's gene pool. ICRISAT has notified the release of 266 varieties/cultivars, germplasm, and elite genetic stocks with unique traits, with some having a significant impact on breeding programs. Seventy-five germplasm lines have been directly released for cultivation in 39 countries.
Three Critically Endangered Gyps vultures endemic to South Asia continue to decline due to the use of diclofenac to treat livestock. High nephrotoxicity of diclofenac to Gyps vultures, leading to death, has been established by experiment and observation, in four out of five Gyps vulture species which occur in South Asia. Declines have also been observed in South Asia’s four other non-Gyps vulture species, but to date there has been no evidence about the importance of diclofenac as a potential cause. Neither is there any evidence on the toxicity of diclofenac to the Accipitridae other than vultures. In this study, gross and microscopic lesions and diclofenac tissue levels in Steppe Eagles Aquila nipalensis found at a cattle carcass dump in Rajasthan, India, show evidence of the toxicity of diclofenac for this species. These findings suggest the possibility that diclofenac is toxic to other accipitrid raptors and is therefore a potential threat to much wider range of scavenging species in South Asia.