Violence in the emergency department: a quantitative survey study of healthcare providers in India.

BACKGROUND: Workplace violence (WPV) in Emergency Departments (EDs) is an increasingly recognized challenge healthcare providers face in low-resource settings. While studies have highlighted the increased prevalence of WPV in healthcare, most of the existing research has been conducted in developed countries with established laws and repercussions for violence against healthcare providers. More data on WPV against ED providers practicing in low-resource settings is necessary to understand these providers' unique challenges. OBJECTIVE: This study aims to gain insight into the incidence and characteristics of WPV among ED healthcare providers in India. METHODS: This study was conducted at two EDs in geographically distinct regions of India. A survey was designed to assess violence in EDs among healthcare providers. Surveys were distributed to ED workplace providers, completed by hand, and returned anonymously. Data was entered and stored in the RedCAP database to facilitate analysis. RESULTS: Two hundred surveys were completed by physicians, nurses, and paramedics in Indian EDs. Most reported events involved verbal abuse (68%), followed by physical abuse (26%), outside confrontation (17%), and stalking (5%). By far, the most common perpetrators of violence against healthcare workers were bystanders including patient family members or other accompanying individuals. Notably, reporting was limited, with most cases conveyed to ED or hospital administration. CONCLUSION: These results underscore the prevalence of WPV among Indian ED healthcare providers. High rates of verbal abuse followed by physical abuse are of concern. Most perpetrators of WPV against healthcare providers in this study were patient family members or bystanders rather than the patients themselves. It is imperative to prioritize implementing prevention strategies to create safer work environments for healthcare workers.

Agronomic bio-fortification of wheat (Triticum aestivum L.) to alleviate zinc deficiency in human being.

Worldwide, 40% population consumes wheat (Triticum aestivum L.) as a staple food that is low in zinc (Zn) content. Zn deficiency is a major micronutrient disorder in crop plants and humans worldwide, adversely impacting agricultural productivity, human health and socio-economic concern. Globally, the entire cycle of increasing the Zn concentration in wheat grains and its ultimate effect on grain yield, quality, human health & nutrition and socio-economic status of livelihood is less compared. So the present studies were planned to compare the worldwide studies for the alleviation of Zn malnutrition. Zn intake is affected by numerous factors from soil to crop, crop to food and food to humans. The post-harvest fortification, diversification in dietary habits, mineral supplementation and biofortification are various possible approaches to enhance the Zn concentration in food. The wheat grains Zn is influenced by the Zn application technique and time concerning crop developmental stages. The use of soil microorganisms mobilize unavailable Zn, and improve Zn assimilation, plant growth, yield and Zn content in wheat. Climate change can have an inverse impact on the efficiency of agronomic biofortification methods due to a reduction in grain-filling stages. Agronomic biofortification can improve Zn content, crop yield as well as quality and ultimately, have a positive impact on human nutrition, health and socioeconomic status of livelihood. Though bio-fortification research has progressed, some crucial areas are still needed to be addressed or improved to achieve the fundamental purpose of agronomic biofortification.

Sleep Posture Detection Using an Accelerometer Placed on the Neck.

Sleep position monitoring is key when attempting to address posture triggered sleep disorders. Many studies have explored sleep posture detection from a dedicated physical sensing channel exploiting optimum body locations, such as the torso; or alternatively non-contact approaches. But, little work has been done to try to detect sleep position from a body location which, whilst being suboptimal for that purpose, does however allow for better extraction of more critical biomarkers from other sensing modalities, making possible multi-modal monitoring in certain clinical applications. This work presents two different approaches, at varying levels of complexity, for detecting 4 main sleep positions (supine, prone, lateral right and lateral left) from accelerometry data obtained by a single wearable device placed on the neck. An ultra light-weight threshold-based model is presented in this work, in addition to an Extra-Trees classifier. The threshold-based model was able to achieve 95% average accuracy and 0.89 F1-score on out-of-sample data, showing that it is possible to obtain a moderately high classification performance using a simple rule-based model. The ExtraTrees classifier, on the other hand, was able to achieve 99 % average accuracy and 0.99 average F1-score using only 25 base estimators with maximum depth of 20. Both models show promise in detecting sleep posture with high accuracy when collecting the signals from a neck-worn accelerometer sensor.

Effects of denoising strategies on R-wave detection in ECG analysis.

The use of ECG in cardiovascular health monitoring is well established. The signal is collected using specialised equipment, capturing the electrical discharge properties of the human heart. This produces a well-structured signal trace, which can be characterised through its peaks and troughs. The signal can then be used by clinicians to diagnose cardiac disorders. However, as with any measuring equipment, the ECG output signal can experience deterioration resulting from noise. This can happen due to environmental interference, human issues or measuring equipment failure, necessitating the development of various denoising strategies to reduce, or remove, the noise. In this paper, we study typically occurring types of noise and implement popular strategies used to rectify them. We also show, that the given strategy's denoising potential is directly related to R-wave detection, and provide best strategies to apply when faced with specific noise type.

Analysis of the factors affecting the adoption and compliance of the NHS COVID-19 mobile application: a national cross-sectional survey in England.

OBJECTIVES: To conduct an independent study investigating how adults perceive the usability and functionality of the 'National Health Service (NHS) COVID-19' application (app). This study aims to highlight strengths and provide recommendations to improve adoption of future contact tracing developments. DESIGN: A 60-item, anonymous online questionnaire, disseminated through social media outlets and email lists by a team from Imperial College London. SETTING: England. PARTICIPANTS: Convenience sample of 1036 responses, from participants aged 18 years and above, between December 2020 and January 2021. PRIMARY OUTCOME MEASURES: Evaluate the compliance and public attitude towards the 'NHS COVID-19' app regarding its functionality and features. This included whether participants' expectations were met, and their thoughts on the app privacy and security. Furthermore, to distinguish how usability, perception, and adoption differed with varying demographics and user values. RESULTS: Fair compliance with the app features was identified, meeting expectations of the 62.1% of participants who stated they downloaded it after weighted analysis. However, participants finding the interface challenging were less likely to read information in the app and had a lesser understanding of its functionality. Furthermore, little understanding regarding the app's functionality and privacy concerns was a possible reason why users did not download it. A readability analysis of the text revealed information within the app was conveyed at a level that may be too complex for up to 43% of the UK population. The study highlighted issues related to the potential of false positives caused by the design choices in the 'Check-In' feature. CONCLUSION: This study showed that while the 'NHS COVID-19' app was viewed positively, there remained issues regarding participants' perceived knowledge of app functionality, potentially affecting compliance. Therefore, we recommended improvements regarding the delivery and presentation of the app's information, and highlighted the potential need for the ability to check out of venues to reduce the number of false positive contacts.

An observational study of switching infliximab biosimilar: no adverse impact on inflammatory bowel disease control or drug levels with first or second switch.

BACKGROUND: Biologics account for a significant cost in inflammatory bowel disease (IBD) management; however, switching from infliximab originator to its biosimilars has enabled cost saving without compromising disease control. The effects on IBD activity and infliximab trough levels of a second switch to another biosimilar are, however, uncertain. AIMS: To assess the effects on disease activity and infliximab trough levels associated with switching from infliximab biosimilar CT-P13 to another biosimilar SB2 and compare outcomes in those switching for the first and second time. METHODS: IBD patients on CT-P13, including some previously switched from originator, were prospectively followed during a switch to SB2. C-reactive protein (CRP), trough infliximab level and clinical disease activity indices were collected at baseline, Infusion 3 or 4 ('early' after switch), and 1 year. RESULTS: One hundred eighty-six patients (n = 99 second switch) on stable infliximab dosing underwent switching. Compared with baseline, there was no significant change in CRP, clinical disease activity scores or median trough infliximab level at the early time point among first-switch (baseline vs early: 5.7 vs 6.6 µg/mL, P = 0.05) and second-switch (4.3 vs 4.9 µg/mL, P = 0.07) patients nor at 1 year (median infliximab trough levels, baseline vs 1 year, in first-switch [5.7 vs 5.7 µg/mL, P = 0.37] and second-switch [4.3 vs 4.7 µg/mL, P = 0.06] patients). The proportion of patients in clinical remission did not significantly change at the early (92% vs 91% at baseline, P = 0.75) or 1 year (95% vs 91% at baseline, P = 0.16) time points. There was no significant difference in time to loss of response between patients switching for the first or second time (P = 0.69). CONCLUSIONS: Switching from one infliximab biosimilar to another had no adverse impact on infliximab trough levels, and clinical and biochemical disease activity, regardless of whether switching for the first or second time.

Rifampicin and isoniazid behave as non-creatinine chromogens and interfere with Jaffe's reaction: A phenomenon with the potential to give a false-positive result in creatinine estimation.

Tuberculosis is a health concern worldwide. The anti-tubercular drugs (particularly rifampicin) used for its management offers side effects like acute kidney injury. Creatinine, which is recognised as an important biomarker for the renal function, is commonly estimated with Jaffe's reaction (alkaline picrate reaction). However, interference of Jaffe's reaction with non-creatinine chromogens has been reported. In this context, we have checked the possibility of interference by Rifampicin and Isoniazid at therapeutic concentration with the Jaffe's reaction. Through in-silico study, we have studied the reaction prediction of picric acid with other chemicals/reactant (i.e. Rifampicin, Isoniazid and non-creatinine chromogens) in terms of confidence value. It is observed that the confidence value of reaction prediction between picric acid and INH and Rifampicin is much more than the same of pyruvic acid (non-creatinine chromogen). Further, we have checked the absorbance value of Jaffe's reaction mixture in aqueous media in the presence of both the drugs at 520nm. It is observed that the absorbance of alkaline picric acid increases with an increase in drug concentration. However, the increasing trend of absorbance is much more in the case of rifampicin compared to INH. It appears from our result rifampicin, and isoniazid has the potential to behave as non-creatinine chromogen and can give false positive creatinine results in Jaffe's reaction. Thus, it can cause misdiagnosis in patients consuming these drugs. We recommend study in the biological matrix for further validation of the result.

Treatment options for alcoholic and non-alcoholic fatty liver disease: A review.

Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) are serious health problems worldwide. These two diseases have similar pathological spectra, ranging from simple steatosis to hepatitis to cirrhosis and hepatocellular carcinoma. Although most people with excessive alcohol or calorie intake display abnormal fat accumulation in the liver (simple steatosis), a small percentage develops progressive liver disease. Despite extensive research on understanding the pathophysiology of both these diseases there are still no targeted therapies available. The treatment for ALD remains as it was 50 years ago: abstinence, nutritional support and corticosteroids (or pentoxifylline as an alternative if steroids are contraindicated). As for NAFLD, the treatment modality is mainly directed toward weight loss and co-morbidity management. Therefore, new pathophysiology directed therapies are urgently needed. However, the involvement of several inter-related pathways in the pathogenesis of these diseases suggests that a single therapeutic agent is unlikely to be an effective treatment strategy. Hence, a combination therapy towards multiple targets would eventually be required. In this review, we delineate the treatment options in ALD and NAFLD, including various new targeted therapies that are currently under investigation. We hope that soon we will be having an effective multi-therapeutic regimen for each disease.

Man's best friend: How humans can develop Dirofilaria immitis infections.

Canine heartworm, Dirofilaria immitis, is a nematode parasite that infects dogs by way of mosquito bite. Rarely, humans play accidental hosts to this parasite and are not a suitable environment for the nematode to live. As the parasite dies in the pulmonary vessels it embolizes the vessels causing infarction and eventual nodule formation in the lungs. In the right clinical context, a nodule can be considered malignant prompting invasive tissue sampling. We describe a case of a 48-year-old man who was found to have multiple asymptomatic scattered pulmonary nodules during imaging workup for an insulinoma. Fine needle biopsy of the largest nodule revealed a necrotic granuloma, lab testing and culture ruled out fungal and bacterial causes. Clinically, this picture was consistent with D. immitis infection.

Intrathecal dextmedetomidine to reduce shoulder tip pain in laparoscopic cholecystectomies under spinal anesthesia.

BACKGROUND: General anesthesia as a technique for laparoscopic cholecystectomies has disadvantage in terms of the stress response, lack of postoperative analgesia and emesis. Regional anesthesia offers advantages over general anesthesia in terms of cost, postoperative analgesia, intact respiratory control mechanism and early ambulation. Shoulder tip pain remains the main concerns that can be alleviated by adding various adjuvants to local anesthetics. AIMS AND OBJECTIVES: To study the effect of adding intrathecal dexmedetomidine to bupivacaine to decrease shoulder tip pain, onset and duration of sensory and motor block, hemodynamic changes and side effects if any. MATERIALS AND METHODS: Totally, 60 patients were divided into two groups of 30 each. Group A received 3 ml of bupivacaine heavy and group B received 5 µg of dexmedetomidine along with 3 ml of bupivacaine diluted to total volume of 3.5 ml in each group. STATISTICAL ANALYSIS: It was done using Chi-square and Student's t-test. RESULTS AND CONCLUSIONS: Intrathecal dexmedetomidine provides stable hemodynamics, excellent sedation and analgesia and abolishes shoulder tip pain.

A speculated ribozyme site in the herpes simplex virus type 1 latency-associated transcript gene is not essential for a wild-type reactivation phenotype.

During herpes simplex virus-1 (HSV-1) latency in sensory neurons, LAT (latency-associated transcript) is the only abundantly expressed viral gene. LAT plays an important role in the HSV-1 latency-reactivation cycle, because LAT deletion mutants have a significantly decreased reactivation phenotype. Based solely on sequence analysis, it was speculated that LAT encodes a ribozyme that plays an important role in how LAT enhances the virus' reactivation phenotype. Because LAT ribozyme activity has never been reported, we decided to test the converse hypothesis, namely, that this region of LAT does not encode a ribozyme function important for LAT's ability to enhance the reactivation phenotype. We constructed a viral mutant (LAT-Rz) in which the speculated ribozyme consensus sequence was altered such that no ribozyme was encoded. We report here that LAT-Rz had a wild-type reactivation phenotype in mice, confirming the hypothesis that the speculated LAT ribozyme is not a dominant factor in stimulating the latency-reactivation cycle in mice.

Anti-free radical activities of kaempferol isolated from Acacia nilotica (L.) Willd. Ex. Del.

In the present study the polyphenolic compound has been isolated from methanol extract of Acacia nilotica Willd. Ex. Del. which has been identified as kaempferol (AN-5) by NMR and mass spectroscopy. The antioxidant potential of the AN-5 was demonstrated in several in vitro assays: measuring the proton radical scavenging activity (DPPH scavenging assay), hydroxyl radical scavenging activity (deoxyribose degradation assay), metal chelating activity, reducing power and inhibition of lipid peroxidation. It was found that the effect of the compound AN-5 was strongly dose dependent up to the concentrations 1-50 microg/ml in DPPH assay and 1-100 microg/ml in deoxyribose degradation assay but did not show further change above the highest concentrations.

Evaluation of antioxidant potential of ethyl acetate extract/fractions of Acacia auriculiformis A. Cunn.

The present study estimates the free radical scavenging activity of the ethyl acetate extract/fractions of Acacia auriculiformis A. Cunn in different assays viz. 1'-1' diphenyl-2'picrylhydrazyl (DPPH), deoxyribose (site specific and non-site specific), relative reducing power, chelating power and lipid peroxidation. The bark powder of the plant was extracted with different solvents by maceration method in the order of increasing and decreasing polarity. The crude ethyl acetate extract was partitioned with ethyl acetate and water (Flow Chart 1 and 2). The scavenging activity of fractions was found to be more as compared to the crude extract. The percent inhibition with water fraction of ethyl acetate extract was observed to be 71.2%, 73.66%, 83.37%, 75.63% and 72.92% in DPPH, chelating power, lipid peroxidation, site specific and non-site specific deoxyribose scavenging assays respectively at maximum concentration tested. l-ascorbic acid and BHT were used as reference compounds for comparing the activity of plant extract/fractions. Studies are in progress to evaluate the effect of extract/fractions in other antioxidant assays and identify the factors responsible for the activity.