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The present study aims to study the Life Skills among Secondary School Students using the Descriptive Survey Method. The sample consists of 405 Secondary Students selected from six Secondary Schools in Idukki District. The technique used for selecting the sample is Stratified Random Sampling giving due representation to Gender and Locale. The investigator used a scale- Life Skills Scale to measure Life Skills among Secondary School Students. For analysis, statistical techniques like Mean, Standard Deviation and Test of Significance of the Difference between Means(t-test) are used. The findings of the study reveal that there is no significant difference between the means of scores on Life Skills among the Secondary Students with regard to Gender, Life Skills of Boys and Girls are more or less the same. However, there is a significant difference between the means of scores on Life Skills among the Secondary Students with regard to Locale- Life Skills of students in Urban Schools is higher than that of Rural schools. Therefore, the investigator concludes that Gender has no influence and Locale influences the Life Skills of Secondary Students Key Words: Life Skills, Boys, Girls, Urban, Rural, Secondary School Students.

Academic procrastination is one of the main problems students encounter during studying. It affects their mental health, academic performance, and even everyday activities. A lack of time management was once thought to be the cause of procrastination. Procrastination, however, has been linked to mood control, according to recent studies. Decision-making is also a factor that is influenced by emotion or a person's affect. The present study aims to find whether decision-making and affective styles influence academic procrastination among Indian students. The participants (N = 211) who are currently studying any discipline in a regular mode and who are between the ages of 17 to 30 years (mean = 21.10 & SD = 2.168) were selected using purposive sampling, and data was collected online using Academic Procrastination Scale, General Decision-Making Style Instrument and Affective Style Questionnaire. Data were analyzed using Pearson correlation, along with multiple regression analysis. Results found a significant inverse correlation between rational decision-making and academic procrastination and a weak inverse correlation between adjusting affective style and academic procrastination. A significant positive correlation between avoidant decision-making and academic procrastination was also found. Through regression analysis avoidance, decision-making has been found as a positive predictor of academic procrastination along with rational decision-making, and spontaneous decision-making as negative predictors. No significant correlations were found for academic procrastination with intuitive, dependent, spontaneous, concealing, and tolerating styles. The current results contribute to the existing literature on academic procrastination and the development of effective strategies to reduce academic procrastination by managing unhealthy decision-making styles.

The information on land use/land cover (LULC) is indispensable in regional planning, policy formulation and tracking land use/land cover changes (LULCC). The rapid urbanization of hilly terrains, driven by population growth, has significant implications for landslide risk reduction. Recognizing the need for an innovative approach for extracting LULC information, the present study uses a random forest (RF) classifier to develop a novel, pre-trained and universal tool that automatically generates LULC classification maps based on natural colour satellite imagery without any training input from the end-user. The proposed framework with an overall accuracy of 0.75 and an area under the curve (AUC) score of 0.95 in the receiver operating characteristic curve (ROC) approach was used for mapping built-up area expansion in regions susceptible to rainfall-induced landslides in Idukki block panchayat (administrative division), Kerala, India. By comparing the LULC information for the years 2012 and 2022, it was understood that the built-up area in the location has increased from 12.76% of the total area in 2012 to 26.48% in 2022. It is important to consider the rapid increase in built-up area expansion in the 'very high' landslide susceptibility zones in the study area. This clearly demonstrates the need for hazard inclusive planning and tracking of LULCC, for disaster risk reduction. Research Highlights: A pre-trained Land Use/Land Cover (LULC) classification tool is developed using the Random Forest (RF) classifier. Based on natural colour satellite imagery, the tool automatically generates LULC maps for various landscapes worldwide. The tool demonstrates a satisfactory performance, achieving an overall accuracy of 0.75 and an overall ROC AUC score of 0.95. The tool was used to understand the LULC changes in Idukki block panchayat between 2012 and 2022. [ABSTRACT FROM AUTHOR]

Today most education institutions around the world have adopted the philosophy of outcome-based education. The emphasis in outcome-based education is achievement of outcomes; hence the curriculum should be designed in a way that it includes the components targeted specifically at achieving these outcomes. A discipline-based approach results in fragmentation of learning and lack of clinical applicability. Integrated teaching could be a solution to achieve required outcomes in a holistic way. Hence, the aim of this study was to develop, implement, and evaluate an integrated teaching module. Temporal coordination of the basic sciences, along with correlation of learned topics to clinical settings, was done in the first year of the undergraduate medical program. The module was evaluated by obtaining qualitative and quantitative feedback from students. Student assessment was conducted with a test that had case vignettes and multiple-choice questions. In addition, students' change in learning approaches and self-directed learning readiness were collected. Students' perception regarding the educational environment was also obtained. Analysis of the data showed positive feedback from the students regarding the integrated teaching. Students' average score in the test was 86%. There was a significant increase in the scores for the deep approach and self-directed learning readiness in the posttest compared with the pretest. Moreover, students were found to be satisfied with the educational environment. Evaluation of integrated teaching revealed that it was well accepted by the students. Moreover, it facilitated the achievement of the students' outcomes.

Raman spectroscopy discovered by Nobel laureate Sir Chandrasekhara Venkata Raman from India in 1928 changed the history of Oncosurgery and gave a new direction and dimension to the diagnosis, management, screening, and treatment of cancer. The amalgamation of laser and artificial intelligence in spectroscopy made this invention of Raman an extremely useful non-invasive tool in cancer surgery and management. Apart from intraoperative guidance, early detection, and tumor classification, Raman spectroscopy was found to be useful in the assessment of residual disease, therapeutic monitoring of chemotherapy drugs and radiotherapy, biomarker invention, drug delivery monitoring, and cancer screening. While Raman spectroscopy shows great promise in cancer research and diagnosis, it is still a developing field, and further research is needed to fully understand its potential. [ABSTRACT FROM AUTHOR]

AbstractCritical care is the specialized treatment provided to patients in intensive care units who are severely ill and need extensive care and close monitoring. Hence the present study was undertaken. A total of hundred samples were collected exclusively on those who stayed a minimum of five days in Intensive Care Unit from two reputed Multispecialty Tertiary Hospitals from Kerala, India. APACHE II scoring system, Day World Wide’s ICU Questionnaire and Glasgow Coma Scale were adopted to collect patient’s data such as personal details, demographic data, medical history, bio-physical parameters, bio- chemical parameters, feeding techniques, time of feeding and nutritional requirements. Admission to Medical ICU were about 43% with respiratory failure, sepsis and other infections, 22% were admitted with neurological diseases and 35% were nephrology patient. It is evident that about 79% were suffering from anorexia. Comparing the administration of exclusive commercial feed to commercial plus kitchen feed, it was observed that patients fed with the latter experienced increased abdominal pain (21%) and vomiting (17%). Diarrhea was more common in patients fed with commercial formula (12%), while constipation was higher in patients fed with kitchen feed (19%). There is no conclusive evidence favoring either exclusive commercial feed or kitchen plus commercial feed. A small percentage (7%) of patients had a mortality rate exceeding 80%. Positive outcomes were observed in critically ill patients through the enteral feeding system, with no significant difference between exclusive commercial feed and kitchen plus commercial feed. [ABSTRACT FROM AUTHOR]

Introduction: Coronary atherosclerosis is a condition that affects the arteries supplying the heart. The soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) belongs to the immunoglobulin superfamily, and its expression is increased in vascular endothelial cells in atherosclerosis. Aim: To estimate serum sVCAM-1 in atherosclerotic Coronary Artery Disease (CAD) patients with varying severity and to look for its association with the Atherogenic Index (AI). Materials and Methods: This hospital-based cross-sectional study was carried out in the Department of Biochemistry at NEIGRIHMS, a tertiary care Institute in the northeastern part, Shillong India, for a period of one year (2019) with 68 angiographically confirmed newly diagnosed CAD patients and were divided into three groups as Single Vessel Disease (SVD), Double Vessel Disease (DVD) and Triple Vessel Disease (TVD). The following biochemical tests were performed on fasting serum samples: Glucose, lipid profiles {Total cholesterol, High Density Lipid (HDL)-C, Low Density Lipid (LDL)-C, Triglycerides (TG)}, Interleukin-6(IL-6), and sVCAM-1. The Chi-square test was used to assess the significance of the association of risk factors such as hypertension, smoking, and diabetes in the participants. One-way Analysis of Variance (ANOVA) was conducted to identify significant differences in the levels of the estimated parameters among the participant groups. Results: The average age of presentation for the study participants was 61±10.8 years. The study involved 68 recently diagnosed patients with confirmed CAD, of whom 59 (87%) were males and 9 (13%) were females. Among the total patients, 44 (65%) were smokers, 45 (66%) had hypertension, and 29 (43%) were diabetic. The Chi-square test revealed a significant association between smoking (p-value=0.015) and hypertension (p-value=0.008) with CAD, but no association was found with diabetic status. The level of serum sVCAM-1 was found to increase with the number of vessels involved. Significant differences were observed in the levels of serum cholesterol and LDL-C among the groups (TVD>DVD>SVD). The bivariate Pearson’s correlation test between Antherogenic Index (AI) and sVCAM-1 showed a statistically significant positive correlation (r=0.33, p-value=0.0059). Conclusion: Serum sVCAM-1 levels may be used for the follow up study of patients with CAD, which could be more economical and convenient compared to {Total cholesterol, High Density Lipid (HDL)-C, Low Density Lipid (LDL)-C, Triglycerides (TG)} angiography. [ABSTRACT FROM AUTHOR]

The present study reports perceptions of first-year undergraduate medical students (n= 120), regarding modified directed self-learning (DSL) sessions in physiology. Students were provided with prereading assignments (faculty developed PowerPoint slides containing diagrams with incomplete labeling/ flowcharts with missing steps) pertaining to the DSL topic 1 wk before the scheduled small-group DSL presentations. During DSL presentation sessions, which were facilitated by teachers, a few students individually presented learning objectives in the specified topic. Apart from that, students discussed answers for the questions in the prereading assignment. Students were also given an opportunity to use technology to support DSL, by way of involving them in Pecha Kucha (PK) talks. The impact of the modified DSL method was determined by requesting students to respond to a validated questionnaire. Frequency analysis of the responses revealed that > 60% of students were positive about the modified DSL sessions improving their DSL, presentation, collaborative learning, and information retrieving skills. Students agreed that PK talks helped them to learn how to organize content (65%), present concise information (65.8%), and apply creativity (72.5%). Even though small in number, there were comments that the prereading assignments were useful for learning. The present study revealed that, even though students actively participated in modified DSL sessions, their perceptions on satisfaction and usefulness of the same toward achievement of various skills were not encouraging. The study generated significant results, which implies that undergraduate medical students should be oriented on the relevance of active learning strategies in their future studies.

Introduction: Despite advances in medical therapy, liver replacement continues to be the only definitive mode of therapy for children with end-stage liver disease (ESLD). However, its acceptance in India has been discouraging more due to financial and logistic reasons than the availability of expertise. This report outlines our journey and highlights issues pertinent to circumstances in an emerging economy like India. Aim: The aim is to review a single center's 100 case experience with liver transplantation (LT). Materials and Methods: A prospective analysis of all children who underwent LT since 2005 at our institute was done. The data were collated from a maintained structured database. Results: Hundred children underwent LT. Sixty-four were boys. Age ranged from 5 to 144 months, with a median of 17 months. The mean weight of the cohort was 7.5 kg (ranging from 3.7 to 31.5 kg), with 60% of our children weighing between 5 and 10 kg. Biliary atresia is the most common indication (57%); others include metabolic disorders, progressive familial intrahepatic cholestasis, and hepatoblastoma. Two patients were for acute liver failure. Ninety-one children underwent live donor LT (mothers being the majority of the donors). None of the donors had any major postoperative complications. Major intraoperative complications include sepsis (39%), vascular complications (17%), biliary leak (11%), and intestinal complications (11%). Early postoperative deaths occurred in 18% of patients with sepsis being most common cause. The mean follow-up was 8.5 years and the overall survival is 70%. The mean survival is time (months) = 176.1. All surviving patients were followed up and had achieved good catch up growth by 3rd and 5th years posttransplant. The long-term sequalae include recurrent intercurrent infections, graft rejection (9%), posttransplant lymphoproliferative disease (5%), and portal vein stenosis (5%). Conclusion: 0ur experience demonstrates the feasibility of LT in children with ESLD in India. With longer-living grafts, patients often struggle with other issues such as compliance with follow-up, financial issues, recurrent infections, and neurological problems. Close monitoring with regular follow-up of patients helps in early recognition and treatment of late-onset complications, thus helping the overall long-term outcomes. [ABSTRACT FROM AUTHOR]

Objective: Acute encephalitis syndrome (AES) in children results in significant neurocognitive deficits or mortality. It is pertinent to study the AES patterns periodically to identify the changes in the etiological trends and outcomes. Our objective was to find the etiological agents of AES, mode of diagnosis, treatment given, and outcomes. Methods: We reviewed the electronic records of children aged 1 month to 15 years who were admitted with AES in our centre from January 2015 to December 2019. We analyzed the the clinical, laboratory, and radiological profile of these children and adolescents in relation to their outcome. Poor outcome was defined as death, discharge against medical advice with neurological deficits, or Glasgow Outcome Score Extended (GOS-E) d≤ 5 at the time of discharge. Results: Among 250 patients admitted with AES during the study period, a definitive etiological diagnosis was established in 56.4% of children (30.4% viral, 22% bacterial). Scrub typhus (11.2%) and dengue (9%) were the two most common underlying illnesses. Serology helped in clinching the diagnosis in 30% of children. A surge in AES cases in the post-monsoon season was observed in our cohort. Third-generation cephalosporin drugs (85.7%) and acyclovir (77.7%) were the most commonly used empiric antimicrobial drugs. About one-third of children (n = 80) had a poor outcome. GCS ≤ 8 at presentation and requirement for invasive ventilation were found to be significant predictors of poor outcome. Conclusion: A definitive diagnosis was obtained in about half of the children with AES. Viral (30.4%) and rickettsial infections (22%) were the common etiologies identified. Poor outcome was observed in 32 % of patients. [ABSTRACT FROM AUTHOR]

India's space program attracted international admiration in 2023 for becoming the first country to successfully land a craft on the moon's south pole. The program is now in its sixth decade and stands as one of India's most successful technology missions, not least for the hard currency revenues it generates. The reasons for this success are less well known: they include inspired early leadership, considerable foreign assistance, a strategic decision to leapfrog traditional "stages of growth," and relative autonomy from India's powerful state bureaucracy. Over the years, the space program has moved from being a developmental focus to serving as a lens through which the nation views itself and its place in the world. The essay closes by imagining what its founders would think of the space program today. [ABSTRACT FROM AUTHOR]

Debris flows are geomorphological processes that affect the landscape evolution process of any region. In this study, an integrated methodology is proposed to identify the chance of further debris flows and quantify the similarities between debris flow locations, materials and rheology, using field and laboratory investigations and remote sensing data. The method was tested for four failure‐triggered debris flow sites in the Western Ghats of India, using dimensionless parametric similarity values ranging from 0 to 1. The maximum parametric similarity was observed as 0.84 when comparing the flow accumulation values of Sites 3 and 4, and the maximum overall site similarity was 0.68. The calibrated rheological parameters of one site were found to be satisfactory in modelling the shape of debris flow at all other sites. The findings can be used to identify similar hotspots in the region and to simulate debris flows for quantitative hazard assessment. [ABSTRACT FROM AUTHOR]

Animals, animal labour and animal capital, were vital in developing colonial capitalism. For labour theories, working animals constituted only as tools or resources and affirmed the property rights of humans over animals by capturing, confining, breeding and training. The capitalist interactions with animals developed from the early warfare and hunting practices to the later discourses of conservation, juridical control and the commoditization of animals in the capital-intensive colonial industries. This article examines the entangled histories of wild elephants in colonial settings who were captured, tamed, and trained as working animals and sold as commodities to the capitalist timber industries. By using Jonathan Saha's conceptualization of 'undead capital', this article addresses how the wild elephants were transformed from being hunted to being protected, fed, provided for and kept healthy by veterinarians through the Kraal system only to be commoditized as working animals. However, such commoditization resulted in the subjugation of animals, the transformation of ecologies, and the fostering of new interspecies relationships between the elephants and their caretakers. The knowledge and experience of caretakers of elephants became central in colonial animal management and was perceived as a route through which colonialism created new knowledge about wild animals and the forests. [ABSTRACT FROM AUTHOR]

Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality. Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0. Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%—29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 – 13.301), lower social class (OR 4.455, 95% CI 1.236 – 16.050) and functional impairment (3.643, 95% CI 1.373 – 9.668) were found to be significant factors associated with self–neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect. [ABSTRACT FROM AUTHOR]

Background: Molecular subtyping of endometrial carcinomas (EC) has been shown to classify tumors into prognostically relevant groups. Characterizing EC with a limited number of markers viz., POLE mutations, p53 mutations, and MMR status, can provide valuable information. Design: Paraffin sections of a cohort of 48 EC from a tertiary care center were characterized for the above-mentioned molecular markers and analyzed in the context of survival. Methods: Formalin fixed paraffin embedded tissues from 48 EC were characterized for POLE mutations by Sanger sequencing (exons 9–14), for MMR (MLH1, MH2, MSH6) using immunohistochemistry (IHC) and copy number (high/low) using p53 IHC. Mutational status was integrated along with the clinicopathological details and survival analysis performed. Results: Eleven (22.9%) patients were MMR deficient, 3 (6.3%) had POLE mutation, while 2 (4.1%) had both POLE and P53 mutations (regarded as multiple classifiers). Twelve (25%) patients were found to have P53 mutations, while the remaining 20 (41.7%) had no specific molecular profile (NSMP). Median follow-up duration was 43.5 (2–62) months with 8 recurrences and 9 deaths. Tumors with POLE mutation had the most favorable prognosis followed by the NSMP and the MMR mutated group while the P53 and multiple classifier groups had the worst prognosis in terms of OS (Log-rank p: 0.006) and PFS (Log-rank p: 0.001). Conclusion: The integration of molecular-clinicopathologic data for endometrial cancer classification, through cost-effective, clinically applicable assays appears to be a highly objective tool that can be adopted even in resource-limited settings. It has the potential to cause a shift in the paradigm of EC pathology and management practice. [ABSTRACT FROM AUTHOR]

Background: Glasgow coma scale (GCS) score is the most widely used clinical score for the initial assessment of neurologically injured patients and is also frequently used for prognostication. Other scores such as the Full Outline of UnResponsivness (FOUR) score and the Glasgow Coma Scale-Pupils (GCS-P) score have been more recently developed and are gaining popularity. This prospective cohort study was conducted to compare various scores in terms of their ability to predict outcomes at 3 months in patients with traumatic brain injury (TBI). Materials and methods: The study was carried out between October 2020 and March 2022. Patients who presented to the hospital with TBI were assessed for inclusion. Initial coma scores were assessed in the emergency department and again after 48 hours of admission. Outcome was assessed using the extended Glasgow outcome score (GOSE) at 3 months after injury. The receiver operating curve (ROC) was plotted to correlate coma scores with the outcome, and the area under the curve (AUC) was compared. Results: A total of 355 patients with TBI were assessed for eligibility, of which 204 patients were included in the study. The AUC values to predict poor outcomes for initial GCS, FOUR, and GCS-P scores were 0.75 each. The AUC values for 48-hour coma scores were 0.88, 0.87, and 0.88, respectively. Conclusion: The GCS, FOUR, and GCS-P scores were found to be comparable in predicting the functional outcome at 3 months as assessed by GOSE. However, coma scores assessed at 48 hours were better predictors of poor outcomes at 3 months than coma scores recorded initially at the time of hospital admission. [ABSTRACT FROM AUTHOR]

Resumen: En este artículo se examina el impacto de la reserva de puestos de trabajo en el rendimiento empresarial del sector público en la India. Tras analizar datos de todas las empresas públicas manufactureras de 2014 a 2017 con técnicas de variables instrumentales, se corrobora la hipótesis de que las reservas benefician el rendimiento empresarial si se implementan en puestos de todos los niveles jerárquicos. También se constata que las categorías reservadas están desproporcionadamente representadas en el extremo inferior de la jerarquía organizativa. Este desequilibrio se debe principalmente a limitaciones sistemáticas en las notificaciones de vacantes y a prácticas discriminatorias de las organizaciones. [ABSTRACT FROM AUTHOR]

Background: Only a small percentage of patients with acute stroke are currently eligible for thrombolysis, partly due to severe delays in hospital arrival. We had previously conducted the first regional study to assess the factors delaying acute stroke care in India. The present study aims to understand and describe in depth the variables associated with prehospital delay among patients admitted with an acute ischemic stroke. Methods: Data were prospectively collected by conducting an in-depth interview of 470 acute ischemic stroke patients and their bystanders, aged above 18 years, presenting to the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur. Patients who arrived within 4.5 h of symptom onset were considered as "early arrival" and those who arrived after 4.5 h were considered as "delayed arrival." Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Results: Of the 470 patients who met the inclusion criteria, 73 patients reached within 4.5 h (15.5%), whereas 397 patients arrived after 4.5 h. The mean age of acute stroke patients who reached within 4.5 h was 63 ± 13.7 years, whereas the mean age of those who reached after 4.5 h was 63 ± 12.1 years. Binary logistic regression performed to quantify the associations of prehospital factors showed an increased risk of prehospital delay among individuals with lack of awareness (odds ratio [OR] = 5.16 [3.040--8.757], P < 0.001), followed by those for whom a vehicle was not available at the site of event (OR = 3.745 [1.864--7.522], P < 0.001). Within the predefined socioeconomic strata, compared to lower class, upper middle class had less risk (OR = 0.135 [0.018--1.035], P = 0.054), whereas the distance from first medical contact to emergency department contributed moderate risk (OR = 1.071 [1.028--1.116], P < 0.001) for prehospital delay. Conclusions: Health promotion techniques that increase public knowledge about the early signs of stroke, transferring patients directly to hospitals with thrombolysis capabilities, and making ambulance services more widely available are appropriate measures to reduce prehospital delay. [ABSTRACT FROM AUTHOR]

The article discusses the impact of job reservations on Indian public sector enterprises (PSEs) and discovers that, despite reservations being in existence since 1951, the majority of central government-owned manufacturing PSEs do not meet quotas. It states that the disproportionate representation of reserved categories in lower organizational tiers is the result of institutional constraints and discriminatory actions.

Epoxy resin coating often exhibits good anticorrosive properties. The present study evaluates the corrosion of aluminum coupons using bacterial and fungal isolates and the synthesis of aluminum nanoparticles using sol–gel method for anticorrosion assay of coupons. Isolates were collected from the sewage area, VIT, Vellore, Tamil Nadu, India. Surface or topological analyses were performed using SEM and AFM analytical methods. The weight loss results revealed that a higher corrosion rate was observed in bacterial treated (0.032 ± 0.1 mm/y) compared with that of fungal-treated (0.026 ± 0.01 mm/y) at the end of the exposure period of 336 h. This is because microbial colonies boost corrosion rates locally by establishing a corrosive environment. Corrosion rate of bacterial treated aluminum coupon was found to be 0.051 mm/year, and fungal-treated metal was found to be 0.041 mm/year. Nanoparticles synthesized showed good anticorrosion property due to their larger surface area and growth inhibition property. Scanning electron microscopic images of epoxy nanoparticle coated workpiece exhibited no pitting showing good anticorrosive nature. [ABSTRACT FROM AUTHOR]

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A study examined adaptations made prior to or during the adoption of the Training and Visit (T&V) extension system. This system was developed in Turkey, based on the Israeli experience of the developer, and was further refined in India. It was later adopted by many countries in Southeast Asia, Africa, and other parts of the world. Experience showed the necessity to adapt the system to the very different sociocultural and agroeconomic conditions of the adopting countries. Examination of the revisions of the T&V guidelines showed that T&V had clear basic principles, but these had to be adapted to each existing situation. Most adaptations were made in relation to five basic T&V guidelines and key features: (1) extension exclusively (professionalism); (2) linkages with research; (3) regular and continuous training; (4) time-bound work (systematic visits); and (5) imitable contact farmers (field and farmer orientation). The case studies showed that adaptations were not only possible, they were necessary. Development of an adaptation instrument was suggested to help less experienced, potential T&V adaptors to make the needed alterations. (Contains 61 references.) (YLB)

Objectives: The incidence of young‐onset oral squamous cell carcinoma (OSCC) is growing, even among non‐smokers/drinkers. The effects of adverse histopathological features on long‐term oncologic outcomes between the young and old are controversial and confounded by significant heterogeneity. Few studies have evaluated the socio‐economic impact of premature mortality from OSCC. Our study seeks to quantify these differences and their economic impact on society. Materials and Methods: Four hundred and seventy‐eight young (<45 years) and 1660 old patients (≥45 years) with OSCC were studied. Logistic regression determined predictors of recurrence and death. Survival analysis was calculated via the Kaplan–Meier method. A separate health economic analysis was conducted for India and Singapore. Years of Potential Productive Life Lost (YPPLL) were estimated with the Human Capital Approach, and premature mortality cost was derived using population‐level data. Results: Adverse histopathological features were seen more frequently in young OSCC: PNI (42.9% vs. 35%, p = 0.002), LVI (22.4% vs. 17.3%, p = 0.013) and ENE (36% vs. 24.5%, p < 0.001). Although 5‐year OS/DSS were similar, the young cohort had received more intensive adjuvant therapy (CCRT 26.9% vs. 16.6%, p < 0.001). Among Singaporean males, the premature mortality cost per death was US $396,528, and per YPPLL was US $45,486. This was US $397,402 and US $38,458 for females. Among Indian males, the premature mortality cost per death was US $30,641, and per YPPLL was US $595. This was US $ 21,038 and US $305 for females. Conclusion: Young‐onset OSCC is an aggressive disease, mitigated by the ability to receive intensive adjuvant treatment. From our loss of productivity analysis, the socio‐economic costs from premature mortality are substantial. Early cancer screening and educational outreach campaigns should be tailored to this cohort. Alongside, more funding should be diverted to genetic research, developing novel biomarkers and improving the efficacy of adjuvant treatment in OSCC. [ABSTRACT FROM AUTHOR]

The Supreme Court of India has directed the National Medical Commission to find out the rationality of conducting live surgical workshops during medical conferences several times without any clear guidelines or directives. Whilst live surgical workshops are great learning tools for young surgeons, there exists a risk of a breach of patient confidentiality and safety. Do the pros outweigh the cons is to be addressed. The time may be ripe to explore other options like live operations on simulators with the scenario manipulated by Artificial Intelligence (AI), to make it more a real, challenging experience for surgical trainees. [ABSTRACT FROM AUTHOR]

Loharghat Forest Range, within the Indo-Burma biodiversity hotspot, features diverse habitats like wetlands, scrublands, grasslands, tropical and deciduous forests. Chandubi, a vital tectonic wetland in the landscape, is designated as Important Bird Area (2003) and Key Biodiversity Area (2005) but remains largely unexplored. This study aims to establish a baseline database of avifaunal assemblages from the Loharghat Forest Range in Kamrup District, Assam, which includes the Mayang Reserved Forest and Barduar Reserved Forest. The forest is protected and managed by the local community. The surveys were conducted between August 2021 to June 2023. The study revealed the occurrence of a total of 224 avian species belonging to 20 orders and 58 families. The birds are further categorised on the basis of their seasonal movements, diets, and rarity in the region. Our findings indicate that the community-managed forests have a rich and diverse avifauna. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysregulation leading to diabetes is a major public health concern in India. While evidence has pointed to a role for genetic factors, there is still limited knowledge regarding the specific variants that play a part in this process. Recent studies have implicated Tumor protein, p53, a well-known tumor suppressor, in maintaining metabolic homeostasis in our body. Polymorphisms that can disrupt this function are thought to increase susceptibility to diabetic and prediabetic phenotypes like Metabolic syndrome (MetS). A common polymorphism at codon 72 (rs1042522) is associated with obesity and other metabolic disorders. However, its role may vary depending on the specific population and disease context. Our study aimed to evaluate whether the polymorphism at codon 72 of p53 (rs1042522) is associated with MetS and Diabetes, in a Central Indian population. Results: A total of 66 individuals and 63 healthy controls, identified based on the National Cholesterol Education Program (NCEP)/Adult Treatment Panel-III (ATP-III) 2001 guidelines, were enrolled in the study. The carriers expressing mutant allele "G" for arginine at codon 72 had higher weight than those having wild-type allele "C" which codes for proline (p = 0.038). The majority of the subjects were heterozygous for p53 codon 72 polymorphism though the association was not statistically significant for either MetS or diabetes. Conclusion: Our findings suggest that p53 codon 72 (rs1042522) varaints may trigger metabolic dysfunction by impacting weight. The polymorphism appears to confer a heterozygous advantage, as individuals with a heterozygous genotype exhibited the highest susceptibility to metabolic disease. Although further studies are required, our results for the first time indicate that the p53 codon 72 (rs1042522) polymorphism could be considered a genetic marker to predict the increased susceptibility to diabetic and prediabetic phenotypes among Central Indian population. [ABSTRACT FROM AUTHOR]

Introduction: The Modified Mallampati (MM) grading and Friedman's Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current descriptions of performing these scores do not specify the route of breathing taken by the patient during the examination. The dynamic changes in the tongue and palate, in relation to the route of breathing, may contribute to the high interobserver variability in MM scoring. Aim: To explore the differences in MM scores and Friedman's scores obtained during mouth breathing and nose breathing in order to standardise the scoring system. Materials and Methods: A community-based cross-sectional study was conducted at the Departments of Anaesthesiology and Community Medicine at Believers Church Medical College Hospital in Central Kerala, India between April 2022 and October 2022, on 702 adults. MM scores and FTP scores were recorded separately for each person during mouth breathing and nose breathing. Socio-demographic variables such as age, gender, and Body Mass Index (BMI) were also collected. The data was analysed using the Z-test for proportions. Results: The mean age of the study participants was 3.58±16.42 years. The majority of the participants were females (69.2%), and more than half (59%) were above 50 years of age. Out of the 135 participants with an MM Score-1 during mouth breathing, 99 (73.3%) had higher scores during nose breathing. For the 196 individuals with an MM Score-2 during mouth breathing, 87 (44.3%) had higher scores during nose breathing. Similarly, out of the 220 people with an MM score of -3 during mouth breathing, 106 (48.2%) had a Score-4 during nose breathing. A similar pattern was observed for the FTP scores. Conclusion: The present study demonstrates significant variability in MM and FTP scores obtained during oral and nasal breathing, highlighting the need to standardise the route of breathing during examination. The study suggests that advising patients to breathe through the mouth may relax the tongue and improve the predictive value of MM grading. [ABSTRACT FROM AUTHOR]

Aims and background: Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal therapy to support oxygenation of patients with severe cardiac or respiratory failure. Studies have shown that acute kidney injury (AKI) can worsen the outcome in these patients. This study aims to assess the incidence and outcome of AKI in patients on ECMO support. Materials and methods: This retrospective study included 64 patients who underwent ECMO for more than 24 hours. Patients who died within 48 hours of initiation of ECMO and patients with end-stage renal disease (ESRD) on maintenance hemodialysis were excluded. Acute kidney injury was diagnosed and categorized according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results: Of the 64 patients studied, 38 patients (59.38%) developed AKI and 17 patients (44.73%) among them developed AKI within 24 hours of initiation of ECMO. Age, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, hypertension, use of nephrotoxic agents, inotropic support, and poor cardiac function were the risk factors associated with the development of AKI. Diabetes mellitus, type of ECMO used, and duration of ECMO were not found to be risk factors for AKI. Renal replacement therapy was initiated in 31 patients (81.58%). The overall mortality in the whole group was 67.19%, while it was 81.58% among the patients with AKI. Conclusion: Acute kidney injury was found to be an independent risk factor for mortality in patients on ECMO. Early identification of the risk factors for AKI and management may help to improve the survival rate. Clinical significance: The occurrence of AKI among patients on ECMO support increases the risk of mortality significantly. Hence, measures to prevent AKI, as well as early detection and appropriate management of AKI, would improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Polyetheretherketone, also known as PEEK, is a semicrystalline thermoplastic material with many advantages. Since its grey material, it has to veneering with composite resin to enhance its aesthetic appeal. Bonding PEEK and composite veneers poses challenges due to its inert surface. Aim: To assess and compare the Shear Bond Strength (SBS) between various polyetheretherketone materials and veneering composites following various surface treatments. Materials and Methods: The in-vitro study was conducted at KSR Dental College and Hospital in Tiruchengode, Tamil Nadu, India, over a period of three months from December 2022 to February 2023. A total of 108 PEEK discs were prepared for the study, divided into three groups: unfilled PEEK, 30% carbon reinforced PEEK, and 10% carbon + 10% graphite + 10% Polytetrafluoroethylene (PTFE) reinforced PEEK. The specimens underwent different surface treatments, including no treatment, sandblasting with 110 um alumina particles, and acid etching with 98% sulphuric acid. Additionally, 108 composite discs were prepared and bonded to the PEEK specimens using adhesive and resin cement. The bonded specimens were immersed in distilled water for 24 hours, and the Shear Bond Strength (SBS) was determined using a universal testing machine. Statistical analysis was performed using one-way ANOVA, and mean values were compared using posthoc tests. Results: The results indicated significant variation in SBS among the three groups without treatment (p=0.011) and after sandblasting with 110 um alumina (p=<0.001). The 30% carbon reinforced PEEK exhibited the highest SBS regardless of the surface treatments. Conclusion: Among the tested materials, 30% carbon reinforced PEEK demonstrated the highest SBS, regardless of the surface treatments. Acid etching yielded the highest SBS among the various surface treatments, irrespective of the type of PEEK material used. [ABSTRACT FROM AUTHOR]

The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist. [ABSTRACT FROM AUTHOR]

This paper examines the impact of structural change, economic growth, hydro energy consumption, and coal energy consumption on ecological footprint, in the case of India. We employ a novel dynamic autoregressive distributed lag (DYNARDL) method to improve the existing studies' limitations and weaknesses. Thus, the current research contributes empirically and methodological to the literature. The study used the newly proposed DYNARDL simulation method and frequency domain causality using data from 1970–2017 to inspect the impact of structural change, economic growth, hydro energy consumption, and coal energy consumption on ecological footprint in the case of India. Empirical results reveal that institutional structural change decreases ecological footprint in the short and long term, whereas hydropower usage decreases ecological footprint only in the long term. Conversely, economic growth positively affects ecological footprint in both the short and long term. Likewise, coal energy usage increases ecological footprint in the long term. In addition, the findings confirm the validity of the environment Kuznets curve (EKC) hypothesis in India. Furthermore, the results of the frequency domain causality test revealed that structural change, hydro-energy usage, and coal consumption could predict ecological footprint in the long term. In contrast, economic growth can predict the medium- and long-term ecological footprint. We observed that as India's production level continues to surge, so does environmental deterioration, which is associated with the scale effect. [ABSTRACT FROM AUTHOR]

Influence of seasonal variations in environmental parameters on fish assemblage and species diversity patterns was studied in a tropical reservoir of Central India during March 2021 to February 2022. A total of 41 species belonging to 7 orders, 15 families and 29 genera were recorded with highest diversity during post‐monsoon season compared to the pre‐monsoon season and monsoon season. The fish abundance similarity between the monsoon and post‐monsoon reached a maximum of 89%. Seasonal variations in the mean species abundance, Simpson dominance index, Shannon diversity index, Pielou's evenness index and Margalef's richness index were determined. One‐way ANOVA revealed a significant difference (P < 0.05) at the temporal scale. There was a significant seasonal difference in species abundance (P = 0.0006) and evenness index (P = 0.02) among the diversity indices. During the study period, three 'vulnerable' species, three 'near threatened' species and two 'endangered' species were caught. Carnivore dominance was evident throughout the year in the trophic guild of fishes. The Pearson correlation test revealed that water pH, dissolved oxygen, sediment organic carbon and clay percentage were positively correlated to all four diversity indices. Simpson and Margalef species richness diversity indices were positively correlated to sediment pH. Fish abundance was positively associated with sediment pH, silt, phosphorus and nitrogen content. Canonical correspondence analysis was used to investigate the relationships between fish assemblages and environmental conditions. Among the 19 physicochemical parameters, nine (dissolved oxygen, total dissolved solids, conductivity, transparency, hardness, phosphate and chlorophyll‐a, sediment nitrogen and phosphorus) characteristics were shown to be statistically significant (P < 0.05) in determining fish diversity. Dissolved oxygen, total dissolved solids, conductivity, transparency, hardness, phosphate and chlorophyll‐a of water and sediment nitrogen and phosphorus qualities were the key factors for the species abundance. The reservoir boasts a diverse fish population that allows multi‐species fishing and generates revenue for numerous local fishers. Fish habitats should be protected in order to maintain diversity and long‐term ecological benefits. [ABSTRACT FROM AUTHOR]

Due to the steep rise in grid-connected solar Photovoltaic (PV) capacity and the intermittent nature of solar generation, accurate forecasts are becoming ever more essential for the secure and economic day-ahead scheduling of PV systems. The inherent uncertainty in Numerical Weather Prediction (NWP) forecasts and the limited availability of measured datasets for PV system modeling impacts the achievable day-ahead solar PV power forecast accuracy in regions like India. In this study, an operational day-ahead PV power forecast model chain is developed for a 250 MWp solar PV park located in Southern India using NWP-predicted Global Horizontal Irradiance (GHI) from the European Centre of Medium Range Weather Forecasts (ECMWF) and National Centre for Medium Range Weather Forecasting (NCMRWF) models. The performance of the Lorenz polynomial and a Neural Network (NN)-based bias correction method are benchmarked on a sliding window basis against ground-measured GHI for ten months. The usefulness of GHI transposition, even with uncertain monthly tilt values, is analyzed by comparing the Global Tilted Irradiance (GTI) and GHI forecasts with measured GTI for four months. A simple technique for back-calculating the virtual DC power is developed using the available aggregated AC power measurements and the inverter efficiency curve from a nearby plant with a similar rated inverter capacity. The AC power forecasts are validated against aggregated AC power measurements for six months. The ECMWF derived forecast outperforms the reference convex combination of climatology and persistence. The linear combination of ECMWF and NCMRWF derived AC forecasts showed the best result. [ABSTRACT FROM AUTHOR]

E-rickshaws are relatively new additions to India's public road transportation system, gaining popularity as a convenient and cost-effective means of commuting for fellow travelers. However, they do not come equipped with a regenerative braking system. This paper proposes a simple and cost-effective regenerative braking system for e-rickshaw motors, incorporating an energy management system based on the state of charge of the battery. The proposed system can function effectively even when the battery is fully or nearly fully charged. Additionally, it eliminates the need for any supplementary current or voltage sensors, significantly reducing the circuit's complexity and cost. To evaluate the system's performance under various traction conditions, simulations, and tests are conducted using the MATLAB/Simulink model. The results confirm the high capabilities of the proposed system. The functionality and effectiveness of the proposed regenerative braking system are validated through laboratory experiments conducted under various conditions, including different speeds and levels of braking force, on a prototype equipped with an e-rickshaw motor. The results of the experiments demonstrate that the proposed regenerative braking system is successful in achieving its intended purpose, even with the fully charged battery, and without the need for any additional current sensors or voltage sensors. The proposed regenerative braking system not only enhances the efficiency and sustainability of e-rickshaws but also contributes to reducing overall energy consumption and environmental impact. As a result, this innovative solution holds great potential for widespread adoption in India's growing e-rickshaw industry. [ABSTRACT FROM AUTHOR]

BACKGROUND: An important sequelae post myocardial infarction is left ventricular remodelling, which determines the long term outcome and occurrence of heart failure. Biomarkers are used as a tool to identify high risk individuals, to diagnose disease conditions promptly/accurately and to effectively prognosticate and treat patients with disease. ST2 is one such promising relatively new biomarker. Myocytes that are subjected to mechanical stress secrete ST2 and the ST2 level has been found to be an independent predictor of heart failure and adverse outcome in patients with acute myocardial infarction. METHODS: We checked the Serum ST2 level on admission of 102 patients admitted with acute myocardial infarction in our hospital. In 34 patients out of these a discharge time ST2 level was also measured. The ST2 levels obtained on presentation, were correlated with the clinical severity of the disease on presentation and subsequent acute complications during hospital stay. ST2 level at discharge was correlated with readmission and occurrence of heart failure or cardiovascular event after discharge for a follow up period of 6 months. RESULTS: In our study high ST2 levels on admission significantly correlated (P values < 0.05) with disease severity in the form of high TIMI score and low LV systolic function. High ST2 level had a statistically non-significant negative association with blood pressure (lower blood pressures having higher ST2 values) and a positive association with duration of symptoms (longer duration had higher values), ‘in hospital’ adverse events. In our study none of the patients from low ST2 group had ‘in hospital’ adverse events or mortality. Majority of patients readmitted were from high ST2 group (statistically non-significant). CONCLUSION: ST2 is a promising biomarker for prognostication and can be included in routine biomarkers for risk stratification of acute myocardial infarction and heart failure. Patients admitted with acute MI or heart failure who have high ST2 levels should be followed up closely to prevent the occurrence of adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

Background: Though typically being a hepatotrophic virus (1), HBV also binds to peripheral blood mononuclear cells (PBMC) and infects hematopoietic cells. HBV infection has been associated with an increased risk for hematologic malignancies. (2,3) Occult HBV DNA persists in the lymphoid cells of the individual (4) and it is difficult to detect persistence of occult hepatitis B virus infection by routine HBV surface antigen testing. Anti-HBc may be used as a surrogate marker for detection of OBI. Although it may not be as sensitive as molecular methods, it has been shown to be an useful screening tool for detection of occult hepatitis B virus infection (5). We enrolled 70 leukemia patients for the study and tested them for anti HBc. We later analysed only 69 of these patients for OBI as 1 patient was HBsAg positive (overt HBV infection) and hence excluded from the study. We found 4.35% of the patients to be anti HBc positive indicating occult HBV infection. [ABSTRACT FROM AUTHOR]

Background: Low birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings. Methods: This study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach. Results: All participants believed that mother's own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance. Conclusion: This study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system. [ABSTRACT FROM AUTHOR]

The betterment of environmental conditions is widely recognized as a significant priority for India, which is a critical aspect of the Sustainable Development Goals (SDGs). As an emerging economy, pursuing economic expansion is paramount, requiring significant amount of energy and a degree of openness to other nations. Meanwhile, the nation's energy demands are heavily met by the usage of biomass and coal energy sources. Furthermore, the nation is part of the top consumer of biomass and coal energy globally. However, over the last 50 years, the level of ecological footprint in India has surged by about 82%, despite the country's commitment to achieving environmental sustainability, which tends to raise concerns such as: What is the role of India's major energy sources, biomass, and coal energy, towards ecological sustainability? Does economic globalization promote and hinder India's environmental sustainability goals? As a result, this current study offers answers to these concerns by investigating the effect of economic globalization, coal energy, and biomass energy on the ecological footprint in India while controlling economic growth. Using the dynamic ARDL to analyze the dataset from 1970 to 2018, the result suggests that biomass energy and economic globalization improve ecological quality. However, economic growth and coal energy impede ecological quality in India. Furthermore, we adopted the time-varying causality test solely to understand the causality analysis, which established that economic globalization, biomass energy, economic growth, and coal energy could forecast the future direction of the ecological footprint. [ABSTRACT FROM AUTHOR]

Objective: To study and compare the maternal and neonatal outcomes of COVID‐19 in pregnancy during the two waves of the pandemic in India. Methods: This observational, retrospective cohort study on pregnant women with SARS‐CoV‐2 infection was conducted in a 2700‐bed tertiary referral center in South India from March 1, 2020 to June 30 2021. The clinical presentation, severity, and maternal and neonatal outcomes of COVID‐19 were compared between the two waves. Results: A total of 623 pregnant women tested positive for SARS‐CoV‐2 infection in our institute; 379 (60.8%) were diagnosed during the first wave and 244 (39.2%) in the second wave. Most of the affected women (81.1%) were in their third trimester. Maternal mortality rate was 823 per 100 000 live births. Composite maternal outcome (increasing requirement for ventilation, pulmonary embolism, disease progression) were more pronounced during the second wave (2.1% vs 6.1%). Between the two waves, both maternal (1 vs 3; P = 0.162) and perinatal (3.2% vs 6.7%; P = 0.065) deaths were higher during the second wave. The cesarean section rate was high during the first wave (48% vs 32.4%; P < 0.001). Preterm births were comparable between the two waves (19.5% vs 22%; P < 0.500). Conclusion: The women presented with more severe illness during the second wave of COVID‐19. There was higher perinatal mortality, but the maternal mortality was similar between the two waves. Synopsis: Composite maternal outcomes of SARS‐CoV‐2 infection (increasing requirement of ventilation, pulmonary embolism, disease progression) were more pronounced during the second wave in India. [ABSTRACT FROM AUTHOR]

Climate change and land use land cover (LULC) change are two major factors influencing river basin hydrology. This study explored these drivers' isolated and combined impacts on the ecologically relevant flow in the Achencoil basin, Kerala, India. The LULC classification in the study is carried out with the Random Forest (RF) algorithm in the Google Earth Engine (GEE) platform, and Land Change Modeler (LCM) is incorporated for change detection and projection. The future climate data from the National Aeronautics and Space Administration Earth Exchange Global Daily Downscaled Projections (NEX-GDDP) is used for climate change impact assessment. The Soil and Water Assessment Tool (SWAT) is employed to simulate streamflow under LULC and climate change scenarios. The historical and projected future LULC change in the basin revealed an increase in the built-up and barren land, with a significant decrease in agricultural and forest areas. The results show that the projected future precipitation will decrease under the RCP 4.5 and increase under the RCP 8.5 scenario. The projected average maximum and minimum temperature are expected to increase under both scenarios in the basin. The LULC 2050 scenario shows the most significant rise in average annual streamflow, at 7.5%. Whereas in the climate change scenarios, the average annual flow decreases under RCP 4.5 and increases under RCP 8.5. The combined impacts of climate change and LULC change are relatively higher than the isolated effects of these drivers in the basin. The study outcomes are expected to help policymakers consider the effect of climate change and LULC change on the river's hydrology so as to implement the management activities that account for the riverine ecosystem. Changes in land use land cover and meteorological parameters are important environmental issues that must be pointed out. These changes will affect the river flow and eventually affect the river ecosystem. The current research investigates the combined effects of land use land cover and climate change in the flow of the Achencoil basin in India. This study area is one of the most frequently flooded in the state. As a result, the projected climate and land use land cover provide an idea of future streamflow in the basin. This research enables a better understanding of the response of streamflow components to climate variability and land use land cover changes in the Achencoil basin, which might help policymakers develop strategies for regional water resource management. Implementing these policies and management strategies will necessitate collaboration and coordination across various levels of government, private sector, and local communities in order to mitigate the risk and support a sustainable riverine ecosystem. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’, a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40–0.56). Tobacco use (OR = 0.76, CI 0.59–0.98) and never having attended school (OR = 0.75, CI 0.62–0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48–1.02), feelings of anxiety (OR = 0.84, CI 0.66–1.08) and feelings of depression (OR = 0.90, CI 0.70–1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51–2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions—as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status. [ABSTRACT FROM AUTHOR]

January 2022 onward, India witnessed a sudden increase in Omicron COVID-19 infections, having a mild course that prompted us to identify the key host factors/immune molecules modulating disease course/outcomes. The current study evaluated the percentages of lymphocyte subsets by flowcytometry, SARS-CoV-2 specific T-cell immune response by ELISPOT, estimation of plasma cytokine/chemokine levels on a Bio-plex Multiplex Immunoassay System and anti-SARS-CoV-2 IgG levels by enzyme-linked immunosorbent assay in 19 mild Omicron infected patients, 45 mild SARS-CoV-2 (2020) patients and 36 uninfected controls from India. Natural killer cells, B and memory B cells were high in vaccinated and total Omicron-infected patients groups compared to the mild SARS-CoV-2 (2020) patient group, while CD8+ T cells were high in total Omicron-infected patients group compared to the uninfected control group (p < 0.05 each). Omicron-infected patients had T-cell response against SARS-CoV-2 whole virus, S1 proteins (wild type and delta variant) in 10 out of 17 (59%), 10 out of 17 (59%), and 8 out of 17 (47%), respectively. The current study of Omicron-infected patients elucidates broadly reactive antibody, T-cell response, and participation of memory B and T cells induced by vaccination/natural infection. The limited effect of Omicron's mutations on T-cell response is suggestive of protection from severity. Pro-inflammatory IL-6, IFN-γ, chemokines CCL-2, CCL-3, CCL-4, CCL-5, and IL-8 as potential biomarkers of Omicron infection may have future diagnostic importance. The cellular immune response data in Omicron-infected patients with parental Omicron lineage could serve as a starting point to define the readouts of protective immunity against circulating Omicron subvariants. [ABSTRACT FROM AUTHOR]

Introduction: Noise pollution in operating theatres has deleterious effects on patient outcomes and staff performance. At the same time, the use of noisy technological equipment in operation theatres has increased in recent years. In light of this trend, it can be assumed that noise pollution in operating theatres remains challenging for patients and providers. Objective: To measures noise levels during laparoscopic procedures in operation theatres of a tertiary care hospital in Southern India and compare them with the recommended standards. Methods: In this cross-sectional observational study, the noise level in the operating theatre of a tertiary care hospital in Southern India during laparoscopic procedures was evaluated using a Decibel Meter from January 2022 and June 2022. Statistical analysis was done using descriptive statistics and one-way ANOVA. Results: Noise levels between 73.68 dB(A) and 49.30 dB(A) during laparoscopic procedures exceeds national and international recommended standards. The highest noise level is observed in the extubation phase of laparoscopic surgery, followed by the surgery and induction phases. Conclusion: Prolonged exposure to high levels of noise during laparoscopic procedures in operating theatres is a hazard to surgeons, anesthetists, personnel, and patients. Government, healthcare professionals, and other agencies should discuss guidelines for improving measures to reduce noise in operation theatres. [ABSTRACT FROM AUTHOR]

Background: One needs to choose wisely between primary neoadjuvant chemotherapy and primary cytoreductive surgery in ovarian cancer. The aim was to determine the recurrence free survival and overall survival after surgery for epithelial ovarian cancer and also the risk factors for recurrence and death. Methods: Electronic medical records of 322 women operated for ovarian, fallopian or primary peritoneal cancer between 2011 and 2015 were reviewed. Descriptive statistics were used to describe patients and their clinical outcomes. Cox proportional hazard models were used for risk factor analysis. Adjusted hazard ratios were obtained for recurrence and death, adjusted for stage, primary treatment modality, residual disease and histology. Kaplan-Meier curves were drawn for probability of recurrence-free survival and overall survival. The log rank test was used to compare survival probabilities. Results: The majority were stage III or stage IV (78%), serous histology (71%) and high grade (64%). Primary cytoreduction was done in 48% and interval cytoreduction in 52%. The median duration of follow up (survival) was 77 months (95% CI 72-82). There were 179 known recurrences (55.6 %). The estimated median time to recurrence was 22 (95% CI 14.5- 29.5) months. The independent risk factors for recurrence were neoadjuvant chemotherapy [HR 2.14, 95% CI 1.48-3.09], stage III/IV [HR 2.75; 95% CI 1.40-5.41], high grade serous histology [HR 1.69; 95% CI 1.12-2.54] and sub-optimal debulking [HR 3.15, 95% CI 2.19-4.55]. There were 78 known deaths (24.2 %) with a mean time to death of 24.3 (SD 16.1) months. The independent risk factors for death were sub-optimal debulking [HR 3.07; 95% CI 1.78-5.29] and stages III and IV cancer [HR 3.07; 95% CI 1.14-8.27]. Conclusions: Most ovarian cancers recur within 2 years. Risk factors for mortality are advanced stage and sub-optimal debulking. Maximal efforts at down staging and surgical resection will increase survival. [ABSTRACT FROM AUTHOR]

A quasiexperimental field study was undertaken in 576 exclusively breastfed (EBF) infants from 0 to 14 weeks in Gujarat, India to assess the effect of the use of appropriate breastfeeding techniques on daily weight gain rate and on reducing the underweight rate in early infancy. The interventions were delivered through the existing health system and focused primarily on counselling pregnant women during antenatal and post‐natal sessions for ensuring 'effective breastfeeding' by adoption of the technique of 'cross cradle hold', appropriate breast attachment, emptying of one breast before shifting to the other along with conducting regular monitoring of infant's weight. The intervention care group (ICG) of 300 EBF infants were compared with 276 EBF infants in the control standard care group (SCG). The findings revealed that median weight gain per day between 0 and 14 weeks was significantly higher (p = 0.000) in ICG (32.7 g) as compared with SCG (28.05 g). The median weight‐for‐age Z at 14 weeks of age was also significantly higher in ICG compared with SCG (p = 0.000). Underweight prevalence was three times lower in ICG (5.3%) compared with SCG (16.7%) at 14 weeks of age. Infants in the ICG were noted to be 2.65‐fold more likely to achieve a weight gain of 30 g or more per day compared with infants in SCG. Nutrition interventions, therefore, must aim not only on mere promotion of EBF for up to 6 months but stress on ensuring EBF is 'effective' for optimum transfer of breastmilk through adoption of appropriate techniques, including cross‐cradle hold, by mothers. Key messages: Breastfeeding, even if exclusive, can be suboptimal if the skills of mothers are not appropriate resulting in poor breastmilk transfer and poor intake of nutrients by a baby.Effective counselling on appropriate attachment to the breast, hold and positioning, is important to increase secretion of milk and optimise the transfer of breastmilk and thus improve infant nutritional status.This study shows that counselling mothers on cross cradle hold technique of breastfeeding during antenatal and post‐natal care periods combined with the frequent weighing of infants significantly escalates daily weight gain to over 30 g/day in 0–14 weeks of age. [ABSTRACT FROM AUTHOR]

Radioactive contamination of the earth’s biosphere has always been a source of concern. From the health point of view, radiation exposure and dose delivered to human beings are of prime importance. Certain parts of coastal southwest districts of the state of Kerala in India namely Thiruvananthapuram (Trivandrum), Kollam (Quilon) and Alappuzha (Alleppey) are known high background radiation areas (HBRA) owing to the presence of rich quantities of thorium and uranium. Surface soil samples from these districts' HBRAs and adjoining regions were studied for their primordial radionuclide levels using NaI(Tl) based gamma-ray spectrometry. Specific activities of 226Ra, 232Th and 40K nuclides in soil samples from the whole study area were between 4.7 Bq/kg to 130 Bq/kg, 6.5 Bq/kg to 611 Bq/kg and 101 Bq/kg to 1852 Bq/ kg, respectively. Important dosimetric parameters namely radium equivalent activity (Raeq), absorbed gamma dose (D), Indoor and outdoor Annual Effective Dose equivalents (AEDin & AEDout), internal and external hazard indices (Hin & Hex) for gamma exposure, and Excess Lifetime Cancer Risk (ELCR) were also determined to assess probable health effects on human beings residing in these regions. A comparison of average specific radioactivities and average indoor annual effective doses between the HBRA and Normal background Radiation Area (NBRA) is presented. Results show that the neighbouring regions have considerably lower radiation dosimetric parameters. [ABSTRACT FROM AUTHOR]

Background: Cytogenetic analysis continues to have an important role in the management of acute myeloid leukemia (AML) because it is essential for prognostication. It is also necessary to diagnose specific categories of AML and to determine the most effective form of treatment. Reports from South Asia are few because the availability of cytogenetic services is relatively limited. Methods: We performed a retrospective analysis of the cytogenetic findings in adults with AML seen consecutively in a single centre in India. The results were categorised according to the 2022 World Health Organisation (WHO), International Consensus Classification (ICC) and European LeukemiaNet (ELN) classifications. Results: There were 1791 patients aged 18–85 years (median age 42, 1086 males). Normal karyotypes were seen in 646 (36%) patients. The 1145 (64%) abnormal karyotypes comprised 585 (32.7%) with recurrent genetic abnormalities (RGA), 403 (22.5%) with myelodysplasia-related cytogenetic abnormalities (MRC), and 157 (8.8%) with other abnormalities. There were 567 (31.7%) patients with solitary abnormalities and 299 (16.7%) with two abnormalities. Among the 279 (15.6%) patients with ≥ 3 abnormalities, 200 (11.2%) had complex karyotypes (CK) as per the WHO/ICC and 184 (10.3%), as per the ELN definition. There were 158 (8.8%) monosomal karyotypes (MK). Patients with normal karyotypes had a higher median age (45 years) than those with abnormal karyotypes (40 years, p < 0.001), and those with ≥ 3 abnormalities (43 years), than those with fewer abnormalities (39 years, p = 0.005). Patients with CK (WHO/ICC) and monosomal karyotypes had a median age of 48 years. Those with RGA had a lower median age (35 years, p < 0.001) than MRC (46 years) or other abnormalities (44 years). The t(15;17) was the most common abnormality (16.7%),followed by trisomy 8 (11.6%), monosomy 7/del 7q (9.3%), t(8;21) (7.2%), monosomy 5/del 5q (6.7%) and monosomy 17/del 17p (5.2%). Conclusion: Our findings confirm the lower age profile of AML in India and show similarities and differences with respect to the frequencies of individual abnormalities compared to the literature. The frequencies of the t(15;17), trisomy 8 and the high-risk abnormalities monosomy 7 and monosomy 5/del 5q were higher, and that of the inv(16), lower than in most reports. [ABSTRACT FROM AUTHOR]