Background: The burden and outcome of stroke in indigenous populations is less well understood. This review evaluates ischemic stroke outcomes in indigenous populations as compared to the general population in the context of recent advances in ischemic stroke therapy. Methods: The OVID Medline and EMBASE databases were searched for this review. Clinical outcome was measured using standardized outcome scale (eg. mRS) at 90 days following stroke intervention in indigenous as compared to non-indigenous adult populations. Results: 897 studies were identified, with 4 studies included in the final analysis. A total of (n=68895) patients were included who underwent thrombolysis. Study populations from Australia, New Zealand, United States and Canada comprised of (n=2012) indigenous patients. Mortality was significantly higher in indigenous populations as compared to non-indigenous (Odds Ratio-1.28, 95% CI-1.12; 1.46). The odds ratios of atrial fibrillation (1.26, 95% CI-1.12;– 1.41), diabetes (1.43, 95% CI- 1.27; 1.62), hypertension (1.33, 95% CI- 1.17; 1.51) and IHD (0.71, 95% CI- 0.62; 0.81) in indigenous patients was significantly higher than in non-indigenous patients. Conclusions: Indigenous populations undergoing stroke therapy are at a significantly increased risk of mortality as compared to non-indigenous populations. Comorbidities including diabetes, atrial fibrillation and hypertension are more prevalent in indigenous populations.

Background: Sex differences in treatment response to intravenous thrombolysis (IVT) are poorly characterized. We compared sex-disaggregated outcomes in patients receiving IVT for acute ischemic stroke in the Alteplase compared to Tenecteplase (AcT) trial, a Canadian multicentre, randomised trial. Methods: In this post-hoc analysis, the primary outcome was excellent functional outcome (modified Rankin Score [mRS] 0-1) at 90 days. Secondary and safety outcomes included return to baseline function, successful reperfusion (eTICI≥2b), death and symptomatic intracerebral hemorrhage. Results: Of 1577 patients, there were 755 women and 822 men (median age 77 [68-86]; 70 [59-79]). There were no differences in rates of mRS 0-1 (aRR 0.95 [0.86-1.06]), return to baseline function (aRR 0.94 [0.84-1.06]), reperfusion (aRR 0.98 [0.80-1.19]) and death (aRR 0.91 [0.79-1.18]). There was no effect modification by treatment type on the association between sex and outcomes. The probability of excellent functional outcome decreased with increasing onset-to-needle time. This relation did not vary by sex (pinteraction 0.42). Conclusions: The AcT trial demonstrated comparable functional, safety and angiographic outcomes by sex. This effect did not differ between alteplase and tenecteplase. The pragmatic enrolment and broad national participation in AcT provide reassurance that there do not appear to be sex differences in outcomes amongst Canadians receiving IVT.

Himalayan glaciers have been shrinking and losing mass rapidly since 1970s with an enhanced rate after 2000. The shrinkage is, however, quite heterogeneous and it is important to document individual glacier characteristics and their changes at the basin scale. We present an updated glacier inventory of the Upper Alaknanda Basin (UAB), Central Himalaya for the year 2020 and report area, debris cover and length changes for the periods 1994–2006 and 2006–2020 based on remote-sensing data. We identified 198 glaciers, comprising an area of 354.6 ± 8.5 km2, and classified them according to their size and morphology. The glaciers of the basin lost 4.2 ± 2.9% (0.16 ± 0.11% a−1) of their frontal area (from 368.6 ± 9.2 to 353.0 ± 5.3 km2) from 1994 to 2020. The average retreat rate was higher in the period 2006–2020 (13.3 ± 1.8 m a−1) in comparison to 1994–2006 (9.3 ± 1.9 m a−1). However, the area change rate was similar for the two periods (0.14 ± 0.27% a−1 for 1994–2006 and 0.16 ± 0.19% a−1 for 2006–2020). The debris-covered area has increased by 13.4 ± 4.4% from 1994 to 2020. A comparison with previous studies in UAB indicates consistent area loss of ~0.15% a−1 since the 1960s.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led the implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 6 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=150 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics “last seen normal to puncture” (305.7 vs 407.2 min; p=0.05) and “hospital arrival to puncture” (80.4 vs 121.2 min; p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2; p=0.506) or successful EVT rate (89.6% vs 90%; p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.

A supraglacial debris layer controls energy transfer to the ice surface and moderates ice ablation on debris-covered glaciers. Measurements of vertical temperature profiles within the debris enables the estimation of thermal diffusivities and sub-debris ablation rates. We have measured the debris-layer temperature profiles at 16 locations on Satopanth Glacier (central Himalaya) during the ablation seasons of 2016 and 2017. Debris temperature profile data are typically analysed using a finite-difference method, assuming that the debris layer is a homogeneous one-dimensional thermal conductor. We introduce three more methods for analysing such data that approximate the debris layer as either a single or a two-layered conductor. We analyse the performance of all four methods using synthetic experiments and by comparing the estimated ablation rates with in situ glaciological observations. Our analysis shows that the temperature measurements obtained at equispaced sensors and analysed with a two-layered model improve the accuracy of the estimated thermal diffusivity and sub-debris ablation rate. The accuracy of the ablation rate estimates is comparable to that of the in situ observations. We argue that measuring the temperature profile is a convenient and reliable method to estimate seasonal to sub-seasonal variations of ablation rates in the thickly debris-covered parts of glaciers.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led an implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 9 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=144 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics “last seen normal to puncture” (305.7 vs 407.2 min; p=0.05) and “hospital arrival to puncture” (80.4 vs 121.2 min; p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2; p=0.506) or successful EVT rate (89.6% vs 90%; p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during the pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.

We report a familial cluster of 24 individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The index case had a travel history and spent 24 days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only four individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.

Field experiments were conducted to standardize protocols for site-specific fertilizer nitrogen (N) management in Bt cotton using Soil Plant Analysis Development (SPAD) chlorophyll meter. Performance of different SPAD-based site-specific N management scenarios was evaluated vis-à-vis blanket fertilizer N recommendation. The N treatments comprised a no-N (control), four fixed-time and fixed N doses (60, 90, 120, and 150 kg N ha-1) including the recommended dose (150 kg ha-1), and eight fixed-time and adjustable N doses based on critical SPAD readings of 45 and 41 at first flowering and boll formation stages, respectively. The results revealed that by applying 45 or 60 kg N ha-1 at thinning stage of the crop and critical SPAD value-guided dose of 45 or 30 kg N ha-1 at first flowering stage resulted in yields similar to that recorded by applying the recommended dose of 150 kg N ha-1. However, significantly higher N use efficiency as well as 30–40% less total fertilizer N use was recorded with site-specific N management. Applying 30 kg N ha-1 at thinning and SPAD meter-guided 45 kg N ha-1 at first flowering were not enough and required additional SPAD meter-guided 45 kg N ha-1 at boll formation for sustaining yield levels equivalent to those observed by following blanket recommendation but resulted in 20% less fertilizer N application. Our data revealed that SPAD meter-based site-specific N management in Bt cotton results in optimum yield with dynamic adjustment of fertilizer N doses at first flowering and boll formation stages. The total amount of N fertilizer following site-specific management strategies was substantially less than the blanket recommendation of 150 kg N ha-1, but the extent may vary in different fields.

Using an anonymised case study (with written consent), we describe a process aiming to understand the impact a patient's learning disability, personality disorder and bipolar affective disorder each had upon her capacity to make decisions and to ascertain in which areas of her life the patient had the ability to take responsibility. This information was then used to plan an effective management strategy.

We have developed an approach to care planning in which we analyse management areas by defining which diagnosis is relevant and so deciding if the patient has capacity for that specific area of life. in this way we can be clear with patients when they have capacity and encourage greater responsibility and independence in their lives.

DS with aging is associated with greatly increased risk of developing dementia similar to Alzheimer's. Anti-dementia drug discontinuation is recommended when clinical benefit is not determined. In DS it is more complex as medication ill effects of stopping needs to be weighed in balance to extraneous processes such as environment changes, sensory impediments and physical ill health and natural progression of dementia.

The Nilgiri tahr Nilgiritragus hylocrius is an Endangered species of mountain ungulate endemic to the Western Ghats of India, a biodiversity hotspot. Habitat fragmentation, hunting and a restricted range are the major threats to this species. Although several surveys have assessed the species’ status, a population estimate based on a scientifically robust method is needed. We used the double-observer method to estimate the population of the Nilgiri tahr in the Anamalai Tiger Reserve, a protected area in the Western Ghats. We walked 257 km of transects across the Reserve, covering 36 grassland blocks (i.e. clusters of montane grasslands that were relatively separate from each other). We counted a minimum of 422 individuals in 28 groups, and estimated the tahr population in the study area to be 510 individuals (95% CI 300–858) in 35 groups. The male:female ratio was 0.71 and the young:female ratio was 0.56. Comparing our estimate with previous surveys suggests that the Nilgiri tahr population in Anamalai Tiger Reserve is stable. We found the double-observer survey method to be appropriate for population estimation and long-term monitoring of this species, and make recommendations for improved field protocols to facilitate the implementation of the method in the tropical mountains of the Western Ghats. Our findings suggest that the Reserve harbours 20–25% of the global population of the Nilgiri tahr, highlighting the area's importance for the conservation of this species.

Glaciological ablation is computed from point-scale data at a few ablation stakes that are usually regressed as a function of elevation and averaged over the area-elevation distribution of a glacier. This method is contingent on a tight control of elevation on local ablation. However, in debris-covered glaciers, systematic and random spatial variations of debris thickness modify the ablation rates. We propose and test a method to compute sub-debris ablation where stake data are interpolated as a function of debris-thickness alone and averaged over the debris-thickness distribution at different parts of the glacier. We apply this method on Satopanth Glacier located in Central Himalaya utilising ~1000 ablation measurements obtained from a network of up to 56 stakes during 2015–2017. The estimated mean sub-debris ablation ranges between 1.5±0.2 to 1.7±0.3 cm d−1. We show that the debris-thickness-dependent regression describes the spatial variability of the sub-debris ablation better than the elevation dependent regression. The uncertainties in ablation estimates due to the corresponding uncertainties in the measurement of ablation and debris-thickness distribution, and those due to interpolation procedures are estimated using Monte Carlo methods. Possible biases due to a finite number of stakes used are also investigated.