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Background: Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use., Objective: We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India., Methods: We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources., Results: This location's EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO 2 e] per year or 0.361 kg CO 2 e per patient visit compared with 20,800 kg CO 2 e per year or 0.037 kg CO 2 e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO 2 e (0.046 kg CO 2 e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories., Conclusions: The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system's GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care., (©Cordelia Kwon, Lernik Essayei, Michael Spencer, Tom Etheridge, Rengaraj Venkatesh, Natrajan Vengadesan, Cassandra L Thiel. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.02.2024.)

Background and Aims: This study aimed to assess the current status of India's COVID-19 research from the top 100 most cited papers, using bibliometrics methods and indicators and suggest strengths and weaknesses., Methodology: Publications on COVID-19 research from India between December 2019 and 22 August 2023 were retrieved from the Scopus database. From 37101 studies retrieved, the first top 100 Highly Cited Papers (HCPs) having received 270 to 2931 citations, were identified., Results: The top 100 most cited Indian papers were published from 2020 to 2023, with the majority (75) in the year 2021, followed by 24 in 2022. They were cited a total of 56661 times (average - 566.61 times). The 242 authors of these HCPs were from 159 Indian organizations, and the articles were published in 60 journals. 29 % and 59 % of these HCPs received external funding support and were involved in international collaborations, respectively. There was poor collaboration among Indian research institutions and a dearth of funding from India. None of the Indian HCPs figured in the global 100 HCPs., Conclusions: Although citations of research papers published from India increased during COVID-19, limited collaboration, inadequate funding, and subpar publications hindered Indian scientists. To enhance India's research landscape, we propose dismantling barriers, nurturing collaboration, and encouraging knowledge exchange among domestic institutions., Competing Interests: Declaration of competing interest All the authors hereby declare that there is conflict of interest regarding this manuscript & no funding was received from any source. We declare that this manuscript has been solely submitted to this journal and is not under consideration by any other journal. All the research presented in this paper is original., (Copyright © 2023 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Herpes zoster (HZ) is a debilitating viral infection causing a dermatomal vesicular rash. Many known risk factors exist in India and adults >50 years of age may be especially susceptible to HZ. However, HZ is not a notifiable disease in India and data on incidence and disease burden is lacking. An Expert Consensus Group meeting was conducted with experts from relevant specialties to discuss HZ disease, its local epidemiology, and suggestions for implementing HZ vaccination in the Indian healthcare system. Currently, there is lack of patient awareness, poor reporting practices and general negligence in the treatment of the disease. HZ patients generally approach their general physicians or specialists for diagnosis, which is usually based on patient history and clinical symptoms. Recombinant zoster vaccine (RZV) has >90% efficacy and is recommended in adults ≥50 years of age to prevent HZ in the United States. Despite RZV being approved for use, it is not yet available in India. India has a growing elderly population with known risk factors for HZ like immunosuppression, and co-morbidities like diabetes and cardiovascular disease. This indicates the need for a targeted immunization program in India. Meeting also emphasized adult vaccine availability and accessibility in the country.

Competing Interests: None

Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC)., Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC., Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results., Results: In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ₹15,100 ($220.6). In other scenarios, the estimated cost reduction for e-R, e-STATA, p-R, p-STATA was ₹-274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC-SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust., Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.

The extended frozen semen (EFS) batches produced from infectious bovine rhinotracheitis (IBR) sero-positive cattle and buffalo bulls housed in various semen stations in India are transported to the testing laboratory in liquid nitrogen (LN 2 ) for screening bovine herpesvirus-1 (BoHV-1). This procedure is laborious and poses LN 2 related hazards. An alternative logistics for transportation of samples was investigated. Use of Flinders Technology Associates (FTA ® ) elute card was evaluated for transportation of extended bovine semen to screen BoHV-1 DNA by real-time PCR targeting gB gene and the method was compared with the OIE approved Chelex resin based method. A protocol for extraction of BoHV-1 DNA from FTA ® card spotted with extended semen was optimized. The viral DNA was found to be stable on FTA ® card for at least 28 days when the cards are stored at 4°-37 °C. The analytical sensitivity for the assay was determined using variable dilutions of BoHV-1 spiked semen and positive plasmid harbouring gB gene (97bp) spotted onto FTA ® card and it was found to be 10 0.8 TCID 50 /ml or 100 copies respectively in real-time PCR. The test could detect as low as 10 0.008 TCID 50 /ml or 1 copy of positive plasmid when more number of replicates (n = 6) of the same sample were tested. This sensitivity was found to be comparable to Chelex method and both the methods demonstrated a very strong correlation (r = 0.9774; 95% CI: 0.9620-0.9860) in terms of Ct value (p < 0.0001). The diagnostic sensitivity and specificity of the FTA method in comparison to the Chelex method was 83.08% (95% CI: 71.73%-91.24%) and 93.23% (95% CI: 89.38%-96.01%) respectively when 316 samples were screened by both the methods. The degree of agreement between these two tests was good (Kappa value: 0.738; 95% CI: 0.646-0.829). The method was found to be robust and highly repeatable in inter-assay and intra-assay precision testing. The result suggests that the FTA ® card holds promise as an alternative system for transportation of EFS for downstream screening of BoHV-1 DNA., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Telemedicine is the delivery of health care from a distance. It also includes research and evaluation of such services using health data which are stored in "Electronic Health Record" (EHR) platforms. EHR has proved to be useful in monitoring health care delivery but setting up of such platforms is tedious and resource-consuming in developing countries. With the recent surge of telemedicine utility during the COVID-19 pandemic, telemedicine has emerged to be pivotal in reaching stranded patients needing care without EHR-based practice. The practice of patient health record (PHR)-based teleconsultations in India has demonstrated how a conventional "paper and pen" method can be combined to popularise telemedicine utility. Thus, use of PHR-based system to maintain health records would prove to be a pragmatic solution for physicians in low-resource settings to improve their reach to a larger population in need for the future., Competing Interests: None

Advances in the medical field and healthcare sector during the last few decades have resulted in increased longevity. Increased lifespans have in turn led to a rapid global rise of the elderly population. However, ensuring the health and quality of life, especially in the context of chronic age-related ailments, among the growing geriatric population is a challenge. Ageing is associated with several changes in body composition including a decline in the lean body mass usually accompanied by an increase in body fat content which have a bearing on the nutrient requirements for the elderly. The nutrient requirements currently recommended for Indian adults are primarily computed using a factorial approach, that considers the cumulative loss of nutrients and is adjusted for optimal body weights and bioavailability. It is logical that physiological and metabolic changes associated with ageing influence several of these factors: body weight, lean mass, energy expenditure, nutrient retention and bioavailability and thus alter nutrient requirements compared to the adult population. Acknowledging these age-related changes, some international organizations have suggested nutrient requirements specific to the elderly. Given the contextual differences in physiology, caution needs to be exercised in adopting these guidelines for the Indian elderly. In addition, in the Indian context, there is sparse information on the diet and nutrient intakes vis-à -vis nutritional status and physiology of the elderly. This status paper highlights some of the pertinent issues related to nutritional requirements for the elderly that advocate a need for deriving nutritional requirements for the elderly in India.

The JK Paper industry located at Rayagada discharges biologically untreated effluent more than the permissible limit prescribed by Pollution Control Board, Odisha in to the environment. The industry is seriously polluting the surrounding aquatic and terrestrial environment. No detailed intensive study was carried out by previous workers on this industry earlier. The present study aims at finding out the impact of effluent on the flora at the contaminated site. The chemically treated effluent (TE) contained significant amount of mercury and cadmium. The TE has high BOD, COD, dissolved solids and suspended solids when compared to normal river water at the site of discharge. The TE deteriorated the natural water bodies changing the physico-chemical properties of natural river water. After meeting the river water the TE was diluted after 1 km distance from the meeting point of the river. Crop plants collected from the contaminated site showed higher level of residual Hg and Cd and significant depletion in pigment was observed. Plants collected from both the sides of the treated effluent canal showed significant amount residue mercury and cadmium in the plant leaves. The plants exposed to the TE, showed variation in chlorophyll and Phaeophytin pigment content when compared to their respective control values in all terrestrial plants collected from the contaminated site. In some plant leaves little increment in the pigment level was noted but the values were not significant. The changes observed in the plant pigment might be due to heavy metal accumulation. The presence of residual Hg and Cd in crop plants and plant leaves grazed by grazing animals after absorption, accumulation and enrichment may lead to a possible biological magnification, warrants attention. Proper biological treatment, treatment of effluent by modern methods and removal of heavy metals from the effluent before discharge by the industry is suggested., (Copyright © 2021 Elsevier Inc. All rights reserved.)

This article questions the economic rationale of colonial experimentation and prison labor, arguing that for many administrators a prison-based experiment's success mattered less than its existence. It examines the position of convict labor and penal discipline within colonial industrial experiments in colonial India, where convicts performed experiments for what one administrator described as "the most penal" form of labor, papermaking. The belief that Indian fibers could open a new export market for global papermaking meant that prisons became prominent sites of experimentation with new pulps. Regional prisons gained state monopolies for handmade paper, often decimating local independent producers. Yet prison and industrial officers counterintuitively positioned the frequent failures of papermaking experiments as a continuing potential source for industrial improvement. They argued that the failures demonstrated the need to improve discipline and supervision. Prison experiments slotted convicts into repetitive, mechanized roles that served European investigations into the utility of Indian products.

Ropalidia marginata is a common primitively eusocial wasp in peninsular India. Their colonies contain a single egg-laying queen and several non-egg-laying workers. Queens and workers are morphologically indistinguishable, and individuals can change from one role to the other. Unlike most primitively eusocial species, queens of R. marginata are docile, non-aggressive and non-interactive. Nevertheless, the queens maintain a complete reproductive monopoly mediated by non-volatile pheromones. Upon the death or removal of the queen, one worker becomes temporarily hyper-aggressive and becomes the next queen within about a week; we refer to her as the 'potential queen'. Because only one individual becomes hyper-aggressive and reveals herself as the potential queen, and the other wasps never challenge her, we have been much interested in identifying the potential queen in the presence of the queen. However, we have failed to do so until recently. Here, we recount the four decades of search for the potential queen, ending with the recent resolution that emerged from applying the novel technique of multilayer network analysis. Identifying the potential queen in the presence of the previous queen is now possible by integrating behavioural information from multiple social situations to form a holistic view of the social structure of the wasps.

Discharged pulp and paper mill wastewater (PPMW) were collected near M/s K. R. pulp and papers Limited, Shahjahanpur, India. Chemical analysis of the wastewater showed high BOD (3653-4180 mg L -1 ) and COD (17,890-19100 mg L -1 ) values from two different sampling sites. The levels of total phenol were in the range of 389-432 mg L -1 ; nitrogen (125-234 mg L -1 ), sulfate (1926-2098 mg L -1 ), chloride (3.12-5.43 mg L -1 ) and lignin (38,950-39,000 mg L -1 ) along with various heavy metals (Fe, 87-79; Zn, 34-22; Cu, 3.28-2.57; Cd, 1.90-0.36; Ni, 6-5, and Pb, 41.23-36.54 mg L -1 ) were above the permissible limits recommended by the CPCB and the USEPA. The BOD/COD ratio was  < 0.2 which indicated very low biodegradability of the organic matters present in the effluent. The organometallic complex generated from the pulp and paper industry persists in the environment and might be toxic to aquatic organisms. The organic polymers, lignin, metals and ions present in the PPMW were characterized using SEM, EDAX, FTIR, and UV-VIS spectroscopy. The major pollutants detected in the discharged PPMW included nonacosane, heptacosane, octadecanoic acid, hexadecane, and 6-benzamide- 3- [2- [1-(phenylmethyl)-4-piperidinyl] ethyl]-1, 2-benzisoxazole, as well as a group of plant fatty acids classified as EDCs, and mutagenic pollutants. The cytotoxic and androgenic properties of these complex organics were examined. The seed germination test with Phaseolus mungo and cytotoxicity test with Allium cepa showed that at > 20% concentration of PPMW, α-amylase production was inhibited and chromosomal segregation at metaphase and anaphase during cell division was disturbed, which resulted in c-mitosis, sticky chromosomes, and laggard chromosomes. In addition, SEM of the root of A. cepa showed fissures and fractured tissues of the root cap, probably due to the inhibition of auxins that were responsible for root cap formation. The findings indicated A. cepa as a good test model for examining the DNA damage and cytotoxicity by PPMW, and the discharged effluent should be treated at a tertiary stage for environmental protection.

Waste paper, an essential substitute for wood and other plant-based fibers in paper making, is an indispensable part of the circular economy; yet, the impacts of China's ban on global waste paper cycles have not been well understood. We modeled the evolution of the global waste paper trade network during 1995-2019. We found that the cumulative trade volume of global waste paper reached 1010 million tons in the last 25 years and showed a downward trend since 2015. The global import center of waste paper experienced a transfer from Europe to East Asia and then to Southeast Asia. The ban has stimulated some developed countries to reduce the exports of unsorted waste paper since 2017, but for many major importers their changes in waste paper trade patterns were related to waste paperboard, which was not banned by China, suggesting that this import change trend may be inevitable and irrespective of China's ban. Besides, India has replaced China to become a new import hub of unsorted waste paper. Our results lay a foundation for exploring the evolution of the future global solid waste cycle under the background of zero import of solid waste increasingly implemented by China and many other developing countries.

Introduction: As part of an investment by the Bill & Melinda Gates Foundation to support the Government of Bihar to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide, BBC Media Action implemented multiple communication tools to support front-line worker (FLW) outreach. We analyse the impacts of a package of mHealth audio messaging and paper-based job aids used by FLWs during government-sponsored village health, sanitation and nutrition days (VHSNDs) on knowledge and practices of childbearing women across the RMNCHN continuum of care., Methods: Data from two surveys collected between July and September 2016 were analysed using logistic regression to compare health-related knowledge and behaviours between women who had been exposed at VHSNDs to the mHealth GupShup Potli (GSP) audio recordings or interpersonal communication (IPC) tools versus those who were unexposed., Results: Exposure to GSP recordings (n=2608) was associated with improved knowledge across all continuum-of-care domains, as well as improved health-related behaviours in some domains. The odds of having taken iron-folic acid (IFA) tablets were significantly higher in exposed women (OR 1.5, 95% CI 1.1 to 2.2), as was contraceptive use (OR 2.0, 95% CI 1.2 to 3.2). There were no differences in birth preparedness or complementary feeding practices between groups. Exposure to IPC paper-based tools (n=2002) was associated with a twofold increased odds of IFA consumption (OR 2.3, 95% CI 1.7 to 3.2) and contraceptive use (OR 1.8, 95% CI 1.2 to 2.8). Women exposed to both tools were generally at least twice as likely to subsequently discuss the messages with others., Conclusion: BBC Media Action's mHealth audio messaging job aids and paper-based IPC tools were associated with improved knowledge and practices of women who were exposed to them across multiple domains, suggesting their important potential for improving health outcomes for beneficiaries at scale in low-resource settings., Trial Registration Number: NCT02726230., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The paper examines 1037 publications on bipolar disorder (BD) during the years 2000-19 from India, as listed in the Scopus database. India's publications constituted 2.27 % share of global output (45,624 publications) in the study period of 20 years. India does not figure in the top 10 countries in terms of research output on BD. The number of publications on BD from India increased from 13 in 2000 to 107 in 2019, registering 14.44 % annual average growth, higher than world's growth of 6.02 %. India's 10-year cumulative publications increased from 264 during 2000-09 to 773 during 2010-19, registering 192.8 % absolute growth, much higher than world cumulative growth of 63.27 %. India's publications on BD averaged citation impact per paper of 14.24, which decreased from 25.38 to 10.43 from 2000-09 to 2010-19. Maximum numbers of papers from India on BD were published by researchers from National Institute of Mental Health and Neurosciences, Bangalore (222 papers),Post Graduate Institute of Medical Education and Research, Chandigarh(118 papers), and AII India Institute of Medical Sciences, New Delhi (79 papers). Lady Harding Medical College, New Delhi (36.20 and 2.54), Schizophrenia Research Foundation, Chennai (27.45 and 1.93), and King George's Medical University, Lucknow (25.21 and 1.77) were the most significant organizations in terms of citation per paper and relative citation index. Maximum number of papers were published in Indian Journal of Psychiatry (101 papers), followed by Asian Journal of Psychiatry (88 papers) and Indian Journal of Psychology Medicine (34 papers)., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Venomous snakebite is one of the leading preventable causes of mortality and morbidity with tremendous socio-economic impact on the family and nation. Venomous snakebite has been relisted as a neglected tropical disease after having been removed off the list in 2013. This paper discusses the various reasons which could be attributed to the high mortality and morbidity due to venomous snakes and also provides recommendations on policy decisions, improvement on the quality of venom and anti-snake venom and in promoting awareness on how to avoid snakebite., Competing Interests: None

Academics are expected to publish their research work. Hence, during the past few years, the scientific community has witnessed an ever-increasing growth and output in scientific papers. However, a large number of authors have violated ethical norms of research leading to retractions of their research works as well. The article focuses on the scientific fraud emanating from China and India in Health Sciences for a period of three years i.e. 2015 to 2018. The present data were extracted from http://retractiondatabase.org/using a search filter term "Research Articles OR Articles in Press" on the subject category of Health Sciences (HSC). A total of 318 retracted papers were retrieved and the result of the study indicated that majority (268 items) of the retracted papers in Health Science originated from China, whereas just 50 retracted papers originated from India as on 21-02-2019. While analyzing the data, 26 redundant articles from China have been removed that received retraction notices. Further, the results of the study suggest that there are several factors associated with retraction of scientific papers, which include unreliable results, duplication of results, plagiarism, forged authorship, error in the text, error in data and so on.

The present investigation aims to assess the phytoremediation potential of six aquatic macrophytes, viz. Eichhornia crassipes, Hydrilla verticillata, Jussiaea repens, Lemna minor, Pistia stratiotes and Trapa natans grown in paper mill effluent of JK Paper mill of Rayagada, Orissa, for remediation of heavy metals. The experiment was designed in pot culture experiments. Assessment of physico-chemical parameters of paper mill effluent showed significant decrease in pH, conductivity, total dissolved solids, total suspended solids, chlorine, sulphur, biological and chemical oxygen demand after growth of macrophytes for 20 days. Phytoremediation ability of these aquatic macrophytic species for copper (Cu) and mercury (Hg) was indicated by assessing the decrease in the levels of heavy metals from effluent water. Maximum reduction (66.5 %) in Hg content of untreated paper mill effluent was observed using L. minor followed by T. natans (64.8 %). L. minor showed highest reduction (71.4 %) of Cu content from effluent water followed by E. crassipes (63.6 %). Phytoextraction potential of L. minor was remarkable for Hg and Cu, and bioaccumulation was evident from bioconcentration factor values, i.e. 0.59 and 0.70, respectively. The present phytoremediation approach was considered more effective than conventional chemical treatment method for removing toxic contaminants from paper mill effluent.

Background: Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations., Objective: The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India., Methods: In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India., Results: Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents., Conclusion: The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings., Competing Interests: Declaration of competing interest The listed authors declare and report no conflict of interest for this work and received no honorarium for the development of this Position Paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Smokeless tobacco (SLT) use is widespread across many nations and populations, and India shares more than three-quarters of the global burden of SLT consumption. Tobacco use in India has been largely viewed as a male-dominant behaviour. However, evidence from medical, social and behavioural sciences show significant SLT use among women and young girls. This paper highlights key dimensions of SLT use among women in India including prevalence and determinants, the health effects arising from SLT use and cessation behaviours. The paper concludes by providing recommendations with the aim of setting research priorities and policy agenda to achieve a tobacco-free society. The focus on women and girls is essential to achieve the national targets for tobacco control under the National Health Policy, 2017, and Sustainable Development Goals 3 of ensuring healthy lives and promote well-being for all., Competing Interests: None

Pulp and paper mills generate varieties of pollutants depending upon type of the pulping process being used. This paper presents the characteristics of wastewater from South India Paper Mill, Karnataka, India which is using recycled waste paper as a raw material. The raw wastewater consists of 80-90 mg L( - 1) suspended solid and 1,010-1,015 mg L( - 1) dissolved solid. However, pH varied from 5.5-6.8. The biochemical oxygen demand and chemical oxygen demand ranged from 200-210 and 1,120-1,160 mg L( - 1), respectively. Aerobic treatment of raw effluent attribute to significant reduction in suspended solid (range between 25 to 30 mg L( - 1)) and total dissolved solid (range between 360 to 390 mg L( - 1)). However, pH, temperature, and electrical conductivity were found superior after treatment. Copper, cadmium, iron, lead, nickel, and zinc were found in less quantity in raw effluent and were almost completely removed after treatment. The dendrogram of the effluent quality parameters clearly indicate that South India Paper Mill does not meet Minimal National Standard set by central Pollution Control Board to discharge in agricultural field.

The goal of this study was to optimize the coagulation-flocculation process in wastewater generated from the paper and pulp industry using a grey relational analysis (GRA)-based Taguchi method. Process parameters included types and doses of natural coagulants and coagulant aid, and pH. To track the efficiency of the treatment process, the following responses were chosen for optimization: chemical oxygen demand (COD), total dissolved solids (TDS) and turbidity of wastewater, alone or in combination or all together. Analysis of variance showed that the type and dose of the coagulant aid were the most significant parameters, followed by pH and the dose of the coagulant; the type of coagulant used was found to be insignificant in the coagulation-flocculation process. Optimization of process parameters to achieve lower turbidity and greater removal of COD and TDS was verified in a separate confirmatory experiment, which showed improvements in COD and TDS removal and a decrease in turbidity of 8.2, 6.35 and 26.17%, respectively, with the application of the Taguchi method and GRA.

Generally, handmade paper industries are considered as eco-friendly industries. These industries are known to use vegetable dyes which are thought to be safe and non-toxic. However, cardboard industries are considered as pollution-causing industries. The present study focuses on the genotoxic assessment of handmade paper and cardboard industry's effluent by Ames test using Salmonella typhimurium TA 98 and TA 100 strains. On mutagenicity analysis, effluents of both industries were found to be mutagenic with either one strain of Salmonella typhimurium or with both. Besides this, no significant difference was observed in effluent of both small-scale and large-scale handmade paper industries. Moreover, mutagenic compounds reach the nearby water body i.e. Amani Shah Drainage through connecting drain. Discharging of untreated effluent not only deteriorates the water quality but also reaches the food chain when used for irrigating nearby fields. Workers of these industries may suffer various health hazards when they are exposed to mutagenic effluent without having any information about it. Hence, discharging of effluents should thus be restricted or the workers while handling mutagenic substances should at least take proper precautions.

National Rabies Control Programme, India, is in operation since 2012-2013 without much impact due to poor funding and no set policy for the rabies prevention and control. An effort was made to develop a draft policy paper which can help the Government of India to develop a national rabies vaccination policy for humans and for achieving the goal of zero dog-mediated human rabies deaths by the year 2030. A technical stakeholders meeting was held under the chairmanship of the Drug Controller General of India at New Delhi in December 2017 to discuss the problems and solutions for providing essential rabies postexposure prophylaxis (PEP). The following problems and dilemmas were identified: frequent shortages of life-saving rabies vaccines and rabies immunoglobulin for PEP; as rabies vaccines are mostly procured by the state governments that often face resource crunch and hurdles in logistics within the states; production levels of rabies biologicals in the public sector are low; and the export of rabies biologicals from the private sector needs to be critically evaluated in the context of frequent stock-outs in the domestic market and also the national vaccine security.

India has the highest burden of Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) worldwide. Innovative technology is the need of the hour to identify these cases that remain either undiagnosed or inadequately diagnosed due to the unavailability of appropriate tools at primary healthcare settings. We developed and evaluated 3 kits, namely 'TB Detect' (containing BioFM-Filter device), 'TB Concentration and Transport' (containing Trans-Filter device) and 'TB DNA Extraction' kits. These kits enable bio-safe equipment-free concentration of sputum on filters and improved fluorescence microscopy at primary healthcare centres, ambient temperature transport of dried inactivated sputum filters to central laboratories and molecular detection of drug resistance by PCR and DNA sequencing (Mol-DST). In a 2-site evaluation (n = 1190 sputum specimens) on presumptive TB patients, BioFM-Filter smear exhibited a significant increase in positivity of 7% and 4% over ZN smear and LED-FM smear (p<0.05), respectively and an increment in smear grade status (1+ or 2+ to 3+) of 16% over ZN smear and 20% over LED-FM smear. The sensitivity of Mol-DST in presumptive MDR-TB and XDR-TB cases (n = 148) was 90% for Rifampicin (95% confidence interval [CI], 78-96%), 84% for Isoniazid (95% CI, 72-92%), 83% for Fluoroquinolones (95% CI, 66-93%) and 75% for Aminoglycosides (95% CI, 35-97%), using phenotypic DST as the reference standard. Test specificity was 88-93% and concordance was ~89-92% (κ value 0.8-0.9). The patient-friendly kits described here address several of the existing challenges and are designed to provide 'Universal Access' to rapid TB diagnosis, including drug-resistant disease. Their utility was demonstrated by application to sputum at 2 sites in India. Our findings pave the way for larger studies in different point-of-care settings, including high-density urban areas and remote geographical locations., Competing Interests: The authors have read the journal’s policy and the authors of this manuscript state the following competing interests: NKG and AG are Managing and Executive directors of the company ‘Advanced Microdevices Pvt. Ltd.’ (mdi) respectively, the partial funder of this study. All the other authors are joint inventors with mdi in an Indian Provisional Patent application named ‘Apparatus and method for processing a sample for rapid diagnosis of tuberculosis and safe transport of bacteria’, (Patent application number- 201811042155). This does not alter the authors’ adherence to all the ‘PLOS ONE’ policies on sharing data and materials, as detailed online in the guide for authors.

Rice crop (var. Luit) was grown under controlled conditions in paper mill effluent contaminated soil and irrigated with undiluted paper mill effluent as well as normal water and compared the results against a control treatment consisting of similar unaffected soil irrigated with normal water. The effluent was alkaline (pH 7.5), containing high soluble salts (EC 2.93 dS m(-1)), chloride (600 mg L(-1)) and total dissolved solids (1875 mg L(-1)). At maximum tillering (MT) stage effluent irrigation significantly (P < 0.05) reduced the leaf numbers per hill and leaf area by 19.8 and 36.4 %, respectively. Tiller number and maximum root length were reduced by 19.3% and 12.5%, respectively at fifty percent flowering (FF) stage. Effluent irrigated crop recorded significant reduction in the dry matter production (17.5-24.9%) and grain yield (19%). Unfilled grain was increased by 10.7%. Higher concentration of sodium, calcium and magnesium in the effluent irrigated soil affected K uptake. Available soil P was lowest while available N, K, S and exchangeable and water soluble Na, K, Ca, Mg were highest in effluent irrigated soil. Chloride content found to increase (3-7 folds) while microbial biomass carbon reduced (10-37%). The adverse effect of the paper mill effluent on the crop as well as on the affected soil could be reduced significantly through normal water irrigation.

Background: Infection with Staphylococcus aureus was initially considered a major problem in hospitals, but over the last few decades the incidence of community-acquired infection has also increased. Paper currency has recently been identified as another mode of spread by which community-acquired S. aureus infection may be transmitted, since paper currency is frequently transferred from one person to another. In the present study, S. aureus strains were isolated from paper currency and screened to detect virulence-associated genes., Methods: Paper currency was collected randomly from operators in mutton shops, vegetable shops, hospitals, medical stores, snacks corners, and restaurants in the two cities of India, Dehradun and Delhi. Samples were screened for pathogenic S. aureus by various biochemical assays. Three isolates were used to study the survival of S. aureus on paper currency. Virulence genes were amplified by PCR. Antibiotic susceptibility was determined against nine antibiotics by the disk diffusion method., Results: Sixty-seven isolates of Staphylococcus aureus were isolated from paper currency from the two Indian cities. The maximum number of isolates was recovered from hospitals, followed by mutton shops, and the minimum from restaurants. The test isolates could survive on paper currency for eight days under in vitro conditions (27 degrees C temperature and 30% relative humidity). A set of four virulence genes viz. cna (16 isolates), icaA (19 isolates), hlg (21 isolates), and sdrE (18 isolates) was amplified using gene-specific primers. Only eight isolates possessed all four virulence genes. Antimicrobial susceptibility tests showed that those isolates having all the tested virulence genes were more resistant., Conclusions: This study clearly suggests that paper currency can serve as a carrier for the spread of resistant bacterial pathogens.

Agro-based pulp and paper mills in India are one of the most polluting industries; in addition, they are high consumers of raw water. Growing scarcity of high quality freshwater as well as stringent regulatory standards is compelling these units to explore appropriate water management options. Based on data obtained through a questionnaire survey and plant visits, this work provides an overview of the water use and effluent treatment status in Indian agro-residue and recycled pulp and paper mills. The challenges faced by this sector are reviewed and practices adopted by progressive units to minimize freshwater use are illustrated through case studies.

Paper industries using different raw materials such as hard wood, bamboo, baggase, rice-straw and waste papers and bleaching chemicals like chlorine, hypochlorite, chlorine dioxide, hydrogen peroxide, sulphite and oxygen were studied to estimate organic pollution load and Adsorbable Organic Halides (AOX) per ton of production. The hard wood based paper industries generate higher Chemical Oxygen Demand (COD) loads (105-182 kg t(-1)) and Biochemical Oxygen Demand (BOD) loads (32.0-72 kg t(-1)) compared to the agro and waste paper based industrial effluents. The bleaching sequences such as C-EP-H-H, C-E-H-H, C-E-Do-D1 and O-Do-EOP-D1 are adopted in the paper industries and the molecular elemental chlorine free bleaching sequence discharges low AOX in the effluent. The range of AOX concentration in the final effluent from the paper industries was 0.08-0.99 kg t(-1) of production. Water consumption was in the range of 100-130 m(3) t(-1) of paper production for wood based industries and 30-50 m(3) for the waste paper based industries. Paper machine effluents are partially recycled after treatment and pulp mill black liquor are subject to chemical recovery after evaporation to reduce the water consumption and the total pollution loads. Hypochlorite bleaching units of textile bleaching processes generate more AOX (17.2-18.3 mg l(-1)) and are consuming more water (45-80 l kg(-1)) whereas alkali peroxide bleaching hardly generates the AOX in the effluents and water consumption was also comparatively less (40 l kg(-1) of yarn/cloth).

The present study was undertaken with the objective to study the characteristics of the effluent of Century Pulp and Paper Mill, Lalkuan (Uttarakhand) in different seasons. The variations in the physicochemical characteristics were observed and monitored up to 12 months at three different sites. Mean values of temperature, pH, chlorides and total phenols of the effluent were found below, whereas colour, BOD5, COD and lignin concentrations were above the minimum national standards (MINAS).

In continuation of their studies on Biodegradation of cellulosic waste materials, the authors have presented their experimental data on biodegradation on waste paper pulp. Greater efficiency in the cow dung and M3 culture experimental setups have been pointed out and discussed. Necessity of detailed data evaluation of temperature, pH, dry weight, cellulose, protein, carbohydrate, Nitrate, Phosphate & Potassium levels is suggested. Derivation of %, absolute and increase/decrease % of BOO, COD and VS have been pointed out for the first time in solid waste Biodegradation. Further data evaluation and derivation of critical reaction rate kinetics have been recommended for further studies in solid waste-degradation to achieve quicker Bioconversion of cellulosic wastes into compost.

Competing Interests: None

Aim: Neonatal hypothermia is a preventable cause of neonatal mortality and morbidity, and wrapping neonates in newspaper sandwiched between cotton sheets is a simple intervention. This 2017 Indian pilot study tested the heat insulating property of sandwiched sheets., Methods: At birth, we randomised 100 neonates who were more than 32 weeks of gestation and needed neonatal intensive care unit (NICU) observation or care without a ventilator or bilevel positive airway pressure support into two groups of 50. The intervention and control groups were wrapped in two prewarmed sheets at birth that did or did not contain a layer of newspaper. Their axillary temperatures on arrival at the NICU and one hour after arrival were measured. Other environmental factors were similar., Results: The neonates wrapped in the sandwiched sheets showed significantly higher temperatures on arrival at the NICU than the control group (35.9°C versus 35.4°C, p < 0.01) and after one hour (36.5°C versus 36.3°C, p < 0.01). No change in behaviour or training was required for the healthcare staff to implement this initiative., Conclusion: Wrapping newborn infants in two cloth sheets with a newspaper layer resulted in a higher body temperature on arrival at the NICU and after one hour., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

In the present study, plant-scale process integration was applied to an Indian paper mill using the water cascade analysis (WCA) technique. Three limiting constraints, chemical oxygen demand (COD), total dissolved solids (TDS), and adsorbable organic halides (AOX), were considered for the study. A nearest neighbor algorithm was used to distribute the freshwater and recycled water among the plant operations. It was found that the limiting critical constraint depends upon the types of processes and streams involved in the integration. The limiting critical constraint can differ for different sections of the same industry, and can differ in different schemes of integration. After process integration, a 55.6% reduction in effluent flow, a 36% reduction in COD, and a 73% reduction in AOX were observed. After process integration, a 35.21% reduction in pollution costs can be achieved and, assuming the average production of the mill to be 225 tons per day, a savings of Indian rupees (INR) 1.73 per kg of paper produced can be achieved by employing process integration. The water cess was calculated as INR 3024.77 per day without integration for the sections that were considered for integration, while after integration, a 41.53% savings in the form of water cess was calculated., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The genetic and functional diversity of Bacillus and Bacillus-derived genera was analyzed in soil samples collected from three different fields near Century Paper Mill, Lal Kuan, Uttarakhand, India. Two had been subjected to concentrated and diluted effluent irrigation for the past 25 years and were designated as a concentrated effluent irrigated field (CEIF) and a dilute effluent irrigated field (DEIF), respectively. The field irrigated with fresh water was designated as a water irrigated field (WIF). Increase in pH, Na and Zn content and decrease in Fe content was observed due to effluent irrigation. The population count of Bacillus and Bacillus-derived was maximum in DEIF followed by WIF and CEIF. Variations in plant growth-promoting traits and extracellular enzymes were observed among the isolates from the three different field soils. Based on the amplified ribosomal DNA restriction analysis (ARDRA) with three restriction enzymes, all the selected 104 isolates were clustered into 14 groups. The sequencing of the representative isolates revealed that the majority belonged to the genus Bacillus, while three isolates belonged to Paenibacillus, Lysinibacillus and Orthinibacillus. There were a few species like Orthinibacillus contaminans, B. oleronius, B. safensis, B. methylotrophicus, B. stratosphericus, B. aryabhattai, B. asahii and B. bataviensis that were prevalent only in DEIF and CEIF but not in WIF field soil. The diversity index parameters like the Shannon Index, indices of species richness and species evenness based on biochemical profiling and ARDRA profiling revealed that Bacillaceae members in the fresh water irrigated field were diverse.

The seasonal physico-chemical and microbial quality of Gola river water has been analyzed after confluence of pulp paper mill waste. The study revealed that it has enhanced 20-30 times pollution load of BOD, COD, TDS, TSS, sulphate, chloride, sodium, nitrate, potassium, lignin and phenol after mixing of pulp paper mill waste with river water in all season. Further, it induced the bacterial growth by increasing most probable number value of E. coli was 1.57 x 10(4), 1.6 x 10(4), 1.37 x 10(4) and SPC count was 1.68 x 10(4), 1.64 x 10(4), 1.67 x 10(4)/100 ml during summer, monsoon, winter respectively. While the most probable number value in river water before mixing of pulp paper mill waste was 1.4 x 10(2), 1.82 x 10(2), 1.5 x 10(2) and SPC count was 2.8 x 10(3), 2.89 x 10(3), 2.78 x 10(3)/100 ml during summer, monsoon and winter respectively. This indicated from 88-114 fold increase in most probable number value of E. coli and 56.55-60.0 times increase in SPC count of river water after mixing of effluent in summer, monsoon and winter. Moreover, the most probable number value in effluent itself before mixing was 3.4 x 10(2), 3.3 x 10(2), 2.8 x 10(2) and SPC count was 6 x 10(4), 6.5 x 10(4), 6 x 10(4)/100 ml during summer, monsoon, winter, respectively. Furthermore, it was revealed that the seasonal variation also regulated the bacterial population dynamics as per the physico-chemical quality, in which E. coli was found highest at the rate of (5.9 x 10(4)), E. aerogenes (5.3 x 10(4)), P. aeruginosa (1.3 x 10(4)), S. aureus (3.2 x 10(3)), K. pneumoniae (2.6 x 10(4)), Enteritidis (1.1 x 10(4)) on monsoon season and V. cholerae (7.4 x 10(2)), V. vulnificus (9.2 x 10(2))/100 ml in river water when contaminated with pulp paper mill waste in monsoon season. Thus, the monsoon season showed presence of FC and TC indicated the thermo-tolerant and disease causing group of bacterial population in effluent and its sequence was observed as monsoon>summer>winter. This indicated the growth of many pathogenic and non-pathogenic bacteria for health hazards with contamination of pulp paper waste in aquatic ecosystem within the vicinity of pulp paper mill industry.

The indiscriminate discharge of large volumes of highly putrescible liquid waste from the Sanjai Paper & Chemical Industries Ltd. created serious pollution problem in river Ami near Maghar town area in the district Sant Kabir Nagar of U.P., India. The river is originated from Sikahra Tal near Hallaur (Tehsil - Dumariaganj) of Siddharthnagar district U.P. and disappears into Rapti river near Kouriram of Gorakhpur district U.P. In present investigation an attempt has been made to ascertain the present water quality condition of river Ami in relation to paper mill effluent discharge. The samples were collected from the upstream and downstream of the flow-path of the river from point source of pollution by the mill. The high degree of water quality degradation is reflected by the changes in values of BOD, COD, DO, nitrogen contents and chlorides etc in downstream.

The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine in Emergency Medicine as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3 year superspeciality course after completion of MD Diplomate of National Board (DNB) Pediatrics or MD DNB in EM. The National Board of Examinations that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG ACEE India) gives its recommendations for starting 3 year DM DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.