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The increasing use of Automatic Dependent Surveillance-Broadcast (ADS-B) technology in flight control systems has created many serious concerns.These weaknesses threaten the security and safety of our aviation industry. Therefore, to enhance aviation control security and better deal with these problems, this research focuses on developing a strong ADS-B injection detection system. It combines XGBoost and Random Forest with Logistic Regression in an Ensemble Learning Meta-Learning Model to identify ADS-B injection risks and categorise them. Ensemble methods, which combine several models can increase the detection accuracy and robustness of the model used to identify the threat. In addition, Explainable AI (XAI) methods are employed to enhance the process of explaining how the model reaches its decisions and building trust in aviation security systems. The system’s training, testing, and evaluation are conducted with ADS-B data. This result indicates that the Stacked Random Forest and XGBoost with Logistic Regression Meta-Learner with 99.60% accuracy, along with good recall rates (99.49%) and precision (99.41%). Also, aviation control authorities are reassured by the model’s transparent and applicable decision logic through the application of XAI techniques. This research contributes to enhanced aviation security by proposing a new, highly accurate ADS-B injection detection system with explainable outcomes. A strategy like this can help flight control systems maintain integrity amidst an ever-digitising aviation reality.

Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-centre prospective randomised and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

IntroductionThere is a lack of both data and, more significantly, computational analyses of the linguistic behavior near an individual's final moments of life. The present study is aimed to reduce human bias and save time in psycholinguistic studies by providing data-backed insights.MethodsA novel machine learning based pipeline proposed, using elements of semantic similarity (BERT and transformers) and emotion extraction in collaboration, to analyze the final statements of death row inmates to understand the consistency in their verbal expression moments before their death. A new method of analysis was proposed in this study to explore the notions inherent in the statements. A large database of 466 final statements from death row inmates in Texas was utilized in this study. Manual notion analysis was validated by a computational method of notion inferencing.ResultsBasic emotions of Anger and Fear majorly dominated the statements, constituting 54% of the whole, while 21% of all statements were of emotional states of Happiness and Serenity.DiscussionThe outcomes of this study are expected to contribute to psychological analyses of humans, moments before death, and provide insights to criminology researchers to formulate better strategies of rehabilitation and debate the death penalty.

Background:. Effective operating theater (OT) communication and teamwork are essential to optimal surgical outcomes. We mapped the OT team dynamics and infection control practices using visual methods to guide reflexive feedback and optimize perioperative practices. Methods:. Data were gathered from adult gastrointestinal surgical teams at a tertiary hospital in India using observations, sociograms (communication mapping tool), and focus group discussions (FGDs). Our methods aimed to map team communication, roles and responsibilities in infection-related practices, and door openings. Qualitative data were thematically analyzed. Quantitative data were analyzed using descriptive statistics. Results:. Data were gathered from 10 surgical procedures (over 51 hours) using 16 sociograms, 15 traffic flow maps, and 3 FGDs. Senior surgeons directly influence team hierarchies, dynamics, and communication. While the surgeons, anesthetic residents, and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating activity among role players across hierarchies. Failing to provide the scrub nurse with complete details of the planned surgery leads to multiple door openings to fetch equipment and disposables. Traffic flow observed in 15-minute intervals corresponds to a mean frequency of 56 door openings per hour (min: 16; max: 108), with implications for infection control. Implementing the World Health Organization surgical safety checklist was inconsistent across pathways and does not match reported compliance data. Conclusions:. Human factors research is important in optimizing surgical teamwork. Using visual methods to provide feedback to perioperative teams on their communication patterns and behaviors, provided an opportunity for contextualized enhancement of infection prevention and control practices.

Summary: Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in patients receiving mechanical ventilation in India. Surveillance of VAP is essential to implement data-based preventive measures. Implementation of ventilator-associated events (VAE) criteria for surveillance has major constraints for low resource settings, which can lead to significant underreporting. Surveillance of VAP using common protocols in a large network of hospitals would give meaningful estimates of the burden of VAP in low resource settings. This study leverages a previously established healthcare-associated infections (HAI) surveillance network to develop and test a modified VAP definition adjusted for Indian settings. Methods: In this observational pilot study, thirteen hospitals from the existing HAI surveillance network were selected for developing and testing a modified VAP definition between February 2021 and April 2023. The criteria used for diagnosing VAP were adapted from the CDC’s Pediatric VAP definition and modified to cater to the needs of Indian hospitals. Designated nurses recorded each VAP event in a case report form (CRF) and also collected denominator data. The data was entered into an indigenously developed database for validation and analysis. At the time of data analysis, a questionnaire was sent to sites to get feedback on the performance of the modified VAP definitions. Findings: Out of 133,445 patient days and 40,533 ventilator days, 261 VAP events were recorded, with an overall VAP rate of 6.4 per 1000 ventilator days and a device utilization ratio (DUR) of 0.3. A total of 344 organisms were reported from the VAP events. Of these, Acinetobacter spp (29.6%, 102) was the most frequent, followed by Klebsiella spp (26.7%, 92). Isolates of Acinetobacter spp (98%) and Enterobacterales (85.5%) showed very high resistance against Carbapenem. Colistin resistance was observed in 6% of Enterobacterales and 3.2% of Acinetobacter spp. Interpretation: Data from this pilot study needs to validated in the larger Indian HAI surveillance network so that it can help in wider implementation of this protocol in order to assess its applicability p VAP across India. Funding: This work was supported by a grant received from the Indian Council of Medical Research (code I-1203).

Across social structures within society, including healthcare, power relations manifest according to gender, socioeconomic status, race, ethnicity, and class influencing infection related healthcare access and health providing-behaviours. Therefore, accounting for sociocultural drivers, including gender, race, and class, and their influence on economic status can improve healthcare access and health-providing behaviours in infection prevention and control (IPC) as well as antibiotic use, which in turn helps mitigate the spread of antimicrobial resistance (AMR). This Wellcome funded research will investigate how and why the social determinants of health and economic status influence how people seek, experience, and provide healthcare for suspected or proven (bacterial) infections and how these factors influence antibiotic prescribing and use in South Africa (upper middle-income country) and India (lower middle-income country). The aim of this body of work is to, (1) define and estimate the sociocultural and economic drivers for AMR in different resource settings, (2) design, implement and evaluate context-sensitive IPC and antimicrobial stewardship (AMS) interventions, and (3) inform policy and strategy for AMR mitigation. The population will be healthcare workers (HCWs), patients, and their carers across acute medical and surgical pathways where IPC and antibiotic-related healthcare access and health-providing behaviours will be studied. Qualitative methods will include ethnographic research, semi-structured in-depth interviews, and focus groups with healthcare providers, patients and carers. Quantitative analysis of bedside observational data from hospitals and population level data on antibiotic use will study the various predictors of AMR using bivariable and multivariable regression analyses. The research will provide high-quality evidence on how social determinants intersect with health, social well-being, and vulnerability in IPC practices and antibiotic use. Using this knowledge we will: 1) design, implement, and measure effects of interventions accounting for these factors; 2) provide a toolkit for advocacy for actors in AMR, and healthcare to assist them to promote dialogue, including policy dialogue on this issue. This work directly benefits the target population and informs healthcare services and practice across the participating countries with potential for wider translation. The setting will be hospitals in South Africa (middle-income country) and India (lower middle-income country). The population will be healthcare workers (HCWs), patients, and their carers across acute medical and surgical pathways where IPC and antibiotic-related health-seeking and health-providing behaviours will be studied. These populations represent communities most affected by infections and AMR because existing interventions do not address a) differences in how surgical versus medical teams manage infections; b) the role of the wider social network of individuals on their decision-making, c) intersection of the social determinants of health including race, gender, socioeconomic deprivation with AMR.

Background: Pfizer in the USA has pioneered an orally active drug called Nirmatrelvir (PF-07321332) targeting the main protease (Mpro) protein of SARS-CoV-2. However, the current scenario demands additional scaffolds with greater potency and binding affinity. Methods: Various computational techniques were employed to detect the new scaffold in comparison to Mpro. These techniques included shape-based screening, molecular docking, molecular dynamic simulation (MDS), and ADMET studies. The query molecule for the shape-based screening in the ZINC database was PF-07321332. In docking investigations, every screened molecule was assessed for binding mode analysis. The binding strength of the top 10 screened compounds was further examined using the Prime/MMGBSA, Glimpse, and KDeep tools. Only best four of the screened molecules were chosen for stability assessments within Mpro's active site using Gromacs for MDS studies. To validate the Gromacs MDS results, all of these screened molecules were subsequently processed in Desmond software for triplicate MDS investigations (per complex). Significant findings: Through analysis involving RMSD, RMSF, H-bonding, and the radius of gyration, it was observed that during both MDS studies, the molecules ZINC000073548482, ZINC000036121206, and ZINC000064468475 displayed minimal fluctuations while exhibiting higher binding free energy against Mpro. This suggests that these molecules showcased exceptional stability within Mpro's active site throughout both MDS processes when compared to the reference (6W63). Consequently, these chemically varied screened molecules (ZINC000073548482, ZINC000036121206, and ZINC000064468475) could potentially serve as novel, diverse shape similar scaffolds against Mpro, previously unreported against SARS-CoV-2. However, these claims require experimental validation. The multiple screening methods with both MDS tools found valuable to find the novel scaffolds against Mpro. These scaffolds hold promise for furthering the development of innovative and refined therapeutics targeting Mpro in SARS-CoV-2.

Introduction: Insufficient training in antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in the pharmacy curricula limits pharmacists’ participation in AMS activities in India. We explored the potential impact of an AMR curriculum implemented as part of a research project in one of the pharmacy colleges in Kerala, India. Methods: Data were collected using documentary analysis (minutes of meetings and the AMR curriculum developed) and semi-structured qualitative interviews with key informants face-to-face or via the Zoom platform at the participant's convenience. Anonymized interview transcripts were thematically analyzed aided by NVivo 12 software. Results: We interviewed faculty (n = 4), clinical pharmacists (n = 3), and students (n = 6) involved in the design, implementation, and use of the new curriculum. The development and implementation of the new curriculum was conducted through strategically planned and established methodology with equal involvement from the pharmacy college and the research project team. Challenges in this process included a lack of human resources to take classes, time, limited interactions, and motivation of students during the online classes. Despite this, students who attended the classes agreed that the curriculum introduced them to AMS and AMR concepts which helped them during their clinical postings. They agreed that it would be beneficial if a similar curriculum was implemented in other pharmacy colleges. Conclusion: Learnings from this study would be beneficial for other pharmacy colleges to implement a similar AMR curriculum for training pharmacy students to take key roles in AMS, especially in countries like India where postgraduate training for pharmacists remains limited.

This study aimed to compare whether Bispectral Index (BIS) reduces the consumption of the anaesthetic drug and improves recovery time in coronary artery-bypass grafting off-pump (CABG-OP) surgery without awareness during surgery (ADS). The study was a single centre, prospective, randomised, and double-blind comparative research on ASA 3 patients booked for elective CABG-OP operation under general anaesthesia (GA). Patients received either propofol or isoflurane anaesthesia, and their consumption was calculated and compared. The conventional groups CPG-1 and CIG-3 received propofol and isoflurane, and haemodynamic parameters (± 20% of initial values) were considered for anaesthesia. The groups BPG-2 and BIG-4 received propofol and isoflurane, and BIS (value 50±5) was used to maintain anaesthesia. In addition, haemodynamic parameters, awakening conditions, length of intubation, hospital stay and drug utilisation were recorded. To explicit ADS, patients were interviewed 24 hours after extubation. The quantity of propofol used was 178 ± 11 ml in CPG-1 and 117 ± 6 ml in BPG-2, with a 34.26% reduction with BIS. The isoflurane used was 39 ± 8 ml in CIG-3 and 25± 6ml in BIG-4, with a 35.89% reduction in isoflurane requirement. This difference was statistically significantly low with BIS monitored anaesthesia compared to conventional anaesthesia. The length of intubation was 2.2 ±1.27 and 2.3 ±1.49 hours in groups BPG-2 and BIG-4, respectively (p

Abstract Renal disorders are an emerging global public health issue with a higher growth rate despite progress in supportive therapies. In order to find more promising treatments to stimulate renal repair, stem cell-based technology has been proposed as a potentially therapeutic option. The self-renewal and proliferative nature of stem cells raised the hope to fight against various diseases. Similarly, it opens a new path for the treatment and repair of damaged renal cells. This review focuses on the types of renal diseases; acute and chronic kidney disease—their statistical data, and the conventional drugs used for treatment. It includes the possible stem cell therapy mechanisms involved and outcomes recorded so far, the limitations of using these regenerative medicines, and the progressive improvement in stem cell therapy by adopting approaches like PiggyBac, Sleeping Beauty, and the Sendai virus. Specifically, about the paracrine activities of amniotic fluid stem cells, renal stem cells, embryonic stem cells, mesenchymal stem cell, induced pluripotent stem cells as well as other stem cells.

Abstract Objective The irrational use of antibiotics is a leading contributor to antibiotic resistance. Antibiotic stewardship (AS) interventions predominantly focus on prescribers. This study investigated the influence and participation of inpatients in infection‐related care, including antibiotic decision‐making, within and across two tertiary hospitals in South Africa (Cape Town) and India (Kerala). Methods Through ethnographic enquiry of clinical practice in surgical pathways, including direct nonparticipant observation of clinical practices, healthcare worker (HCW), patient and carer interactions in surgical ward rounds and face‐to‐face interviews with participants (HCWs and patients), we sought to capture the implicit and explicit influence that patients and carers have in infection‐related care. Field notes and interview transcripts were thematically coded, aided by NVivo 12® Pro software. Results Whilst observational data revealed the nuanced roles that patients/carers play in antibiotic decision‐making, HCWs did not recognize these roles. Patients and carers, though invested in patient care, are not routinely involved, nor are they aware of the opportunities for engagement in infection‐related decision‐making. Patients associated clinical improvement with antibiotic use and did not consider hospitalization to be associated with infection acquisition or transmission, highlighting a lack of understanding of the threat of infection and antibiotic resistance. Patients' economic and cultural positionalities may influence their infection‐related behaviours. In the study site in India, cultural norms mean that carers play widespread but unrecognized roles in inpatient care, participating in infection prevention activities. Conclusion For patients to have a valuable role in AS and make informed decisions regarding their infection‐related care, a mutual understanding of their role in this process among HCWs and patients is crucial. The observed differences between the two study sites indicate the critical need for understanding and addressing the contextual drivers that impact effective patient‐centred healthcare delivery. Patient or Public Contribution Ethnographic observations and interviews conducted in this study involved patients as participants. Patients were recruited for interviews after obtaining signed informed consent forms. Patients' identities were completely anonymized when presenting the study findings.

Introduction: Proximal Interphalangeal (PIP) Joint fracture dislocation commonly observed to involve one or both the condyles of proximal phalanx or base of middle phalanx. Clinical aspects of PIP joint fracture dislocation typically include pain, swelling, and restricted movements over the site of the lesion. Achieving functional and painless range of motion at the PIP joint is a reasonable outcome. The ideal goal for treating these comminuted intra-articular fractures of the PIP joint is to achieve anatomical reduction and stable fixation of the fracture fragments combined with traction followed by early mobilization to prevent joint stiffness. Thereby, the purpose of this study is to evaluate the effectiveness of dynamic external traction systems to allow both reduction of fracture fragments by capsule-ligamentotaxis and early mobilization. Materials and Methods: A total of thirty patients with PIP joint fracture dislocation who were operated with a dynamic external traction system were assessed as a part of the study between the period of December 2019 and July 2021. All the patients included in the study showed a PIP joint fracture dislocation on anteroposterior and lateral radiographs of the 2nd, 3rd, 4th, or 5th phalanx. All patients were operated for PIP joint fracture dislocation with dynamic external traction system under general anesthesia or regional block under fluoroscopy guidance and assessed for functional outcome postoperatively according to Ishida scoring system. Results: According to Ishida scoring system, our study observed 19 (63.33%) cases with excellent outcome, 6 (20%) cases with good, 4 (13.33%) cases with fair, and 1 (3.33%) case with poor outcome compared to a study conducted by Ishida et al., which observed 9 (39.13%) cases with excellent outcome, 6 (26.08%) with good, and 6 (26.08%) with fair outcomes each and 2 (0.08%) cases with poor outcome. Conclusion: In this prospective study, we have concluded that the dynamic distraction external fixation of PIP joint fracture dislocation is a good method for obtaining early rehabilitation of the patient with minimal complications. The technique ensures an anatomic reduction, stable fixation, good union, and early mobilization with good and fast recovery. However, this is a small study and requires a larger sample size for definitive conclusion.

Background: The objective of the study was to use docking and pharmacological research to explore phytochemicals as therapeutic candidates for the treatment of type 2 Diabetes Mellitus. Methods: The 100 plant compounds for the study were selected after a thorough review of the most recent literature using PubMed and Google Scholar. Three-dimensional structure in Structure-Data File Format of all phytochemicals was downloaded and collected from the PubChem platform. In parallel, the three-dimensional structure of the target protein dipeptidyl peptidase-4 in Protein Data Bank (PDB) format was obtained from the website of the Research Collaboratory for Structural Bioinformatics-PDB. AutoDock Vina software was used for the docking purpose. SwissADME and the admetSAR web server were used to further examine the top docked compounds for the pharmacological investigation. Results: Out of 100 phytochemicals, only 15 have shown better or comparable binding affinity above the benchmark medication, sitagliptin (−7.9 kcal/mol). All of these compounds were assessed to determine their viability as potential drugs by predicting their Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) properties. Two of these phytochemicals have proven their potential as medication candidates by passing the ADMET requirements. Conclusions: In silico studies help explore and find drug candidates among the enormous pool of phytochemicals and narrow down the screening process, saving time and money on experiments. In vitro and in vivo testing can be used in the future to further validate drug candidature.

Abstract Introduction Postoperative infections represent a significant burden of disease, demanding antibiotic prescriptions, and are contributing to antimicrobial resistance. The burden of infection as a surgical complication is greater in low- and middle-income countries (LMICs). We report the protocol of a pilot study for the co-design, implementation and evaluation of two infection prevention and control (IPC) and antimicrobial stewardship (AMS) interventions across the surgical pathway in a teaching hospital in India. Methods and analysis The two interventions developed following in-depth qualitative enquiry are (i) surveillance and feedback of postoperative infections to optimise the use of antibiotics in two surgical departments (gastrointestinal and cardiovascular and thoracic surgery) and (ii) raising awareness amongst patients, carers and members of public about IPC and AMS. We will conduct a prospective study, formatively evaluating the implementation process of delivering the two co-designed interventions using implementation science frameworks. The study will systematically assess the context of intervention delivery, so that implementation support for the interventions may be adapted to the needs of stakeholders throughout the study. Analysis of implementation logs and interviews with stakeholders upon completion of the implementation period, will offer insights into the perceived acceptability, appropriateness, feasibility and sustainability of the interventions and their implementation support. Implementation costs will be captured descriptively. Feasibility of clinical data collection to investigate effectiveness of interventions will also be assessed for a future larger study. Thematic framework analysis and descriptive statistics will be used to report the qualitative and quantitative data, respectively. Strengths and limitations of this study • The paired interventions have been co-designed from their inception with involvement of stakeholders at different stages in the surgical pathway. • Simultaneous evaluation of implementation and clinical outcomes will inform the development of a future larger study to enable/assess the scalability of interventions • The study offers a novel combination of implementation theory-informed, stakeholder-driven and clinically relevant evaluation, carried out in the context of a middle-income country hospital. • The project may not be applicable to every low-resource setting and surgical context due to differences in healthcare systems and cultures. However, the application of implementation science concepts may facilitate transferability and adaptation to other settings.

Objectives: We investigated the roles of patient carers in infection-related care on surgical wards in a South Indian hospital from the perspective of healthcare workers (HCWs), patients, and their carers. Methods: Ethnographic study included ward-round observations (138 hours) and face-to-face interviews (44 HCWs, 6 patients/carers). Data (field notes, interview transcripts) were coded in NVivo 12 and thematically analyzed. Data collection and analysis were iterative, recursive, and continued until thematic saturation. Results: Carers have important, unrecognized roles. At the study site, institutional expectations are formalized in policies, demanding a carer to always accompany in-patients. Such intense presence embeds families in the patient care environment, as demonstrated by their high engagement in direct personal (bathing patients) and clinical care (wound care). Carers actively participate in discussions on patient progress with HCWs, including therapeutic options. There is a misalignment between how carers are positioned by the organization (through policy mandates, institutional practices, and HCWs expectations), and the role that they play in practice, resulting in their role, though indispensable, remaining unrecognized. Conclusion: Current models of patient and carer involvement in infection prevention and control are poorly aligned with sociocultural and contextual aspects of care. Culture-sensitive infection prevention and control policies which embrace the roles that carers play are urgently needed.

The posterior approach to the humerus is one of the most common approaches used for osteosynthesis and exploration of the radial nerve. The radial nerve anomalies even though rare are a possibility that the operating surgeon should be aware of during radial nerve exploration. A 42-year-old female presented with closed shaft of humerus fracture. The plan was to expose fracture site using a routine posterior approach and fix it with a dynamic compression plate but to our surprise found a trifurcation of radial nerve in the spiral groove. We describe a rare anomaly of trifurcation of radial nerve in the spiral groove. The nerves were protected, and the fracture was reduced and fixed with a dynamic compression plate.

This study aims to analyze the market share of four leading mobile phone companies in the context of their spending on R&D and the number of filed patents. The study aims to identify whether the companies that invest the most in R&D and file more patents have a competitive edge and increased market share compared to others. The adoption and advancement of technologies throughout the documented history of humankind have revealed how employing specific devices has cultivated the power for people and society to communicate. Moreover, innovations in travelling have increased prospects for real-time communication, and innovations in virtual real-time communication like mobile phones and the internet have become a part of everyday life. Following innovations, many companies emerged from nowhere with unique mobile phone devices and continued the business. But, few of them were wiped out from the market because their mobile phone offering was inferior to other competitors. This paper explores the innovation journey of mobile phone companies. In addition, it focuses on four leading brand names and corresponding success failures as well as the role of R&D expense and patents regarding innovations. Usually, innovation is considered as the engine of economic growth that serves customers better products and services and stays relevant in the market. Measuring innovation is not easy, but focusing on R&D and the quantifiable patent indicates that individual companies consistently serve customers with newer and better products.

Purpose – A qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could influence vaccination-related behaviors and their utilization. This study aims to document the perceptions of caretakers, community members and healthcare service providers related to childhood vaccination practices in slums under the national immunization program (NIP) of India. Design/methodology/approach – This was a qualitative community-based cross-sectional study. Focus group discussions with caretakers, community members and healthcare service providers were used to build a holistic, detailed description and analysis of the factors associated with childhood vaccination practices within its real-world context. Findings – Lack of awareness, fear of adverse events following immunization, inappropriate timing of vaccination sessions, loss of daily earnings, migration, lack of good behavior of health staffs, shortage of logistics and vaccines, limited resources and infrastructures and high expectations of beneficiaries were some of the vital barriers impacting vaccination practices in slums. Research limitations/implications – Though this study provides significant good information on the indicators that can be considered to improve the vaccination practices in any slum settings, it has is also a limitations too due to its setting. Therefore, one needs to be cautious while generalizing these results to other settings like rural. In addition, Though we believe that these strategies could be useful in any setting, it is also important to tailor these observations them as per the need of the society and the population. Also, this is a self-reported qualitative study and therefore the perspectives reported in this study need to be taken with caution. Further, low vaccination, poor awareness, compromised healthcare services, high expectations could be considered as a stigma/fear among the responders and therefore there is always a chance of underreporting. Thus, it would be important in future to conduct a study involving a broader group of people in society and to establish factors associated with the vaccination coverage. that can help in improvement of vaccination. Originality/value – Initiatives such as regular interactions at different levels, effective communication including reminders, behavior interventions, the continued supply of vaccines and logistics, additional resources for the vaccination program, incentives and recognition, extended sessions and people-friendly healthcare delivery system could be helpful to strengthen the routine vaccination practices in slums.

Summary: At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs. Although there have been regional and global analyses of NAPs from a One Health and policy perspective, a global assessment of the NAP objectives targeting antimicrobial use in human populations is needed. In this Health Policy, we report a systematic evidence synthesis of existing NAPs that are aimed at tackling AMR in human populations. We find marked gaps and variability in maturity of NAP development and operationalisation across the domains of: (1) policy and strategic planning; (2) medicines management and prescribing systems; (3) technology for optimised antimicrobial prescribing; (4) context, culture, and behaviours; (5) operational delivery and monitoring; and (6) patient and public engagement and involvement. The gaps identified in these domains highlight opportunities to facilitate sustainable delivery and operationalisation of NAPs. The findings from this analysis can be used at country, regional, and global levels to identify AMR-related priorities that are relevant to infrastructure needs and contexts.

This article summarizes the consequences of the COVID-19 pandemic, on an international project to tackle antimicrobial resistance (AMR). The research leadership and process, the access to data, and stakeholders were deeply disrupted by the national and international response to the pandemic, including the interruption of healthcare delivery, lockdowns, and quarantines. The key principles to deliver the research through the pandemic were mainly the high degree of interdisciplinary engagement with integrated teams, and equitable partnership across sites with capacity building and leadership training. The level of preexisting collaboration and partnership were also keys to sustaining connections and involvements throughout the pandemic. The pandemic offered opportunities for realigning research priorities. Flexibility in funding timelines and projects inputs are required to accommodate variance introduced by external factors. The current models for research collaboration and funding need to be critically evaluated and redesigned to retain the innovation that was shown to be successful through this pandemic.

Background: Worldwide, 21% of deliveries are by elective cesarean sections (C/S) as a procedure to reduce maternal and neonatal mortality and morbidity. Blood loss during C/Ss is more than vaginal delivery. Therefore, reducing blood loss during the C/Ss is essential and challenging for anesthesiologists and obstetricians. This study aimed to assess the efficacy of intravenous oxytocin versus tranexamic acid + ethamsylate (TXA + Eth) in reducing blood loss in pregnant women at high risk of primary PPH undergoing elective lower-segment cesarean section. Materials and Methods: A single-center, prospective, randomized, and double-blind study was started after obtaining institutional ethical approval. The study involved women undergoing elective C/Ss at full-term pregnancy at high risk for primary postpartum hemorrhage (PPH) at the SAMSRI between September 2021 and March 2022. The study participants received an infusion of either oxytocin 10 International Unit or TXA 1 g + Eth 250 mg before the skin incision. The primary outcome was the blood loss calculation, alongside hemoglobin and hematocrit before and after the surgery. The secondary outcome was the percentage of participants who progressed into primary PPH and required blood transfusion. Results: Analyses included 132 women in each group, and results showed that TXA + Eth significantly reduced bleeding during and after cesarean section in pregnant women at high risk for PPH. In oxytocin and TXA + Eth groups, postoperative blood loss was (613.7 ± 123.7 and 406.2 ± 116.5) ml, respectively, P < 0.001. The duration of surgery in oxytocin and TXA + Eth groups were (48.5 ± 9.3) and (44.3 ± 9.8) minutes, respectively (P = 0.287). The blood transfusion requirement in the oxytocin and TXA + Eth groups were 10.69% and 0.75%, respectively (P = 0.023). The PPH in the oxytocin and TXA + Eth groups were 2.30% and 0%, respectively (p < 0.017). Pre- and postoperative hemoglobin and hematocrit values at 24 h after cesarean section in the oxytocin (10.78 and 8.29) and (32.23 + 25.10) and TXA + Eth groups were (11.07 and 10.02) and (33.20 and 30.73), respectively (P < 0.001). Conclusion: The use of TXA and Eth is safe and more effective than oxytocin in minimizing blood loss, and the demand for blood transfusion after cesarean section.

Background: Infant mortality due to congenital malformations has an incident rate of 8 cases per 1000 live births. Due to Africa's inadequate health-care systems, congenital cardiac disease (CCD) remains a paediatric health-care issue. CCD patients undergo an open-heart operation (OHO) at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Aim: This study aimed to compare trends of cardiac anaesthesia protocols before and after 2014 and to assess the efficiency and quality of surgical care provided to children with CCD following the implementation of new cardiac anaesthesia protocols in 2014. Materials and Methods: Groups A and B were represented by the years before and after 2014. This was a retrospective study involving 118 patients who underwent OHO under general anaesthesia from 2007 to 2016 after obtaining Institutional ethical approval. Results: In Groups A and B, the mean length of hospitalization in days and cardiac care unit stay in days were (6.87 ± 3.51 and 4.20 ± 3.66) (P = 0.046) and (3.14 ± 2.37 and 1.96 ± 2.85) (P = 0.382), respectively. In Group B, ultrafast track extubations increased from 7.25% to 39.71% (P = 0.021), while patients mean mechanically ventilation time decreased by 82.34 ± 11.70–23.48 ± 7.94 h (P = 0.018). In the first 48 h, the chest tube's postoperative drainage reduced by 133 ± 28.46–95 ± 20.38 ml (P = 0.018) and haemorrhage leading to re-exploration decreased 11.77%–1.50% (P = 0.019). After 2014, postoperative haemorrhage, the chest tube's drainage, and re-exploration were statistically significantly reduced by tranexamic acid. Conclusions: This ten-year program primarily focused on selecting simple cases and simplifying anaesthesia protocols after 2014. Given the success of our OHO program at KATH Kumasi, there is a need for a paradigm shift to sustain OHO programs in other parts of Africa.

Wireless communication technologies, smart sensors, enormously enhanced computational capabilities, intelligent controls merge to form Cyber-Physical Systems (CPSs). The synergy achieved due to this integration will considerably transform how humans’ interaction with engineered systems in future smart cities. Such cities will leverage technologies to design, develop, and implement intelligent solutions to provide inclusive development, efficient community infrastructure, and a clean and sustainable environment. One of the domains likely to witness paradigm- shift in future smart cities is transport. The development of urban structures, functionality, and prosperity are intricately connected to how the city designs its mobility infrastructure. Shortly, all vehicles and roadside infrastructures in a city-wide ITS will be enabled with integrated smart sensors, edge computing devices and communication units to provide diversified and inclusive services to its residents. Nonetheless, due to the high heterogeneity and complexity of cross-cutting aspects of CPS, the transportation domain is susceptible to cyber vulnerabilities, threats, illegal access, cyber-attacks, unauthorized information sharing, and so on. This paper attempts to understand smart CPS-enabled transportation systems, it’s conceptual framework, the connected and automated vehicles and other associated technologies and communication networks. Finally, we present the expected demands of the transportation domain in a future smart city and the capabilities of CPS in a demand-supply framework. However, the major intellectual challenge lies in effectively designing-developing-deploying models and algorithms to harness the powers of the integrated TCPS system implemented in the intended environment.

Diversity serves as the foundation for breeding and evolution. In the science of genomics, the investigation of genetic variation has long been a prominent subject. Researchers now have access to previously unheard volumes of data, thanks to the development of new genomic technologies which allow them to thoroughly examine the complexity of genetic variation. As a result, new definitions and measurements of diversity have been created, taking into consideration things like how genetic variation is distributed throughout populations, the impact of natural selection, and the connection between genetic and phenotypic diversity. One crucial idea is ''genetic ancestry'' which describes the percentage of a person's genetic composition that may be linked to particular ancestral populations. Heterozygosity, which measures the degree of genetic variation within a population, is another crucial indicator of diversity. Recent developments in genomics have resulted in the creation of new tools and methodologies for examining the complexity of genetic variation in addition to these conventional diversity measurements. Generally, the area of diversity research is rapidly changing in the genomics age, with new theories and measures being created on a regular basis. The origins and effects of genetic variation are expected to continue to be revealed as our knowledge of genetic diversity deepens, with substantial ramifications for human health, evolutionary biology, and a variety of other domains.

Abstract The genomic diversity and relationship among seven diverse cattle breeds viz. Sahiwal, Tharparkar, Gir, Vechur, Ongole, Kangayam and Hariana were investigated in 132 random samples based on high density SNP array comprising > 777 K SNPs. A total of 1993 SNPs (0.25% of the total) having greater power (FST ≥ 0.20) to differentiate these cattle populations were identified, and utilized to partition genome of each animal into a predefined number of clusters. The structure of these cattle indicated shared ancestry of dairy breeds viz. Gir, Tharparkar and Sahiwal. Most of the animals (> 76%) of different populations under study except Vechur clustered into their own group of animals called breed. Vechur population retained highest rate of admixture, consistent with its crossing with other breeds. Ongole, Kangayam and Hariana shared comparatively less of their genome (≤ 15%) with other breeds. The study indicated that all seven breeds evolved from their independent ancestry but there was intermixing of these breeds in the recent past. The selection signatures identified between draft (Kangayam) and dairy breeds included several genes like FAM19A2, RAB31P, BEST3, DGKA, AHCY, PIGU and PFKP which are involved in immune response, metabolic pathway, transportation of glucose and sugars, signaling pathways, cellular processes, cell division and glycolysis regulation, respectively. Moreover, these genomic regions also harbour QTLs affecting milk performance traits. The signatures were also identified even between the dairy breeds. In comparison to large-sized cattle, there were significant differences in the number of QTLs affecting production (body weight, growth rate etc.) and morphological traits (height) in short-statured Vechur breed. The presence of HMGA2 gene in the selection signature on chromosome 5 may explain the variations in stature between these cattle.

In this paper, a composite control strategy for improved off-grid configuration based on photovoltaic (PV array), a wind turbine (WT), and a diesel engine (DE) generator to achieve high performance while supplying nonlinear loads is investigated. To operate the WT efficiently under variable speed conditions and to obtain accurate and fast convergence to the maximum global operating point without a speed sensor, an iterative interpolation method is integrated with the perturbation and observation (P&O) technique. To ensure the balance of power in the system and to achieve the maximum power from the PV array without using any maximum power point tracking (MPPT) method, and ensuring stable operation during the disturbance, a double-loop control strategy for a two-switches buck-boost converter is developed. Furthermore, to protect the synchronous generator of the diesel generator (DG) from the 5th and 7th order-harmonics created by the connected nonlinear loads and to solve the issue of the filter resonance, the interfacing three-phase inverter is controlled using an improved synchronous-reference frame algorithm (SRF) with virtual impedance active damping. The presented work demonstrates effective and efficient control along with improved performance and cost-effective option as compared to the similar works reported in the literature. The performance of the presented off-grid configuration and its developed composite control strategy are tested using MATLAB/Simulink and validated through small-scale hardware prototyping.

ABSTRACT: Objective: To explore the existing evidence on patient understanding of and/or participation in infection-related care in surgical specialties. Method: A scoping review of the literature was conducted. PubMed, Web of Science, Scopus, and grey literature sources were searched using predefined search criteria for policies, guidelines, and studies in the English language. Data synthesis was done through content and thematic analysis to identify key themes in the included studies. Results: The initial search identified 604 studies, of which 41 (36 from high-income and five from low- and middle-income countries) were included in the final review. Most of the included studies focused on measures to engage patients in infection prevention and control (IPC) activities, with few examples of antimicrobial stewardship (AMS) engagement strategies. While patient engagement interventions in infection-related care varied depending on study goals, surgical wound management was the most common intervention. AMS engagement was primarily limited to needs assessment, without follow-up to address such needs. Conclusion: Existing evidence highlights a gap in patient participation in infection-related care in the surgical pathway. Standardization of patient engagement strategies is challenging, particularly in the context of surgery, where several factors influence how the patient can engage and retain information. Infection-related patient engagement and participation strategies in surgery need to be inclusive and contextually fit.

Introduction: The Emergency Medicine Education and Research by Global Experts (EMERGE) network was formed to generate and translate evidence to improve global emergency care. We share the challenges faced and lessons learned in establishing a global research network. Methods: We describe the challenges encountered when EMERGE proposed the development of a global emergency department (ED) visit registry. The proposed registry was to be a six-month, retrospective, deidentified, minimal dataset of routinely collected variables, such as patient demographics, diagnosis, and disposition. Results: Obtaining reliable, accurate, and pertinent data from participating EDs is challenging in a global context. Barriers experienced ranged from variable taxonomies, need for language translation, varying site processes for curation and transfer of deidentified data, navigating institution- and country-specific data protection regulations, and substantial variation in each participating institution’s research infrastructure including training in research-related activities. We have overcome many of these challenges by creating detailed data-sharing agreements with bilateral regulatory oversight agreements between EMERGE and participating EDs, developing relationships with and training health informaticians at each site to ensure secure transfer of deidentified data, and formalizing an electronic transfer process ensuring data privacy. Conclusion: We believe that networks like EMERGE are integral to providing the necessary platforms for education, training, and research collaborations for emergency care. We identified substantial challenges in data sharing and variation in local sites’ research infrastructure and propose potential approaches to address these challenges.

Abstract Background Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. The objective of this work is to describe a multidisciplinary approach towards the investigation and containment of a Candida auris outbreak and the preventive measures adopted in a resource limited setting. Methods This outbreak investigational study was conducted at a 1300-bedded tertiary care academic hospital in South India. The study included 15 adult inpatients with laboratory confirmed Candida auris isolates. The outbreak cluster was identified in adult patients admitted from September 2017 to 2019. The system response consisted of a critical alert system for laboratory confirmed Candida auris infection and multidisciplinary ‘Candida auris care team’ for patient management. The team implemented stringent Infection Prevention and Control (IPC) measures including patient cohorting, standardized therapy and decolonization, staff training, prospective surveillance and introduction of Candida auris specific care bundle. Results Two outbreak clusters were identified; first cluster occurring between October and November 2017 and the second cluster in May 2018. The cohorts consisted of 7 and 8 Candida auris positive patients in the first and second waves of the outbreak respectively with a total survival rate of 93% (14/15). Deployment of containment measures led to gradual decline in the incidence of adult Candida auris positive cases and prevented further cluster formation. Conclusions The sustained implementation of guideline and evidence-based IPC measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Low- and Middle-income country.

Purpose – Throughout history, pandemics have played a significant role in reshaping human civilizations through mortalities, morbidities, economic losses and other catastrophic consequences. The present COVID-19 pandemic has brought the world to its knees resulting in overstretched healthcare systems, increased health inequalities and disruptions to people’s right to health including life-saving routine immunization programs across the world. Design/methodology/approach – This is a commentary paper. Findings – Immunization remains one of the most successful, safe, cost-effective and proven fundamental disease prevention measures in the history of public health. However, the COVID-19 pandemic has effectively thrown the world's immunization practices out of gear, depriving approximately 80 million infants, in rich and poor countries alike, at risk of triggering a resurgence of vaccine-preventable diseases such as diphtheria, measles and polio. It is estimated that each COVID-19 death averted by suspending immunization sessions in Africa could lead to 29-347 future deaths due to other diseases including measles, yellow fever, polio, meningitis, pneumonia and diarrhoea. Originality/value – The value of implementing robust immunization policies cannot be underestimated. Risks associated with postponing immunization services and the fact that COVID-19 is now an integral part of human civilization have resulted in several countries making special efforts to continue their immunization services. However, critical precautionary measures are warranted to prevent COVID-19 among healthcare service providers, facilitators, caregivers and children during the immunization sessions.

Abstract Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

Background: The use of membrane with the guided bone regeneration (GBR) has been a controversial aspect of the implant placement, which helps achieve the primary graft stabilization and inhibit early graft loss. Objectives: The present clinical trial was aimed to determine the results of GBR with nonresorbable (expanded polytetrafluoroethylene [e-PTFE]) and resorbable (collagen) membrane both clinically and radiographically for 2 years with dental implant placement. Materials and Methods: 16 subjects having 32 sites for implant placement in a split-mouth pattern were included in the study. The sites for implant was prepared and grafted with the autogenous graft procured from the mandibular ramus area followed by graft coverage with either e-PTFE or collagen membrane. Various radiographic and clinical parameters were assessed for 2 years at an interval of 6 months each. The collected data were recorded for each study subject for all the implant sites and were statistically analyzed. Results: The mean values for periodontal probing depth at 6 months, 12 months, 18 months, and 24 months were 2.25 ± 0.17, 2.67 ± 1.84, 2.64 ± 1.21, and 3.01 ± 0.52, respectively, for the e-PTFE group. For the collagen group, the probing depth mean values at 6 months, 12 months, 18 months, and 24 months were 2.30 ± 0.14, 2.59 ± 1.76, 2.62 ± 1.30, and 2.98 ± 0.81, respectively. The corresponding clinical and radiographic parameters at all time intervals were nonsignificant on the intergroup comparison. Conclusion: Dental implants placed with simultaneous GBR have an acceptable survival rate at the end of 2 years irrespective of the resorbable or non-resorbable membrane used.

Medical experts employ electroencephalography (EEG) for analyzing the electrical activity in the brain to infer disorders. However, the time costs of human experts are very high, and the examination of EEGs by such experts, therefore, accounts for a plethora of medical resources. In this study, an improved one-dimensional CNN-only system of 25 layers has been proposed to identify abnormal and normal adult EEG signals using a single EEG montage without using any explicit feature extraction technique. Most of the previous systems based on deep learning, that have been proposed to solve this problem, use extremely deep architectures containing very large numbers of layers. This study also presents an independent preprocessing module that has been exhaustively evaluated for optimal parameters with the target of adult EEG signal classification. The achieved accuracy of the proposed classifier as a part of the decision support system is 82.24%, which is a substantial improvement of ~3% over the previous best reported classifier of comparable depth. The system also exhibits significantly higher F1-score and sensitivity as well as lower loss. The proposed system is intended to be a part of an expert system for overall brain health evaluation.

Abstract. Management of candidemia in developing countries like India encounters laxity in appropriate clinical management and challenges in terms of healthcare capacity, despite its association with high morbidity and mortality. Our study aims to evaluate the impact of a comprehensive candidemia care bundle implementation on appropriateness of therapy and major clinical outcomes. The single-center, quasi-experimental study conducted at a south Indian tertiary care center included adult patients diagnosed with candidemia. Following a retrospective review of candidemia patients of the pre-implementation period (January 2013–December 2015), the hospital antifungal stewardship team instituted a clinical pharmacist driven comprehensive candidemia care bundle for candidemia patients during the post-implementation period (October 2017–2019) and its impact on appropriateness of antifungal prescriptions and inpatient mortality was evaluated. The study included 175 patients with candidemia, comprising of 103 patients in the pre-implementation period and 72 patients in the post-implementation period. Appropriateness of antifungal prescriptions rose to 65% during post-implementation period from 30% observed in pre-implementation phase (P = .0005). The inhospital mortality rate reduced from 40% in the pre-implementation phase to 36% in the post-implementation phase, recording a 10% reduction over 2 years post-implementation (P = .26). No significant difference was observed in terms length of stay (P = .17). Our study demonstrates the successful implementation of an antifungal stewardship led comprehensive care bundle in a low middle income countries setting. The results of our study will have profound implications in improving the appropriateness of management of candidemia and feasibility of scaling up to wider settings could be explored.

Current practice for chemotherapy in most oncology departments is the use of dedicated venous access for the continuous and frequent delivery of drugs, fluids and blood products, and the monitoring of the effects of treatment. The frequent venipuncture of peripheral veins is associated with various complications and discomfort to the patients. Permanent central venous access is therefore very important. Totally Implantable Vascular Access Device (TIVAD) is a type of central venous access that utilizes the central veins; the internal jugular vein, the subclavian or the femoral veins. It is a kind of permanent central venous access where a central venous catheter is connected to a subcutaneously buried port or septum which can be accessed at any time and has the ability to stay for almost 5 years. They are therefore the preferred form of long-term central venous access in patients treated by oncology departments. We share our initial experience of 5 patients in our institution. There were 4 females and one young boy who had been diagnosed with Hemophilia. Three of the patients had new implantation, one had removal of her 5-year-old TIVAD that had been implanted in another country and one had the TIVAD accessed when she had been referred to our hospital for breast surgery after neoadjuvant chemotherapy.

This paper explores the Wancho communities in the Longding District of Arunachal Pradesh, located in the north-east of India, analysing their architecture in its traditional cultural and geographical context. Through a phenomenological study of the landscape and architecture of the Wancho, it reveals how these communities create forms and inscribe their particular patterns upon the landscape, resulting in a unique built expression. Phenomenology emphasizes lived experience and enquires into the related concepts of space and place, understanding how physical phenomena are inscribed with meanings. Accordingly, the Wancho settlements in Arunachal Pradesh have been seen through the lens of lived-experiences that provide them with meanings. In Wancho settlements the emotional and subjective attachment of the community to their place is strong, and is reflected through the material reality of the village and its environment. Seen as a whole, the settlements integrate climatic and other natural environmental factors, as well as the cultural institutions, values and practices of these people, which are also reflected through the craft and local skills of the community. The traditional Wancho settlements are “read” here by considering their landscape and townscape as “texts”.

Cultural landscapes represent a closely woven net of inter-relationships between people, events and places over time; they are a symbol of the growing recognition of the fundamental links between local communities and their heritage, between people and their natural environment, and are hence crucial to their identity. In architectural projects like post-disaster reconstruction, which revolves around the needs of the communities decimated by a disaster, decisions taken become especially critical, as they have a long-term impact on the community and its built environment. It therefore requires one to take into account the cultural, social, and environmental context. This paper considers the case of Khokana, a traditional Newari settlement in the Kathmandu valley, in order to study its spatial configuration, determined by its socio-cultural activities, through the lens of collective memory mapping. It further analyzes the repercussions on the intangible values and tangible built environment of the community following the 2015 Nepal earthquake, and proposes a new design approach based on an understanding of Khokana’s traditional knowledge system and practices. Finally, we propose a model to achieve community resilience while keeping the community’s values and spatial ethos intact.

IntroductionBeyond the provision of services, quality of care and patient safety measures such as optimal clinical handover at shift changes determine maternity outcomes. We aimed to establish the proportion of women handed over and the content of clinical handovers and communication between shifts within 3 diverse obstetrics units in Kerala, India, and to describe the handover environment.MethodsA cross sectional study was conducted for six weeks during February and March 2015at three hospitals in Kerala, India, during nurses obstetric handover in one tertiary private, one tertiary government and one secondary government hospital. Nursing handovers in obstetric post-operative, in-patient and labour wards were sampled. An SBAR-based (situation, background, assessment and recommendation) data schedule was completed whilst observing handover at nursing shift changes. Since obstetricians had no scheduled handover, qualitative interviews were conducted with obstetricians in two hospitals to establish how they acquire information when beginning a shift.ResultsData was obtained on 258 patients handed over, within 67 shift changes. The median percentage of women handed over was 100% in two of the hospitals and 27.6% in the other. The median number of information items included out of a possible 25 was 11, 5 and 4,and did not change significantly for women with high-risk status. Important items regarding assessment and recommendation for care were often missed, including high-risk status. The median number of environment items achieved was good at 7 out of 10 in all hospitals. Obstetricians sought information in various ways when required. All supported the development of structured tools, face-to-face and team handovers.ConclusionsMaternity unit handovers for doctors and nurses were inadequate. Ensuring handover of all women and including critical information, between shifts as well as between doctors, needs to be improved to increase patient safety.

An electric vehicle uses multiple energy-storage systems to power the traction motor. Dual-source inverters (DSIs) are used for single-stage power conversion by skipping the dc/dc boost converter stage; therefore, eliminating the passive magnetic storing element which improves the overall efficiency of the drive; moreover, multiple energy-storage systems improve the power density of the system. This article discusses the fine control of a traction motor from zero speed to rated speed supplied through a dual-source inverter. Field-oriented control with space vector modulation technique is applied to achieve closed-loop control. Two dc sources are used, one having a higher-voltage battery and one a lower-voltage battery. The higher-voltage battery is the main battery which supplies power to the traction motor, whereas the lower-voltage battery supplies power to supplementary loads of the EV. This article presents improved dynamic behaviour of an induction-motor-driven EV fed from a dual-source inverter using modified closed-loop field-oriented control with space vector modulation. The improvement includes reduced control complexity due to space vector modulation and achieving the option of EV operation in an emergent situation using the same converter and control system. The simulated performance of the presented system is obtained in MATLAB/Simulink. A step-down experimental prototype is used for verification of effective control of the induction motor as the EV is under constant torque variable speed operation with real-time parameters such as power, power factor, current harmonics, and voltage/current stresses across the switch using two batteries individually.

The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The prospective observational study recruited 1009 adult sepsis patients presenting to the emergency department at the center based on Sepsis-2 criteria for a period of three years. Of the patients, 41% were between 61 and 80 years with a mean age of 57.37 ± 13.5%. A total of 13.5% (136) was under septic shock and in-hospital mortality for the study cohort was 25%. The 3 h and 6 h bundle compliance rates observed were 37% and 49%, respectively, without significant survival benefits. Predictors of mortality among patients with bloodstream infections were septic shock (p = 0.01, OR 2.4, 95% CI 1.23–4.79) and neutrophil-to-lymphocyte ratio (p = 0.008, OR 1.01, 95% CI 1.009–1.066). The presence of Acinetobacter (p = 0.005, OR 4.07, 95% CI 1.37–12.09), Candida non-albicans (p = 0.001, OR16.02, 95% CI 3.0–84.2) and septic shock (p = 0.071, OR 2.5, 95% CI 0.97–6.6) were significant predictors of mortality in patients with community-acquired pneumonia. The registry has proven to be a key data source detailing regional microbial etiology and clinical outcomes of adult sepsis patients, enabling comprehensive evaluation of regional community-acquired sepsis to tailor institutional sepsis treatment protocols.

Abstract Hepatitis A, an acute inflammatory liver disease caused by hepatitis A virus (HAV) infection from close contact with infected people, is highly endemic in the Indian subcontinent. Due to poor sanitary conditions, most of the population is exposed to the virus in childhood. At this age, the disease is asymptomatic and provides life-long protection against the disease. Due to rapid socioeconomic development in some areas, however, pockets of the population are reaching adolescence/adulthood without prior exposure to the virus and are thus susceptible to infection. At these ages, infection carries a higher risk of symptomatic disease and complications including mortality. This review of epidemiology and burden of disease studies in the Indian subcontinent, published since 2005, shows increasing evidence of a shift from high to intermediate endemicity in high-income—typically urban—populations. The prevalence of anti-HAV antibodies (previously reported at > 90%) is lower now in adolescents and young adults (e.g., around 80% in Bangladesh and 55% in 5–15 years in India). As a result, HAV is responsible for more acute viral hepatitis predominantly in this age group (e.g., > 15 years: 3.4% in 1999 to 12.3% in 2003 or high socioeconomic status 13–20 years: 27% in 1999 to 62% in 2003), with a greater clinical and economic burden. Numerous outbreaks due to HAV have been reported [e.g., Sri Lanka (2009–2010): > 13,000 affected; Kashmir (2015–2017): 12 outbreaks; Kerala (2012–2016): 84 outbreaks] from water or food contamination. Due to current shifts in endemicity, a growing proportion of the population is no longer exposed in childhood. As the disease remains highly endemic, it also provides a source for more severe disease in susceptible people at an older age and for outbreaks. Well-tolerated and effective vaccines are available and help prevent disease burden and provide long-term protection. These should now be used more widely to protect more patients from the growing disease burden of hepatitis A. Funding GlaxoSmithKline Biologicals SA. Plain Language Summary Plain language summary available for this article—please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.9963044 . Fig. 1 Plain Language Summary. Highlights the context of the article, the endemicity shift and the burden of hepatitis A in adolescents and adults and steps to be taken to address the impact of this disease

Abstract Pertussis is an under-recognized cause of neonatal morbidity and mortality. To review information on the epidemiology and disease burden of neonatal pertussis in South and Southeast Asian countries, a systematic literature review of three bibliographic databases was undertaken. Peer-reviewed original studies on neonatal pertussis epidemiology and burden published since 2000, with a geographical scope limited to South and Southeast Asian countries, were included. Data were systematically extracted based on parameters defined a priori. Our findings show that the burden of neonatal pertussis and its complications is substantial. An increase in the number of pertussis cases has been noted since early 2000, ranging from 61 to 92.9% in infants 0–3 months old. The most common symptoms an infant is likely to present with are cough with or without paroxysms, cyanosis, apnea, tachypnea, difficulty in breathing and leukocytosis. In addition, it can lead to hospitalization (length of stay: 5–7 days), complications (e.g., pneumonia, seizures) and mortality ranging from 5.6 to 14.7%. Other observations indicate that diagnosis is challenging because of non-specific clinical symptoms. Specifically, for obstetricians and gynecologists, the information available for making informed decisions on the prevention of neonatal pertussis is unreliable. Maternal immunization against pertussis during late stages of pregnancy has proven to be efficacious and well tolerated. A high burden of neonatal pertussis, as well as its complications, is observed in South and Southeast Asian countries. There is a need to intensify efforts to protect this vulnerable population with maternal vaccination. Funding: GlaxoSmithKline Biologicals SA Plain Language Summary: Plain language summary available for this article. Please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.7951187.

Diabetes mellitus is a severe metabolic disorder, which consistently requires medical care and self-management to restrict complications, such as obesity, kidney damage and cardiovascular diseases. The subtype gestational diabetes mellitus (GDM) occurs during pregnancy, which severely affects both the mother and the growing foetus. Obesity, uncontrolled weight gain and advanced gestational age are the prominent risk factors for GDM, which lead to high rate of perinatal mortality and morbidity. In-depth understanding of the molecular mechanism involved in GDM will help researchers to design drugs for the optimal management of the condition without affecting the mother and foetus. This review article is focused on the molecular mechanism involved in the pathophysiology of GDM and the probable biomarkers, which can be helpful for the early diagnosis of the condition. The early diagnosis of the metabolic disorder, most preferably in first trimester of pregnancy, will lead to its effective long-term management, reducing foetal developmental complications and mortality along with safety measures for the mother.

Significant research in reservoir computing over the past two decades has revived interest in recurrent neural networks. Owing to its ingrained capability of performing high-speed and low-cost computations this has become a panacea for multi-variate complex systems having non-linearity within their relationships. Modelling economic and financial trends has always been a challenging task owing to their volatile nature and no linear dependence on associated influencers. Prior studies aimed at effectively forecasting such financial systems, but, always left a visible room for optimization in terms of cost, speed and modelling complexities. Our work employs a reservoir computing approach complying to echo-state network principles, along with varying strengths of time-delayed feedback to model a complex financial system. The derived model is demonstrated to act robustly towards influence of trends and other fluctuating parameters by effectively forecasting long-term system behavior. Moreover, it also re-generates the financial system unknowns with a high degree of accuracy when only limited future data is available, thereby, becoming a reliable feeder for any long-term decision making or policy formulations.

The reinforcement of natural fibre and fillers in polymer resin is the latest trend followed by research groups and industries for the development of sustainable composites. Basalt fibre and waste marble powder are naturally occurring substances used to enhanced polymer properties. The present research examined the effect of both basalt fibre and waste marble powder in epoxy resin. The hand lay-up method was employed to fabricate the composite and test for mechanical and wear behaviour. The tensile, flexural, and impact energy were enhanced up to 7.5 wt. % of WMP, and the Vickers hardness of epoxy enhanced every state of reinforcement of WMP. The specific wear rate was observed to be increased with the addition of WMP until 7.5 wt. %. Scanning electron microscopy was performed to examine the nature of fractured surface wear phenomena.

Heat shock proteins (HSPs) are evolutionary conserved family of proteins produced by living cells in response to various biological stresses, including heat shock. Heat stress affects the productivity of the livestock species, which causes severe economic losses to the animal keepers. The present study was undertaken to establish reference baseline values for thyroid (T3 and T4) and adrenal gland (cortisol) hormones in four indigenous sheep breeds (Chokla, Marwari, Magra and Madras Red). The effect of the seasons and genotypes of the HSP90 and HSP70 genes on the functions of the thyroid gland as well as cortisol levels were examined in plasma samples of these sheep breeds. A total of 80 plasma samples (10 animals per breed for the summer and winter season) were analyzed. The least square analysis revealed significant seasonal effect on Triiodothyronine (T3) and Thyroxine (T4). Significantly higher T3 and T4 levels were observed in the winter with a low temperature humidity index (THI) than in summer with high THI. Cortisol was non-significantly higher in the summer than in winter season. Overall, the influence of the breeds on these three parameters was non-significant. Genotypes of SNP1 (HSP90 gene) and SNP2 (HSP70 gene) had significant effect on T3 level. These SNP markers may be useful for identifying animals that are more adaptable to heat stress following a thorough association analysis over a large sample size.

Genome-wide runs of homozygosity (ROH) are suitable for understanding population history, calculating genomic inbreeding, deciphering genetic architecture of complex traits and diseases as well as identifying genes linked with agro-economic traits. Autozygosity and ROH islands, genomic regions with elevated ROH frequencies, were characterized in 112 animals of seven Indian native cattle breeds (B. indicus) using BovineHD BeadChip. In total, 4138 ROH were detected. The average number of ROH per animal was maximum in draft breed, Kangayam (63.62 ± 22.71) and minimum in dairy breed, Sahiwal (24.62 ± 11.03). The mean ROH length was maximum in Vechur (6.97 Mb) and minimum in Hariana (4.04 Mb). Kangayam revealed the highest ROH based inbreeding (FROH>1Mb = 0.113 ± 0.059), whereas Hariana (FROH>1Mb = 0.042 ± 0.031) and Sahiwal (FROH>1Mb = 0.043 ± 0.048) showed the lowest. The high standard deviation observed in each breed highlights a considerable variability in autozygosity. Out of the total autozygous segments observed in each breed except Vechur, > 80% were of short length (< 8 Mb) and contributed almost 50% of the genome proportion under ROH. However, in Vechur cattle, long ROH contributed 75% of the genome proportion under ROH. ROH patterns revealed Hariana and Sahiwal breeds as less consanguineous, while recent inbreeding was apparent in Vechur. Maximum autozygosity observed in Kangayam is attributable to both recent and ancient inbreeding. The ROH islands were harbouring higher proportion of QTLs for production traits (20.68% vs. 14.64%; P≤ 0.05) but lower for reproductive traits (11.49% vs. 15.76%; P≤ 0.05) in dairy breeds compared to draft breed. In draft cattle, genes associated with resistant to diseases/higher immunity (LYZL1, SVIL, and GPX4) and stress tolerant (CCT4) were identified in ROH islands; while in dairy breeds, for milk production (PTGFR, CSN1S1, CSN2, CSN1S2, and CSN3). Significant difference in ROH islands among large and short statured breeds was observed at chromosome 3 and 5 involving genes like PTGFR and HMGA2 responsible for milk production and stature, respectively. PCA analysis on consensus ROH regions revealed distinct clustering of dairy, draft and short stature cattle breeds.