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Ramachandran Natarajan,1 Venkateswaran Ramanathan,1 Sujatha Sistla2 1Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India; 2Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IndiaCorrespondence: Venkateswaran Ramanathan, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry, 605006, India, Email drvenks@gmail.comBackground: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with a high mortality rate.Aim: The study was conducted to estimate the frequency, outcomes, and predictors of polymicrobial VAP.Methods: A prospective observational study was conducted in mechanically ventilated adult patients in the medical intensive care unit in a tertiary care hospital in India from July 2016 to July 2018 with a 30-day follow-up period. The patients were grouped into monomicrobial and polymicrobial VAP. We compared the 30-day outcome parameters such as discharge from hospital, in-hospital stay, death, and complications such as catheter associated urinary tract infection (CAUTI), central line associated blood stream infection (CRBSI), bacteremia and collapse of lung. The predictors of polymicrobial VAP were identified by multiple logistic regression.Results: Out of 301 patients clinically diagnosed with VAP, 151 patients were excluded, and the remaining 150 developed 186 episodes of VAP during the study period. The incidence of polymicrobial VAP was 62.9%. Out of 150 patients, 51 patients had monomicrobial VAP, and 99 had polymicrobial VAP. On univariate analysis, diabetes mellitus and poor sensorium (Glasgow Coma Scale [GCS] score < 8) during endotracheal intubation; 30-day outcome, mean days of mechanical ventilation after VAP diagnosis and days in ICU; and CAUTI were significantly associated with polymicrobial VAP. On multivariable logistic regression, poor sensorium (GCS score < 8) at the time of endotracheal intubation was an independent predictor of polymicrobial VAP.Conclusion: The incidence of polymicrobial VAP is high in the medical ICU and is associated with increased duration of mechanical ventilation, hospital stay, and incidence of CAUTI. Poor GCS score was the single independent predictor of polymicrobial VAP.Keywords: monomicrobial VAP, nosocomial infection

The repurposing of biomedical data is inhibited by its fragmented and multi-formatted nature that requires redundant investment of time and resources by data scientists. This is particularly true for Type 1 Diabetes (T1D), one of the most intensely studied common childhood diseases. Intense investigation of the contribution of pancreatic β-islet and T-lymphocytes in T1D has been made. However, genetic contributions from B-lymphocytes, which are known to play a role in a subset of T1D patients, remain relatively understudied. We have addressed this issue through the creation of Biomedical Data Commons (BMDC), a knowledge graph that integrates data from multiple sources into a single queryable format. This increases the speed of analysis by multiple orders of magnitude. We develop a pipeline using B-lymphocyte multi-dimensional epigenome and connectome data and deploy BMDC to assess genetic variants in the context of Type 1 Diabetes (T1D). Pipeline-identified variants are primarily common, non-coding, poorly conserved, and are of unknown clinical significance. While variants and their chromatin connectivity are cell-type specific, they are associated with well-studied disease genes in T-lymphocytes. Candidates include established variants in the HLA-DQB1 and HLA-DRB1 and IL2RA loci that have previously been demonstrated to protect against T1D in humans and mice providing validation for this method. Others are included in the well-established T1D GRS2 genetic risk scoring method. More intriguingly, other prioritized variants are completely novel and form the basis for future mechanistic and clinical validation studies The BMDC community-based platform can be expanded and repurposed to increase the accessibility, reproducibility, and productivity of biomedical information for diverse applications including the prioritization of cell type-specific disease alleles from complex phenotypes.

Anthropogenic aerosols mask the climate warming caused by greenhouse gases (GHGs). In the absence of observational constraints, large uncertainties plague the estimates of this masking effect. Here we used the abrupt reduction in anthropogenic emissions observed during the COVID-19 societal slow-down to characterize the aerosol masking effect over South Asia. During this period, the aerosol loading decreased substantially and our observations reveal that the magnitude of this aerosol demasking corresponds to nearly three-fourths of the CO2-induced radiative forcing over South Asia. Concurrent measurements over the northern Indian Ocean unveiled a ~7% increase in the earth's surface-reaching solar radiation (surface brightening). Aerosol-induced atmospheric solar heating decreased by ~0.4 K d-1. Our results reveal that under clear sky conditions, anthropogenic emissions over South Asia lead to nearly 1.4 W m-2 heating at the top of the atmosphere during the period March-May. A complete phase-out of today's fossil fuel combustion to zero-emission renewables would result in rapid aerosol demasking, while the GHGs linger on.

Histopathology of tuberculosis and leprosy is expected to correlate with the clinical and gross pathological aspects of the disease. However, this may not be the case, particularly in tuberculosis. This reflects our inadequate interpretation of the cellular events in tissues. The advent of immunocytochemistry for finding the cell types in lesions and some of their functions have helped in the interpretation of these changes. Immunocytochemical studies using monoclonal antibodies have shown consistent relationship between histology and lymphocyte organization in leprosy, a related mycobacterial disease. The study of the patterns of cellular responses in the granuloma per se from the different clinical expressions of tuberculosis is essential to comprehend the different immunopathogenic mechanisms in each. CD stands for cluster designation and is a nomenclature for the identification of specific cell surface antigens defined as monoclonal antibodies. This procedure can be applied to both formalin-fixed and frozen tissues. It is very helpful in identifying subpopulations of T and B cell lymphocytes. CD3 T cell is marked by receptors for antigen recognition, while CD20 is meant for Pan B cells and dendritic cells. Since CMI is the preeminent immune response to the Mycobacterium tuberculosis infection, interaction of antigen-presenting cells with antigen specific B and T lymphocytes is of paramount importance, which should be accompanied by cytokine production and liberation. The present study is undertaken for evaluating the cell types in lesions of cutaneous tuberculosis and some of their functions using B and T cell markers.

BackgroundTo explore the hypothesis that sight restoring cataract surgery provided to impoverished rural communities will improve not only visual acuity and vision-related quality of life (VRQoL) but also poverty and social status.MethodsParticipants were recruited at outreach camps in Tamil Nadu, South India, and underwent free routine manual small incision cataract surgery (SICS) with intra-ocular lens (IOL) implantation, and were followed up one year later. Poverty was measured as monthly household income, being engaged in income generating activities and number of working household members. Social status was measured as rates of re-marriage amongst widowed participants. VRQoL was measured using the IND-VFQ-33. Associations were explored using logistic regression (SPSS 19).ResultsOf the 294 participants, mean age ± standard deviation (SD) 60 ± 8 years, 54% men, only 11% remained vision impaired at follow up (67% at baseline; pConclusionThese findings indicate the broad positive impact of sight restoring cataract surgery on the recipients' as well as their families' lives. Providing free high quality cataract surgery to marginalized rural communities will not only alleviate avoidable blindness but also - to some extent - poverty in the long run.

Trends in surface air temperature (SAT) are a common metric for global warming. Using observations and observationally driven models, we show that a more comprehensive metric for global warming and weather extremes is the trend in surface equivalent potential temperature (Thetae_sfc) since it also accounts for the increase in atmospheric humidity and latent energy. From 1980 to 2019, while SAT increased by 0.79[Formula: see text], Thetae_sfc increased by 1.48[Formula: see text] globally and as much as 4[Formula: see text] in the tropics. The increase in water vapor is responsible for the factor of 2 difference between SAT and Thetae_sfc trends. Thetae_sfc increased more uniformly (than SAT) between the midlatitudes of the southern hemisphere and the northern hemisphere, revealing the global nature of the heating added by greenhouse gases (GHGs). Trends in heat extremes and extreme precipitation are correlated strongly with the global/tropical trends in Thetae_sfc. The tropical amplification of Thetae_sfc is as large as the arctic amplification of SAT, accounting for the observed global positive trends in deep convection and a 20% increase in heat extremes. With unchecked GHG emissions, while SAT warming can reach 4.8[Formula: see text] by 2100, the global mean Thetae_sfc can increase by as much as 12[Formula: see text], with corresponding increases of 12[Formula: see text] (median) to 24[Formula: see text] (5% of grid points) in land surface temperature extremes, a 14- to 30-fold increase in frequency of heat extremes, a 40% increase in the energy available for tropical deep convection, and an up to 60% increase in extreme precipitation.

During recent decades, there has been dramatic Arctic sea ice retreat. This has reduced the top-of-atmosphere albedo, adding more solar energy to the climate system. There is substantial uncertainty regarding how much ice retreat and associated solar heating will occur in the future. This is relevant to future climate projections, including the timescale for reaching global warming stabilization targets. Here we use satellite observations to estimate the amount of solar energy that would be added in the worst-case scenario of a complete disappearance of Arctic sea ice throughout the sunlit part of the year. Assuming constant cloudiness, we calculate a global radiative heating of 0.71 W/m2 relative to the 1979 baseline state. This is equivalent to the effect of one trillion tons of CO2 emissions. These results suggest that the additional heating due to complete Arctic sea ice loss would hasten global warming by an estimated 25 years.

Improved cookstoves (ICS) can deliver "triple wins" by improving household health, local environments, and global climate. Yet their potential is in doubt because of low and slow diffusion, likely because of constraints imposed by differences in culture, geography, institutions, and missing markets. We offer insights about this challenge based on a multiyear, multiphase study with nearly 1,000 households in the Indian Himalayas. In phase I, we combined desk reviews, simulations, and focus groups to diagnose barriers to ICS adoption. In phase II, we implemented a set of pilots to simulate a mature market and designed an intervention that upgraded the supply chain (combining marketing and home delivery), provided rebates and financing to lower income and liquidity constraints, and allowed households a choice among ICS. In phase III, we used findings from these pilots to implement a field experiment to rigorously test whether this combination of upgraded supply and demand promotion stimulates adoption. The experiment showed that, compared with zero purchase in control villages, over half of intervention households bought an ICS, although demand was highly price-sensitive. Demand was at least twice as high for electric stoves relative to biomass ICS. Even among households that received a negligible price discount, the upgraded supply chain alone induced a 28 percentage-point increase in ICS ownership. Although the bundled intervention is resource-intensive, the full costs are lower than the social benefits of ICS promotion. Our findings suggest that market analysis, robust supply chains, and price discounts are critical for ICS diffusion.

Anthropogenic greenhouse gases and aerosols are associated with climate change and human health risks. We used a global model to estimate the climate and public health outcomes attributable to fossil fuel use, indicating the potential benefits of a phaseout. We show that it can avoid an excess mortality rate of 3.61 (2.96-4.21) million per year from outdoor air pollution worldwide. This could be up to 5.55 (4.52-6.52) million per year by additionally controlling nonfossil anthropogenic sources. Globally, fossil-fuel-related emissions account for about 65% of the excess mortality, and 70% of the climate cooling by anthropogenic aerosols. The chemical influence of air pollution on aeolian dust contributes to the aerosol cooling. Because aerosols affect the hydrologic cycle, removing the anthropogenic emissions in the model increases rainfall by 10-70% over densely populated regions in India and 10-30% over northern China, and by 10-40% over Central America, West Africa, and the drought-prone Sahel, thus contributing to water and food security. Since aerosols mask the anthropogenic rise in global temperature, removing fossil-fuel-generated particles liberates 0.51(±0.03) °C and all pollution particles 0.73(±0.03) °C warming, reaching around 2 °C over North America and Northeast Asia. The steep temperature increase from removing aerosols can be moderated to about 0.36(±0.06) °C globally by the simultaneous reduction of tropospheric ozone and methane. We conclude that a rapid phaseout of fossil-fuel-related emissions and major reductions of other anthropogenic sources are needed to save millions of lives, restore aerosol-perturbed rainfall patterns, and limit global warming to 2 °C.

Let R be a ring (not necessarily commutative) with identity 1 and let CL (R) be its clean graph. In this paper, we investigate the genus number of the compact Riemann surface in which CL (R) can be embedded and explicitly determine all commutative rings R (up to isomorphism) such that CL (R) has genus at most two. It is shown that for any Artinian ring R , CL (R) is a projective graph if and only if R is isomorphic to F 4. Furthermore, we determine all isomorphism classes of commutative rings whose clean graphs have crosscap two. [ABSTRACT FROM AUTHOR]

Three billion of the world's poorest people mostly rely on solid biomass for cooking, with major consequences to health and environment. We demonstrate the untapped potential of wireless sensors connected to the 'internet of things' to make clean energy solutions affordable for those at the bottom of the energy pyramid. This breakthrough approach is demonstrated by a 17-month field study with 4,038 households in India. Major findings include: self-reported data on cooking duration have little correlation with actual usage data from sensors; sensor data revealed that the distribution of high and low users varied over time, and the actual mitigation of climate pollution was only 25% of the projected mitigation; climate credits were shown to significantly incentivize the use of cleaner technologies.

The scale of the decarbonisation challenge to meet the Paris Agreement is underplayed in the public arena. It will require precipitous emissions reductions within 40 years and a new carbon sink on the scale of the ocean sink. Even then, the world is extremely likely to overshoot. A catastrophic failure of policy, for example, waiting another decade for transformative policy and full commitments to fossil-free economies, will have irreversible and deleterious repercussions for humanity’s remaining time on Earth. Only a global zero carbon roadmap will put the world on a course to phase-out greenhouse gas emissions and create the essential carbon sinks for Earth-system stability, without which, world prosperity is not possible.

The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth's clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.

The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth's clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.

There are many contributing factors which determine the micro- and macrophysical properties of clouds, including atmospheric vertical structure, dominant meteorological conditions, and aerosol concentration, all of which may be coupled to one another. In the quest to determine aerosol effects on clouds, these potential relationships must be understood. Here we describe several observed correlations between aerosol conditions and cloud and atmospheric properties in the Indian Ocean winter monsoon season. In the CARDEX (Cloud, Aerosol, Radiative forcing, Dynamics EXperiment) field campaign conducted in February and March 2012 in the northern Indian Ocean, continuous measurements were made of atmospheric precipitable water vapor (PWV) and the liquid water path (LWP) of trade cumulus clouds, concurrent with measurements of water vapor flux, cloud and aerosol vertical profiles, meteorological data, and surface and total-column aerosol from instrumentation at a ground observatory and on small unmanned aircraft. We present observations which indicate a positive correlation between aerosol and cloud LWP only when considering cases with low atmospheric water vapor (PWV < 40 kg m-2), a criterion which acts to filter the data to control for the natural meteorological variability in the region. We then use the aircraft and ground-based measurements to explore possible mechanisms behind this observed aerosol-LWP correlation. The increase in cloud liquid water is found to coincide with a lowering of the cloud base, which is itself attributable to increased boundary layer humidity in polluted conditions. High pollution is found to correlate with both higher temperatures and higher humidity measured throughout the boundary layer. A large-scale analysis, using satellite observations and meteorological reanalysis, corroborates these covariations: high-pollution cases are shown to originate as a highly polluted boundary layer air mass approaching the observatory from a northwesterly direction. The source air mass exhibits both higher temperatures and higher humidity in the polluted cases. While the warmer temperatures may be attributable to aerosol absorption of solar radiation over the subcontinent, the factors responsible for the coincident high humidity are less evident: the high-aerosol conditions are observed to disperse with air mass evolution, along with a weakening of the high-temperature anomaly, while the high-humidity condition is observed to strengthen in magnitude as the polluted air mass moves over the ocean toward the site of the CARDEX observations. Potential causal mechanisms of the observed correlations, including meteorological or aerosol-induced factors, are explored, though future research will be needed for a more complete and quantitative understanding of the aerosol-humidity relationship.

We are living in a world of over seven billion people, with annual greenhouse gas emissions of approximately 50 billion tons a year and rising steadily. If continued unabated, the world is on target to warm by about 2 °C in less than 40 years, pushing the climate to a regime unlike any that has been witnessed in the last million years. Nonetheless, we still have time to avert such a catastrophic scenario, or delay its occurrence by several decades to provide human societies and the ecosystem with the time to adjust. In order to mitigate the possibility of climate disruption, we need to recognize that fossil fuel based technologies have become outdated and transform the energy system to that of low-carbon, sustainable and secure energy systems. In addition, we have to mitigate emissions of the four short-lived climate pollutants to bring immediate relief from climate change and protect vulnerable societies. Stability of the climate system involves not only the centrality of scientific and technological advancements and investments, but also necessary shifts in social structure and behavior by individuals, communities and societies worldwide as well as market based instruments, sub-national collaborations and governance structure. Fortunately, living laboratories—such as the State of California and the University of California system, which has pledged to become carbon neutral by 2025—provide demonstrable solutions which hold promise in alleviating the climate warming in the next generation. These jurisdictions are tiny emitters in the global picture, but they offer the potential for leverage through demonstrating (Figure 1) new technologies as well as workable institutions that cut emissions. We outline 10 pragmatic solutions—a “kit of parts” rooted in California but scalable to the world—that taken together, can “bend the curve” of the upward trajectory of human-caused warming trends. Wholesale transformation of our current fossil fuel based energy systems towards sustainable energy is among the greatest of societal challenges—and opportunities—faced in the 21st century.

The decline of Arctic sea ice has been documented in over 30 y of satellite passive microwave observations. The resulting darkening of the Arctic and its amplification of global warming was hypothesized almost 50 y ago but has yet to be verified with direct observations. This study uses satellite radiation budget measurements along with satellite microwave sea ice data to document the Arctic-wide decrease in planetary albedo and its amplifying effect on the warming. The analysis reveals a striking relationship between planetary albedo and sea ice cover, quantities inferred from two independent satellite instruments. We find that the Arctic planetary albedo has decreased from 0.52 to 0.48 between 1979 and 2011, corresponding to an additional 6.4 ± 0.9 W/m(2) of solar energy input into the Arctic Ocean region since 1979. Averaged over the globe, this albedo decrease corresponds to a forcing that is 25% as large as that due to the change in CO2 during this period, considerably larger than expectations from models and other less direct recent estimates. Changes in cloudiness appear to play a negligible role in observed Arctic darkening, thus reducing the possibility of Arctic cloud albedo feedbacks mitigating future Arctic warming.