Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

Genome-wide selection signatures address trait specific candidate genes in cattle indigenous to arid regions of India

The peculiarity of Indian cattle lies in milk quality, resistance to diseases and stressors as well as adaptability. The investigation addressed selection signatures in Gir and Tharparkar cattle, belonging to arid ecotypes of India. Double digest restriction-site associated DNA sequencing (ddRAD-seq) yielded nearly 26 million high-quality reads from unrelated seven Gir and seven Tharparkar cows. In all, 19,127 high-quality SNPs were processed for selection signature analysis. An approach involving within-population composite likelihood ratio (CLR) statistics and between-population FST statistics was used to capture selection signatures within and between the breeds, respectively. A total of 191 selection signatures were addressed using CLR and FST approaches. Selection signatures overlapping 86 and 73 genes were detected as Gir- and Tharparkar-specific, respectively. Notably, genes related to production (CACNA1D, GHRHR), reproduction (ESR1, RBMS3), immunity (NOSTRIN, IL12B) and adaptation (ADAM22, ASL) were annotated to selection signatures. Gene pathway analysis revealed genes in insulin/IGF pathway for milk production, gonadotropin releasing hormone pathway for reproduction, Wnt signalling pathway and chemokine and cytokine signalling pathway for adaptation. This is the first study where selection signatures are identified using ddRAD-seq in indicine cattle breeds. The study shall help in conservation and leveraging genetic improvements in Gir and Tharparkar cattle.

Diversity assessment of a lesser known buffalo population from Central India and its comparative evaluation reveals presence of sufficient genetic variation and absence of selection

Planned breeding and conservation strategies for a lesser-known population require an assessment of complete genetic diversity and population structure analysis in addition to its morphometric characteristics. In the present study, a comparative analysis of the genetic structure of a rare buffalo population, namely Chhattisgarhi, was extensively studied using a panel of FAO-recommended microsatellite markers along with well-established breeds namely Murrah, Nili-Ravi, Gojri, Kalahandi, and Nagpuri. Mode shift analysis indicated the absence of genetic bottleneck in the recent past. Assessment of genetic diversity indices across all loci indicated the presence of sufficient genetic variation within and between populations. Analysis of molecular variance between the six different buffalo populations attributed 19.05% of the variations to between-population differentiation. Cluster analyses using DAPC and Bayesian approach along with the phylogenetic tree based on UPGMA grouped six populations into three groups. The Chhattisgarhi population was revealed to be genetically closer to Nagpuri and Kalahandi populations. The study reveals the presence of sufficient genetic diversity within the Chhattisgarhi population and indicates the absence of a systematic selection program. We suggest improvement and conservation programs should be planned for this breed in the near future through short-term selection.

Comparative measurement of CO2, CH4 and CO at two traffic interjunctions having inflated vehicular flow in Delhi

Vehicular emissions are considered one of the major anthropogenic sources of greenhouse gases and poor air quality in metropolitan cities. This study aims to see the correlation of CO2, CH4, and CO through monitoring over a period from December 2020 to October 2021 covering three seasons' winter, summer, and monsoon at two different traffic locations of Delhi having different traffic volumes, road patterns, and traffic management. The annual average morning concentration of CO2, CH4 and CO was found (533 ± 105), (7.3 ± 3.1), (10.7 ± 3.0) ppm at Najafgarh and (480 ± 70), (5.2 ± 1.8), (7.8 ± 2.8) ppm at Rajendra Place, respectively. A relationship between concentration of all three gases and meteorological parameters such as temperature, humidity, wind speed and wind direction has also been investigated using Pearson correlation coefficient and pollution rose diagram. A comparable pattern in concentration was observed for all three gases in spatial (location) and temporal (diurnal) distribution. The concentration trend of CO2 in different seasons is winter > summer > monsoon, while in the case of CH4 winter = summer > monsoon but not any seasonal trend was noted in CO case. It is observed that CO2 has a good relation with CO (a tracer for vehicular emission) in terms of diurnal variation, whereas, CH4 does not represent a relation with CO and CO2 diurnally, suggesting that vehicles are the source of CO2 but not much contributing to other greenhouse gases like CH4.

Visual hazardous models: A hybrid approach to investigate road hazardous events

Road users (drivers, passengers, pedestrians, and Animals) are exposed to hazardous events during their commute. With 23 % of global fatalities among pedestrians, their safety continues to be a principal interest for policymakers worldwide. Owing to limited budgets available, there is a growing emphasis on data-driven stochastic models to decide on policies. However, statistical models have limitations due to crash data having redundant features, inherent heterogeneity, and unobserved characteristics. The random parameter model framework addresses the unobserved heterogeneity, but redundant features and inherent heterogeneity among the data's characteristics still compute the biased estimates. This is further complicated if the data has spatiotemporal attributes. To address this, we developed two visual hazardous (VH) models: (i) addresses the unobserved heterogeneity in the data, and (ii) addresses the dimensionality, inherent heterogeneity among the characteristics and unobserved heterogeneity in the collected data after spatiotemporal pattern identification. The feature selection model reduces the dimensionality, whereas latent class clustering classifies the data into maximum heterogeneity between classes. This integration reduces bias in the estimates. As a use-case, pedestrian crosswalk crashes for a decade (2009-2018) in the Indian state of Tamil Nadu extracted from the Road Accident Database Management System (RADMS) was used to understand model performance. This data comprises the crash location, road, vehicle, driver, pedestrian, and environment details. Results show that visual hazardous model 2 allows for generating crash scenarios with five homogeneous sub-classes and the magnitude with marginal effects of contributing factors impacting it. For example, pedestrians during their crosswalks are likely to sustain 82% more chance of fatal/grievous injuries on expressways (posted speed limit: 100 km per hour) in annual hazardous zone locations. Working pedestrian age group (25-64 years), an older pedestrian (>64 years), the pedestrian position on a pedestrian crossing and not in the centre of the road, pedestrian action: walking along the edge of the road, multiple lanes, two lanes, paved shoulder, straight and flat road, motorcycle, bus, truck, medium-duty vehicle, illegal driver (<=17 years), going ahead/ overtaking, high speed, expressways, and rural region were statistically significant (positively) contributing to the fatal/grievous injury pedestrian crashes during their crosswalk. This technique serves as a structure for engineers, researchers, and policymakers to formulate effective countermeasures that enhance road safety.

Deciphering the impact of cold-adapted bioinoculants on rhizosphere dynamics, biofortification, and yield of kidney bean across varied altitudinal zones

Agriculture stands as a thriving enterprise in India, serving as both the bedrock of economy and vital source of nutrition. In response to the escalating demands for high-quality food for swiftly expanding population, agricultural endeavors are extending their reach into the elevated terrains of the Himalayas, tapping into abundant resources for bolstering food production. Nonetheless, these Himalayan agro-ecosystems encounter persistent challenges, leading to crop losses. These challenges stem from a combination of factors including prevailing frigid temperatures, suboptimal farming practices, unpredictable climatic shifts, subdivided land ownership, and limited resources. While the utilization of chemical fertilizers has been embraced to enhance the quality of food output, genuine concerns have arisen due to the potential hazards they pose. Consequently, the present investigation was initiated with the objective of formulating environmentally friendly and cold-tolerant broad ranged bioinoculants tailored to enhance the production of Kidney bean while concurrently enriching its nutrient content across entire hilly regions. The outcomes of this study unveiled noteworthy advancements in kidney bean yield, registering a substantial increase ranging from 12.51 ± 2.39 % to 14.15 ± 0.83 % in regions of lower elevation (Jeolikote) and an even more remarkable surge ranging from 20.60 ± 3.03 % to 29.97 ± 5.02 % in higher elevated areas (Chakrata) compared to the control group. Furthermore, these cold-tolerant bioinoculants exhibited a dual advantage by fostering the enhancement of essential nutrients within the grains and fostering a positive influence on the diversity and abundance of microbial life in the rhizosphere. As a result, to effectively tackle the issues associated with chemical fertilizers and to achieve sustainable improvements in both the yield and nutrient composition of kidney bean across varying elevations, the adoption of cold-tolerant Enterobacter hormaechei CHM16, and Pantoea agglomerans HRM 23, including the consortium, presents a promising avenue. Additionally, this study has contributed significant insights-into the role of organic acids like oxalic acid in the solubilization of nutrients, thereby expanding the existing knowledge in this specialized field.

Wide spectrum of novel and rare hemoglobin variants in the multi-ethnic Indian population: A review

The hemoglobin (Hb) variants are qualitative abnormalities due to production of structurally abnormal globin proteins. They are categorized based on the type of mutation present in the α1, α2, β, Gγ, Aγ and δ globin genes. So far, more than 1550 Hb variants are reported in the database. They could lead to Hb polymerization, Hb instability, altered oxygen affinity and decreased oxygen-carrying capacity of Hb or have no clinical manifestations. In India, ethnic diversity, consanguinity, regional variations and migration result in the presence of different Hb variants. We have compiled all the variants of α, β and δ globin chains in heterozygous, homozygous and in compound heterozygous forms reported from India in the last 52 years. Of the 63 rare and novel hemoglobin variants reported from India, 22 were α-globin chain variants, 37 were β-globin chain variants and 4 were δ-globin chain variants. Twelve novel Hb variants (Hb J Rajappan, Hb Koya Dora, Hb Rampa, Hb Godavari, Hb Chandigarh, Hb D Agri, Hb Lucknow, Hb Vellore, Hb Midnapore, Hb Bijnor, Hb A2Tianhe and Hb A2Saurashtra) were identified among persons of Indian origin. Majority of them were picked up on HPLC. Some of the variants like Hb Titusville, Hb Shimonoseki, Hb Chandigarh, Hb D Agri, Hb Yaizu and Hb Vellore eluted in the HbS window whereas variants like HbD Iran, Hb St. Louis, Hb G Coushata, HbM Saskatoon, Hb Lucknow, Hb Grange-Blanche and Hb Tianshui showed falsely elevated HbA2. Hence, careful and systematic investigations are required to identify them.

Assessing environmental sustainability by combining product service systems and life cycle perspective: A case study of hydroponic urban farming models in India

Hydroponics technology offers an environmentally sustainable alternative to conventional farming for urban food needs. It attracts technologists, non-farmers, retailers, restaurants, and consumers. However, the environmental impact of hydroponics-based urban farming models is yet to be quantified. This study assesses the environmental impact of hydroponics-based urban farming models and makes suggestions to improve their adoption. The methodology involves the use of the Product-Service Systems perspective to categorise the hydroponics-based urban farming models and the Life Cycle Assessment (LCA) method to quantify their environmental impact from a cradle-to-gate perspective. The analysis focuses on the lettuce crop in the state of Tamil Nadu, India. The results from the study suggest that that greenhouse farming (BM1) is more environmentally sustainable than indoor farming (BM2), Cabinet selling and remote monitoring (BM3), and conventional farming. It outperforms other models in terms of GHG emissions, Human Toxicity, and fossil fuels per unit of product, with BM3 having high environmental impacts.

Pollen morphology of Acanthoideae species from the Shivalik Foothills in Rajaji National Park (Uttarakhand, India)

Apart from its role in plant taxonomy, the understanding of pollen morphology is considered an essential interdisciplinary tool in diverse applied fields, including plant systematics, melissopalynology, aeropalynology, forensic palynology, paleopalynology, and copropalynology. In palynotaxonomy, it is frequently employed to classify and validate natural groups across a range of hierarchical levels, from higher categories down to the infrageneric level. The subfamily Acanthoideae, within the Acanthaceae family, consists of a diverse group of flowering plants that are distributed globally. The present study attempted a comprehensive analysis of the pollen morphology, employing both light microscopy (LM) and scanning electron microscopy (SEM), for a total of 13 Acanthoideae species from the Shivalik Foothills in Rajaji National Park (located in the northern Indian state of Uttarakhand, Western Himalaya). The findings indicated that the Acanthoideae is characterized by eurypalynous features, and the studied species exhibited pollen grains that were monads, radially symmetrical, and varied in size from small to large. The pollen grains were predominantly tricolporate or heteroaperturate, with porate occurrences being rare. The significant variation in exine sculpturing, including reticulate, coarsely reticulate, and bireticulate patterns, holds substantial taxonomic significance. The detailed presentation encompasses pollen morphological characters described with LM and SEM micrographs, along with a species-level identification key. RESEARCH HIGHLIGHTS: This article provides a thorough analysis of the pollen morphology of Acanthoideae taxa using both light microscopy and scanning electron microscopy, covering 13 species across 10 genera and revealing a broad spectrum of pollen characteristics, including size, shape, aperture type, and exine sculpturing. The microscopic investigation of these Acanthoideae species not only enhances our understanding of their pollen morphology but also aids in species identification through the development of a pollen-based key.

Novel mutations found in Mycobacterium leprae DNA repair gene nth from central India

INTRODUCTION

The importance of DNA repair enzymes in maintaining genomic integrity is highlighted by the hypothesis that DNA damage by reactive oxygen/nitrogen species produced inside the host cell is essential for the mutagenesis process. Endonuclease III (Nth), formamidopyrimide (Fpg) and endonuclease VIII (Nei) DNA glycosylases are essential components of the bacterial base excision repair process. Mycobacterium leprae lost both fpg/nei genes during the reductive evolution event and only has the nth (ML2301) gene. This study aims to characterize the mutations in the nth gene of M. leprae strains and explore its correlation with drug-resistance.

METHOD

A total of 91 M. leprae positive DNA samples extracted from skin biopsy samples of newly diagnosed leprosy patients from NSCB Hospital Jabalpur were assessed for the nth gene as well as drug resistance-associated loci of the rpoB, gyrA and folP1 genes through PCR followed by Sanger sequencing.

RESULTS

Of these 91 patients, a total of two insertion frameshift mutations, two synonymous and seven nonsynonymous mutations were found in nth in seven samples. Sixteen samples were found to be resistant to ofloxacin and one was found to be dapsone resistant as per the known DRDR mutations. No mutations were found in the rpoB region. Interestingly, none of the nth mutations were identified in the drug-resistant associated samples.

CONCLUSION

The in-silico structural analysis of the non-synonymous mutations in the Nth predicted five of them were to be deleterious. Our results suggest that the mutations in the nth gene may be potential markers for phylogenetic and epidemiological studies.

Why do healthcare researchers in South Asia publish in predatory journals? A scoping review

Predatory journals offer the promise of prompt publication to those willing to pay the article submission or processing fee. However, these journals do not offer rigorous peer review. Studies have shown that a substantial share of corresponding authors in predatory journals come from South Asia, particularly India. This scoping review aims to assess what is known about the reasons why healthcare researchers working in South Asia publish in predatory journals. 66 reports (14 editorials, 20 letters, 5 research reports, 10 opinion articles, 14 reviews, 2 commentaries and 1 news report) were included in the data charting and analysis. The analysis of the reports identified three main reasons that made South Asian healthcare researchers publish in predatory journals: pressure to publish, lack of research support, and pseudo benefits. The review shows that predatory publishing in South Asia is a complex phenomenon. Combating predatory publications requires a holistic strategy that supersedes merely blacklisting these journals or listing criteria for journals that do meet academic standards.

Variations in biophysical characteristics of mangroves along retreating and advancing shorelines

Mangrove shoreline retreat or advance is a natural process in a mangrove delta. However, due to various natural and anthropogenic stressors, mangrove shoreline retreat is the second largest cause of mangrove loss globally. It is important to understand the scale at which mangrove shoreline changes are causing biophysical changes along the mangrove shorelines and, in turn, understand if certain biophysical characteristics can explain the changes along the shoreline. This will help identify the response of mangroves to shoreline changes. Videography and spatial mapping were used to study temporarily and permanently changing mangrove shorelines in the Sundarbans, the largest mangrove forest in the world (~10,000 km2), located in India and Bangladesh. Data was collected along a ~ 239 km shoreline at 54 sites. 36.4 % of all the studied shorelines were experiencing major retreat, 63.8 % and 27.2 % of all (major and minor) retreating areas had 1-25 % and > 25 % dead trees. The biophysical characteristics statistically (P < 0.0001) associated with retreating mangrove shorelines were - cliff-type shoreline profiles, number of dead trees, and absence of stream and grass, with shoreline profiles as the strongest predictor of shoreline retreat. Moreover, 68.7 % and 73 % of historically retreating shorelines had a cliff-type shoreline profile and Excoecaria agallocha as the dominating species, respectively. Moreover, due to the strong correlation between historical changes and current shoreline types, it was concluded that characteristics along the shoreline are partly a product of historical shoreline transitions. Thus, the present status of the shoreline can not only predict the history of the shoreline but can also give insights into the future biophysical changes in the mangrove forests.

Microbial degradation of low-density polyethylene (LDPE) and polystyrene using Bacillus cereus (OR268710) isolated from plastic-polluted tropical coastal environment

The study focused on marine bacteria, specifically Bacillus cereus, sourced from heavily polluted coastal areas in Tamil Nadu, aiming to assess their efficacy in degrading low-density polyethylene (LDPE) and polystyrene over a 42-day period. When LDPE and polystyrene films were incubated with Bacillus cereus, they exhibited maximum weight losses of 4.13 ± 0.81 % and 14.13 ± 2.41 %, respectively. Notably, polystyrene exhibited a higher reduction rate (0.0036 day-1) and a shorter half-life (195.29 days). SEM images of the treated LDPE and polystyrene unveiled surface erosion with cracks. The energy dispersive X-ray (EDX) analysis revealed elevated carbon content and the presence of oxygen in the treated LDPE and polystyrene films. The ATR-FTIR spectra exhibited distinctive peaks corresponding to functional groups, with observable peak shifts in the treated films. Notable increases were detected in carbonyl, internal double bond, and vinyl indices across all treated groups. Additionally, both treated LDPE and polystyrene showed reduced crystallinity. This research sheds light on Bacillus cereus (OR268710) biodegradation capabilities, emphasizing its potential for eco-friendly waste management in coastal regions.

Protobothrops jerdonii (Jerdon's pit viper) and Protobothrops himalayanus (Himalayan lance-headed pit viper) bites: Clinical report on envenomings from North-East India, managed through remote consultation by a national-level Poison control center

Members of the genus Protobothrops are amongst the more than twenty-eight range-restricted Indian pit viper species. Their bites and envenomings are rarely documented from India. Pit viper envenomings can be challenging to treat in the Indian setting, since available antivenoms do not satisfactorily neutralize their venoms. Herein, we present the first Indian reports on bites and envenoming by Protobothrops jerdonii and Protobothrops himalayanus resulting in local effects, coagulopathy and acute kidney injury in the case of the former and possible mild, isolated coagulopathy in the case of the latter; and discuss management-related challenges in the context of absent specific antivenoms.

Indian green pit vipers: A lesser-known snake group of north-east India

Green pit vipers are one of the most widely distributed group of venomous snakes in south-east Asia. In Indian, green pit vipers are found in the Northern and North-eastern states spreading across eastern and central India and one of the lesser studied venoms. High morphological similarity among them has been a long-established challenge for species identification, however, a total of six species of Indian green pit viper belonging to genus Trimeresurus, Popeia and Viridovipera has been reported from North-east India. Biochemical and biological studies have revealed that venom exhibits substantial variation in protein expression level along with functional variability. The symptoms of envenomation are painful swelling at bite site, bleeding, necrosis along with systemic toxicity such as prolonged coagulopathy. Clinical data of green pit viper envenomated patients from Demow community health centre, Assam advocated against the use of Indian polyvalent antivenom pressing the need for a suitable antivenom for the treatment of green pit viper envenomation. To design effective and specific antivenom for green pit vipers, unveiling the proteome profile of these snakes is needed. In this study, a comparative venomic of green pit vipers of Northern and North-eastern India, their clinical manifestation as well as treatment protocol has been reviewed.

Examining stereotypes in a dynamic social order: the stereotype content model in India

Stereotypes are tools of social perception that attribute a superficial uniformity to individuals within a social group, providing an instrument to assess individuals and groups. The stereotype content model (SCM) provides a framework for understanding these dynamics. SCM explores how groups are stereotyped on competence and warmth. This research utilizes the SCM to study India, a heterogenous society with diverse social groups. The purpose of this paper is to study caste stereotypes using SCM within India while also comparing two distinct regions of the country - the north and the south. This study is unique because (a) earlier studies have not explored stereotyping while recognizing the regional variations "within" India and (b) it applies SCM to caste. We also include how caste perceptions are further defined for groups that fall under the affirmative action program. Using Amazon's Mechanical Turk, we recruited subjects who responded to questions that assessed stereotypes of different social groups. The results indicate the presence of more ambivalent stereotypes and higher belief in karmic ideology in the four southern states compared to the northern states. Possible explanations discussed.

Retrolental Bullous Retinal Detachment as the Presenting Feature of Vogt-Koyanagi-Harada Disease in an Elderly Indian Female: Diagnostic and Therapeutic Challenge

PURPOSE

To report an atypical case of Vogt-Koyanagi-Harada (VKH) disease with retrolental bullous retinal detachment (RD).

METHODS

A case report.

CASE

A 67-year-old Indian woman with bilateral, gradual visual loss presented with both eyes light perception, keratic precipitates, 2+ cells and bullous RD, which was retrolental in right eye (RE). Systemic investigations were unremarkable. She received systemic corticosteroids, and underwent pars plana vitrectomy (PPV) in left eye (LE). Intraoperatively, sunset glow with leopard-spot fundus were suggestive of VKH disease. Immunosuppressive therapy was added. At 2 years, vision was 3/60 in RE and 6/36 in LE. The LE retina reattached immediately following surgery, while RE exudative RD resolved very gradually following corticosteroids.

SUMMARY

This report illustrates diagnostic as well as therapeutic challenge in VKH disease presenting with retrolental bullous RD. PPV provided a faster anatomical and functional restoration than systemic corticosteroid therapy alone, which has potential adverse effects in the elderly.

Clinical Evaluation of a Novel, Patented Green Coffee Bean Extract (GCB70®), Enriched in 70% Chlorogenic Acid, in Overweight Individuals

OBJECTIVE

Obesity and overweight are challenging health problems of the millennium that lead to diabetes, hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), and atherosclerosis. Green coffee bean exhibited significant promise in healthy weight management, potentiating glucose-insulin sensitization and supporting liver health. The safety and efficacy of a novel, patented water-soluble green coffee bean extract (GCB70® enriched in 70% total chlorogenic acid and <1% caffeine) was investigated in 105 participants for 12 consecutive weeks. An institutional review board and Drugs Controller General (India) (DCGI) approvals were obtained, and the study was registered at ClinicalTrials.gov.

METHOD

Body weight, body mass index (BMI), waist circumference, lipid profile, plasma leptin, glycosylated hemoglobin (HbA1c), and total blood chemistry were assessed over a period of 12 weeks of treatment. Safety was affirmed.

RESULTS

GCB70 (500 mg BID) supplementation significantly reduced body weight (approximately 6%; p = 0.000**) in approximately 97% of the study population. About a 5.65% statistically significant reduction (p = 0.000**) in BMI was observed in 96% of the study volunteers. Waist circumference was significantly reduced by 6.77% and 6.62% in 98% of the male and female participants, respectively. Plasma leptin levels decreased by 13.6% in 99% of the study population as compared to the baseline value. Upon completion of 12 weeks' treatment, fasting glucose levels decreased by 13.05% (p = 0.000**) in 79% of the study population. There was a statistically significant decrease in HbA1c levels in both male and female participants (p = 0.000**), while 86.7% of the study participants showed a statistically significant decrease in thyroid-stimulating hormone (TSH) levels (p = 0.000**). The mean decrease in TSH levels on completion of the treatment was 14.07% in the study population as compared to baseline levels. Total blood chemistry analysis exhibited broad-spectrum safety.

CONCLUSIONS

This investigation demonstrated that GCB70 is safe and efficacious in healthy weight management.

Quality testing of mifepristone and misoprostol in 11 countries

OBJECTIVE

Previous studies have demonstrated quality concerns with misoprostol. Mifepristone, however, has not been extensively assessed for quality. Between 2020 and 2021, Concept Foundation and the International Planned Parenthood Federation conducted a study to determine the quality of these medical abortion drugs in low- and middle-income countries (LMIC).

METHODS

The collection of batch samples of misoprostol and mifepristone was carried out by trained sampling agents in selected LMIC. Single drug packs and combipacks were sampled. A World Health Organization prequalified laboratory conducted testing method verifications and subsequent sample analysis. Tests included identification, assay, related substances, and content uniformity for misoprostol, and identification, assay, related substances, and dissolution for mifepristone.

RESULTS

Samples were collected from Burkina Faso, Cambodia, Democratic Republic of Congo, India, Kyrgyzstan, Moldova, Nepal, Nigeria, Pakistan, Uganda and Vietnam. Sixty-four pooled batch samples were tested, consisting of 31 combipacks, 26 misoprostol-only and seven mifepristone-only products. Overall, 54.7% of samples were non-compliant with one or more of the specifications, representing 51.6% of combipack products, 57.1% of misoprostol tablets analyzed and 23.7% of mifepristone tablets. One falsified misoprostol-only product was found.

CONCLUSION

The present study confirms that a significant problem still exists in relation to the quality of medical abortion drugs in LMIC. For misoprostol, our findings suggest that historical concerns around primary packaging may have been largely resolved but that manufacturing processes for both finished product and active pharmaceutical ingredient need to be improved. The present study also provides evidence of mifepristone quality issues.

Lethal dog attacks on adult rhesus macaques (Macaca mulatta) in an anthropogenic landscape

For nonhuman primates living in anthropogenic areas, predation by larger predators is relatively rare. However, smaller predators, such as free-ranging as well as domesticated dogs, can shape the socioecology of urban nonhuman primates, either directly by attacking and killing them or indirectly by modifying their activity patterns. Here, we describe three (two probably fatal) cases of dog attacks on adult rhesus macaques inhabiting an anthropogenic landscape in Northern India and the circumstances surrounding these incidents. We discuss the importance of considering human presence and intervention in dog-nonhuman primate relationships while studying nonhuman primate populations across anthropogenic gradients, and its potential influences on group social dynamics and transmission of zoonotic agents.

Autophagy related gene 5 polymorphism rs17587319 (C/G) in asthmatic patients in North Indian population

Objective: Genetic background and environmental stimuli play an important role in asthma, which is an individual's hyper-responsiveness to these stimuli leading to airway inflammation. Autophagy Related Gene 5 (ATG5) plays a critical role in the autophagy pathway and has been shown to be involved in asthma. The genetic polymorphisms in the ATG5 have been reported to predispose individuals to asthma. The role of single nucleotide polymorphism rs17587319 (C/G) of ATG5 in asthma has not been studied so far. Materials and methods: In this study, we in silico analysed rs17587319 (C/G) using web-based tools Human Splice Finder (HSF) and RegulomeDB and further a case-control study was conducted that included 187 blood samples (94 asthmatic and 93 healthy controls). Results: In silico analysis suggested alteration of splicing signals by this intronic variant. The samples were genotyped by applying the PCR-RFLP method. The MAF obtained was 0.022 and 0.043 in healthy controls and asthmatic individuals, respectively. The statistical analysis revealed no association (allelic model, OR = 2.02, 95%CI = 0.59-6.83, p = 0.25; co-dominant model, OR = 2.06, 95%CI = 0.6-7.12, p = 0.24) of rs17587319 (C/G) with the susceptibility to asthma in the north Indian population. Conclusions: In conclusion, rs17587319 (C/G) of ATG5 does not predispose individuals to asthma in our part of the world. Further studies are needed including more number of samples to ascertain the role of this polymorphism in asthma.

Formal support and service needs of family caregivers of adults with intellectual and/or developmental disabilities in India

BACKGROUND

Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally-tailored programs are developed.

METHOD

A strengths-based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi-structured interviews.

RESULTS

Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions.

CONCLUSIONS

Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access.

A high performance thin layer chromatography (HPTLC) method for the quality assessment of agarwood (Aquilaria malaccensis) oil from Northeast India

The high-value agarwood oil, largely used in perfumery is generally graded by the traditional method of sensorial assessment. The compositional complexity and variation made its quality control challenging. Besides, non-volatile contaminants and adulterants are the bottlenecks in gas-chromatographic detection. Herein, a HPTLC based technique was developed for the quality assessment of agarwood oil from Northeast India. A 'marker band' (anisylacetone and oxygenated sesquiterpene rich) on HPTLC profile, containing major peaks of the oil and characteristic agarwood aroma was quantified to assess the quality. The developed method was validated in terms of specificity, linearity, sensitivity, recovery and precision. The application of the method in test samples of three different grades indicated a positive correlation between 'marker band' quantity and oil quality. Its abundance in the superior grade oil was >50% and <20% in poor grade. It can be an efficient analytical tool for the quality assessment and grading of agarwood oil.

Cooking with liquefied petroleum gas or biomass and fetal growth outcomes: a multi-country randomised controlled trial

BACKGROUND

Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth.

METHODS

The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda. Pregnant women aged 18-34 years (9-19 weeks of gestation) were randomly assigned in a 1:1 ratio to receive an LPG stove, continuous fuel delivery, and behavioural messaging or to continue usual cooking with biomass for 18 months. We conducted ultrasound assessments at baseline, 24-28 weeks of gestation (the first pregnancy visit), and 32-36 weeks of gestation (the second pregnancy visit), to measure fetal size; we monitored 24 h personal exposures to household air pollutants during these visits; and we weighed children at birth. We conducted intention-to-treat analyses to estimate differences in fetal size between the intervention and control group, and exposure-response analyses to identify associations between household air pollutants and fetal size. This trial is registered with ClinicalTrials.gov (NCT02944682).

FINDINGS

Between May 7, 2018, and Feb 29, 2020, we randomly assigned 3200 pregnant women (1593 to the intervention group and 1607 to the control group). The mean gestational age was 14·5 (SD 3·0) weeks and mean maternal age was 25·6 (4·5) years. We obtained ultrasound assessments in 3147 (98·3%) women at baseline, 3052 (95·4%) women at the first pregnancy visit, and 2962 (92·6%) at the second pregnancy visit, through to Aug 25, 2020. Intervention adherence was high (the median proportion of days with biomass stove use was 0·0%, IQR 0·0-1·6) and pregnant women in the intervention group had lower mean exposures to particulate matter with a diameter less than 2·5 μm (PM2·5; 35·0 [SD 37·2] μg/m3vs 103·3 [97·9] μg/m3) than did women in the control group. We did not find differences in averaged post-randomisation Z scores for head circumference (0·30 vs 0·39; p=0·04), abdominal circumference (0·38 vs 0·39; p=0·99), femur length (0·44 vs 0·45; p=0·73), and estimated fetal weight or birthweight (-0·13 vs -0·12; p=0·70) between the intervention and control groups. Personal exposures to household air pollutants were not associated with fetal size.

INTERPRETATION

Although an LPG cooking intervention successfully reduced personal exposure to air pollution during pregnancy, it did not affect fetal size. Our findings do not support the use of unvented liquefied petroleum gas stoves as a strategy to increase fetal growth in settings were biomass fuels are used predominantly for cooking.

FUNDING

US National Institutes of Health and Bill & Melinda Gates Foundation.

TRANSLATIONS

For the Kinyarwanda, Spanish and Tamil translations of the abstract see Supplementary Materials section.

Molecular insights into the variability and pathogenicity of Fusarium odoratissimum, the causal agent of Panama wilt disease in banana

Fusarium wilt or Panama disease of banana caused by the hemibiotroph fungus, Fusarium odoratissimum, also known as F. oxysporum f.sp. cubense Tropical Race 4 is a serious threat to banana production worldwide. Being the world's largest grower and the origins of bananas in its northeast region, India is particularly vulnerable to this deadly fungus. In the present study, a total of 163 Fusarium isolates from infected banana were characterized for their pathogenic traits. Considering the variability in the Fusarium, the contaminated banana plants were collected from five districts of Uttar Pradesh and Bihar, two major primary infection states of India. All the isolates were screened using universal and specific primers to identify the F. odoratissimum strains. The identified F. odoratissimum strains were subjected to in vivo pathogenicity assessment using the susceptible banana cultivar 'Grand Naine'. The identified six most virulent strains were further characterized for their pathogenicity via in vivo bipartite interaction in terms of biochemical assays. Assessment of in vivo pathogenicity through qRT-PCR for three pathogenesis responsive genes, Six 1a (Secreted in xylem), Snf (Sucrose non-fermenting) and ChsV (Chitinase V), ascertained that the identified F. odoratissimum strains exhibit both intra- and inter-specific variability. The variability of F. odoratissimum strains signifies its importance for the assessment of spread of infection at specific sites to enable efficient management strategy of Fusarium wilt in banana.

Geochemical evaluation, ecological and human health risk assessment of potentially toxic elements in urban soil, Southern India

Roadside soil contamination is mostly caused by human-caused pollutant deposition. PTEs are among the many substances that are harmful for both humans and the environment. PTE concentrations in roadside soil in Chennai, southern India, have been determined in this study. To evaluate the seriousness of the threats, more environmental and geochemical indices have been applied. 83 soil samples have been obtained from the study regions and focusing on important roads. Elemental analysis has been analyzed with ED-XRF and sieve-filtered samples focused on PTEs such as arsenic, barium, cobalt, chromium, copper, iron, potassium, nickel, lead, thorium, titanium, zinc, and uranium. Significant metallic variations have been found in soil samples around roads by the investigation. The elements this study examined section ascending in the following sequence: Fe > Ti > Zn > Cr > Pb > Cu > Ni > Th > As > U > K. In the research area, the CD classification denotes high contamination, whereas the CF indices show mild to significant pollution. PLI indicates moderate to high pollution, whereas EF suggests excessive enrichment. Igeo demonstrates a range from uncontaminated to highly contaminated. PERI showed high levels in the northern study region, whereas GUFI shows several hot spots indicating moderate to severe pollution. The Hazard Index (HI) values for all metals were less than one, demonstrating the absence of non-carcinogenic risks for both adults and children. Multivariate data show natural and anthropogenic PTEs in roadside soil. In addition, a soil quality monitoring system is needed to mitigate continual contamination risks.

Utilisation of public healthcare services by an indigenous group: a mixed-method study among Santals of West Bengal, India

A barrier to meeting the goal of universal health coverage in India is the inequality in utilisation of health services between indigenous and non-indigenous people. This study aimed to explore the determinants of utilisation, or non-utilisation, of public healthcare services among the Santals, an indigenous community living in West Bengal, India. The study holistically explored the utilisation of public healthcare facilities using a framework that conceptualised service coverage to be dependent on a set of determinants - viz. the nature and severity of the ailment, availability, accessibility (geographical and financial), and acceptability of the healthcare options and decision-making around these further depends on background characteristics of the individual or their family/household. This cross-sectional study adopts ethnographic approach for detailed insight into the issue and interviewed 422 adult members of Santals living in both rural (Bankura) and urban (Howrah) areas of West Bengal for demographic, socio-economic characteristics and healthcare utilisation behaviour using pre-tested data collection schedule. The findings revealed that utilisation of the public healthcare facilities was low, especially in urban areas. Residence in urban areas, being female, having higher education, engaging in salaried occupation and having availability of private allopathic and homoeopathic doctors in the locality had higher odds of not utilising public healthcare services. Issues like misbehaviour from the health personnel, unavailability of medicine, poor quality of care, and high patient load were reported as the major reasons for non-utilisation of public health services. The finding highlights the importance of improving the availability and quality of care of healthcare services for marginalised populations because these communities live in geographically isolated places and have low affordability of private healthcare. The health programme needs to address these issues to improve the utilisation and reduce the inequality in healthcare utilisation, which would be beneficial for all segments of Indian population.

Retrieval of high-resolution aerosol optical depth (AOD) using Landsat 8 imageries over different LULC classes over a city along Indo-Gangetic Plain, India

Aerosol optical depth (AOD) serves as a crucial indicator for assessing regional air quality. To address regional and urban pollution issues, there is a requirement for high-resolution AOD products, as the existing data is of very coarse resolution. To address this issue, we retrieved high-resolution AOD over Kanpur (26.4499°N, 80.3319°E), located in the Indo-Gangetic Plain (IGP) region using Landsat 8 imageries and implemented the algorithm SEMARA, which combines SARA (Simplified Aerosol Retrieval Algorithm) and SREM (Simplified and Robust Surface Reflectance Estimation). Our approach leveraged the green band of the Landsat 8, resulting in an impressive spatial resolution of 30 m of AOD and rigorously validated with available AERONET observations. The retrieved AOD is in good agreement with high correlation coefficients (r) of 0.997, a low root mean squared error of 0.035, and root mean bias of - 4.91%. We evaluated the retrieved AOD with downscaled MODIS (MCD19A2) AOD products across various land classes for cropped and harvested period of agriculture cycle over the study region. It is noticed that over the built-up region of Kanpur, the SEMARA algorithm exhibits a stronger correlation with the MODIS AOD product compared to vegetation, barren areas and water bodies. The SEMARA approach proved to be more effective for AOD retrieval over the barren and built-up land categories for harvested period compared with the cropping period. This study offers a first comparative examination of SEMARA-retrieved high-resolution AOD and MODIS AOD product over a station of IGP.

Evaluating seismic risk by MCDM and machine learning for the eastern coast of India

Natural disasters such as earthquakes endanger human lives and infrastructure, particularly in urban areas. With the advancements in science and technology in understanding natural hazards, recent studies have attempted to mitigate them by mapping the risks using geospatial technology. In this paper, we attempt to integrate the multi-criteria decision-making (MCDM) models, namely the Analytical Hierarchy Process (AHP) and the Criteria Importance Through Inter-criteria Correlation (CRITIC), besides using the artificial neural network (ANN) to assess the seismic risk in the eastern coast of India. The AHP-CRITIC technique is used to evaluate the earthquake coping capacity and vulnerability and has been further used to generate a training base for earthquake probability mapping by ANN. The earthquake probability and spatial intensity information are used to develop the hazard map. Following that, integrating vulnerability, hazard and coping capacity spatial information assessed earthquake risk. Our results indicate that approximately 5% of the study area is at high risk, whilst more than 11% of the population is at high risk due to seismic induced hazards. The area under the curve of the receiver operating characteristic curve is 0.85, which indicates reliable results. The results of this study may help various agencies involved in planning, development and disaster mitigation to develop seismic hazard mitigation methods by better understanding their impacts on the eastern coastal region of India.

Seed biology imperative for conservation and restoration of Swertia thomsonii C.B. Clarke-an endemic medicinal plant of Himalaya

Endemic medicinal plants deserve immediate research priorities as they typically show a limited distribution range, represent few and fragmented populations in the wild and are currently facing anthropogenic threats like overharvesting and habitat degradation. One of the important aspects of ensuring their successful conservation and sustainable utilization lies in comprehending the fundamental seed biology, particularly the dormancy status and seed germination requirements of these plants. Here, we studied the seed eco-physiology and regeneration potential of Swertia thomsonii-an endemic medicinal plant of western Himalaya. We investigated the effect of different pre-sowing treatments, sowing media and sowing depth on seed germination parameters of S. thomsonii. Seeds of S. thomsonii exhibit morphophysiological dormancy (MPD), i.e. when the embryo of the seed is morphologically and/or physiologically immature. Wet stratification at 4 °C for 20 days, pre-sowing treatment with 50 ppm GA3 and pre-sowing treatment with 50 ppm KNO3 were found ideal for overcoming dormancy and enhancing the seed germination of S. thomsonii. Furthermore, seed germination and seedling survival were significantly influenced by pre-sowing treatments, sowing media and sowing depth. The percentage of seed germination and seedling survival got enhanced up to 84-86% and 73-75% respectively when seeds were pre-treated with GA3 or KNO3 and then sown in cocopeat + perlite (1:1) at a depth of 1 cm. The information obtained in the present study outlines an efficient protocol for large-scale cultivation of S. thomsonii thereby limiting the pressure of overexploitation from its natural habitats and may also help in the restoration and conservation of this valuable plant species.

Plant cultural indicators of forest resources from the Himalayan high mountains: implications for improving agricultural resilience, subsistence, and forest restoration

AIM

Biocultural legacy practices are intricately tied to forestry resources, ethnic identity, and social cohesiveness. This study aims to determine the plant cultural values of forest resources and identify plant cultural indicators in each ethnic group, which can aid in long-term natural resource management plans in the current debate on socio-environmental and ecological transitions.

METHODS

Semi-structured interviews, focus group discussions, and field observations were employed to collect data for a comprehensive and systematic ethnobotanical survey from February 2018 to October 2022.

RESULTS

A total of 330 informants reported 154 plant species from 65 families. Asteraceae was the most prominent botanical family, with herbaceous plant groups outnumbering trees and shrubs. The Gujjar and Pahari groups exhibited the highest level of overlap, followed by significant overlaps between the Gujjar and Kashmiri communities. The close affinity observed between the Gujjar and Pahari groups suggests the horizontal pattern of local plant knowledge between these communities, influenced by their sociocultural interactions and intermarriages. Notably, the Pahari community displayed a rich understanding of medicinal plants and shared unique uses for the reported taxa. This study affirms that both ecological factors and sociocultural influences have played significant roles in shaping local plant knowledge. A total of 31 plant species have been identified as plant cultural markers among all four ethnic groups. We observed a positive correlation between plant cultural values and plant use with the Gujjar and Kashmiri ethnic groups. Artemisia absinthium reported the highest use value of (0.57) with use reports of (189). Adonis aestivalis, Cynoglossum nervosum, Geum elatum, Geranium himalayense, Juncus inflexus, Oxalis acetosella, Polygonatum biflorum, and Salvia hians from the Himalayan region are among the plant taxa whose ethnomedicinal applications are described here for the first time.

CONCLUSION

Our data show that local and indigenous forest knowledge and practices could significantly contribute to forest conservation and ecological transition. This may happen if stakeholders generate clear frameworks and biocultural conservation strategies aimed at both dynamically preserve natural habitats and ways of traditional management of local natural resources.

Mental health markers and protective factors in students with symptoms of physical pain across WEIRD and non-WEIRD samples - a network analysis

BACKGROUND

Studies conducted in Western societies have identified variables associated with chronic pain, but few have done so across cultures. Our study aimed to clarify the relationship between specific mental health markers (i.e., depression, anxiety, posttraumatic stress disorder [PTSD], perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students across non-WEIRD and WEIRD samples.

METHOD

A total of 188 university students (131 women and 57 men) were included in the study. We used network analysis to ascertain mental health markers especially central to the experience of physical pain.

RESULTS

No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Anxiety was the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain.

CONCLUSION

Our results identify factors that may serve as important treatment targets for pain interventions among students of both countries before it becomes chronic.

Soil organic carbon fractionation, carbon index, and microbial activity under different agroforestry systems in North Eastern Himalayas, India

The potential of soil organic carbon fractions for agroforestry systems (AFSs) is not well understood. Five distinct AFSs were tested for its impact on soil organic carbon fractionation, carbon index, and microbial activity in North Eastern Himalayas, India. The mean labile carbon (LC) ranged from 4.55 to 5.43 kg soil-1 across the land use systems. Napier system observed the lowest very labile carbon (VLC) 12.36 kg soil-1 in 60-75-cm depth. The mean non labile carbon (NLC) ranged from 15.67 to 16.83 g kg soil-1 across the land use. Highest less labile carbon (LLC) was observed in agri-horti-silviculture (AHS) followed by agri-silvi-horticulture (ASH) land use system. The black gram + mandarin + Alnus nepalensis land use recorded higher lability index (1.66) followed by maize + Schima wallichii (1.65) in 0-15-cm depth. Among the different land use systems, carbon pool index increased in all the depths over buckwheat + mandarin. The mean carbon management index (CMI) value ranged from 167.02 to 210.12 among the land use system. The mean CMI was highest in black gram + mandarin + Alnus nepalensis (210.12) followed by soybean + Ficus hookerii + guava (191.56), maize + Schima wallichii (281.71), and lowest in buckwheat + mandarin (167.02). Among the AFSs, black gram + mandarin + Alnus nepalensis showed greater amount of carbon pool index, lability index, and carbon management index and, hence, considered the best sustainable agroforestry system to sequester more carbon in the Sikkim Himalaya. Such system also retained more different organic carbon fractions. The mean CMI value ranged from 167.02 to 210.12 among AFSs. Acid phosphatase activity was more during the rainy season followed by winter and summer season. Similar trends were followed by the urease activity in all the three seasons. Overall conclusion from this investigation is that SOC fractions, carbon index, and microbial activity levels are strongly influenced by the prevailing agroforestry systems.

A mixed methods evaluation of the impact of ECHO® telementoring model for capacity building of community health workers in India

INTRODUCTION

India has the largest cohort of community health workers with one million Accredited Social Health Activists (ASHAs). ASHAs play vital role in providing health education and promoting accessible health care services in the community. Despite their potential to improve the health status of people, they remain largely underutilized because of their limited knowledge and skills. Considering this gap, Extension for Community Healthcare Outcomes (ECHO)® India, in collaboration with the National Health System Resource Centre (NHSRC), implemented a 15-h (over 6 months) refresher training for ASHAs using a telementoring interface. The present study intends to assess the impact of the training program for improving the knowledge and skills of ASHA workers.

METHODS

We conducted a pre-post quasi-experimental study using a convergent parallel mixed-method approach. The quantitative survey (n = 490) assessed learning competence, performance, and satisfaction of the ASHAs. In addition to the above, in-depth interviews with ASHAs (n = 12) and key informant interviews with other stakeholders (n = 9) examined the experience and practical applications of the training. Inferences from the quantitative and qualitative approaches were integrated during the reporting stage and presented using an adapted Moore's Expanded Outcomes Framework.

RESULTS

There was a statistically significant improvement in learning (p = 0.038) and competence (p = 0.01) after attending the training. Participants were satisfied with the opportunity provided by the teleECHO™ sessions to upgrade their knowledge. However, internet connectivity, duration and number of participants in the sessions were identified as areas that needed improvement for future training programs. An improvement in confidence to communicate more effectively with the community was reported. Positive changes in the attitudes of ASHAs towards patient and community members were also reported after attending the training. The peer-to-peer learning through case-based discussion approach helped ensure that the training was relevant to the needs and work of the ASHAs.

CONCLUSIONS

The ECHO Model ™ was found effective in improving and updating the knowledge and skills of ASHAs across different geographies in India. Efforts directed towards knowledge upgradation of ASHAs are crucial for strengthening the health system at the community level. The findings of this study can be used to guide future training programs. Trial registration The study has been registered at the Clinical Trials Registry, India (CTRI/2021/10/037189) dated 08/10/2021.

Concordance of multigene genealogy along with morphological evidence unveils five novel species and two new records of boletoid mushrooms (fungi) from India

Agaricales, Russulales and Boletales are dominant orders among the wild mushrooms in Basidiomycota. Boletaceae, one of the major functional elements in terrestrial ecosystem and mostly represented by ectomycorrhizal symbionts of trees in Indian Himalaya and adjoining hills, are extraordinarily diverse and represented by numerous genera and species which are unexplored or poorly known. Therefore, their hidden diversity is yet to be revealed. Extensive macrofungal exploration by the authors to different parts of Himalaya and surroundings, followed by through morphological studies and multigene molecular phylogeny lead to the discovery of five new species of wild mushrooms: Leccinellum bothii sp. nov., Phylloporus himalayanus sp. nov., Phylloporus smithii sp. nov., Porphyrellus uttarakhandae sp. nov., and Retiboletus pseudoater sp. nov. Present communication deals with morphological details coupled with illustrations and phylogenetic inferences. Besides, Leccinellum sinoaurantiacum and Xerocomus rugosellus are also reported for the first time from this country.

Study on endolichenic fungal assemblage in Parmotrema and Heterodermia lichens of Shivamoga, Karnataka

BACKGROUND

Lichen is a symbiotic association of algae and fungi, recognized as a self-sustaining ecosystem that constitutes an indeterminant number of bacteria, actinomycetes, fungi, and protozoa. We evaluated the endolichenic fungal assemblage given the dearth of knowledge on endolichenic fungi (ELFs), particularly from part of the Central Western Ghats, Karnataka, and conducted a phylogenetic analysis of xylariaceous fungi, the most diversified group of fungi using ITS and ITS+Tub2 gene set.

RESULTS

Out of 17 lichen thalli collected from 5 ecoregions, 42 morphospecies recovered, belong to the class Sordariomycetes, Eurotiomycetes, Dothideomycetes, Leotiomycetes, Saccharomycetes. About 19 and 13 ELF genera have been reported from Parmotrema and Heterodermia thallus. Among the ecoregions EC2 showing highest species diversity (Parmotrema (1-D) = 0.9382, (H) = 2.865, Fisher-α = 8.429, Heterodermia (1-D) = 0.8038, H = 1.894, F-α = 4.57) followed the EC3 and EC1. Xylariales are the predominant colonizer reported from at least one thallus from four ecoregions. The morphotypes ELFX04, ELFX05, ELFX08 and ELFX13 show the highest BLAST similarity (> 99%) with Xylaria psidii, X. feejeensis, X. berteri and Hypoxylon fragiforme respectively. Species delimitation and phylogenetic position reveal the closest relation of Xylariaceous ELFs with plant endophytes.

CONCLUSIONS

The observation highlights that the deciduous forest harness a high number of endolichenic fungi, a dominant portion of these fungi are non-sporulating and still exist as cryptic. Overall, 8 ELF species recognized based on phylogenetic analysis, including the two newly reported fungi ELFX03 and ELFX06 which are suspected to be new species based on the present evidence. The study proved, that the lichen being rich source to establish fungal diversity and finding new species. Successful amplification of most phylogenetic markers like RPB2, building of comprehensive taxonomic databases and application of multi-omics data are further needed to understand the complex nature of lichen-fungal symbiosis.

Comparing attitudes towards compulsory interventions in severe and persistent mental illness among psychiatrists in India and Switzerland

BACKGROUND

Psychiatrists face a major ethical challenge when deciding whether to make use of coercive measures in the treatment process of patients suffering from severe and persistent mental illness (SPMI). As India and Switzerland show major cultural, political and financial differences, it is hypothesized that attitudes towards coercive measures among Indian and Swiss psychiatrists will vary too. Exploring differences in attitudes between cultures strengthens the critical reflection on one's own stances and in consequence, on our way of action. Especially when it comes to situations involving power imbalances between patients and health practitioners, self-reflection is essential to prevent ethically inappropriate behavior.

METHODS

An online survey on aspects of care for patients with SPMI was sent to 3'056 members of the Indian Psychiatric Society between April and June 2020 and to 1'311 members of the Swiss Society for Psychiatry and Psychotherapy between February and March 2016. The respondents' answers were compared. This article deals with the questionnaire's items on autonomous decision making and the implementation of coercive measures in clinical practice. More precisely, participating psychiatrists were asked to rate the importance of patient's autonomy in general and their willingness to apply coercive measures regarding two specific case vignettes depicting a patient with schizophrenia and one with depression. The statistical analysis, namely descriptive data analysis and calculation of arithmetic means, Shapiro Wilks tests and Mann-Whitney U tests, was carried out using IBM SPSS Statistics version 27.

RESULTS

Answers were received from 206 psychiatrists in India and 457 psychiatrists in Switzerland. Indian participants tended to value autonomous decision making as slightly less important than Swiss participants (62.2% vs. 91%, p =.01). Regarding a case of severe and persistent depression, psychiatrists in the Indian group were on average more in favor of acting against the wishes of the patient (55% vs. 34.1%, p <.0001) as well as of accepting a temporary decrease in quality of life due to coercion (40% vs. 23%, p =.008). Answers concerning a case of schizophrenia revealed that Indian participants were more in favor of acting against the patient's wishes than Swiss participants (39% vs. 37%, p =.007), whereas the comparison whether to accept a temporary decrease in quality of life regarding this case showed no significant difference (p =.328).

CONCLUSIONS

The significant difference in attitudes towards coercive measures among Indian compared to Swiss psychiatrists found in this study might arise from a predominantly more collectivist society in India compared to Switzerland. Moreover, differences in financial resources, the organization of the health care system, and the historical background might have an influence. Continuous and critical reflection on one's own views and behavior is essential, especially if ethical principles and individual rights could be violated through a power imbalance, as in the case of coercive measures.

Largest known madtsoiid snake from warm Eocene period of India suggests intercontinental Gondwana dispersal

Here we report the discovery of fossils representing partial vertebral column of a giant madtsoiid snake from an early Middle Eocene (Lutetian, ~ 47 Ma) lignite-bearing succession in Kutch, western India. The estimated body length of ~ 11-15 m makes this new taxon (Vasuki indicus gen et sp. nov.) the largest known madtsoiid snake, which thrived during a warm geological interval with average temperatures estimated at ~ 28 °C. Phylogenetically, Vasuki forms a distinct clade with the Indian Late Cretaceous taxon Madtsoia pisdurensis and the North African Late Eocene Gigantophis garstini. Biogeographic considerations, seen in conjunction with its inter-relationship with other Indian and North African madtsoiids, suggest that Vasuki represents a relic lineage that originated in India. Subsequent India-Asia collision at ~ 50 Ma led to intercontinental dispersal of this lineage from the subcontinent into North Africa through southern Eurasia.

Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach

BACKGROUND

Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial.

METHODS

One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers.

RESULTS

The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences.

CONCLUSIONS

UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings.

TRIAL REGISTRATION

ISRCTN26008944 (Registration Date: 30/10/2019).

Decoding the molecular phylogenetics of ornamental catfishes (siluriformes) of North East India using DNA barcoding approach

BACKGROUND

Catfishes (order Siluriformes) are among the most diverse and widely distributed fish groups in the world. They are not only used for human consumption but are also a major part of the ornamental fish trade. Being a Biodiversity Hotspot, the North Eastern Region of India is home to a diverse population of ornamental fishes. Catfishes contain a humongous number of species; in this study, the authors have tried to elucidate the phylogenetic relationship of some important ornamental catfishes found in North East India using DNA barcodes.

METHODS AND RESULTS

In this study, we have tried to explore the phylogenetic history of 13 species (41 specimens) of ornamental catfishes spanning 12 genera and 9 families of Siluriformes using DNA barcoding. Pairwise genetic distances using Kimura 2-Parameter (K2P) were calculated at intra-specific and inter-specific levels. A Neighbor-Joining tree was constructed to understand the phylogenetic relationship among the nine different catfish families. All the specimens under this study clustered with their respective species under the same family and formed three sub-clades. However, Olyra longicaudata, belonging to the Bagridae family, did not cluster with other species from the same family. In this study, the authors have suggested a revision of the classification of O. longicaudata back to its original family, Olyridae.

CONCLUSIONS

In this study, the maximum intraspecific genetic distance of 0.03 and the minimum interspecific genetic distance of 0.14 were observed among the species. Therefore, it is evident that there is a barcoding gap among the species, which helped in the correct identification of the species. Thus, DNA barcoding helped complement the phenetic approach and also revealed a different phylogenetic relationship among the catfishes belonging to the Bagridae family.

Low diversity, high dominance, and high host prevalence of parasitic isopods of the family Cymothoidae in Chilika lagoon, India: a comparative study between a semi-enclosed ecosystem and its adjoining open region

Patterns in parasite diversity are shaped by their environmental and ecological settings, and to better understand their interactions with hosts and the corresponding biology, it is crucial to understand these context-dependent patterns. To achieve this, we use cymothoid isopods, an important group of fish parasites, to test a long-standing hypothesis about parasite diversity and prevalence pattern: whether semi-enclosed water bodies allow low diversity and high prevalence of parasitic isopods. Specifically, we compare these patterns between Chilika lagoon (Odisha, India), a semi-enclosed water body, and the adjoining Odisha coast (India). Our finding reveals that the semi-enclosed Chilika lagoon has a considerably lower diversity of parasitic isopods than its adjoining open sea along the Odisha coast. Additionally, the parasitic isopod infection levels in Chilika lagoon are noticeably higher, and isopod assemblage is less even than those in coastal waters along the Odisha coast. Our results support the hypothesised association between enclosed water bodies, parasite diversity, and host prevalence and contribute to an enhanced comprehension of the ecology of parasitic isopods in distinct marine environments.

Assessment of coastal river water quality in Bangladesh: Implications for drinking and irrigation purposes

Saltwater intrusion in the coastal areas of Bangladesh is a prevalent phenomenon. However, it is not conducive to activities such as irrigation, navigation, fish spawning and shelter, and industrial usage. The present study analyzed 45 water samples collected from 15 locations in coastal areas during three seasons: monsoon, pre-monsoon, and post-monsoon. The aim was to comprehend the seasonal variation in physicochemical parameters, including water temperature, pH, electrical conductivity (EC), salinity, total dissolved solids (TDS), hardness, and concentrations of Na+, K+, Mg2+, Ca2+, Fe2+, HCO3-, PO43-, SO42-, and Cl-. Additionally, parameters essential for agriculture, such as soluble sodium percentage (SSP), sodium absorption ratio (SAR), magnesium absorption ratio (MAR), residual sodium carbonate (RSC), Kelly's ratio (KR), and permeability index (PI), were examined. Their respective values were found to be 63%, 16.83 mg/L, 34.92 mg/L, 145.44 mg/L, 1.28 mg/L, and 89.29%. The integrated water quality index was determined using entropy theory and principal component analysis (PCA). The resulting entropy water quality index (EWQI) and SAR of 49.56% and 63%, respectively, indicated that the samples are suitable for drinking but unsuitable for irrigation. These findings can assist policymakers in implementing the Bangladesh Deltaplan-2100, focusing on sustainable land management, fish cultivation, agricultural production, environmental preservation, water resource management, and environmental protection in the deltaic areas of Bangladesh. This research contributes to a deeper understanding of seasonal variations in the hydrochemistry and water quality of coastal rivers, aiding in the comprehension of salinity intrusion origins, mechanisms, and causes.

Purification and Characterization of Desferrioxamine B of Pseudomonas fluorescens and Its Application to Improve Oil Content, Nutrient Uptake, and Plant Growth in Peanuts

Microorganisms produce siderophores, which are low-molecular-weight iron chelators when iron availability is limited. The present analyzed the role of LNPF1 as multifarious PGPR for improving growth parameters and nutrient content in peanut and soil nutrients. Such multifarious PGPR strains can be used as effective bioinoculants for peanut farming. In this work, rhizosphere bacteria from Zea mays and Arachis hypogaea plants in the Salem area of Tamil Nadu, India, were isolated and tested for biochemical attributes and characteristics that stimulate plant growth, such as the production of hydrogen cyanide, ammonia (6 µg/mL), indole acetic acid (76.35 µg/mL), and solubilizing phosphate (520 µg/mL). The 16S rRNA gene sequences identified the isolate LNPF1 as Pseudomonas fluorescens with a similarity percentage of 99% with Pseudomonas sp. Isolate LNPF1 was evaluated for the production of siderophore. Siderophore-rich supernatant using a Sep Pack C18 column and Amberlite-400 Resin Column (λmax 264) produced 298 mg/L and 50 mg/L of siderophore, respectively. The characterization of purified siderophore by TLC, HPLC, FTIR, and 2D-NMR analysis identified the compound as desferrioxamine, a hydroxamate siderophore. A pot culture experiment determined the potential of LNPF1 to improve iron and oil content and photosynthetic pigments in Arachis hypogaea L. and improve soil nutrient content. Inoculation of A. hypogea seeds with LNPF1 improved plant growth parameters such as leaf length (60%), shoot length (22%), root length (54.68%), fresh weight (47.28%), dry weight (37%), and number of nuts (66.66) compared to the control (untreated seeds). This inoculation also improved leaf iron content (43.42), short iron content (38.38%), seed iron (46.72%), seed oil (31.68%), carotenoid (64.40%), and total chlorophyll content (98.%) compared to control (untreated seeds). Bacterized seeds showed a substantial increase in nodulation (61.65%) and weight of individual nodules (95.97) vis-à-vis control. The results of the present study indicated that P. fluorescens might be utilized as a potential bioinoculant to improve growth, iron content, oil content, number of nuts and nodules of Arachishypogaea L., and enrich soil nutrients.

Co-production of metallo-β-lactamase and OXA-type β-lactamases in carbapenem-resistant Acinetobacter baumannii clinical isolates in North East India

Carbapenem-resistant Acinetobacter baumannii poses a significant threat to public health globally, especially due to its ability to produce multiple carbapenemases, leading to treatment challenges. This study aimed to investigate the antibiotic resistance pattern of carbapenem-resistant A. baumannii isolates collected from different clinical settings in North East India, focusing on their genotypic and phenotypic resistance profiles. A total of 172 multidrug-resistant A. baumannii isolates were collected and subjected to antibiotic susceptibility test using the Kirby-Bauer disk diffusion method. Various phenotypic tests were performed to detect extended-spectrum β-lactamase (ESBL), metallo-β-lactamase (MBL), class C AmpC β-lactamase (AmpC), and carbapenem hydrolyzing class D β-lactamase (CHDL) production among the isolates. Overexpression of carbapenemase and cephalosporinase genes was detected among the isolates through both phenotypic and genotypic investigation. The antibiotic resistance profile of the isolates revealed that all were multidrug-resistant; 25% were extensively drug-resistant, 9.30% were pan-drug-resistant, whereas 91.27% were resistant to carbapenems. In the genotypic investigation, 80.81% of isolates were reported harbouring at least one metallo-β-lactamase encoding gene, with blaNDM being the most prevalent at 70.34%, followed by blaIMP at 51.16% of isolates. Regarding class D carbapenemases, blaOXA-51 and blaOXA-23 genes were detected in all the tested isolates, while blaOXA-24, blaOXA-48, and blaOXA-58 were found in 15.11%, 6.97%, and 1.74% isolates respectively. Further analysis showed that 31.97% of isolates co-harboured ESBL, MBL, AmpC, and CHDL genes, while 31.39% of isolates co-harboured ESBL, MBL, and CHDL genes with or without ISAba1 leading to extensively drug-resistant or pan drug-resistant phenotypes. This study highlights the complex genetic profile and antimicrobial-resistant pattern of the isolates circulating in North East India, emphasizing the urgent need for effective infection control measures and the development of alternative treatment strategies to combat these challenging pathogens.