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The COVID-19 pandemic adversely affected the essential care of newborns. In a tertiary care hospital in India, all COVID-19 suspect post-natal mothers awaiting COVID results were transferred to a ward shared with symptomatic COVID suspect female patients from other clinical specialities, due to shortage of space and functional health workforce. Babies born to COVID-19 suspect mothers were moved to a separate ward with a caretaker until their mothers tested negative. Due to shortage of beds and delay in receiving COVID results, mothers and babies were often discharged separately 2-3 days apart to their home. This deprived babies of their mother's milk and bonding. We, therefore, undertook a quality improvement (QI) initiative aiming to improve rooming-in of eligible COVID-19 suspect mother-newborn dyads from 0% to more than 90% over a period of 6 weeks.A QI team was formed which ran multiple Plan-Do-Study-Act cycles. The results were reviewed at regular intervals and interventions were adopted, adapted or abandoned. These included advocacy, rearrangement of wards, counselling of mothers and caretakers regarding infection prevention practices and coordination between labour room, post-natal ward and nursery staff.An improvement in rooming-in from 0% to more than 90% was achieved.QI methodology is a systematic approach in addressing and solving unexpected unforeseen problems effectively.

This study examines whether people update the inferred intensity of emotions differently from facial and situational cues. Additionally, we examine whether people's lay beliefs about facial expressions relate to this asymmetry in updating of emotion inferences.

This project examines people's lay beliefs about artificial intelligence technology that claims to recognize human's emotions.

Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial linking psychosocial deprivation in early childhood to changes in cortical development from childhood to adolescence using longitudinal data from the Bucharest Early Intervention Project. Changes in cortical structure due to randomization to foster care were most pronounced in the lateral and medial prefrontal cortex and in white matter tracts connecting the prefrontal and parietal cortex. Demonstrating the causal impact of exposure to deprivation on the development of neural structure highlights the importance of early placement into family-based care to mitigate lasting neurodevelopmental consequences associated with early-life deprivation.

Background: Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) differ in their memory, attention, and visuoconstructional characteristics. The subscales of the well-known Mini-Mental State Examination (MMSE) provide an opportunity to assess these characteristics. Previous research has shown that analysis of the MMSE subscale performance of AD and DLB patients helps to differentiate them. Objective: Study the MMSE scores of AD and DLB patients to see if the ability of previously reported analyses to differentiate them could be improved. Include other dementia patients for perspective. Methods: We studied the MMSEs of all patients seen in our clinics during an 18-month period. Different equations were studied, derived from the subscales of Memory (M, 3 points maximum), Attention (A, 5 points maximum), and Pentagon-copying (P, 1 point maximum). Results: We obtained 400 MMSEs, 136 from AD patients and 24 from DLB patients, scoring range 1–30. The equation P minus M provided the best discrimination between AD and DLB. Using a P-M score = 1 to identify AD, the positive predictive value was 0.97, negative predictive value 0.22, specificity 0.92, and sensitivity 0.43. As a secondary finding, the P-M = 1 equation was also helpful to differentiate AD from Parkinson’s disease dementia. Conclusion: Considering AD versus DLB in our clinic population, a demented patient who was unable to recall the three memory words on the MMSE but able to copy the intersecting pentagons had a 97% likelihood of having AD. Additional work is needed to improve the sensitivity of the P-M = 1 equation.

BackgroundSepsis severity scores are used in clinical practice and trials to define risk groups. There are limited data to derive hospital-based sepsis severity scores for neonates and young infants in high-burden low- and middle-income country (LMIC) settings where trials are urgently required. We aimed to create linked sepsis severity and recovery scores applicable to hospitalized neonates and young infants in LMIC which could be used to inform antibiotic trials.Methods & FindingsA prospective observational cohort study was conducted across 19 hospitals in 11 countries in sub-Saharan Africa, Asia, Latin America and Europe. Infants aged 3204 infants were enrolled between 2018-2020. Median age was 5 days (IQR 2-15), 90.4% (n=2,895) were A related NeoSep Recovery Score based on evolving post-baseline clinical signs and supportive care discriminated well between infants who died or survived the following day or subsequent few days. The area under the ROC curve for score on day 2 and death in the following 5 days was 0.82 (95%CI 0.78-0.85) and 0.85 (95%CI 0.78-0.93) in the derivation and validation data, respectively.ConclusionThe baseline NeoSep Severity Score predicted 28-day mortality and could identify infants with high risk of mortality for inclusion in hospital-based sepsis trials. The NeoSep Recovery Score predicts day-by-day inpatient mortality and could, with further validation, help to identify poor response to antibiotics.Author SummaryWhy was this study done?➣Evidence to guide hospital-based antibiotic treatment of sepsis in neonates and young infants is scarce, and clinical trials are particularly urgent in low- and middle-income (LMIC) settings where antimicrobial resistance threatens to undermine existing guidelines➣There is limited data to inform the design of antibiotic trials in LMIC settings, particularly to define risk stratification and inclusion and escalation criteria in hospitalised neonates and young infantsWhat did the researchers do and find?➣To our knowledge this is the first global, prospective, hospital-based observational study of clinically diagnosed neonatal sepsis across 4 continents including LMIC settings, with extensive daily data collection on clinical status, antibiotic use and outcomes.➣There was a high mortality among infants with sepsis in LMIC hospital settings. 4 non-modifiable and 6 modifiable factors predicted mortality and were included in a NeoSep Severity score which defines patterns of mortality risk at baseline➣A NeoSep Recovery Score including the same modifiable factors (with the addition of cyanosis) predicted mortality on the following day during the course of treatment.What do these findings mean?➣The NeoSep Severity Score and NeoSep Recovery score are now informing inclusion and escalation criteria in the NeoSep1 antibiotic trial (ISRCTN48721236) which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis➣The NeoSep Severity Score could be used to predict mortality at baseline in future studies of targeting resources in routine care. With further validation, the NeoSep Recovery Score could potentially be used to identify poor response to empiric antibiotic treatment

Home diagnostics are essential to assist members of the general population become active agents of case detection. In Indonesia, a country with an over-burdened healthcare system, individuals could use rapid SARS-CoV-2 antigen tests to self-detect COVID-19. To assess the general population's values and attitudes towards SARS-CoV-2 self-testing, a survey was conducted in mid-2021 in Jakarta and the provinces of Banten and North Sulawesi.This was a quantitative survey that approached respondents in600 randomly selected street-points in the three study geographies in July-August 2021. A 35-item questionnaire was used to collect data on key variables, such as likelihood to use a SARS-CoV-2 self-test, willingness to pay for a self-test device, and likely actions following a positive self-test result. Bivariate and multivariate regression analyses were performed.Of 630 respondents (318 were female), 15.53% knew about COVID-19 self-testing, while 62.70% agreed with the idea of people being able to self-test at home, unassisted, for COVID-19. If self-tests were available in Indonesia,60% of respondents would use them if they felt it necessary and would undertake regular self-testing for example weekly if recommended. Upon receiving a positive self-test result, most respondents would communicate it (86.03%), request post-test counselling (80.79%), self-isolate (97.46%), and/or warn their close contacts (90.48%).The use of rapid SARS-CoV-2 antigen detection tests for self-testing appears acceptable to a majority of the Indonesian public, to learn whether they have COVID-19. Self-testing should be prioritised to complement to an over-burdened healthcare system by helping the public, asymptomatic individuals included, become agents of change in epidemiological surveillance of SARS-CoV-2 in their communities.

Objective The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation. Study Design This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271). Results Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser. Conclusion Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed. Key Points

ObjectivesInnovative diagnostics are essential to assist members of the general population become active agents of case detection. In Indonesia, a country with an over-burdened healthcare system, individuals could use self-tests for SARS-CoV-2 to determine their COVID-19 status. To assess the acceptability of SARS-CoV-2 self-testing among the general population in Indonesia, a cross-sectional, population-based survey was conducted in mid-2021 in Jakarta and the provinces of Banten and North Sulawesi.MethodsThis was a survey that approached respondents in >600 randomly selected street-points in the three study geographies. A 35-item questionnaire was used to collect data on key variables, such as willingness to use and to pay for a SARS-CoV-2 self-test and likely actions following a positive result. Bivariate and multivariate regression analyses were performed.ResultsOf 630 respondents, (318 were female), 14% knew about COVID-19 self-testing, while 62.7% agreed with the concept of people being able to self-test at home, unassisted, for COVID-19. If self-tests were available in Indonesia, >60% of respondents would use them if they felt it necessary and would undertake regular self-testing e.g., weekly if recommended. Upon receiving a positive self-test result, most respondents would communicate it (86.03%), request post-test counseling (80.79%), self-isolate (97.46%), and/or warn their close contacts (n=570, 90.48%).ConclusionsSARS-CoV-2 self-testing would be acceptable to a majority of the Indonesian public, to learn whether they have COVID-19. Self-testing could contribute to an over-burdened healthcare system by helping COVID-19-infected people become agents of change in epidemiological surveillance of SARS-CoV-2 in their communities.

Trust in leaders is central to citizen compliance with public policies. One potential determinant of trust is how leaders resolve conflicts between utilitarian and non-utilitarian ethical principles in moral dilemmas. Past research suggests utilitarian responses to dilemmas can both erode and enhance trust in leaders: sacrificing some people to save many others (i.e., instrumental harm) reduces trust, while impartially maximizing the welfare of everyone equally (i.e., impartial beneficence) may increase trust. Here, we investigate moral dilemmas and trust in leaders during the COVID-19 pandemic. Across 22 countries on 6 continents, participants will complete behavioral and self-reported measures of trust in leaders who endorse either utilitarian or non-utilitarian principles in COVID-19 dilemmas. We predict that endorsement of instrumental harm will decrease trust, while endorsement of impartial beneficence will increase trust. These results can advance our understanding of trust in leaders and inform effective public communication during times of crisis.ITEMS:Stage 1 Registered Report Protocol & Stage 1 Registered Report Supplementary Information.

The COVID-19 pandemic has had a significant impact on the operation of donor human milk banks in various countries such as China, Italy and India. It is understandable that this impact on operations of donor human milk might hamper the capability of these milk banks to provide sufficient pasteurized donor milk to neonates who need it. Contrary to developed world, predominant donors in developing nations are mothers of hospitalised neonates who have a relatively long period of hospital stay. This longer maternal hospital stay enhances the feasibility of milk donation by providing mothers with access to breast pumps to express their milk. Any excess milk a mother expresses which is above the needs of their own infant can be voluntarily donated. This physical proximity of milk banks to donors may help continuation of human milk donation in developing nations during the pandemic. Nevertheless, protocols need to be implemented to i) ensure the microbiological quality of the milk collected and ii) consider steps to mitigate potential consequences related to the possibility of the donor being an asymptomatic carrier of COVID-19. We present the procedural modifications implemented at the Comprehensive Lactation Management Centre at Lady Hardinge Medical College in India to promote breastfeeding and human milk donation during the pandemic which comply with International and National guidelines. This commentary provides a perspective from a milk bank in India which might differ from the perspective of the international donor human milk banking societies.

Human face landmark detection algorithms have numerous applications. Current face landmark detection algorithms limit themselves to features around eyes, nose, cheeks and lips. Face landmark detection combined with augmented reality technology has given rise to commercially popular virtual try-on applications. To realize use cases of virtual jewelry try-on like earrings on smartphones, landmark points of human ear is required, but this field is not much explored in the literature. Existing methods are not accurate enough in different face poses and lighting conditions. Proposed method offers solution for ear landmark detection considering the computational requirements of mobility devices, and comprises ear localization followed by ear landmark detection. It adopts Haar cascade based model for ear localization and an Ensemble of Regression Trees for ear landmark detection. The experimental results and comparison with state-of-the-art methods show that the proposed method accurately localizes the ear, provides correct landmark points and is fast enough to run on mobility devices with low memory footprints. Comparison with popular methods shows the novelty points in the proposed approach.

Audio to Video generation is an interesting problem that has numerous applications across industry verticals including film making, multi-media, marketing, education and others. High-quality video generation with expressive facial movements is a challenging problem that involves complex learning steps for generative adversarial networks. Further, enabling one-shot learning for an unseen single image increases the complexity of the problem while simultaneously making it more applicable to practical scenarios. In the paper, we propose a novel approach OneShotA2V to synthesize a talking person video of arbitrary length using as input: an audio signal and a single unseen image of a person. OneShotA2V leverages curriculum learning to learn movements of expressive facial components and hence generates a high-quality talking-head video of the given person. Further, it feeds the features generated from the audio input directly into a generative adversarial network and it adapts to any given unseen selfie by applying fewshot learning with only a few output updation epochs. OneShotA2V leverages spatially adaptive normalization based multi-level generator and multiple multi-level discriminators based architecture. The input audio clip is not restricted to any specific language, which gives the method multilingual applicability. Experimental evaluation demonstrates superior performance of OneShotA2V as compared to Realistic Speech-Driven Facial Animation with GANs(RSDGAN) [43], Speech2Vid [8], and other approaches, on multiple quantitative metrics including: SSIM (structural similarity index), PSNR (peak signal to noise ratio) and CPBD (image sharpness). Further, qualitative evaluation and Online Turing tests demonstrate the efficacy of our approach., Comment: Accepted in CVPR Deep Vision 2020. arXiv admin note: text overlap with arXiv:2012.07304

Introduction: Today we believe that our society is very well aware of dentist, dentistry and its principles, but this crude traveling has its marks left in the minds of our society, and these exist in the form of myths. Aim & Objectives: The aim of this study was to find the prevalence of myths related to dental healthcare among the population of district Lucknow. It was done by finding the prevalence of myths related to dental healthcare among Urban and Rural population of district Lucknow and also comparing both the population. Material & Method: A total number of 687 individuals were interviewed out of which 408 were male and 279 were female, with a questionnaire containing a set of nine close-ended multiple choice questions, to facilitate data analysis avoid ambiguity. Results: Among various myths associated with tooth extraction, the myth that tooth extraction ?weakens eyesight? was most common (71.2%) followed by ?should not be done during rainy season? (68.1%), ?consumption of certain contraindicated items causes inflammation in gums? (51.7%), ?restriction on intake of certain food items? (42.9%), ?affecting hearing? (13.5%), affecting brain (12.1%) and causing hair fall (13.1%). For each of the items related with tooth extraction a high proportion of respondents (2.9% to 18.9%) did not reflect any opinion. Conclusion: The findings of present study showed that prevalence of dental myths was more common in underprivileged population, particularly women from lower socioeconomic strata. These findings indicated the need for a community initiative. Keeping in view the modifiable nature of myths, mass awareness campaigns using mass media, particularly audio-visual media are recommended apart from holding dental checkup camps in less privileged urban and rural areas.

Aim: Our aim was to come forward and provide recommendations to Prosthodontist, Endodontist and Radiologist on the issue of biomedical waste management i.e. management of waste generated by them. Material & Method: A thorough computer search using PubMed, Google Scholar, Wikipedia and Yahoo search engine, search through cross-references and hand search in the libraries was performed.With this agroup of practitioner, academic scholars and other prominent persons of the field were consulted and a questioneare was designed. Their after the recommendations were drafted. Results: Biomedical waste likeImpression materials waste, Titanium based waste, Metal based waste, Zinc based waste, Gypsum based waste, Resin based waste and Ceramic waste, need a very precise and specific management. Conclusion: Mishandling of biomedical waste (both infected and non-infected) is a growing problem for our self and society. Lack of awareness is adding a big amount of fuel to this fire. If proper segregation, collection, transportation and final disposal protocols are followed from the point of generation (keeping in mind the harmful effects on our self and our environment), we can reduce a lot of non-infected waste turning to infected ones and contribute in the safety of generations to come.

This paper proposes an image stitching method for increasing the Field-of-View (FoV) of widely used face photographs called ‘selfies’. Unlike traditional methods that deal with the far-field object and single dominant plane homography, we focus on the near-field aspect of the face and two dominant planes. In this context, significant depth difference between the face and a background plane poses significant parallax challenges. To mitigate this, we automatically calculate robust homographies for each plane by segmenting images into the foreground and background regions. To address the issue of holes caused by dual homography based stitching, we estimate a per-pixel homography by weighting the foreground and background homographies using distance transform from segmentation boundary. The experimental results show that the proposed method generates aesthetically stitched face photographs under the natural environment with reasonable post-processing time.

The demand for cost-efficient separations requires membranes with high gas flux and high selectivity which opens the path for further improvements. Mixed matrix membranes (MMMs) made from 33.3 wt % ZIF-8 in 6FDA-durene were tested at 35 °C and 3.5 atm. At 33.3 wt % loading of ZIF-8, H2, N2, O2, and CH4 gas permeabilities increased approximately 400%. Cross-linking the surface of this MMM, by reacting with ethylenediamine vapor, yielded a 10-fold increase in H2/CO2, H2/N2, and H2/CH4 selectivities with respect to 6FDA-durene, preserving 55% of the H2 permeability of 6FDA-durene. The permselective properties of the cross-linked skin of the MMM fall above the most recent permeability–selectivity trade-off lines (2008 Robeson upper bounds) for H2/CO2, H2/N2, and H2/CH4 separations. To the best of our knowledge, this is the first example of a cross-linked ZIF/polymer MMM for gas separation.

Internet is actively used for the exchange of information. People upload the web pages and updating the new web pages very frequently. There is a frequent change in the content of the web page hence it become necessary to develop an efficient system which could detect these changes efficiently and in the minimum browsing time. So as to achieve this we compare the old web page and the new web page. Changes in a web page can be detected with the use of various algorithms. Various tools and services are also available which can be used to detect these changes. In this paper a new algorithm for the structural as well as content change detection has been proposed and described. For better results tree has been designed for the corresponding web pages. The proposed change detection algorithm is based on assigning hash value to each leaf node and tag value to the non leaf nodes. Bottom up approach has been used for assignment. The level of each node has been used to find hash values and modification in a node. It has been shown with the help of suitable examples that the proposed algorithm extracts the changes very efficiently from the various web pages.

Neonatal hypothermia is a common and dangerous condition around the world. 70% of neonates born in Kalawati Saran Children’s Hospital in New Delhi, India, and subsequently admitted to the neonatal intensive care unit (NICU) had a temperature below 36.5°C on admission. In July 2016, we formed a team of staff from the labour room, NICU and auxiliary staff to reduce hypothermia in babies transported to our NICU using quality improvement methods. We identified problems related to staff awareness of hypothermia and its dangers, environmental factors and supply issues in the labour room, and challenges with rapidly and safely transferring sick newborns to the NICU. We used the Plan-Do-Study-Act cycles to test and adapt solutions to these problems. Because infection is a common complication of hypothermia, we also instituted a training programme to improve handwashing skills among parents and health workers. Within 9 months of starting our quality improvement project, the proportion of neonates who were normothermic on admission increased from 27% to 75%, the number of cases of late-onset neonatal sepsis decreased from 15.2 to 5 cases/1000 patient days, and all-cause mortality fell from 4.2 to 2.6 neonatal deaths per week. Multiple factors can lead to neonatal hypothermia, and the most important factors will differ from facility to facility. Quality improvement methods provide health workers with the skills to identify the key factors contributing to hypothermia in their facility and to develop strategies to address them. Addressing processes of care can lead to improved thermal care and save lives.

This article is a review of current and emerging methods used for prenatal detection of chromosomal aneuploidies. Chromosomal anomalies in the developing fetus can occur in any pregnancy and lead to death prior to or shortly after birth or to costly lifelong disabilities. Early detection of fetal chromosomal aneuploidies, an atypical number of certain chromosomes, can help parents evaluate their pregnancy options. Current diagnostic methods include maternal serum sampling or nuchal translucency testing, which are minimally invasive diagnostics, but lack sensitivity and specificity. The gold standard, karyotyping, requires amniocentesis or chorionic villus sampling, which are highly invasive and can cause abortions. In addition, many of these methods have long turnaround times, which can cause anxiety in mothers. Next-generation sequencing of fetal DNA in maternal blood enables minimally invasive, sensitive, and reasonably rapid analysis of fetal chromosomal anomalies and can be of clinical utility to parents. This review covers traditional methods and next-generation sequencing techniques for diagnosing aneuploidies in terms of clinical utility, technological characteristics, and market potential.