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Introduction: The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. Methods: We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. Results: Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. 'Poor'-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson's disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. Conclusion: Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation. [ABSTRACT FROM AUTHOR]

The estimation of the night-time cloud fraction (CF) is found to be one of the key parameters for evaluating the number of useful nights at an astronomical site. This work evaluates useful astronomical night-time observation over eight sites using a minimum threshold of CF from 21 years (2000–2020) of ground-based hourly visual and daily satellite data along with 41 years (1980–2020) of long-term hourly reanalysis data. The estimated number of photometric nights is underestimated by 8–24 per cent using the reanalysis data at Indian Astronomical Observatory-Hanle in comparison with the visual observations, while the estimated number of spectroscopic nights is 70–75 per cent per year and in good agreement with the visual observations. Among the astronomical sites, Paranal is found to be the best for astronomical observations, with 87 per cent spectroscopic nights per year. On the other hand, Hanle, Ali and Devasthal, located in the Himalayan region, exhibit an average of 68–78 per cent spectroscopic nights per year based on long-term reanalysis data, while Merak exhibits 61–68 per cent spectroscopic nights per year. Vertical profiles and global horizontal distributions for CF and related variable parameters are further compared among the sites. Global CF trends based on 41 years of reanalysis data show a decreasing tendency over most land regions and an increasing tendency over oceanic regions as well as over the Sahara desert, Middle East, and Indian subcontinent along the adjacent Tibetan Plateau. Such different CF trends between the ocean and land regions are thought to be the result of differential surface warming and water vapour changes associated with climate change. [ABSTRACT FROM AUTHOR]

• Number of clear nights are quantified using cloud fraction (CF) data at various astronomical sites. • Observed CF data from visual observation are validated with MERRA-2 and AIRS data at IAO-Hanle • Visual CF data shows good correlation of 0.78–0.84 with AIRS (ascending) data at the site • Median CF for night at Hanle and Mauna Loa are 0.32 and 0.49,respectively using MERRA-2. We report for validation of cloud fraction estimated from high-resolution (hourly) data from MERRA-2 and AIRS instrument aboard NASA's Aqua satellite during its ascending and descending orbits with hourly ground-based visual observation taken at Indian Astronomical Observatory (IAO), Hanle during 1997–2018. The study reveals 70% useful nights, equivalent to 254 spectroscopic nights in a year. A comparative study of cloud fraction was performed using homogeneous and continuous data spanning six years (2013–2018) from MERRA-2 and AIRS over IAO, Hanle and Merak sites in the Himalayan region, and several astronomical observatories located in Atacama desert in Chile, Canary islands in Spain, National Astronomical Observatory (NAO), Mexico, and Mauna Loa in Hawaii. The study reveals cloud fractions of 0.07–0.11 at 25% (1st Quartile) and 0.32–0.40 at 50% (median) at the Himalayan sites. On the other hand, the median cloud fractions are 0.06–0.13 at the Chilean sites, 0.16 at NAO, and 0.29 at Canary islands. The observed 25% of the cloud fraction at the Himalayan sites during the lowest three cloud-fractional months (October-December) are comparable with other sites located in Chile and Canary islands. The median cloud fraction at Hanle is slightly lower than Mauna Loa. The study further concluded that the percentage of useful nights obtained from the visual observation (70%) at IAO-Hanle is very close to the percentage of clear sky (68%) estimated from the MERRA-2 data. [ABSTRACT FROM AUTHOR]

Abstract After successful implementation of the Montreal Protocol, total ozone column (TOC) has considerably increased since the mid 1990s. However, the recovery is weak and statistically non-significant particularly at low-latitudes as the healing encounters many obstacles during the process. Decline trend of TOC over high-altitude (3000 m–5000 m amls) entire region in Ladakh (32N - 35N, 77E - 80E), India located in the western trans-Himalayan region which extends upto Tibetan Plateau (TP) in mid-latitude, is approaching in an alarming rate of ∼ -1.30 DU/year from the last few decades. The present work intends to examine whether the ozone recovery is already started or yet to start over the region using TOMS-OMI and SBUV-merged data during 1970–2017. During the TOC depletion, the estimated trends are deepening and statistically significant with −1.27 to −1.32 DU per year over the region. However, recovery of TOC has noticed over the region in the recent years and healing is still slow and statistically non-significant with 0.14–0.23 DU per year. Such non-significant trends are associated with variabilities from natural cycles, such as Brewer-Dobson circulation (BDC), Quasi-Biennial Oscillation (QBO), 11 year solar cycle, etc., and these effects can be removed using multiple linear regression (MLR) model. Solar maxima during the last four cycles (21–24) are nearly followed by the TOC maxima. Upward transport of air by BDC can move ozone poor air into the lower stratosphere as noticed by elevated vertical pressure velocity which may offset the ozone recovery over the region. With relevant to the TOC recovery, the surface temperature over Ladakh region is warming at a rate of 0.3–0.4 K per year during 1980–2016. Further, the study noticed recovery of TOC at both the hemispheres with maximum of 0.23–0.50 DU per year at high-latitudes (45–60) using the MRL model. However, results of the TOC recovery at low-latitudes (15–30) in both the hemispheres are weak with 0.03–0.10 DU per year. Highlight • Recovery of total ozone column (TOC) over Ladakh region is around 0.10 to 0.12 DU/year. • TOC recovery in high-latitudes NH and SH are 0.24 and 0.50 DU/year, respectively. • TOC recovery in low-latitudes at NH and SH are very weak with 0.03 to 0.1 DU/year. • MLR model effectively removes the noise or uncertainties in the TOC trend estimation. • Ladakh region is warming at an alarming rate of 0.3-0.4 K/year from last few decades. [ABSTRACT FROM AUTHOR]

The present work evaluates eleven existing empirical models to estimate Precipitable Water Vapor ( P W V ) over a high-altitude (4500 m amsl), cold-desert environment. These models are tested extensively and used globally to estimate P W V for low altitude sites (below 1000 m amsl). The moist parameters used in the model are: water vapor scale height ( H c ), dew point temperature ( T d ) and water vapor pressure ( E s 0 ). These moist parameters are derived from surface air temperature and relative humidity measured at high temporal resolution from automated weather station. The performance of these models are examined statistically with observed high-resolution GPS ( G P S P W V ) data over the region (2005–2012). The correlation coefficient (R) between the observed G P S P W V and Model P W V is 0.98 at daily data and varies diurnally from 0.93 to 0.97. Parameterization of moisture parameters were studied in-depth (i.e., 2 h to monthly time scales) using G P S P W V , T d , and E s 0 . The slope of the linear relationships between G P S P W V and T d varies from 0.073°C −1 to 0.106°C −1 (R: 0.83 to 0.97) while G P S P W V and E s 0 varied from 1.688 to 2.209 (R: 0.95 to 0.99) at daily, monthly and diurnal time scales. In addition, the moist parameters for the cold desert, high-altitude environment are examined in-depth at various time scales during 2005–2012. [ABSTRACT FROM AUTHOR]

Integrated precipitable water vapor (PWV) retrieved from Moderate Resolution Imaging Spectro-radiometer (MODIS) in near-infrared channels is examined with the PWV estimated from the Global Positioning System (GPS) data and measured surface temperature and pressure values over Hanle, located at a high-altitude (∼4500 m) trans-Himalayan region. Since the accuracy of MODIS derived PWV over the large elevated topography of the region is not well studied, the present work focus on the validation of MODIS PWV using the GPS data during 2005–2012. The study reveals that MODIS PWV compares well with the GPS PWV data with bias −0.018 cm, root mean square error (RMSE) 0.137 cm and coefficient of determination ( R 2 ) 0.91. The two types of data products are compared on short (daily) and long temporal (monthly-seasonal) scales in order to evaluate the seasonal dependence of PWV. The peak values of PWV from MODIS and GPS data at the site varied from 1.7 to 2.05 cm and 1.2 to 1.4 cm as the daily and the monthly means, respectively, which occurred during August. However, the seasonal peak of PWV occurred during summer as 0.88 and 0.97 cm for MODIS and GPS data, respectively. The present study noticed that about 85% of the total PWV estimated from MODIS as well as GPS data lies below 1.0 cm over the site. The seasonal study of PWV reveals that MODIS data is found to be underestimating the PWV when compared to GPS data with bias −0.095 cm and RMSE 0.215 cm particularly during summer. This is due to dry and high-altitude terrain of Hanle particularly during summer months. However, there are marginal differences (bias varied from 0.007 to 0.017 cm) during the remaining seasons and seasonally R 2 varies from 0.62 to 0.87. GPS PWV exhibits distinct diurnal cycle with minimum in morning as well as in night and peak in the late afternoon (16–18 h) irrespective of the seasons. However, the diurnal cycle is very prominent during summer than the rest of the seasons. [ABSTRACT FROM AUTHOR]

The aim of the present study is to explore pharmacokinetic and protein binding characteristics of a novel dipeptidylpeptidase-4 (DPP-4) inhibitor, teneligliptin in rats using an ultra high performance liquid chromatography–quadrupole time-of-flight mass spectrometry (UHPLC–QTOF-MS). It is required for demonstrating the high protein binding nature of teneligliptin which can be extended for drug repositioning to brain disorders. Sample preparation was accomplished through a protein precipitation procedure using acetonitrile. Separation of teneligliptin and sitagliptin (IS) from endogenous components with high selectivity and sensitivity (0.5 ng/mL) was achieved within 4 min using Poroshell 120 EC-C18 column (100 × 3.0 mm, 2.7 μ). A gradient mobile phase consisting of 10 mM ammonium formate and acetonitrile was applied at a flow rate of 0.45 mL/min. Detection of target ions [M + H] + at m/z 427.2274 for teneligliptin and m/z 408.1258 for IS was performed in selective ion mode using positive ion electrospray ionization high resolution accurate mass spectrometry. The linearity of the method was found to be in the range of 0.5–1000 ng/mL. The matrix effect was 88.7–94.5% for teneligliptin. Plasma samples were found to stable under different storage conditions. It was successfully applied to pharmacokinetic and plasma protein binding study of drug in rats. Results showed linear dose proportionality of pharmacokinetics at 0.1 and 1 mg/kg and relatively high protein binding of teneligliptin (85.46 ± 0.24 %) compared with other DPP-4 inhibitors. [ABSTRACT FROM AUTHOR]

Estimation of aerosol radiative forcing (ARF) was performed using a radiative transfer model (Rstar6b) along with physical and optical parameters of aerosols obtained from sky radiometer observation over Indian Astronomical Observatory (IAO), Hanle, Ladakh, during 2008–2010 from dust, anthropogenic, and aged background observing conditions. ARF was estimated at the top of the atmosphere (TOA), in the atmosphere, and at the surface during the three observing conditions. During dust and anthropogenic events, average aerosol optical depth (AOD at 500 nm) went up to 0.24 from the aged background observing condition 0.04. Such enhancement of AOD is associated by the combination of desert-dust and anthropogenic aerosols transported from distant sources as noticed from Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO). Such three types of aerosols are also identified from the observed properties of single scattering albedo (SSA), aerosol asymmetry (AS) parameter, and aerosol size distribution. The estimated ARFs at TOA, at the surface, and in atmosphere are − 3.73, − 6.82, and 3.40 Wm − 2 , respectively during the dust advection period. On the contrary, the respective ARFs during the aged background observing condition are − 1.50, − 2.22, and 0.70 Wm − 2 , respectively. A significant difference of spectral AOD is observed during dust, anthropogenic, and aged background observing conditions. Ångström exponent (AE) decreases from 1.05 in the aged background observing condition to 0.40 in the dust event. A significant difference of coarse–fine mode volume distribution is also observed between the dust and the anthropogenic cases. Further, the study reveals high aerosols induced during the dust and the anthropogenic episodes caused warming at atmosphere and cooling at surface which collectively may affect the local atmospheric circulation. [ABSTRACT FROM AUTHOR]

Diurnal features of aerosol optical depth (AOD) at a high-altitude station, Hanle (4500 m amsl) in the western Himalayas, were studied using direct/diffuse solar irradiance measurement from a Skyradiometer (Prede) during October 2007 to December 2010. The study reveals a diurnal asymmetry in the measured aerosol characteristics, with three types of diurnal variation in AOD. Among them, Types I and II are prominent during pre-monsoon, while Type III dominates during post-monsoon. Type I appears to be associated with new-particle formation process from gaseous precursors, in addition to the combination of anthropogenic and desert-dust aerosols, probably brought by the prevailing westerly/south-westerly winds during the pre-monsoon season. The diurnal feature of the Type II may be attributed by the transported desert-dust aerosols brought by the prevailing winds. Further, Type III may be associated with the aged background aerosols over the region, pertaining to a small contribution from gaseous precursors. [ABSTRACT FROM AUTHOR]

Advection of anthropogenic aerosols from the Indo-Gangetic Plain (IGP) and dust aerosols from distant deserts towards a high-altitude station Merak, in the trans-Himalayan region are reported during June–July 2011. In order to differentiate the advection event, aerosol optical properties were examined during aged background conditions at the site. During the aged background conditions, aerosol optical depth (AOD at 500 nm) and Angstrom exponent ( α ) at the station were ∼0.06 and 1.36, respectively which were increased to 0.13 and 1.62, respectively during the advection event. Further, a strong signature of fine-mode aerosol volume size distribution, dominated by absorbing aerosols, was observed during the advection event. The average atmospheric forcing during the aged background condition was found to be 0.57 Wm −2 (with corresponding heating rate of 0.05 Kday −1 ) and these results were enhanced to 2.58 Wm −2 (with corresponding heating rate of 0.22 Kday −1 ) during the advection event. The present study reveals that during the advection event, heating rate in the atmosphere was increased by about four times than the aged background condition. Such atmospheric warming in the region may influence the melting of the Himalayan glaciers and consequently it may effect the local atmospheric circulation. [ABSTRACT FROM AUTHOR]

Abstract: The present work was carried out to check the performance of a Prede Sky radiometer and the stability of the solar calibration constant (F0s) at two high altitude pristine stations, Hanle and Merak in Ladakh region during 2008 to 2012. Two procedures for F0s calculation were applied: one based on the normal Langley plot technique, the other based on a modified method that allows determining F0s from measurements of sky irradiance. The instrument measures sun/sky irradiance at five wavelengths in the visible and near infrared regions, and the data were processed using 4.2 version of the Skyrad.Pack software. The inputs of the software are solid view angles (SVA) at the five wavelengths and sky irradiances at different scattering angles normalized by the direct irradiances. Auxiliary sets of data such as surface albedo, atmospheric pressure, and total column ozone of the station are required to run the software. The software has two processing levels. In the first scheme, Aerosol optical depth (AOD) is retrieved along with single scattering albedo (SSA), phase function, and volume size distribution as the products of radiative transfer calculation. In the second scheme, AOD and the other parameters are calculated from Lambert–Beer law after estimating the F0s from the first scheme. On an average, the deviation of SVA during the last five year period was found to be stable with less than 1.0% from the SVA values set during installation. The estimated F0s from normal and improved Langley methods were quite agreed. The estimated F0s show temporal variation and the uncertainties of estimated F0s in the present study were within 2%. Further, uncertainties of AOD and SSA due to ±2% variation in the F0s were within 0.02 and 0.2, respectively. The estimated coefficients of variation (CV) of the determined F0s show a dependence on the observed AOD. [Copyright &y& Elsevier]

Differential scanning calorimetry (DSC) is a primary technique for measuring the thermal properties of materials, which reflects the physico-chemical properties of drug substances. In the present study, it is used as a screening technique for assessing the compatibility of sitagliptin with some currently employed pharmaceutical excipients. The influence of processing conditions and their effects (simple blending, co-grinding or kneading) on drug stability was evaluated. Sitagliptin showed a sharp endothermic peak at 212.1 °C with an enthalpy change of 131.5 J g indicating melting of drug. Facile transformation of dehydrated sitagliptin to monohydrate form was observed in some mixtures, disappearance of sharp melting endothermic peak of sitagliptin was observed in some mixtures. On the basis of DSC results, sitagliptin was found to be compatible with micro crystalline cellulose, croscarmellose, and pregelatinized starch. Some excipient interaction was observed with magnesium stearate, ascorbic acid, and citric acid. X-ray diffractometry and FT-IR were used as supportive tools in interpreting the DSC results. Overall, the excipients selected were compatible with the API and the mixtures are stable within the tested conditions. These results would be useful for formulation development of the film coated tablets of sitaglitptin. [ABSTRACT FROM AUTHOR]

Optical properties of aerosols over Hanle (4500mamsl) in the western Himalayas were studied using skyradiometer observations during October 2007 to December 2010. Yearly mean value of aerosol optical depth (AOD) at 500nm is 0.042±0.002, which demonstrates the pristine environment of the station. Seasonal mean AODs at 500nm during summer, autumn, winter, and spring are 0.044±0.002, 0.031±0.001, 0.031±0.001, and 0.061±0.002, respectively. The relatively high AOD during spring, associated with an elevated aerosol layer observed from space, supports the hypothesis of middle-upper tropospheric heating during pre-monsoon period. Seasonal mean values of Angstrom exponent (α) estimated from linear regression method varied from minimum 0.65 (spring) to maximum 1.02 (autumn). Dominance of coarse mode aerosols at the site is thus evident during spring. Analysis of AOD profiles obtained from satellite data and airmass back trajectories superimposed with fire-counts data indicated the presence of desert–dust at the altitudes of 5 to 7kmamsl during the episodes of high AOD and low α. These trajectories indicated airmasses mostly coming from different desert regions, e.g in north-west Asia and Iran in the Middle east. Further, arrival of airmasses from the densely populated and industrialized Punjab and Haryana regions from the north-west of India apparently explains the relative contribution of transported anthropogenic aerosols over the station. [ABSTRACT FROM AUTHOR]

Objective: To develop and validated a new stability indicating reverse phase high performance liquid chromatography (RP-HPLC) method for analysis of naftopidil (NAF), both as a bulk drug and in formulation. Method: The separation was achieved using a C18 GRACE column (250 mm × 4.6 mm i.d., 5 μm particle size) and gradient mobile phase system consisting of (A) 10 mM of ammonium acetate buffer pH adjusted to 4.0 with glacial acetic acid and (B) acetonitrile. The flow rate was 1.0 mL/min with UV detection at 284 nm. NAF was subjected to stress conditions like hydrolysis (acid, alkali and neutral degradation), oxidation, photolytic and thermal decomposition. The linearity of the proposed method was investigated in the range of 10-150 μg/mL. Application of design of experiments for the robustness study method was carried out, where in five factors was selected: pH of mobile phase, flow rate, strength of the buffer and column temperature. These factors were examined using JMP@ (SAS Institute) software. Result: The analytical method for NAF was developed and validated at the linearity range of 10-150 μg/mL. The LOD and LOQ were 0.6 and 2.04, respectively and accuracy of analysis was 100.5-101.1%. Conclusion: A robuststabilityindicating HPLC assay method was developed using DOE, for the quantitation of NAF in its bulk and tablet dosage forms [ABSTRACT FROM AUTHOR]

The impacts of climate change have severely affected geosphere, biosphere and cryosphere ecosystems in the Hindu Kush Himalayan (HKH) region. The impact has been accelerating further during the last few decades due to rapid increase in anthropogenic activities such as modernization, industrialization and urbanization, along with energy demands. In view of this, the present work attempts to examine aerosol optical depth (AOD) over the HKH region using the long-term homogeneous MERRA-2 reanalysis data from January, 1980 to December, 2020. The AOD trends are examined statistically with student's t-test (t). Due to a vast landmass, fragile topography and harsh climatic conditions, we categorized the HKH region into three sub-regions, namely, the northwestern and Karakoram (HKH1), the Central (HKH2) and the southeastern Himalaya and Tibetan Plateau (HKH3). Among the sub-regions, the significant enhancement of AOD is observed at several potential sites in the HKH2 region, namely, Pokhara, Nainital, Shimla and Dehradun by 55.75 × 10 − 4 ± 3.76 × 10 − 4 , 53.15 × 10 − 4 ± 3.94 × 10 − 4 , 51.53 × 10 − 4 ± 4.99 × 10 − 4 and 39.16 × 10 − 4 ± 4.08 × 10 − 4 AOD year − 1 (550 nm), respectively, with correlation coefficients (Rs) of 0.86 to 0.93. However, at a sub-regional scale, HKH1, HKH2 and HKH3 exhibit 23.33 × 10 − 4 ± 2.28 × 10 − 4 , 32.20 × 10 − 4 ± 2.58 × 10 − 4 and 9.48 × 10 − 4 ± 1.21 × 10 − 4 AOD year − 1 , respectively. The estimated trends are statistically significant (t > 7.0) with R from 0.81 to 0.91. Seasonally, the present study also shows strong positive AOD trends at several potential sites located in the HKH2 region, such as Pokhara, Nainital, Shimla and Dehradun, with minimum 19.81 × 10 − 4 ± 3.38 × 10 − 4 to maximum 72.95 × 10 − 4 ± 4.89 × 10 − 4 AOD year − 1 with statistical significance. In addition, there are also increasing AOD trends at all the high-altitude background sites in all seasons. [ABSTRACT FROM AUTHOR]

We examine the impact of atmospheric aerosols and clouds on the surface solar radiation and solar energy at Nainital, a high-altitude remote location in the central Gangetic Himalayan region (CGHR). For this purpose, we exploited the synergy of remote-sensed data in terms of ground-based AERONET Sun Photometer and satellite observations from the MODerate Resolution Imaging Spectroradiometer (MODIS) and the Meteosat Second Generation (MSG), with radiative transfer model (RTM) simulations and 1 day forecasts from the Copernicus Atmosphere Monitoring Service (CAMS). Clouds and aerosols are one of the most common sources of solar irradiance attenuation and hence causing performance issues in the photovoltaic (PV) and concentrated solar power (CSP) plant installations. The outputs of RTM results presented with high accuracy under clear, cloudy sky and dust conditions for global horizontal (GHI) and beam horizontal irradiance (BHI). On an annual basis the total aerosol attenuation was found to be up to 105 kWh m−2 for the GHI and 266 kWh m−2 for BHI, respectively, while the cloud effect is much stronger with an attenuation of 245 and 271 kWh m−2 on GHI and BHI. The results of this study will support the Indian solar energy producers and electricity handling entities in order to quantify the energy and financial losses due to cloud and aerosol presence. [ABSTRACT FROM AUTHOR]

The present work reports atmospheric opacity at 220 GHz over Indian Astronomical Observatory (IAO)-Hanle during 2006 to 2018. The opacity data were derived from the radiometric measurement of sky-brightness temperature as a function of zenith angle for every 10 min during day and night. Since the operating frequency range is not completely opaque during rainfall or cloudy atmosphere, observations are performed even during rainfall or cloudy sky conditions. The minimum opacities observed at the site varied from 0.06-0.07 at 1st quartile and 0.08-0.09 at 2nd quartile during December-January. Opacity at Hanle is linearly correlated with high temporal resolution GPS (Global Positioning System) Precipitable Water Vapor (PWV) with a correlation coefficient of about 0.8. The observed median opacity at Hanle has increased by 44% during the best observing months (October–March) and 24% over the annual data (October-September) with reference to the opacity observed during 2000–2003. Such increasing opacity trends are apparently due to effects of the dynamics of the regional and global hydrological cycle. In order to assess the impacts of the regional and global hydrological cycle, PWV obtained from AErosol RObotic NETwork (AERONET), satellite and reanalysis data were studied at nine high-altitude astronomical observatories spread spatially across the globe such as Atacama desert in Chile, Mauna Loa Observatory in Hawaii, Hanle and Merak in India, Ali and Yangbajing Observatories in Tibet, LLAMA in Argentina, and Dome A and Dome C in the Antarctic Plateau during 2003-2018. On an average, PWV trend over Atacama desert is increasing by 0.01 to 0.03 mm per year and at IAO-Hanle, Merak and Ali by 0.01 to 0.05 mm per year, indicating non uniform dynamic hydrological cycles. Interestingly, there is no noticeable PWV trend for the sites located in the Antarctic Plateau. During the four best observing months, PWV observed at Hanle, Merak and Ali sites have values lower than the Mauna Loa observatory by 0.14 mm and 0.56 mm at 1st and 2nd quartiles, respectively. • Median opacities at Hanle during 2006–2018 varied from 0.08–0.09 in winter. • Increasing opacity trends of 24% are noticed at Hanle using multi-year data sets. • Median precipitable water vapor (PWV) at Merak and Hanle varied from 2.16–2.23 mm. • Increasing opacity trends are attributed to increasing PWV of 0.01–0.05 mm yr-1. • Increasing PWV (0.01–0.03 mm yr-1) is observed at driest site in Atacama desert. [ABSTRACT FROM AUTHOR]

Analysis of the climatology of aerosol properties is performed over Hanle (4500 m) and Merak (4310 m), two remote-background sites in the western trans-Himalayas, based on eleven years (2008–2018) of sun/sky radiometer (POM-01, Prede) measurements. The two sites present very similar atmospheric conditions and aerosol properties allowing us to examine them as continuous single-data series. The annual average aerosol optical depth at 500 nm (AOD 500) is 0.04 ± 0.03, associated with an Ångström exponent (AE 440 – 870) of 0.58 ± 0.35 and a single scattering albedo (SSA 500) of 0.95 ± 0.05. AOD 500 exhibits higher values in May (~0.07) and lower in winter (~0.03), while AE 400 – 870 minimizes in spring, indicating influence by coarse-mode dust aerosols, either emitted regionally or long-range transported. The de-convolution of AOD 500 into fine and coarse modes justifies the aerosol seasonality and sources, while the marginal diurnal variation in all aerosol properties reveals a weak influence from local sources, except for some few aerosol episodes. The aerosol-volume size distribution presents a mode value at ~10 μm with secondary peaks at accumulation (~ 2 μm) and fine modes (~0.03 μm) and low variability between the seasons. A classification of the aerosol types based on the fine-mode fraction (FMF) vs. SSA 500 relationship reveals the dominance of aerosols in the FMF range of 0.4–0.6, characterized as mixed (39%), followed by fine aerosols with high scattering efficiency (26%), while particles related to dust contribute ~21%, with low fractions of fine-absorbing aerosols (~13%). The aerosol radiative forcing (ARF) estimates reveal a small cooling effect at the top of the atmosphere (−1.3 Wm−2), while at the surface, the ARF ranges from −2 Wm−2 to −6 Wm−2 on monthly basis. The monthly-mean atmospheric radiative forcing (~1 to 4 Wm−2) leads to heating rates of 0.04 to 0.13 K day−1. These ARF values are higher than the global averages and may cause climate implications over the trans-Himalayan region. Unlabelled Image • Long-term measurements over remote-background sites in western trans-Himalayas • Aerosol classification was studied for the first time over Ladakh region. • De-convolution of AOD into fine and coarse modes justifies aerosol seasonality and sources. • Dominance of mixed aerosols and fine particles with high scattering efficiency • Estimated aerosol radiative forcing over the region is higher than the global average. [ABSTRACT FROM AUTHOR]

The climatological characteristics of biomass burning over the western Indo-Gangetic Plain (IGP) are examined during the post-monsoon (October-November) season from 2001-2018 using the Moderate resolution Imaging Spectrometer (MODIS) fire products. The intensity of the biomass burning are estimated from the fire pixels detected by the MODIS satellites in the form of fire counts, surface brightness temperature, and fire radiative power. Such biomass burning are mostly affected over Lahore and Patiala region of the western IGP. These fire products are examined along with optical and physical properties of aerosols and its radiative forcing estimated from AErosol RObotic NETwork (AERONET) data. Due to non-availability of long-term aerosol data, the study was performed only at Lahore (AERONET) and Patiala (MODIS) of the western IGP region. The current study shows increasing trends of average brightness temperature by 16% year−1 over Patiala and 14% year−1 over Lahore, which enhances the aerosol optical depth (AOD) by 3%–7% year−1 over the study region. The sphericity of the fine-mode aerosols are rising from 23% to 61% during non-fire to fire events and the dominance of fine-mode aerosols are observed during the active fire events. Further, the absorptivity of AOD (at 440 nm) has enhanced from 0.07 to 0.14 during non-fire to fire events. Asymmetric parameter (AS) of fine-mode aerosol increases from 0.65 to 0.68 during non-fire to active fire events. The characteristics of elevated aerosol layers due to the active fire events are clearly distinguished from the non-fire events within 0-2 km above the surface as noticed from high aerosol extinction and attenuated back scatter coefficients, obtained from the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO). Absorbing aerosols associated from biomass-burning contribute to the surface radiative forcing by -173.96 ± 47 W m−2 and atmospheric forcing by 123.57 ± 41 W m−2 over Lahore. The impact of the biomass-burning over Lahore has making the atmosphere more warming by 3.50 ± 1.14 K Day−1. The estimated heating rates (HR) in the atmosphere are rising during both fire and non-fire events by 3.79% and 3.44% per year, respectively. • Increasing biomass-burning (14-16% year −1) in western IGP enhances AOD 3-7% year−1. • Aerosol sphericity increases from 23% to 61% during non-fire to active fire events. • Absorptivity of AOD increased from 0.07 to 0.14 (at 440 nm) during active fire events. • Elevated aerosol layer during active-fire events noticed below 2 km from the ground. • High value of heating rate (4K day−1) was observed due to enhance biomass-burning. [ABSTRACT FROM AUTHOR]

Using the Solar Back-scatter Ultraviolet merged ozone data during 1980–2016, the recovery of total ozone column (TOC) is examined in 5° wide latitude bands from 65°S to 65°N across the globe. Since the variability of TOC is influenced by various natural and anthropogenic proxies, a multiple linear regression (MLR) is employed to remove the dynamic variability. Among the proxies, lower stratospheric temperature at ~100hPa plays a significant role in the dynamics of the TOC variability. The MLR model has significantly improved after including the lower stratospheric temperature along with other proxies and the standard deviation of the estimated TOC trend has significantly reduced about 35 to 43% in 50°N-65°N and 16 to 20% in 45°S-65°S after using the lower stratospheric temperature during both the depletion (1980–1996) and recovery (1997–2016) phases. Cooling of lower-middle stratospheric temperature are observed during the depletion phase with −0.09 °C to −0.02 °C year−1. However, during the recovery phase, the temperature at the lower stratosphere is warming. Due to weak signals, the estimated warming trends are not statistically significant. The TOC trends are examined by the increasing or decreasing emission of chlorofluorocarbon, indicated by Equivalent Effective Stratospheric Chlorine (EESC) index. During the recovery phase, the EESC varies from 0.82±0.01 to 0.29±0.005 DU year−1 at 45–65°S using the lower stratospheric temperature. In the northern hemisphere, the recovery trends are weak and varied from 0.21±0.004 to 0.25±0.005 DU year−1 and these trends are statistically significant. This study suggests the importance of the lower stratospheric temperature to derive proper trends using the MLR model. • TOC is healing by 0.3 to 0.8 DU/year at 45-65S and 0.2 to 0.3 DU/year at 45-65 N with statistically significant. • The weak signature of TOC recovery at low latitudes may elusive by prolonged weakening of solar cycles. • During recovery phase, TOC is more sensitive to stratospheric temperature than the depletion phase. • Cooling rate of lower stratospheric temperature during depletion phase has altered in the recovery phase. [ABSTRACT FROM AUTHOR]

Presents a study on the impact of vertical gastroplasty on ghrelin secretion. Comparison of the outcome of two bariatric surgeries; Association of ghrelin with stimulating appetite and eating behaviors; Documentation of stable body weight in all cases.

Background: It has been previously reported in the literature that the COVID-19 pandemic resulted in overall excess deaths and an increase in non-COVID deaths during the pandemic period.Specifically, our research elucidates the impact of the COVID-19 pandemic on non-COVID associated mortality., Study Aim: To compare mortality rates in non-COVID conditions before and after the onset of the COVID-19 pandemic in England and Wales., Study Design: Annual mortality data for the years 2011-2019 (pre-pandemic) and 2020 (pandemic) in England and Wales were retrieved from the Office for National Statistics (ONS). These data were filtered by ICD-10 codes for nine conditions with high associated mortality. We calculated mortality numbers - overall and age stratified (20-64 and 65+ years) and rates per 100 000, using annual mid-year population estimates., Methods: Interrupted time series analyses were conducted using segmented quasi-Poisson regression to identify whether there was a statistically significant change (p < 0.05) in condition-specific death rates following the pandemic onset., Results: Eight of the nine conditions investigated in this study had significant changes in mortality rate during the pandemic period (2020). All-age mortality rate was significantly increased in: 'Symptoms Signs and Ill-defined conditions', 'Cirrhosis and Other Diseases of the Liver', and 'Malignant Neoplasm of the Breast', whereas 'Chronic Lower Respiratory Disorders' saw a significant decrease. Age-stratified analyses also revealed significant increases in the 20-64 age-group in: 'Cerebrovascular Disorders', 'Dementia and Alzheimer's Disease', and 'Ischaemic Heart Diseases'., Conclusion: Trends in non-COVID condition-specific mortality rates from 2011 to 2020 revealed that some non-COVID conditions were disproportionately affected during the pandemic. This may be due to the direct impact COVID-19 had on these conditions or the effect the public health response had on non-COVID risk factor development and condition-related management. Further work is required to understand the reasons behind these disproportionate changes., Competing Interests: There are no conflicts of interest to declare., (© 2024 The Authors.)

Background: The Quality Outcomes Framework (QOF) is a pay incentive scheme in England designed to improve and standardise general practice. QOF attainment has been used as a proxy for primary care quality in previous research., Aim: To investigate whether there is a relationship between socioeconomic deprivation and QOF attainment in primary care in England., Design & Setting: Retrospective longitudinal study of primary care providers in England., Method: QOF scores were obtained for individual general practices in England from between 2007-2019 and linked to practice-level Indices of Multiple Deprivation (IMD) scores derived from census data. Beta regression analyses were used to analyse the relationship with either percentage of total QOF attainment or of domain-specific attainment with multivariate analyses, adjusting for additional practice-level demographics. QOF attainment in the most affluent quintile was used as the reference group., Results: General practices in less deprived areas have consistently outperformed those in more deprived areas in terms of QOF achievement. Initially, the gap between least and most deprived practices decreased, however since 2015 there has been relatively little change in comparative performance. The magnitude of inequality was reduced after adjusting for demographic factors. Of the independent variables analysed, the proportion of patients aged >65 years ('over 65s') had the strongest relationship with QOF attainment., Conclusion: There remains an inequality in primary care quality by socioeconomic deprivation in England, even after accounting for demographic differences., (Copyright © 2023, The Authors.)

Objective: Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants., Methods: We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias., Findings: A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies., Conclusion: Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The UK Health Security Agency (UKHSA) has provided vaccine manufacturers with post-marketing surveillance reports which the companies are required to submit to the UK Licensing Authority in compliance with their Risk Management Strategy, and a cost recovery charge is made for these reports., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Introduction: Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity., Methods: Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented., Results: Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified., Conclusion: Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Shortland et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Non-pharmaceutical interventions (NPIs), such as travel restrictions, social distancing and isolation policies, aimed at controlling the spread of COVID-19 may have reduced transmission of other endemic communicable diseases, such as measles, mumps and meningitis in England., Methods: An interrupted time series analysis was conducted to examine whether NPIs was associated with trends in endemic communicable diseases, using weekly reported cases of seven notifiable communicable diseases (food poisoning, measles, meningitis, mumps, scarlet fever and pertussis) between 02/01/2017 to 02/01/2021 for England., Results: Following the introduction of COVID-19 restrictions, there was an 81.1% (95% CI; 77.2-84.4) adjusted percentage reduction in the total number of notifiable diseases recorded per week in England. The greatest decrease was observed for measles, with a 90.5% percentage reduction (95% CI; 86.8-93.1) from 42 to 5 cases per week. The smallest decrease was observed for food poisoning, with a 56.4% (95%CI; 42.5-54.2) decrease from 191 to 83 cases per week., Conclusions: A total reduction in the incidence of endemic notifiable diseases was observed in England following the implementation of public health measures aimed at reducing transmission of SARS-COV-2 on March 23, 2020. The greatest reductions were observed in diseases most frequently observed during childhood that are transmitted via close human-to-human contact, such as measles and pertussis. A less substantive reduction was observed in reported cases of food poisoning, likely due to dining services (i.e., home deliveries and takeaways) remaining open and providing a potential route of transmission. This study provides further evidence of the effectiveness of non-pharmaceutical public health interventions in reducing the transmission of both respiratory and food-borne communicable diseases., (© 2022. The Author(s).)

Lithium ion batteries (LIB) are the domain power house that gratifies the growing energy needs of the modern society. Statistical records highlight the future demand of LIB for transportation and other high energy applications. Cathodes play a significant role in enhancement of electrochemical performance of a battery, especially in terms of energy density. Therefore, numerous innovative studies have been reported for the development of new cathode materials as well as improving the performance of existing ones. Literature designate stable cathode-electrolyte interface (CEI) is vital for safe and prolonged high performance of LIBs at different cycling conditions. Considering the context, many groups shed light on stabilizing the CEI with different strategies like surface coating, surface doping and electrolyte modulation. Local temperature variation across the globe is another major factor that influences the application and deployment of LIB chemistries. In this review, we discuss the importance of nano-scale engineering strategies on different class of cathode materials for their improved CEI and hence their low and high temperature performances. Based on the literature reviewed, the best nano-scale engineering strategies investigated for each cathode material have been identified and described. Finally, we discuss the advantages, limitations and future directions for enabling high performance cathode materials for a wide range of applications., (© 2022 IOP Publishing Ltd.)

Extending the charge cutoff voltage of LiCoO 2 (LCO) beyond 4.2 V is considered as a key parameter to obtain higher energy densities. Following gaps have been identified based on a thorough literature survey especially for higher cutoff voltage of nanoscale engineered LCO cathodes, (i) different metal oxides and metal fluoride surface coatings have been mostly done independently by different groups, (ii) room temperature performance was the focus with limited investigations at high temperature, (iii) nonexistence of low temperature cycling studies and (iv) no reports on high rate capability of LCO beyond 4.5 V (especially at 4.8 V) needs to be investigated. Herein, we report the effect of nanoscale engineering of LCO along with the role of coating chemistry and thickness to study its electrochemical performance at higher voltages and at wide operating temperatures. Surface coating was implemented with different metal oxides and a metal fluoride with tunable thickness. At 4.5 V, 5 wt% Al 2 O 3 coated LiCoO 2 (LCO@Al 2 O 3 -5) delivered a reversible capacity of 169 mAh g -1 at 100 mA g -1 and 151 mAh g -1 at high rate of 10 C (2 A g -1 ) and 72% retention at the end of 500 cycles. At 55 °C, it exhibited better stability over 500 cycles at 5 C and even at -12.5 °C it maintained 72% of its initial capacity after 100 cycles at 200 mA g -1 . At 4.8 V cut-off, LCO@Al 2 O 3 -5 rendered reversible capacity of 213 mAh g -1 at 100 mA g -1 , a high value compared to literatures reported for LCO. Also noted that it delivered a capacity of 126 mAh g -1 at a current density of 1 A g -1 , whereas bare could only exhibit 66 mAh g -1 under same testing conditions. Enhanced performance of LCO@Al 2 O 3 -5 can be ascribed to the lower charge transfer resistance derived from the stable solid solution formation on the interface. Ex situ XRD and ex situ Raman analysis at different stages of charge/discharge cycles correlates the enhanced performance of LCO@Al 2 O 3 -5 with its structural stability and minimal structural degradation., (© 2022 IOP Publishing Ltd.)

Background: Socioeconomic deprivation is associated with health inequality. Previous studies have described associations between primary care prescribing rates and deprivation for individual drugs or drug classes. We explore the correlation between socioeconomic deprivation and the rate of prescribing of individual pharmaceutical drugs, and drug classes, in primary care in England, to identify prescribing inequalities that would require further investigation., Methods: In this cross-sectional study, national primary care prescribing data, by primary care practice, were retrieved for the calendar year 2019 in England. Socioeconomic deprivation was quantified using the Index of Multiple Deprivation (IMD) score. Correlations were calculated using Spearman's rank correlation coefficient (ρ), adjusting for practice list size and demographics, with a Bonferroni-corrected p value threshold of 5×10 -5 ., Results: We included 1.05 billion prescription items dispensed from 6896 England practices. 142/206 (69%) drug classes and 505/774 (65%) drugs were significantly correlated with IMD score (p<5×10 -5 ). Of the 774 included drugs, 31 (4%) were moderately positively associated with IMD score (ρ>0.4). Only one was moderately negatively correlated with IMD score (ρ<-0.4), suggesting higher prescribing rates in more affluent areas. The drug classes most strongly associated with IMD score included opioid and non-opioid analgesics, antipsychotics and reflux medications. Drug classes most strongly associated with affluence included epinephrine, combined oral contraceptives and hormone replacement therapy., Conclusion: We identify novel associations of prescribing with deprivation. Further work is required to identify the underlying reasons for these associations so that appropriate interventions can be formulated to address drivers of inequality., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

We conducted a scoping review of studies on health outcomes from electronic nicotine delivery systems (ENDS). The objective was to identify, narratively synthesize, assess the strength and quality of evidence and critically appraise studies that have reported disease end points associated with the use of ENDS. We included published literature on the health impact of ENDS from 01/01/2015 until 01/02/2020 following the PRISMA guidelines using PubMed, Embase, Scopus and Google Scholar. The database search identified 755 studies, and other sources 265; 37 studies met final eligibility criteria. Levels of evidence included 24(65%) cross-sectional, one (2.7%) case-control and six (16%) case studies, four (11%) cohort studies, one (2.7%) randomized controlled trial (RCT) and one (2.7%) meta-analysis; 27(73%) studies reported only on harms, eight (22%) reported on benefits, two (2%) on benefits and harms. Quality ratings were poor in 20 (54%), fair in 9(24%) and good in 8(22%) of studies. In our review, ENDS was not shown to be causative for harmful cardiovascular disease (CVD) outcomes and shown to be beneficial for hypertensive patients. Switching from cigarettes to e-cigarettes resulted in reduced exacerbations of chronic obstructive pulmonary disease (COPD), with no evidence of long-term deterioration in lung function. Mental Health, cancer and mortality were not adequately studied to form any consensus. Our review has not demonstrated ENDS to be causative of harmful CVD outcomes; furthermore switching from cigarettes to e-cigarettes was associated with improved hypertensive control and reduced exacerbations of COPD, with no evidence of increased asthma risk or long-term respiratory harm. Mental health, cancer and mortality outcomes have not been adequately studied to form a conclusion. Overall, the findings of our review did not provide evidence to counter the consensus held by many that ENDS use is safer than the risks posed from smoking cigarettes., (© 2021. The Author(s).)

In the present study, a protocol was developed for processing of human adipose derived mesenchymal stem cell secretome formulation of varying concentration. Its molecular composition was evaluated, and its effectiveness in vitro using breast cancer cell lines, and in vivo in a nude mice breast cancer model was studied to determine its role in suppressing triple negative breast cancer in a dose dependent manner. Because the secretome could have value as an add-on therapy along with a current drug, the effectiveness of the secretome both in monotherapy and in combination therapy along with paclitaxel was evaluated. The results showed significant cell kill when exposed to the secretome above 20 mg/ml at which concentration there was no toxicity to normal cells. 70 mg/ml of SF showed 90 ± 10% apoptosis and significant decrease in CD44 + /CD24 - , MDR1+ and PDL-1+ cancer cells. In vivo, the tumor showed no growth after daily intra tumor injections at 50 mg/ml and 100 mg/ml doses whereas substantial tumor growth occurred after saline intra tumor injection. The study concludes that SF is a potential biotherapeutic for breast cancer and could be used initially as an add-on therapy to other standard of care to provide improved efficacy without other adverse effects., (© 2021. The Author(s).)

Objectives: Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries., Methods: Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically., Results: 108 articles were included. Most focussed on the Zika virus outbreak ( n  = 50) and the COVID-19 pandemic ( n  = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted., Conclusions: To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.

Early detection of liver tumors and cirrhotic lesions by magnetic resonance imaging (MRI) remains a great challenge. Here, we report a biomineral nanocontrast agent based on iron-doped nanocalcium phosphate (nCP:Fe-CA) for magnetic resonance imaging of early-stage liver cirrhotic and hepatocellular carcinoma nodules using rat models. We have optimized an intravenously injectable, aqueous suspension of nCP:Fe-CA having an average size of 137.6 nm, a spherical shape, magnetic relaxivity of 63 mM -1 S -1 , and colloidal stability for 48 h, post-resuspension in an aqueous phase. Compared to superparamagnetic iron oxide nanoparticles (SPIONs), the optimized nCP:Fe-CA could detect liver tumor lesions as small as ∼0.25 cm, whereas the current clinical detection limit is ∼1 cm. In addition, multiple cirrhotic nodules of size <0.2 cm could be detected by nCP:Fe-CA-assisted MRI. The number of nodules observed after injecting nCP:Fe-CA was ∼3 times higher than that without CA (5-10 nodules). A biocompatibility study on healthy rats injected with nCP:Fe-CA showed unaltered liver transaminases, blood urea nitrogen, serum creatinine, and insignificant hemolysis. Furthermore, hepatobiliary clearance of nCP:Fe-CA was observed in 72 h compared to prolonged retention of SPIONs for 30 days when tested under identical conditions. Overall, the nCP:Fe-CA nanoparticles showed promising results as a biocompatible, MR contrast (T2) agent for the early-stage imaging of liver cirrhosis and hepatocellular carcinoma.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been predominantly respiratory. This study aimed to evaluate the presence of virus in non-airborne body fluids as transmission vehicles. Medline, EMBASE, and Cochrane Library databases were searched from December 01, 2019, to July 01, 2020, using terms relating to SARS-CoV-2 and non-airborne clinical sample sources (feces, urine, blood, serum, serum, and peritoneum). Studies in humans, of any design, were included. Risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy 2 tool. Preferred Reporting Items for Systematic Reviews & Meta-Analyses) guidelines were used for abstracting data. If ≥5 studies reported proportions for the same non-respiratory site, a meta-analysis was conducted using either a fixed or random-effects model, depending on the presence of heterogeneity. A total of 22 studies with 648 patients were included. Most were cross-sectional and cohort studies. The SARS-CoV-2 RNA was most frequently detected in feces. Detectable RNA was reported in 17% of the blood samples, 8% of the serum, 16% in the semen, but rarely in urine. Prevalence of SARS-CoV-2 in non-airborne sites varies widely with a third of non-airborne fluids. Patients with bowel and non-specific symptoms have persistence of virus in feces for upto 2 weeks after symptom resolution. Although there was a very low detection rate in urine, given the more frequent prevalence in blood samples, the presence of SARS-CoV-2 in patients with disrupted urothelium or undergoing urinary tract procedures, is likely to be higher. Healthcare providers need to consider non-airborne transmission and persistence of SARS-CoV-2 in body fluids to enable appropriate precautions to protect healthcare workers and carers.

Background: In March 2018, NHS England published guidance for clinical commissioning groups (CCGs) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia., Aim: To investigate the impact of guidance publication on prescribing rates of simple analgesia (oral paracetamol, oral ibuprofen, and topical non-steroidal anti-inflammatory drugs) in primary care; CCG guidance implementation intentions; and whether the guidance has created health inequality based on socioeconomic status., Design and Setting: Interrupted time series analysis of primary care prescribing data in England., Method: Practice-level prescribing data from January 2015 to March 2019 were obtained from NHS Digital. Interrupted time series analyses were used to assess the association of guidance publication with prescribing rates. The association between practice-level prescribing rates and Index of Multiple Deprivation scores before and after publication was quantified using multivariable Poisson regression. Freedom of information requests were submitted to all CCGs., Results: There was a statistically significant 4.4% reduction in prescribing of simple analgesia following guidance publication (adjusted incidence rate ratio 0.96, 95% CI = 0.92 to 0.99, P = 0.027), adjusting for underlying time trend and seasonality. There was considerable diversity across CCGs in whether or how they chose to implement the guidance. Practice-level prescribing rates were greater in more deprived areas., Conclusion: Guidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating additional health inequality. Careful implementation by CCGs would be required to optimise cost saving to the NHS., (© The Authors.)

The current study examines the impact of the COVID-19 lockdown (25th March until May 17, 2020) period in particulate matter (PM) concentrations and air pollutants (NO x , SO 2 , CO, NH 3 , and O 3 ) at 63 stations located at Delhi, Uttar Pradesh and Haryana states within the Delhi-NCR, India. Large average reductions are recorded between the stations in each state such as PM 10 (-46 to -58%), PM 2.5 (-49 to -55%), NO 2 (-27 to -58%), NO (-54% to -59%), CO (-4 to -44%), NH 3 (-2 to -38%), while a slight increase is observed for O 3 (+4 to +6%) during the lockdown period compared to same periods in previous years. Furthermore, PM and air pollutants are significantly reduced during lockdown compared to the respective period in previous years, while a significant increase in pollution levels is observed after the re-opening of economy. The meteorological changes were rather marginal between the examined periods in order to justify such large reductions in pollution levels, which are mostly attributed to traffic-related pollutants (NO x , CO and road-dust PM). The WRF-CHIMERE model simulations reveal a remarkable reduction in PM 2.5 , NO 2 and SO 2 levels over whole Indian subcontinent and mostly over urban areas, due to limitation in emissions from the traffic and industrial sectors. A PM 2.5 reduction of -48% was simulated in Delhi in great consistency with measurements, rendering the model as a powerful tool for simulations of lower pollution levels during lockdown period., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Turkish National Committee for Air Pollution Research and Control. Production and hosting by Elsevier B.V. All rights reserved.)

Background : High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods : This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019-Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).

Introduction: Globally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension., Methods: A literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate., Results: Sixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations., Conclusion: Hypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)