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The coronavirus disease 2019 (COVID-19) pandemic has been impacting individuals throughout the world. Millions have been affected, and while many have recovered, a growing number of recovered COVID...

BackgroundDifferential exposure to public activities may contribute to stark deprivation-related inequalities in SARS-CoV-2 infection and outcomes but has not been directly investigated. We set out to investigate whether participants in Virus Watch—a large community cohort study based in England and Wales—reported differential exposure to public activities and non-household contacts during the autumn–winter phase of the COVID-19 pandemic according to postcode-level socioeconomic deprivation.MethodsParticipants (n=20 120–25 228 across surveys) reported their daily activities during 3 weekly periods in late November 2020, late December 2020 and mid-February 2021. Deprivation was quantified based on participants’ residential postcode using English or Welsh Index of Multiple Deprivation quintiles. We used Poisson mixed-effect models with robust standard errors to estimate the relationship between deprivation and risk of exposure to public activities during each survey period.ResultsRelative to participants in the least deprived areas, participants in the most deprived areas exhibited elevated risk of exposure to vehicle sharing (adjusted risk ratio (aRR) range across time points: 1.73–8.52), public transport (aRR: 3.13–5.73), work or education outside of the household (aRR: 1.09–1.21), essential shops (aRR: 1.09–1.13) and non-household contacts (aRR: 1.15–1.19) across multiple survey periods.ConclusionDifferential exposure to essential public activities—such as attending workplaces and visiting essential shops—is likely to contribute to inequalities in infection risk and outcomes. Public health interventions to reduce exposure during essential activities and financial and practical support to enable low-paid workers to stay at home during periods of intense transmission may reduce COVID-related inequalities.

Purpose: To construct, apply, and evaluate a multidisciplinary approach in teaching radiology to Canadian medical students. Methods: A multidisciplinary team of radiology and other disciplines experts designed an online 5-session course that was delivered to medical students. The topics of each session were clinical cases involving different systems. The target audience was medical students of Canadian schools. Pretests and post-tests were administered before and after each session respectively. An evaluation survey was distributed at the end of the course to gauge students’ perceptions of this experience. Results: An average of 425 medical students attended the live sessions. For each session, 405 students completed both the pre-tests and post-tests. In general, students scored an average of 56% higher on the post-test than on the pre-test. The final course survey was completed by 469 students. The survey results show that more than 98% of students found the course to meet or exceed their expectations. Over 80% of students agreed that the course increased their interest in radiology and about 81% agree that the topics presented were excellent and clinically important. The ratings in the final survey results also indicate that students increased their confidence in basic radiology skills after completing the course. Conclusions: The implementation of an integrative clinical approach to teaching radiology in a virtual setting is achievable. It provides efficient use of educational resources while being accessible by a large number of students across different medical schools.

PurposeDrawing from the Job Demands–Resources (JD-R) theory, this paper aims to identify unique job demands, job resources and personal resources in the context of Indian women flexpatriates (IWFs) and understand how they manage to perform in their short-term international assignments (SIAs).Design/methodology/approachThis study takes a qualitative approach by conducting in-depth interviews of 15 IWFs.FindingsThematic analysis reveals dual-role workload, emotional demands and diluted importance of the assignments as job demands; opportunity for professional growth, social support and combination of work and leisure as job resources, and building up of self-esteem and self-efficacy as personal resources. Also, the unique Indian family structure, Indian women's desire to have “me-time” and zeal to strengthen their identity emerge as differentiating factors for IWFs that enhance their performance.Practical implicationsIWFs are enthusiastic to take up SIAs as it gives them opportunity to enhance their career and strengthen their identity. In addition to their willingness to travel, advance planning of SIAs and profiling of women based on marital status, family type and children can be done for selection.Social implicationsDespite hailing from paternalistic and male-dominating society and facing familial challenges, IWFs find SIAs liberating, which gives them an opportunity to spend some “me-time,” strengthen their identity and enhance their professional growth.Originality/valueThis is the first qualitative study contextualizing flexpatriation with gender and region by studying Indian women professionals.

PurposeThis study examines how emerging market multinational enterprises operating in the service sector manage knowledge and team members in their overseas subsidiaries and what role expatriates play in their operations.Design/methodology/approachThe authors use a multiple case study design and interview 20 senior managers representing 16 Indian IT firm's subsidiaries in Australia. The onsite-offshore concept and the SECI model are used to explain the knowledge management process.FindingsThe findings show that Indian IT firms mostly transfer knowledge from their headquarters in the parent country to their subsidiaries in the host country using the onsite-offshore model where work is divided and coordinated between team members situated between the two locations. Furthermore, the host country subsidiaries have limited independence in decision-making due to a forward, one-way diffusion of knowledge, thus limiting a two-way interaction between the HQ and the subsidiary for opportunities to create and exchange new knowledge.Originality/valueThe study is one of the few to investigate the onsite-offshore phenomenon in service-based emerging market multinational enterprises.

Purpose Given that the policy is rather comprehensive and detailed, this paper aims to identify some of the key features and discuss the mechanisms by which the benefits of the policy might reach all sections of society. Design/methodology/approach In this paper, we analyse India’s new education policy (NEP) and discuss how it might impact education and employment in India and the neighbourhood. Findings This paper believes that the NEP (2020) is likely to alter the educational landscape of India and make education accessible to all sections of society. In addition, the impact of this bill will be felt in the Indian workplace. Research limitations/implications This paper would urge the policymakers, educationists and corporate leaders to conduct research on the benefits of the NEP in two phases. In the short run, they could study the implementation – in the long run, all three stakeholders should track the changes in the quality of graduates being produced as a result of the new policy. Originality/value This is the first known critique of the NEP (2020) written by five Indian-origin academics and practitioners, offering insight into the policy for scholars and practitioners.

Background Cerebral arterial thromboses or ischemic strokes may be caused by cumulative or independent effects of a variety of risk factors. High factor VIII level is one of those important but less known risk factors for arterial and venous thrombosis. We hereby provide a comprehensive review of the role of high factor VIII levels as a risk factor of arterial thrombosis. Moreover, we present our views on inclusion of factor VIII testing in the etiology workup protocol of young patients with ischemic strokes and their treatment with anticoagulant therapy. Case presentation We illustrate a case of 32-year-old North Indian female patient with Ischemic stroke whose only identifiable risk factor was revealed to be an elevated factor VIII level. She was treated with oral anticoagulant with an uneventful follow-up of 6 months. Conclusions Elevated factor VIII levels have their independent and additive effects in causation and prognosis of arterial strokes. We herein discuss the mechanism of this association, the feasibility and yield of routine testing, appropriate cut-off levels, and further treatment protocol especially in young stroke patients.

In these modern times, the requirement of the energy is not always constant but often periodic. In a hot climatic country like India, a large amount of energy is consumed in cooling application. A heat-exchanger which can store the thermal energy during off-peak hours and use the same energy during peak hours for cooling applications may flatten the periodic energy requirements. Water has a very high value of latent heat of fusion. This latent heat can be utilized to store the thermal energy and use it at a later stage for cooling purposes. The cooling temperature management will be more effective during the phase change process due to the constant fluid temperature. The present study analyzes the heat transfer performance of Ice-Freezing type phase change material (PCM) based heat-exchanger (HEX) during the solidification process. The prediction of solidification time and variation of heat transfer coefficient (HTC) under various configurations is performed. commercialized computational fluid dynamics (CFD) software, Fluent 19 is used to analyze the solidification phenomenon in water. To evaluate the optimum element size, Mesh-independent study is conducted on a single block. Initially, the single block is considered for analyzing the solidification process. The simulations are performed on multiple pipe with varying pitch. The results indicated a drastic change in solidification time as the pitch is decreased. An optimum pitch has to be decided based on the application. The transient variation of the HTC during the solidification process is studied. Initially, during the sensible cooling stage, the HTC decreases at a faster rate. While during the solidification process, the transient variation in HTC is less.

When Virginia expanded Medicaid, many citizens still faced barriers to enrolling in Medicaid. In response, a student-led Medicaid Enrollment Team was created at the HOPES free clinic to provide comprehensive enrollment assistance. In reviewing this program, this paper outlines steps taken that may be used by future enrollment efforts.

Aim: To compare and analyze the clinical adequacy of two topical anesthetic gels, Precaine (8% lidocaine + 0.8% dibucaine) and Precaine B (20% benzocaine) in children before intraoral local anesthetic injections. Materials and Methods: This clinical study included thirty children who needed an inferior alveolar nerve block. They were divided into three groups: Group A: Precaine topical gel group, Group B: Precaine B topical gel Group, Group C: no anesthetic topical gel group (control group). These two effective topical gels were applied before giving intraoral local anesthesia, and afterward, the child's pain response was surveyed utilizing the Wong-Baker Faces Pain Rating Scale. The scores obtained were subjected to statistical analysis. Results: Intergroup comparison showed a significant mean difference between the control group and Precaine group (P > 0.05) as well as Precaine B group (P > 0.05). However, there is no significant difference obtained between Group A and Group B (P < 0.05). Conclusion: It is psychologically and clinically beneficial to apply a topical anesthetic agent before injecting any intraoral anesthesia. In this study, both anesthetic gels showed a nonsignificant difference in reducing inferior alveolar injection pain, but Precaine B shows more promising results than Precaine.

The aim of this research work is to optimize material removal process parameters using CNC turning operation to get the desired value of the surface roughness. With an orthogonal array of L27, the Taguchi approach is used where three levels of each parameter are taken into account, which are cutting speed, feed and nose radius. The experiments were done on EN8D carbon steel and a carbide insert was used for a total run of 27 experiments. Using the surface roughness tester, the roughness values were obtained. Analysis of variance (ANOVA) was executed on Minitab software to recognize the impact of individual machining parameter on surface roughness. Regression equation is prepared from the experimental data and validated by performing random experiment.

Background: Ankle fracture is important in sense that ankle is distal most weight bearing joint and locomotion depends upon stability of ankle mortise. The best option for management of distal fibula fracture remains unclear due to availabity of various implant and different types of fractures. Aim: This study was conducted to know the indication for the two modalities of surgical fixation as this comparative study between close reduction internal fixation and open reduction internal fixation in lower fibula (at syndesmotic level: Weber type B) with lower tibia or medial malleolar fracture. Aim of the study was to perform randomised controlled trial to compare complication and functional modalities in fixation of fibula Materials and Methods: This was a randomised prospective and comparative study for the methods used for management of the lower fibula fracture (Weber type B) done In dept. of orthopaedics, civil hospital, Ahmedabad within time of 1st may 2019 to 1st may 2020 in total of 62 patient in which 39 patient were operated by CRIF and 23 patient operated by ORIF Results: There was significant difference in rate of union as platting was found superior to nailing there were less complication in nailing as compare to platting and better functional score found with nailing. Conclusion: Nailing in lower fibula fracture is a better technique with comminuted ankle fractures that provides better functional outcome with fewer complication than platting. By the syndesmotic point of view there is no such diffrence between crif and orif method for post weight bearing syndesmotic failure. There seems higher chances of ankle stiffness perticularly at syndesmotic level seen after orif method. Keywords: There was no significant difference in syndesmotic diastasis during cyclic loading or at maximal external rotation between the rod and plate groups. Post-cycle external rotation stiffness across the syndesmosis was significantly higher for the locking pla

PurposeThis research examines Indian service managers' perceptions on impact of convergent technologies on their work and resultant organisational performance. The research uses four dimensions – task productivity, task innovation, customer satisfaction and management control – taken together, to investigate the perceived impact of convergent technologies adoption in service organisations context and further examines the resultant organisational performance, based on these dimensions.Design/methodology/approachThe study used partial least squares (PLS) approach to evaluate the measurement model and the structural model. The study was conducted in service industry firms that have made a significant progression towards adopting convergent technologies.FindingsThe results of the study demonstrated higher levels of perceived impact of adoption of convergent technologies on all the four dimensions (i.e. task productivity, task innovation, customer satisfaction and management control). The results of the study also indicate that all the impact dimensions positively influence organisational performance.Research limitations/implicationsThe results of the study suggest that all the impact dimensions positively influence organisation, therefore the service sector managers should be aware about the role of adopting latest convergent technologies so as to enhance the task productivity, innovation, customer satisfaction and management control in their job roles.Practical implicationsThe practical implications of this research are derived on the basis of Future of Work, Labour Market Information Systems, Productivity, Enterprise Development, Enhancing skills of service employees and Employability themes.Originality/valueTo researchers best knowledge is to first study of its kind to evaluate the perceived impact of convergent technologies on organisational performance in Indian context.

Traditional in-person discussion alone is often used for preoperative education in Mohs micrographic surgery (MMS). The appropriate use of more modern education techniques is not well defined in the MMS literature. The authors aim to evaluate patient education techniques for MMS, address education in special populations, and highlight opportunities for improvement. We performed a PubMed literature search with keywords “Mohs” and “education”, “teaching”, “understanding”, “explanation”, “preoperative”, or “consent” with no restriction on publication time frame due to literature scarcity. Teledermatology consultation, MMS videos, 3D models, pamphlets/online materials, and shared medical appointments appear to be effective techniques (GRADE B). Analogies are also anecdotally helpful when integrated into traditional verbal education (GRADE C). The role of preoperative educational phone calls is more controversial (GRADE C). Regardless of the education technique utilized, no singular technique entirely replaces the traditional in-person discussion. Having access to multiple modalities can be beneficial for patients, allowing them options to choose their preferred method(s) of education. MMS is a difficult topic to conceptualize, and further research into educational techniques is needed to provide clear guidelines for Mohs surgeons.

The risk and determinants of HCC in patients with primary biliary cholangitis (PBC) are unclear. We conducted a systematic review and meta-analysis of the incidence of HCC and risk factors associated with HCC risk among patients with PBC. We searched PubMed, EMBASE, MEDLINE, Cochrane databases and reference lists from relevant articles to identify cohort studies that examined incidence of HCC in patients with PBC from inception through November 2019. A total of 29 studies including 22,615 patients met the eligibility criteria. The median cohort size was 292 patients followed for an average of 76 months. The pooled incidence rate for patients with PBC was 4.17 per 1000 patient-years (95% CI 3.17–5.47). On subgroup analysis, the incidence of HCC in patients with PBC cirrhosis was 15.7 per 1000 patient-years (95% CI 8.73–28.24). The HCC incidence rate was 9.82 per 1000 person-years (95% CI 5.92–16.28) in men and 3.82 per 1000 person-years (95% CI 2.85–5.11) in women. Cirrhosis is the strongest risk factor for HCC in patients with PBC. Male gender was also a risk factor. Our meta-analysis supports current recommendations of HCC surveillance in patients with PBC cirrhosis. Further studies are needed to evaluate risk factors in this population.

It is unclear how hypertrophic cardiomyopathy (HCM) affects cardiac metabolic pathways at rest and with exercise. This case–control study compared 15 cases with HCM to 2 control groups without HCM. Metabolomic profiling of 210 metabolites was carried out at rest and at peak exercise. The 50 most discriminant metabolites differentially regulated during exercise were selected using partial least squares discriminant analysis. Pathway enrichment analysis was also performed. At rest, no significant difference was observed in metabolomic profiling of HCM cases as compared to controls. By contrast, there were significant differences in metabolomic profiling in response to exercise (p

The development and kilogram-scale demonstration of an improved process for the synthesis of the epoxyketone warhead of carfilzomib is described. Critical to the success of this process was: (1) de...

Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome. Early diagnosis and treatment are important to minimize the risk of these complications. We systematically reviewed the accuracy of diagnostic tests for first-episode and recurrent DVT of the lower extremities, including proximal compression ultrasonography (US), whole leg US, serial US, and high-sensitivity quantitative D-dimer assays. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 43 studies. For any suspected DVT, the pooled estimates for sensitivity and specificity of proximal compression US were 90.1% (95% confidence interval [CI], 86.5-92.8) and 98.5% (95% CI, 97.6-99.1), respectively. For whole-leg US, pooled estimates were 94.0% (95% CI, 91.3-95.9) and 97.3% (95% CI, 94.8-98.6); for serial US pooled estimates were 97.9% (95% CI, 96.0-98.9) and 99.8% (95% CI, 99.3-99.9). For D-dimer, pooled estimates were 96.1% (95% CI, 92.6-98.0) and 35.7% (95% CI, 29.5-42.4). Recurrent DVT studies were not pooled. Certainty of evidence varied from low to high. This systematic review of current diagnostic tests for DVT of the lower extremities provides accuracy estimates. The tests are evaluated when performed in a stand-alone fashion, and in a diagnostic pathway. The pretest probability of DVT often assessed by a clinical decision rule will influence how, together with sensitivity and specificity estimates, patients will be managed.

Background: Workers differ in their risk of acquiring SARS-CoV-2 infection according to their occupation; however, few studies have been able to control for multiple confounders or investigate the work-related factors that drive differences in occupational risk. Using data from the Virus Watch community cohort study in England and Wales, we set out to estimate the total effect of occupation on SARS-CoV-2 serological status, whether this is mediated by frequency of close contact within the workplace, and how exposure to poorly ventilated workplaces varied across occupations. Methods: We used data from a sub-cohort (n =3761) of adults (≥18) tested for SARS-CoV-2 anti-nucleocapsid antibodies between 01 February-28 April 2021 and responded to a questionnaire about work during the pandemic. Anti-nucleocapsid antibodies were used as a proxy of prior natural infection with COVID-19. We used logistic decomposition to estimate the total and direct effect of occupation and indirect effect of workplace contact frequency on odds of seropositivity, adjusting for age, sex, household income and region. We investigated the relationship between occupation and exposure to poorly-ventilated workplace environments using ordinal logistic regression. Results: Seropositivity was 16.0% (113/707) amongst workers with daily close contact, compared to 12.9% (120/933) for those with intermediate-frequency contact and 9.6% (203/2121) for those with no work-related close contact. Healthcare (OR= 2.14, 95% CI 1.47,3.12), indoor trade, process and plant (2.09, 1.31,3.33), leisure and personal service (1.96, 1.004,3.84), and transport and mobile machine (2.17, 1.12,4.18) workers had elevated total odds of SARS-CoV-2 seropositivity compared to other professional and associate occupations. Frequency of workplace contact accounted for a variable part of the increased odds in different occupational groups (OR range 1.04 [1.0004,1.07] - 1.22 [1.07, 1.38]). Healthcare workers and indoor trades and process plant workers continued to have raised odds of infection after accounting for work-related contact, and also had had greater odds of frequent exposure to poorly-ventilated workplaces (respectively 2.15 [1.66, 2.79] and (1.51, [1.12, 2.04]). Discussion: Marked variations in occupational odds of seropositivity remain after accounting for age, sex, region, and household income. Close contact in the workplace appears to contribute substantially to this variation. Reducing frequency of workplace contact is a critical part of COVID-19 control measures.

This paper examines the effect of home country characteristics on the internationalization of emerging market multinational enterprises (EMNEs). Drawing on the institution-based view (IBV), we argue that institutional, political, and social characteristics will positively relate to the internationalization of EMNEs. Further, drawing on the knowledge-based view (KBV), we also argue that a firm’s knowledge stock (KS) will positively moderate the aforementioned relationship. Our research setting involves the incorporation of primary data collected from Iranian multinational enterprises (MNEs) operating in the food and beverage industry. The results provide support for the hypotheses that home country characteristics positively impact the international growth of EMNEs but this does not lead to their further expansion. Also, supported was the hypothesis that EMNEs' knowledge stock positively moderates the relationship between home country characteristics and their international growth. These findings not only contribute to the current knowledge about the drivers of EMNE’s internationalization but also stress upon the idiosyncratic role of home country institutions and the impact of knowledge-specific capabilities on the internationalization of EMNEs, their international growth, and expansion.

Objective We aimed to assess physicians’ perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs’ listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

With a lack of comprehensive health care systems in resource constrained countries, Global Cardiac Surgery plays a vital role in bridging the gap in access to surgical care. Global Cardiac Surgery relies primarily on voluntary humanitarian multidisciplinary teams whose make up vary but often include medical students. The inclusion of medical students on humanitarian missions has been called into question because of the perceived limited sociocultural competence, risks to patient safety, ethical concerns, diverting focus to medical education over patient care, and financial burden. However, there is growing evidence that for appropriately selected medical students, surgical mission trips can serve as a professional investment by providing them knowledge in global health and surgery and help foster a future career in Global Cardiac Surgery. In order to help develop the next generation of global surgeons, medical students should be adequately trained and encouraged to participate in Global Cardiac Surgery while ensuring their education does not come at a cost to the local population or patient safety.

Background:Respiratory protective equipment recommended in the UK for healthcare workers (HCWs) caring for patients with COVID-19 comprises a fluid-resistant surgical mask (FRSM), except in the context of aerosol generating procedures (AGPs). We previously demonstrated frequent pauci- and asymptomatic severe acute respiratory syndrome coronavirus 2 infection HCWs during the first wave of the COVID-19 pandemic in the UK, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020).Methods:Here, we use observational data and mathematical modelling to analyse infection rates amongst HCWs working on ‘red’ (coronavirus disease 2019, COVID-19) and ‘green’ (non-COVID-19) wards during the second wave of the pandemic, before and after the substitution of filtering face piece 3 (FFP3) respirators for FRSMs.Results:Whilst using FRSMs, HCWs working on red wards faced an approximately 31-fold (and at least fivefold) increased risk of direct, ward-based infection. Conversely, after changing to FFP3 respirators, this risk was significantly reduced (52–100% protection).Conclusions:FFP3 respirators may therefore provide more effective protection than FRSMs for HCWs caring for patients with COVID-19, whether or not AGPs are undertaken.Funding:Wellcome Trust, Medical Research Council, Addenbrooke’s Charitable Trust, NIHR Cambridge Biomedical Research Centre, NHS Blood and Transfusion, UKRI.

BackgroundSARS-CoV-2 vaccines stimulate production of antibodies targeting the spike protein (anti-S). The level of antibodies following vaccination and trajectories of waning may differ between vaccines influencing the level of protection, how soon protection is reduced and, consequently the optimum timing of booster doses.MethodsWe measured SARS-CoV-2 anti-S titre in the context of seronegativity for SARS-CoV-2 anti-Nucleocapsid (anti-N), in samples collected between 1st July and 24th October 2021 in a subset of adults in the Virus Watch community cohort. We compared anti-S levels after BNT162b2 (BioNTech/Pfizer) or ChAdOx1 (AstraZeneca/Oxford) vaccination using time since second dose of vaccination, age, sex and clinical vulnerability to investigate antibody waning. To investigate the use of anti-S levels as a correlate of protection against SARS-CoV-2 infection, we undertook a survival analysis (Kaplan-Meier and Cox) with individuals entering 21 days after their second dose of vaccine, or first antibody test after 1st July (whichever was latest) and exiting with the outcome of SARS-Cov-2 infection or at the end of follow up 24th October 2021. We also undertook a negative test design case-control analysis of infections occurring after the second vaccine dose (breakthrough infections) to determine whether the type of vaccine affected the risk of becoming infected.Results24049 samples from 8858 individuals (5549 who received a second dose of ChAdOx1 and 3205 BNT162b2) who remained anti-N negative were included in the analysis of anti-S waning over time. Three weeks after the second dose of vaccine BNT162b2 mean anti-S levels were 9039 (95%CI: 7946-10905) U/ml and ChadOx1 were 1025 (95%CI: 917-1146) U/ml. For both vaccines, waning anti-S levels followed a log linear decline from three weeks after the second dose of vaccination. At 20 weeks after the second dose of vaccine, the mean anti-S levels were 1521 (95%CI: 1432-1616) U/ml for BNT162b2 and 342 (95%CI: 322-365) U/ml for ChadOx1. We identified 197 breakthrough infections and found a reduced risk of infection post second dose of vaccine for individuals with anti-S levels greater than or equal to 500 U/ml compared to those with levels under 500 U/ml (HR 0.62; 95%CIs:0.44-0.87; p=0.007). Time to reach an anti-S threshold of 500 U/ml was estimated at 96 days for ChAdOx1 and 257 days for BNT162b2. We found an increased risk of a breakthrough infection for those who received the ChAdOx1 compared to those who received BNT162b2 (OR: 1.43, 95% CIs:1.18-1.73, pDiscussionAnti-S levels are substantially higher following the second dose of BNT162b2 compared to ChAdOx1. There is a log linear waning in levels for both vaccines following the second dose. Anti-S levels are an important correlate of protection as demonstrated by those with anti-S levels < 500U/ml following vaccination being at significantly greater risk of subsequent infection. Since anti-S levels are substantially lower in ChAdOx1 than in BNT162b2 and both decline at similar rates we would expect waning immunity to occur earlier in ChAdOx1 compared to BNT162b2. Our results showing an increased risk of breakthrough infections for those who were vaccinated with ChAdOx1 compared to BNT162b2 are in line with this hypothesis. Consistent with our data, national analyses of vaccine effectiveness also suggest that waning of immunity for infection and, to a lesser extent for severe disease, is seen earlier in ChAdOx1 than in BNT162b2. Our data demonstrate the importance of booster doses to maintain protection in the elderly and clinically vulnerable and suggest that these should be prioritised to those who received ChAdOx1 as their primary course.

Background Vaccination intention is vital to the success of any vaccination programme, alongside vaccine availability and access. Public intention to take a COVID-19 vaccine if offered is high in the UK, but evidence of disparities between ethnic, social and age groups has led to concern. Methods Online survey of prospective household community cohort study participants across England and Wales (Virus Watch). Vaccination intention was measured by individual participant responses to ‘Would you accept a COVID-19 vaccine if offered?’, collected in December 2020 and February 2021. Responses to a 13-item questionnaire collected in January 2021 were analysed using factor analysis to investigate psychological influences on vaccination intention. Results Survey response rate was 56% (20,785/36,998) in December 2020 and 53% (20,590/38,727) in February 2021, with 14880 adults reporting across both time points. Of participants reporting across both timepoints, 13,411 (90%) answered ‘Yes’ and 1,469 (10%) responded ‘No’ or ‘Unsure’ in December 2020. Of those answering ‘No’ or ‘Unsure’ in December 2020, 1,266 (86%) subsequently answered ‘Yes’ or ‘Already had a COVID-19 vaccine’ in February 2021. Vaccination intention increased across all ethnic groups and levels of social deprivation. Age was most strongly associated with vaccination intention, with 16–24-year-olds more likely to respond “Unsure” or “No” versus “Yes” than 65-74-year-olds in December 2020 (OR: 4.63, 95%CI: 3.42, 6.27 & OR 7.17 95%CI: 4.26, 12.07 respectively) and February 2021 (OR: 27.92 95%CI: 13.79, 56.51 & OR 17.16 95%CI: 4.12, 71.55). The association between ethnicity and vaccination intention has weakened, but not disappeared, over time. Both vaccine- and illness-related psychological factors were shown to influence vaccination intention. Conclusions Four in five adults (86%) who were reluctant or intending to refuse a COVID-19 vaccine in December 2020 had changed their mind in February 2021 and planned to accept, or had already accepted, a vaccine.

Social media enables medical professionals and authorities to share, disseminate, monitor, and manage health-related information digitally through online communities such as Twitter and Facebook. Simultaneously, artificial intelligence (AI) powered social media offers digital capabilities for organizations to select, screen, detect and predict problems with possible solutions through digital health data. Both the patients and healthcare professionals have benefited from such improvements. However, arising ethical concerns related to the use of AI raised by stakeholders need scrutiny which could help organizations obtain trust, minimize privacy invasion, and eventually facilitate the responsible success of AI-enabled social media operations. This paper examines the impact of responsible AI on businesses using insights from analysis of 25 in-depth interviews of health care professionals. The exploratory analysis conducted revealed that abiding by the responsible AI principles can allow healthcare businesses to better take advantage of the improved effectiveness of their social media marketing initiatives with their users. The analysis is further used to offer research propositions and conclusions, and the contributions and limitations of the study have been discussed.

Background Immune dysregulation is one of the main reasons for mortality and morbidity in coronavirus disease 2019 (COVID-19). Mycobacterium w (Mw) is recently approved for gram-negative sepsis. Moreover, it is also found effective in COVID-19 patients in previous studies. The traditional route of administration for Mw is intradermal, which has a limitation of administering 0.1 mL per injection and local injection site reaction. Intravenous (IV) administration of Mw has not been explored in COVID-19. We report the retrospective analysis of six critically ill COVID-19 patients who received Mw (IV). Patients and methods At baseline, all patients in this case series required O2 supplementation, and their inflammatory biomarkers were elevated. All patients received 0.6 mL Mw (high-dose) in normal saline along with the standard-of-care treatment. Results After Mw administration, gradual improvement in O2 requirement was observed and patients were discharged from the hospital with no mortality. A reduction in mean C-reactive protein (CRP) (51.48–18.52 mg/dL), interleukin-6 (IL-6) (260.22–14.47 pg/mL), and FiO2 (81.67–43.33) was also observed. No side effects were observed with the use of Mw by IV route. Conclusion Use of 0.6 mL Mw by IV route in this case series was associated with decreased O2 supplementation without any side effects in critically ill patients of COVID-19. How to cite this article Patel PS, Patel S, Shah V, Aswani V, Narwaria M. Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19. Indian J Crit Care Med 2021;25(9):1066–1068.

Background: Present study was done with an aim to study the clinical profile and its relation to spirometry and 2D ECHO in COPD patients. Methodology: Sixty COPD patients with anonymous rigorousness attending department of respiratory medicine, G.K. General Hospital Bhuj, were incorporated in the study from 2017 onward. The patients were subjected to spirometry and classified according to GOLD guidelines. Whole history concerning the symptoms, past history, smoking history, occupational history and other linked illnesses were taken and noted in a proforma. Echocardiographic assessments of right ventricular and left ventricular function were done. Results: COPD was more common in males (88.33%) as compared to females (11.66%) because of smoking prevalence high in male patients. COPD patients were having most common chest x-ray finding of Emphysema (75%), followed by increase bronchovascular markings (28.33%), cardiomegaly (6.66%), consolidation or mass (3.33%), calcification (3.33%), reticular pattern (3.33%) and bronchiectasis (3.33%). COPD patient were had mainly common ECG finding of normal (50%), p- pulmonale in (40%), right ventricular hypertrophy in (25%), right axis deviation in (18.33%), RBBB in (6.66%) and AF in (3.33%). Conclusions: Severity of COPD has straight relation connection with occurrence of ECG changes in COPD. In the present study 50% of the patients had normal ECG. LV diastolic dysfunction was present in 38.33% of the patients. As the severity increases, frequency of LV diastolic dysfunction on 2 D and Doppler echocardiography goes on escalating. Keywords: Chronic obstructive pulmonary diseases; Smoking; Spirometry.

PurposeThe purpose of this paper is to examine the control mechanisms used by multinational corporations (MNCs) from emerging economies to manage their subsidiaries in developed countries and their implications for human resource management practices.Design/methodology/approachThe paper draws on data collected through in-depth case studies and interviews with senior subsidiary managers of 12 major Indian information technology (IT) MNCs operating in Australia.FindingsIndian IT MNCs rely heavily on the use of people-centric controls exerted through global staffing practices (via the transfer of parent-country nationals), which, in turn, influence their subsidiary’s discretion over their HR practices. The use of people-centric controls allows Indian IT multinationals to replicate parent-country HRM practices in their Australian subsidiaries in an ethnocentric manner and significantly leverage the people-based competitive advantages from India through short- and long-term expatriate assignments.Research limitations/implicationsThe study investigates control and HRM practices from a single country and a single industry perspective. It provides an insight into the normative means of control in foreign subsidiaries of MNCs and enhances our understanding by explaining the integrated relationship that control mechanisms (and their people-centric components) have with HRM practices including the global staffing approaches and expatriate management practices of emerging MNCs.Practical implicationsIndian MNCs are using their business model to leverage the Australian immigration and skilled visa programme to maintain cost advantages. However, the immigration legislation in developed countries needs to be capable of allowing emerging multinational corporations (EMNCs) to maintain such advantages as developed countries seek to attract foreign direct investment from emerging economies.Originality/valueThe results indicate that the control practices of EMNCs are similar to the controls exerted by MNCs from developed countries. They also show that EMNCs do not adopt a portfolio approach to global staffing, and that the people-centric components of their control have a clear impact on their subsidiaries’ HRM practices.

Selecting an appropriate career is one of the most important decisions and with the increase in the number of career paths and opportunities, making this decision have become quite difficult for the students. According to the survey conducted by the Council of Scientific and Industrial Research's (CSIR), about 40% of students are confused about their career options. This may lead to wrong career selection and then working in a field which was not meant for them, thus reducing the productivity of human resource. Therefore, it is quite important to take a right decision regarding the career at an appropriate age to prevent the consequences that results due to wrong career selection. This system is a web application that would help students studying in high schools to select a course for their career. The system would recommend the student, a career option based on their personality trait, interest and their capacity to take up the course.

Gastroesophageal reflux disease is an extremely prevalent illness in the United States; however, clinicians report that its association with chronic cough is often overlooked and undiagnosed. We used the CERNER Health Facts® database to analyze the statistical prevalence. Our findings indicate that there is a minority of patients who are untreated for this common complaint. We propose considering this on the differential diagnosis and following current treatment guidelines with proton pump inhibitors to effectively treat this complaint.

Chronic pruritus is a complex yet prevalent concern without a gold standard treatment. The mainstay therapy for chronic pruritus includes topical ointments such as corticosteroids, capsaicin, local anesthetics, antihistamines, and immunomodulators. There are many different subtypes of chronic pruritus, and each unique subtype may benefit from specialized treatments. This review article sheds light on the role of psychiatric, analgesic, and antiepileptic medications in chronic pruritus. We believe that further large-scale studies are needed to determine the true effectiveness of these medications in treating chronic pruritus.

To our knowledge,this is the first report of 31 Y F has no family history and usually,patients do not manifest symptoms if they are heterozygous.Individuals heterozygous for C282Y who have a coexisting insult to the liver,associated with the use of medications,may present with overt manifestations of iron overload.

BackgroundSome evidence suggests that individuals may change adherence to public health policies aimed at reducing contact, transmission and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination. In this study, we aim to estimate the rate of change in average daily travel distance from a participant’s registered address before and after SARS-CoV-2 vaccination.MethodParticipants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants and vaccination status was collected from January 2021 onwards. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute towards our tracker sub-cohort which uses the Global Positioning System (GPS) to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose.ResultsWe analysed the daily travel distance of 228 vaccinated adults. Between 157 days prior to vaccination until the day before vaccination, the median daily travel distance travelled was 8.9km (IQR: 3.50km, 24.17km). Between the day of vaccination and 100 days after vaccination, the median daily travel distance travelled was 10.30km (IQR: 4.11, 27.53km). Between 157 days prior to vaccination and the vaccination date, there was a daily median decrease in mobility of 40m (95%CI: −51m, −31m, p-value ConclusionsOur study demonstrates the feasibility of collecting high volume geolocation data as part of research projects, and the utility of these for understanding public health issues. Our results are consistent with both an increase and decrease in movement after vaccination and suggest that, amongst Virus Watch participants, any changes in movement distances post-vaccination are small.

The Coronavirus outbreak globally has changed the medical system and also led to a shortage of medical facilities in both developing and underdeveloped countries. The COVID19 disease, being novel in nature along with high infectivity and frequent mutational rate, has been termed to be fatal across the globe. The advent of infection by SARS-CoV-2 has brought a myriad of secondary complications and comorbidities resulting in additional challenges to the health care system induced by novel therapeutic procedures. The emerging variant with respect to the Indian subcontinent and the associated genetic mutations have worsened the situation at hand. Proper clinical management along with epidemiological studies and clinical presentations in scientific studies and trials is necessary in order to combat the simultaneous waves of emerging strains. This article summarizes three of the major fungal outbreaks in India namely mucormycosis, candidiasis and aspergillosis, and elaborates their subtypes, pathogenesis, symptoms and treatment and detection techniques. A detail of future therapeutics under consideration are also elaborated along with a general hypothesis on how COVID19 is related to immunological advances leading to major widespread fungal infection in the country. The factors that contribute in promoting virus proliferation and invasive fungal infections include cell-mediated immunity, associated immunocompromised conditions and treatment protocols that slows down immune mechanisms. To better comprehend a fungal or bacterial outbreak, it is very important to conduct audits mediated through multicenter national and state research teams for recognizing patterns and studying current cases of fungal infection in both healthy and comorbid groups of COVID19 patients.

Manipulation of a large amount of data becomes a very tedious task. Hence, the authors took the approach of memory networks for the implementation of the chatbot. Traditionally, the LSTM model was used to implement chatbots and QA systems. But the LSTM failed to store relevant information when given a longer information set. On the contrary, the memory networks have an additional memory component with it. This can help in storing long information for further use which is greatly advantageous for the QA and chatbot systems as compared to LSTM. The authors trained and tested their model over Facebook's bAbi dataset which consists of several tasks and has questions regarding each task to retrieve the accuracy of the model. On the pedestal of that dataset, they have presented the accuracy for every task in their study with memory networks.