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Wireless communication is significantly influenced by the Mobile Ad Hoc Network (MANET), which consists of nodes like mobile phones, tablets, computers, or other devices that can connect with one another. MANET is a decentralized network that communicates without using any specified infrastructure. The lack of battery power in this multihop network with no infrastructure is problematic. As a result, proper transmission power utilization must be considered. Transmission power significantly impacts the data dissemination of different routing protocols used in this MANET environment. By taking this issue into account, the performance of routing protocols is examined based on different transmission power settings. The packet delivery ratio (PDR), packet loss (PL), jitter, and Dealy all play a role in determining network service quality. This study investigates how transmission power impacts MANET routing protocols’ quality of Service (QoS). The MANET routing protocols investigated in this study include AODV, OLSR, DSDV, and DSR. NS3 is used to create the simulation environment. According to this analysis, AODV outperforms other routing protocols in overall performance.

Actinobacillus pleuropneumoniae is the primary aetiological agent of contagious porcine pleuropneumonia associated with serious economic impact on pig husbandry worldwide. Diagnosis of the disease by existing techniques including isolation and identification of bacteria followed by serotyping, serological techniques, conventional PCR, real-time PCR and LAMP assays are cumbersome, time-consuming, costly and not suitable for rapid field application. A novel isothermal polymerase chain reaction (PSR) technique is standardized for all the reagents, incubation time and incubation temperature against A. pleuropneumoniae. The sensitivity of the assay was determined against various dilutions of purified DNA and total bacterial count. The specificity of the assay was determined against 11 closely related bacterial isolates. The relative sensitivity and specificity were compared with bacterial isolation, conventional PCR and real-time PCR assays. The PSR assay for specific detection was standardized at 64°C for 30 min of incubation in a water bath. The result was visible by the naked eye after centrifugation of the reaction mixture or after incorporation of SYBR Green dye as yellowish-green fluorescence. The technique was found to be 100% specific and equally sensitive with real-time PCR and 10 times more sensitive than conventional PCR. The PSR assay could be applicable in the detection of the organisms in porcine nasal swabs spiked with A. pleuropneumoniae. This is the first-ever report on the development of PSR for specific detection of A. pleuropneumoniae and can be applied for early diagnosis at the field level.

We report the first experimental determination of the collision-energy dependence of the muon transfer rate from the ground state of muonic hydrogen to oxygen at near-thermal energies. A sharp increase by nearly an order of magnitude in the energy range 0 - 70 meV was found that is not observed in other gases. The results set a reliable reference for quantum-mechanical calculations of low-energy processes with exotic atoms, and provide firm ground for the measurement of the hyperfine splitting in muonic hydrogen and the determination of the Zemach radius of the proton by the FAMU collaboration., 30 pages, 10 figures

BACKGROUND Durable palliation of advanced lung cancer is a common objective for radiation oncologists. However, there is no consensus on how to deliver the radiation course. Herein we report our experience of using split course radiotherapy and our assessment of outcomes based on planning from three-dimensional (3D) simulation before each treatment course. METHODS All lung cancer patients from 2006-2020 were identified. Of these, 52 patients received a split course treatment of 50-60 Gy in 18-25 fractions intended to provide durable palliation for disease not amenable to curative therapy. Treatment involved 3D planning with repeat computed tomography (CT) simulation prior to the second course. Survival and symptomatic response were analyzed via chart review. We categorized rapid responders versus non-rapid responders from the initial radiation course based on ≥30% gross tumor volume (GTV) reduction at the second CT simulation. We evaluated the impact of response on overall survival and palliative response. RESULTS Among our cohort treated with split course palliative radiotherapy, 33 (63%) had a rapid response to initial treatment. There was no difference in survival between groups [hazard ratio (HR) =1.30, P=0.47]. There was no significant difference in palliative response rates between rapid and non-rapid responders. On multivariable analysis, only female sex (HR =0.26, P

Symptomatic severe aortic regurgitation (ssAR) is a Class I recommendation for surgical aortic valve replacement (SAVR). We sought to evaluate the practice patterns and drivers of ssAR patients rec...

This article on ‘Micro-machining: An Overview (Part II)’ is in continuation to ‘Micro-machining: An Overview (Part I)’ published in this journal ( Journal of Micromanufacturing). It consists of four parts, namely, electrochemical micro-texturing, electrochemical spark micro-machining, molecular dynamics simulation and sustainability issues of micro-machining processes. Electrochemical micro-texturing (ECMTex) deals with various techniques developed for micro-texturing on different types of workpiece-surfaces, namely, flat, curved and free-form surfaces. Here, basically two categories of techniques have been reviewed, namely, with mask and without mask. It also deals with ‘single point tool micro-texturing’ which turns out to be a single-step technique requiring minimum time, but the accuracy and repeatability obtained after micro-texturing need to be critically analysed. For mass production, one needs to go for sinking kind of ECMTex processes. Electrochemical spark micro-machining (ECSMM) is an interesting hybrid (ECM+EDM) process which can be applied for electrically conducting as well as electrically non-conducting materials. However, the work reported in this article deals only with the electrically non-conducting materials for which this process was initially developed. This process has a lot of potential for theoretical work to be done. In this article, two theories of sparking/discharging have been briefly mentioned: single bubble discharging/sparking and single surface discharging. It also dicusses its applications for different types of electrically non-conducting materials. Molecular dynamics simulation (MDS) of micro-/nano-machining processes is very important, but it is very cumbersome to understand at atomic/molecular scale. In these processes, the material behaviour at micro-/nano-level machining is completely different as compared to bulk-machining (macro-machining) processes. Hence, some fundamentals of MDS have been discussed. It just gives the idea of available techniques, softwares and models for different types of processes. However, there is the need of further research work to be done for clearly understanding the MDS of micro-/nano-machining. In the end, the sustainability of micro-machining issues have been discussed, mainly based on the energy consumption per unit mass of production. It is concluded that the advanced micro-manufacturing processes are highly energy-intensive processes, and they need further studies to be done for making them more suitable from sustainability point of view. At the end of each section, some potential areas of research for enhancing the accuracy and repeatability, and minimising the production time of each process have been discussed.

Purpose: This research paper aims to find out the dimensions of depression in relation to medical and engineering aspirants. Design/Methodology/Approach: The dimensions are recognized with an exploratory factor analysis (EFA). Subsequently, the validity and reliability of the factors are established by confirmatory factor analysis (CFA) using AMOS. Findings: Researchers find out two dimensions of depression – IntrinsicInstability and ExtrinsicInstability. Originality/value: This research introduces a new tool in the context of depression research in relation to medical and engineering aspirants in India. Practical implications: We are very familiar to the suicides by the unsuccessful medical and engineering aspirants in India and somehow the depression is one of the influential factorassociated with it. So, it is the need of the hour to identify the depression level of each aspirant and restore it before any loss.

The purpose of this paper is to carry out an in-depth analysis of the intriguing van Dantzig problem which consists on characterizing the set $\mathbb{D}$ of analytic characteristic functions $\mathcal{F}$ which remains stable by the action of the mapping $V\mathcal{F}(t)=1/\mathcal{F}(it)$, $t\in\mathbb{R}$. % is also a characteristic function. We start by observing that the celebrated Lee-Yang property, appearing in statistical mechanics and quantum field theory, and the Riemann hypothesis can be both rephrased in terms of the van Dantzig problem, and, more specifically, in terms of the set $\mathbb{D}_L \subset \mathbb{D}$ of real-valued characteristic functions that belong to the Laguerre-P\'olya class. Motivated by these facts, we proceed by identifying several non-trivial closure properties of the set $\mathbb{D}$ and $\mathbb{D}_L$. This not only revisits but also, by means of probabilistic techniques, deepens the fascinating studies of the set of even characteristic functions in the Laguerre-P\'olya class carried out by P\'olya, de Bruijn, Lukacs, Newman and more recently by Newman and Wu, among others. We continue by providing a new class of entire functions that belong to the set $\mathbb{D}$ but not necessarily to $\mathbb{D}_L$, offering the first examples outside the set $\mathbb{D}_L$. This class, which is derived from some entire functions introduced by the second author, is in bijection with a subset of continuous negative-definite functions and includes several notable generalized hypergeometric-type functions. Besides identifying the characteristic functions, we also manage to characterize the pair of the corresponding van Dantzig random variables revealing that one of them is infinitely divisible. Finally, we investigate the possibility that the Riemann $\xi$ function belongs to this class.

Introduction: Strategic naps are considered as efficacious means of maintaining performance and reducing the individual’s sleep debt. It can reduce subjective feelings of fatigue and improve performance and alertness. However, literature is scant on assessment of naps and associated cognitive performance in the Indian military aviation scenario. This study is an attempt to assess the nap duration and its objective assessment on gain in performance, if any. Material and Methods: In this cross-sectional observational study, sleep data were collected from 23 aviation personnel in a military flying base using actigraphy device. The actigraphic data were then fed into a software called fatigue avoidance scheduling tool. The nap duration and its effect on cognitive parameters were analyzed. Results: About 65.2% of the participant were found to be Day-Time Habitual Nappers. Of the 50 Naps logged by these participants, 11 (22%) naps were less than 30 min, 14 (28%) were between 30 and 60 min, 15 (30%) were between 60 and 120 min, and only 10 (20%) were above 120 min. Post-nap gain in the effectiveness and other cognitive parameters was found to be different in different cognitive domains. Conclusion: Naps more than 30 min had the optimal efficiency. The nap-induced gain in the task effectiveness and cognitive performance was confirmed. While the performance enhancement was significant for the naps more than 30 min, naps more than 60 min did not have any added advantages.

Renal dysfunction following cardiopulmonary bypass is well recognized. The pathophysiology of renal injury is multifactorial and culmination of the interplay of several pathophysiological mechanism. Cardiac surgery requiring cardiopulmonary bypass (CPB) is being carried out on an extended patient population of different age groups and undergoing complex surgical procedure, and thus it places them at an increased risk of renal impairment. Valve replacement surgery is a major and complex surgical procedure requiring CPB. This study was therefore designed to observe the impact of CPB and short term outcome on patients with reduced estimated Glomerular Filtration Rate (eGFR) (60-89ml/min/1.73m²) after valve replacement surgery. This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardio Vascular Diseases (NICVD) during the period of January 2015 to August 2016. After fulfillment of enrollment criteria 100 patients were studied for the purpose of the study and they were grouped in two, patients with normal eGFR (≥90ml/min/1.73m²) in Group A and patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. A total of 100 patients, 50 in each group were studied for renal function alteration after valve replacement surgery under cardiopulmonary bypass. The incidence of Acute Kidney Injury (AKI) was higher in Group B. Chi-square test was done and p value was 0.011 which is statistically significant. Postoperative blood loss (ml/hr) (p=0.038), duration of Intensive Care Unit (ICU) stay (in hours) (p=0.009), postoperative hospital stay (days) (p=0.014) was significantly higher and postoperative Urine Output (ml/hr) (p=0.001) was significantly lower in patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. Deterioration of renal function is more in patient with eGFR (60-89ml/min/1.73m²) after valve replacement surgery under cardiopulmonary bypass in comparison with patients with eGFR (≥90ml/min/1.73m²).

Built on deep-rooted political and cultural heritage, ‘rice security’ is the foundation of ‘food security’ in Bangladesh. The country has been in production-surplus of rice in the current decade feeding over 165 million people. This on-going ‘selfsufficiency momentum’ would require to maintain to meet increased demand from growing future population. On developmental side, Bangladesh is placed among the three of the world’s fastest growing economies in the years through to 2050. Rice sector would need to match with the pace of this growth. In addition, agriculture sector, that includes rice, is to double the productivity as the government commits to meet the SDG goal 2.3.1. This study addresses those issues through scoping increased rice production and productivity in Bangladesh, developing a plan of work (POW) on translating the scope and designing implementation plans and actions, incorporating efficiency, resilience, stability and sustainability issues, to achieve the POW. The study has used brainstorming, and rigorous analysis to achieve the objectives. The productivity has been explained in terms of yield- and labour-productivity. The developed three-winged ‘doubling rice productivity (DRP)’ framework directs yield enhancement and production accumulation in unexplored spaces (Wing-1); increased adoption of mechanization to impact on labour productivity (Wing-2), and improvements in nutritional quality and rice-based product diversity, and stabilizing the farmgate price (Wing-3). Analyses show, from the baseline figure of 35.29 MT in 2015, rice production in the country can be raised to 46.90 MT in 2030, 54.09 MT in 2040 and 60.85 MT in 2050 with combined contributions of three pillars – yield improvements by enhanced varietal potential (Pillar 1), reduction in existing yield gap (Pillar 2) and production increase by exploring unexplored spaces for rice (Pillar 3) of Wing-1 of the DRP. This production will produce a surplus of 6.50, 10.29 and 13.65 MT in 2030, 2040 and 2050, respectively, over the production target (40.40, 43.80 and 47.20 MT in 2030 and 2050, respectively). Results further reveal that through scale-appropriate mechanization backed up by estimated fair price, labour productivity in rice will be doubled by 2029, meeting the SDG 2.3.1. Good number of released varieties have been identified to have specific nutritional trait, and value adding quality. We have emphasized on much needed actions on demand-driven research for varietal development and field-adoptable management, mechanization for transplanting and harvesting operations, accommodation of rice in unexplored spaces, farmer-based speedy seed multiplication and dissemination system, establishment of commission for agricultural costs and prices, input buffer stock terminals for managing production risk, long-term storage and export of surplus production, and research-publicity-market development for rice-based products through public-private partnership. It is concluded that efficiency, resilience and sustainability around the three wings of DRP in the rice production systems to be ensured to achieve the rice production, productivity and labour use estimates. Bangladesh Rice J. 24 (2): 1-47, 2021

High input-intensive Boro rice cultivation needs substantial agricultural credit for the resource-poor Bangladeshi farmers. An investigation was conducted at Fulbaria upazila of Mymensingh district to assess loan attainment cost from Bangladesh Krishi Bank (BKB) and its utilization pattern; evaluate the effects of credit on Boro cultivation, and identify the major drivers of the agricultural credit programme. For the study, 140 farmers were divided into two groups: those who took a loan from BKB and those who did not. Results revealed that the borrowers had to pay Tk 10.23 for getting a hundred taka loan from BKB most of which was an unofficial cost. More than half of the obtained loan was used for Boro cultivation whereas 21% was used for family consumption and the rest (25%) was used for other purposes such as reimbursement of the previous loan from formal and informal sources, wedding and other income-generating activities including petty business. BKB credit borrowers obtained more benefits through Boro cultivation than non-borrowers. The major strengths of the BKB’s agricultural credit programme were well-established infrastructure, experienced manpower, country-wide network, and lower interest rate. Whereas complex and lengthy institutional procedures, the inevitability of collateral and poor institutional capacity were being revealed as the weaknesses of the programme. Prevalence of brokers or corrupt officials and political influence were identified as the major constraints for the loan acquirement. More advanced research is recommended, with an emphasis on agricultural credit programmes, to ensure their effectiveness. Bangladesh Rice J. 24 (1): 85-95, 2020

Using cross-sectional data obtained through carrying out a sample survey conducted during 2018, we examined the perception of farmers and millers about the paddy and rice procurement system and its feasibility. A probit model was employed to ascertain the factors influencing the likelihood of participating in the procurement system by farmers from two districts of Bangladesh. The results showed that the government procurement system has significant impacts on both the participant farmers and millers. The farmers and millers' net profit was TK 4,205 and TK 3,930 by selling a ton of paddy and cleaned rice, respectively, to the procurement center rather than in the local market. The probit regression analysis revealed nine different factors that significantly influenced farmers' participation in the paddy procurement programme. Results further implied that educated farmers had procurement cards with sufficient system knowledge, residing near the hub with improved road access, and association with political parties get preference in participating in the programme. The findings also indicate that lucrative prices, programme scheduling and good conduct of procurement employees inspire farmers to participate in the programme. The government procurement programme has several drawbacks such as anomalies in selecting farmers, taking extra paddy by the employees, corruption, unsuitable payment system, and procurement capacity. Therefore, the government would be vigilant to ensure that the procurement system will provide farmers with price support. A well-functioning procurement system is crucial for guaranteeing the country's food security by ensuring a fair price for the producers. Finally, the study proposed some policy guidelines based on the findings to establish a sound paddy and/or rice procurement system in Bangladesh. Bangladesh Rice J. 24 (1): 31-46, 2020

This research work investigates the influence of process parameters e.g. feed rate and milling layer depth with tool rotation on various performance criteria e.g. overcut, machining depth, perpendicularity, radius of curvature of the side wall and surface roughness during electrochemical (EC) milling of Ti6Al4V with the indigenously developed setup. In this study, three most accepted multicriteria and decision-making (MCDM) techniques e.g. SAW, TOPSIS and MOORA are utilized for finding out the optimal parametric combination followed by fabrication of different three-dimensional complex features on Ti6Al4V at that optimal parametric combination. This study confirms that internal flushing with tool rotation improves the accuracy of the machined profile due to better removal of sludge from the machining zone. Developed milling setup is able to generate different complex and three- dimensional features on Ti6Al4V with desired accuracy. Using 1[Formula: see text]M of NaNO3 and NaCl mixed electrolyte, at 4.4[Formula: see text]mm/min of feed rate and 0.25[Formula: see text]mm of milling layer depth with tool rotation, best values of width overcut, average depth, side angle, radius of curvature and surface roughness ([Formula: see text] are achieved as 0.666[Formula: see text]mm, 1.538[Formula: see text]mm, 47∘, 2.091[Formula: see text]mm, and 1.462[Formula: see text][Formula: see text]m, respectively.

The geoinformatics platform integrates remotely sensed data and Geographic Information Systems (GIS). It has a vast range of applications. The technique is widely used not only to study the physical aspects of a region but also to analyse the social and economic setup. The objective of this study is to understand the socio-economic setup of Ravangla, which is a small tourist town located in South Sikkim, India. The primary data have been collected from the field survey and analysed using GIS tools. The social indices such as social structure, housing condition, and the condition of basic facilities such as health, education, transport, market, and others have been analysed in the present study. GIS has been used to study the spatial distribution of these social and economic parameters. The technique has also been used to assess the socio-economic vulnerability of the community living in Ravangla. The Composite Vulnerability at the community level has been calculated based on socioeconomic parameters and a vulnerability map has been prepared. Based on the Composite Vulnerability Index, the households in the study area have been classified as Highly, Moderately, and Less Vulnerable. The GIS techniques have been used to amalgamate the socioeconomic components of vulnerability to recognize the most vulnerable households in Ravangla. The study will help planners, policymakers, and administrators to take necessary steps for mitigating socio-economic problems in the study area.

International Conference on Geospatial Science for Digital Earth Observation (GSDEO 2021) The international conference on “Geospatial Science for Digital Earth Observation” (GSDEO) 2021 was successfully held on a virtual platform of Zoom on March 26th and 27th, 2021. The conference was jointly organized by the Indian Society of Remote Sensing (ISRS), Kolkata chapter, and the Department of Geography, School of Basic and Applied Sciences, Adamas University. Due to the non-predictable behaviour of the COVID-19 second wave, which imposed restrictions on organizing offline events, the GSDEO (2021) organizing committee decided to organize the conference online, instead of postponing the event. Remotely sensed data and geographic information systems have been increasingly used together for a vast range of applications, which include land use/land cover mapping, water resource management, weather forecasting, environmental monitoring, agriculture, disaster management, etc. Currently, intensive research is being carried out using remotely sensed data on the geoinformatics platform. New developments have led to dynamic advances in recent years. The objective of the international conference on Geospatial Science for Digital Earth Observation (GSDEO 2021) was to bring the scientists, academicians, and researchers, in the field of geo-environmental sciences on a common platform to exchange ideas and their recent findings related to the latest advances and applications of geospatial science. The call for papers received an enthusiastic response from the academic community, and over 100+ participants from 50+ colleges, universities, and institutions participated in the conference. In total 50+ research papers had been presented through the virtual Zoom conference platform in GSDEO 2021. The conference witnessed the presentation of research papers from diverse applied fields of geospatial sciences, which include the application of geoinformatics in geomorphology, hydrology, urban science, land use planning, climate, and environmental studies. There were four sessions namely, TS 1: Geomorphology and Hydrology, TS 2: Urban Science, TS 3: Social Sustainability and Land Use Planning, and TS 4: Climate and Environment. Each session was further subdivided, into two parts, namely Technical Session 1-A and 1-B. Each sub-session had been designed with one keynote speech and 5 oral presentations. Oral sessions were organized in two parts and offered through live and pre-recorded components based on the preference of the presenters. The presentation session was followed by a live Q&A session. The session chairs moderated the discussions. Similarly, poster sessions were organized in three parts and offered e-poster, live, and pre-recorded components. The best presenter of each sub-session received the best paper award. Dr. Prithvish Nag, Ex-Director of NATMO & Ex Surveyor General of India delivered the inaugural speech, and Dr. P. Chakrabarti, Former Chief Scientist of the DST&B, Govt. of West Bengal delivered a special lecture after the inaugural session. Eight eminent keynote speakers, Prof. S.P. Agarwal from the Indian Institute of Remote Sensing, Prof. Ashis Kumar Paul from Vidyasagar University, Prof. Soumya Kanti Ghosh from the Indian Institute of Technology, Kharagpur, Prof. L. N. Satpati from the University of Calcutta, Prof. R.B. Singh from the University of Delhi, Dr. A.K. Raha, IFS (Retd), Prof. Gerald Mills from the University College Dublin and Prof. Sugata Hazra from Jadavpur University enriched the knowledge of participants in the field of geoinformatics by their informative lectures. The presentations and discussions widely covered the various spectrums of geoinformatics and its application in monitoring natural resources like vegetation mapping, agricultural resource monitoring, forest health assessment, water, and ocean resource management, disaster management, land resource management, water and climate studies, drought vulnerability assessment, groundwater quality monitoring, accretion mapping and the use of geospatial science in studying morphological, hydrological, and other biophysical characteristics of a region etc. Application of geoinformatics in predicting urban expansion, urban climate, disaster management, healthcare accessibility, anthropogenic resource monitoring, spatial-interaction mapping, and, sustainable regional planning were well-discussed topics of the conference. List of Committees, photos are available in the pdf.

Information related to Land use and Land Cover (LULC) change is important for conservation of natural resources and sustainable development of an area. Siliguri is one of the populated metropolitan of West Bengal, India that has witnessed rapid urbanization. The major challenge is to identify the reason and pattern of urbanization due to inadequate and insufficient data in small cities like Siliguri. This paper has mainly assessed the LU & LC change of Siliguri municipality for the period of 1991-2001, 2001-2011 and 2011-2021. The main aim of the study is to determine the pattern and direction of future expansion. Satellite images from Landsat 4-5(1991-2011) and Landsat 8(2021) were used to extract LU & LC map of the municipality. Supervised classification using maximum likelihood classification was used to developed LULC maps. The supervised classification produced good results with overall accuracy of more than 80%. The change of the LULC pattern was obtained using change detection method. Four major classes viz. Vegetation, water body, sand and built-up have been identified. The analysis shows that maximum transformation has happened in the buildup environment from other land surface features.

To analyse and characterise land use-land cover (LULC) change, remote sensing (RS) data and geographic information system (GIS) approaches are required. The landscape metrics are also extensively used to explain the structure and pattern of the spatial landscape. This case study has been conducted in the area of the Bhagirathi-Hugli River banks in West Bengal. The study area’s satellite image data from various periods (1989-2017) were used to analyse the spatiotemporal variation of LULC change. The LULC fragmentation was analysed using a total of six landscape measures. Landscape metrics such as Number of Patches (NP), Largest Patch Index (LPI), Landscape Shape Index (LSI), Mean Shape Index (MSI), Contagion (CONTAG), and Shannon’s Diversity Index were used to determine the changes over four different periods. The main features of land use change were the continuous expansion of built-up area (9.30 km2), vegetation (189.14 km2), and the decrease in agricultural fallow land and water bodies from 1989 to 2017. The landscape pattern in the study area has also changed significantly. The landscape metrics indicate that the studied region had a highly fragmented landscape during the study period. The proposed technique is easy to use and can address more than one metric while selecting the appropriate setting can prove problematic.

Introduction Consultation liaison psychiatrists may be asked to evaluate for capacity when a patient with guardianship refuses life-saving treatment. The team and guardian may turn to the Consultation psychiatrist for guidance if they themselves are uncertain of the patient’s true values or underlying wishes. While these consultation requests may be dismissed as unnecessary, we argue there is merit to clarifying the uncertainties that prompted the consultation. Case An elderly man with diabetes, dementia, and court-appointed guardianship, developed progressive sepsis and required bilateral above-the-knee amputations to prolong his life. When he refused these amputations, the surgery team placed a capacity consultation request, as both the team and guardian were unsure if this refusal reflected his underlying values. Methods We examine relevant literature and judicial precedents to explore the role of values-based discussions with patients legally determined to lack competency. We furthermore collaborate with an Ethics consultant to investigate the underlying reason for placing such a consultation request, which in this case stemmed from the clinical team’s hesitancy to perform the amputations. Conclusion While the Consultation liaison team did not ultimately assess for capacity to refuse the amputations, the team drew upon noncognitive factors to glean insight into the patient’s underlying values. This guided the guardian in applying substituted judgement to determine the approach in the best interest of the patient.

Phlebotomus argentipes is the main vector of visceral leishmaniasis in Bangladesh and is controlled using deltamethrin, a synthetic pyrethroid, through indoor residual spraying (IRS). A mutation at L1014 (leucine at codon 1014) of the voltage-gated sodium channel (VGSC), known as a knockdown resistance (kdr) gene, is thought to be an important pyrethroid resistance mechanism. This study detected mutations at codon 1014, and at codons 1011, 1016, and 1020, which are kdr sites in other insects. The kdr relationship with deltamethrin resistance in P. argentipes from an IRS-targeted site in Bangladesh was also evaluated.Sand flies were collected from Magurjora village, Mymensingh district, Bangladesh in November 2012. A WHO cone bioassay test using deltamethrin was conducted and specimens were grouped as 'live' or 'dead'. After morphological identification, genomic DNA was used to genotype a partial VGSC gene from P. argentipes. The kdr/ pyrethroid resistance relationship was evaluated using Fisher's exact test.Targeted codons were genotyped from 8 'live' and 63 'dead' P. argentipes. All 'live' specimens had mutant alleles (L1014F and L1014S) at codon 1014. The mutant allele rate was 94% for 'live' specimens and 55% for 'dead' specimens. The mutant allele survival odds were higher for the wild-type L1014L allele, and L1014F odds were lower for L1014S. There were no mutations at codons 1011, 1016, and 1020.The L1014 mutations suggested that pyrethroid resistance had appeared in Bangladesh. Further research on kdr mutations in P. argentipes is important for the appropriate IRS.