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1. To assess quality of VTE risk assessment and recording; particularly to look at the impact of COVID-19 on VTE (Venous Thrombo-embolism). 2. To ensure VTE criteria have been adhered to from Tees, Esk and Wear Valleys NHS foundation trust 2019 ” Risk assessment for Venous Thromboembolism (VTE) (Ref: CLIN-0085-v 1.2)Specifically, due to additional risks posed by COVID-19 on increase in risk of VTE.
The Audit was conducted in Secure inpatient service in Teesside, Roseberry Park Hospital, TEWV NHS trust audit team.
This was done on the back of a scheduled Quality improvement reaudit of VTE risk assessment and recording review in Forensic SIS.
One of the main results was that VTE risk assessment and recording, post finding of a COVID-19 positive result was less than 100% in the records we checked. Other results are included in the poster.
The main conclusion is the need for increased vigilance in assessment and recording of (and any actions thereof) in the VTE risks, particularly in those with COVID-19 positive tests.
We propose that this increased vigilance will enhance patient safety and deliver effective and timely care. We highlight some challenges of conducting an Audit and how to embed results and improve practices in a timely manner. This describes how we did both- acted on results and followed process; rather than just one or the other!
The study primarily focuses on analyzing married women’s attitudes towards negotiating safer sex in two contexts. The first context is when a woman refuses to have sex with husband if she knows her husband has a sexually transmitted disease (STD) and the second is when she does so if she knows he has sex with other women. The study examined predictors of Indian women’s attitude towards negotiating safer-sex using data on 92,306 ever married women from the state module of the 2015-16, National Family Health Survey 4. Descriptive and multilevel logistic regression was used to understand the interplay between the attitude towards negotiation of safer sexual relationships with husband and the selected background characteristics with a primary focus on controlling behaviour and power relations. About 17% of women did not believe in negotiating safer sexual relations with the husband. An approximately equal proportion of ever-married women (79% each) believed in doing so under the two specific conditions, that is, if they knew the husband had an STD and they knew he had sex with other women. Multilevel regression analysis showed that women who had household decision-making power [AOR=0.71; p<0.01] and those whose husbands displayed low control towards them [AOR=0.91; p<0.05] were more likely to believe in negotiating safer-sex. Our findings suggest that women who have controlling partners or those who live under the umbrella of the husband’s authority lack the power to negotiate for safer sex. Interventions promoting sexual well-being must deal with negative male perceptions and expectations that perpetuate unhealthy sexual habits and marriage ties.
In existing historiography, the modernity discourse presents modern knowledge as being more economically efficient and technologically advanced compared to traditional skills. This theoretical lens has introduced a hierarchy of production and restructured the meaning of work and division of labour within the profession of weaving. Historically, the contexts of both the modern textile industry and traditional handloom weaving were interrelated in terms of technology and skills, but they have become increasingly segregated over the last two centuries. This article suggests an apparent distinction between “modernization” as a historical process and “modernity” as a condition. Analysis of the policies and prejudices of the colonial state explains the dynamics between producers, products, and techniques in the handloom textile sector of the United Provinces during the early twentieth century, as well as the impact of government policies, nationalist ideas, and global processes on the sector. Studying these interactions allows us to explore localized nuances pertaining to knowledge and skill that have often been ignored in historiography due to preconceived cultural, political, and institutional compartmentalization of craft communities.
COVID-19 serosurvey provides a better estimation of people who have developed antibody against the infection. But limited information on such serosurveys in rural areas poses many hurdles to understand the epidemiology of the virus and to implement proper control strategies. This study was carried out in the rural catchment area of Model Rural Health Research Unit in Odisha, India during March–April 2021, the initial phase of COVID vaccination. A total of 60 village clusters from four study blocks were identified using probability proportionate to size sampling. From each cluster, 60 households and one eligible participant from each household (60 per cluster) were selected for the collection of blood sample and socio-demographic data. The presence of SARS-CoV-2 antibody was tested using the Elecsys Anti-SARS-CoV-2 immunoassay. The overall seroprevalence after adjusting for test performance was 54.21% with an infection to case ratio of 96.89 along with 4.25% partial and 6.79% full immunisation coverage. Highest seroprevalence was observed in the age group of 19–44 years and females had both higher seroprevalence as well as vaccine coverage. People of other backward caste also had higher seropositivity than other caste categories. The study emphasises on continuing surveillance for COVID-19 cases and prioritizing COVID-19 vaccination for susceptible groups for better disease management.
Our selection and endogeneity corrected findings suggest that firms' political connections negatively influence their market value. We find that firms with a larger size, more operationally efficient in utilizing their assets, and those operating in more concentrated industries benefit more from the political connections than the otherwise corresponding firms. We also report that political connections do not influence firms' leverage choices. However, we find that politically connected firms with higher leverage have significantly lower market value. Further, we note that political connections help the firms operating in unregulated but more concentrated industries, probably to obtain ‘private benefits’, leading to their higher market value. Overall, our results indicate that the effect of political connections is not homogeneous across the sample firms. They also raise questions on the motivation of sample firms' political connections, suggesting that these firms probably obtain political connections for reasons other than enhancing their market value.
The role of skills has been eclipsed in the transition from an agrarian-craft economy rooted in hand-labour in small households to a modern political economy where productive work takes place outside the household, in offices and factories. Yet the ideological erasure of skilled work should not be confused with its actual disappearance. Precisely because such work was typically construed as private and unimportant, the embedded hierarchies and skills that shaped the handloom weaving industry in the North Indian province of United Provinces under colonial rule could escape systematic conversion to capitalist structures. Skill as human capital constituted the capitalist labour processes in the modern handloom industry, not as an abstract act, but as a historical experience. Handloom workers were reproduced, generationally, socially, and hierarchically, through the passing on of skilled labour within the unorganized informal sector of handloom weaving. Thus the stuff of community skills should move beyond its projection as either ‘endangered’ or ‘regressive’ to explore its access to capitalist structures and the exploitative networks that contain, transmit, and enable the production of skills.
Applause sign (AS) is a clinical phenomenon observed in several neurological disorders including progressive supranuclear palsy (PSP). We investigated the factors associated with AS in patients with PSP. PSP patients with AS showed greater motor impairment compared to those with negative AS. Global cognition including attention and memory were affected more in patients with positive AS. We also observed that gait variability, a known marker for unstable gait is pronounced in those who presented with positive AS. Hence, the clinician might expect a more severe disease and an unstable gait in a PSP patient presenting with AS.
Recent epidemiological studies analysing sex-disaggregated patient data of coronavirus disease 2019 (COVID-19) across the world revealed a distinct sex bias in the disease morbidity as well as the mortality – both being higher for the men. Similar antecedents have been known for the previous viral infections, including from coronaviruses, such as severe acute respiratory syndrome (SARS) and middle-east respiratory syndrome (MERS). A sound understanding of molecular mechanisms leading to the biological sex bias in the survival outcomes of the patients in relation to COVID-19 will act as an essential requisite for developing a sex-differentiated approach for therapeutic management of this disease. Recent studies which have explored molecular mechanism(s) behind sex-based differences in COVID-19 pathogenesis are scarce; however, existing evidence, for other respiratory viral infections, viz. SARS, MERS and influenza, provides important clues in this regard. In attempt to consolidate the available knowledge on this issue, we conducted a systematic review of the existing empirical knowledge and recent experimental studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The qualitative analysis of the collected data unravelled multiple molecular mechanisms, such as evolutionary and genetic/epigenetic factors, sex-linkage of viral host cell entry receptor and immune response genes, sex hormone and gut microbiome-mediated immune-modulation, as the possible key reasons for the sex-based differences in patient outcomes in COVID-19.
This reel analysis identifies quotes and actions of fictional characters from TV shows, namely: Hercules Poirot, Sherlock Holmes and House who can demonstrate learning points for clinical students to use within real psychiatric practice, using scientific theories such as the Hypothetico-deductive model, Empirical falsification and Occam's razor. This analysis explores what an ideal psychiatric interview consists of and what can be learnt from these characters and implemented within medical education.
Each show was watched by one researcher over the period of March to August 2020. The researcher noted insightful quotes which were relevant to one of the three philosophical theories. Quotes were included if they demonstrated deduction skills, revealed a character's ethos and supported the Calgary-Cambridge model of interviewing such as building rapport. 32 quotations were collected in total and narrowed to 6 quotations. These were then analysed, learning points were made and linked to the Calgary Cambridge model.
Dr House demonstrates objectivity when taking a patient's history. He utilises empirical falsification when diagnosing to avoid missing a differential diagnosis. Detective Poirot displays how empathic listening allows disclosure of details in the history, which would have otherwise been omitted. Additionally, he illustrates the importance of collateral interviewing which allows one to identify misinterpretations and inconsistencies. Sherlock teaches us the importance of perception regarding mismatching information which can help to gather new facts. All three characters interview beginning with open questions to more closed questions, supplementing with deductive reasoning in order to solve cases. Objectivity, empirical falsification, empathetic listening and deductive reasoning are the key skills displayed by these characters, that medical students can most use in their own practices.
The perfect interview discovers new information through synchronised collaboration, whilst adhering to the Hypothetico-deductive model of thought. A combination of the Calgary-Cambridge model of interviewing and skillset of the TV characters should be considered for implementation in some aspects of psychiatric interviewing. Medical education can utilise these TV shows to teach students how to conduct history-taking.
The current study aimed to predict disability-adjusted life years (DALY) rate in Japan through 2040 with plausible future scenarios of fruit intake for neoplasms, cardiovascular diseases (CVD) and diabetes and kidney diseases (DKD).
Data from National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017 were used. We developed an autoregressive integrated moving average model with four future scenarios. Reference scenario maintains the current trend. Best scenario assumes that the goal defined in Health Japan 21 is achieved in 2023 and is kept constant afterwards. Moderate scenario assumes that the goal is achieved in 2040. Constant scenario applies the same proportion of 2016 for the period between 2017 and 2040.
DALY rates in Japan were predicted for the period between 2017 and 2040.
Population aged more than than 20 years old.
In our reference forecast, the DALY rates in all-ages group were projected to be stable for CVD and continue increasing for neoplasms and DKD. Age group-specific DALY rates for these three disease groups were forecasted to decrease, with some exceptions. Among men aged 20–49 years, DALY attributable to CVD differed substantially between the scenarios, implying that there is a significant potential for reducing the burden of CVD by increasing fruit intake at the population level.
Our scenario analysis shows that higher fruit intake is associated with lower disease burden in Japan. Further research is required to assess which policies and interventions can be used to achieve an increase in fruit intake as modelled in the scenarios of the current study.
Radiation therapy has historically used margins for target volume to ensure dosimetric planning criteria. The size of margin for a given treatment site is still uncertain particularly for moving targets along with set-up variations leading to a fuzziness of target volume. In this study, we have estimated the dosimetric benefit of normal structures using biological-based optimal margins. The treatment margins are derived by knowledge-based fuzzy logic technique which is considering the radiotherapy uncertainties in treatment planning.
Materials and methods:
All treatment plans were performed using stepped increments of asymmetric margins to estimate prostate radiobiological indices such as tumour control probability (TCP) and normal tissue complication probability (NTCP). An absolute NTCP of 5% was considered to be the maximum acceptable value while TCP of 85% was considered to be the minimal acceptable limit for each volumetric modulated arc therapy (VMAT) plan of localised prostate cancer radiotherapy. Results were used to formulate rules and membership functions for Mamdani-type fuzzy inference system (FIS). In implementing the rules for the fuzzy system for ΔNTCP values above 10%, the PTV margin was not permitted to exceed 5 mm to avoid rectal complications due to margin selection. The new margins were applied in VMAT planning of prostate cancer for standard displacement errors. The dosimetric results of normal tissue predictors were estimated such as organ mean doses, rectum V60 (volume receiving 60 Gy), bladder V65 (volume receiving 65 Gy) and other clinically significant dose–volume indicators and compared with VMAT plans using current margin formulations.
Dosimetric results compared well to the results obtained by current techniques. Good agreement was obtained between proposed fuzzy model margins and currently used margins in lower error magnitude, but significant results were observed at higher error magnitude when organ toxicity concerned without compromising the target volumes.
The new margins may be helpful to estimate possible outcomes of normal tissue complications and thus may improve complication free survival particularly when organ motion errors are inevitable, case by case.
A numerical model that allows one to study numerically the evolution of waves along the test section of a wind-wave tank is offered. The simulations are directly related to wind-wave tank experiments carried out for a range of steady wind velocities. At each wind forcing condition, the evolving wind-wave field is strongly non-homogeneous, with wave energy growth along the test section accompanied by frequency downshifting. The wave parameters measured at a short fetch serve as a basis for generating numerous realizations of the initial conditions in the Monte Carlo numerical simulations. The computations are based on a modified unidirectional spatial version of the Zakharov equation that accounts for wind input and dissipation and is applicable for the whole range of wind velocities employed. The model contains two empirical parameters that are selected by comparison of the experimental and numerical results; the same values of those parameters are applied for all wind forcing conditions. The availability of an experimentally verified numerical model allows one to study the contributions of nonlinear wave–wave interactions, dissipation and wind input separately. Special attention is given to accounting for the three-dimensional and random nature of wind waves as observed in experiments. The suggested model combines approaches adopted in the wind-wave growth theories by Miles and Phillips.
Carbonatite melts derived from the mantle are enriched in CO2- and H2O-bearing fluids. This melt can metasomatize the peridotitic lithosphere and liberate a considerable amount of CO2. Experimental studies have also shown that a CO2–H2O-rich fluid can form Fe- and Mg-rich carbonate by reacting with olivine. The Sung Valley carbonatite of NE India is related to the Kerguelen plume and is characterized by rare occurrences of olivine. Our study shows that this olivine is resorbed forsterite of xenocrystic nature. This olivine bears inclusions of Fe-rich magnesite. Accessory apatite in the host carbonatite contains CO2–H2O fluid inclusions. Carbon and oxygen isotopic analyses indicate that the carbonatites are primary igneous carbonatites and are devoid of any alteration or fractionation. We envisage that the forsterite is a part of the lithospheric mantle that was reprecipitated in a carbonatite reservoir through dissolution–precipitation. Carbonation of this forsterite, during interaction between the lithospheric mantle and carbonatite melt, formed Fe-rich magnesite. CO2–H2O-rich fluid derived from the carbonatite magma and detected within accessory apatite caused this carbonation. Our study suggests that a significant amount of CO2 degassed from the mantle by carbonatitic magma can become entrapped in the lithosphere by forming Fe- and Mg-rich carbonates.
The aim of the present study was to estimate the prevalence and examine the determinants of consanguineous marriage types in India. Data for 456,646 ever-married women aged 15–49 years were analysed from the National Family Health Survey (NFHS)-4 conducted in 2015–16. The overall prevalence of consanguineous marriage was 9.9%; the South region (23%) and North-East region (3.1%) showed the highest and lowest prevalences, respectively. Muslims had a higher prevalence (15%) than Hindus (9%). The prevalence of first cousin marriage (8.7%) was more than that of second cousin (0.7%) and of uncle–niece marriages (0.6%). Women living in urban areas and in nuclear families, having a higher level of education and belonging to affluent families were less likely to marry their cousins (p < 0.01). Women living in the South region of the country were more likely to marry their cousins, as well as uncles (p < 0.001). Close scrutiny of the trends in the results (odds ratios) revealed no clear relationship between socioeconomic condition and consanguineous marriage. The study results suggest that religion and north–south regional dichotomy in culture largely determine consanguineous marriage rather than socioeconomic condition in India.
Psychiatric patients have a rather infamous, albeit widely publicised distinction of causing harm to themselves: at times leading to suicide and equally worryingly for society: harm to others occasionally leading to homicide.
There is a collateral knock-on distress, aside of incremental cost effects to various members of society, inclusive of both parties. These acts resulting in harm are termed “irrational”, “mad”, “and dangerous” and were deemed predictable. No doubt, improved psychotropic medications, evolving teams with greater responsibilities and incorporating ever improving psychological therapies have improved delivery of high quality care to our patients.However, the quest for a standardised, valid, generalisable, user friendly risk tool remains elusive, albeit increasingly improving, or is it?
Psychiatrists now more than ever are tasked with the challenge of assessing, managing and preventing if not predicting such harm and to aid seamless recovery and rehabilitation into society and thereof.
Risk assessment has gone through four generations of tools/ methods. All have their merits and areas that can be improved upon. Significantly, all emphasise a time limited and context driven assessment rather than one off documents. Each method has its place and time and contribute not only to effective risk management but also to recovery oriented treatments and facilitating, monitoring and supervising optimal rehabilitation needs of psychiatric patients.
In this poster we follow the journey of risk assessment tools ranging from the “unstructured/clinician based” to START (Short Term Assessment of Risk and Treatability), pondering if we have now come full circle?
Management of mentally unwell people and understanding of mental disorder in general has swung from the earlier, Meyer-ian (DSM founder) developmental approaches to the more commonly practised medical/disease model of the mind rooted in the quest for “hard” evidence in macro and micro level changes.
Sadly, it is made out that these two schools are at conflict, or at best exist in dialectic with each other and that one needs to be practised at the expense of the other. This belief is extended to assessment and management of risk to self and harm to others (bio-psycho-social approach mainly receiving a lip service), which is one of the primary outcome measures in psychiatry.
The training in cure-oriented model of medicine is in contrast to the bread and butter of what a psychiatrist deals within a day to day setting: recovery and rehabilitation of chronic remitting and relapsing illnesses. The psychiatrist thus left with an armoury of descriptive based approaches to deal with behaviour patterns that are seemingly irrational and leading to serious outcomes such as suicide and harm to others.
Highly specific interest in the nature/form of illness has ironically led to the sacrifice of sensitivity of the person's story, which brought the patient to us in the first place.
We suggest that in addition to “routine case management” the risk that patients present to self and others becomes comprehensive and an interesting exercise, leading to better outcomes for both patients and their guardians by marrying the two approaches.
New whole-rock geochemical analyses along with laser ablation multi-collector inductively coupled plasma mass spectrometry U–Pb zircon ages of the granite–rhyolite from the Karakoram Batholith, exposed along the Shyok Valley, NW India, have been performed to understand the timing and geochemical evolution of these magmatic bodies and their implications for the geodynamic evolution of the Karakoram Batholith. New geochronological data on granites and rhyolites along with previously published geochronological data indicate that the Karakoram Batholith evolved during Albian time (~110–100 Ma) owing to the subduction of Tethys oceanic lithosphere along the Shyok Suture Zone. This region witnessed a period of no magmatism during ~99–85 Ma. Following this, the Kohistan–Ladakh arc and Karakoram Batholith evolved as a single entity in Late Cretaceous and early Palaeogene times. Late Cretaceous (~85 Ma) rhyolite intrusions within the Karakoram Batholith show calc-alkaline subduction-related signatures with a highly peraluminous nature (molar A/CNK = 1.42–1.81). These intrusions may have resulted from c. ~13.8 % to ~34.5 % assimilation of pre-existing granites accompanied by fractional crystallization during the ascent of the magma. The contamination of mantle wedge-derived melts with crust of the active continental margin of the Karakoram most likely enhanced the high peraluminous nature of the rhyolite magma, as has been constrained by assimilation fractional crystallization modelling. Two granite samples from the contact of the Shyok Metamorphic Complex and Karakoram Batholith indicate that the post-collisional Miocene magmatism was not only confined along the Karakoram Fault zone but also extends ~30 km beyond the Shyok–Muglib strand.
This article presents a compact novel quasi-self-complementary semi-octagonal-shaped antenna for ultra-wideband (UWB) application. The proposed novel structure is fed by a microstrip line where different rectangular truncation is etched to the ground plane as an impedance matching element, which results for much wider impedance bandwidth (VSWR<2) from 2.9 to 20 GHz. In order to obtain band-notched characteristics at 5.5 GHz, an open-ended, quarter wavelength, spiral-shaped stub is introduced in the vicinity of the truncated part of the ground plane. An equivalent circuit model is adopted to investigate the band rejection characteristics of the ground plane stub. Sharpness of the rejection band can be controlled by maintaining the gap between stub resonator and the slotted periphery of ground plane. The proposed antenna design is validated by experimental measurements.
Iron deficiency chlorosis (IDC) is common among groundnut grown in calcareous and alkaline soils in India, China and Pakistan and causes considerable reduction in pod yield. To identify genetically diverse IDC tolerant accessions, the mini-core collection of groundnut representing geographical diversity was evaluated for IDC response over 2 years in iron-deficient calcareous soils. Enormous genetic variability was evident in the mini-core collection for IDC tolerance-related traits such as a visual chlorotic rating (VCR) and SPAD chlorophyll meter reading (SCMR) across five growth stages. Several IDC tolerant sources belonging to different botanical varieties such as hypogaea bunch (ICG # 5051, 6766, 5286, 6667, 4538, 14008, 5663, 9842, 11855), hypogaea runner (ICG 10479), fastigiata (ICG 10890) and vulgaris (ICG # 11651, 118) were identified. Among the six botanical varieties of groundnut, hypogaea bunch types were found most tolerant to IDC and this is the first report in groundnut. The IDC tolerant sources identified were irrespective of their country of origin. The principal component analysis based on VCR, SCMR, pod yield and its related traits revealed five major principal components that explained 80% of the total variation. The biplot generated using PC1 and PC2 revealed a distinct separation of IDC tolerant genotypes from the susceptible ones. The hierarchical clustering using five major principal components revealed seven major clusters that were mainly based on IDC response of the accessions.