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Scapolite occurrences are widely observed in the metasedimentary rocks exposed around the Khetri Copper Belt and adjoining Nim ka Thana copper mineralized area in western India. Amoeboidal to well-developed and rounded/elliptical-shaped marialitic scapolite (Na-rich end-member) rich zones with variable Cl contents ranging from 1.0 wt % to 2.9 wt % have been identified in proximity to the ore-bearing hydrothermal fluid activity zones. Although scapolite is formed as a product of regional metamorphism in many places, in this study, we propose a strong possibility that scapolite was formed by hydrothermal ore-bearing fluid interaction with metasediments. The evidence of hydrothermal activity and Cl sourcing is attributed to (i) the absence of evaporite beds in the area and no Na-rich plagioclase as inclusions within the scapolite suggesting the formation of marialitic scapolite from sodic plagioclase in the metasediments with the interacting hydrothermal fluid; (ii) an epithermal to mesothermal hydrothermal fluid with moderate salinity responsible for the Cu mineralization that is ascribed to be the source of Cl for the formation of marialitic scapolite; (iii) diffusion of SO2 in the scapolite in close association with the sulfide mineral phase (chalcopyrite) supporting the involvement of ore-bearing fluid in the development of scapolite; (iv) the absence of zoned scapolite, the spatial distribution of scapolite in a particular lithology, the occasional incorporation of sulfur into marialitic scapolite and the texture/geometry in the scapolite suggesting a broad hydrothermal linkage instead of a pure metamorphic origin.
Poor academic performance has been linked to factors such as sleep, health, illicit drug use, physical fighting, social media use, cyber bullying, physical activity, homelessness, times spent in video games and television. It is difficult to get a sense of the interplay between and relative importance of different behaviours/factors on academic performance as only limited research has been aimed at quantifying these factors.
To evaluate association of school performance and variables in five categories of the YRBSS: physical fighting, diet/lifestyle, electronic device usage, concurrent substance use, and violence/self-harm.
The CDC Youth Risk Behavior Surveillance System (YRBSS) data from 1991-2019 was used in study. Respondents were grouped by good and poor school performance and variables related to nutrition/lifestyle, electronic device use, concurrent substance use, mood/violence/self-harm were analyzed using chi-square
A total of 41,235 student respondents.Nutrition/Lifestyle, electronic device use, concurrent substance use, mood/violence/self-harm are found to be significantly correlated with school performance.
Poor Performance n(%)
Good Performance n(%)
Concurrent Substance Use
Felt sad or hopeless
In national data, we found school performance is affected by nutrition, lifestyle, substance use, mood and exposure to surrounding violence, and self-harm. Further studies should be planned to evaluate benefits from the risk stratification to reduce this burden amongst US adolescents.
Psychiatry emergencies in India is major challenge for emergency service providers due to rapid growth of various behavioural, higher morbidity and mortality rate. Despite, psychiatry conditions are neglected area related to stigma, share, lack of awareness, and superstitious beliefs. There is an urgent need for specialist psychiatric emergency services, which can fill the huge gap between policymakers and health service providers joined together.
Present feasibility study has been undertaken to evaluate the safety and efficacy of combined emergency and Ayurveda medicine management of psychiatric emergencies in community-based settings.
Ayu-Emergency Care project was developed in partnership with policy makers, researchers and health care providers, a collaborative platform of emergency medicine and Ayurveda medicine (Indian Traditional Medicine) for developing whole-system perspective, where providers work in a coordinated and joined-up way. Twenty trained care providers in psychiatry emergency and Ayurveda management worked in partnership with community-based organisation.
Patients with major clinical difficulties, in the acute phase were treated and managed by Ayu-Emergencypractitioners. Severe Agitation and violence relating to substance abuse, anxiety disorder and psychosis were the most common admission diagnoses. 2-weeks results indicate that Ayurveda intervention can reduce anxiety(p<0.01), aggression (p< 0.001) and agitation (p<0.01) significantly with no side effects reported. Intervention found to be clinically beneficial and cost-efficient alternative to out-of-home placements (i.e., Incarceration, psychiatric hospitalisation).
The study’s findings highlight safety, efficacy and feasibility of intervention. Patients both prefer and seem to benefit from community-based ayu-psychiatric care, and early-intervention community program could be a good model for such care.
By studying the odds of developing idiopathic subglottic stenosis in the isolated and genetically unique Hutterite population, this study sought to strengthen the hypothesis that an underlying genetic predisposition may exist for its development.
A retrospective chart review examined the medical records of all adult patients treated for idiopathic subglottic stenosis in Saskatchewan between 2008 and 2018. Cases were segregated into Hutterite and non-Hutterite.
Four out of 36 cases of idiopathic subglottic stenosis occurred among Hutterites. The odds of a Hutterite developing idiopathic subglottic stenosis are 21.89 times higher than for non-Hutterites. Positive family history was only observed in the Hutterite population.
The study strengthens the hypothesis that genetics may play a role in the aetiology of idiopathic subglottic stenosis by demonstrating that the genetically and socially unique Hutterites are more likely to develop this rare disease. This study is the first to demonstrate that a specific subpopulation is at a higher risk for developing idiopathic subglottic stenosis.
Tracheostomy, being a high aerosol-generating procedure, poses a great challenge to surgeons, especially during the coronavirus disease 2019 pandemic. It is important to preserve staff numbers as this fight may go on for a long time. Personal protective equipment plays a key role in the protection of healthcare workers. Barrier enclosure has been attempted in procedures such as intubation and tracheostomy. The use of boxes became popularised for intubation and they have been utilised in many centres.
This paper describes the box designed by our team and presents our surgical experience with the box. The box is made of transparent acrylic. It is sealed at all ends, with a negative-pressure environment. The hand ports were designed to allow maximum manoeuvrability for surgeons, without restricting hand movements.
The proposed box will provide more protection to healthcare workers during tracheostomy. However, the box is yet to be validated.
Invasive alien species are a major threat to global biodiversity due to the tremendous ecological and economic damage they cause in forestry, agriculture, wetlands, and pastoral resources. Understanding the spatial pattern of invasive alien species and disentangling the biophysical drivers of invasion at the forest stand level is essential for managing forest ecosystems and the wider landscape. However, forest-level and species-specific information on Invasive Alien Plant Species (IAPS) abundance and their spatial extent are largely lacking. In this context, we analysed the cover of one of the world’s worst invasive plants, Chromolaena odorata, in Sal (Shorea robusta) forest in central Nepal. Vegetation was sampled in four community forests using 0.01 ha square quadrats, covering the forest edge to the interior. C. odorata cover, floral richness, tree density, forest canopy cover, shrub cover, tree basal area, and disturbances were measured in each plot. We also explored forest and IAPS management practices in community forests. C. odorata cover was negatively correlated with forest canopy cover, distance to the road, angle of slope, and shrub cover. Tree canopy cover had the largest effect on C. odorata cover. No pattern of C. odorata cover was seen along native species richness gradients. In conclusion, forest canopy cover is the overriding biotic covariate suppressing C. odorata cover in Sal forests.
Background: The HINTS examination is a sensitive and specific tool for determining whether a patient presenting with an acute vestibular syndrome has had a stroke. Despite its efficacy, it is often not used by Emergency Medicine (EM) physicians when assessing patients with vertigo. Methods: To ascertain why, we surveyed, by email, physicians registered with the Canadian Association of Emergency Physicians, to gather information on their practices when assessing patients with vertigo, and their utilization and perspectives concerning the HINTS examination. Results: 185 participants responded to our survey, demographically representative of Canadian EM physicians. The majority regularly use the HINTS exam in the appropriate setting, but significant minorities employ the exam inappropriately, such as in patients without nystagmus, with other neurological findings, or alongside tests for intermittent vertigo. Misapplication was associated with older age, years of practice, non-academic practice settings, and less residency training (p<0.05). The predominant reasons for not using this examination are lack of confidence in recalling and performing component exam techniques, particularly the head-impulse test, and doubts about the necessity, safety, or validity of this examination. Conclusions: HINTS examination use is limited by lack of provider skill, safety concerns, and doubts on its validity in excluding stroke when employed by EM physicians.
In spite of continuous refinements in tympanoplasty techniques, results are variable, and it is not uncommon to see a discharging eardrum even after a good graft uptake. This study aimed to evaluate the efficacy of total annulus excision tympanoplasty in comparison with conventional underlay tympanoplasty.
This was a double blinded, randomised, controlled trial performed at a tertiary care centre. After inclusion and exclusion criteria were met, 56 patients were enrolled and randomised, and 28 patients were allocated to each group (group A (conventional tympanoplasty) and group B (total annulus excision)). Patients and evaluators were blind to the procedure performed.
Patients in group B (total annulus excision) showed better graft uptake and no discharge with better gains in air conduction thresholds (p < 0.05) when compared with group A (conventional tympanoplasty).
In view of the advantages it offers, total annulus excision tympanoplasty may be preferred over the conventional techniques in patients with central perforations.
This study was performed to investigate the occurrence of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in batches of pigs at slaughter and at different stages along the slaughter line. Nasal and ear skin swabs were collected from 105 batches of 10 pigs at six abattoirs. Cultures (pooled or individual) were performed for MRSA using selective media; presumptive MRSA were confirmed by mecA and nuc gene detection and a selection was spa-typed. MRSA was detected in 46 batches. All spa-types detected were those associated with LA-MRSA clonal complex 398. The proportion of positive batches varied among abattoirs (0–100%). Two abattoirs were subsequently further investigated, with samples taken at post-stunning, chiller and either at lairage or post-singe. Results suggested cross-contamination occurred between the lairage and point of post-stunning, but the slaughter processes appeared effective at reducing contamination before carcases entered the chiller. One abattoir provided only negative samples in the initial study and in the subsequent study along the slaughter line (26 batches in total), suggesting differences possibly in the MRSA status of pigs on arrival from supply farms or in its abattoir practices affecting the MRSA status of pigs at the sampling points. This study highlights that in the investigated abattoirs, MRSA was detected in 43.8% of batches of pigs at slaughter using sensitive selective culture methods.
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 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.
Underrepresentation of Black biomedical researchers demonstrates continued racial inequity and lack of diversity in the field. The Black Voices in Research curriculum was designed to provide effective instructional materials that showcase inclusive excellence, facilitate the dialog about diversity and inclusion in biomedical research, enhance critical thinking and reflection, integrate diverse visions and worldviews, and ignite action. Instructional materials consist of short videos and discussion prompts featuring Black biomedical research faculty and professionals. Pilot evaluation of instructional content showed that individual stories promoted information relevance, increased knowledge, and created behavioral intention to promote diversity and inclusive excellence in biomedical research.
As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.
This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.
Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.
A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.
Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing’s disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
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.