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India boasts of a vast freshwater resource network (rivers, wetlands, and groundwater), which has unique ecological, social and economic values associated with it. Despite their importance for both people and biodiversity, its freshwater ecosystems (FWEs) are heavily impacted through multiple factors such as pollution, overexploitation, habitat loss/modification and climate change. India is also among the hotspots of water resource overuse that has caused a serious decline in freshwater availability.Given that healthy FWEs lie at the centre for supporting the country's ecology, health, economy, livelihoods and ultimately achieving multiple policy goals, it is crucial that holistic and focused efforts are made to protect, conserve, and restore all types of FWEs.We call for an urgent and a greater focus on implementing conservation actions for FWEs in India and suggest the following strategy to enhance focus on their conservation: (1) establishing a shared freshwater conservation vision at a national scale, (2) developing and including national freshwater conservation goals within global efforts, (3) conducting simultaneous conservation action planning at regional scales and (4) bridge planning to implementation gap by strengthening key enabling conditions: i) mainstream FWE conservation within key existing governance instruments, ii) secure sustainable conservation funding, iii) improve data access and knowledge translation; iv) create national awareness around importance of FWEs; v) facilitate collaboration among key actors. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) account for over three-quarters of all deaths taking place in developing nations. Objective: The present study aims to stratify noncommunicable disease (NCD) patients using the Globorisk chart for predicting their 10-year risk of a major (fatal or nonfatal) CVD event and to estimate the level of agreement between this country-specific chart and the existing World Health Organization (WHO)/International Society of Hypertension (ISH) risk strata. Methods: A record-based cross-sectional analytical study was conducted in 2018 among adults attending the NCD clinic of one rural and one urban primary health center in Puducherry. Laboratory and office risk calculators of the Globorisk chart were used to calculate the risk. Results: The median age (interquartile range (IQR)) of the 760 study participants was 58 (50--65) years. When calculated using the Globorisk prediction chart, 22.1% (n = 168) of the participants had a <10% risk for any CVD event in the next 10 years, whereas the same risk was found in 71.1% (n = 540) by using the WHO/ISH risk chart. There was no agreement found between the two risk charts (k = 0.0174; P-value = 0.26). Conclusion: The Globorisk chart was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts. [ABSTRACT FROM AUTHOR]

The study proposes a hybrid renewable energy system in India that combines solar and wind energy conversion. The system is designed to meet user load demands at specific locations, reducing electricity usage. The system is optimized using various sizing components, including climatological data, load profile, PV array parameters, wind parameters and battery parameters. The hybrid optimization model for electric renewables is used to design, analyse and optimize the system. The performance of each module, inverter, and battery is examined, considering factors such as energy production, consumption, emissions, initial cost, operating cost, net present cost, and energy cost. [ABSTRACT FROM AUTHOR]

Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics, and to examine the association of risk clusters with manifest psychopathology. Participants (n = 8300) between 6 and 23 years were recruited from seven sites in India. We administered questionnaires to elicit history of previous exposure to adverse childhood environments, family history of psychiatric disorders in first-degree relatives, and a range of antenatal and postnatal adversities. We used these variables to generate risk clusters. Mini-International Neuropsychiatric Interview-5 was administered to evaluate manifest psychopathology. Two-step cluster analysis revealed two clusters designated as high-risk cluster (HRC) and low-risk cluster (LRC), comprising 4197 (50.5%) and 4103 (49.5%) participants, respectively. HRC had higher frequencies of family history of mental illness, antenatal and neonatal risk factors, developmental delays, history of migration, and exposure to adverse childhood experiences than LRC. There were significantly higher risks of any psychiatric disorder [Relative Risk (RR) = 2.0, 95% CI 1.8–2.3], externalizing (RR = 4.8, 95% CI 3.6–6.4) and internalizing disorders (RR = 2.6, 95% CI 2.2–2.9), and suicidality (2.3, 95% CI 1.8–2.8) in HRC. Social-environmental and developmental factors could classify Indian children, adolescents and young adults into homogeneous clusters at high or low risk of psychopathology. These biopsychosocial determinants of mental health may have practice, policy and research implications for people in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Purpose: Most of the research studies on entry mode have been done through the lens of manufacturing firms from mature economic countries entering the Global South countries, and most of the related frameworks and theories have been developed to explain this perspective. This paper presents an understanding of entry mode strategies of services firms from the Global South countries entering into countries with mature economies by considering six software services firms in India entering the US market. The study develops a framework that incorporates multiple theories – both from an emerging economy perspective as well as a services perspective. Design/methodology/approach: This study is exploratory in nature and focuses on the how and why aspects of strategic decisions. Qualitative research has traditionally been chosen when the main research objective is to improve understanding of a phenomenon. A multiple case study approach was used in this research. One of the key aspects of this study is the impact of different theories (institutional, network and other theories) on enterprises of different sizes. Therefore six cases – two each on small, medium and large enterprises – were selected. Findings: Results identify addressable market size, cultural aspects, firm size, resource and service characteristics as dominating factors that influenced choice of entry modes. From a theoretical perspective, the author finds that theories such as transaction cost theory, eclectic paradigm and other popular theories associated with entry mode do not successfully explain the entry mode strategies for firms from the Global South. Strategic theory, such as resource-based view, motivation of a firm, have some application but do not explain, in isolation, all aspects of the entry mode choices. Research limitations/implications: The study is an exploratory study and needs more data to validate the themes expressed in its conclusions. The study also focused on one industry and one country. Different industries within the same country may have different characteristics and may not follow the observations found in this study. Similarly, firms from other countries with similar economic characteristics may exhibit very different behavior. As a result, the themes that were expressed for software companies in India may not be generalizable across other industries and countries. Originality/value: This study is significant for both academics and managers. For academics, the study addresses a significant gap in the literature. For managers, this study provides a framework for managers to evaluate and select the entry mode strategy that would be most effective in a successful expansion into foreign countries. [ABSTRACT FROM AUTHOR]

Reports on behavioral interventions for the treatment of Tourette's disorder (TD) from India are limited. This patient series describes the usefulness and feasibility of conducting behavioral interventions for patients with TD from an Indian general hospital psychiatric unit. Behavioral treatments in these seven consecutively treated adult/adolescent patients with TD included all components of habit reversal treatment, comprehensive behavioral intervention for tics, and exposure with response prevention in some patients. Patients were predominantly male, with adolescent-onset severe TD, typical features and psychiatric comorbidities, and poor response to multiple medications prior to the institution of behavior therapy. In addition to long delays in diagnosis, none of the patients or their caregivers had been informed by the doctors they had consulted earlier about TD or the need for behavioral treatments before attending our center. Institution of behavioral treatments along with medications led to a 75% reduction in the severity of tics and reduction in comorbid symptoms. Patients and caregivers also reported similar rates of improvement as well as reductions in subjective distress and caregiver burden. Five patients have been followed up for seven months to seven years; apart from one patient, all others have had only minor exacerbations of tics during this period. This limited experience suggests that behavior therapies for TD can be successfully implemented in low-resource, non-specialized Indian settings. They are effective, and gains from such treatment are usually enduring. [ABSTRACT FROM AUTHOR]

Background: Currently nonselective cyclooxygenase (COX) inhibitors, ibuprofen and indomethacin, are approved drugs for closure of patent ductus arteriosus but have potential toxicities. There are reports of the effectiveness of paracetamol in ductal closure. However, there is paucity of data comparing paracetamol to ibuprofen or indomethacin in relation to the efficacy and safety profile.Methods: This randomized clinical trial was done in our tertiary care neonatal unit from October 2014 to January 2016 after clearance from ethical committee. It was registered with clinical trial registry of India (CTRI/2016/09/007261) and drug controller general of India (CT/Drugs/56/2014). Preterm neonates with clinical suspicion of hemodynamically significant PDA after echo confirmation were included in the study. Randomization was done by stratified randomization through sealed opaque envelopes. A sample size of 150 was estimated with an expected difference in success of closure as 20% between the treatment groups at level of 5% significance and 80% power. The echocardiography was done 24 hours after completion of treatment by a cardiologist blinded to treatment.Results: The baseline parameters were comparable between two groups. One hundred and forty-six babies had hs-PDA, out of which 110 babies were randomized. No significant difference was found between the two groups with respect to PDA closure (RR 0.97, 95%CI 0.78-1.20, p = 1), mortality or cardio-respiratory morbidity. The babies who received ibuprofen had a higher occurrence of acute kidney injury (RR 0.33, 95%CI 0.13-0.85, p = 0.024).Conclusions: Paracetamol is as effective as ibuprofen for PDA closure in preterm neonates. Ibuprofen used for PDA closure in preterms poses an increased risk for acute kidney injury compared to paracetamol. [ABSTRACT FROM AUTHOR]

• OCD severity and relapse rate were similar in the pandemic and non-pandemic cohorts. • COVID-19-related anxiety declined over time. • Medication non-adherence and COVID-19-related anxiety predicted worsening of OCD. • Prevalence of COVID-19-themed obsessions and compulsions was 8 %. There is limited data on the long-term effect of the COVID-19 pandemic on obsessive-compulsive disorder (OCD). We report on the course of a cohort of individuals with OCD followed-up over a period of one year during the first wave of the COVID-19 pandemic in India. A cohort of 240 individuals registered at a specialty OCD clinic was regularly followed-up using standardized rating tools at three months, six months, and one year into the onset of the COVID-19 pandemic in India. These were compared with clinical ratings recorded in a comparable historical cohort of 207 individuals with OCD, followed up during a non-pandemic year. The pandemic and non-pandemic (historical control) cohorts did not differ in illness severity and rate of relapse. It was found that COVID-19-related anxiety declined over time. Among those patients who were treatment responders prior to the pandemic, COVID-19-related anxiety and non-adherence to medication predicted a relapse of symptoms. Contrary to our expectations, the rate of relapse and illness trajectory in the pandemic cohort did not differ from the non-pandemic cohort, suggesting that the pandemic did not impact our largely medication-adherent cohort. Adherence to treatment seemed to have a protective effect during the pandemic. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the diagnostic accuracy of a novel hypothermia monitoring and alert bracelet device (BEMPU Bracelet) in low birth weight (LBW) neonates weighing less than 2000 g.Design: This was a controlled prospective study.Setting: This study was done in the step-down nursery of a tertiary level newborn unit of a major teaching hospital in India.Methods: Eligible cases fulfilling inclusion criteria were given BEMPU Bracelets for a period of 24 h. A comparison was made between skin temperatures taken at the axilla by a mercury thermometer and skin temperatures taken at the wrist by the BEMPU Bracelet. Temperatures were taken every 6 h and every time the BEMPU Bracelet alarmed. Trained nurses obtained temperature measurements on newborns during their 24-h stay in the hospital step-down nursery.Results: A total of 461 neonates were screened for hypothermia, giving 2428 temperature readings. Three hundred and eleven of 461 babies experienced hypothermia at some point. The 461 babies studied experienced 495 episodes of hypothermia in total. The sensitivity and the specificity of the bracelet in diagnosing hypothermia were 98.6% and 95% respectively. The positive and negative predictive values of the bracelet were 83.6% and 99.6%, respectively. The accuracy of the bracelet in diagnosing hypothermia was 95.8%.Conclusion: The BEMPU Bracelet is an accurate screening tool to detect and alert for neonatal hypothermia, thereby facilitating prompt management, which could prevent complications. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study is to assess the opinion of young psychiatrists (aged ≤45 years) about the various scientific activities of Indian Psychiatric Society (IPS). Materials and Methods: An online survey using SurveyMonkey electronic platform was conducted. Data of 350 participants were available for analysis. Results: The mean age of the participants (spread across 115 institutes/medical colleges) was 33.61 (standard deviation [SD] – 5.32) years and their mean number of years of experience in psychiatry including the training period was 8.25 (SD – 5.5) years. About 70% of the participants (n = 243) rated the current format of the Annual National Conference of the IPS (ANCIPS) to be "good/very good," and more than half of the participants agreed that the conferences at the zonal and state level help in enhancing the academic knowledge of the participants as well as such activities help in enhancing the social interaction among fellow colleagues. Among the various scientific sessions of the ANCIPS, workshops and guest lectures were rated as very useful by three-fifth of the participants. Regarding opinion in terms of changes required in the current format of the ANCIPS and other conferences/continuing medical educations (CMEs) being conducted by IPS, more than half to about two-third of the participants reported that having more hands-on workshops, having sessions like meet the experts, having mentorship programs, and more expert speakers from India will "definitely" be useful. Majority of the participants expressed that reduction of concurrent sessions would be definitely be beneficial. In terms of modification of ongoing activities and introduction of new activities, about two-third of the participants expressed that having IPS supported travel fellowship programs within the country and abroad, having subject/topic-focused conferences, and starting online CMEs will be definitely be useful. Conclusions: The present survey reflects that there is a need to have more subject/topic-focused conferences/CMEs, need to introduce online CME activities, reduction of concurrent sessions during the conferences and strengthening the travel fellowship programs. All these can be considered as expectations of the young generation of psychiatrists from the organization like IPS, which should be duly considered while planning future conferences and CMEs. [ABSTRACT FROM AUTHOR]

Introduction: Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. Aim: The aim of the study was to assess the perceptions on patient safety culture among health-care providers (HCPs) at a public sector tertiary care hospital in South India. Settings and Design: A hospital-based cross-sectional study was conducted 1 year after patient safety initiatives were implemented. Materials and Methods: Participants were selected through proportionate stratified random sampling. The Hospital Survey on Patient Safety Culture was used to assess perception of patient safety culture. Responses were collected on a Likert scale and were categorized into four types as negative, neutral, positive response, and nonresponse. Statistical Analysis Used: The data were entered in EpiData Version 3.1 and analyzed using SPSS Version 17. "Composite positive response rate" for the various dimensions was calculated. Results: The overall response rate in the study was 91.6%. Average composite positive response rate was 58%, and it varied among different cadres of HCPs ranged from 53% to 61%. The dimensions "teamwork within the unit," "organizational learning and continuous improvement," and "supervisor or officer-in-charge expectations" showed highest positive responses (80.1%, 77.8%, and 71.5%, respectively). Conclusions: This survey conducted after implementation of patient safety drive showed that, in many dimensions, the patient safety culture has taken roots. The dimensions such as "hand-off and transitions," "frequency of events reporting," and "communication openness" had scope for further improvement. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the influence of CYP2C9, VKORC1, CYP4F2, and GGCX genetic polymorphisms on mean daily dose of acenocoumarol in South Indian patients and to develop a new pharmacogenetic algorithm based on clinical and genetic factors. Methods: Patients receiving acenocoumarol maintenance therapy ( n = 230) were included in the study. Single nucleotide polymorphisms (SNP) of CYP2C9, VKORC1, CYP4F2, and GGCX were genotyped by real-time polymerase chain reaction (RT-PCR) method. Results: The mean daily acenocoumarol maintenance dose was found to be 3.7 ± 2.3 (SD) mg/day. The CYP2C9 *1*2, CYP2C9 *1*3, and CYP2C9 *2*3 variant genotypes significantly reduced the dose by 56.7 % (2.0 mg), 67.6 % (1.6 mg), and 70.3 % (1.5 mg) than wild-type carriers 4.1 mg, p < 0.0001. The genetic variants of CYP2C9 and GGCX (rs11676382) were found to be associated with lower acenocoumarol dose, whereas CYP4F2 (rs2108622) was associated with higher doses. Age, body mass index (BMI), variation of CYP2C9, VKORC1, CYP4F2, and GGCX were the major determinants of acenocoumarol maintenance dose, accounting for 61.8 % of its variability (adjusted r = 0.615, p < 0.0001). Among the VKORC1 variants, rs9923231 alone contributed up to 28.6 % of the acenocoumarol dose variation. Conclusion: VKORC1 rs9923231 polymorphism had the highest impact on acenocoumarol daily dose. A new pharmacogenetic algorithm was established to determine the acenocoumarol dose in South Indian population. [ABSTRACT FROM AUTHOR]

Background. Insulin resistance has been associated with dyslipidemia and cardiovascular disease. Even though homeostasis model assessment of insulin resistance (HOMA-IR) is a well-known insulin resistance predictor, estimation of serum lipoprotein ratios has been recently suggested as a surrogate marker for insulin resistance. Here, we evaluated the relationship between lipoprotein ratios and insulin resistance in normoglycemic nondiabetic south Indians with acute coronary syndrome. Methods. 100 normoglycemic nondiabetic ACS patients and 140 controls were enrolled in the study. Levels of fasting glucose, fasting insulin, and lipid profile [total cholesterol (TC), triglycerides (TG), and high density lipoprotein cholesterol (HDL-C)], lipoprotein(a) [Lp(a)] levels were measured and lipoprotein ratios were computed. HOMA-IR was used to calculate the insulin resistance. Receiver operating characteristic curves (ROC) analysis was used to compare the power of these lipoprotein ratios to predict insulin resistance. Results. Lipoprotein ratios were significantly higher in normoglycemic nondiabetic ACS patients, as compared to healthy controls, and were significantly correlated with HOMA-IR by Spearman's rank correlation analysis. ROC curve showed that Lp(a)/HDL-C and TG/HDL-C ratios were the best surrogate predictors of insulin resistance in normoglycemic nondiabetic ACS. Conclusion. This study demonstrates that serum lipoprotein ratios significantly correlate with insulin resistance in normoglycemic nondiabetic ACS. Lp(a)/HDL-C and TG/HDL-C ratios could be used as surrogate markers of insulin resistance in atherosclerosis-prone south Indians with normoglycemic nondiabetic ACS. [ABSTRACT FROM AUTHOR]

Objective: To determine the influence of genetic polymorphisms on warfarin maintenance dose and to explicate an algorithm using the pharmacogenetic and clinical factors to determine the maintenance and/or starting dose of warfarin in South Indian patients receiving warfarin therapy. Methods: Patients receiving stabilized warfarin therapy ( n = 257) were included in the study. Single nucleotide polymorphisms (SNPs) of CYP2C9 (rs1799853 and rs1057910), VKORC1 (rs9923231, rs7196161, rs2884737, rs9934438, rs8050894, rs2359612 and rs7294), CYP4F2 (rs2108622) and GGCX (rs11676382) were genotyped by the quantitative real time-PCR method. Results: The mean daily maintenance dose of warfarin was found to be 4.7 ± 2.1 mg/day. Patients with the CYP2C9*1/*2, *1/*3 and *2/*3 variant genotypes required a 51.0 (2.8 mg), 60.9 (2.3 mg) and 62.2 % (2.2 mg) lower daily maintenance dose of warfarin, respectively, than those patients with the CYP2C9*1/*1 wild-type genotype (5.2 mg) ( p < 0.0001). The genetic variants of CYP2C9, VKORC1 and GGCX were associated with decreased warfarin dose, except for rs7196161, rs7294 and rs2108622 which were associated with an increased warfarin dose. Genetic variations of CYP2C9 ( *2 and *3), VKORC1 (rs9923231, rs7294, rs9934438 and rs2359612), CYP4F2, GGCX and non-genetic factors such as age, body weight, clinical status (post mechanical valve replacement) could explain up to 62.1 % of the overall variation (adjusted r 60.2 %, p < 0.0001) in warfarin maintenance dose. Conclusion: Genetic polymorphisms of CYP2C9, VKORC1, CYP4F2 and GGCX are important predictive factors of warfarin maintenance dose, and the developed algorithm will be useful to predict the required maintenance and/or starting warfarin dose in South Indian populations. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Incidence of Low Back Pain (LBP) in athletes is as high as 30%. Patients with LBP show altered postural and neuromuscular responses to various functional tasks. The objective of the study was to compare long latency reflex response (occurring between 40 to &nvsim; 100 ms duration) in athletes with chronic LBP with asymptomatic athletes. METHODS: Surface electromyography (EMG) of superficial trunk muscles - Rectus Abdominis (RA) and Erector Spinae (ES) were studied in athletes with chronic LBP (n=24) and asymptomatic athletes (n=25). Perturbations were introduced in standing both expectedly and unexpectedly. The latency of onset and the Root Mean Square (RMS) amplitudes within the reaction duration were compared between the two groups. RESULTS: The latency of onset was delayed in Unexpected perturbations but no change was observed in Expected tasks. The mean RMS amplitudes were significantly lower in both tasks for RA and in the Expected task for ES (p< 0.05). CONCLUSION: Chronic LBP athletes exhibit a delay in onset latency to Unexpected perturbations and reduced long latency response amplitudes to perturbation tasks compared to asymptomatic athletes. These changes could predispose athletes to recurrent low back pain and further injury. [ABSTRACT FROM AUTHOR]

Background & objectives: Several studies reported the polymorphisms of β1-adrenergic receptor gene in healthy volunteers and its influence on cardiovascular disorders. We investigated the genotype and allele frequencies of Ser49Gly and Arg389Gly polymorphism in healthy volunteers of South Indian Tamilian population vis-à-vis other major ethnic groups. Methods: The genetic variants were determined by using Taqman 5′ nuclease assay- real time PCR analysis in 533 normal healthy volunteers (18-60 yr; M=290; F=243). The allelic discrimination analysis was done by 7700 SDS software. Results: The estimated genotype and allele frequencies of Ser49Gly and Arg389Gly polymorphism were compared with other major populations. The frequencies of the variant alleles Gly49 and Gly389 were 15.1 and 25.8 per cent respectively. Interpretation & conclusions: Our study shows that interethnic variation exists in the polymorphisms of β1-adrenergic receptor gene and the results generated in this study might serve as a genetic marker for further studies in Tamilian (South India) population. [ABSTRACT FROM AUTHOR]