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Background The vulnerability of female sex workers (FSWs) to HIV infection increases if unprotected heterosexual anal intercourse (HAI) is practiced. Objectives To estimate the prevalence of HAI among FSWs, and associated factors, and prevalence of consistent condom use (CCU) during HAI and associated factors. Methods Analysis of cross-sectional data from nationwide biological and behavioural survey, conducted at 73 randomly selected domains with sample size of 27,000 in India. Results A total of 25,932 FSWs were included in the analysis, after excluding 1075 (3.9%) FSWs for which the data were incomplete. The prevalence of HAI was 29.9% (95% CI, 29.3, 30.4); The CCU during HAI in the last one month was 58.9%. Younger age at the start of sex work, use of mobile phone/internet for soliciting client, home as a place of sex work, consumption of alcohol/drug, and physical violence against FSWs were associated with higher odds of HAI. Frequent contact with outreach workers, awareness of sexually transmitted infection, and older age at the start of sex work was associated with CCU. Conclusion Prevalence of HAI was high among FSW in India. The national program could target those factors that reduce the odds of HAI and/or promote CCU.

Frailty models are the possible choice to counter the problem of the unobserved heterogeneity in individual risks of disease and death. Based on earlier studies, shared frailty models can be utilised in the analysis of bivariate data related to survival times (e.g. matched pairs experiments, twin or family data). In this article, we assume that frailty acts additively to the hazard rate. A new class of shared frailty models based on generalised Lindley distribution is established. By assuming generalised Weibull and generalised log-logistic baseline distributions, we propose a new class of shared frailty models based on the additive hazard rate. We estimate the parameters in these frailty models and use the Bayesian paradigm of the Markov Chain Monte Carlo (MCMC) technique. Model selection criteria have been applied for the comparison of models. We analyse kidney infection data and suggest the best model.

Why are social networks necessary at the place of destination? What roles do they play as a form of “social capital” for newly arrived migrants in urban centers? These are some relevant questions that scholars in migration studies have explored, especially in the context of international migration, but significant gaps exist in the case of internal migration. Using the migration history of the head of 400 households living in eight slum areas of Delhi, the present study attempts to differentiate the social networks available to the head of the households at their first arrival in Delhi based on the strong and weak ties and the caste-based network. The study also disentangles the role played by these social networks in providing social protection to household heads at their first arrival. The results show that social networks, especially strong family/kinship-based and caste-based networks, play an essential role in providing social protection by assisting newly arrived migrants with housing, food and information about employment.

Relapsed, resistant and untreated congenital talipes equinovarus poses significant challenges in view of functional outcome following conventional serial casting and soft tissue release procedures. The Ilizarov ring fixator here offers significant possibilities as an extended conservative treatment modality. The aim of the present study was to critically evaluate effectiveness of the Ilizarov ring fixator with regard to radiological, clinical and functional outcome, in the difficult clubfeet. The study was carried out on patients presenting with relapsed, resistant or untreated congenital talipes equinovarus deformity, who underwent deformity correction using the Ilizarov ring fixator application. All patients were reviewed at 6 monthly intervals for over 3 years following fixator removal with an objective clinical, radiological and functional assessment. Twenty-three patients with 30 clubfeet were enrolled in our study. The mean age was 8.3 +/- 3.6 (range 4 to 17) years. The postoperative clinical, radiological and functional scores showed statistically significant improvement among all patients when compared with the pre-operative data. All 30 feet developed varying complications during treatment with pin track infections being the most common. However, they were managed while continuing the distraction correction process. The Ilizarov ring fixator is an effective and reliable solution for difficult and challenging clubfeet. However, one must be aware of a strict adherence to a bracing protocol to avoid recurrence of deformities. A regular periodical functional and clinical follow up must be ensured among these children for a favourable outcome. Level of clinical evidence: 3

Introduction Congenital dislocation of the knee (CDK) is a rare condition and includes a characteristic hyperextension deformity at the knee with varying degrees of anterior and lateral subluxation. Developmental dysplasia of the hip (DDH) is a common disorder and presents frequently to a pediatrician. DDH with CDK is common, but hip pathology usually remains unnoticed because of more obvious deformity at the knee. Through this case, we aim to highlight the association of CDK with DDH and discuss its management. Case Presentation A preterm, 31-week baby girl, appropriate for gestational age, delivered to a primigravida mother with early antenatal oligohydramnios. At birth, the baby had an externally rotated left lower limb and the knee in hyperextension. A clinical diagnosis of CDK with ipsilateral DDH was confirmed further with a radiological evaluation of the left hip and knee. Staged correction of deformities was done starting with the knee, followed by the hip joint. By the 12th week of life, the knee and hip dislocations were corrected satisfactorily, which remained stable till the last follow-up (6 months). Conclusion CDK can present with an ipsilateral DDH, and this possibility needs attention. Newborns having congenital knee dislocation should undergo hip screening for instability by clinical methods. Ultrasound screening of the hip can be done if clinical examination is inconclusive. Such cases can be managed successfully by staged knee and hip disorder correction.

Objective To explore the differentials of postpartum contraceptive adoption between rural and urban poor after adjusting for utilization of MCH services and other selected socioeconomic and demographic covariates. Methods The data for this study is taken from the 4th round of NFHS survey conducted in India during 2015–16. The analysis is limited to 125,340 currently married women whose menses had returned at the time of survey. Discrete time complementary log–log multilevel model was applied. Results The results clearly indicate that women from rural areas had a lower chance of early initiation of modern spacing methods after having recent birth as compare to that of Urban Poor and Urban non-poor areas. The contributions of several socioeconomic and demographic characteristics that were important for family planning practice were also highlighted in this study. Conclusion There is an urgent need of designing an intervention that will result in effective delivery of services to achieve the greatest impact. Policy planners must focus on targeted interventions for family planning use in the postpartum period than simply focusing on family planning.

Adam Michael Auerbach. Demanding development: The Politics of Public Goods Provision in India’s Urban Slums (Cambridge: Cambridge University Press), 2020. ISBN: 9781108649377

A new noninvasive therapeutic device developed in our laboratory called the Oncomagnetic device provides a novel approach to glioblastoma (GBM) treatment. It involves repeated stimulation with oscillating magnetic fields (sOMF) produced by spinning permanent magnets. It is technologically and mechanistically distinct from the Optune® device approved by the FDA for the treatment of newly diagnosed and recurrent GBM. Use of this device in one end-stage GBM patient reversed the progression of his recurrent tumor causing >30% reduction in its contrast-enhanced volume within 4 weeks of treatment. Mice with implanted mouse glioma cells in their brains also showed marked reduction in tumor size, increased survival (p< 0.05, n = 10) and higher DNA damage (g-H2AX foci) after sOMF treatment with a whole-body stimulation method developed by us. Normal mice exposed to sOMF for 4 months had no adverse effects on the brain and other organs. In-vitro, sOMF markedly increased reactive oxygen species (ROS) levels in cancer cells leading to the selective death of these cells, while sparing normal neurons and astrocytes. Detection of g-H2AX and 53BP1 foci showed that sOMF caused significant DNA damage in GBM cells and diffuse intrinsic pontine glioma (DIPG) cells but not in normal astroglial SVGp12 cells. Furthermore, sOMF exposure for just 2 h resulted in >40% loss of surviving GBM and DIPG cell colonies detected by clonogenic cell survival assay, similar to that produced by 2 Gy radiation dose. This loss was rescued by the antioxidant Trolox. These results indicate that sOMF stimulation has high anticancer potency comparable to low dose radiation therapy at the cellular level with an underlying mechanism of action that is substantially different from that proposed for Optune® TTF.

Paediatric femur neck fracture is an uncommon injury and is known for high rate of complications. This in turn, can have significant impact on development of hip and overall function of the child. Controversy prevails in many areas of management and it still remains a difficult injury to manage. Through this paper, an attempt has been made to summarize the current concepts in management and suggest current recommendations regarding the controversies so that these injuries can be managed judiciously. A systematic review was done as per PRISMA guidelines using pre-defined inclusion and exclusion criteria. 18 studies with better scientific evidence after quality assessment were included in the systematic review. Current trends and Controversial issues in management were then identified and discussed. It was observed that existing literature is inconclusive regarding several aspects of management of this injury with no clear guideline available. However, certain recommendations useful for decision making could be made. These injuries should be managed aggressively with operative fixation at the earliest and one should not hesitate to open reduce if acceptable alignment is not obtained after one or two gentle closed manipulations. Choice of implant and their configuration in neck can vary depending on age and weight of patient, type of injury and surgeon’s preference. Initial fracture displacement could be considered to be most predictive for development of osteonecrosis of the femoral head, whereas, role of surgical decompression, type of fixation and timing of surgery is still debatable. Functional outcome is primarily affected by osteonecrosis of the femoral head, nonunion and severe coxa vara, whereas mild coxa vara, shortening, and premature closure of physis when considered alone, don’t have significant influence on functional outcome in short term. Treatment of fracture neck femur in children is still controversial in many aspects and needs further research. It should be understood that complications can occur regardless of the method of treatment and might reveal their full impact many years after injury. Hence, a guarded prognosis should be explained to the parents and care-givers at the time of injury.

Human civilization reached a milestone in the first decade of the 21st century, when the global urban population became higher than rural for the first time. However, the process of urbanisation is not uniform across the globe, and striking differences exist in the spatial structure and trends of urbanisation in developed and developing regions because of varying rates of demographic and economic growth. The success of Sustainable Development Goals (SDGs) depends on addressing urbanisation challenges with comparative knowledge of the spatial structure and growth pattern of the cities across regions. In this context, the present study examines the spatial structures and urbanisation trends of cities in Asia and Europe through standardised data and visualisation, with particular reference to India and Germany. The results show that ‘shrinking cities’ are more common in Europe and particularly in Germany. In contrast, Indian cities have registered an overall increase in population of cities, although at a slower growth rate. Also, the rate of growth of the built-up areas is relatively higher in India than Europe. However, both these geographies are experiencing higher growth of built-up areas as compared to population. A detailed analysis of the built-up areas in select cities of Europe and India in different time-periods reveals the cities’ growth pattern to be aligned with transport routes. The study concludes that developing a common methodological approach to study the spatial structures and trends of different geographies is a crucial prerequisite for achieving the goals set under SDGs and the New Urban Agenda.

In this article, we propose inverse Gaussian correlated frailty model based on logistic exponential as baseline distribution. The Bayesian approach of Markov Chain Monte Carlo (MCMC) technique was ...

Structural reforms were adopted by India in the early 1990s. Despite a slowdown in the major economies of the world due to global financial crisis in 2008–2009, Indian economy has consistently performed better and achieved a growth rate of 8–9 per cent in the past decade. The proponents of the economic reforms thus believe that the measures of structural adjustment would bring about economic growth and narrow down the rural–urban gap in India. In this context, this article examines the impact of the reforms on rural–urban disparities with regard to select indicators of socio-economic development. This has been addressed by studying the pattern of education attainment levels, employment level and status, and the wage and consumption expenditures of rural and urban workers in India from 1993–1994 to 2011–2012. The results from the four rounds of the national sample survey (NSS) show that in the corresponding period, the gap between rural and urban areas has come down in the select indicators except employment.

Frailty models are used in the survival analysis to account for the unobserved heterogeneityin individual risks to disease and death. To analyze the bivariate data on relatedsurvival times (e.g. matched pairs experiments, twin or family data), the shared frailtymodels were suggested. In this manuscript, we propose a new mixture shared inverse Gaussian frailty model based on modified Weibull as baseline distribution. The Bayesian approach of Markov Chain Monte Carlo technique is employed to estimate the parameters involved in the models. In addition, a simulation study is performed to compare the true values of the parameters with the estimated values. A comparison with the existing model was done by using Bayesian comparison techniques. A better model for infectious disease data related to kidney infection is suggested.

In this manuscript, we propose a new mixture shared gamma frailty model based on Gompertz as baseline distribution. The Bayesian approach of Markov Chain Monte Carlo technique was employed to estimate the parameters involved in the models. A simulation study was performed to compare the true values and the estimated values of the parameters. Comparison with the existing model was done by using Bayesian comparison techniques and a better model for the infectious disease data is suggested.

The cryosphere plays a vital role in the climate system by changing the energy and mass transfer between the atmosphere and the surface, and it is the most important land cover type in the Himalayan and Polar Regions, which act as an important source of freshwater for rivers. This study examines Snow-Covered Area (SCA) and Snowline variations in the Uttarakhand Himalaya using the Normalized Difference Snow Index (NDSI). Three Landsat series imagery for 1990, 2000, 2010, and Sentinel Data from 2015 to 2021 were processed and analyzed through open-source software. In order to estimate the average elevation of the snowline, a digital elevation model was used and an area estimation study using multispectral imagery. The research focuses on the snowline and snow cover variations over the Uttarakhand Himalaya from 1990 to 2021 and the average snow line-height, respectively. This study shows that in the years 1990, 2000, 2010, and 2015 to 2021, snow line variations and area estimation differences in Uttarakhand, Central Himalaya, and snow line at above sea level (a.s.l.) in the western and eastern part of the study area. This study deals with the analysis of snow line shifting and cover. It suggests that the snow cover area in the Uttarakhand, Central Himalaya, is depleting steadily, which will have adverse impacts, especially upon water resources causing various economic and social disruptions in the near future.

Himalayan mountain region lying in the northern part of Indian sub-continent is among those zones which bears the most ecologically sensitive environments and is also a repository of biodiversity, fresh water storage and ecosystem services. Over the last three decades, land transformation related to exploitative land uses is among the main drivers of changing snow cover, vegetation cover and productivity in western Himalayas region. In a region where field-based research is challenging due to heterogenous relief and high altitude, quantifying the changes in temperature pattern using Remote Sensing Techniques can provide essential information regarding variating trends in different elements relating to temperature. This paper studies the trend analysis of changing temperature patterns using SWAT data (1979–2014) over Uttarakhand Himalayas and its association with altitudinal gradient. This paper investigates the trends in maximum (Tmax), minimum (Tmin) & mean (Tmean) temperatures in the annual, seasonal and monthly time-scales for 55 stations in the 5 regions of Uttarakhand’s Western Himalayan region which are categorized on the basis of elevation, from year 1979-2014. Statistical approaches are used to examine the effect of change in pattern of temperature upon the phenology of vegetation in the region under study, fresh water ecosystems, agricultural productivity, decreasing snow line & increasing tree line, change in duration of the seasons etc.

A new noninvasive therapeutic device developed in our laboratory called the Oncomagnetic device provides a novel approach to glioblastoma (GBM) treatment. It involves repeated stimulation with oscillating magnetic fields (sOMF) produced by spinning permanent magnets. It is technologically and mechanistically distinct from the Optune® device approved by the FDA for the treatment of newly diagnosed and recurrent GBM. Use of this device in end-stage GBM patients reversed the progression of their recurrent tumor causing >30% reduction in its contrast-enhanced volume within 4-6 weeks of treatment. Mice with implanted mouse glioma cells in their brains also showed marked reduction in tumor size, increased survival (p< 0.05, n = 10) and higher DNA damage (γ-H2AX foci) after sOMF treatment with a whole-body stimulation method developed by us. Normal mice exposed to sOMF for 4 months had no adverse effects on the brain and other organs. In-vitro, sOMF markedly increased reactive oxygen species (ROS) levels in cancer cells leading to the selective death of these cells, while sparing normal neurons and astrocytes. Detection of γ-H2AX and 53BP1 foci showed that sOMF caused significant DNA damage in GBM cells and diffuse intrinsic pontine glioma (DIPG) cells but not in normal astroglial SVGp12 cells. Furthermore, sOMF exposure for just 2 h resulted in >40% loss of surviving GBM and DIPG cell colonies detected by clonogenic cell survival assay, similar to that produced by 2 Gy radiation dose. This loss was rescued by the antioxidant Trolox. These results indicate that sOMF stimulation has high anticancer potency comparable to low dose radiation therapy at the cellular level with an underlying mechanism of action that is substantially different from that proposed for Optune® TTF. Citation Format: Shashank Hambarde, Arvind Pandey, David S. Baskin, Santosh A. Helekar. Spin oscillating magnetic field sOMF of oncomagnetic device selectively kills glioma cancer cells by inducing oxidative stress and DNA damage. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4789.

Background: Glioblastoma (GBM) is the most lethal primary malignant brain tumor with a median survival of 15-20 months. Concurrent temozolomide (TMZ) chemotherapy and radiation (XRT) remain the current standard of care (SOC) treatment for newly diagnosed GBM. The addition of tumor treating fields (TTFs) improves median survival from 16 to 20.9 months. This modest improvement underscores the urgent need to identify a new treatment modality as standalone therapy. We have reported recently that brief 2 - 6 h of daily brain stimulation with a new noninvasive, non-contact, magnetic stimulation device causes >30% reduction of contrast-enhanced tumor (CET) volume in an end-stage recurrent GBM patient after a ~30-day treatment. Purpose: The noninvasive Oncomagnetic device developed in our laboratory selectively kills glioblastoma (GBM) and other cancer cells while sparing normal developing neurons and astrocytes in vitro. The spinning oscillating magnetic field (sOMF) generated by this device disrupts electron transport in the mitochondrial respiratory chain leading to a marked increase in reactive oxygen species (ROS) and consequent cancer cell death. However, the downstream molecular mechanism of sOMF action is under investigation. We studied the cellular and molecular effects of sOMF treatment on GBM cell lines and investigated the response to Oncomagnetic monotherapy (OMT) in a syngeneic mouse model. We treated LN229 and U87 GBM cells with sOMF with and without a sub-therapeutic dose of TMZ in vitro. To study the anticancer effect of sOMF in vivo, we developed syngeneic GBM tumors in BALB/c mice by stereotactic intracranial injection of GL261WT cells. Tumor growth was monitored periodically by MRI scans. Results: Our results showed that sOMF significantly reduce cell proliferation and cell survival in vitro. We observed that sOMF induces DNA damage and arrests cells in G1 phase of cell cycle. OMT of tumor-bearing mice using a whole-body sOMF stimulation method caused a substantial retardation of tumor growth and reduction of the contrast-enhanced tumor volume in 9.4 T MRI scans. OMT also showed significant increase in overall survival in these mice. Conclusion: These experiments contribute to unraveling the mechanism of action underlying the response to OMT in GBM and provide a strong rationale for a standalone Oncomagnetic therapy for GBM. Citation Format: Arvind Pandey, Shashank Hambarde, David S. Baskin, Santosh A. Helekar. Antitumor effect of oncomagnetic therapy in glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 337.

Introduction: Perivascular fibrosis, characterized by increased amount of connective tissue around vessels, is a hallmark for vascular disease. Angiotensin II (Ang II) contributes to vascular disease via promoting T-cell activation and end-organ damage. Despite recent data suggesting the role of T cells in the progression of perivascular fibrosis, the underlying mechanisms are poorly understood. Objective: Kruppel-like Factor 10 is a transcription factor expressed in T cell subsets. We sought to investigate the role of KLF10 in CD4+ T cells in regulating vascular damage in an AngII mouse model. Methods: CD4-targeted KLF10 deficient (TKO) and CD4-Cre (WT) mice were generated and subjected to 28 days of Ang II infusion. Endpoint characterization included fibrotic organ transcriptomic analysis, multi-organ histology, flow cytometry, cytokine analysis, myograph vasoreactivity, and cardiac echocardiography. Results: TKO mice showed enhanced perivascular fibrosis compared to WT mice by histological analysis in the aorta, heart, and kidney. TKO mice had vessels with enhanced vasoconstriction to phenylephrine, hearts with impaired global longitudinal strain by echo, and kidneys with elevated albumin/creatinine ratio. However, no change was found in blood pressure between TKO and WT. Plasma IL-9 and IL-15 were increased in TKO mice. IL-9 mRNA and secreted protein were also increased in activated TKO CD4+ T cells, as well as in Ang II treated WT-CD4+ T cells in vitro . Mechanistic studies revealed that KLF10 regulated Il9 transcription through interaction with promoter region of Il9 by ChIP assay. Notably, injection of anti-IL9 antibody reversed perivascular fibrosis in Ang II infused TKO mice. Conclusion: CD4+ T cell deficiency of Klf10 exacerbated perivascular fibrosis and multi-organ dysfunction in response to Ang II via upregulation of IL-9. Klf10 or IL-9 in T cells might represent novel therapeutic targets for the treatment of vascular or fibrotic diseases.

The noninvasive Oncomagnetic device developed in our laboratory selectively kills glioblastoma (GBM) and other cancer cells while sparing normal developing neurons and astrocytes in vitro. We have reported that brief 2 – 6 h of daily Oncomagnetic brain stimulation causes >30% reduction of contrast-enhanced tumor (CET) volume in an end-stage recurrent GBM patient after a ~30-day treatment. We have evidence that the spinning oscillating magnetic fields (sOMF) generated by this device disrupts electron transport in the mitochondrial respiratory chain, at least in part by inhibiting the activity of Complex II succinate dehydrogenase, leading to a marked increase in reactive oxygen species (ROS) and consequent cancer cell death. Here, we further studied the cellular effects of sOMF treatment alone and in combination with Temozolomide (TMZ) on GBM cell lines with other methods and investigated the response to Oncomagnetic monotherapy (OMT) in a mouse GBM model. We treated LN229 and U87 GBM cells with sOMF with and without a sub-therapeutic dose of TMZ. To study the anticancer effect of sOMF in vivo, we developed syngeneic GBM tumors in BALB/c mice by stereotactic intracranial injection of GL261WT cells. Our results show that cytotoxic effects of sOMF or TMZ alone, as measured by the MTT assay and reduced cell survival, are significantly potentiated by combining the two treatments. OMT of tumor-bearing mice using a whole-body sOMF stimulation method causes substantial retardation of tumor growth and reduction of the CET volume in 9.4 T MRI scans. To study the molecular pathways involved in the treatment response we are mapping alterations in various key biomarkers in treated tumor tissues and comparing them with those in untreated controls. These experiments will unravel the molecular mechanism of action underlying the response to OMT in GBM and help develop a sound rationale for an effective therapeutic protocol.

Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS’s recommended metrices. Method The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030.

The emphasis of conventional survival research methods has historically been on the occurrence of failures over time. The lack of knowledge of related observed and unobserved covariates during the study of such events can have negative consequences. Frailty models are a viable option for investigating the impact of unobserved covariates in this context. In this article, we suppose that frailty multiplies the hazard rate. As a useful method to ensure the effect of unobserved heterogeneity, we propose weighted Lindley (WL) frailty models with generalized Weibull (GW) and generalized log-logistic-II (GLL2) as the baseline distributions. The Bayesian paradigm of Markov Chain Monte Carlo (MCMC) methodology is used to estimate the model parameters. Subsequently, model comparisons are performed via Bayesian comparison techniques. The popular kidney data set is considered to illustrate the results. It is shown that the new models perform better than those based on gamma and inverse Gaussian frailty distributions.

There are several causes for the increasing rate of deglaciation, such as global warming, increase in the concentration of black carbon, and extensive use of fossil fuels which causes the change in the overall climate system and shifting glacier ecosystem. This study was conducted on Pindari valley glaciers part of lesser Himalaya in Uttarakhand. This study investigates to (1) monitor and map change in the frontal length or the snout region of a glacier that can be studied with the help of remote sensing techniques and (2) evaluate the decadal and annual retreat rate of the glacier from 1972 to 2018. The study applies both the maximum likelihood classifier and NDSI spectral indices based classification for extracting the glacier region for different periods. This study reveals a significant amount of retreats taking place in the selected glaciers, Pindari, Sundardhunga, Kafni, and Baljuri base camp glaciers, from 1972 to 2018 as 1719.95 m, 1751.21 m, 1057.01 m, and 810.78 m, respectively. The highest amount of change is noticed in Pindari and Sundardhunga glaciers, higher than ~ 1700 m. The study analyses temporal variation of the annual and decadal retreat rate in the Pindari valley glaciers, which would be helpful for the further study of the other glaciers.

Background India plans elimination of HIV-Mother-to-Child-Transmission in 2020. Targets include >95% coverage of Antenatal-care (ANC) and HIV-testing. In 2015-16, while 43% of the estimated Indian pregnant-women (PW) received HIV-tests, one state reported >95% testing. Indian public-health-care is a three-tiered system from primary-level sub-centres (population-5000) to tertiary-level hospitals. ANC involves multiple-visits per pregnancy at different care-levels and data are aggregated in the Health-Management-Information-System (HMIS) at all levels. We validated (public and private-sector data from this state, for duplication in ANC registration and HIV-testing using mixed methods. Methods In the absence of guidelines for assessing aggregate-data duplication, we used mixed-methods, including surveys among 9845 PW and providers from 240 facilities in 10/36 representative districts; in-depth-interviews; case-studies and analysis of HMIS and HIV-program data (April 2015-Mar 2017). Interviews and case-studies highlighted inadvertent duplicate data-capture. Surveys quantified levels of duplication and adjustment factors (public and private-sector) were developed. Results Twenty-four% PW, visited multiple facilities for ANC, while 81% providers reported all the PW coming to their facilities as new ANC registrations (irrespective of lower-tier registration); identifying a minimum duplication of 19% (24%*81%) in ANC coverage. Twenty-nine% and 28% PW from public and private-facilities reported >1 HIV-test; while 75% and 36% reported visiting another public-facility where HIV test was likely to be reported again. Minimum duplication of 22% and 10% in HIV testing was noted in public and private-sectors respectively. Conclusions We report methods to quantify repeat HIV-testing and duplicate-reporting, due to inherent processes in ANC in public-healthcare in India. Modification of data-capture was recommended and adopted across India. Key messages Assessing duplication in aggregate health data is key to developing robust datasets for disease elimination

Background Improvement in people’s knowledge of HIV/AIDS and reduction in stigma and discrimination have been key factors in the fight against HIV/AIDS. The objective of the present paper is to examine the mediation effect of comprehensive knowledge on people’s attitudes towards HIV positives in India. Methods Data for the study have been drawn from nationally representative India’s National Family Health Survey, 2015-16. Statistical methods of data analysis included odds ratio and logistic regression models. Results Two in every five men and of women with comprehensive knowledge held a positive attitude towards PLHIVs. The people in rural areas and females against their counterparts are less likely (OR: 0.85, p Conclusions There existed a difference between males and females in attaining comprehensive knowledge and having comprehensive positive attitude. The mediation by comprehensive knowledge contributed, though partially, direct effects from gender perspective on comprehensive positive attitude. The findings are programmatically relevant to device content analysis of the material in the information, education and communication strategies. Key messages The mediation effect of comprehensive knowledge on people’s attitudes towards HIV positives has been substantial in India.

Solution combustion route was employed for synthesis of the parent, La2Mo2O9 and its derivatives with formula La2-xBixMo1.95V0.05O9-δ (0.200≤x≤0.075). Powder X-Ray diffraction, SEM, DSC and...

The doubly-doped bismuth vanadate with Al and Ti having formula unit, Bi2V1−xAlx/2Titx/2O5.5-δ (0.10 ⩽ x ⩽ 0.25) was synthesized. The specimens were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared (FT-IR), differential scanning calorimetric (DSC), UV-Vis, and electrochemical impedance spectroscopy (EIS) for their structural, thermal, optical, and electrical studies. Influence of both dopant cations (Al and Ti) was observed in the gradual stabilization of the tetragonal phase of Bi2VO5.5-δ with dopant amount. A non-uniform grain growth phenomenon was observed up to x = 0.175, with dopant addition. UV-Vis study revealed the comparatively higher order of oxide ion vacancies for the composition x = 0.175. Impedance spectroscopy measurements indicate a significant decrease of both the grain (Rg) and grain boundary resistances (Rgb) with the rise in temperature and the overall resistance is found to be dominated by the grain interior contribution. Enhancement of ionic conductivity was found in all the compositions in the intermediate temperature range as compared to the parent compound, and the single Al-doped system and the highest value were obtained for x = 0.175.

La2Mo2-xVxO9-δ (0 ≤ × ≤ 0.100) has been synthesized using solution combustion method. The specimens were subjected to structural and electrical characterizations. X-Ray diffraction, DSC and the conductivity vs temperature plot reveal the stabilization of cubic structure for × ≥ 0.050. At temperature 425 °C , transition from Arrhenius to VTF behaviour is observed for the compositions × ≥ 0.050. The conductivities of V-doped compounds (for × ≥ 0.050) have been found to increase in the intermediate temperature range (425–510 °C ) as compared to the parent compound. The conductivities of the parent compound in the cubic region are observed to be marginally higher than the β-stabilized vanadium substituted compounds. Among the β-stabilized compositions, x = 0.050 exhibit the highest conductivities in the intermediate temperature range as well as in the high-temperature regime.

Background Cephalomedullary nails are presently the gold standard in management of unstable trochanteric fractures. The tip-apex distance (TAD) is one of the most important factors that determines success or failure of fixation, but was described originally in context of an extramedullary hip screw. Cephalomedullary nails use a different biomechanical approach to fixation; and it is hypothesized that the TAD rule may not apply similarly with these. The aim of this study is to assess whether a high TAD correlates with poor outcomes with cephalomedullary nails, and to elucidate other factors that may predict such outcome. Methods We retrospectively reviewed the clinical and radiographic records of patients with intertrochanteric fractures, treated at our institution over a 2-year period. Those with unstable fractures (31.A2 and 31.A3), and who were treated with cephalomedullary nails were included in the study. The TAD and the position of the device in the femoral head (Cleveland index) were assessed. Other factors that could influence outcome like age, gender, AO fracture type, restoration of neck-shaft angle and degree of osteoporosis were analysed. Radiographic records of up-to at-least 3 months post-operatively were assessed for complications. Results After applying the exclusion criteria, 75 patients were included in the analysis. The overall rate of complications was 12%. They occurred in two major patterns - varus collapse and cut-out occurred in 5 patients (6.67%), and device migration in 4 patients (5.33%). The average TAD of patients with cut-out was 28.78 mm, compared to 19.44 mm in those without cut-out (p = 0.002). Our data predicted a cut-off TAD >23.56 mm as most significant for cut-out with cephalomedullary nails. On univariate logistic regression, high TAD (p = 0.009), sub-optimal device positioning (p = 0.02) and poor restoration of neck-shaft angle (p = 0.04) were found to be significant for varus collapse and cut-out, but not for complications relating to device migration. On multivariate analysis, none of the above factors reached statistical significance in isolation. Conclusion As with extramedullary devices, TAD, along with sub-optimal device positioning and poor restoration of neck-shaft angle is a useful predictor of cut-out even with cephalomedullary nails, negating the initial hypothesis. The above factors in combination have a more significant effect than any one factor in isolation to cause varus collapse and implant cut-out. However these do not affect Z effect, reverse Z effect or other types of device migration seen especially with dual-screw nails.

In this article, we propose additive shared gamma frailty model and additive shared inverse Gaussian frailty model with Lindley as baseline distribution to analyze the infectious disease data set o...

Summary Background India had the largest number of under-5 deaths of all countries in 2015, with substantial subnational disparities. We estimated national and subnational all-cause and cause-specific mortality among children younger than 5 years annually in 2000–15 in India to understand progress made and to consider implications for achieving the Sustainable Development Goal (SDG) child survival targets. Methods We used a multicause model to estimate cause-specific mortality proportions in neonates and children aged 1–59 months at the state level, with causes of death grouped into pneumonia, diarrhoea, meningitis, injury, measles, congenital abnormalities, preterm birth complications, intrapartum-related events, and other causes. AIDS and malaria were estimated separately. The model was based on verbal autopsy studies representing more than 100 000 neonatal deaths globally and 16 962 deaths among children aged 1–59 months at the subnational level in India. By applying these proportions to all-cause deaths by state, we estimated cause-specific numbers of deaths and mortality rates at the state, regional, and national levels. Findings In 2015, there were 25·121 million livebirths in India and 1·201 million under-5 deaths (under-5 mortality rate 47·81 per 1000 livebirths). 0·696 million (57·9%) of these deaths occurred in neonates. There were disparities in child mortality across states (from 9·7 deaths [Goa] to 73·1 deaths [Assam] per 1000 livebirths) and regions (from 29·7 deaths [the south] to 63·8 deaths [the northeast] per 1000 livebirths). Overall, the leading causes of under-5 deaths were preterm birth complications (0·330 million [95% uncertainty range 0·279–0·367]; 27·5% of under-5 deaths), pneumonia (0·191 million [0·168–0·219]; 15·9%), and intrapartum-related events (0·139 million [0·116–0·165]; 11·6%), with cause-of-death distributions varying across states and regions. In states with very high under-5 mortality, infectious-disease-related causes (pneumonia and diarrhoea) were among the three leading causes, whereas the three leading causes were all non-communicable in states with very low mortality. Most states had a slower decline in neonatal mortality than in mortality among children aged 1–59 months. Ten major states must accelerate progress to achieve the SDG under-5 mortality target, while 17 are not on track to meet the neonatal mortality target. Interpretation Efforts to reduce vaccine-preventable deaths and to reduce geographical disparities should continue to maintain progress achieved in 2000–15. Enhanced policies and programmes are needed to accelerate mortality reduction in high-burden states and among neonates to achieve the SDG child survival targets in India by 2030. Funding Bill & Melinda Gates Foundation.

Genome damage and their defective repair have been etiologically linked to degenerating neurons in many subtypes of amyotrophic lateral sclerosis (ALS) patients; however, the specific mechanisms remain enigmatic. The majority of sporadic ALS patients feature abnormalities in the transactivation response DNA-binding protein of 43 kDa (TDP-43), whose nucleo-cytoplasmic mislocalization is characteristically observed in spinal motor neurons. While emerging evidence suggests involvement of other RNA/DNA binding proteins, like FUS in DNA damage response (DDR), the role of TDP-43 in DDR has not been investigated. Here, we report that TDP-43 is a critical component of the nonhomologous end joining (NHEJ)-mediated DNA double-strand break (DSB) repair pathway. TDP-43 is rapidly recruited at DSB sites to stably interact with DDR and NHEJ factors, specifically acting as a scaffold for the recruitment of break-sealing XRCC4-DNA ligase 4 complex at DSB sites in induced pluripotent stem cell-derived motor neurons. shRNA or CRISPR/Cas9-mediated conditional depletion of TDP-43 markedly increases accumulation of genomic DSBs by impairing NHEJ repair, and thereby, sensitizing neurons to DSB stress. Finally, TDP-43 pathology strongly correlates with DSB repair defects, and damage accumulation in the neuronal genomes of sporadic ALS patients and in Caenorhabditis elegans mutant with TDP-1 loss-of-function. Our findings thus link TDP-43 pathology to impaired DSB repair and persistent DDR signaling in motor neuron disease, and suggest that DSB repair-targeted therapies may ameliorate TDP-43 toxicity-induced genome instability in motor neuron disease.

Background: This mixed-methods study was undertaken to ascertain undergraduate medical students’ perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study. Methods: Data was collected using a validated questionnaire and four focus group discussions. Results: Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures. Conclusions: Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback.

Background Estimating the clinical demand for blood and components arising in a health facility is crucial to ensure timely availability of blood. This study aims to estimate disease-specific clinical demand, supply and utilization of whole blood and components in India. Methods We conducted a national level cross-sectional study in five randomly selected states from five regions of the country. We included 251 public and private facilities representing primary, secondary and tertiary care facilities. We collected annual disease-specific demand, supply and utilization of blood and components using a structured tool. We estimated the national demand by extrapolating the study data (demand and beds) to the total number of estimated beds in the country. Findings According to the study, the total clinical demand of 251 health facilities with 51,562 beds was 474,627 whole blood units. Based on this, the clinical demand for India was estimated at 14·6 million whole blood units (95 CI: 14·59–14·62), an equivalent of 36·3 donations per 1,000 eligible populations, which will address whole blood and component requirement. The medicine specialty accounted for 6·0 million units (41·2%), followed by surgery 4·1 million (27·9%), obstetrics and gynecology 3·3 million (22·4%) and pediatrics 1·2 million (8·5%) units. The supply was 93% which is equivalent to 33·8 donations against the demand. Conclusion The study indicated a demand and supply gap of 2.5 donations per 1,000 eligible persons which is around one million units. The gap emphasises the need for sustained and concerted efforts from all stakeholders and for increasing the awareness about repeat voluntary non-remunerated blood donation (VNRBD); optimizing the availability of blood components through efficient blood component separation units; promoting modern principles of patient blood management and strengthening capacities of human resources in the blood transfusion system in India.

Background The stability of biological samples is vital for reliable measurements of biomarkers in large-scale survey settings, which may be affected by freeze-thaw procedures. We examined the effect of a single freeze-thaw cycle on 13 nutritional, noncommunicable diseases (NCD), and inflammatory bioanalytes in serum samples. Method Blood samples were collected from 70 subjects centrifuged after 30 minutes and aliquoted immediately. After a baseline analysis of the analytes, the samples were stored at − 70°C for 1 month and reanalyzed for all the parameters. Mean percentage differences between baseline (fresh blood) and freeze-thaw concentrations were calculated using paired sample t-tests and evaluated according to total allowable error (TEa) limits (desirable bias). Results Freeze-thaw concentrations differed significantly (p < 0.05) from baseline concentrations for soluble transferrin receptor (sTfR) (− 5.49%), vitamin D (− 12.51%), vitamin B12 (− 3.74%), plasma glucose (1.93%), C-reactive protein (CRP) (3.45%), high-density lipoprotein (HDL) (7.98%), and cholesterol (9.76%), but they were within respective TEa limits. Low-density lipoprotein (LDL) (− 0.67%), creatinine (0.94%), albumin (0.87%), total protein (1.00%), ferritin (− 0.58%), and triglycerides (TAG) (2.82%) concentrations remained stable following the freeze-thaw cycle. In conclusion, single freeze-thaw cycle of the biomarkers in serum/plasma samples after storage at − 70°C for 1 month had minimal effect on stability of the studied analytes, and the changes in concentration were within acceptable limit for all analytes.