Revisiting Changes in Growth, Physiology and Stress Responses of Plants under the Effect of Enhanced CO2 and Temperature

Climate change has universally affected the whole ecosystem in a unified manner and is known to have improbable effects on agricultural productivity and food security. Carbon dioxide (CO2) and temperature are the major environmental factors that have been shown to increase sharply during the last century and are directly responsible for affecting plant growth and development. A number of previous investigations have deliberated the positive effects of elevated CO2 on plant growth and development of various C3 crops, while detrimental effects of enhanced temperature on different crop plants like rice, wheat, maize and legumes are generally observed. A combined effect of elevated CO2 and temperature has yet to be studied in great detail; therefore, this review attempts to delineate the interactive effects of enhanced CO2 and temperature on plant growth, development, physiological and molecular responses. Elevated CO2 maintains leaf photosynthesis rate, respiration, transpiration and stomatal conductance in the presence of elevated temperature and sustains plant growth and productivity in the presence of both these environmental factors. Concomitantly, their interaction also affects the nutritional quality of seeds and leads to alterations in the composition of secondary metabolites. Elevated CO2 and temperature modulate phytohormone concentration in plants, and due to this fact, both environmental factors have substantial effects on abiotic and biotic stresses. Elevated CO2 and temperature have been shown to have mitigating effects on plants in the presence of other abiotic stress agents like drought and salinity, while no such pattern has been observed in the presence of biotic stress agents. This review focuses on the interactive effects of enhanced CO2 and temperature on different plants and is the first of its kind to deliver their combined responses in such detail.

Bioprospecting of endophytic fungi from medicinal plant Anisomeles indica L. for their diverse role in agricultural and industrial sectors

Endophytes are microorganisms that inhabit various plant parts and cause no damage to the host plants. During the last few years, a number of novel endophytic fungi have been isolated and identified from medicinal plants and were found to be utilized as bio-stimulants and bio fertilizers. In lieu of this, the present study aims to isolate and identify endophytic fungi associated with the leaves of Anisomeles indica L. an important medicinal plant of the Terai-Duars region of West Bengal. A total of ten endophytic fungi were isolated from the leaves of A. indica and five were identified using ITS1/ITS4 sequencing based on their ability for plant growth promotion, secondary metabolite production, and extracellular enzyme production. Endophytic fungal isolates were identified as Colletotrichum yulongense Ai1, Colletotrichum cobbittiense Ai2, Colletotrichum alienum Ai2.1, Colletotrichum cobbittiense Ai3, and Fusarium equiseti. Five isolates tested positive for their plant growth promotion potential, while isolates Ai4. Ai1, Ai2, and Ai2.1 showed significant production of secondary metabolites viz. alkaloids, phenolics, flavonoids, saponins, etc. Isolate Ai2 showed maximum total phenolic concentration (25.98 mg g-1), while isolate Ai4 showed maximum total flavonoid concentration (20.10 mg g-1). Significant results were observed for the production of extracellular enzymes such as cellulases, amylases, laccases, lipases, etc. The isolates significantly influenced the seed germination percentage of tomato seedlings and augmented their growth and development under in vitro assay. The present work comprehensively tested these isolates and ascertained their huge application for the commercial utilization of these isolates both in the agricultural and industrial sectors.

Epidemiology of cancers among older adults in India: findings from the National Cancer Registry Programme

OBJECTIVE

This study describes the epidemiology, clinical extent of disease at diagnosis and treatment modalities of cancer among older adults (aged 60 years and older) in India.

STUDY DESIGN

Secondary data analysis of the National Cancer Registry Programme, which includes 28 Population-Based Cancer Registries (PBCRs) and 96 Hospital-Based Cancer Registries (HBCRs).

METHODS

PBCR data were used to estimate the incidence in terms of crude rate (CR), age-adjusted incidence rate (AAR), age-specific rate (ASpR) and cumulative risk. Trends in the AAR were calculated with the Annual Percentage Change (APC) using join-point regression. HBCR data were used to describe the clinical extent of the disease at diagnosis and the treatment modalities.

RESULTS

There is a wide heterogeneity across the country for the incidence of cancer and for the leading cancer sites among older adults. Males had a higher incidence rate compared to females in the majority of the registries. Aizawl had the highest AARs among both genders (males: 1388.8; females: 1033.0). Females had the highest ASpR at 65-69 years (482.8), whereas for males it was above 75 years (710.4). Cervical, stomach and oesophageal cancers were on the decline. The incidence of cancer among older adults was estimated to increase by 13.5% in 2025 as compared to 2020.

CONCLUSION

The increasing cancer incidence among older adults in India poses a huge burden on the health system. There is a need to increase their participation in clinical trials, advocating comprehensive geriatric assessment and strengthening geriatric oncology within programs addressing older adult's care to deal with the rising cancer burden on the health system borne by them.

POSTCHOLECYSTECTOMY SYNDROME: UNDERSTANDING THE CAUSES AND DEVELOPING TREATMENT STRATEGIES FOR PERSISTENT BILIARY SYMPTOMS AFTER GALLBLADDER REMOVAL

Persistent biliary symptoms following gallbladder removal, known as postcholecystectomy (PCS), can significantly impact patients' quality of life. The term PCS describes biliary symptoms that emerge or continue after the surgical removal of the gallbladder. Cholecystectomy is generally a safe procedure; however, some individuals may still experience symptoms of the biliary system thereafter. Biliary stones are more likely to be retained in patients who arrive later. Many of those people won't have a known reason for their condition. Therefore, this group will have fewer therapy alternatives. After a cholecystectomy, up to 10% of individuals may develop PCS. Patients with cholecystectomy procedures can appear with extra-biliary and associated biological illnesses. A wide range of therapeutic options are available for PCS, each having a different chance of being the cause of the condition. The purpose of this study is to present an overview of the many causes of PCS, as well as the effectiveness and prevalence of various treatments. PCS has a variety of etiologies, many of which may be related to extra-biliary reasons that may exist before the operation. From the beginning, an endoscopy of the upper gastrointestinal tract may be necessary when symptoms first appear. Biliary rocks are more likely to be retained in patient presentations that are postponed. PCS has various causes, including extra-biliary conditions that could have existed before operations. Initial symptoms might involve higher digestive problems. As a result, this group will only have a few therapeutic alternatives.

Bias in artificial intelligence algorithms and recommendations for mitigation

The adoption of artificial intelligence (AI) algorithms is rapidly increasing in healthcare. Such algorithms may be shaped by various factors such as social determinants of health that can influence health outcomes. While AI algorithms have been proposed as a tool to expand the reach of quality healthcare to underserved communities and improve health equity, recent literature has raised concerns about the propagation of biases and healthcare disparities through implementation of these algorithms. Thus, it is critical to understand the sources of bias inherent in AI-based algorithms. This review aims to highlight the potential sources of bias within each step of developing AI algorithms in healthcare, starting from framing the problem, data collection, preprocessing, development, and validation, as well as their full implementation. For each of these steps, we also discuss strategies to mitigate the bias and disparities. A checklist was developed with recommendations for reducing bias during the development and implementation stages. It is important for developers and users of AI-based algorithms to keep these important considerations in mind to advance health equity for all populations.

Endophytic fungi mediates production of bioactive secondary metabolites via modulation of genes involved in key metabolic pathways and their contribution in different biotechnological sector

Endophytic fungi stimulate the production of an enormous number of bioactive metabolites in medicinal plants and affect the different steps of biosynthetic pathways of these secondary metabolites. Endophytic fungi possess a number of biosynthetic gene clusters that possess genes for various enzymes, transcription factors, etc., in their genome responsible for the production of secondary metabolites. Additionally, endophytic fungi also modulate the expression of various genes responsible for the synthesis of key enzymes involved in metabolic pathways of such as HMGR, DXR, etc. involved in the production of a large number of phenolic compounds as well as regulate the expression of genes involved in the production of alkaloids and terpenoids in different plants. This review aims to provide a comprehensive overview of gene expression related to endophytes and their impact on metabolic pathways. Additionally, this review will emphasize the studies done to isolate these secondary metabolites from endophytic fungi in large quantities and assess their bioactivity. Due to ease in synthesis of secondary metabolites and their huge application in the medical industry, these bioactive metabolites are now being extracted from strains of these endophytic fungi commercially. Apart from their application in the pharmaceutical industry, most of these metabolites extracted from endophytic fungi also possess plant growth-promoting ability, bioremediation potential, novel bio control agents, sources of anti-oxidants, etc. The review will comprehensively shed a light on the biotechnological application of these fungal metabolites at the industrial level.

Acute Kidney Injury Following Naphthalene (Mothball) Poisoning

Naphthalene is a widely available moth repellant in the Asian subcontinent. Toxicity can occur either accidentally or intentionally as a suicide attempt. An overdose can lead to a variety of clinical symptoms, including intravascular hemolysis, and can sometimes lead to life-threatening clinical situations. A young male was admitted to our center with an alleged history of ingesting an unknown quantity of naphthalene balls (mothballs). He developed methemoglobinemia, intra-vascular hemolysis, anuria, and acute kidney injury (AKI), followed by cardiorespiratory arrest. He was treated successfully with intravenous methylene blue and dialysis. Naphthalene toxicity can lead to methemoglobinemia and intravascular hemolysis. This can result in AKI caused by pigment nephropathy.

Engineered nanoparticles in plant growth: Phytotoxicity concerns and the strategies for their attenuation

In the agricultural sector, the use of engineered nanoparticles (ENPs) has been acclaimed as the next big thing for sustaining and increasing crop productivity. A vast amount of literature is available regarding the growth-promoting attributes of different ENPs. In this context, it has been emphasized that the ENPs can bolster vegetative growth, leaf development, and seed setting and also help in mitigating the effects of abiotic and biotic stresses. At the same time, there have been a lot of speculations and concerns regarding the phytotoxicity of ENPs off-late. In this connection, many research articles have presented the negative effects of ENPs on plant systems. These studies have highlighted that almost all the ENPs impart a certain degree of phytotoxicity in terms of reduction in growth, biomass, impairment of photosynthesis, oxidative status of plant cells, etc. Mostly, the ENPs based on metal or metal oxides (Cd, Cr, Pb, Ag, Ce, etc.) and nonmetals (C) that are introduced into the environment are known to incite inhibitory effects. However, the phytotoxicity of ENPs are known to be determined mostly by the chemical nature of the element, size, surface charge, coating molecules, and abiotic factors like pH and light. This review article, therefore, elucidates the phytotoxic properties of different ENPs and the plant responses induced at the molecular level subjected to nanoparticle exposure. Moreover, the article highlights the probable strategies that may be adopted for the suppression of the phytotoxicity of ENPs to ensure the safe and sustainable application of ENPs in crop fields.

The ethical matrix as a method for involving people living with disease and the wider public (PPI) in near-term artificial intelligence research

INTRODUCTION

The rapid pace of research in the field of Artificial Intelligence in medicine has associated risks for near-term AI. Ethical considerations of the use of AI in medicine remain a subject of much debate. Concurrently, the Involvement of People living with disease and the Public (PPI) in research is becoming mandatory in the EU and UK. The goal of this research was to elucidate the important values for our relevant stakeholders: People with MS, Radiologists, neurologists, Registered Healthcare Practitioners and Computer Scientists concerning AI in radiology and synthesize these in an ethical matrix.

METHODS

An ethical matrix workshop co-designed with a patient expert. The workshop yielded a survey which was disseminated to the professional societies of the relevant stakeholders. Quantitative data were analysed using the Pingouin 0.53 python package. Qualitative data were examined with word frequency analysis and analysed for themes with grounded theory with a patient expert.

RESULTS

184 participants were recruited, (54, 60, 17, 12, 41 respectively). There were significant (p < 0.00001) differences in age, gender and ethnicity between groups. Key themes emerging from our results were the importance fast and accurate results, explanations over model performance and the significance of maintaining personal connections and choice. These themes were used to construct the ethical matrix.

CONCLUSION

The ethical matrix is a useful tool for PPI and stakeholder engagement with particular advantages for near-term AI in the pandemic era.

IMPLICATIONS FOR PRACTICE

We have produced an ethical matrix that allows for the inclusion of stakeholder opinion in medical AI research design.

Artificial Intelligence for Perioperative Medicine: Perioperative Intelligence

The anesthesiologist's role has expanded beyond the operating room, and anesthesiologist-led care teams can deliver coordinated care that spans the entire surgical experience, from preoperative optimization to long-term recovery of surgical patients. This expanded role can help reduce postoperative morbidity and mortality, which are regrettably common, unlike rare intraoperative mortality. Postoperative mortality, if considered a disease category, will be the third leading cause of death just after heart disease and cancer. Rapid advances in technologies like artificial intelligence provide an opportunity to build safe perioperative practices. Artificial intelligence helps by analyzing complex data across disparate systems and producing actionable information. Using artificial intelligence technologies, we can critically examine every aspect of perioperative medicine and devise innovative value-based solutions that can potentially improve patient safety and care delivery, while optimizing cost of care. In this narrative review, we discuss specific applications of artificial intelligence that may help advance all aspects of perioperative medicine, including clinical care, education, quality improvement, and research. We also discuss potential limitations of technology and provide our recommendations for successful adoption.

An inexpensive and rapid diagnostic method for detection of SARS-CoV-2 RNA by loop-mediated isothermal amplification (LAMP)

SARS-CoV-2 is a public pandemic health concern globally. Nasopharyngeal and oropharyngeal swab samples are used for Covid-19 viral detection. Sample collection procedure was tedious and uncomfortable and unsuitable for biochemical and CBC analysis in swab samples. Biochemistry and CBC tests are key determinant in management of Covid-19 patients. We developed a LAMP test to detect viral RNA in blood samples. LAMP is required four specific primers targeting the internal transcribed S-region and loop primers for viral RNA amplification. RNA was extracted from blood samples by TRIzol method. LAMP reaction was performed at 60 °C for 1 hour and amplicons were visualized in HNB dye. No cross-reactivity was seen with HBV, HCV, and HIV infected sample. Out of 40 blood samples, 33 samples were positive for LAMP and Q-PCR analysis, one sample was positive for LAMP and negative for Q-PCR, two samples were negative for LAMP but positive for Q-PCR, and four blood samples were negative for LAMP and Q-PCR. LAMP method has an accuracy of 92.50%, with sensitivity and specificity of 94.28% and 80%, respectively. Thus, LAMP diagnostic test has proved reliable, fast, inexpensive and can be useful for detection where the limited resources available.•LAMP method is a potential tool for detection of SARS-CoV-2.•Blood samples are the key determinant for routine diagnostics as well as molecular diagnostics.•LAMP assay is an appropriate diagnostics method which offers greater simplicity, low cost, sensitivity, and specificity than other methods in molecular diagnostics.

Exogenous nano-silicon application improves ion homeostasis, osmolyte accumulation and palliates oxidative stress in Lens culinaris under NaCl stress

Lentil is one of the highly nutritious legumes but is highly susceptible to salinity stress. Silicon has been known to reduce the effect of various environmental stresses including salinity. Moreover, silicon when applied in its nano-form is expected to augment the beneficial attributes of silicon. However, very little is known regarding the prospect of nano-silicon (nSi) application for alleviating the effect of salinity stress in non-silicified plants like lentil. In this study, the primary objective was to evaluate the efficacy of nSi in the alleviation of NaCl stress during germination and early vegetative stages. In this context, different concentrations of nSi (0, 1, 5, 10 g L-1) was applied along with four different concentrations of NaCl (0, 100, 200, 300 mM). The results indicated the uptake of nSi which was confirmed by the better accumulation of silica in the plant tissues. Most importantly, the enhanced accumulation of silica increased the K+/Na+ ratio of the NaCl-stressed seedlings. Moreover, nSi efficiently improved germination, growth, photosynthetic pigments, and osmotic balance. On the other hand, the relatively reduced activities of antioxidative enzymes were surmounted by the higher activity of non-enzymatic antioxidants which mainly scavenged the increased ROS. Reduced ROS accumulation in return ensured better membrane integrity and reduced electrolyte leakage up on nSi application. Therefore, it can be concluded that the application of nSi (more specifically at 10 g L-1) facilitated the uptake of silica and improved the K+/Na+ ratio to reclaim the growth and physiological status of NaCl-stressed seedlings.

Hydrogen sulphide (H2 S) in the hidden half: Role in root growth, stress signalling and rhizospheric interactions

Apart from nitric oxide (NO) and carbon monoxide (CO), hydrogen sulphide (H₂ S) has emerged as a potential gasotransmitter that has regulatory roles in root differentiation, proliferation and stress signalling. H₂ S metabolism in plants exhibits spatio-temporal differences that are intimately associated with sulphide signalling in the cytosol and other subcellular components, e.g. chloroplast and mitochondria. H₂ S biosynthesis in plant organs uses both enzymatic and non-enzymatic pathways. H₂ S generation in roots and aerial organs is modulated by developmental phase and changes in environmental stimuli. H₂ S has an influential role in root development and in the nodulation process. Studies have revealed that H₂ S is a part of the auxin and NO signalling pathways in roots, which induce lateral root formation. At the molecular level, exogenous application of H₂ S regulates expression of several transcription factors, viz. LBD (Lateral organ Boundaries Domain), MYB (myeloblastosis) and AP2/ERF (Apetala 2/ Ethylene Response Factor), which stimulate upregulation of PpLBD16 (Lateral organ boundaries domain 16), thereby significantly increasing the number of lateral roots. Concomitantly, H₂ S acts as a crucial signalling molecule in roots during various abiotic stresses, e.g. drought, salinity heavy metals (HMs), etc., and augments stress tolerance in plants. Interestingly, extensive crosstalk exists between H₂ S, NO, ABA, calcium and ethylene during stress, which escalate plant defence and regulate plant growth and productivity. Hence, the present review will elaborate the role of H₂ S in root development, stress alleviation, legume-Rhizobium symbiosis and rhizosphere signalling. The review also examines the mechanism of H₂ S-mediated abiotic stress mitigation and cross-talk with other signaling molecules.

Hybrid Nanofluid Flow of Non-Newtonian Casson Fluid for the Analysis of Entropy Through a Permeable Medium

The magnetohydrodynamic (MHD) flow of an electrically conducting fluid through a rotating channel is used for the enhancement of heat transfer properties. The entropy analysis due to the irreversibility of the system for the non-Newtonian Casson hybrid nanofluid is proposed in this investigation. Ethylene glycol (EG) is considered as the base liquid in which the metal nanoparticle i.e., copper (Cu) and oxide like aluminium oxide (Al2O3) nanoparticles are submerged into it for the preparation of nanofluid. In addition, the implementation of radiative heat, viscous and Joule dissipation in the energy equation enhance the profile as well. The dimensionless for of the governing equations are obtained by using suitable similarity transformations. The solution is obtained numerically for both the primary and the secondary velocity distributions along with the temperature profiles and the physical significance of the pertinent parameters are presented via graphs. The simulated results for the rate coefficients at both the walls are presented in tabular form. Further, the irreversibility process for the thermal system i.e., the entropy analysis is carried out for the several parameters along with the Bejan number and deliberated clearly. Further, the important findings are; an increasing rotation retards the thickness of the bounding surface of the primary velocity near the lower wall however, significant augmentation in the shear rate as well as heat transfer rate is revealed for the augmenting magnetic and the rotation parameter.

Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI

A growing number of artificial intelligence (AI)-based clinical decision support systems are showing promising performance in preclinical, in silico evaluation, but few have yet demonstrated real benefit to patient care. Early-stage clinical evaluation is important to assess an AI system's actual clinical performance at small scale, ensure its safety, evaluate the human factors surrounding its use and pave the way to further large-scale trials. However, the reporting of these early studies remains inadequate. The present statement provides a multi-stakeholder, consensus-based reporting guideline for the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by Artificial Intelligence (DECIDE-AI). We conducted a two-round, modified Delphi process to collect and analyze expert opinion on the reporting of early clinical evaluation of AI systems. Experts were recruited from 20 pre-defined stakeholder categories. The final composition and wording of the guideline was determined at a virtual consensus meeting. The checklist and the Explanation & Elaboration (E&E) sections were refined based on feedback from a qualitative evaluation process. In total, 123 experts participated in the first round of Delphi, 138 in the second round, 16 in the consensus meeting and 16 in the qualitative evaluation. The DECIDE-AI reporting guideline comprises 17 AI-specific reporting items (made of 28 subitems) and ten generic reporting items, with an E&E paragraph provided for each. Through consultation and consensus with a range of stakeholders, we developed a guideline comprising key items that should be reported in early-stage clinical studies of AI-based decision support systems in healthcare. By providing an actionable checklist of minimal reporting items, the DECIDE-AI guideline will facilitate the appraisal of these studies and replicability of their findings.

Postoperative Respiratory Failure After Elective Abdominal Surgery: A Case-Control Study

INTRODUCTION

Postoperative respiratory failure (PRF) contributes significantly to morbidity and mortality. We sought to identify patient characteristics and perioperative risk factors associated with PRF in patients undergoing elective abdominal surgery to improve patient outcomes.

METHODS

We retrospectively reviewed patients undergoing elective abdominal surgery from 2011 to 2016 at our institution. An experimental group consisting of adult patients with the Patient Safety Indicator 11 diagnosis of PRF was compared with a time-matched control group.

RESULTS

Each group consisted of 233 patients. Comorbidities associated with PRF included ascites, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus type II, hypertension, and hypoalbuminemia (P < 0.05). American Society of Anesthesiologists score IV (20.2% versus 3.95%; P < 0.001), operative time (4.13 versus 2.55 h; P < 0.001), laparotomy with open operation (77.7% versus 45.5%; P < 0.001), and net intraoperative fluid balance (3635 versus 2410 mL; P < 0.001) were higher in patients with PRF. On multivariate analysis, age, American Society of Anesthesiologists score, chronic obstructive pulmonary disease, diabetes mellitus type II, laparotomy, and net intraoperative fluid balance maintained significance (P < 0.05).

CONCLUSIONS

We identified contributing pre- and intra-operative risk factors for PRF undergoing elective abdominal surgery. These findings may help identify those at increased risk for respiratory failure and mitigate complications.

Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment

Background

Daily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID.

Methods

The ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis.

Results

One hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28–276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred.

Conclusions

This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

Evaluation framework to guide implementation of AI systems into healthcare settings

Objectives

To date, many artificial intelligence (AI) systems have been developed in healthcare, but adoption has been limited. This may be due to inappropriate or incomplete evaluation and a lack of internationally recognised AI standards on evaluation. To have confidence in the generalisability of AI systems in healthcare and to enable their integration into workflows, there is a need for a practical yet comprehensive instrument to assess the translational aspects of the available AI systems. Currently available evaluation frameworks for AI in healthcare focus on the reporting and regulatory aspects but have little guidance regarding assessment of the translational aspects of the AI systems like the functional, utility and ethical components.

Methods

To address this gap and create a framework that assesses real-world systems, an international team has developed a translationally focused evaluation framework termed ‘Translational Evaluation of Healthcare AI (TEHAI)’. A critical review of literature assessed existing evaluation and reporting frameworks and gaps. Next, using health technology evaluation and translational principles, reporting components were identified for consideration. These were independently reviewed for consensus inclusion in a final framework by an international panel of eight expert.

Results

TEHAI includes three main components: capability, utility and adoption. The emphasis on translational and ethical features of the model development and deployment distinguishes TEHAI from other evaluation instruments. In specific, the evaluation components can be applied at any stage of the development and deployment of the AI system.

Discussion

One major limitation of existing reporting or evaluation frameworks is their narrow focus. TEHAI, because of its strong foundation in translation research models and an emphasis on safety, translational value and generalisability, not only has a theoretical basis but also practical application to assessing real-world systems.

Conclusion

The translational research theoretic approach used to develop TEHAI should see it having application not just for evaluation of clinical AI in research settings, but more broadly to guide evaluation of working clinical systems.

Entropy based analysis of SARS-CoV-2 spread in India using informative subtype markers

India became one of the most COVID-19 affected countries with more than 4 million infected cases and 71,000 deaths by September 2020. We studied the temporal dynamics and geographic distribution of SARS-CoV-2 subtypes in India. Moreover, we analysed the RGD motif and D614G mutation in the spike protein of SARS-CoV-2. We used a previously proposed viral subtyping method based upon informative subtype markers (ISMs). The ISMs were identified on the basis of information entropy using 94,515 genome sequences of SARS-CoV-2 available publicly at the Global Initiative on Sharing All Influenza Data (GISAID). We identified 11 distinct positions in the SARS-CoV-2 genomes for defining ISMs resulting in 798 unique ISMs. The most abundant ISM in India was transferred from European countries. In contrast, the second most abundant ISM in India was found to be transferred via Australia. Moreover, the eastern regions in India were infected by the ISM most abundant in China due to geographical linkage. Our analysis confirmed higher rates of new cases in the countries abundant with S-G614 strain compared to countries with abundant S-D614 strain. In India, overall S-G614 was most prevalent compared to S-D614, except a few regions including New Delhi, Bihar, and Rajasthan.

Delineating the mechanisms of elevated CO2 mediated growth, stress tolerance and phytohormonal regulation in plants

Global climate change has drastically affected natural ecosystems and crop productivity. Among several factors of global climate change, CO₂ is considered to be the dynamic parameter that will regulate the responses of all biological system on earth in the coming decade. A number of experimental studies in the past have demonstrated the positive effects of elevated CO₂ on photosynthesis, growth and biomass, biochemical and physiological processes such as increased C:N ratio, secondary metabolite production, as well as phytohormone concentrations. On the other hand, elevated CO₂ imparts an adverse effect on the nutritional quality of crop plants and seed quality. Investigations have also revealed effects of elevated CO₂ both at cellular and molecular level altering expression of various genes involved in various metabolic processes and stress signaling pathways. Elevated CO₂ is known to have mitigating effect on plants in presence of abiotic stresses such as drought, salinity, temperature etc., while contrasting effects in the presence of different biotic agents i.e. phytopathogens, insects and herbivores. However, a well-defined crosstalk is incited by elevated CO₂ both under abiotic and biotic stresses in terms of phytohormones concentration and secondary metabolites production. With this background, the present review attempts to shed light on the major effects of elevated CO₂ on plant growth, physiological and molecular responses and will highlight the interactive effects of elevated CO₂ with other abiotic and biotic factors. The article will also provide deep insights into the phytohormones modulation under elevated CO₂.

Insights into the plant responses to drought and decoding the potential of root associated microbiome for inducing drought tolerance

Global increase in water scarcity is a serious problem for sustaining crop productivity. The lack of water causes the degeneration of the photosynthetic apparatus, an imbalance in key metabolic pathways, an increase in free radical generation as well as weakens the root architecture of plants. Drought is one of the major stresses that directly interferes with the osmotic status of plant cells. Abscisic acid (ABA) is known to be a key player in the modulation of drought responses in plants and involvement of both ABA-dependent and ABA-independent pathways have been observed during drought. Concomitantly, other phytohormones such as auxins, ethylene, gibberellins, cytokinins, jasmonic acid also confer drought tolerance and a crosstalk between different phytohormones and transcription factors at the molecular level exists. A number of drought-responsive genes and transcription factors have been utilized for producing transgenic plants for improved drought tolerance. Despite relentless efforts, biotechnological advances have failed to design completely stress tolerant plants until now. The root microbiome is the hidden treasure that possesses immense potential to revolutionize the strategies for inducing drought resistance in plants. Root microbiota consist of plant growth-promoting rhizobacteria, endophytes and mycorrhizas that form a consortium with the roots. Rhizospheric microbes are proliferous producers of phytohormones, mainly auxins, cytokinin, and ethylene as well as enzymes like the 1-aminocyclopropane-1-carboxylate deaminase (ACC deaminase) and metabolites like exopolysaccharides that help to induce systemic tolerance against drought. This review, therefore focuses on the major mechanisms of plant-microbe interactions under drought-stressed conditions and emphasizes the importance of drought-tolerant microbes for sustaining and improving the productivity of crop plants under stress.

Nanosilica facilitates silica uptake, growth and stress tolerance in plants

Nanobiotechnology has gained considerable momentum in the field of plant sciences in the last few years. Nanomaterials of various metal oxides has been utilized for enhancing growth, productivity and in crop protection strategies. Among them, nanosilica has emerged as a key player in orchestrating plant growth and conferring tolerance to various abiotic and biotic stresses. Nanosilica has increased absorptivity that accounts for an increased uptake of silica, although the exact mechanism is not fully understood. Nanosilica uptake in the roots and leaves reduces the accumulation of reactive oxygen species (ROS) and membrane lipid peroxidation. It is known to restrict the entry of sodium ions and other heavy metals in plants. Concurrently, nanosilica deposition in the leaf tissue enhances the plant defense against pathogens. The present review attempts to provide a novel insight into its uptake mechanism and nanosilica mediated abiotic and biotic stress tolerance in plants. This review will also shed light on the prospects and challenges related to application of nanosilica based fertilizers.

Intake of Ultra-processed Foods Among Adolescents From Low- and Middle-Income Families in Delhi

OBJECTIVE

To assess the contribution of ultra-processed foods to the macronutrient intake of adolescents from low- and middle-income families in Delhi.

METHOD

Adolescents (n=1030) aged 12-16 years from four private and four government schools of Delhi were interviewed using 24-hour recall (repeated on three days), and a food frequency questionnaire.

RESULTS

The mean energy intake from ultra-processed foods was 371 kcal (16.2%) of the total energy intake. The mean intake of macronutrients from ultra-processed foods was 7.1 g (16.3%) fat, 78.9 g (18.6%) carbohydrate and 4.8 g (10.9%) protein. Children from middle-income families consumed significantly higher (P<0.05) amounts of macronutrients coming from ultra-processed foods, as compared to those from low-income families.

CONCLUSIONS

Adolescents reported regular consumption of variety of ultra-processed foods, and measures to reduce this consumption and encouraging healthy food choices are urgently needed.

Quality improvement during the COVID-19 pandemic

In response to the COVID-19 pandemic, quality improvement teams at Cleveland Clinic initiated a number of measures to guide the care of patients with suspected or confirmed COVID-19 infection and protect care givers. This included increasing the frequency of team meetings from monthly to daily or weekly and creating task forces to create protocols for patient transport, airway management, and management of personal protective equipment and medications in short supply. Enterprise wide, we postponed non-essential surgeries, set up an overflow intensive care unit onsite, created a web-based COVID-19 toolkit for all care givers, and sent daily emails about the most recent developments, decisions, and recommendations from national and international societies.

Perioperative anesthesia care for patients with confirmed or suspected COVID-19

The operating room environment is very dynamic with many unique challenges for anesthesia teams caring for patients with confirmed or suspected COVID-19. Specific recommendations by national organizations and institution specific step-by-step guidelines and education materials are required to maintain safety for both patients and caregivers perioperatively, with transport, and medication management.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Secondary colonic stent insertion in acute large bowel obstruction following primary stent failure

INTRODUCTION

Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery.

METHODS

Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent.

RESULTS

Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention.

CONCLUSIONS

Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.

Calcium ionophore enhanced developmental competence and apoptotic dynamics of goat parthenogenetic embryos produced in vitro

Parthenogenetically developed embryos are efficient sources of in vitro embryo production, having less ethical issue and being useful for investigating culture conditions/treatments, early developmental, genomic studies, and homonymous source of stem cells. Keeping its advantages in mind, we aimed to study the effects of different activating agents on embryo production and its quality and gene expression. In the present study, 1348 immature oocytes recovered were parthenogenetically developed to embryos. Usable-quality immature oocytes were collected by puncturing the surface follicles and matured in in vitro maturation (IVM) medium for 27 h in a humidified 5% CO₂ incubator at 38.5°C. The matured oocytes were parthenogenetically activated by exposure to 5 μM calcium ionophore for 5 min or 7% ethanol for 7 min sequentially followed by 4 h incubation in 2 mM 6-DMAP and then in vitro cultured (IVC) in RVCL/G-2 medium for 8 days. Matured oocytes were activated by calcium ionophore, the cleavage rate observed was 76.67 ± 3.47%, and further they developed into 4-cell, 8-16-cell, morula, blastocyst, and hatched blastocyst with 85.30 ± 1.57%, 70.60 ± 2.00%, 45.05 ± 2.66%, 22.89 ± 2.40%, and 5.70 ± 1.97%, respectively. Whereas ethanol-activated oocytes showed cleavage rate of 87.60 ± 1.70% and further culture developed into 4-cell, 8-16 cell, morula, blastocyst, and hatched blastocyst with 86.14 ± 1.03%, 71.56 ± 2.21%, 40.90 ± 2.45%, 19.02 ± 1.26%, and 2.22 ± 0.38%, respectively. Blastocyst developed from calcium ionophore-activated oocytes showed significantly (P < 0.05) higher total cell number (282.25 ± 27.02 vs 206.00 ± 40.46) and a lower apoptotic index (2.42 ± 0.46 vs 4.07 ± 1.44) than blastocyst developed from ethanol-activated oocytes. The relative expression of anti-apoptotic genes (BCL2, BCL2A1, MCL) at different stages of embryos produced by either calcium ionophore or ethanol activation was found to be increased in earlier stages and decreased in later stages of embryonic development. Similarly, when these embryos were subjected to pro-apoptotic genes (BAX, BAD, BAK), expression was found to be slightly higher in blastocysts than other stages. This study shows that calcium ionophore-activated blastocysts were developmentally more competent than the ethanol-activated blastocysts.

Does the presence of Klebsiella pneumoniae carbapenemase and New Delhi metallo-β-lactamase-1 genes in pathogens lead to fatal outcome?

INTRODUCTION

Infections due to multidrug-resistant (MDR) pathogens are a medical challenge. There is considerable apprehension among clinicians regarding pathogens reported as carrying New Delhi metallo-β-lactamase-1 (NDM) and Klebsiella pneumoniae carbapenemase (KPC) genes from their patients. In the face of extremely high rates of antimicrobial resistance, it is essential to gauge the clinical significance of isolation of pathogens carrying these genes from clinical samples. This study compares the outcome of patients infected with pathogens carrying NDM/KPC genes versus those without these genes.

METHODS

The study was conducted over a 1-year period at a Level-1 trauma centre. Hospital-acquired infections were diagnosed on the basis of CDC's criteria. The correlation of isolation of a multi-resistant pathogen carrying KPC or NDM genes with the clinical outcome was ascertained.

RESULTS

A total of 276 consecutive patients admitted to the Intensive Care Units/wards of the JPNA Trauma Centre were included in this study. Of the 371 isolates recovered from these patients, 116 were from patients who had a fatal outcome. The difference in prevalence of blaNDMand blaKPCwas not significant in any genera of Gram-negative pathogens isolated from patients who survived versus those who had a fatal outcome.

CONCLUSION

Isolation of MDR pathogens carrying NDM/KPC genes from clinical samples is not always a harbinger of a fatal outcome. Efforts should be made to prevent cross-transmission of these pathogens.

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus seroprevalence in critically ill emergency department patients at a Trauma Care Centre, India

INTRODUCTION

Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the most common occupationally acquired infections amongst the healthcare workers (HCWs) with critically ill patients attending the emergency department being the most common source of occupationally acquired infections. Therefore, the present study was conducted at a 165 bedded level-1 trauma centre of India to ascertain the seroprevalence rate of HIV, HBV and HCV; and thus the risk associated with the occupational exposure in a busy emergency setting of the developing world.

METHODOLOGY

A retrospective, 7 years study (2007-2013) was carried out at the JPNA Trauma Centre of the 2,500 bedded All India Institute of Medical Sciences, New Delhi. Records of all patients whose serum samples were sent to the laboratory for viral markers testing were obtained and those falling in the red area were included.

RESULTS

A total of 11,630 patients were received in the red area; and samples from 7,650 patients were sent for testing. Seropositivity of HIV, HBV and HCV in these samples was 0.28%, 3.4% and 0.9% respectively. The number of samples received was lesser than the total number of patients received in the red area.

CONCLUSION

Adopting Standard Precautions (SP) can be used as an easy method to decrease the risk of occupationally acquired infections.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.