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Persons with mental health issues are among the most under-represented populations in rights discourse, and more so those from the Global South, who have been further subjugated by the intersections of poverty, patriarchy, and systemic isolation wrought by colonial and outmoded psychiatric treatments. The issue is worse still for women with mental illness in the Global South, many of whom are driven to the extreme margins, including but not limited to chronic homelessness. Through an enquiry into the lives of these women, and their experiences of exclusion, homelessness, and involuntary commitment, this chapter aims to deconstruct traditionally accepted notions of human rights and recalibrate a service paradigm that can mould itself to fit the diverse needs of an ultra-vulnerable population over a strong foundation of liberty, access to choice, and commitment to diversity. The study is set in The Banyan, a Chennai (India)-based not-for-profit organisation, focussed on humanitarian, equity, and justice-centric responses to the needs of homeless women with mental health issues.
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.
Laws intended to address the sexual harassment that millions of women experience every day in the course of their work have taken two broad, mutually non-exclusive approaches in India. One approach is to treat sexual harassment as a crime, to be dealt with through the retributive powers of the criminal justice system. Another approach is to view sexual harassment as a violation of women's constitutional rights to equality, dignity and the freedom to carry out their profession or employment free from discrimination. This second approach has often taken the form of anti-discrimination laws and laws designed to provide women with redressal mechanisms through their place of employment.
In India, both these approaches to combat workplace sexual harassment were formalised into legislative enactments at around the same time. In April 2013, the Indian parliament passed a law to address sexual harassment faced by women in the workplace, the first successful legislative initiative on the subject. Around the same time, the parliament also introduced sexual harassment as a criminal offence under the Indian Penal Code (IPC) through the Criminal Law (Amendment) Act, 2013. This amendment to the IPC came into force retrospectively from February 2013. In this chapter, we use the framework of legal pluralism to examine how the law relating to workplace sexual harassment has played out in the seven years that have passed since these legislative interventions came into force.
Laws, of course, do not operate in isolation and are not the only tools that women have used in their battle for gender equality and in making the workplace free from discrimination. The #metoo movement has had a powerful impact in India and is the most recent example of women using avenues outside the formal legal system, such as social media, to make their voices heard. Even prior to #metoo, there have been efforts by women, the state and various institutions to make use of all available avenues to voice their concerns on gender equality in the workplace. While we do not examine these other avenues in detail, they provide the context and backdrop in which we analyse the evolution of workplace sexual harassment law in India and how women have used these laws, along with other tools, in bargaining for and advancing their right to equality.
This study examines the prevalence and associations between recent violence experience, mental health and physical health impairment among Female Sex Workers (FSWs) in north Karnataka, India.
Multi-morbidity, in particular the overlap between physical and mental health problems, is an important global health challenge to address. FSWs experience high levels of gender-based violence, which increases the risk of poor mental health, however there is limited information on the prevalence of physical health impairments and how this interacts with mental health and violence.
We conducted secondary analysis of cross-sectional quantitative survey data collected in 2016 as part of a cluster-RCT with FSWs called Samvedana Plus. Bivariate and multivariate analyses were used to examine associations between physical impairment, recent (past 6 months) physical or sexual violence from any perpetrator, and mental health problems measured by PHQ-2 (depression), GAD-2 (anxiety), any common mental health problem (depression or anxiety), self-harm ever and suicidal ideation ever.
511 FSWs participated. One fifth had symptoms of depression (21.5%) or anxiety (22.1%), one third (34.1%) reported symptoms of either, 4.5% had ever self-harmed and 5.5% reported suicidal ideation ever. Over half (58.1%) reported recent violence. A quarter (27.6%) reported one or more chronic physical impairments. Mental health problems such as depression were higher among those who reported recent violence (29%) compared to those who reported no recent violence (11%). There was a step-wise increase in the proportion of women with mental health problems as the number of physical impairments increased (e.g. depression 18.1% no impairment; 30.2% one impairment; 31.4% ≥ two impairments). In adjusted analyses, mental health problems were significantly more likely among women who reported recent violence (e.g. depression and violence AOR 2.42 (1.24–4.72) with rates highest among women reporting recent violence and one or more physical impairments (AOR 5.23 (2.49–10.97).
Our study suggests multi-morbidity of mental and physical health problems is a concern amongst FSWs and is associated with recent violence experience. Programmes working with FSWs need to be mindful of these intersecting vulnerabilities, inclusive of women with physical health impairments and include treatment for mental health problems as part of core-programming.
Samvedana Plus was funded by UKaid through Department for International Development as part of STRIVE (structural drivers of HIV) led by London School of Hygiene and Tropical Medicine and the What Works to Prevent Violence Against Women and Girls Global Programme led by South African Medical Research Council
The aim of this re-audit was to review whether inpatientprescription cards are completed correctly by doctors and administered by nurses, and to compare the results with the previous audit.
We carried out a re-audit of Medical Prescription and Nursing Administration of Medication in Learning Disabilities In-patient Settings. Black Country Partnership NHS Foundation Trust is committed to managing medicines safely, efficiently and effectively as a key part of delivering high quality patient centred care. In BCPFT medications are recorded by doctors on paper prescription cards and administered by registered nurses.
This audit compared results against the standards for prescribing medication in BCPFT Medicines Policy.Prescription charts were retrospectively reviewed against 22 standards for all LD inpatients as outlined in the LD trust policy across all 3 of the Learning Disabilities in-patient units during May 2019 as long as they were still inpatients during this month. 27 prescription cards were reviewed in total.
100% of prescription cards had patients full names , address , ward name, were fully legible , written in black ink, route of administration, approved abbreviation for route, date of prescription, signature of prescriber , prescription labelled as 1of 1 /2, frequency of prn meds and indication . Whereas only 96% had generic drug names, clearly documented doses and time of administration along with acceptable abbreviation and appropriate code for omission. 85% drugs had a stop date once drug was stopped and 85% had allergies recorded in red and had a line drawn through once drug was omitted.
The re- audit was highlighted to inpatient managers, nursing staff, The Medicines Management Committee (MMC) anddoctors in the Learning Disability division. Prescribers werereminded of the importance of documenting a stop date for the prescriptions and signing off once drug is crossed out. It was discussed in MMC to consider removing the standard for recording allergies in red ink as the box is already red in colour. The PRN section for medication does not have an area to sign when the drug is cancelled and this in particular is the case when PRN medication is re-written. It was discussed to limit this standard to regular medication and to be taken in consideration if the current drug chart requires redesigning in the future. We also recommended a re- audit in 2 years’ time.
In this paper we study a large system of N servers, each with capacity to process at most C simultaneous jobs; an incoming job is routed to a server if it has the lowest occupancy amongst d (out of N) randomly selected servers. A job that is routed to a server with no vacancy is assumed to be blocked and lost. Such randomized policies are referred to JSQ(d) (Join the Shortest Queue out of d) policies. Under the assumption that jobs arrive according to a Poisson process with rate
, we establish functional central limit theorems for the fluctuation process in both the transient and stationary regimes when service time distributions are exponential. In particular, we show that the limit is an Ornstein–Uhlenbeck process whose mean and variance depend on the mean field of the considered model. Using this, we obtain approximations to the blocking probabilities for large N, where we can precisely estimate the accuracy of first-order approximations.
The coronavirus disease 2019 (COVID-19) vaccine was launched in India on 16 January 2021, prioritising health care workers which included medical students. We aimed to assess vaccine hesitancy and factors related to it among medical students in India. An online questionnaire was filled by 1068 medical students across 22 states and union territories of India from 2 February to 7 March 2021. Vaccine hesitancy was found among 10.6%. Concern regarding vaccine safety and efficacy, lack of awareness regarding their eligibility for vaccination and lack of trust in government agencies predicted COVID-19 vaccine hesitancy among medical students. On the other hand, the presence of risk perception regarding themselves being affected with COVID-19 reduced vaccine hesitancy as well as hesitancy in participating in COVID-19 vaccine trials. Vaccine-hesitant students were more likely to derive information from social media and less likely from teachers at their medical colleges. Choosing between the two available vaccines (Covishield and Covaxin) was considered important by medical students both for themselves and for their future patients. Covishield was preferred to Covaxin by students. Majority of those willing to take the COVID-19 vaccine felt that it was important for them to resume their clinical posting, face-to-face classes and get their personal life back on track. Around three-fourths medical students viewed that COVID-19 vaccine should be made mandatory for both health care workers and international travellers. Prior adult vaccination did not have an effect on COVID-19 vaccine hesitancy. Targeted awareness campaigns, regulatory oversight of vaccine trials and public release of safety and efficacy data and trust building activities could further reduce COVID-19 vaccine hesitancy among medical students.
The total coronavirus disease (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have reached 139 million worldwide and nearing 3 million deaths on April 16, 2021. The availability of accurate data is crucial as it makes it possible to analyze correctly the infection trends and make better forecasts. The reported recovered cases for many US states are surprisingly low. This could be due to difficulties in keeping track of recoveries, which resulted in higher numbers for the reported active cases than the actual numbers on the ground. In this work, based on the typical range of recovery rate for COVID-19, we estimate the active data from the total cases and death cases and bring out a correction for the data for all the US states reported on Worldometer.
Clustering is a general term for techniques that, given a set of objects, aim to select those that are closer to one another than to the rest, according to a chosen notion of closeness. It is an unsupervised-learning problem since objects are not externally labeled by category. Much effort has been expended on finding natural mathematical definitions of closeness and then developing/evaluating algorithms in these terms. Many have argued that there is no domain-independent mathematical notion of similarity but that it is context-dependent; categories are perhaps natural in that people can evaluate them when they see them. Some have dismissed the problem of unsupervised learning in favor of supervised learning, saying it is not a powerful natural phenomenon. Yet, most learning is unsupervised. We largely learn how to think through categories by observing the world in its unlabeled state. Drawing on universal information theory, we ask whether there are universal approaches to unsupervised clustering. In particular, we consider instances wherein the ground-truth clusters are defined by the unknown statistics governing the data to be clustered.
The present systematic review aimed to explore the published literature on the application of yoga and meditation for tinnitus.
A systematic search was carried out to identify the eligible studies exploring the effect of yoga and meditation on tinnitus in PubMed, Scopus and Cochrane Library electronic databases. Studies on the application of yoga and meditation on tinnitus were identified following a three-step screening process by both the authors independently. A mixed-methods appraisal tool was used to perform the quality appraisal of the included studies.
Five studies were shortlisted and included in the present review. Four studies had used different types of yoga and pranayama, while one used relaxation therapy. Three studies concluded that there were positive effects of yoga on tinnitus, such as a reduction in severity, stress, anxiety and irritability associated with tinnitus and improved quality of life.
This review highlights the application of yoga and meditation in management of tinnitus along with regular otological and audiological treatment options. Furthermore, there is a need to have more randomised controlled trials in this area to evidence the effect of yoga and meditation on tinnitus empirically.
To determine the demographic pattern of juvenile-onset parkinsonism (JP, <20 years), young-onset (YOPD, 20–40 years), and early onset (EOPD, 40–50 years) Parkinson’s disease (PD) in India.
Materials and Methods:
We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.
A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sleep-related issues more common in EOPD subjects. Overall, dyskinesias were documented in 32.8%. YOPD subjects had a higher frequency of dyskinesia than EOPD subjects (39.9% vs. 25.5%), but they were first noted later in the disease course (5.7 vs. 4.4 years).
This large cohort shows differing clinical patterns in JP, YOPD, and EOPD cases. We propose that cutoffs of <20, <40, and <50 years should preferably be used to define JP, YOPD, and EOPD.
Exposure to acute versus chronic stressors and threats activates the immune system in adaptive and maladaptive manners respectively. Chronic activation arising from persistent stress exposure can contribute to an inflammatory response in the periphery and in the brain that has been implicated in stress-related psychopathology, including depression and anxiety. We review the immunology of acute and chronic stress exposure, integrate this discussion with the emerging literature linking heightened immune activation and inflammation to mood and anxiety disorders, and consider the translational implications of the immune system's role in these psychiatric conditions, with a brief overview of potential interventions.