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Patients with progressive neurologic illness still lack access to quality palliative care services. Barriers to the comprehensive provision of neuropalliative care include gaps in palliative care education. To address this barrier, a novel international model of neuropalliative care education e-learning program was launched in 2022.
Methods
This is a qualitative study on the self-reported learning outcomes and educational gains of participants of a neuropalliative care e-learning course.
Results
Thematic analysis shows changes in the participants’ perceptions of neuropalliative care and several specific educational gains. After attending the course, participants recognized neuropalliative care as a multiprofessional and interdisciplinary effort requiring more than medical knowledge and disease-specific treatment skills. They gained understanding of the complexity of prognosis in neurological diseases, as well as ethical concepts as the basis to approach difficult decisions. Valuing the needs of patients and caregivers, as well as honest and open communication were recognized as key components of the caring process. In particular, providing emotional support and building relationships to enhance the spiritual component of care were avidly discussed as essential nonmedical treatment options.
Significance of results
E-learning courses are helping to close the gaps in healthcare professionals’ knowledge and skills about neuropalliative care.
Polycystic Ovary Syndrome PCOS is an endocrine disorder affecting 8 to 13% of reproductive aged women(1). Dietary and physical activity changes are the first-line therapy to assist with symptom and weight management and to reduce the risk of reproductive, metabolic and psychological comorbidities(2). However, women with PCOS have a higher weight, experience weight gain, and a higher prevalence of living in a larger body. Health care professionals (HCPs) play a crucial role in delivering diet and physical activity advice for people with PCOS. Thus, the aim of this systematic review is to understand the barriers, facilitators, experiences, and perceptions of engagement and compliance with diet and physical activity modifications in people with PCOS and in HCPs providing or referring people with PCOS to diet and physical activity modifications. A mixed-method systematic review was conducted with quantitative studies narratively synthesised and all studies thematically analysed. There were 68 eligible papers, including n = 59 (n = 5198) people with PCOS and n = 17 (n = 2,622) HCPs. Several themes were identified as impacting people with PCOS’ ability to make diet and physical activity changes. HCP education on PCOS management through diet and physical activity was viewed by HCPs and people with PCOS to be inadequate, further impacting the quality of care and health outcomes. Dietary and physical activity advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. Both people with PCOS and HCPs agreed that there was a need for individualised and PCOS-specific diet and physical activity advice. However, HCPs viewed that there was limited evidence supporting these recommendations and a lack of time to deliver this care. Weight stigma was identified as impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that diet and physical activity are overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including receiving diet and physical activity advice that meet the individual’s needs, are necessary for leading to long-term sustainable changes and improvements in health outcomes. A multidisciplinary team approach and an overhaul of HCPs’ perceptions and mentality of weight and weight-centric care for those with PCOS are essential in delivering effective diet and physical activity advice.
Rice crop is affected by different types of floods at different stages of the crop cycle. Constant efforts of researchers resulted in the development of rice varieties for anaerobic germination, flash floods and stagnant flooding by both conventional and molecular breeding approaches. Detection of QTLs for different types of floods in new genetic source (AC39416A) is needed to combat adverse effects of climate change. Present investigation was carried out to identify QTLs for flood tolerance using recombinant inbred lines derived from Indra and AC39416A. QTL mapping resulted in identification of QTLs, qAG3.1 on chromosome 3 for anaerobic germination and qSF10.1 on chromosome 10 for plant survival % under stagnant flooding. These QTLs explain 59.08 and 13.21% of phenotypic variance respectively. Two candidate genes were identified in qAG3.1 region, LOC_Os03g42130 gibberellin 20 oxidase2 and LOC_Os03g44170 glutathione S-transferase. The underlying mechanism might be the inhibition of gibberellic acid synthesis and thereby protecting seedlings from oxidative stress under anoxia condition. Genomic region of qSF10.1 revealed LOC_Os10g35020 glycosyltransferase and LOC_Os10g35050 aquaporin protein loci, which might be responsible for adaptive mechanism for plant survival % under stagnant flooding. This indicates that the new genetic resource AC39416A has an ability to adopt to different types of flood tolerance in response to environmental stress. Unveiling physiological and molecular mechanisms for flood tolerance in AC39416A using advanced omics studies would help in precise genomic selections for sustained production in flood-prone areas.
The advent of modern, high-speed electron detectors has made the collection of multidimensional hyperspectral transmission electron microscopy datasets, such as 4D-STEM, a routine. However, many microscopists find such experiments daunting since analysis, collection, long-term storage, and networking of such datasets remain challenging. Some common issues are their large and unwieldy size that often are several gigabytes, non-standardized data analysis routines, and a lack of clarity about the computing and network resources needed to utilize the electron microscope. The existing computing and networking bottlenecks introduce significant penalties in each step of these experiments, and thus, real-time analysis-driven automated experimentation for multidimensional TEM is challenging. One solution is to integrate microscopy with edge computing, where moderately powerful computational hardware performs the preliminary analysis before handing off the heavier computation to high-performance computing (HPC) systems. Here we trace the roots of computation in modern electron microscopy, demonstrate deep learning experiments running on an edge system, and discuss the networking requirements for tying together microscopes, edge computers, and HPC systems.
Beachpea (Vigna marina) is a halophytic wild leguminous plant which occurs throughout tropical and subtropical beaches of world. As quantitative trait loci (QTLs) for salt tolerance in V. marina and its crossability with other Vigna species are known, the current study was undertaken to know the presence of these QTLs in the V. marina accessions along with check varieties of pulses. Accordingly, 20 Vigna genotypes (15 accessions of V. marina collected from sea-shore areas of Andaman and Nicobar Islands along with five check varieties of green gram and black gram) were subjected to molecular characterization using seven simple sequence repeat (SSR) markers associated with salt tolerance. Of the markers used, only four SSR markers amplified in the studied germplasm. Number of alleles detected per primer and size of alleles ranged from 1 to 3 and 100 to 325 bp, respectively. Polymorphism information content and heterozygosity values ranged from 0.305 to 0.537 and 0.375 to 0.612, respectively. Three major clusters, cluster I, II and III were obtained at Jaccard's similarity coefficient value of 0.48 through the un-weighted paired group method with arithmetic means method of cluster analysis. It grouped green gram and black gram genotypes in clusters I (04) and II (01), whereas all V. marina genotypes were grouped in cluster III (15). Principal co-ordinate analysis explained 85.9% of genetic variation among genotypes which was further confirmed by cluster analysis. This study indicated the effectiveness of SSR markers in separating cultivated Vigna species from wild V. marina. The findings will be useful for transferring trait of robust salt tolerance of V. marina in cultivated Vigna species using marker-assisted breeding.
Case fatality rate (CFR) and doubling time are important characteristics of any epidemic. For coronavirus disease 2019 (COVID-19), wide variations in the CFR and doubling time have been noted among various countries. Early in the epidemic, CFR calculations involving all patients as denominator do not account for the hospitalised patients who are ill and will die in the future. Hence, we calculated cumulative CFR (cCFR) using only patients whose final clinical outcomes were known at a certain time point. We also estimated the daily average doubling time. Calculating CFR using this method leads to temporal stability in the fatality rates, the cCFR stabilises at different values for different countries. The possible reasons for this are an improved outcome rate by the end of the epidemic and a wider testing strategy. The United States, France, Turkey and China had high cCFR at the start due to low outcome rate. By 22 April, Germany, China and South Korea had a low cCFR. China and South Korea controlled the epidemic and achieved high doubling times. The doubling time in Russia did not cross 10 days during the study period.
Depression is known to be associated with low serum Brain-Derived Neurotrophic Factor (BDNF) and elevated levels of cortisol. Yoga has been shown to be associated with significant antidepressant effect as well as increase in serum BDNF levels and reduction in serum cortisol levels in these patients.
Aims and Objectives
We examined the association between serum cortisol and BDNF levels in patients with depression who were on treatment with antidepressants, yoga therapy, and both in combination.
Methods
Fifty-one consenting drug-naive outpatients (29 males) aged between 18-55 years, diagnosed with Major Depression received antidepressant medication alone (n=15), yoga therapy with (n=18), or without (n=18) concurrent antidepressants. Subjects in the yoga groups practiced a specific Yoga module for three months. Depression was assessed using the Hamilton Depression Rating Scale (HDRS). Serum BDNF & cortisol levels were obtained before and after three months using sandwich ELISA method. The group differences were analyzed using one-way ANOVA. Correlations between Serum BDNF & cortisol levels were analyzed using Pearson's correlation.
Results
Significant negative correlations were observed between baseline BDNF & cortisol levels in the Yoga+Medication group (r=0.569*; P=0.01), and between change in BDNF and cortisol level in the Yoga alone group (r=0.582*; P=0.01). No other significant correlations were found.
Conclusion
There is a significant association between serum cortisol and BDNF levels in patients with depression who underwent Yoga with or without antidepressants. This suggests that Yoga may have stress reduction and neuroplastic effects alone or in combination with medications in depressed patients.
In this study, we estimate the burden of foodborne illness (FBI) caused by five major pathogens among nondeployed US Army service members. The US Army is a unique population that is globally distributed, has its own food procurement system and a food protection system dedicated to the prevention of both unintentional and intentional contamination of food. To our knowledge, the burden of FBI caused by specific pathogens among the US Army population has not been determined. We used data from a 2015 US Army population survey, a 2015 US Army laboratory survey and data from FoodNet to create inputs for two model structures. Model type 1 scaled up case counts of Campylobacter jejuni, Shigella spp., Salmonella enterica non-typhoidal and STEC non-O157 ascertained from the Disease Reporting System internet database from 2010 to 2015. Model type 2 scaled down cases of self-reported acute gastrointestinal illness (AGI) to estimate the annual burden of Norovirus illness. We estimate that these five pathogens caused 45 600 (5%–95% range, 30 300–64 000) annual illnesses among nondeployed active duty US Army Service members. Of these pathogens, Norovirus, Campylobacter jejuni and Salmonella enterica non-typhoidal were responsible for the most illness. There is a tremendous burden of AGI and FBI caused by five major pathogens among US Army Soldiers, which can have a tremendous impact on readiness of the force. The US Army has a robust food protection program in place, but without a specific active FBI surveillance system across the Department of Defence, we will never have the ability to measure the effectiveness of modern, targeted, interventions aimed at the reduction of specific foodborne pathogens.
Throughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66–20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04–2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7–3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance under-estimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.
This study was conducted to characterize new plant type (NPT) traits among 650 genetically diverse rice genotypes of tropical japonica and indica and to establish an initial core set for NPT traits. Analysis of variance revealed highly significant differences among the genotypes for all the traits assessed except flag length and width and leaf angles. Dendrogram categorized the genotypes into five distinct duration groups. Genotypes viz., Pumphamah, IRGC5097, IRGC37015, IRGC43741, IRGC50448, IRGC53089, IRGC39111, IRGC18021, Haorei Machang, IRGC44069, IRGC8269, Thangmoi, IRGC33130 and IRGC29772 were identified as possessing strong culm. Long panicles with a length of more than 35 cm were found in IRGC8269, IRGC9147, IRGC14694, IRGC19642, IRGC27435, IRGC39111, IRGC31051, IRGC26011and IRGC25892. Ideal leaf angle of NPT genotypes of 5°, 10° and 20° of flag leaf, 1st and 2nd leaves was not found in any genotype but with a combination of 5°, 10° and 10° was observed in IRGC63102 and IRGC66644. NPT flag leaf length and width of 50 and 2 cm, respectively, was seen in ‘Kemenya Kepeu’ and ‘IRGC29772’. High grain number of more than 350 was observed in IRGC53089, IRGC31063 and Azhoghi. A total of 72 genotypes were found with a combination of one or more ideal plant type traits of which, hierarchical cluster analysis based on genetic distances selected 32 as NPT core set. This core set will serve as an ideal genetic resource for breeding programs aimed at NPT development.
Common bean (Phaseolus vulgaris L.) is the most important food legume for human consumption. Drought stress is the major abiotic stress limitation of bean yields in smallholder farming systems worldwide. The current work aimed to determine the role of enhanced photosynthate mobilization to improve adaptation to intermittent and terminal drought stress and to identify a few key adaptive traits that can be used for developing drought-resistant genotypes. Field studies were conducted over three seasons at Centro Internacional de Agricultura Tropical, Palmira, Colombia to determine genotypic differences in adaptation to intermittent (two seasons) and terminal (one season) drought stress compared with irrigated conditions. A set of 36 genotypes, including 33 common bean, two wild bean and one cowpea were evaluated using a 6 × 6 lattice design under irrigated and rainfed field conditions. Three common bean elite lines (NCB 226, SEN 56, SER 125) were identified with superior levels of adaptation to both intermittent and terminal drought stress conditions. The greater performance of these lines under drought stress was associated with their ability to remobilize photosynthate to increase grain yield based on higher values of harvest index, pod harvest index, leaf area index and canopy biomass. Two wild bean germplasm accessions (G 19902, G 24390) showed very poor adaptation to both types of drought stress. One small-seeded black line (NCB 226) was superior in combining greater values of canopy biomass with greater ability to mobilize photosynthates to grain under both types of drought stress. Two small-seeded red lines (SER 78, SER 125) seem to combine the desirable traits of enhanced mobilization of photosynthates to seed with effective use of water through canopy cooling under terminal drought stress. Pod harvest index showed significant positive association with grain yield under both types of drought stress and this trait can be used by breeders as an additional selection method to grain yield in evaluation of breeding populations for both types of drought stress.
To assess trends in nutrient intakes and nutritional status of rural adult women (≥18–60 years) and the association of sociodemographic characteristics with overweight/obesity.
Design
Community-based cross-sectional studies carried out during 1975–79 to 2011–12 by the National Nutrition Monitoring Bureau (NNMB) were used. Anthropometric measurements such as height, weight and waist circumference, carried out during the surveys, were used. Association and logistic regression analyses between sociodemographic characteristics and overweight/obesity and abdominal obesity were conducted using a complex samples procedure.
Setting
Ten NNMB states of India.
Subjects
Non-pregnant and non-lactating rural women aged ≥18–60 years covered during the above periods from ten states in India.
Results
The prevalence of chronic energy deficiency has declined from 52 % during 1975–79 to 34 % during 2011–12, while that of overweight/obesity has increased from 7 % to 24 % during the same period. Median intakes of most of the nutrients have increased over the same period, although they were below recommended levels. The chance of overweight/obesity and abdominal obesity was significantly (P<0·01) higher among women aged 40–60 years, those belonging to Christian religion and other backward communities, women living in pucca houses, literate women, women engaged in service and business, and those having higher per capita income.
Conclusions
Prevalence of chronic energy deficiency has declined significantly; however, overweight/obesity has increased during the same period. This increase in overweight/obesity may be attributed to increased consumption of fatty foods, sedentary lifestyle and improved socio-economic status. There is a need to educate the community about regular physical exercise, low intakes of fats and oils, and a balanced diet.
Investigation of optical absorption in ∼25μm thick, monocrystalline silicon (Si) substrates obtained from a novel exfoliation technique is done by fabricating solar cells with single heterojunction architecture (without using intrinsic amorphous silicon layer) with diffused back junction and local back contact. The ease of process flow and the rugged and flexible nature of the substrates due to thick metal backing enables use of various light-trapping and optical absorption enhancement schemes traditionally practiced in the industry for thicker (>120μm) substrates. Optical measurement of solar cells using antireflective coating, texturing on both surfaces, and back surface dielectric/metal stack as mirror to reflect the long wavelength light from the back surface show a very low front surface reflectance of 4.6% in the broadband spectrum (300nm-1200nm). The illuminated current voltage (IV) and external quantum efficiency (EQE) measurement of such solar cell shows a high integrated current density of 34.4mA/cm2, which implies significant internal photon reflection. Our best cell with intrinsic amorphous silicon (i-a-Si) layer with only rear surface textured shows an efficiency of 14.9%. EQE data shows improved blue response and current density due to better front surface passivation. Simulations suggest that with optimized light trapping and surface passivation, such thin c-Si cells can reach efficiencies >20%.