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This study investigates the major environmental and socio-economic impacts of an increase in the area of rubber plantations and the changing patterns of drivers of land use changes by combining geospatial technologies and socio-economic methods. Using a combination of geospatial techniques and socio-economic methods, we mainly analysed the rate of increase in area under rubber plantations, major impacts of land use changes and the changing drivers of land use changes. Our results shows that the area under rubber plantations has increased significantly within the study area, with the area under rubber plantations increasing from 30–74% of the total area within five decades. Impact assessment of land-use changes based on household surveys showed significant improvement in socio-economic conditions of the farmers however at the expense of severe environmental degradation. Our results also indicate that while areas under rubber plantations continue to increase, the drivers of land use changes have changed over time. Furthermore, it has been observed that in the past many interventions prioritized social and economic development and placed less emphasis on the ecological stability of the region. Perceptions of farmers revealed that the effects of ecological fragility already affected the economic robustness of the whole area. Therefore, we conclude that government interventions to support additional rubber cultivation should also focus on ecosystem stabilization in order to minimize the risk of an ecological catastrophe that would significantly affect the economic prosperity of the region.

Purpose There is a dearth of data on epidemiology, diagnosis and management of slow growing non tuberculous mycobacteria(NTM) in India, despite being a TB endemic country. This study aims to describe the geographic distribution, risk factors, and the challenges in management of slow growing NTM causing pulmonary infections. Methods Over a period of 3 years, all slow growing NTM received from pulmonary specimens at a tertiary care centre were further studied from electronic hospital records to correlate non tuberculous mycobacteria species with demographics, geographic location, describe comorbidities including immunosuppression, radiologic findings and treatment regimes. Results M.intracellullare was found in the majority of isolates with significant geographic variation and M.simiae the second commonest found exclusively in southern states. Common comorbidities included a previous history of treatment for tuberculosis, structural lung disease as well as systemic risk factors. Disseminated disease only occurred in immunocompromised hosts as was expected, but at a high rate of 44%. Treatment completion and outcomes were difficult to attain in our population. Conclusion The burden of NTM infection and its management in India remain a challenge. Ensuring it is made a notifiable disease may improve the current situation.

OBJECTIVETo identify predictors of glycemic worsening among youth and adults with impaired glucose tolerance (IGT) or recently diagnosed type 2 diabetes in the Restoring Insulin Secretion (RISE) Study.RESEARCH DESIGN AND METHODSA total of 91 youth (10–19 years) were randomized 1:1 to 12 months of metformin (MET) or 3 months of glargine, followed by 9 months of metformin (G-MET), and 267 adults were randomized to MET, G-MET, liraglutide plus MET (LIRA+MET), or placebo for 12 months. All participants underwent a baseline hyperglycemic clamp and a 3-h oral glucose tolerance test (OGTT) at baseline, month 6, month 12, and off treatment at month 15 and month 21. Cox models identified baseline predictors of glycemic worsening (HbA1c increase ≥0.5% from baseline).RESULTSGlycemic worsening occurred in 17.8% of youth versus 7.5% of adults at month 12 (P = 0.008) and in 36% of youth versus 20% of adults at month 21 (P = 0.002). In youth, glycemic worsening did not differ by treatment. In adults, month 12 glycemic worsening was less on LIRA+MET versus placebo (hazard ratio 0.21, 95% CI 0.05–0.96, P = 0.044). In both age-groups, lower baseline clamp-derived β-cell responses predicted month 12 and month 21 glycemic worsening (P < 0.01). Lower baseline OGTT-derived β-cell responses predicted month 21 worsening (P < 0.05). In youth, higher baseline HbA1c and 2-h glucose predicted month 12 and month 21 glycemic worsening, and higher fasting glucose predicted month 21 worsening (P < 0.05). In adults, lower clamp- and OGTT-derived insulin sensitivity predicted month 12 and month 21 worsening (P < 0.05).CONCLUSIONSGlycemic worsening was more common among youth than adults with IGT or recently diagnosed type 2 diabetes, predicted by lower baseline β-cell responses in both groups, hyperglycemia in youth, and insulin resistance in adults.

OBJECTIVE Obstructive sleep apnea (OSA) is associated with insulin resistance and has been described as a risk factor for type 2 diabetes. Whether OSA adversely impacts pancreatic islet β-cell function remains unclear. We aimed to investigate the association of OSA and short sleep duration with β-cell function in overweight/obese adults with prediabetes or recently diagnosed, treatment-naive type 2 diabetes. RESEARCH DESIGN AND METHODS Two hundred twenty-one adults (57.5% men, age 54.5 ± 8.7 years, BMI 35.1 ± 5.5 kg/m2) completed 1 week of wrist actigraphy and 1 night of polysomnography before undergoing a 3-h oral glucose tolerance test (OGTT) and a two-step hyperglycemic clamp. Associations of measures of OSA and actigraphy-derived sleep duration with HbA1c, OGTT-derived outcomes, and clamp-derived outcomes were evaluated with adjusted regression models. RESULTS Mean ± SD objective sleep duration by actigraphy was 6.6 ± 1.0 h/night. OSA, defined as an apnea-hypopnea index (AHI) of five or more events per hour, was present in 89% of the participants (20% mild, 28% moderate, 41% severe). Higher AHI was associated with higher HbA1c (P = 0.007). However, OSA severity, measured either by AHI as a continuous variable or by categories of OSA severity, and sleep duration (continuous or CONCLUSIONS In this baseline cross-sectional analysis of the RISE clinical trial of adults with prediabetes or recently diagnosed, untreated type 2 diabetes, the prevalence of OSA was high. Although some measures of OSA severity were associated with HbA1c, OSA severity and sleep duration were not associated with measures of insulin sensitivity or β-cell responses.

The extent to which weight loss contributes to increases in insulin sensitivity (IS) and β-cell function after surgical or medical intervention has not been directly compared in individuals with impaired glucose tolerance or newly diagnosed type 2 diabetes.The Restoring Insulin Secretion (RISE) Study included adults in the Beta-Cell Restoration Through Fat Mitigation Study (n = 88 randomized to laparoscopic gastric banding or metformin [MET]) and the Adult Medication Study (n = 267 randomized to placebo, MET, insulin glargine/MET, or liraglutide + MET [L + M]). IS and β-cell responses were measured at baseline and after 12 months by modeling of oral glucose tolerance tests and during arginine-stimulated hyperglycemic clamps. Linear regression models assessed differences between and within treatments over time.BMI decreased in all treatment groups, except placebo, at 12 months. IS increased in all arms except placebo and was inversely correlated with changes in BMI. L + M was the only treatment arm that enhanced multiple measures of β-cell function independent of weight loss. Insulin secretion decreased in the laparoscopic gastric banding arm proportional to increases in IS, with no net benefit on β-cell function.Reducing demand on the β-cell by improving IS through weight loss does not reverse β-cell dysfunction. L + M was the only treatment that enhanced β-cell function.

The spread of COVID-19 caused wide scale disruptions in the educational sector across the globe. Digital education, which involves the use of digital tools, virtual platforms and online learning, is seen as one of the viable alternatives to continue academic activities in such an environment. Higher education institutions have largely switched to this new mode of learning and continue to rely on digital mode in many parts of the world, due to the ongoing pandemic threat. However, learners' competency to effectively engage in online courses and the impact of their socioeconomic background on this competency has not been adequately addressed in the literature. The present study was an attempt to explore these aspects, as they are crucial to the success of digital education. The study was conducted with 833 undergraduate, postgraduate, and doctoral students from an agricultural university to assess their digital competencies and factors that influence effective participation in online courses. The Digital Competence Framework 2.0 of EU Science Hub (DIGCOMP) was adapted and used for this study. Our findings suggest that the learners have a satisfactory level of competence in most of the aspects of digital competence. Majority of the participants were relying on smart phones both as the device for accessing internet as well as for their learning activities. The results of a Tukey's difference in the mean test reveals that learners' digital competence varies significantly by gender, economic profile, and academic level. This finding can be attributed to the difference in their socio-economic background, which confirms digital divide among learners. Our findings have implications for the design of digital higher education strategies and institutional management to ensure effective learner participation, especially for higher education institutions in developing countries.

The chapter presents three case studies on resilience initiatives adopted by communities in response to water scarcity and severe floods exacerbated by climate change in the southern Indian state of Kerala. The post-flood management strategies undertaken by farmer collectives supported by a strong presence of the state resulted in sustainable outcomes. On the contrary, the resilience mechanisms to adapt to water scarcity have proved to be environmentally unsustainable and socially undesirable resulting in resource depletion and loss of social welfare. The participation of state and collective action was absent in the latter case. The study reiterates the importance of cohesive action from the government and local communities to generate sustainable community resilience programmes.

Climate change and consequent variations in temperature pose a significant challenge for sustaining wheat production systems globally. In this study, the potential impact of rising temperature on wheat yield in the north Indian plains, India's major wheat growing region, was analyzed using panel data from the year 1981 to 2009. This study deviates from the majority of the previous studies by including non-climatic factors in estimating the impact of climate change. Two temperature measures were used for fitting the function, viz., Growing Season Temperature (GST) and Terminal Stage Temperature (TST), to find out the differential impact of increased temperature at various growth stages. Analysis revealed that there was a significant rise in both GST as well as TST during the study period. The magnitude of the annual increment in TST was twice that of GST. Wheat yield growth in the region was driven primarily by increased input resources such as fertilizer application and technological development like improved varieties and management practices. Most importantly, the study found that the extent of yield reduction was more significant for an increase in temperature at terminal crop growth stages. The yield reduction due to unit increase in TST was estimated to be 2.26 % while rise in GST by 1◦C resulted in yield reduction of 2.03%.

OBJECTIVE: Poor sleep may increase obesity and type 2 diabetes (T2D) risk in youth. We explored whether subjective sleep duration, sleep quality, or risk for obstructive sleep apnea (OSA) are associated with glycemia, body mass index (BMI), or blood pressure (BP) in overweight/obese youth. METHODS: Two-hundred and fourteen overweight/obese youth of 10 to 19 years of age at risk for or recently diagnosed with T2D who were screened for the Restoring Insulin Secretion (RISE) Study had a 2-hour oral glucose tolerance test (OGTT) and completed a Cleveland Adolescent Sleepiness questionnaire and a Sleep Disturbances Scale questionnaire. Independent associations between sleep variables and measures of glycemia, BMI, and BP were evaluated with regression models. RESULTS: The multiethnic cohort was 67% female, 14.1 ± 2.1 years, and BMI 35.9 ± 6.5 kg/m(2). Habitual sleep duration

Insulin resistance is common among women with PCOS independent of adiposity. However, the severity of insulin resistance in these women worsens with obesity especially in those who present with the classical phenotype of PCOS (NIH criteria) consisting of hyperandrogenism and menstrual irregularity. Hence, obese women with PCOS, especially those with the classic phenotype of PCOS, are at high risk for metabolic complications. These complications include type 2 diabetes (DM2), metabolic syndrome, dyslipidaemia and obstructive sleep apnoea (OSA). Additionally, these women are at increased risk for cardiovascular disease even though the exact risk for this complication is not established. Due to heightened risk for metabolic disorders, close screening and follow-up for development of glucose intolerance, metabolic syndrome, and OSA is essential and is supported by current guidelines. Management of women with PCOS is individualized and should depend on the patient’s symptoms as well as their risk for development of various complications.

Objective: Identify predictors of glycemic worsening among youth and adults with impaired glucose tolerance (IGT) or recently-diagnosed type 2 diabetes in the RISE Study. Research Design and Methods: Ninety-one youth (10-19 years) were randomized 1:1 to 12 months of metformin (MET), or 3 months of glargine followed by 9 months of metformin (G-MET); 267 adults to MET, G-MET, liraglutide plus MET (LIRA+MET) or placebo for 12 months. All participants underwent baseline hyperglycemic clamp and 3-h oral glucose tolerance test (OGTT) at baseline, month-6, month-12 and off treatment at month-15 and month-21. Cox models identified baseline predictors of glycemic worsening (HbA1c increase ≥0.5% from baseline). Results: Glycemic worsening occurred in 17.8% of youth vs. 7.5% of adults at month-12 (p=0.008), and 36% of youth vs. 20% of adults at month-21 (p=0.002). In youth, glycemic worsening did not differ by treatment. In adults, month-12 glycemic worsening was less on LIRA+MET vs. placebo (HR 0.21, CI 0.05-0.96, p=0.044). In both age groups, lower baseline clamp-derived β-cell responses predicted month-12 and month-21 glycemic worsening (p Conclusions: Glycemic worsening was more common among youth than adults with IGT or recently-diagnosed type 2 diabetes, predicted by lower baseline β-cell responses in both groups, hyperglycemia in youth and insulin resistance in adults.

Objective: Obstructive sleep apnea (OSA) is associated with insulin resistance and has been described as a risk factor for type 2 diabetes. Whether OSA adversely impacts pancreatic islet beta-cell function remains unclear. We aimed to investigate the association of OSA and short sleep duration with beta-cell function in overweight/obese adults with prediabetes or recently-diagnosed, treatment-naïve type 2 diabetes. Research Design and Methods: 221 adults (57.5% men, age 54.5±8.7 years, BMI 35.1±5.5 kg/m2) completed one week of wrist actigraphy and one night of polysomnography before undergoing a 3-h oral glucose tolerance test (OGTT) and a two-step hyperglycemic clamp. Associations of measures of OSA and actigraphy-derived sleep duration with HbA1c, OGTT-derived and clamp-derived outcomes were evaluated with adjusted regression models. Results: Mean±SD objective sleep duration by actigraphy was 6.6±1.0 hours/night. OSA defined as an apnea-hypopnea index (AHI) ≥5 events per hour was present in 89% of the participants; 20% mild, 28% moderate and 41% severe. Higher AHI was associated with higher HbA1c (p =0.007). However, OSA severity, measured by either AHI as a continuous variable or by categories of OSA severity, and sleep duration (continuous or Conclusion: In this baseline cross-sectional analysis of the RISE clinical trial of adults with prediabetes or recently-diagnosed, untreated type 2 diabetes, the prevalence of OSA was high. Although some measures of OSA severity were associated with HbA1c, OSA severity and sleep duration were not associated with measures of insulin sensitivity or beta-cell responses.

Women with polycystic ovary syndrome (PCOS) have a substantially increased risk for diabetes and cardiovascular disease. Obstructive sleep apnea (OSA) is the most common sleep disorder in PCOS. Recent population-based studies indicate a high incidence of OSA among adult women with PCOS. Obesity and increasing age are the main factors for this association. There is strong evidence indicating that OSA is an important modulator of metabolic risk in the general population. There is also some evidence to suggest that OSA may contribute to insulin resistance and glucose intolerance among women PCOS, and thus increase their metabolic risk. The potential mechanisms for adverse metabolic consequences of OSA are likely to be multiple. Whether treatment of OSA in PCOS improves metabolic outcomes requires further rigorous research.

Introduction: Autism is a lifelong neurodevelopmental disease characterised by qualitative abnormalities in reciprocal social interaction and patterns of communication. The incidence of autism has increased in recent years and therefore, the possibility of dentists encountering children with autism is higher. Knowledge about the prevalence of dental disease in these children and the awareness of their care providers towards oral health is crucial to provide quality dental healthcare. Aim: To evaluate the oral health status of children with Autism Spectrum Disorder (ASD) and to assess the awareness of the parents/care providers regarding their oral health. Materials and Methods: This study was a two-stage cross-sectional study carried out in July, August 2015 at AB Shetty Memorial Institute of Dental Sciences, affiliated to NITTE Deemed to be University. Twenty children diagnosed with ASD formed the study group while 20 healthy children formed the control group. A clinical examination assessed dental caries (DMFT/dft). Gingival disease and oral hygiene of all children were evaluated using the Loe and Sillness gingival index and simplified oral hygiene index, respectively. Parents/care providers of the autistic children were asked to complete a questionnaire regarding the oral hygiene practices and oral health problems of the children. Descriptive statistics were performed for continuous variables, frequencies and percentages for categorical variables and comparisons were made using the Mann-Whitney U test, independent t-test and Chi-square test. Statistical analyses were conducted using EZR software (R version 3.6.3© 2020) and significance level was set at p

Aim: To evaluate the performance of VITEK®MS with DNA sequencing for laboratory diagnosis of non-tuberculous mycobacteria (NTM) species in a resource-limited setting. Methods: 16SrRNA sequencing and MALDI-TOF mass spectrometry (VITEK®MS) was performed at a tertiary-care hospital in India. MALDI-TOF results were confirmed by 16S rRNA sequencing. In addition, sequencing of the internal transcribed spacer region was performed on slowly growing NTM. Results: Commonest species isolated were M. abscessus, M. intracellulare, M. avium, M. fortuitum and M. simiae. 16S rRNA sequencing and MALDI-TOF results had agreement of 94.5% for rapidly growing and 77.5% for slowly growing NTM. Conclusion: There is good correlation between VITEK®MS and sequencing for rapidly growing NTM. For slowly growing species, sequencing would be required in a third isolates.

We compared 3-hr OGTT model-derived measures of insulin sensitivity and β-cell function after 12 mo treatment with placebo (PLAC), metformin (MET), liraglutide plus MET (L+M), 3 mo glargine followed by 9 mo MET (G/M) and gastric banding (GB) in adults with IGT or T2D in the Restoring Insulin Secretion (RISE) Study. Modeling parameters included insulin sensitivity (OGIS), insulin secretion rate (ISR) at reference glucose 6.5 mM (ISR@6.5), total integrated ISR (tISR), glucose sensitivity (GS: slope ISR vs. glucose concentration) and rate sensitivity (RS: ISR relative to glucose rate of change). Adjusted linear mixed models compared model parameters over time within and between each study arm. Results: Baseline model parameters did not differ by treatment arm. OGIS increased in all groups except PLAC. ISRs and GS increased in L+M but decreased or were unchanged in the other treatment arms. RS only increased in the G/M and GB arms. Treatment effects differed by arm. For L+M, GS and ISRs were increased vs. all other arms. For GB, RS was increased and tISR decreased vs. PLAC and GS was increased vs. MET. In summary, L+M augments insulin secretion and increases GS, while GB increases RS. Clinically, both L+M and GB appear to improve β-cell function at 12 mo and may benefit adults with IGT or recent-onset T2D while on treatment. Disclosure K. Utzschneider: Other Relationship; Self; Medtronic. L. El Ghormli: None. S. Sam: None. D.A. Ehrmann: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. E. Barengolts: None. T.S. Hannon: None. M. Tripputi: None. S. Edelstein: None. A. Mari: Consultant; Self; Lilly Diabetes. Research Support; Self; Boehringer Ingelheim International GmbH. T. Consortium: None. Funding American Diabetes Association (1-14-RISE-01); National Institute of Diabetes and Digestive and Kidney Diseases

We derived β-cell measures compensating for insulin resistance (disposition indices [DI]) from two-step hyperglycemic clamps with arginine stimulation, and examined their associations with glycemia cross-sectionally and longitudinally after treatment. Data included 355 adults (age 23-66 y; 51% female) and 89 youth (age 10-19 y; 71% female) from the RISE Consortium studies. Clamps were done at baseline and after 12 mo treatment with medications or gastric banding. Insulin sensitivity was quanitfied as M/I. β-cell responses included acute insulin (AIRg) and C-peptide (ACPRg) responses to glucose; steady-state C-peptide (SSCP) at glucose ∼11.1 mmol/L; and maximum insulin (AIRmax) or C-peptide (ACPRmax) responses to arginine at glucose >25 mmol/L. DIs were calculated from M/I and β-cell responses as [responses x (M/I)-b ]. The Table shows the correlations between each DI and glucose at baseline, and changes after treatment. The correlations were higher in youth than adults, except for changes in AIRmax or ACPRmax and 2-hour glucose. The correlations for ACPRg and AIRg were generally higher, followed by SSCP and then maximal responses. Thus, in the RISE cohorts, measures of early β-cell response were more strongly associated with glycemia than were late responses, with stronger correlations in youth. This underscores different contributions of early and late insulin secretion in the regulation of glycemia. Disclosure A. Xiang: None. T.S. Hannon: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. E. Barengolts: None. M. Cree-Green: Advisory Panel; Self; Novo Nordisk Inc. K.J. Nadeau: None. S. Sam: None. S.E. Kahn: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Intarcia Therapeutics, Janssen Scientific Affairs, LLC., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc. T.A. Buchanan: None. T. Consortium: None. Funding American Diabetes Association (1-14-RISE-01 to S.E.K.); National Institute of Diabetes and Digestive and Kidney Diseases

The Restoring Insulin Secretion (RISE) Study examined the effect of medications to preserve β-cell function in 267 adults with IGT or drug-naïve, recently diagnosed T2D. Participants were randomized to receive 12 months of blinded metformin (MET) or placebo, 12 months of liraglutide (LIRA)+MET, or 3 months of glargine followed by 9 months of MET, all followed by 9 months off treatment. We examined glycemic worsening, defined as progression from IGT to diabetes by fasting or 2-h glucose on an OGTT at baseline, 6, 12, 15 and 21 months or a rise in quarterly HbA1c to ≥7%s. Time-to-worsening was evaluated across treatment groups using a modified product-limit life-table distribution with a log-rank test. Compared to the other treatments, LIRA+MET had less glycemic worsening at 12 months (on treatment) and 21 months (9 months off treatment); each p Disclosure S. Sam: None. S. Edelstein: None. K. Utzschneider: Other Relationship; Self; Medtronic. T.S. Hannon: None. E. Barengolts: None. A. Xiang: None. D.A. Ehrmann: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. S.E. Kahn: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Intarcia Therapeutics, Janssen Scientific Affairs, LLC., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc. T. Consortium: None. Funding American Diabetes Association (1-14-RISE-01 to S.E.K.); National Institute of Diabetes and Digestive and Kidney Diseases

Patients with adrenal insufficiency (AI), in whom cortisol release is absent, need to be on lifelong replacement therapy. Depending on the modality of glucocorticoid replacement, the resulting 24-h profile of circulating cortisol levels maybe dampened, enhanced, abnormally timed or inconsistent. The 24-h cortisol profile is a major internal synchronizing signal between central and peripheral circadian clocks. Misalignment between central and peripheral clocks has a host of adverse effects, particularly on metabolism and cardiovascular function. Melatonin, normally secreted by the pineal gland exclusively at night and considered a robust marker of central circadian timing, also plays a role as an internal synchronizing signal. Conditions like AI, where the 24-h profile of glucocorticoid levels deviates from normality, could produce misalignment between central and peripheral oscillators. We examined whether AI patients are at higher risk of disturbances of the circadian system. Participants were 13 AI patients (11 females, 2 men; mean age 45.8 yrs old; mean BMI 25.5) and 13 controls (11 females, 2 males; mean age 48.5 yrs old, mean BMI 26.4) matched for age, sex, and BMI. 10 of the AI patients were on hydrocortisone treatment (total dose range: 20 to 40mg/day, number of doses: 1-5 doses/day) and 3 of the AI patients were on prednisone treatment. Cortisol and melatonin were measured over a 24-h period every 30-60 minutes in all patients and controls. The 24-h profile of cortisol was quite variable across patients, dependent on replacement therapy. Those on prednisone had very little detectable cortisol with small peaks that occurred around dosing. Those on hydrocortisone, had multiple peaks across the 24-h cycle dependent on medication regime and dosing. As expected, control subjects had a quiescent period of cortisol release from early evening to mid-sleep (18:00 to 02:00) and a mid-sleep rise in serum cortisol that peaks in the morning and subsequently dissipates across the day. In contrast, AI patients have low levels of cortisol across the entire sleep period, with a sharp morning rise, delayed compared to controls. Unexpectedly, we observed a marked difference in the melatonin profile in AI subjects compared to controls. Indeed, a significant daytime phase of elevated melatonin levels was detected in 7 of the 13 AI patients. The nocturnal elevation in the patients was similar to that observed in controls albeit advanced. In conclusion, the abnormalities of the circadian profile of glucocorticoid levels in AI are associated with an abnormal 24-hr profile of melatonin release, a marker of central circadian function, suggesting that the disruption of the glucocorticoid rhythm may affect central circadian function. It is possible that this circadian dysfunction contributes to the well-known adverse cardio-metabolic outcomes in AI.

In spite of green revolution and rapid economic growth, India’s vast population still suffers from hunger and poverty, especially in the rural areas. Moreover, drought adversely affects India’s economy by declining agricultural production and purchasing power. It also escalates rural unemployment which ultimately affects household food security. Our study investigated the food security of drought prone rural households in a broader context by linking the dimensions of food security with dimensions of climate change vulnerability. We used the primary data of 157 drought prone rural households of Odisha state in India for analysis. This study employed polychoric principal component analysis to construct an aggregate food security index. An ordered probit model was used to estimate the determinants of food security. The FSI showed that three-fourth of the respondents were facing food security issues with varying degrees. The estimates of ordered probit model indicated that joint family, education, migration and health insurance are key variables that determine food security, whereas drought adversely affected food security of rural households. Overarching strategies are required to effectively address food security issues in the wake of increased drought risk. This study provides an insight for policy makers in India and in similar south Asian countries who must consider food security in the light of drought.

The food security situation in India has improved due to economic growth, increased agricultural productivity, public policies and hunger eradication programmes. Nevertheless, much of India's population still suffers from hunger and poverty. Floods obstruct agricultural production; destroy infrastructure; and disrupt livelihoods, normal services, health care, etc. In this way, floods ultimately affect households' food security. We examined household food security in flood-prone rural areas of India in a more extensive way than in previous studies by constructing an index that incorporates various factors of the food security dimensions. Factors determining the level of flood-prone households' food security were also analyzed. By polychoric principal component analysis, an aggregate food security index was constructed. The food security score was regressed on different explanatory variables to evaluate their effect on the overall food security situation in the study area. Our results showed that three-fourths of the respondent households faced food security issues to varying degrees. Family type, physical assets and employment scheme showed positive impacts on the level of food security of the respondents. In contrast, households with female household heads and those suffering losses of property due to floods were adversely affected in terms of negative impacts on overall food security. The results suggest the need for the adoption of integrated strategies to effectively address food security issues amidst the increased severity of flood events. The study findings are useful for policy makers in India and countries with similar backgrounds to tackle the food insecurity brought about by flood hazards.

Polycystic ovary syndrome (PCOS), the most common hormonal disorder among women of reproductive age, has various metabolic and reproductive consequences. Metformin was originally shown to lower testosterone levels in women with PCOS in the 1990s, an effect presumably related to its insulin sensitising actions. However, the precise mechanisms of metformin action in PCOS remain unclear and there is considerable heterogeneity in the clinical response to this therapy in women with PCOS. Recent evidence indicates that genetic factors may play a significant role in predicting response to metformin therapy in PCOS and future studies are needed to further identify women who are most likely to benefit from this therapy. At present, there is no clear evidence to support broad metformin use in PCOS. Well-designed prospective trials are needed to establish clear benefit for metformin use in the treatment of the reproductive and metabolic consequences associated with PCOS.

Flooding constitutes the most predominant natural disaster in India. The degree and causes of vulnerability to flood risk vary by society, geographical region and over time. The rural people of India are highly vulnerable to flood hazards due to high dependence on natural resources for livelihood and poor socio-economic situations. The information regarding the degree of vulnerability of these people is limited. In order to formulate improved adaption policies and effective programmes to reduce vulnerability, it is crucial to quantify the vulnerability of rural households affected by floods at a regional level. Our study provides insight into the vulnerability of rural households affected by floods in India. We use primary data of 220 flood-prone rural households of Odisha state in India for analysis. The vulnerability is analysed using the Livelihood Vulnerability Index and the Socio-economic Vulnerability Index. Our results show that these households are vulnerable to flood in more than one dimension. Sociodemographic characteristics such as a low literacy rate, a high dependency ratio and a weak housing structure increase these residents’ vulnerability. Access to social networks and social institutions plays a significant role in uplifting poor rural households. Our study concludes that the vulnerability of a household is governed by both non-climatic factors and the incidence of floods. The findings of our study may be considered in developing policies and programmes that will reduce the flood risk. The recommendations we suggested in this study can be applied in other south Asian counties with similar socio-economic profiles.

BACKGROUND Ovarian cancer is the most lethal malignancy of the female reproductive system. Risk of ovarian cancer increases with age, but the rate of increase slows after the menopause. Tubal ligation confers long-term protection against ovarian cancer. This observational study examines the factors affecting the ovarian cancer risk and also studies the correlation between ovarian cancer risks with reproductive experiences. MATERIALS AND METHODS This study was conducted at Department of Obstetrics and Gynaecology, Government Medical College, Kottayam, Kerala, for a period of one year. Information was collected from 112 women diagnosed with ovarian cancer as treatment group and 336 women without ovarian cancer as control group. A binary logit regression analysis was conducted to study the factors that are affecting the ovarian cancer. The Chi-square test was done to find the association of ovarian cancer risk with different reproductive experiences. RESULTS We found that months of lactation, tubal ligation and oral contraceptive pills had a negative impact on ovarian cancer risk. Our study also proved that age of first pregnancy, age of menarche and age of menopause had a significant association with ovarian cancer risk. CONCLUSION Our findings signify the importance of providing awareness to the public regarding the prevalence, symptomatology, screening/diagnostic techniques, treatment modalities and prognosis of ovarian cancer. The dual benefits of tubal ligation need to be made aware among the public and tubal sterilisation rates have to be enhanced. We recommend the promotion of tubal ligation as a permanent method of contraception in those who have completed their families.

BACKGROUND Ovarian cancer is the most lethal malignancy of the female reproductive system. Risk of ovarian cancer increases with age, but the rate of increase slows after the menopause. Use of contraceptives confers long-term protection against ovarian cancer. This observational study examines the correlation between ovarian cancer risks with different contraceptive methods. MATERIALS AND METHODS This study was conducted at Department of Obstetrics and Gynaecology, Government Medical College, Kottayam, Kerala, for a period of one year. Information was collected from 112 women diagnosed with ovarian cancer as treatment group and 336 women without ovarian cancer as control group. The Chi-square test was done to find the association of ovarian cancer risk with different contraceptive methods. RESULTS In the sample of 112 women with ovarian cancer, 53.6% women were using any of the contraceptive methods, whereas in the control group, only 5.1% women were using contraceptive methods. Our study found out a significant association of ovarian cancer risk with oral contraceptives and tubal ligation. There was no significant association of ovarian cancer risk with IUCD, sheath and vasectomy. CONCLUSION Tubal ligation and oral contraceptives reduce the risk of ovarian cancer. The dual benefits of tubal ligation need to be made aware among the public and tubal sterilisation rates have to be enhanced. Oral contraceptive pill use has to be propagated as a temporary contraceptive method due to its added advantage. We recommend future research on the association of ovarian cancer risk and contraceptive methods using large samples comparable to those done in developed countries.

OBJECTIVE Sleep disturbances and circadian misalignment (social jet lag, late chronotype, or shift work) have been associated with worse glycemic control in type 2 diabetes (T2D). Whether these findings apply to adults with prediabetes is yet unexplored. We hypothesized that self-reported short sleep, poor sleep quality, and/or circadian misalignment are associated with higher glycemia, BMI, and blood pressure (BP) in adults with prediabetes or recently diagnosed, untreated T2D. RESEARCH DESIGN AND METHODS Our cohort included 962 overweight/obese adults ages 20–65 years with prediabetes or recently diagnosed, untreated T2D who completed a 2-h oral glucose tolerance test and validated sleep questionnaires. Independent associations of sleep and circadian variables with glycemia, BMI, and BP were evaluated with regression models. RESULTS The multiethnic cohort was 55% men, with mean ± SD age 52.2 ± 9.5 years and BMI 34.7 ± 5.5 kg/m2. Mean sleep duration was 6.6 ± 1.3 h. Poor sleep quality was reported by 54% and high risk for obstructive sleep apnea by 64%. HbA1c was significantly higher in those reporting 8 h sleep per night. Sleep duration >8 h was also associated with higher fasting glucose and CONCLUSIONS In our cohort, self-reported short and long sleep were both associated with adverse measures of glycemia, and short sleep and shift work were associated with higher BMI. Further research using objective measures of sleep is needed to better delineate the relationship between sleep and glycemia in adults with prediabetes or T2D.

Bariatric surgery is now the most widely used intervention for the treatment of human obesity. A large body of literature has demonstrated its efficacy in sustained weight loss and improvement in its associated comorbidities. Here, we review the effect of bariatric surgery in gut hormone physiology, bone remodeling and the reproductive axis. Rapid improvements in insulin release and sensitivity appear to be weight loss independent and occur immediately after surgery. These effects on pancreatic beta cells are mostly due to increased gut hormone secretion due to augmented nutrient delivery to the small intestine. Bone remodeling is also affected by gut hormones. Phenotypic skeletal changes observed in mice deficient in GLP‐1 or GIP suggest that increased incretins may improve bone density. However, these positive effects may be counterbalanced by the association between weight loss and a reduction in bone density. Finally, studies have shown a marked improvement following bariatric surgery in infertility and PCOS in women and hypogonadism in men. Thus, the net effect on endocrine systems after bariatric surgery will likely vary on an individual basis and depend on factors such as comorbidities, peri‐menopausal state, amount of weight loss, and likelihood to adhere to vitamin supplementation after surgery.

Context Increasing salinity levels demand adaptative and transformative changes in farming systems in regions affected by saltwater intrusion intensified by global climate change. The study area, a narrow delta affected by salinity intrusion due to rising sea levels as well as by diminishing rainfall during the dry season in north-central coastal region of Vietnam represents this global challenge. Apart from the level of salinity, farmer characteristics, legal framework and the expected returns to investment on the available choices shape the future trajectories of these farming systems. Nevertheless, relatively less research efforts are focused on understanding these choices and the trade-offs. Objective The study focus on identifying and determining the acceptability of adopting stress tolerant rice varieties, changes in cropping sequences, or a transformative shift to aquaculture conditional to the degree of saltwater intrusion as well as gaining insight into required policy changes to facilitate the adaptation and transformation in rice farming deltas. Methods The current study reports a novel choice experiment (CE) approach to analyse the roles of risk attitude, expected returns, production costs, effort levels and legal restrictions on the preferences for adaptation alternatives and their interactions with salinity levels using random parameter models. Results and conclusions The results reveal the role of perceived risks and labour efforts in adaptative choices and highlight the need for risk offset mechanisms as well as labour-saving interventions. The simulations using the estimated random parameter models predict farmers affected by salinity below the critical threshold of 4 dS/m of electrical conductivity (EC) will have a 34.4% adoption rate for traditional rice and a 43.6% rate for salinity-tolerant rice varieties, which will drop by 2 to 3 percentage points when the current legal restrictions on conversion to aquaculture are waived. In the case of farmers facing higher salinity levels, aquaculture would likely become the dominant option, with 40% of the cohort of farmers adopting aquaculture (17.2% adopting shrimp and 22.4% adopting polyculture), followed by saline-tolerant rice (36% to 38%). Significance The results reveal the need for increased investment in rice breeding for salinity tolerance, market development for alternative crops, introduction of risk offset mechanisms and a planned shift to transformative alternatives such as aquaculture. The findings of this study call for a balanced effort for adaptative and transformative options for rice farmers, infrastructural options preventing salinity intrusion and enhanced global mitigation efforts to reduce the possible rise in sea levels and limit salinity intrusion.