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The COVID-19 pandemic has led to the disruption of classroom activities and adoption of online teaching-learning in almost all parts of the globe, including India. The sudden switch from classroom blackboards to laptop screens may have influenced students' study approaches, especially with challenges related to technology access and readiness for online learning among Indian students. Since different social and economic factors bring about differences in students' learning, an online survey was conducted with 296 randomly selected undergraduate distance learning (DL) students at Indira Gandhi National Open University to examine how technology access during the pandemic influenced the study approaches of Indian DL students from various marginalized and non-marginalized groups. The research results showed that marginalized students had lower access to technology than did their non-marginalized counterparts, although no gender differences were found in access to technology in both the groups. Lower access to technology was associated with a surface approach to study among the DL students in general and the marginalized students in particular. Females in the marginalized group were found to be at risk in terms of both access to technology and study approaches. The findings were intended to enrich our understanding of the role of technology vis-à-vis distance learners' study approaches during the pandemic and formulate appropriate teaching-learning strategies for the future.

E-learning was the most preferred mode of instruction during COVID-19 pandemic. In March 2020, the Government of India closed all the educational institutions in India due to spread of COVID-19 pandemic. The closure of educational institutions affected the schools, colleges and universities. To overcome this, the HEI's adopted various online learning methods to reach out to students. E-learning was the method which HEI's adopted for continuing the education during COVID-19 pandemic. E-learning was one of the solutions which helped students to carry their teacher learning from the safety of their respective homes. It offered flexibility to students in terms of when and where they can learn. E-learning helped students and teachers in continuity of education during pandemic as it offered a quick and scalable solution for delivering educational content remotely which allowed students to continue their education without any interruption. The aim and objectives of the current study is to analyze the scenario of E-learning in India during COVID-19 pandemic. It also highlights the importance of E-learning platforms because of which it was adopted during pandemic. Further, the study also highlights various challenges faced by teachers and students during pandemic.

Since the outbreak of the COVID-19 pandemic, cases of discrimination and hate crimes against minority populations including international students have soared in the U.S. This study explores the relationship between international students' perceived discrimination and their self-reported overall health and the role of social support and positive emotions in such relationship. In total, 203 international students studying at two U.S. universities participated in an online survey. The results indicated that: (1) when international students perceive higher levels of discrimination, they experience lower levels of positive emotions and have lower levels of perceived social support; and (2) positive emotions were significantly associated with both psychological distress and physical health. Perceived social support was only significantly associated with physical health not psychological distress. We also provided meaningful implications for higher educational institutions that strive to enhance international students' overall health.

This qualitative study captured the reflections of 53 English language teachers from 40 different contexts including Bangladesh, Colombia, France, India, Scotland, Taiwan, Türkiye and the United Kingdom on teaching English during the times of COVID-19 and its post-effects on their practices. Data were collected through an online form consisting of three stems and the participants were asked to create similes about teaching English before, during and after the pandemic. By conducting thematic analysis, images created for each phase were categorized under occupational well-being, digital transformation, transactional distance, gap of communication and social isolation. Teachers pointed out work overload, lack of administrational support, instructions' not making sense, decreasing level of participation, dropouts, loss of student--teacher interaction and isolation as the drawbacks of the process along with the possibility of digital transformation ahead of their profession.

The most destructive period the world has experienced seems to be behind us. Not a single nation was spared by this disease, and many continue to struggle today. Even after recovering from COVID, patient may continue to experience some post-COVID effects, such as heart irregularities or a decline in lung vitality. In the past three years (2019-2022), the world has witnessed the power of a small entity, a single peculiar virus. Science initially appeared to be helpless in this regard, but due to the emergence of disease, pharmaceutics (the development of anti-covid drugs), immunology (the rapid antigen test), microbiology (the isolation of viruses from infected people), biotechnology (the development of recombinant vaccines), biochemistry (the blood profile, the D-dimer test), and biochemistry (blood profile, D-dimer test), biophysics (PCR, RT-PCR, CT Scan, MRI) had worked together to fight the disease. The results of these efforts are the development of new diagnostic techniques, possible treatment and finally the availability of vaccines against COVID-19. However, it is not proven that the treatment through the traditional medical system is directly active on SARS-CoV-2 but is instead indirectly acting on SARS-CoV-2 effects by improving symptoms derived from the viral disease. In India, the traditional system of medicine and tradition knowledge together worked in the pandemic and proved effective strategies in prevention and treatment of SARS-CoV-2. The use of effective masks, PPE kits, plasma therapy, yoga, lockdowns and social seclusion, use of modern antiviral drugs, monoclonal antibodies, herbal remedies, homoeopathy, hygienic practice, as well as the willpower of people, are all contributing to the fight against COVID. Which methods or practices will be effective against COVID nobody is aware since medical professionals who wear PPE kits do not live longer, and some people in India who remained unprotected and roamed freely were not susceptible to infection. The focus of this review is on the mode of transmission, diagnosis, preventive measures, vaccines currently under development, modern medicine developed against SARS-CoV-2, ayurvedic medicine used during pandemic, homoeopathic medicine used during pandemic, and specific yoga poses that can be used to lessen COVID-related symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study introduces a detailed compartmental model developed to understand the complex dynamics of COVID-19 transmission, focusing on the Delta and Omicron variants in India. The model tracks disease progression through different population compartments, considering factors like vaccination, time-dependent transmission, economic burden and COVID-19 death rates, loss of vaccine-induced immunity, and the transition of asymptomatic cases to recovery. The model is validated against established epidemiological knowledge and real-world data, emphasizing dynamic parameterization and accurate representation of immunity dynamics. The basic reproduction number for both variants is calculated, and sensitivity analysis for various parameters is conducted. Time-dependent parameters are estimated using the discrete inverse method. The study also explores the economic burden, impact of different types of masks, vaccine efficacy, and vaccine-induced immunity through numerical analysis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This paper studied the career experiences of emerging adults amid the pandemic and how they make sense of their career identities during this time. Twenty Indian Emerging adults (18-25 years) wrote narratives about their career stories during the pandemic. Using thematic analysis, three key themes of (1) Perceived Impact of Pandemic Crisis on Career Identity, (2) Positive Meaning-Making of Career Identity amid the Crises, and (3) Negative Meaning-Making of Career Identity amid the Crises were identified. The study concluded that despite the negative impact of COVID-19 on career experiences, most emerging adults cognitively reframed negative experiences as positive.

Background: With the emergence of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, such as the Omicron variant, during the third wave of the coronavirus disease 2019 (COVID-19) pandemic, there was a need to identify useful homeopathic medicines. This study aimed to identify such medicines and their indications using prognostic factor research (PFR)., Methods: This was an open-label, multi-centred observational study conducted in January 2022, on confirmed COVID-19 cases. The data were collected from integrated COVID Care Centres in Delhi, India, where homeopathic medicines were prescribed along with conventional treatment. Only those cases that met a set of selection criteria were considered for analysis. The likelihood ratio (LR) was calculated for the frequently occurring symptoms of the frequently prescribed medicines. An LR of 1.3 or greater was considered meaningful., Results: Out of the 362 COVID-19 cases, 263 cases were selected for analysis after applying selection criteria. Common symptoms included fatigue, cough, sore throat, myalgia and headache. Twenty-one medicines were prescribed, of which nine medicines - Gelsemium sempervirens , Bryonia alba , Hepar sulphuris , Rhus toxicodendron , Pulsatilla nigricans , Arsenicum album , Belladonna , Nux vomica and Phosphorus - were frequently used. By calculating LRs, the study identified meaningful indications for these medicines., Conclusion: Homeopathic medicines have shown promising results in the third wave of COVID-19 as an adjunct therapy. The medicines that were used in the first and second waves were found useful in the third wave also, and their indications were analogous to those found in the earlier waves. Certain new indications of some medicines were elicited in this wave, which warrant further research. However, it is important not to restrict to these medicines only and to continue data collection on COVID-19 in future waves for the improvement of the COVID-19 mini-repertory., Competing Interests: None declared, (Faculty of Homeopathy. This article is published by Thieme.)

Background: Prior vaccination is often studied for its impact on individuals' post-infection prognosis. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) medicines, advised by the Government of India as prophylaxis during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, were consumed by the masses in 2020. A study was therefore undertaken to observe any association between the prior usage of AYUSH prophylactic medicines and post-infection severity as reported by recovered COVID-19 individuals., Methods: This was a retrospective, multi-centre, cohort study conducted in 21 cities of India from 5th August to 30th November 2020. Data from recovered COVID-19 patients, of either sex or any age, captured information about AYUSH prophylactic medicines intake prior to infection, disease severity, symptomatology, duration of complaints, etc. The study participants were grouped into AYUSH intake and non-intake. Primary composite outcome was the disease clinical course. Secondary clinical outcomes were the rate of and time to clinical recovery., Results: Data of 5,023 persons were analysed. Ayurveda or homeopathic prophylactic medicines were consumed by more than half of the study participants: that is, 56.85% ( n  = 1,556) and 56.81% ( n  = 1,555) respectively. The overall adjusted protective effect (PE) of AYUSH prophylactic intake against moderate/severe forms of COVID-19 disease was 56.7% (95% confidence interval [CI], 48.7 to 63.50; p  < 0.001). Adjusted PE for homeopathy and Siddha was 52.9% (95% CI, 42.30 to 61.50; p  < 0.001) and 59.8% (95% CI, 37.80 to 74.10; p  < 0.001), respectively. A statistically significant association was found between AYUSH prophylactic medicine intake and clinical recovery more frequently by the 3rd day of illness (χ 2  = 9.01; p  = 0.002). Time to resolution of symptoms in the AYUSH intake group was on average 0.3 days earlier than in the non-intake group ( p  = 0.002)., Conclusion: AYUSH prophylactics were associated with statistically significant levels of protection against COVID-19 disease severity. Amongst these, previous intake of homeopathy or Siddha medicines was associated with some protection against moderate/severe illness and with a somewhat quicker clinical recovery. Prospective studies with experimental research design are needed to validate the findings of this study., Study Registration: Clinical Trials Registry-India (CTRI/2020/08/027000)., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background and Objective: Long coronavirus disease 2019 (COVID-19) has emerged as an important consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To identify its incidence 12-18 months following hospitalization in patients with COVID-19, we performed a prospective study., Methods: Virologically confirmed successive patients with moderate-to-severe COVID-19, hospitalized during the delta wave in India, were recruited. Data on clinical features, investigations, and outcomes were obtained. Long COVID-19 was diagnosed using the European quality of life questionnaire (EQ-5D) and Birmingham symptom burden questionnaire (SBQ) at 12-18-month follow-up., Results: During the study period (January-July 2021), we evaluated 8,680 suspected COVID-19 patients, of whom 1,641 were confirmed virologically and 388 were hospitalized. Men accounted for 64.4%, individuals aged >60 years for 41.5%, hypertension for 42.8%, diabetes for 38.4%, and cardiovascular disease for 17.3%. At admission, there was a high prevalence of cough (71.1%), fever (86.6%), and oxygen requirement (38.6%). Proning was deployed in 89.2% of cases, nasal cannula in 36.3%, nonrebreather masks in 15.7%, noninvasive ventilation in 14.4%, and invasive ventilation in 16.2%. In-hospital deaths totaled 75 (19.3%), with 310 discharged for home care and eligible for follow-up. At a median follow-up of 15 months, 9 patients had died, 40 were lost to follow-up, and 264 were evaluated. The incidence of Long COVID-19 was 45 [17.0%, 95% confidence of interval (CI) 12.6-21.9%]. The median EQ-5D score was 5.0, with >5 observed in only 11 patients (0.6%). Using the SBQ, new-onset dyspnea on exertion was noted in 13 (4.9%), rest dyspnea in 7 (2.6%), fatigue in 31 (11.7%), feverishness in 18 (6.8%), and low energy in 16 (6.1%). Long COVID-19 was significantly more prevalent in women and older individuals. In Long COVID-19 compared to controls, the mean duration of oxygen requirement (5.46 ± 9.8 vs 2.46 ± 4.5 days, p = 0.002), use of nonrebreather masks (17.8 vs 7.3%, p = 0.026), noninvasive ventilation (11.1 vs 3.2%, p = 0.020), and duration of intensive care unit (ICU) stay (13.5, 8.7-17.3 vs 8.0, 5.0-11.0 days, p = 0.028) were significantly higher., Conclusion: The incidence of Long COVID-19 at 12-18 months follow-up is 17.0%. It is significantly higher in women, older age groups, and patients requiring longer oxygenation, nonrebreather oxygen masks, noninvasive respiratory support, and extended stays in the ICU., (© Journal of the Association of Physicians of India 2024.)

The COVID-19 pandemic has fast-tracked the development of digital applications and inspired everyone to adapt to the technologies to curb the spread of outbreak. As this crisis intensifies, the rapid usage of digital devices and apps has echoed the serious concerns about civil liberties, privacy, and data protection. Considering the situation, this research aimed to explore the internet using habits of the youths of West Bengal, a state in eastern India, during COVID-19. Besides, the paper explored their experiences of using various digital applications, the fundamental digital literacy and how safely they protect data from breaches. Thus, the paper presents the results by conducting an online survey among the youths in West Bengal. The result, from 215 participants, highlighted that the increased use of these digital applications has not matched the demand for digital privacy literacy among the young generation of the state. While this pandemic has raised their concerns over digital privacy and data protection, yet they do not undertake any strong protection mechanisms to safeguard them digitally. Besides, this paper suggests suitable plans to raise awareness among this generation and form a healthy digital citizenship with a proper regulatory framework as it is the need of the hour.

Purpose: This study examines learner readiness and satisfaction with blended learning systems in India's post-vaccine classrooms, focusing on the relationship between face-to-face (F2F), online learning (OL), and blended learning (BL) indicators and identifying which predictors within these systems most significantly affect learners' satisfaction (LS). Design/methodology/approach: An online survey was conducted with 451 students from both public and private universities in India. The data were analyzed using factor analysis and confirmatory factor analysis, followed by multiple regression to test the hypotheses. Findings: The findings reveal a significant positive correlation between learners' satisfaction and online learning and blended learning, with [beta] values of 28.3 and 27.2, bearing a p-value of 0.000. In contrast, face-to-face (F2F) learning was insignificant, with a [beta] value of 0.070 and a p-value of 0.119. These insights underscore the effectiveness of online and blended learning formats in enhancing learner satisfaction in higher education while also suggesting a re-evaluation of the role of traditional F2F learning methods. The research supports the integration of online learning in higher education due to its balanced mix of teacher-led and student-centered instruction, alongside the practical benefits of reduced travel costs and access to independent study resources. Practical implications: This study provides insights into student perceptions and attitudes towards blended learning in India's post-vaccine classrooms. It highlights the importance of tailoring blended learning strategies to meet colleges' and universities' diverse learning needs and goals in this evolving context. The findings serve as a valuable resource for educators and administrators, aiding in designing effective blended learning frameworks suited explicitly for higher education in India. Originality/value: While there is extensive literature on F2F, OL, and BL, limited research compares these learning approaches and their impact on learner satisfaction within the Indian higher education context. This study fills this gap by providing valuable insights for shaping educational strategies in India's post-vaccine classrooms.

The 2017 general comment (GC21) to the United Nations Convention on the Rights of the Child (UNCRC) on children in street situations, provides a framework of legal guidance for governments developing policies aimed at protecting street-connected children and sets up the rationale for more awareness raising and public education to counter negative and deficit attitudes towards street-connectedness. Within this framework, the media has a role to play in either challenging conceptualisations of street-connected children as out-of-place within the public and predominantly adult domain described by urban streets, or in reinforcing ideological constructions of citizenship and normalised notions of childhood that result in negative stereotypes of these children. GC21 recommends that interventions targeted at street-connected children should be ethically responsible -- adopting child rights approaches aimed at using accurate data/evidence that upholds the dignity of children, their personal integrity, and their right to life. As such, these approaches should also extend to how organisations engage with and utilise the media to represent street-connected children. Focusing on media representations of street-connected children during the six pandemic-affected months of February to July 2020, this paper provides a review of the content of the sources to provide an insight into the structural barriers that face street-connected children because of how they are positioned in society, during the pandemic and in general, and the extent to which the media reinforces or counters the rescue or removal narratives that can lead to inappropriate intervention responses.

Introduction: Public awareness of the COVID-19 pandemic has resulted in a reduction in healthcare utilisation for other diseases. Understanding how the COVID-19 pandemic affects hospital admissions and the disease patterns is crucial for proper triaging and planning of health resources in future pandemics. Aim: To compare the clinical spectrum of paediatric inpatients in the post-COVID-19, pre-COVID-19 and during COVID-19 pandemic periods in a tertiary level teaching centre. Materials and Methods: This ambispective study was conducted at the Paediatrics Department of SAT, Govt. Medical College, Thiruvananthapuram, Kerala, India. The analysis included all cases hospitalised from April 2019 to March 2022, with the data divided into three time periods. The discharge diagnoses of all cases admitted during the study period were coded according to the ICD-10 criteria and included in the analysis. Differences in admissions, disease patterns, and ICU admissions during the three time periods (pre-COVID-19, post-COVID-19, and during COVID-19) were compared using oneway ANOVA and Tukey's post-hoc test. Results: In the present study, ward admissions (p-value <0.001), respiratory infections (p-value 0.031), asthma (p-value 0.009), and chronic systemic diseases (p-value 0.018) decreased in the post-COVID-19 period compared to the pre-COVID-19 period, whereas ICU admissions (p-value 0.010) and Diabetic Ketoacidosis (DKA) (p-value 0.002) increased. When comparing COVID-19 and post-COVID-19 periods, there was an increase in ward admissions (p-value 0.01), respiratory infections (p-value 0.018), and diarrhoea (p-value 0.029), but a decrease in the proportion of ICU admissions (p-value 0.01). There was no significant difference in mortality among the three time periods. Conclusion: There was a significant difference in the clinical spectrum of paediatric inpatients. The significant decrease in admissions of chronic systemic diseases, which require regular follow-up for management changes, raises concerns about the potential impact on patient care. [ABSTRACT FROM AUTHOR]

Purpose: Cancer outcome is dependent on multiple predetermining factors including cancer, type of cancer and its related factors. This study aims to investigate the association between COVID-19 & cancer/cancer types, focusing on risk of in-hospital mortality within 30 days of hospitalization of COVID-19 patients with cancer., Materials and Methods: We did a registry (National Clinical Registry for COVID-19) based retrospective observational study including 51,544 patients, of whom 976 were patients with cancer, admitted with COVID-19 between August 2020 and August 2023 across 42 hospitals of India., Results: Out of 51,544 patients, 976 (1.8%) had cancer. Hematological malignancies made up 15.06% (147 cases), while solid cancers accounted for 29.5% (288 cases), with genitourinary (18.4%, 80 cases), gastrointestinal (15.2%, 49 cases), and lung cancers (10.1%, 34 cases) being the most common. Solid cancers had the highest in-hospital mortality rate at 25%. Survival analysis showed that cancer-related hazards were highest at admission but decreased to levels comparable with other morbidities within nine to ten days. For each cancer type, the hazard was significantly elevated compared to that of the cancer-free (Other Comorbidities and No Comorbiditiy) groups during the initial period of hospitalization. The use of Remdesivir, steroids, and anticoagulants reduced mortality risk, and prior COVID-19 vaccination was protective against mortality across all cancer types., Conclusion: This study shows that both cancer in general and specific cancer types significantly increase the risk of severe outcomes among SARS-CoV-2-infected patients, especially immediately after hospitalization. The findings highlight the need for close monitoring and personalized interventions for COVID-19 patients with cancer for at least 10 days post-hospitalization, with a more specific high-risk period ranging from 7 to 18 days depending on the type of cancer., Competing Interests: Declarations Conflict of interest The authors declare no competing interests., (© 2024. The Author(s).)

The study aims to examine the readiness of Indian parents towards online classes at kindergarten and junior school levels, by identifying the perceived barriers, perceived effectiveness and health impact of online classes on young children. The study is based on data collected across a random sample of 750 parents of students studying at junior and kindergarten levels in urban private schools which offer online classes. The data was analyzed through exploratory factor analysis, ANOVA and multiple regression analysis. Technological, infrastructural, and personal barriers related to students, and parents, were identified as perceived barriers by parents in availing online classes for their kids. Parents' attitude towards online classes at kindergarten and primary levels gets negatively influenced by the barriers they face, and the perceived negative impact of technology usage on their kids' health, while; perceived effectiveness was found to have a positive impact on the parents' attitude. The study is unique as it includes the interest of such young stakeholders of the education system. The study highlights the barriers faced by parents related to online classes and the health-related concerns which play a major role in the adoption of online mode of education for their kids. Research gives insights to school authorities and the government to work on these barriers and make the online education system effective which is the need of the hour during COVID-19.

Background: Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) system of medicine has been extensively used in India for the prevention and management of coronavirus disease 2019 (COVID-19). The present report is the second update of a living systematic review and meta-analysis and has been intended to assess the preventive potential and safety of Ayush drugs against COVID-19. Methods: A search of databases such as PubMed, the Cochrane central register of controlled trials, the World Health Organization (WHO) COVID-19 database, the clinical trial registry-India, the AYUSH research portal, and preprint repositories was performed till March 1, 2023. Randomized controlled trials or analytical observational studies were included. Incidences of COVID-19 infections and mortality were taken as primary outcome measures; and symptomatic severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, incidences of hospital admissions, and adverse events were taken as secondary outcomes. The risk of bias was evaluated by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool. Data were synthesized through the RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Out of 2350 articles, 15 studies were included in the review. The pooled estimate of Guduchi [ Tinospora cordifolia (Thunb.) Miers], Chyawanprasha , and Ayuraksha kit was obtained. Meta-analysis of the data suggested that Guduchi may reduce the incidences of COVID-19 infections (risk ratio [RR]: 0.67 [95% confidence interval, CI: 0.48-0.95]) and the symptom development among the infected (RR: 0.88 [95% CI: 0.73-1.08]), however, no change was observed in hospital admissions (RR: 0.96 [95% CI: 0.20-4.53]). It is uncertain that Chyawanprasha reduces the incidence of COVID-19 infection (RR: 0.28; [95% CI: 0.07-1.08]). Ayuraksha kit as chemoprophylaxis may reduce the incidences of COVID-19 infections (RR: 0.49; [95% CI: 0.32-0.77]). The certainty of the evidence was low to moderate mainly due to the serious risk of bias. Conclusion: Prophylactic use of Ayush medicines for populations at risk may help to prevent COVID-19 infection by reducing incidence and severity. However, considering the certainty and fewer studies, high-quality studies are still desired to confirm the efficacy and safety of Ayush chemoprophylaxis for COVID-19. Nevertheless, this update will serve as a torchbearer for policymakers, physicians, and other stakeholders for their decision-making through evidence-based medicine.

This paper explores the thesis of de-globalisation in relation to international education. Through interrogating accounts of international school leadership during the COVID-19 crisis, the tension between international expectations and localised realities is charted, with four central tenets of internationalism undermined by the pandemic experience. It is argued that the COVID-19 crisis, ostensibly a single global event, resulted in the fractalisation of international education; the conceptualisation of unified internationalism was undermined by the inherently localised material effects of the pandemic. In place of an internationalism that is unified, transcendent, inclusive and connected, international school leaders' accounts of leading through the pandemic focused on their sense that their schools were fractured, rooted, privileged and isolated. It is suggested that this international crisis demonstrates the precarious nature of the respatialising of the global that is intrinsic to international schooling.

Global supply chains for active pharmaceutical ingredients (APIs) are highly centralized in certain countries and are susceptible to supply-chain shocks. However, there is no systematic monitoring or global coordination to manage risk and ensure equitable supply continuity during public health emergencies. In this study, we applied quasi-experimental methods on shipment-level customs data to determine how prices and export volume for APIs exported from India were affected by the COVID-19 pandemic. We found that API prices for key essential medicines not used for COVID-19 did not change significantly in the year after the World Health Organization pandemic declaration, but volume decreased by 80 percent. Prices for medicines speculatively repurposed for COVID-19, such as hydroxychloroquine and ivermectin, increased by as much as 250 percent compared with prices for nonrepurposed medicines, but only ivermectin saw a decrease in volume. Systematic monitoring of API markets, investments to promote supply diversification, and legal and political reforms to disincentivize price speculation could support supply-chain resilience and safeguard access to medicines.

The present study investigates the perception of experience of depression, anxiety, and stress (DAS) among young adults (18-22 years of age) from different locales in India during the global COVID-19 pandemic. The sample included 1,020 participants (603 males and 417 females) with 470 identified talented students (ITS) and 550 nonidentified students (NiS) from Indian villages, towns, and cities. multivariate analysis of variance and ordinal logistic regression analysis were carried out to understand the differences between the various subcategories and the probability of having high negative emotional states among those groups. Results point toward varying levels of DAS depending on whether they were ITS or NiS, whether male or female, and whether they came from Indian villages, towns, or cities. Both similarities and dissimilarities with other studies were observed, and the results provide insights into the effect of the pandemic on the mental health of young adults in India. The importance of developing psychological support systems for all students is implicated in the findings of the study.

Objective: The purpose of this research was to understand the significant changes and challenges regarding teaching experiences during the coronavirus (COVID-19) crisis in three universities, one each in Africa, Asia, and Europe. The study provides information on how teachers adapted to online teaching under COVID-19 conditions. Methods: We employed a descriptive phenomenology approach and used an online survey with open-ended questions to collect the data. Braun and Clarke's six steps of thematic analysis based on the traditions of descriptive phenomenology were employed to analyze the data. Results: The teachers' adaptive mechanisms to the COVID-19 crisis could be described through the following steps: identifying the teaching challenges, developing awareness of personal learning challenges, initiating the process of learning by doing, and recognizing the lessons learned. Conclusions: A global teacher's network could be established to encourage professionals from different fields of education to build conventional wisdom in the awareness of the need to constantly try out new strategies with cutting-edge technologies. Implication for Practice: The results provide evidence of ways that future reactions by higher education to global crises can be anticipated. Further, the research provides an understanding of teachers' adaptation strategies during the COVID-19 crisis. Complementary studies show that institutions should be prepared in terms of both material and human resources for emergency remote teaching (ERT), and students should also be prepared mentally and materially for such unprecedented online teaching delivery and learning. Findings of the present study point to the benefit of faculty using communities of practice as an environment for learning and adapting to emergency situations.

Updated scientific material is needed to incorporate research-based COVID-19 interventions and strategies into basic education. This meta-analysis examined basic education students' COVID-19 Knowledge, Attitude, and Practices (KAP) across the globe. This study identified KAPs needed to integrate COVID-19 into Basic Education after the meta-analysis. Thirteen published studies on basic education students' KAPs toward COVID-19 were analyzed using meta-analysis. PRISMA was utilized in this study. JBI and STROBE checklists assessed these studies' quality. Three low-quality and ten high-quality published studies were identified. Sensitivity and subgroup analyses were used due to the studies' heterogeneity. Low-quality studies had higher KAP pooled levels. Although the pooled KAPs on COVID-19 between the study groups of elementary students only, elementary and high school students, and high school students only were only slightly different, more high school students had good and better KAPs toward COVID-19. Globally, basic education students had high COVID-19 KAPs. There were items in KAPs identified as essential topics for science lesson integration. These six items were identified as essential topics for lesson integration in knowledge, five in attitude, and four items in practice.

This exploratory study analyzes six female school teachers' narratives of navigating increased care work at home with online teaching during COVID-19 in India. A theoretical framework of decolonizing feminist research, with an emphasis on moving beyond Anglo/Eurocentric forms of feminist knowledge-making, frames the study. Based on the interviews, the study reveals that the home emerged as a site for resistance to the gendered division of care work in marriages via the use of the tactical strategy of relying on family members other than the husband. Within the limited scope of the study, the schools emerged as sites of institutional betrayal manifested in administrative actions and inactions such as removing contractual teachers, scheduling meetings outside work hours, increasing surveillance, and not providing digital support. These administrative decisions were perceived by the participants as motivated by profit-making, displaying complete disregard for the teachers' well-being. The findings advance our understanding of how emergencies such as COVID-19 exacerbate the exploitation of female members of the labor force who are already marginalized through contractual undervalued work or the inordinate burden of caregiving. It also offers important suggestions for policymakers concerned with creating safe and inclusive working spaces for female teachers in the global south.

Purpose: With an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic's effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19., Design/methodology/approach: The study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access - availability, accessibility, accommodation, cost and acceptability - were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis., Findings: According to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure., Practical Implications: For Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities., Originality/value: The study's originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study's practical consequences., (© Emerald Publishing Limited.)

Introduction: Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India., Methods: Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach., Results: Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions., Conclusion: This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

BCG vaccination is known to be safe in infants and a part of immunization schedule in high tuberculosis (TB) burden countries. In the conquest to bring down the severity of the COVID 19 pandemic, many drugs were repurposed in research mode including BCG vaccination/revaccination in various populations. We did a study among the elderly population (>60 years of age) to assess the role of BCG revaccination in preventing the severity of COVID 19 disease. Live attenuated BCG vaccine was given to the willing participants and were followed up for 6 months to estimate COVID19 incidence, understand severity and immunogenicity profile. A total of 48 serious adverse events (SAE) were reported among 1566 elders, none of them had more than one SAE. None of the SAEs were related to the BCG revaccination. Among the 372 adverse events reported, 96% were local reactions at the vaccine site and resolved on its own. BCG revaccination appeared to be safe and could be explored further if repurposing studies were planned for other diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Healthcare professionals (HCPs) had to perform their duties under extremely trying circumstances during the COVID-19 pandemic. High expectations further increased HCP's stress, which had an adverse impact on their mental health. The present quasi-randomised clinical trial examined how a specially designed pranayama regimen practised for 4 weeks affected the mental health of frontline, exposed HCPs in terms of perceived stress, wellness and quality of life. A total of 280 frontline HCPs on COVID-19 duties in five public hospitals of Delhi, India participated in this study. The intervention (n = 123) and control (n = 127) groups were alternately allocated. Data on perceived, self-reported mental health of HCPs were collected at baseline and post-test at the end-line (after 28 days of practice). We report that the intervention group (n = 123) had a substantial lower perceived stress at post-test at the end-line in comparison to the control group (n = 127, p-value: .028). Their overall WHO Quality-of-Life score also improved, of which the score on psychological domain increased significantly (p-value: .019). Accordingly, we conclude that a 28-day practice of the pranayama by the frontline HCPs in COVID-19 hospitals significantly decreased their level of perceived stress and enhanced their psychological quality of life., (© 2024 International Union of Psychological Science.)

Background: Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India., Methods: Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model., Results: Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional., Conclusion: These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.

The global crisis of the COVID-19 pandemic has highlighted the need for mathematical models to inform public health strategies. The present study introduces a novel six-compartment epidemiological model that uniquely incorporates a higher isolation rate for unreported symptomatic cases of COVID-19 compared to reported cases, aiming to enhance prediction accuracy and address the challenge of initial underreporting. Additionally, we employ optimal control theory to assess the cost-effectiveness of interventions and adapt these strategies to specific epidemiological scenarios, such as varying transmission rates and the presence of asymptomatic carriers. By applying this model to COVID-19 data from India (30 January 2020 to 24 November 2020), chosen to capture the initial outbreak and subsequent waves, we calculate a basic reproduction number of 2.147, indicating the high transmissibility of the virus during this period in India. A sensitivity analysis reveals the critical impact of detection rates and isolation measures on disease progression, showing the robustness of our model in estimating the basic reproduction number. Through optimal control simulations, we demonstrate that increasing isolation rates for unreported cases and enhancing detection reduces the spread of COVID-19. Furthermore, our cost-effectiveness analysis establishes that a combined strategy of isolation and treatment is both more effective and economically viable. This research offers novel insights into the efficacy of non-pharmaceutical interventions, providing a tool for strategizing public health interventions and advancing our understanding of infectious disease dynamics., (© 2024. The Author(s).)

Background and Objectives: Candidaemia is a potentially life-threatening emergency in the intensive care units (ICUs). Surveillance using common protocols in a large network of hospitals would give meaningful estimates of the burden of candidaemia and central line associated candidaemia in low resource settings. We undertook this study to understand the burden and epidemiology of candidaemia in multiple ICUs of India, leveraging the previously established healthcare-associated infections (HAI) surveillance network. Our aim was also to assess the impact that the pandemic of COVID-19 had on the rates and associated mortality of candidaemia., Methods: This study included adult patients from 67 Indian ICUs in the AIIMS-HAI surveillance network that conducted BSI surveillance in COVID-19 and non-COVID-19 ICUs during and before the COVID-19 pandemic periods. Hospitals identified healthcare-associated candidaemia and central line associated candidaemia and reported clinical and microbiological data to the network as per established and previously published protocols., Results: A total of 401,601 patient days and 126,051 central line days were reported during the study period. A total of 377 events of candidaemia were recorded. The overall rate of candidaemia in our network was 0.93/1000 patient days. The rate of candidaemia in COVID-19 ICUs (2.52/1000 patient days) was significantly higher than in non-COVID-19 ICUs (1.05/patient days) during the pandemic period. The rate of central line associated candidaemia in COVID-19 ICUs (4.53/1000 central line days) was also significantly higher than in non-COVID-19 ICUs (1.73/1000 central line days) during the pandemic period. Mortality in COVID-19 ICUs associated with candidaemia (61%) was higher than that in non-COVID-19 ICUs (41%). A total of 435 Candida spp. were isolated. C. tropicalis (26.7%) was the most common species. C. auris accounted for 17.5% of all isolates and had a high mortality., Conclusion: Patients in ICUs with COVID-19 infections have a much higher risk of candidaemia, CLAC and its associated mortality. Network level data helps in understanding the true burden of candidaemia and will help in framing infection control policies for the country., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)

The COVID-19 pandemic posed significant disruptions in traditional educational policies and practices worldwide. The study adopted an equity, diversity, and inclusion lens to investigate the impact of the pandemic on international students in a Canadian university. The findings from data analysis identified challenges and supports for international students in five areas: academic, financial, health and well-being, socialization, and housing and accommodation. There were several gaps between international students' academic and social needs during the pandemic and the institutional support. While the university prioritized supports in the academic domain, international students identified social challenges as more significant during the pandemic. The gap was also evident in communicating institutional support to students, as some students were not aware of the spectrum of institutional services. Finally, there was a need for more targeted support for international students. The pandemic called for more fundamental and comprehensive actions to support the diverse student population.

The COVID-19 outbreak urged the educational institutions to adopt alternative methods of teaching and learning for the continuity and maintenance of quality education. In India, the pandemic had a major impact on higher education (HE) and it convinced educational institutions to adopt E-learning who earlier were not willing to adopt it. It made the system realize and accept new methods and approaches of teaching-learning like flipped classroom, blended approach of learning etc. The current study provides an overview of the role of E-learning by highlighting the various digital initiatives taken by Government of India especially during and after the pandemic.

During the second wave of COVID-19 pandemic, an increasing number of patients experienced breathlessness, which progressed to acute respiratory distress syndrome, leading to the need for supplemental oxygen therapy and mechanical ventilation. With each passing day, the need for medical oxygen increased and simultaneously medical oxygen reserves in the country were getting depleted. Government agencies deployed multipronged strategies to ensure that the hospitals had an adequate supply of medical oxygen. Mechanisms and formulae were devised for the rational allocation of medical oxygen to various regions in the country; the production of medical oxygen was boosted along with the curtailment of oxygen usage in industries; and efficient supply chain management, which included "Oxygen Express"- special trains for transporting oxygen, aircrafts for transporting medical oxygen, creating green corridors and real-time monitoring of oxygen levels using information technology. The usage and promotion of indigenous PSA oxygen technology augmented the medical oxygen generation capacity at the health care facility level. This emergency situation demonstrated a need for strengthening established intersectoral coordination mechanisms for swift and effective responses to similar situations in future. Various strategies adopted by the Central Government and other government agencies to a large extent helped in addressing the medical oxygen emergencies.

Purpose: This study was conducted to assess patients' outcome and satisfaction with the eye care received with telemedicine and physical consultation at a tertiary care hospital during and after the coronavirus disease 2019 (COVID-19) pandemic., Methods: A descriptive study was carried out on 6052 patients who consulted for eye illness at a tertiary care hospital between April 2020 and December 2022. An outcome scoring system was developed and validated for the assessment of patient outcome after providing treatment on telemedicine consultation and physical consultation. Outcome scores for various symptoms were compared pretreatment and posttreatment. Telehealth Usability Questionnaire (TUQ) was used through an online survey to assess patients' satisfaction with teleophthalmology services during the COVID-19 pandemic. An 18-item Patient Satisfaction Questionnaire (PSQ-18) was used to assess the same with physical consultation., Results: A total of 6052 patients were included in the study. Physical consultation group had 2485 patients (41.06%) and the telemedicine group had 3567 patients (58.93%). Male patients constituted 63.11% and females were 36.89%. There was a significant improvement in outcome scores for pain and redness in both physical and telemedicine consultation groups (P < 0.0001). All subgroups of TUQ had significantly high scores (including usefulness, ease of use and learnability, interface quality, interaction quality, and satisfaction and future use), except one subgroup (reliability). Uneducated patients were significantly more satisfied with telemedicine compared to educated patients (P = 0.044)., Conclusion: Majority of patients expressed satisfaction with teleophthalmology services. The recent pandemic paved the way for the future integration of telemedicine in ophthalmology, especially if virtual eye examinations attain a higher level of reliability., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

During the COVID-19 pandemic, our findings highlight changes in AML management strategies in India. There was a decrease in overall patient registrations, particularly at large referral centers, while smaller centers saw an increase, reflecting a shift towards more localized care. This shift was accompanied by a rise in the use of hypomethylating agents (HMAs). Despite these changes, survival outcomes remained comparable to pre-pandemic levels, likely due to improved infection control measures and maintaining treatment protocols. Our study concludes that standard AML care remained feasible during the pandemic, emphasizing the importance of continuing treatment for eligible patients even in times of crisis., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Objectives: Strict social distancing and lockdown measures imposed to curb transmission during the early phase of the outbreak of the COVID-19 pandemic posed challenges to people's psychological wellbeing, limited access to social support, and disrupted routine mental health service delivery. In response, a consortium of mental health stakeholders from Goa, India launched the COVIDAV program, which provided pro-bono virtual psychiatric and counselling consultations across India through an online platform. This study describes the acceptability and feasibility of the program from the perspective of various stakeholders., Methods: Data were collected via a survey with clinicians who had volunteered on COVIDAV ( n = 40), in depth interviews of the clinicians ( n = 14), and focus group discussion with key collaborators ( n = 1). Process data were mapped at various stages during the online platform's development and use. The qualitative and quantitative data was analysed using thematic analysis and a descriptive analysis respectively., Results: Over 17 months, 63 clinicians conducted 2245 online sessions through the COVID platform, primarily accessed by youth across the country. The clinicians acknowledged the online platform's ability to enhance access and reduce stigma. Challenges included session time constraints, connectivity issues, and user interface inconsistencies that interfered with clients' accessibility to the services. High satisfaction rates amongst the service providers were reported, with 79.3% content with the service provision and 82.8% with pro bono contributions through the platform., Conclusions: This study illustrates the feasibility, flexibility, and applicability of a rapidly designed pro-bono online platform for delivering mental health care services through the collaboration of stakeholder groups in the mental health care, private, social, and governmental sector. Our findings highlight the potential of rapidly deployed digital platforms, developed via cross-sector partnerships, to meet mental health care needs during unprecedented global emergencies such as the COVID-19 pandemic.

This study examined the relation between pandemic-related stressors and mental health among young people (YP) in India during two time points in the waning phase of the pandemic. We use data from two cross-sectional waves of over 20,000 YP aged 5-19 in February 2022, during the peak of the Omicron wave, and October 2022, during a reduction in infections and easing of restrictions. COVID illness/death in the family's social network, current lockdown stringency, and significant change in household income were examined in relation to adult respondents' reports of YP internalizing symptoms. Internalizing symptoms declined slightly from February to October 2022. COVID-19 illness/death in the family's network was generally associated with more internalizing symptoms. Higher lockdown stringency was associated with lower levels of internalizing symptoms. YP in households with increases in income tended to have more internalizing symptoms. Many associations were driven by older adolescents and were stronger during the earlier (Feb-2022) than later (Oct-2022) data collection time-points. The findings illustrate the importance of anchoring results within a study's specific geographic context, including concurrent events during the study period. Importantly, findings that may initially seem counterintuitive ultimately illuminate the dynamic and complex processes underlying child and adolescent mental health., (© 2024. The Author(s).)

Objective: To determine whether a chemokine receptor type 2 antagonist, DMX-200 (repagermanium), in combination with an angiotensin receptor blocker, candesartan, improves clinical outcomes in people with COVID-19., Design: Prospective, multicentre, double-blind, placebo-controlled trial., Setting: Ten acute care hospitals in India., Participants: Adults <65 years old intended for hospital admission with moderate/severe COVID-19 disease (respiratory rate ≥24 breaths per minute or oxygen saturation ≤93% on room air)., Intervention: DMX-200 120 mg two times per day, or placebo, on background of titratable candesartan commencing at 4 mg two times per day, for 28 days., Main Outcome Measures: The primary endpoint was COVID-19 disease severity on a modified WHO Clinical Progression Scale (WHO scale) on day 14. Secondary outcomes included the WHO scale at days 28, 60, 90 and 180; intensive care unit (ICU) admission, respiratory failure or death within 28 days; length of hospitalisation; and requirement for ventilatory support or dialysis., Results: Between December 2021 and August 2022, 518 people were screened, with 49 randomised to DMX-200 or placebo on a background of candesartan. The study was terminated early due to recruitment barriers, including an external requirement to restrict enrolment to adults <65 years old, contributing to a 91% screen failure rate. The median WHO Clinical Progression Scale (WHO scale) score at day 14 for both groups was 1 (IQR 1-1), indicating most participants were discharged with no limitations on activities by this time. Formal comparison was not performed due to the small sample size. One participant receiving DMX-200 died of COVID-19 disease progression. No participants required ICU admission, ventilation or dialysis. Median length of hospitalisation in both groups was 6 days (IQR 6-7 days). WHO scale scores were similar at 28, 60, 90 and 180 days., Conclusion: Due to recruitment barriers, the study was unable to determine whether DMX-200 improves clinical outcomes in people with COVID-19., Trial Registration Number: ClinicalTrials.gov NCT05122182., Competing Interests: Competing interests: This work was an investigator-initiated study that received financial support from Dimerix Bioscience Pty Ltd who manufacture DMX-200., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pharmaceuticals and personal care products (PPCPs) monitoring in surface water is crucial to address the escalating threat of antimicrobial resistance and safeguard public health. This study aimed to investigate the occurrence of 21 different PPCPs, including wastewater chemical markers, antibiotics, and parabens in the surface water of Chennai city using Ultra Performance Liquid Chromatography-Triple Quadrupole Mass Spectrometry (UPLC-MS/MS) analysis. It is noteworthy that chemical markers viz., carbamazepine (CBZ) and caffeine (CAF) were detected in all the sites and contributed to more than 95% of the total PPCPs load indicating a significant intrusion of wastewater. Among the antibiotics, fluoroquinolones were dominant in this study. Interestingly, a significant and strong correlation was seen between fluoroquinolones, CBZ and CAF (R 2  = 0.880-0.928, p < 0.05), suggesting similarities in their sources. More than 50% of the sites exhibited a risk for antimicrobial resistance (RQ AMR ) with RQ AMR  > 1 for ciprofloxacin, indicating a significant public health concern. The ecotoxicological risk assessment of PPCPs showed no risk to any organisms, except for triclosan, which posed a risk to fish and daphnids at one site near an open drain in Buckingham canal., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Human immunodeficiency virus (HIV) is a sexually transmitted infection impacting populations worldwide. While there have been major improvements in controlling HIV over recent years, the COVID-19 pandemic may have potentially resulted in major interruptions to this control of HIV. Bharat (India) is a country that has been greatly impacted by the COVID-19 pandemic, and we aimed to analyse the trends in HIV control since the start of the pandemic., Methods: In this study we evaluated changes in rates of HIV incidence and mortality across Bharat for the years both before, and after, the start of the COVID-19 pandemic. Percent and absolute changes were determined, and thereafter, both bivariate and multi linear regression was conducted to evaluate the relationship between COVID-19 burden and changes in HIV epidemiology across the nation., Results: It was shown that, despite the COVID-19 pandemic, annual incidence and deaths of HIV/AIDS have both decreased across Bharat. From 2019-2021, in Bharat, the total number of new HIV cases annually decreased by 9.03%, and the total number of HIV/AIDS deaths annually decreased by 28.82%. A similar trend was shown across most states/union territories; however, there were notable exceptions (such as Karnataka, Bihar, and Assam) where the rates have instead increased., Conclusions: Our analysis has demonstrated that government efforts to control the HIV/AIDS epidemic have not been greatly impacted across the majority of Bharat since the emergence of COVID-19. The reduction in annual HIV/AIDS deaths in the country has been better than the world average, and the improvements from the period of 2019 to 2021 were greater than those from 2017 to 2019. Regardless, there are regions in the nation where the epidemic has instead worsened during this period., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In this paper, we propose a numerical algorithm to obtain the optimal epidemic parameters for a time-dependent Susceptible-Unidentified infected-Confirmed (tSUC) model. The tSUC model was developed to investigate the epidemiology of unconfirmed infection cases over an extended period. Among the epidemic parameters, the transmission rate can fluctuate significantly or remain stable due to various factors. For instance, if early intervention in an epidemic fails, the transmission rate may increase, whereas appropriate policies, including strict public health measures, can reduce the transmission rate. Therefore, we adaptively estimate the transmission rate to the given data using the linear change points of the number of new confirmed cases by the given cumulative confirmed data set, and the time-dependent transmission rate is interpolated based on the estimated transmission rates at linear change points. The proposed numerical algorithm preprocesses actual cumulative confirmed cases in India to smooth it and uses the preprocessed data to identify linear change points. Using these linear change points and the tSUC model, it finds the optimal time-dependent parameters that minimize the difference between the actual cumulative confirmed cases and the computed numerical solution in the least-squares sense. Numerical experiments demonstrate the numerical solution of the tSUC model using the optimal time-dependent parameters found by the proposed algorithm, validating the performance of the algorithm. Consequently, the proposed numerical algorithm calculates the time-dependent transmission rate for the actual cumulative confirmed cases in India, which can serve as a basis for analyzing the COVID-19 pandemic in India., (© 2024. The Author(s).)

Background: The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19., Methods: A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables., Results: We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession ( β  = 7.89, 95% CI; 3.66, 12.11, p  < 0.0001). The p -value indicates the probability of observing the data if the null hypothesis is true, and the confidence interval shows the range within which we can be 95% confident that the true effect lies. An independent relationship exists between male gender and higher personal-related burnout scores ( β  = 4.45, 95% CI 1.9-6.9)., Conclusion: This study identified key indicators that need further emphasis and the need for organizational and individual-level burnout monitoring in healthcare delivery sectors. Health workers continue to experience burnout due to a combination of personal, professional, and patient-related factors. This underscores the need for targeted organizational and individual interventions. The findings also suggest that the CBI tool could identify healthcare worker burnout risk groups., Competing Interests: Faizan Zaffar Kashoo is an Academic Editor for PeerJ., (©2024 Sidiq et al.)

Background: The coronavirus (COVID-19) pandemic has affected people's economies, lifestyles, and physical, emotional, and sleep health. This research aimed to estimate the prevalence of insomnia and symptoms of stress, anxiety, and depression among teachers with the resumption of in-person instruction at schools following a hiatus after COVID-19 lockdowns in India. We also studied the association of teachers' insomnia with psychological symptoms and demographic variables., Methods: We conducted a cross-sectional survey between October -November 2021 after schools had reopened during the COVID-19 pandemic. Data was collected using standard questionnaires online among schoolteachers. We explored the association of insomnia with teachers' symptoms of stress, anxiety, depression, sex, school boards, and age groups., Results: Of 124 schoolteachers surveyed, the prevalence of insomnia was 37.9% (subthreshold in 25% and clinical in 12.9%). The prevalence of stress, depression, and anxiety was 20.2%, 30.6%, and 45.2%, respectively. There was a significant association (p<0.001) of insomnia with symptoms of anxiety, stress, and depression in univariate analysis. On multivariate analysis, we found that those feeling stressed had a 6.4 times higher risk of insomnia (95% CI: 1.5-28.3, p - 0.01). There was no association of insomnia with age, sex, school educational boards, and type of institution., Conclusions: Over one-third (37.9%) of teachers reported having trouble sleeping when they returned to the school's typical face-to-face instruction modalities through COVID-19 times, and insomnia was more prevalent in those with stress., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Kamath SP et al.)

Objectives: Previous studies suggest that patients' thyroid status might directly impact the course of Coronavirus disease 2019 (COVID-19). The objective of the study was to determine the clinical profile of COVID-19 patients with hypothyroidism and compare it with that of COVID-19 patients without hypothyroidism., Design: Retrospective observational study., Setting: The study was conducted in a tertiary healthcare centre in Tamil Nadu between May and June 2021., Participants: The study included 117 patients admitted with hypothyroidism and COVID-19 as well as 117 age and Gender matched COVID-19 patients without hypothyroidism., Main Outcome Measures: Data regarding the demography, comorbidities, presenting symptoms, method of diagnosis of COVID-19, computed tomography (CT) severity score, Interleukin 6 (IL-6), D-dimer, oxygen requirement, number of days in hospital and outcome were collected for both groups. Data analysis was conducted, and p<0.05 was considered statistically significant., Results: The study comprised 234 patients over two months, from May to June 2021. Distribution of presenting symptoms showed that the hypothyroidism group presented with a higher incidence of fever (66.67%), loose stool (18.80%) and myalgia (7.69%). Results show that RTPCR+, O 2 Requirement, death, D-dimer, IL-6, number of days admitted as well as CT-severity did not show any statistically significant differences (p>0.05) between both groups. The outcomes also showed that both groups reported four mortalities., Conclusions: The results of the study help conclude that the hypothyroidism status of a COVID-19 patient is not associated with higher severity of clinical symptoms, deranged laboratory values as well as mortality., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Studies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants ( n  = 492), 45.3% ( n  = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days-soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study's findings corroborate the safety of the Covishield/AstraZeneca vaccine's first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy., Competing Interests: Russell Kabir is an Academic Editor for PeerJ. The other authors declare that they have no competing interests., (©2024 Majumder et al.)

Influenza, COVID-19, tetanus, pertussis and hepatitis B pose increased risk for pregnant women and infants and could be mitigated by maternal immunization. In India Tetanus-diphtheria (Td) and COVID-19 vaccines are recommended during pregnancy, while influenza and tetanus-acellular pertussis-diphtheria (Tdap) vaccines are not. We conducted a multicenter study from November 2021 to June 2022 among pregnant women ( n  = 172) attending antenatal clinics in three public hospitals in West Bengal, to understand the factors that influence women's decisions to get vaccinated during pregnancy. Questions assessed vaccination coverage, knowledge, intention and willingness to pay for influenza vaccine, and factors influencing decisions to get Td, influenza, and COVID-19 vaccines. 152/172 (88.4%) women were vaccinated with Td, 159/172 (93%) with COVID-19, 1/172 (0.6%) with influenza, and none with Tdap. 10/168 (6%) had received hepatitis B vaccine (HBV). Community health workers advice was crucial for Td uptake and, the belief of protection from COVID for COVID-19 vaccines. Most women were unaware about Tdap (96%), influenza (75%), and influenza severity during pregnancy and infancy (85%). None were advised for influenza vaccination by healthcare providers (HCP), albeit, 93% expressed willingness to take, and pay INR 100-300 (95% CI: ≤100 to 300-500) [$ 1.3-4.0 (95% CI: ≤1.3, 4-6.7)] for it. Vaccination on flexible dates and time, HCP's recommendation, proximity to vaccination center, and husband's support were most important for their vaccination decisions. Women were generally vaccine acceptors and had high uptake of vaccines included in the Universal Immunization Program (UIP). Inclusion of influenza, Tdap, and HBV into UIP may improve maternal vaccine uptake.