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Background: The wastewater disposal into the water bodies without removing the toxic heavy metals and other industrial impurities is a major issue these days. These heavy metals cause serious health issues to the human and animal life and also harm the environment and reduce the productivity of crops. A potent microorganism resistant to hexavalent chromium was isolated. The activity of this isolated strain was analyzed using in silico studies. Methods: In this study, a chromium-resistant fungus was isolated from the soil of the dumping sites of the tanneries in Kanpur, UP, India, followed by isolation by serial dilution, plating method, and finally, genome sequencing. It was identified as Aspergillus proliferans LA that is submitted to the National Collection for Industrial Microorganisms (NCIM) database with accession no. NCIM-1473. In the current study, the comparative analysis of the protein sequence of A. proliferans (NCIM-1473) was done against the known 53 protein sequences of the fungus and bacterial strains already reported for their chromium-resistant nature. The physical and chemical parameters of the known and isolated chromium-resistant proteins were analyzed using the ProtParam tool. The comparative study on the sequence and structural alignment of known and isolated chromium-resistant protein was done using EMBOSS-NEEDLE and FATCAT, respectively. Results: In this analysis, the top 10 strains showing similarity with A. proliferans (NCIM-1473) were reported and among which ChrI, chromium regulatory protein Cupriavidus metallidurans CH34 was showing maximum similarity with isolated chromium resistant protein for all the analysis, namely ProtParam, sequence, and FATCAT analysis. This strain, Cupriavidus metallidurans CH34, has been reported resistant against eight heavy metals, one of which is chromate, and was first identified in the heavy-metal contaminated sludge in a settling tank of Belgium. Conclusion: These studies conclude that the strain isolated in our laboratory (accession no. NCIM-1473) is potentially chromium resistant and a unique strain.

Abstract Background Mentoring relationships play a critical but poorly understood role in mentoring’s overall success. To overcome these knowledge gaps, a study of mentee experiences in the Palliative Medicine Initiative, a structured research-based mentoring program, is proposed. The program’s clearly described mentoring approach, competency-based mentoring stages and curated mentoring environment ensure a consistent mentoring experience. It provides a unique platform to study mentoring relationships longitudinally and its implications on professional identity formation. Methodology The Tool Design Systematic Evidence-Based Approach methodology is used to map and employ current understanding. A review of recent reviews on mentoring processes, mentoring’s effects, professional identity formation and professional identity formation assessment tools lay the foundation for the design of semi-structured interviews and mentoring diaries to evaluate the characteristics of successful mentoring relationships and mentoring’s impact on professional identity formation. The data accrued from these tools were evaluated using this methodology whilst changes in professional identity formation were assessed using the Ring Theory of Personhood. Results The semi-structured interviews revealed four themes: stakeholders, mentoring stages, mentoring relationships and professional identity formation whilst the mentoring diaries revealed two: mentoring processes and mentoring relationships. Two final domains emerged – mentoring relationships and professional identity formation. Conclusions The Palliative Medicine Initiative’s structured stage-based mentoring approach, trained stakeholders, curated environment, assessment-directed and personalized mentoring support reveal seven developmental stages of mentoring relationships. These culminate in changes to the values, beliefs and principles that shape how mentees see, feel and act as professionals. These findings suggest that mentoring programs may help to further develop and fine-tune their professional identity formation.

Abstract Background Reflective writing (RW) allows physicians to step back, review their thoughts, goals and actions and recognise how their perspectives, motives and emotions impact their conduct. RW also helps physicians consolidate their learning and boosts their professional and personal development. In the absence of a consistent approach and amidst growing threats to RW’s place in medical training, a review of theories of RW in medical education and a review to map regnant practices, programs and assessment methods are proposed. Methods A Systematic Evidence-Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure the two concurrent reviews. Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2022 in PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus, Google Scholar, OpenGrey, GreyLit and ProQuest. The Split Approach saw the included articles analysed separately using thematic and content analysis. Like pieces of a jigsaw puzzle, the Jigsaw Perspective combined the themes and categories identified from both reviews. The Funnelling Process saw the themes/categories created compared with the tabulated summaries. The final domains which emerged structured the discussion that followed. Results A total of 33,076 abstracts were reviewed, 1826 full-text articles were appraised and 199 articles were included and analysed. The domains identified were theories and models, current methods, benefits and shortcomings, and recommendations. Conclusions This SSR in SEBA suggests that a structured approach to RW shapes the physician’s belief system, guides their practice and nurtures their professional identity formation. In advancing a theoretical concept of RW, this SSR in SEBA proffers new insight into the process of RW, and the need for longitudinal, personalised feedback and support.

Aim: The aim of this study was to evaluate and compare the accuracy of hexed and nonhexed pickup impression copings with and without splinting using polyether (PE) and polyvinyl siloxane (PVS) impression materials in open-tray technique in recording multiple straight and angulated implant positions. Settings and Design: An accurate impression results in an accurate definitive cast, thus minimizing the incidence of prosthesis misfit. The critical aspect is to record the three-dimensional location of the implant in bone rather than reproducing fine surface details. Precise fit of a fixed implant-supported prosthesis depends on the accuracy of the implant analog location within the definitive cast. Factors which affect impression accuracy include implant angulation, impression material, impression copings, technique, and splinting. Materials and Methods: A sample size of 80 study models fabricated from the impression of different groups was included. A reference master model based on All-on-4 implant concept with two parallel (implants 1 and 2) and two angulated (implant 3 at 17° and implant 4 at 30°) was fabricated using implant angulation guide. All impressions were recorded using open-tray impression technique. The groups were divided into two main groups of 40 samples each. Group A used hexed open-tray impression copings and Group B used nonhexed open-tray impression copings. Both the groups involved impression recording using splinted (Subgroup I) and nonsplinted impression copings (Subgroup II). Further, impressions in each subgroup were made using PE (Subsubgroups a) and PVS (Subsubgroup b). A total of eight subsubgroups with ten samples each were included. Impressions were recorded for each group and poured into Type IV die stone for fabrication of study models. After 24 h, the study models and reference master model were fitted with implant abutments for measurement with coordinate measuring machine. Statistical Analysis Used: The mean differences of the interimplant distance R1 (1–2), R2 (1–3), R3 (2–4), and R4 (3–4) between the reference model and sample models in different subsubgroups were calculated and three-way analysis of variance test was applied with Tukey's post hoc tests. Results: No significant difference was found in mean coronal deviations for distance R1, R2, and R3 (P > 0.05) between different study groups. P = 0.02 for R4 (distance between 17° and 30° implants) between impression materials subsubgroups suggested that significantly less distortion was created in location of highly angulated implants (>30°) using PVS impression material. Splinting and type of coping did not have a significant influence on impression accuracy. Increasing angulation decreased the accuracy. Conclusion: PVS was found equivalent in accuracy to rigid PE for recording parallel or angulated implants. Impressions of implants with higher angulations were recorded more accurately with PVS. The study found no difference in accuracy with or without splinting. Furthermore, nonhexed impression copings facilitate easier and accurate recording of multiple angulated implant location in bone.

Using the Kalman filtering technique, we propose a novel method for estimating the missing video frames to monitor the activities inside the control room of a nuclear power plant (NPP). The purpose of this study is to reinforce the existing security and safety procedures in the control room of an NPP. The NPP control room serves as the nervous system of the plant, with instrumentation and control systems used to monitor and control critical plant parameters. Because the safety and security of the NPP control room are critical, it must be monitored closely by security cameras in order to assess and reduce the onset of any incidents and accidents that could adversely impact the safety of the NPP. However, for a variety of technical and administrative reasons, continuous monitoring may be interrupted. Because of the interruption, one or more frames of the video may be distorted or missing, making it difficult to identify the activity during this time period. This could endanger overall safety. The demonstrated Kalman filter model estimates the value of the missing frame pixel-by-pixel using information from the frame that occurred in the video sequence before it and the frame that will occur in the video sequence after it. The results of the experiment provide evidence of the effectiveness of the algorithm.

Large-scale private real estate projects in the past few decades in vast areas of increasingly varied scales have been created that were once sparsely inhabited agricultural land and wetlands in the remote locations of these urban areas. This paper examines the reasons for India's peripheralization of real estate megaprojects. Such projects are typically constructed on agricultural land, notably paddy fields and wetlands. Developers' site selections are mostly influenced by the low cost of land and future development potential. In contrast to the disarray of existing urban spaces, "bypass urbanism" creates restricted and unique city spaces that allow more contented or high-status lifestyles. They avoid large parts of the city area as part of their daily lives, reinforcing socio-economic isolation, peripheralization, and uneven urban development. With the help of two case studies, this paper explores how peripheralization has created a restricted and exclusive space that facilitates middle-class life while bypassing and neglecting existing urban areas. This massive bypass urbanism constitutes a new quality of urban growth with far-reaching and uncountable repercussions, resulting in the creation of islands and the reshuffling of the entire metropolitan region.

Adrenal and spinal metastases of hepatocellular carcinoma (HCC) are rare entities with significant morbidity and mortality, particularly after liver transplantation (LT). We report a case of a 49-year-old man who underwent LT for hepatitis B-related end-stage liver disease and HCC (single 4.5 cm lesion [T1N0], without vascular invasion) in 2016. Eighteen months later, adrenal metastasis and hepatitis B seropositive conversion were developed with normal serum tumor. Adrenal metastasis was treated with radiation therapy (RT) and hepatitis B showed spontaneous seronegative conversion. However, 35 months later, spinal metastasis occurred with elevation of the protein induced by vitamin K absence or antagonist-II (PIVKA-II) level (197 mAU/mL), along with hepatitis B seropositive conversion. After sorafenib, sequential regorafenib with RT led to partial response of the spinal lesions, along with hepatitis B seronegative conversion and normal PIVKA-II levels. After 9 months of regorafenib combined with RT, two recurrent lesions were found, as well as hepatitis B seropositive conversion and lesions were treated with transarterial chemoembolization. The patient survived for more than 71 months after LT and 53 months after recurrence under various combinations of therapy. Combined systemic and locoregional therapies can be a treatment option for HCC recurrence, even in LT patients.

Abstract Background Introduction to a multi-professional team who are working and caring for the dying, and facing complex moral and ethical dilemmas during Oncology and Palliative Medicine postings influence a medical student’s professional identity formation (PIF). However, limited appreciation of PIF, inadequate assessments and insufficient support jeopardise this opportunity to shape how medical students think, feel and act as future physicians. To address this gap, a systematic scoping review (SSR) of PIF assessment methods is proposed. Methods A Systematic Evidence-based Approach (SEBA) guided SSR of assessments of PIF in medical schools published between 1st January 2000 and 31st December 2021 in PubMed, Embase, ERIC and Scopus databases was carried out. Included articles were concurrently content and thematically analysed using SEBA’s Split Approach and the themes and categories identified were combined using SEBA’s Jigsaw Perspective. The review hinged on the following questions: “what is known about the assessment of professional identity formation amongst medical students?”, “what are the theories and principles guiding the assessment of professional identity formation amongst medical students?”, “what factors influence PIF in medical students?”, “what are the tools used to assess PIF in medical students?”, and “what considerations impact the implementation of PIF assessment tools amongst medical students?”. Results Two thousand four hundred thirty six abstracts were reviewed, 602 full-text articles were evaluated, and 88 articles were included. The 3 domains identified were 1) theories, 2) assessment, and 3) implementation in assessing PIF. Differing attention to the different aspects of the PIF process impairs evaluations, jeopardise timely and appropriate support of medical students and hinder effective implementation of PIF assessments. Conclusion The Krishna-Pisupati model combines current theories and concepts of PIF to provide a more holistic perspective of the PIF process. Under the aegis of this model, Palliative Care and Oncology postings are envisaged as Communities of Practice influencing self-concepts of personhood and identity and shaping how medical students see their roles and responsibilities as future physicians. These insights allow the forwarding of nine recommendations to improve assessments of PIF and shape the design of a PIF-specific tool that can direct timely and personalized support of medical students.

Abstract Species with sympatric distribution influence ecosystem dynamics and are impacted by the presence of other co-existing species. Assessing the coexistence and the role of interspecific interactions with the landscape variables is necessary to know the species co-occurrence in space. In the Indian Himalayan region, such studies are completely lacking due to limited efforts being made, mainly because of complex terrains and inaccessible landscape features. We used camera trapping and sign survey in a multi-species occupancy framework to understand the influence of environmental variables on occupancy and detection probability of species-specific and pair-wise interaction of the three ungulates in Uttarkashi. Our results concluded that individual species' occupancy probabilities were related both to the environmental variables and the presence or absence of other interacting species. Our top model showed evidence of interspecific interaction among species pairs, and the occupancy probability of species one varied in the presence or absence of another species. The overall activity patterns were similar among all the three species and were found active throughout the day. The activity overlap between sambar—barking deer (Dhat1 value = 0.85) was considerably higher than barking deer—goral (Dhat1 value = 0.78). The findings of the present study will be useful for the conservation and management of ungulates in the Indian Himalayan and adjoining regions.

Measurement(s) crop yield and crop water productivity Technology Type(s) remote sensing and machine learning

The cropping systems in south-west coastal Bangladesh face multiple challenges. A clearer understanding of the trajectories of cropping intensification can promote policy responses to current impacts, adaptations, and target support to farmers. This research aimed to assess (i) observed and perceived changes in temperature, rainfall and salinization, (ii) impacts of these changes on local cropping and aquaculture systems, and (iii) cropping system intensification. Primary data were collected in discussions with farmers (n = 63), extension service providers (n = 7) and researchers (n = 5) in the study area. Secondary data on climate, soil salinity, and farming systems were obtained from government sources. Respondents perceived increasing temperature, decreasing rainfall with anomalous patterns, increasing soil salinization, and increasing extreme events consistent with the observed meteorological data. The impacts were changes in farming operations, increased natural enemies, reduced irrigation water supplies, and yield losses. Cropping intensity in the study region increased from 135% in 1992–175% in 2018, though it is still below the national figure (194%). The intensification is driven by biophysical and socio-economics factors and supported by research, extension and infrastructure development. Further intensification opportunities require targeted research, smart farm management technologies, enhance extension services, improved value-chain, and continuing infrastructure development.

Three-dimensional porous architectures (also called scaffolds) of magnesium (Mg) alloys are now highly prevalent for tissue engineering to enable favourable physical and biological environmental support in bone healing. The electrical discharge micro drilling (EDMD) can be projected as an economical manufacturing route for generating micro-perforation or porous architecture in Mg alloys. In the present work, the capability of EDMD is investigated to produce micro-perforation with close dimensional tolerance in ZM21 Mg alloy. The EDMD process variables like; discharge current (Ip), Pulse-on time (Ton), Pulse-off time (Toff), electrode material, electrode polarity, electrode rotation speed (RS), and work height are investigated for micro-drilling in Mg-alloy. The drilling rate (DR), electrode wear ratio (EWR), hole overcut (HO), and circularity are the performance characteristics. The experimental study revealed the significant influence of process variables on performance characteristics. Selecting the combination of EDMD parameters, Ip: 3Amp, Ton: 50 μsec, Toff: 50 μsec, RS: 140 rpm and using copper electrode (diameter 300 μm) with [+ve] polarity, porous architectures with varying porosity are successfully fabricated for Mg-scaffolds.

Introduction: Thrombocytopenia (TCP) refers to a reduction of platelet count below 150 x 109/ L; it’s not a disease entity by itself, but a finding that may result from a number of disease processes. Automated hematology analyzers that determine the Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet Large Cell Ratio (P-LCR), could be very helpful to facilitate the differential diagnosis of thrombocytopenia and to monitor thrombocytopenic conditions. Materials and methods: A cross-sectional study of platelet indices of 512 thrombocytopenic samples by automated hematology analyzers was done. Results: The cases of thrombocytopenia were classified into hypo-productive (362 cases) and hyper-destructive (150) groups. A most common cause of hypo-productive and hyper-destructive thrombocytopenia was Aplastic anemia and ITP, respectively. All the indices were significantly higher (p-value < 0.05) in hyper-destructive TCP compared to hypo-productive TCP, except Plateletcrit. Conclusion: The results of the present study show platelet indices to be a useful and reliable test to differentiate between hyper-destructive thrombocytopenia from the hypo-productive type with statistically significant differences.

In situ effect of metal stress on periphytic algal communities of a river was studied using chemical diffusing substrates. The metal stress caused the inhibition of periphytic biomass in a concentration-dependent manner. The study indicated differential response of various periphytic groups to different metal treatments. Diatoms exhibited tolerance against arsenic (As) and aluminium (Al) treatment but displayed sensitivity against chromium (Cr) treatment. An increased abundance of cyanobacteria was noteworthy in Cr enrichment, but Al and As were hazardous to these organisms. The relative abundance of green algae also increased in all three test metals. The metal stress lowered the species richness and diversity of periphytic algae, apparently due to the elimination of some of the sensitive species followed by an increased abundance of tolerant forms. Periphytic taxa tolerant to one metal were not necessarily tolerant to other metals or metalloids, and vice versa. The metal-induced changes in algal community composition will lead to severe ecological consequences by affecting biological diversity and in turn productivity of aquatic systems. Since algae occupy the aquatic food web base, any harmful effect on these organisms would have repercussions at higher trophic levels. Thus, it seems urgent to incorporate biomonitoring practices and chemical analysis to monitor the river Ganga's ecological health.

BackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities.MethodsA total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression.ResultsMean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p

Summary: Background: Over the years, there has been introduction of newer drugs, like bendamustine and ibrutinib, for the management of chronic lymphocytic leukaemia (CLL). Though these drugs lead to better survival, they are also associated with higher cost. The existing evidence on cost effectiveness of these drugs is from high-income countries, which has limited generalisability for low-income and middle-income counties. Therefore, the present study was undertaken to assess the cost-effectiveness of three therapeutic regimens, chlorambucil plus prednisolone (CP), bendamustine plus rituximab (BR) and ibrutinib for CLL treatment in India. Methods: A Markov model was developed for estimating lifetime costs and consequences in a hypothetical cohort of 1000 CLL patients following treatment with different therapeutic regimens. The analysis was performed based on a limited societal perspective, 3% discount rate and lifetime horizon. The clinical effectiveness of each regime in the form of progression-free survival and occurrence of adverse events were assessed from various randomised controlled trials. A structured comprehensive review of literature was undertaken for the identification of relevant trials. The data on utility values and out of pocket expenditure was obtained from primary data collected from 242 CLL patients across six large cancer hospitals in India. Findings: As compared to the most affordable regimen comprising of CP as first-line followed by BR as second-line therapy, none of the other therapeutic regimens were cost-effective at one time per capita gross-domestic product of India. However, if the current price of either combination of BR and ibrutinib or even ibrutinib alone could be reduced by more than 80%, regimen comprising of BR as first-line therapy followed by second-line ibrutinib would become cost-effective. Interpretation: At the current market prices, regimen comprising of CP as first-line followed by BR as second-line therapy is the most cost-effective strategy for CLL treatment in India. Funding: Department of Health Research, Government of India.

Abstract Background Mentoring’s pivotal role in nurturing professional identity formation (PIF) owes much to its combined use with supervision, coaching, tutoring, instruction, and teaching. However the effects of this combination called the ‘mentoring umbrella’ remains poorly understood. This systematic scoping review thus aims to map current understanding. Methods A Systematic Evidence-Based Approach guided systematic scoping review seeks to map current understanding of the ‘mentoring umbrella’ and its effects on PIF on medical students and physicians in training. It is hoped that insights provided will guide structuring, support and oversight of the ‘mentoring umbrella’ in nurturing PIF. Articles published between 2000 and 2021 in PubMed, Scopus, ERIC and the Cochrane databases were scrutinised. The included articles were concurrently summarised and tabulated and concurrently analysed using content and thematic analysis and tabulated. The themes and categories identified were compared with the summaries of the included articles to create accountable and reproducible domains that guide the discussion. Results A total of 12201 abstracts were reviewed, 657 full text articles evaluated, and 207 articles included. The three domains identified were definitions; impact on PIF; and enablers and barriers. The mentoring umbrella shapes PIF in 3 stages and builds a cognitive base of essential knowledge, skills and professional attitudes. The cognitive base informs thinking, conduct and opinions in early supervised clinical exposure in Communities of practice (COP). The COPs’ individualised approach to the inculcation of desired professional characteristics, goals, values, principles and beliefs reshapes the individual’s identity whilst the socialisation process sees to their integration into current identities. Conclusion The mentoring umbrella’s provides personalised longitudinal support in the COP and socialisation process. Understanding it is key to addressing difficulties faced and ensuring holistic and timely support.

A 3D scanner is a non-contact, non-destructive digital device that uses a light line/laser to accurately capture the shape of a physical object into Computer-Aided Design (CAD) data. It generates a point cloud or a set of data points in a coordinate system that accurately depicts a physical object's size and shape. The urge of human beings to build and recreate 3D objects is an essential requirement in the context of Industry 4.0. In Industry 4.0, 3D scanners are helpful for designing, assessing the minor features of any product, capturing freeform, and providing precise point clouds for complicated geometry and curved surfaces. Today advanced technologies are being introduced in industries, and 3D scanning technology is one of the latest emerging technologies. The situation has progressed significantly, and the ever-emerging world of 3D technology still disrupts a variety of sectors. This paper discusses 3D Scanning, its working process, and its adoption for reverse engineering and Industry 4.0 culture. Finally, this paper covers essential features, traits, and applications of 3D Scanning for Industry 4.0. Using different methods, 3D Scanning can collect information about an item, about an object's highness, breadth, and depth. 3D scanners are available on the market from high-end possibilities. They have different resolutions, and now they provide details of the scan to superimpose colour on an object, but the industry wants them to be developed for other quality attributes.

Abstract Background Characterised by feelings of helplessness in the face of clinical, organization and societal demands, medical students are especially prone to moral distress (MD). Despite risks of disillusionment and burnout, efforts to support them have been limited by a dearth of data and understanding of MD in medical students. Yet, new data on how healthcare professionals confront difficult care situations suggest that MD could be better understood through the lens of the Ring Theory of Personhood (RToP). A systematic scoping review (SSR) guided by the RToP is proposed to evaluate the present understanding of MD amongst medical students. Methods The Systematic Evidence-Based Approach (SEBA) is adopted to map prevailing accounts of MD in medical students. To enhance the transparency and reproducibility, the SEBA methodology employs a structured search approach, concurrent and independent thematic analysis and directed content analysis (Split Approach), the Jigsaw Perspective that combines complementary themes and categories, and the Funnelling Process that compares the results of the Jigsaw Perspective with tabulated summaries to ensure the accountability of these findings. The domains created guide the discussion. Results Two thousand six hundred seventy-one abstracts were identified from eight databases, 316 articles were reviewed, and 20 articles were included. The four domains identified include definitions, sources, recognition and, interventions for MD. Conclusions MD in medical students may be explained as conflicts between the values, duties, and principles contained within the different aspects of their identity. These conflicts which are characterised as disharmony (within) and dyssynchrony (between) the rings of RToP underline the need for personalised and longitudinal evaluations and support of medical students throughout their training. This longitudinal oversight and support should be supported by the host organization that must also ensure access to trained faculty, a nurturing and safe environment for medical students to facilitate speak-up culture, anonymous reporting, feedback opportunities and supplementing positive role modelling and mentoring within the training program.

Background: Modern radiotherapy techniques are using advanced algorithms; however, phantoms used for quality assurance have homogeneous density; accordingly, the development of heterogeneous phantom mimicking human body sites is imperative to examine variation between planned and delivered doses. Objective: This study aimed to analyze the accuracy of planned dose by different algorithms using indigenously developed heterogeneous thoracic phantom (HT). Material and Methods: In this experimental study, computed tomography (CT) of HT was done, and the density of different parts was measured. The plan was generated on CT images of HCP with 6 and 15 Megavoltage (MV) photon beams using different treatment techniques, including three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Plans were delivered by the linear accelerator, and the dose was measured using the ion chamber (IC) placed in HT; planned and measured doses were compared. Results: Density patterns for different parts of the fabricated phantom, including rib, spine, scapula, lung, chest wall, and heart were 1.849, 1.976, 1.983, 0.173, 0.855, and 0.833 g/cc, respectively. Variation between planned and IC estimated doses with the tolerance (±5%) for all photon energies using different techniques. Acuros-XB (AXB) showed a slightly higher variation between computed and IC estimated doses using HCP compared to the analytical anisotropic algorithm (AAA). Conclusion: The indigenous heterogeneous phantom can accurately simulate the dosimetric scenario for different algorithms (AXB or AAA) and be also utilized for routine patient-specific QA.

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 μg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020, clinical study, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groups- RP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 ml+Clonidine (1 μg/kg) and 0.2% Ropivacaine 19 ml+Clonidine(1 μg/kg) diluted upto total 20 ml with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p

Introduction: Renal Cell Carcinoma (RCC) is a group of neoplastic lesions with unique cytogenetic characteristics and histopathological features. The majority of studies till date on RCC have been focusing on tissue histology to plan neoadjuvant treatment in clinical settings. An accurate forecast of the histopathological subtype has clinical implications in management and response to newer treatment strategies. It is pertinent to preoperatively distinguish a solid renal masses histologically but, there are currently no well-established imaging criteria to classify these tumors on the basis of radiographic evaluation. Aim: To evaluate the differences in imaging characteristics of different histological subtypes of RCC by Power Doppler Ultrasound and Multi-Detector Computed Tomography (MDCT) scan. Materials and Methods: This cross-sectional study was conducted in the Department of Urology, Gauhati Medical College and Hospital, Guwahati, Assam, from March 2016 to December 2017. The study population consisted of 61 patients of RCC who were evaluated with MDCT and Doppler ultrasound prior to surgery and findings were correlated with histopathological forms of tumour. The Pearson Chi-square test and ANOVA test was used to statistically analyse the data. Results: Histopathology revealed clear cell Renal Cell Carcinoma (ccRCC), chromophobe Renal Cell Carcinoma (chRCC) and papillary Renal Cell Carcinoma (pRCC) in 52, 4 and 5 patients, respectively. Heterogenous enhancement was found in 51 cases and among these 90.4% were ccRCC. Absolute attenuation values in Corticomedullary Phase (CMP) and Nephrographic Phase (NP) for clear cell and chromophobe subtype were higher than papillary subtype, i.e., 88.04±30.40 Hounsfield Unit (HU) and 72.41±20.17 HU for clear cell, 60.75±22.54 HU and 88±16.06 HU for chromophobe; 22.40±12.52 HU and 58.00±4.41 HU for papillary subtype, respectively. Papillary RCC (pRCC) showed a unique enhancement pattern, with a low peak enhancement (average peak of 55.40 HU) and greatest enhancement during the NP. In this study population ccRCC, ChRCC RCC and pRCC had mean Resistive Index (RI) of 0.63±0.06, 0.58±0.0 and 0.67±0.11, respectively. Conclusion: Power doppler flow imaging is not useful in discriminating subtypes of RCC while multiphasic Computed Tomography (CT) imaging may be useful, particularly the phasic enhancement pattern to distinguish common RCC subtypes which may facilitate treatment planning and choosing appropriate tyrosine kinase inhibitors.

Objectives Guiding the development of longitudinal competencies in communication, ethics and professionalism underlines the role of portfolios to capture and evaluate the multiple multisource appraisals and direct personalised support to clinicians. However, a common approach to these combined portfolios continues to elude medical practice. A systematic scoping review is proposed to map portfolio use in training and assessments of ethics, communication and professionalism competencies particularly in its inculcation of new values, beliefs and principles changes attitudes, thinking and practice while nurturing professional identity formation. It is posited that effective structuring of portfolios can promote self-directed learning, personalised assessment and appropriate support of professional identity formation.Design Krishna’s Systematic Evidence-Based Approach (SEBA) is employed to guide this systematic scoping review of portfolio use in communication, ethics and professionalism training and assessment.Data sources PubMed, Embase, PsycINFO, ERIC, Scopus and Google Scholar databases.Eligibility criteria Articles published between 1 January 2000 and 31 December 2020 were included.Data extraction and synthesis The included articles are concurrently content and thematically analysed using the split approach. Overlapping categories and themes identified are combined using the jigsaw perspective. The themes/categories are compared with the summaries of the included articles in the funnelling process to ensure their accuracy. The domains identified form the framework for the discussion.Results 12 300 abstracts were reviewed, 946 full-text articles were evaluated and 82 articles were analysed, and the four domains identified were indications, content, design, and strengths and limitations.Conclusions This review reveals that when using a consistent framework, accepted endpoints and outcome measures, longitudinal multisource, multimodal assessment data fashions professional and personal development and enhances identity construction. Future studies into effective assessment tools and support mechanisms are required if portfolio use is to be maximised.

Abstract Introduction The redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program. Methods A Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles. Results Fifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA’s Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP’s structured virtual and near-peer mentoring process complement IPT’s accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program. Conclusion This systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out.

Abstract Unmanageable bleeding is one of the significant causes of mortality. Attaining rapid hemostasis ensures subject survivability as a first aid during combats, road accidents, surgeries that reduce mortality. Nanoporous fibers reinforced composite scaffold (NFRCS) developed by a simple hemostatic film-forming composition (HFFC) (as a continuous phase) can trigger and intensify hemostasis. NFRCS developed was based on the dragonfly wing structure's structural design. Dragonfly wing structure consists of cross-veins and longitudinal wing veins inter-connected with wing membrane to maintain the microstructural integrity. The HFFC uniformly surface coats the fibers with nano thickness film and interconnects the randomly distributed cotton gauge (Ct) (dispersed phase), resulting in the formation of a nanoporous structure. Integrating continuous and dispersed phases reduce the product cost by ten times that of marketed products. The modified NFRCS (tampon or wrist band) can be used for various biomedical applications. The in vivo studies conclude that the developed Cp NFRCS triggers and intensifies the coagulation process at the application site. The NFRCS could regulate the microenvironment and act at the cellular level due to its nanoporous structure, which resulted in better wound healing in the excision wound model.

Abstract Background Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the ‘deliberate practice of improving performance through practising beyond one’s comfort level under guidance’. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. Methods Krishna’s Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA’s Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. Results The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. Conclusion Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy’s Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation’s role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.

Abstract Neerja Bhatla Background Human Epididymis protein 4 (HE4) is expressed in ovarian cancer. Preoperative serum testing is still not widely available. This pilot study aimed to investigate the magnitude of expression of HE4 in tissue sections of serous epithelial ovarian carcinoma, its correlation with clinical outcome, and the feasibility of HE4 immunohistochemistry as a prognostic marker. Materials and Method In this ambispective study, immunohistochemistry (IHC) was used to evaluate tissue sections of ovarian serous epithelial carcinoma at primary cytoreductive surgery. On HE4 immunohistochemistry (IHC), the magnitude of HE4 expression was assessed categorically as high or low HE4 expression and semiquantitatively by the H-score, and correlated with clinical outcome in terms of survival status, progression-free survival, and overall survival. Results Of 32 cases, most (n = 31, 96.8%) were positive for HE4 IHC. The mean age was 49 ± 8.2 years; 29 (90.6%) patients were in FIGO stage IIIC; 25 (78.9%) had ≥1cm residual disease after surgery; 31 (96.8%) received adjuvant chemotherapy, either 3-weekly (n = 25, 81.2%) or dose-dense weekly (n = 6, 18.8%) regimen. The majority (n = 31, 96.8%) had a high-grade tumor, of whom 19 (59.4%) had high HE4 expression and 13(40.6%) patients had H-score in the range of 5 to 8. The mean H-score was 6.97 ± 3.61 (range 0 to 12). The overall survival of the study population at 64 months was 36.65% (95% CI: 8.59–66.34), with median overall survival of 59 months. A new scoring system was developed combining categorical HE4 expression and serum CA-125 levels; the combination of HE4 expression with postoperative CA-125 levels was found to be the best prognostic marker for overall survival (p = 0.05). A composite score of 2 identified patients with poor progression-free survival (HR 4.64, p = 0.039) and overall survival (HR 5.45, p = 0.05). Conclusion The new composite scoring system using HE4 IHC with postoperative serum CA-125 levels offers an extremely useful option for prognosticating patients with serous epithelial ovarian carcinoma than serum CA-125 alone. This is useful where preoperative records are not available to the treating clinician.

The application of video processing techniques are useful for the safety of nuclear power plants by tracking the people online on video to estimate the dose received by staff during work in nuclear plants. Nuclear reactors remotely visually controlled to evaluate the plant's condition using video processing techniques. Internal reactor components should be frequently inspected but in current scenario however involves human technicians, who review inspection videos and identify the costly, time-consuming and subjective cracks on metallic surfaces of underwater components. In case, if any frame of the inspection video degraded/corrupted/missed due to noise or any other factor, then it may cause serious safety issue. The problem of missing/degraded/corrupted video frame estimation is a challenging problem till date. In this paper a systematic literature review on video processing techniques is carried out, to perform their suitability analysis for NPP applications. The limitation of existing approaches are also identified along with a roadmap to overcome these limitations.

Climate and environmental change are critical factors affecting water resources, irrigation and farming systems in Ethiopia as most of the population and the country’s economy depend on agriculture. The aim of this study was to investigate farmers’ perceptions of climate and environmental change and impacts of those changes on their farming systems, water resources, and irrigation. The study used a semi-structured questionnaire to interview a total of 201 rural households from nine different villages in Awash River Basin (ARB), Ethiopia. The data collected was analysed by descriptive statistics, quantitative data analysis and multinominal logistic regression using the Statistical Package for Social Scientists (SPSS) software. About 80, 97 and 98% of the respondents perceived the occurrence of climate variability in the Upper, Middle and Lower ARBs, respectively. Between 68 and 80% of the respondents noted that they had observed variable rainfall (either an increase or a decrease) during different seasons of the year. More than 70% of the respondents also confirmed that there was temperature change in their areas. The high awareness of climate change and environmental variability by farmers in the ARB may help decision and policymakers in establishing participatory climate adaptation and mitigation strategies.

Introduction: Patient-specific quality assurance (PSQA) assumes a vital role in precise and accurate radiation delivery to cancer patients. Since the patient body comprises heterogeneous media, the present study aimed to fabricate a heterogeneous thoracic phantom for PSQA.Material and Methods: Heterogeneous thoracic (HT) phantom was fabricated using rib cage madeup of bone equivalent material, kailwood to mimic lungs and wax to mimic various body parts. Physical density of all these materials used in phantom fabrication was measured and compared with that of the corresponding part of actual human thorax. One beam was planned on the computed tomography (CT) images of phantom and actual patient thorax region. Dose distribution in both the plans was measured and analyzed.Results:The estimated densities of heart, lung, ribs, scapula, spine, and chest wall tissues were 0.804±0.007, 0.186±0.010, 1.796±0.061, 2.017±0.026, 2.106±0.029 and 0.739±0.028 respectively in case of HT phantom while 1.038±0.010, 0.199±0.031, 1.715±0.040, 2.006±0.019, 1.929±0.065 and 0.816±0.028 g/cc, respectively in case of actual human thorax region.The depths of isodose curves in HT phantom were also comparable to the isodose curve’s depths inreal patient. PSQA results were within ±3% for flat beam (FB) and flattening filtered free beam (FFFB) of 6 megavolts (MV) energy.Conclusion: Density and dose distribution pattern in HT phantom were similar to that in actual human thorax region. Thus, fabricated HT phantom can be utilized for radiation dosimetry in thoracic cancer patients. The materials used to develop HT phantom are easily available in market at an affordable price and easy to craft.

Introduction: Considering the unwanted exposure to organs in the path of the beam, 4-field (4F) and subsequently, Intensity-modulated-radiation-therapy (IMRT), is known as the standard mode of treatment of carcinoma cervix. It is routine practice to inject intravenous contrast during simulation scan which elopes after that from the patient body. Therefore, the impact of contrast media should be investigated for radiation dose calculations. Material and Methods: An indigenously made phantom, named as ‘original contrast (OC)’, was used with dimensions 15 x 15 x 30 cm3. A sleeve was given to place the ionization chamber at the isocentre of the planning target volume (PTV) inside the cylindrical vial of iodinized contrast. Similarly, a virtual phantom was created with similar dimensions in the presence and absence of contrast media, called as ‘virtual contrast (VC)’ and ‘virtual without contrast (VWC)’ phantom. Plans were generated with photon energies (6MV/10MV/15MV/6FFF/10FFF) using 4F and IMRT technique. Plans were evaluated for PTV (D99%, D10%, Dmean) and Bladder & Rectum (V30Gy, V10Gy). Normal-tissue-integral-dose (NTID) and total-monitor-units (TMU) were also evaluated. Results: D99% of the PTV was comparable in VC and VWC phantoms but was decreased for OC phantom. Similarly, D10% was reportedly higher as 54.03 Gy (4F, 6 MV), 54.71 Gy (4F, 15 MV), 55.78 Gy (4F, 6 FFF) and 57.64 Gy (4F, 10 FFF) for OC phantom. D30% of the bladder and also the NTID was lesser for IMRT cases in all the selected phantoms. Additionally, 4F has shown lesser spillage with 6MV/15 MV photon beam energies in OC phantom. The ‘total monitor units (TMU)’ required for IMRT plans were significantly higher. Conclusion: The contrast material under-estimates the planned dose yet has an insignificant influence on the dose calculation. Therefore, unnecessary exposure of dual scans should be avoided the use of 6MV and IMRT technique should be continued in the clinics.

The present study employs numerical simulations to investigate vertical wall abutment scour with different aspect ratios (B/L, where B is the abutment length in the flow direction, and L is the abutment length transverse to the flow direction) under the combined effect of waves and current. The numerical model solves the Reynolds-averaged Navier–Stokes (RANS) equations and incorporates the Exner formulation to account for bed-level changes. The utilization of the Level Set Method (LSM) in the present numerical model enhances the accurate tracking of free surface and sediment bed. The numerical model validation was performed using a truncated numerical wave tank. The validated model was utilized to examine scour around vertical wall abutments with varying aspect ratios under different wave-current flows. The highest and lowest abutment scour depths were observed for aspect ratios of 0.5 and 2, respectively, in both steady current and the combined effects of waves and current. The vertical wall abutment of aspect ratio 0.5 had a maximum normalized equilibrium scour depth (S/B, where S is equilibrium scour depth), primarily attributed to a sharp edge, leading to increased turbulence and forming a strong primary vortex. The results suggest that the increase in the aspect ratio of the vertical wall abutment decreases the normalized equilibrium scour depth (S/B). According to the authors’ knowledge, this study is the first of its kind that utilizes a three-dimensional, semi-coupled model to examine combined wave- and current-flow-induced scour at vertical wall abutments with varying aspect ratios.

The propagation of waves in shallow waters is affected by the bottom topography unlike deep water waves of the coastal environment. Due to the interaction of the wave with bed topography, the wave transformation processes occur. Refraction, diffraction, shoaling, and breaking are the wave transformation processes that occur in the coastal environment. The significant wave height over rugged topography is a standardized statistics to denote the characteristic height of the random waves in a sea state. Therefore, the objective of the present study is to predict the significant wave height over rugged topography. The SWAN standalone and SWAN DHH platform are used to predict significant wave height over rugged topography in Mehamn harbour, Norway. The SWAN model results are almost similar to the lab data of Vold and Lothe (2009) for all the 22 scenarios at all the output locations. Further, the four cases reported by Taehun (2011) and lab data from Vold and Lothe (2009) for that four cases are compared with the SWAN model results. It is observed that the SWAN model results are much closer to the lab data of Vold and Lothe (2009).

In India, a large number of sanitary care workers are involved in manual scavenging. This exposes them to sewer gas mainly consisting of hydrogen sulphide. Sewer gas toxicity primarily causes neurological injury, followed by cardiac and respiratory involvement. A few cases of diffuse ST-segment elevation in the electrocardiogram (ECG) following hydrogen sulphide poisoning are known in the literature. Here, we report a case of acute sewer gas poisoning in a 45-year-old man with transient and focal ST-segment elevation in the anteroseptal leads of the ECG mimicking acute anterior wall myocardial infarction.

Purpose: To study the impact of different optimization methods in dealing with metallic hip implant using intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques. Materials and Methods: A cohort of 16 patients having metallic implants was selected for the study. Three sets of IMRT and VMAT plans were generated. Set 1 IMRT (IM_Base), VMAT (VM_Base) without any restrictions on beam entry and exit, set 2 (IM_ENT and VM_ENT) optimizer restricts the beam entry and set 3 (IM_EXT+ENT), neither entry nor exit doses were allowed toward the metallic implant. Results: There was no significant difference in target (D95%) and organ-at-risk doses between IM_Base and IM_ENT. There were significant (P = 0.002) improvements in planning target volume (PTV) V95% and homogeneity from IM_EXT+ENT to IM_ENT. There was no significant difference in plan quality between VM_Base and VM_ENT. There were significant (P = 0.005) improvements in PTV, V95%, homogeneity from VM_EXT+ENT to VM_ENT. V40Gy, V30Gy for bladder, rectum, bowel, and bowel maximum dose decreases significantly (P < 0.005) in IM_ENT compared to IM_EXT+ENT, but not significant for VMAT plans. Similarly, there was a significant decrease in dose spill outside target (P < 0.05) comparing 40%, 50%, 60%, and 70% dose spills for IM_ENT compared to IM_EXT+ENT, but variations among VMAT plans are insignificant. VMAT plans were always superior to IMRT plans for the same optimization methods. Conclusion: The best approach is to plan hip prosthesis cases with blocked entry of radiation beam for IMRT and VMAT. The VMAT plans had more volumetric coverage, fewer hotspots, and lesser heterogeneity.

BACKGROUND: Screening of hemoglobin (Hb) before blood donation is one among the vital tests. It is performed to select a blood donor to prevent the collection of blood from an anemic person. However, no accurate, cost-effective, reliable, and standardized method is available to estimate Hb. OBJECTIVE: The aim is to evaluate the efficacy of filter paper cyanmethemoglobin (FPCH) method with the automated hematology analyzer in the estimation of Hb concentration for screening of a suitable donor. METHODOLOGY: This was a cross-sectional study in which the blood samples of 2000 patients visiting KLE's Dr. Prabhakar Kore Charitable Hospital, Belagavi, were collected in vials and directly estimated for Hb using automated hematology analyzer. To evaluate the efficacy of FPCH, 20 μL of blood sample was transferred onto Whatman filter paper and dried at room temperature. After drying, it was placed in 5 mL of Drabkin's solution for 30 min. Optical density was estimated by measuring the absorbance. Data were analyzed using SPSS version 20. The correlation coefficient, paired t-test, and difference between the means of both the methods were calculated. RESULTS: The mean Hb estimated by FPCH was 11.25 g/dL and automated hematology analyzer gave 11.35 g/dL. The difference in the means of both the methods was 0.1 g/dL. Paired t-test was done to test the level of significance and the result was 8.151 (95% confidence interval: 0.08–0.13 g/dL, P < 0.001). The correlation coefficient was found to be 0.976 (P < 0.001). CONCLUSION: FPCH is an efficient method, which is comparable to the automated hematology analyzers for Hb estimation. It could be used as an alternative screening tool for detection of Hb in a blood donation camp.

Introduction: COVID-19 is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2. Imaging plays an essential role in the diagnosis and management of symptomatic patients. Mucormycosis has gained popularity recently as a complication in COVID-19-affected patients. Various types of mucormycosis are rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and uncommon forms. Aim and Objective: We aimed to evaluate various radiological features of different types of mucormycosis infection in COVID-19 patients. Materials and Methods: We studied thirty COVID-19 patients retrospectively who were referred to our hospital over a period of 6 months (January to June 2021). Computed tomography (CT) and magnetic resonance imaging (MRI) were used for imaging evaluation of the patients. Imaging diagnosis was confirmed on histopathology in 21 patients. Results: We identified thirty cases of mucormycosis in COVID-19 patients in our tertiary center. Out of total cases, 18 were of pulmonary form, 9 of rhino-orbital form, and 3 of rhinocerebral form. Bird's nest pattern of cavitation was the most common feature in pulmonary form of mucormycosis. Acute unilateral rhinosinusitis with the presence of T2 hypointensities within periantral and intraorbital fat stranding was found to be the most specific imaging appearance in rhino-orbital form of mucormycosis. Rhinocerebral form showed contiguous spread of the disease from the sinuses to the meninges and brain parenchyma. Conclusion: Imaging plays a decisive role for early identification of the mucormycosis infection in COVID-19 patients and determination of the disease extent. CT and MRI help in accurate diagnosis of the disease and follow-up in postoperative patients.

Abstract Background The COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may have profound effects on their mental and physical health, personal relationships and professional efficacy. Methods With mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria. Results A total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms. Conclusion It is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19’s impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as ‘compensatory’ to one another, with coping mechanisms buffering and fortifying the physician’s overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures.

Aim: We aimed to evaluate the dosimetric influence of Acuros XB (AXB) dose-to-medium (Dm) and dose-to-water (Dw) reporting mode on carcinoma cervix using intensity-modulated radiation therapy (IMRT) and RapidArc (RA) technique. Materials and Methods: A cohort of thirty patients cared for carcinoma cervix was retrospectively selected for the study. Plans were computed using analytical anisotropic algorithm (AAA), AXB-Dm, and AXB-Dw algorithms for dosimetric comparison. A paired t-test and Pitman–Morgan dispersion test were executed to appraise the difference in mean values and the inter-patient variability of the differences. Results: The dose–volume parameters were higher for AXB-Dw in contrast to AAA for IMRT and RA plans, excluding D98%, minimum dose to planning target volume (PTV) and rectum mean dose (RA). There was no systematic trend observed in dose–volume parameters for PTV and organs at risk (OARs) between AXB-Dm and AXB-Dw for IMRT and RA plans. The dose–volume parameters for target were higher for AXB-Dm in comparison to AAA in IMRT and RA plans, except D98% and minimum dose to PTV. Analysis envisaged less inter-patient variability while switching from AAA to AXB-Dm in comparison to those switching from AAA to AXB-Dw. Conclusions: The present study reveals the important difference between AAA, AXB-Dm, and AXB-Dw computations for cervix carcinoma using IMRT and RA techniques. The inter-patient variability and systematic difference in dose–volume parameters computed using AAA, AXB-Dm, and AXB-Dw algorithms present the possible impact on the dose prescription to PTV and their relative constraints to OARs for IMRT and RA techniques. This may help in the decision-making in clinic while switching from AAA to AXB (Dm or Dw) algorithm for cervix carcinoma using IMRT and RA techniques.

Introduction: Respiratory syncytial virus (RSV) is a common cause of morbidity among hematopoietic stem cell transplant (HSCT) recipients, with RSV-associated lower respiratory tract infection carrying high mortality rates. There have been no large studies till date, describing the incidence, clinical features, and outcomes of RSV infection among adult HSCT recipients in India. Methods: A prospective cohort of 100 adults who underwent HSCT was followed up for a maximum period of 18 months starting from the date of transplantation for any episode of respiratory tract infectious disease (RTID). Respiratory samples were collected for laboratory confirmation of the presence and subtyping of RSV by real-time reverse transcriptase-polymerase chain reaction. Results: The study population comprised of 66% (66/100) males and 34% (34/100) females. Autologous HSCT recipients constituted 78% (78/100) and allogeneic HSCT recipients constituted 22% (22/100) of the study population. The incidence of RSV-RTID among adults after HSCT was 0.82/100 patient months. Most cases occurred during the winter season and the predominant subtype was RSV-A (9/11, 81.8%). Lower RTID was the most common clinical diagnosis made at presentation (9/11, 81.8%). Female gender was predictive of RSV-RTID (log rank P = 0.002). All the RSV-RTID episodes recovered completely without targeted therapy. Conclusion: RSV is a significant cause of morbidity among adult HSCT recipients in India. Prophylaxis and treatment measures need to be instituted after a proper risk-benefit assessment. Longitudinal studies with larger sample sizes are needed to confirm these results.

An abnormal union of two or more tooth germs in the development process results in fusion of teeth. Such clinical situations present a diagnostic dilemma and a challenge in treatment planning. This article reports the endodontic and esthetic management of an atypical permanent maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus. A 22-year-old female reported an abnormally large and discolored permanent maxillary left lateral incisor (#22). Cone-beam computed tomographic evaluation revealed a complex, labiolingually thin ribbon-shaped canal system in the central portion interconnected with two other canals along with a coronal dens invaginatus. A 2-year follow-up demonstrated satisfactory clinical and radiographic outcomes after the endodontic therapy and a veneer placement on the concerned tooth.

Background: Psychological morbidities are high among undergraduate medical students. They experience the transition between pre/para-clinical and clinical training as a stressful period, and cope differently. Research from India in this regard is lacking. Aims: The aim of this study was to assess and compare the prevalence of psychological morbidities, associated factors, and coping styles between pre/para-clinical and clinical undergraduate medical students. Materials and Methods: This institution-based cross-sectional observational design study was conducted among pre/para-clinical and clinical group of undergraduate medical students (a total of 382) by using a questionnaire in the period between April and June 2021. Stratified random sampling technique was used to select the study participants. The survey included standard self-administered questionnaires like general health questionnaire-28 (GHQ-28) and Lin-Chen’s coping inventory to assess psychological morbidities and coping styles, respectively. Associated factors for psychological morbidities, and coping styles between two groups were compared using chi-square test, independent t test, and binary logistic regression analysis. Results: Of the 382 responders, psychological morbidities (GHQ-28 score >23) were found in 61% of participants. Both groups reported a high level, a slightly higher preponderance in clinical (61.5%) than pre/para-clinical students (60.6%), and with nonsignificant difference of psychological morbidities. Compared to pre/para-clinical group, clinical group was found to have more substance consumption behavior (P < 0.001), dissatisfaction with academic performance (P < 0.001), sought psychiatric consultation (P < 0.05), and currently on psychiatric treatment (P < 0.05). Overall, coping was found to be average and good among the participants. Active problem coping behavior was more significantly used by pre/para-clinical group, whereas passive problem coping and passive emotional coping behavior were positively significantly correlated with psychological morbidities in the clinical group. Conclusions: This study established a significant correlation between psychological morbidities and passive coping styles in the clinical group. These students need interventions to encourage the use of more active coping styles during the training to provide advances in future career. A strong correlation with dissatisfied academic performance may be a call for an efficient and more student-friendly curriculum.

PURPOSETyrosine kinase inhibitors such as sunitinib and pazopanib are the mainstay of treatment of metastatic renal cell carcinoma (mRCC) in India. However, pembrolizumab and nivolumab have shown significant improvement in the median progression-free survival and overall survival among patients with mRCC. In this study, we aimed to determine the cost-effectiveness of the first-line treatment options for the patients with mRCC in India.METHODSA Markov state-transition model was used to measure the lifetime costs and health outcomes associated with sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab among patients with first-line mRCC. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost-effectiveness using a willingness to pay threshold of one-time per capita gross-domestic product of India. The parameter uncertainty was analyzed using the probabilistic sensitivity analysis.RESULTSWe estimated the total lifetime cost per patient of ₹ 0.27 million ($3,706 US dollars [USD]), ₹ 0.35 million ($4,716 USD), ₹ 9.7 million ($131,858 USD), and ₹ 6.7 million ($90,481 USD) for the sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab arms, respectively. Similarly, the mean QALYs lived per patient were 1.91, 1.86, 2.75, and 1.97, respectively. Sunitinib incurs an average cost of ₹ 143,269 ($1,939 USD) per QALY lived. Therefore, sunitinib at current reimbursement rates (₹ 10,000 per cycle) has a 94.6% probability of being cost-effective at a willingness to pay threshold of 1-time per capita gross-domestic product (₹ 168,300) in the Indian context.CONCLUSIONOur findings support the current inclusion of sunitinib under India's publicly financed health insurance scheme.

A field study was conducted at Crop Research Farm, Department of Agronomy, Sam Higginbottom University of Agriculture Technology and Sciences, Prayagraj, during the zaid season of 2021. (U.P.). This study was carried out with the objective to study the interaction effect of different levels of NPK, FYM, Vermicompost and Panchagavya on growth and yield of cowpea.The experiment used a randomized block design (RBD) with nine treatments which were replicated three times. The soil texture of the experimental plot was sandy loam, with a pH of 7.2, low organic carbon (0.48 percent), available N (171.48 kg/ha), available P (13.6 kg/ha), and available K (215.4 kg/ha). The results showed significantly increase in growth parameters i.e. plant height (69.48 cm), number of nodules/plant (24.37), plant dry weight (22.22 g/plant), crop growth rate (3.0 g/m2/plant) and yield attributing parameters i.e. number of pods/plant (15.45), length of pods (27.02cm), number of seeds/pod (13.57), test weight (85.6 g), seed yield (2.68 t/ha), stover yield (6.09 t/ha). The harvest index (30.56) was recorded with vermicompost 1.5t/ha + RDF 100% kg/ha.

The primary objective of this article is to explore effects of latest development in the area of three dimensional (3D) printing & to assess its abilities, and further undertake helpful reporting. Here the focus is to assess advantages of 3D printing in orthopedics and analyze how 3D printed models help solve complex 3D orthopedics distortions. This study identified that 3D models manufactured by 3D printing models reduce medical parts development cost and surgical planning time. Integrating 3D printing with orthopaedics helps in understanding the conditions of problems and achieving the operation successfully. This technology can enable doctors/surgeons to design, produce, recreate and plan operations more accurately, carefully, and economically. 3D models can assist specialists with a visual comprehension of the patient-particular pathology and life structures. Innovation in 3D printing initiated a scaffold for the virtual outline and execution of medical procedures. This research proposes the utilisation of 3D printers as an elective procedure for the fabrication of parts. It empowers surgeons/patients for better training, education and research. In the future, there is a foreseeable expansion of additive manufacturing in orthopedics.