Search

The main goal of this study is to investigate the strength and compaction characteristics of soil stabilized by fly ash with multiwalled carbon nanotube (MWCNT) as an additive. The materials used in the study were characterized using microscopic techniques like scanning electron microscopy-energy dispersive spectroscopy (SEM–EDS), and X-ray diffraction (XRD). The soil in the current study was replaced up to 50% by fly ash in the presence of MWCNT and sodium hexametaphosphate (SHMP) in different concentrations. The findings demonstrate that the Atterberg limits and specific gravity decrease with the increase in fly ash, MWCNT, and, SHMP. The maximum (46%) and minimum (24.2%) values of the liquid limit were recorded at 0% and 50% fly ash content, respectively. The maximum (34%) and minimum (20.2%) values of the plastic limit were observed at 0% and 50% fly ash content respectively. The specific gravity of natural soil decreases from the maximum value of 2.68 to the minimum value of 2.53 at 0% and 50% fly ash content, respectively. The optimum moisture content also decreases with the increase in fly ash, MWCNT, SHMP, and vice versa for maximum dry density. 0.01% w/w MWCNT + 80% Soil + 20% Fly Ash + 2% SHMP is the optimal mix. It gives maximum unconfined compressive strength (UCS) value in all the durations of curing, i.e. 0.50, 0.725, and 0.984 MPa at 1, 7, and 28 days of curing, respectively. The UCS value of this combination is 147% more than the UCS value of normal soil cured for 28 days. An economic analysis is also conducted to understand the feasibility of the application of MWCNTs in soil-fly ash mix. [ABSTRACT FROM AUTHOR]

Growing concern over the combustion cost and environment has made road engineers and scientists to explore the possible use of locally available materials for the construction of roads. The present study evaluated the strength and durability characteristics of five sites having locally available silty soils using lime and cement–sand stabilization technique. The test results showed that the cement–sand stabilization technique using 6% cement and 5% local sand resulted in higher strength and durability as compared to lime stabilization. There is also a significant increase in the value of the soaked California bearing ratio (CBR). As unconfined compressive strength (UCS) attained the threshold strength as prescribed by IRC SP 72 2015 for the granular sub-base (GSB) layer, by the use of sand cement stabilization, this technique of stabilization for local silty soils could be used for GSB for low volume road (LVR) construction. As observed from microstructural results which were performed by analysing SEM images, sand cement stabilisation leads to CSH gel and agglomerate formation thereby increasing strength and durability properties. The cost analysis for the replaced stabilized GSB layer showed that using sand–cement stabilization, the estimated cost can be reduced by 56% of the total cost as compared to the conventional method. [ABSTRACT FROM AUTHOR]

Warm mix asphalt mixtures became attractive paving mixes by reducing the production temperature to around 25–40 °C as compared to that of conventional hot mix asphalt (HMA). This study aims to evaluate the warm mix asphalt (WMA) using wax-based additives by incorporating two types of industrial wastes. The potential application of low calcium fly ash (FA), i.e. class F type and marble dust (MD), has been evaluated by varying different percentage. The cylindrical samples were prepared and assessed for moisture susceptibility by being subjected to Marshall stability, retained Marshall stability (RMS), indirect tensile strength (ITS) and tensile strength ratio (TSR) tests. Furthermore, the samples were also evaluated for finding the refusal density, Cantabro loss and the rutting performance. A scanning electron microscope (SEM) was also used to evaluate the size and microstructure of the filler particles. The results revealed that the inclusion of fillers into mixes had significant improvement in the mechanical properties and lowered the rutting value with FA and MD addition. The warm mix additive and fillers used were also useful in reducing the binder content of the mixes. The mixing temperature was found to be in the range of 120–130 °C using the warm mix additive. The optimum usage of FA and MD can be up to 5% based on the evaluation. The statistical results reported that there was a significant difference between FA-based and MD-based WMA. [ABSTRACT FROM AUTHOR]

Low-volume roads are anticipated to have less traffic and provide access to socio-economic activities in rural areas. The present study deals with the stabilisation of soil with locally available waste materials, i.e. low calcium fly ash (FA) and brick dust (BD). These two wastes are available abundantly and lead to an increase in pollution levels. Initially, lime was added to make the silty clayey soils plastic-free. The initial consumption of lime was found to be 5%. Then, the soil was stabilised with cement fly ash and cement brick dust techniques for strength, durability and shrinkage evaluation. The cement was varied from 2 to 8% with FA and BD by fixing the ratio to 1:3 as per AASHTO guidelines. The unconfined compressive strength (UCS), indirect tensile strength test and California bearing ratio were conducted for strength evaluation. The wetting and drying cycles were evaluated for durability analysis. The linear shrinkage cracking was evaluated after the curing period of 28 days. It was observed that there was a magnificent increase in strength and durability values. The maximum UCS attained value was so high that it could act as a replacement for the granular sub-base layer in the pavement structure. The linear shrinkage evaluated at fixed relative humidity was significantly reduced. The statistical analysis reported that there was a significant difference between the two admixtures. The utilisation of these wastes not only enhances strength, but also deficits the cost of construction along with reducing the pollutants in the environment. [ABSTRACT FROM AUTHOR]

The diagnosis of chronic pulmonary aspergillosis (CPA) is established by combined clinic-radio-microbiological criteria. Out of the different microbiological criteria, a positive serology for Aspergillus-specific IgG levels is the cornerstone of diagnosis. Alternatively, other microbiological evidence are sometimes sought viz., positive Aspergillus antigen (broncho-alveolar lavage fluid, i.e., BALF galactomannan ≥ 1.0), histopathological demonstration of the fungi following lung biopsy or resection, demonstration of hyaline septate hyphae in direct microscopy resembling Aspergillus spp. or its growth on a respiratory specimen. However, the exact roles of BALF- GM and the newer BALF-PCR have not been confirmed by studies till date. This study enrolled 210 patients with suspected CPA. Of the participants, 88 patients met the criteria for CPA, whereas 122 patients had an alternative diagnosis. The sensitivity—specificity of AsperGenius® PCR and "in-house" PCR were 52.27(36.69–67.54) %—33.78 (23.19–45.72) % and 36.36 (22.41–52.23) %—39.19 (28.04–51.23) % respectively. The sensitivity/specificity of BALF (> 1.0) and serum galactomannan (> 1.0) were 46.55% (33.34–60.13)/64.08% (54.03–73.3) and 29.82% (22.05–37.6)/86.84% (81.1–92.59) respectively. The optimal cut-off values for BALF-Galactomannan and serum galactomannan in diagnosing CPA were found to be 0.69 (sensitivity: 64%; specificity: 53%) and 0.458 (sensitivity: 67%; specificity: 64%) respectively. This results of this study suggests that Aspergillus PCR from BAL may not be a good "rule-in" test for diagnosing CPA. While the performances of GM in BAL and serum may be better than PCR, it should be best used in conjunction with other clinical, radiological, and other microbiological characteristics. [ABSTRACT FROM AUTHOR]

Durability of bituminous mixes is affected by presence or intrusion of moisture into it. The intrusion and amount of trapped moisture largely depend on the air voids present in the mixes. This study explores the combined influence of air voids and hydrated lime (HL, as anti-stripping agent) on moisture-induced damage of bituminous mixes prepared from two different aggregate sources. The aggregates used in the study are siliceous sandstone and basalt. Tensile Strength Ratio (TSR) test was used to determine the moisture susceptibility of bituminous mixes. A higher value of TSR depicts that the mixes are more moisture resistant. TSR was reaffirmed to be lowest at an air void range of about 5% to 13% which is termed as pessimum air void range. At this air void range, moisture gets trapped within the mix, resulting in moisture-induced damage. TSR results showed that bituminous mixes prepared with siliceous sandstone is more susceptible to moisture-induced damage as compared to mixes prepared with basalt. Boil water test reconfirmed the results. Use of HL in bituminous mixes improved its moisture-induced damage resistance only marginally. Thus, moisture-induced damage control at pessimum air void range using anti-stripping agent is not always sufficient. Observations show that air void plays a critical role in moisture-induced damage and control of air void during construction needs to be ensured. [ABSTRACT FROM AUTHOR]

Introduction : In resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people. Methods: Adult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT). Results: Among 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%. Conclusion: Patients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings. [ABSTRACT FROM AUTHOR]

Introduction: Universal coverage of vaccines alone cannot be relied upon to protect at-risk populations in lower- and middle-income countries against the impact of the coronavirus disease 2019 (COVID-19) pandemic and newer variants. Live vaccines, including Bacillus Calmette–Guérin (BCG), are being studied for their effectiveness in reducing the incidence and severity of COVID-19 infection. Methods: In this multi-centre quadruple-blind, parallel assignment randomised control trial, 495 high-risk group adults (aged 18–60 years) were randomised into BCG and placebo arms and followed up for 9 months from the date of vaccination. The primary outcome was the difference in the incidence of COVID-19 infection at the end of 9 months. Secondary outcomes included the difference in the incidence of severe COVID-19 infections, hospitalisation rates, intensive care unit stay, oxygen requirement and mortality at the end of 9 months. The primary analysis was done on an intention-to-treat basis, while safety analysis was done per protocol. Results: There was no significant difference in the incidence rates of cartridge-based nucleic acid amplification test (CB-NAAT) positive COVID-19 infection [odds ratio (OR) 1.08, 95% confidence interval (CI) 0.54–2.14] in the two groups, but the BCG arm showed a statistically significant decrease in clinically diagnosed (symptomatic) probable COVID-19 infections (OR 0.38, 95% CI 0.20–0.72). Compared with the BCG arm, significantly more patients developed severe COVID-19 pneumonia (CB-NAAT positive) and required hospitalisation and oxygen in the placebo arm (six versus none; p = 0.03). One patient belonging to the placebo arm required intensive care unit (ICU) stay and died. BCG had a protective efficacy of 62% (95% CI 28–80%) for likely symptomatic COVID-19 infection. Conclusions: BCG is protective in reducing the incidence of acute respiratory illness (probable symptomatic COVID-19 infection) and severity of the disease, including hospitalisation, in patients belonging to the high-risk group of COVID-19 infection, and the antibody response persists for quite a long time. A multi-centre study with a larger sample size will help to confirm the findings in this study. Clinical Trials Registry: Clinical Trials Registry India (CTRI/2020/07/026668). Plain Language Summary: The Bacillus Calmette–Guérin (BCG) vaccine has been studied previously in several settings, including reducing childhood mortalities due to viral infections and induction of trained immunity and reducing upper respiratory tract infections and pneumonia in older adults. This multi-centre trial has tried to evaluate the efficacy of BCG revaccination in reducing the incidence and severity of COVID-19 infections in adults between 18 and 60 years of age belonging to the high-risk group owing to the presence of comorbidities including diabetes, chronic kidney disease, chronic liver disease and chronic lung diseases. A single dose of BCG vaccine produced significantly high titres of BCG antibodies lasting for six months. While there was no significant reduction in the incidence of COVID-19 infection, there was an 8.4% reduction in the incidence of symptomatic COVID-19 disease at the end of 9 months of follow-up. In addition, there were significantly fewer severe COVID-19 infections requiring hospital stay and oxygen support. However, the overall numbers of severe COVID-19 infections were low. Thus, the study shows that BCG can protect against symptomatic and severe COVID-19 disease. However, it might not reduce the incidence of new infections. The study results are significant for low- and middle-income countries without adequate coverage of primary doses of COVID-19 vaccination, let alone the booster doses. Future studies should evaluate the BCG vaccine's efficacy as a booster compared with routine COVID-19 vaccine boosters. [ABSTRACT FROM AUTHOR]

HIV stigma takes a multidimensional toll on a mother's ability to care for herself and subsequently may impact her ability to care for her child, particularly when mother and child are seroconcordant. A cross-sectional analysis was conducted to examine the association between maternal HIV stigma and child CD4 count in rural India. We assessed 108 mother–child dyads and found that a one-unit increase in community stigma fear decreased child CD4 count by 352 cells (95% CI = − 603, − 102), highlighting the need to develop a better understanding of the consequences of HIV-related stigma on the compounded burden of care in households where mother and child both live with HIV. [ABSTRACT FROM AUTHOR]

Correction to: Efficacy of Bacillus Calmette-Guérin (BCG) Vaccination in Reducing the Incidence and Severity of COVID-19 in High-Risk Population (BRIC): a Phase III, Multi-centre, Quadruple-Blind Randomised Control Trial The original article can be found online at https://doi.org/10.1007/s40121-022-00703-y. The supplementary material file has been corrected and the original article has been updated. [Extracted from the article]

Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections. [ABSTRACT FROM AUTHOR]

HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one’s diagnosis a secret may make it more difficult to take one’s medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members. [ABSTRACT FROM AUTHOR]

We conducted a cross-sectional examination of the physical and psychological factors related to ART adherence among a sample of 400 women living with HIV/AIDS in rural India. Interviewer-administered measures assessed adherence, internalized stigma, depressive symptoms, quality of life, food insecurity, health history and sociodemographic information. CD4 counts were measured using blood collected at screening. Findings revealed that adherence to ART was generally low, with 94% of women taking 50% or less of prescribed medication in past month. Multivariate analyses showed a non-linear association between numbers of self-reported opportunistic infections (OIs) in past 6 months (p = 0.016) and adherence, with adherence decreasing with each additional OI for 0–5 OIs. For those reporting more than 5 OIs, the association reversed direction, with increasing OIs beyond 5 associated with greater adherence. [ABSTRACT FROM AUTHOR]

Background: While anemia occurs in 80 % to 90 % of patients with celiac disease (CD), it may be the sole manifestation of CD. The prevalence of CD in Indian patients with nutritional anemia is not known. Patients and Methods: Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy. Results: Ninety-six patients [mean ± SD age 32.1 ± 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean ± SD duration of diarrhea in them was 9.7 ± 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration. Conclusions: CD screening should be included in the work up of otherwise unexplained nutritional anemia. [ABSTRACT FROM AUTHOR]

Body composition in HIV-infected individuals is subject to many influences. We conducted a pilot 6-month randomized trial of 68 women living with AIDS (WLA) from rural India. High protein intervention combined with education and supportive care delivered by HIV-trained village women (activated social health activist [Asha] life [AL]) was compared to standard protein with usual care delivered by village community assistants (usual care [UC]). Measurements included CD4 counts, ART adherence, socio-demographics, disease characteristics (questionnaires); and anthropometry (bioimpedance analyzer). Repeated measures analysis of variance modeled associations. AL significantly gained in BMI, muscle mass, fat mass, ART adherence, and CD4 counts compared to UC, with higher weight and muscle mass gains among ART adherent (≥66 %) participants who had healthier immunity (CD4 ≥450). BMI of WLA improved through high protein supplementation combined with education and supportive care. Future research is needed to determine which intervention aspect was most responsible. [ABSTRACT FROM AUTHOR]

AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This cross-sectional study ( N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for antiretroviral therapy (ART) adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural Indian WLA. [ABSTRACT FROM AUTHOR]