Search

The construction and development of international transport corridors have become a means of cross-border space governance, promoting the flexibility of international industrial chains and supply chains. Due to the uncertainty of cooperation, the development of international transport corridors entails a long-term and complex system of engineering. Transport corridors can generate wider economic benefits and costs through their effects on a potentially diverse set of development outcomes, such as economic growth, poverty, jobs, equity, environmental quality, and economic resilience. The focus on roads, rails, and waterways is justified, as transport corridors based on these modes have clearer potential for economic spillovers than, for example, airline routes. The current paper describes a multi-method approach involving spatial and non-spatial analysis to investigate spatial disparity along a proposed corridor and examine its integration within the existing settlement structure. The conceptual structure for the review is guided by a simple canonical model describing the policy maker's problem in maximizing the net wider economic benefits of corridors. The meta-analysis confirms that characteristics of individual studies, as well as the placement and design of transport infrastructures, systematically influence the findings of corridor studies. It also shows that, on average, estimated impacts of corridor interventions on economic welfare and equity tend to be beneficial, while they are often detrimental to environmental quality, and possibly also to social inclusion. [ABSTRACT FROM AUTHOR]

This article details the politics of scale manifest in Dignity March, a grassroots speak-out movement against sexual violence that occurred at the same time as the #MeToo movement in India but was not part of the mainstream discourse. The spatial concept of scales explains the production of different spaces and their mutually constitutive nature. Building on the concept, scales are used here as an analytical framework to explain the intersectional and spatial nature of sexual oppression and resistance. Based on ethnographic research and in-depth interviews of sexual violence survivors from mainly oppressed-caste communities in rural India, this article demonstrates how speak-out movements help build communities of resistance. These forged communities, imbued with an understanding of intersectional, lived experience from the margins, create spaces of radical openness across multiple scales, be it at the level of the body, community, or regional/national. This article explores the many abolitionist practices of transformative justice__ a mode of justice that addresses the systems that produce impunity and marginalisation__ that become possible in spaces of radical openness. It argues for reimagining transnational solidarities in the fight against sexual violence and rooting it in an understanding of resistance movements in the margins of the geo-political South. [ABSTRACT FROM AUTHOR]

Background: The second wave of coronavirus disease (COVID‑19) in 2021 was devastating for low‑ and middle‑income countries (LMICs). This led to increased suicide rates among the young, economically productive age group. We analyzed the cohort of attempted suicidal hangings needing admission to the intensive care unit (ICU) and compared the data from the pre‑COVID‑19 era. Materials and Methods: We conducted a retrospective, observational, cohort study of suicidal hanging cases according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Six‑month data of such cases admitted to the neurological ICU after the lockdown of the second wave of COVID‑19 from July 2021 to January 2022 were collected. Demographic data along with the cause of attempted hanging, severity of sickness from hanging, and its outcome were gathered and compared with similar data acquired during 2003–2015 by the same authors in the same ICU. Results: There was a threefold increase in the incidence of suicidal hangings needing ICU care, from 9 to 27% in the pre‑ and post‑COVID‑19 era. A shift toward older aged males, in the third decade of life, was observed. The common cause of attempted suicide was a familial dispute (P = 0.03). Among the younger age group (18–25 years), increased screen time led to fights in the family. The cohort was also sicker with more severe lung involvement, longer ventilation, and hospital stay (P < 0.001). Conclusion: The increased incidence of hanging among young adults, amid the socioeconomic effects of COVID‑19, needs urgent attention. Suicide prevention measures need novel strategies aimed at de‑addiction from electronic gadgets and reducing screen time. [ABSTRACT FROM AUTHOR]

Introduction: Gorlin-Goltz syndrome also known as Nevoid Basal Cell Carcinoma Syndrome is a rare phakomatoses inherited as an autosomal dominant disorder characterized by mutations of PTCH-1 gene along with microdeletion of chromosome 9q. It is manifested by multiple tumours and abnormalities most importantly featured with multiple basal cell carcinoma, Odontogenic Keratocyst (OKC) and other skeletal disorders. Case Report: A 11- year-old girl having facial asymmetry and pain on the right side of the jaw reported to the department. Radiographic examination revealed multiple radiolucencies in the mandible. The biopsy and histopathological examination confirmed the presence of multiple OKC. Further investigations led to the case fulfilling 3 major criteria of multiple OKC, falx and tentorium cerebelli calcifications, palmar and plantar pits which established the diagnosis of Gorlin-Goltz syndrome. Conclusion: Being a condition requiring a multidisciplinary approach, early diagnosis and appropriate prophylactic measures along with proper treatment is essential for a better prognosis. [ABSTRACT FROM AUTHOR]

The ability of energy dissipation from earthquake force in a controlled and iterative manner will play a vital role in maintaining structural reliability for various forces. High force-to-volume (HF2V) extrusion damper is a promising technology with simple designs, high damping force and achieving design requirements. This paper develops HF2V extrusion damper with multiple toothing configuration for seismic application. The experimental verification has been undertaken on lead extrusion dampers with various frequency range of 0.5 to 2 Hz. The maximum load-carrying capacity is 10.48 kN with strokes up to 5mm are observed with hysteresis loop with some recentering capability has a stiffness value up to 2*106 N/m, and force levels up to 2-10 kN. The maximum load carrying capacity for time history loading for Northridge earthquake is 11.57 kN. The overall findings suggest that silicone sealant may be employed to build and characterize extrusion dampers with maximum energy dissipation and high force/volume interactions. The suggested device may be a potentially effective way to provide additional energy dissipation to structures in seismic zones, according to the mechanical characteristics to the frequency. Additionally, the system can withstand for earthquake time histories, and ensuring maintenance-free operation even in the midst of frequent ground vibration. [ABSTRACT FROM AUTHOR]

Background: During the pandemic, traditional family meetings were replaced by remote telecommunications. We assessed the families' satisfaction with these communications using a survey-based questionnaire. Methods: The study involved 20-minute telephonic surveys conducted with the family member who was updated during the hospitalization of the patient. A thematic-based questionnaire with responses on a scale of 5 ranging from very dissatisfied to very satisfied was used. The responses were dichotomized into bad and good reports for analysis. Results: A total of 196 patients were eligible. Only 154 patients' family representatives consented to the study. The frequency and content of the telephonic updates were satisfactory. The bad report was assigned to 5% of families only. Among features assessing empathy of communication providers, the satisfaction rate was much higher with 3% of families alone providing a bad report. The response was significantly biased against the final outcome of the patient with poor review often provided by relatives of patients who had succumbed to the illness. The dissatisfaction rate was much higher, above 12% for the trust of communication and ICU visitation. However, the final outcome of the patient did not affect the trust in the information conveyed by the physician. Interpretation: This study highlights several drawbacks in the communication strategy during the second surge of coronavirus disease-2019 (COVID-19). The final outcome of the patient was the key decisive factor for the response to most of the questionnaire. Sustained faith in communication by the physician despite the final outcome of the patient, re-emphasizes the need for emotional connection and training for breaking bad news. [ABSTRACT FROM AUTHOR]

Byline: Ajith. Sivadasan, Mathew. Alexander, Sanjith. Aaron, Vivek. Mathew, Shalini. Nair, Karthik. Muthusamy, A. Prabhakar, Rohit. Benjamin, Atif. Shaikh, Gideon. Rynjah Introduction: There is scarce literature regarding the clinical course, [...]

The construction industry is on the lookout for cost-effective structural members that are also environmentally friendly. Built-up cold-formed steel (CFS) sections with minimal thickness can be used to make beams at a lower cost. Plate buckling in CFS beams with thin webs can be avoided by using thick webs, adding stiffeners, or strengthening the web with diagonal rebars. When CFS beams are designed to carry heavy loads, their depth logically increases, resulting in an increase in building floor height. The experimental and numerical investigation of CFS composite beams reinforced with diagonal web rebars is presented in this paper. A total of twelve built-up CFS beams were used for testing, with the first six designed without web encasement and the remaining six designed with web encasement. The first six were constructed with diagonal rebars in the shear and flexure zones, while the other two with diagonal rebars in the shear zone, and the last two without diagonal rebars. The next set of six beams was constructed in the same manner, but with a concrete encasement of the web, and all the beams were then tested. Fly ash, a pozzolanic waste byproduct of thermal power plants, was used as a 40% replacement for cement in making the test specimens. CFS beam failure characteristics, load–deflection behavior, ductility, load–strain relationship, moment–curvature relationship, and lateral stiffness were all investigated. The results of the experimental tests and the nonlinear finite element analysis performed in ANSYS software were found to be in good agreement. It was discovered that CFS beams with fly ash concrete encased webs have twice the moment resisting capacity of plain CFS beams, resulting in a reduction in building floor height. The results also confirmed that the composite CFS beams have high ductility, making them a reliable choice for earthquake-resistant structures. [ABSTRACT FROM AUTHOR]

Background: Gynaecological surgeries refer to surgery on the female reproductive system. Woman may undergo a Gynaecological surgery for different reasons, including; Uterine prolapse, Cancer of the uterus, cervix, or ovaries, Endometriosis, Bleeding, Adenomyosis etc.Gynaecological surgeries includes procedures such as hysterectomy, oopherectomy, salphingectomy, myomectomy, ovarin cystectomy, etc. The Physiotherapy referral is essential in such cases but most of time the patients are not referred for Physiotherapy. Hence the current study was undertaken. Thus the objective is to find out the Effectiveness of Physiotherapy management over quality of life in post-operative Gynaecological patients. Methods: 32 females who underwent Gynecological surgery were taken into the study and divided conveniently into Group A and Group B consisting of 16 females each. Physiotherapy intervention given to Group A includes- Breathing exercises, Coughing techniques, Circulatory exercises, Knee rolling, log rolling, patient made to sit, Abdominal exercises, Pelvic tilting, Getting in and out of the bed, Pelvic floor exercises and mobilization inside the ward, outside the ward and stair climbing where as conventional treatment which includes Breathing exercises and Back care were given to Group B for a period of 5 days. Outcome measures used were VAS (Visual Analog Scale) and ASIS (Abdominal Surgery Impact Scale). Results: There was a significant difference in post test score of VAS (p=0.0001) and ASIS (p=0.0001) in Group A as compared to Group B. Conclusion: This study revealed that physiotherapy intervention performed immediately after Gynecological surgery improves quality of life of the patients and a scheduled exercise program benefits the patient more than conventional Physiotherapy management and it should be emphasized to all the post Gynecological surgery Patients.

Background: Rapid diagnostic tests based on detection of histidine-rich proteins (HRPs) are widely used for malaria diagnosis, but parasites carrying pfhrp deletions can evade detection and are increasing in frequency in some countries. Models aim to predict conditions under which pfhrp2 and/or pfhrp3 deletions will increase, but a key parameter-the fitness cost of deletions-is unknown.Methods: We removed pfhrp2 and/or pfhrp3 from a Malawian parasite clone using gene editing approaches) and measured fitness costs by conducting pairwise competition experiments.Results: We observed significant fitness costs of 0.087 ± 0.008 (1 standard error) per asexual cycle for pfhrp2 deletion and 0.113 ± 0.008 for the pfhrp2/3 double deletion, relative to the unedited progenitor parasite. Selection against deletions is strong and comparable to that resulting from drug resistance mutations.Conclusions: Prior modeling suggested that diagnostic selection may drive increased frequency of pfhrp deletions only when fitness costs are mild. Our experiments show that costs of pfhrp deletions are higher than these thresholds, but modeling and empirical results can be reconciled if the duration of infection is short. These results may inform future modeling to understand why pfhrp2/3 deletions are increasing in some locations (Ethiopia and Eritrea) but not in others (Mekong region). [ABSTRACT FROM AUTHOR]

Byline: Shalini. Nair, Mathew. Joseph Normal saline has been the commonest intravenous fluid used both for resuscitation and as a maintenance fluid in emergency departments, operating rooms and intensive care [...]

To the Editor: Artemisinin resistance (ART-R) in Plasmodium falciparum phenotypes may have evolved independently in various areas of the Greater Mekong Subregion (1,2), prompting the World Health Organization to change [...]

Background: An important factor affecting the outcome of traumatic brain injury (TBI) is the early management of raised intracranial pressure (ICP). Head-of-bed elevation (HBE) is a simple and effective method to reduce ICP and prevent aspiration in head injury. Methods: This audit was carried out in a level one trauma center. All adult TBI patients were included in the study except patients who had relative contraindication to HBE, managed in prone or Trendelenburg position or who were able to be seated themselves. Patients were observed twice daily, to check adherence to HBE. Adequate HBE anglewas referred as an angle of 20 to 30degrees. A digital protractor was used to measure the head-end angle. Following the first audit cycle, after discussion with nursing staff, a bedside checklist was formulated and two postintervention audit cycles were carried out. Results: The first cycle showed that 40.35% of patients had inadequate HBE. Following implementation of the checklist, this percentage dropped to 11.27 and 7.5% in the second and third cycles, respectively. Agitation (p-value=0.038) and Glasgow coma scale at admission (p-value=0.028) were found to be confounders for adherence to HBE. Conclusion: Agitation among mild and moderate TBI patients contributed to noncompliance for HBE. There was an increasing trend in adherence to maintaining adequate HBE following the use of a bedside checklist. Sustainability of improvement was confirmed with third audit cycle. [ABSTRACT FROM AUTHOR]

Simple Summary: Metastatic Spinal Cord Compression (MSCC) is a feared complication in oncology patients due to its potential for severe pain, permanent neurological disability and mechanical instability of the spine. This narrative review, conducted by keyword searches in PubMed and Google Scholar databases, aims to describe the important role of imaging in MSCC diagnosis and treatment. Diagnosis is typically achieved via Magnetic Resonance Imaging (MRI), although Computed Tomography (CT) Myelogram and conventional CT imaging can be performed in certain clinical situations. Metal artifact reduction techniques for MRI and CT are continually being researched to facilitate imaging in MSCC patients with spinal implants. Imaging also has an important role in pre-treatment planning, in-room image-guidance, and post-treatment follow-up for MSCC patients treated with stereotactic body radiotherapy. Recent advances in deep learning tools for image analysis can reduce the time to MSCC diagnosis, enabling earlier treatment for superior functional outcomes. Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes. [ABSTRACT FROM AUTHOR]

Byline: Ramanan. Rajagopal, Shalini. Nair A 47-year old gentleman presented 8 hours after an alleged history of a road traffic accident. At presentation, his pupils were 4 mm and nonreactive [...]

Background We compared intraoperative and postoperative anesthetic parameters between simple (S-single suture) and complex (C-more than one suture) craniosynostosis cases. Materials and Methods Data was collected from a retrospective review of anesthetic and postoperative records of patients who underwent craniosynostosis correction surgery between April 2014 and August 2019. Pearson's chi-square and independent sample t-tests were used for analysis. Results We analyzed data of 98 patients (S-simple craniosynostosis: 40 and C-complex craniosynostosis: 58). Statistically significant differences between simple and complex cases were seen only in the incidence of difficult airway, failed extubation, and requirement of postoperative ventilation. Massive blood loss (S: 23.21 mL/kg; C: 22.71 mL/kg) and difficult airway (S: 2.04%; C: 19.39%) were the most common intraoperative adverse events encountered. Metabolic abnormalities, hemodynamic instability, and hypothermia occurred in few patients. The most common postoperative issue was pyrexia (S: 15.31%; C: 17.35%). Anemia and coagulopathy needing transfusion of blood products and vitamin K injection were seen in a significant number of cases. Three nonsyndromic patients developed seizures. Conclusion The incidence of difficult airway and failed extubation with postoperative ventilation is more frequent following surgery for complex craniosynostosis than simple craniosynostosis. Complications secondary to blood loss and airway issues were the primary cause of morbidity and mortality. A staged approach to surgical management resulted in decreased surgical blood loss among the children with complex craniosynostosis. [ABSTRACT FROM AUTHOR]

Functional status of cerebrospinal fluid (CSF) diversion procedure for hydrocephalus is difficult to assess on several occasions. We report the use of serial ultrasonographic measurement of optic nerve sheath diameter (ONSD) to assess the functional status of CSF diversion procedures in patients with hydrocephalus. In this prospective observational study, ultrasonographic ONSD measurement was performed preoperatively, on postoperative days 1, 3, and 7 (n = 51 at each time point) and at follow-up (n = 31) in patients undergoing ventriculoperitoneal shunt or endoscopic third ventriculostomy for hydrocephalus. Change in ONSD values during first week after CSF diversion procedure and at follow-up were correlated with ventriculoperitoneal shunt/ETV function. ONSD ≥5.5 mm strongly correlated with clinical and imaging features of raised ICP (P < 0.001). Mean ONSD progressively decreased in the postoperative period and was the lowest on postoperative day 7 (P < 0.001) with >95% of patients having ONSD <5.5 mm at that time point. At follow-up (median, 12 months; n = 31), ONSD had further reduced in 78.6% of patients. All 3 patients with shunt dysfunction had an increase in the ONSD value compared with that on postoperative day 7. ONSD measurement on postoperative day 7 after CSF diversion correlates well with early surgical outcome but decreases further in many patients at a follow-up of 12 months. Rise in postoperative day 7 ONSD at follow-up correlates with failure of the CSF diversion procedure. [ABSTRACT FROM AUTHOR]

Background and Aims: To compare the performance characteristics of C-MAC video, McCoy, and Macintosh laryngoscopes in elective cervical spine surgery. The primary objective was to assess the ease of intubation with the three study devices. The secondary objectives were the time to intubation and hemodynamic responses during intubation. Material and Methods : The prospective observational comparative study was conducted in a tertiary care hospital. Adult ASA 1 and 11 patients who underwent elective cervical spine surgery were included in the study. Patients with unstable spine and trauma were excluded. The analysis of variance, Bonferroni test, Chi square test and multiple comparison tests were used to compare the performance characteristics of laryngoscopes. Results: The C-MAC video laryngoscope improved glottis view by improving the modified Cormack–Lehane (CL) score and the percentage of glottis opening (POGO) score compared to McCoy and Macintosh laryngoscopes. The ease of intubation was better with the C-MAC video laryngoscope compared to the McCoy and Macintosh laryngoscopes. The time to intubation was comparable between the three laryngoscopes. The C-MAC video and McCoy laryngoscopes had 100% successful first attempt intubations while it was 90% for the Macintosh laryngoscope. Hemodynamic variables observed during intubation were comparable between the three groups. Conclusion: The use of C-MAC video laryngoscope resulted in better visualization of the glottis and easier tracheal intubation as compared to the Macintosh and McCoy laryngoscopes in cervical spine surgery. Both C-MAC video and McCoy laryngoscopes had 100% successful first attempt intubation. [ABSTRACT FROM AUTHOR]

Byline: Shalini. Nair, Bijesh. Nair, Ajay. Vidyasagar, Mathew. Joseph Background and Aims : The routine management of coagulopathy during surgery involves assessing haemoglobin, prothrombin time (PT), activated partial thromboplastin time [...]

Byline: Ajith. George, Shalini. Nair, Jayanthi. Karthic, Mathew. Joseph Introduction: Deep venous thrombosis (DVT) is thought to be less common in Asians than in Caucasian population. The incidence of DVT [...]