Pattern of Violence Among Healthcare Workers in a Tertiary Care Government Hospital and a Multi-Specialty Private Hospital in Sagar, India: A Cross-Sectional Study

Background Workplace violence in hospitals is an occupational hazard that affects healthcare workers (HCWs) negatively in many aspects and causes deterioration of the doctor-patient relationship, resulting in providence of substandard healthcare. This study was conducted to compare the pattern of violence in a tertiary care government teaching hospital and a multi-specialty private trust hospital in Sagar district, Madhya Pradesh, India. Methodology After ethical clearance of this cross-sectional, observational study, participants (frontline healthcare workers, including doctors and nurses) were asked about the type, frequency, department, and place of violence, etc., along with its perceived causes, solutions, and arrangements made by hospitals for dealing with it using a pretested, semi-structured questionnaire. Data analysis was performed using IBM SPSS Version 26.0 (IBM Corp., Armonk, NY). Categorical variables were described using frequency and percentages, and inferential analysis was conducted using the chi-square/Fisher's exact test. A P-value of <0.05 was considered statistically significant. Results Among the 113 participants, 67 (59.3%) were female, 53 (46.9%) were doctors, and 60 (53.1%) were nurses. The mean age of participants was 30.9±7.3 years. Predominantly verbal, emotional, and physical violence were present in 96.5%, 43.4%, and 6.2% of participants, respectively. Violent incidents against healthcare workers were more frequent in government hospitals as compared to private hospitals. Most healthcare workers (87.6%) tried to resolve violent incidents peacefully, and 1.8% tried to fight back. The most perceived cause of violence in both setups was a lack of morality and literacy among patients and their relatives (i.e., 83.2%), followed by a lack of proper facilities and a lack of trust in healthcare workers. Conclusion Both setups faced a substantial amount of violence. The loopholes in both setups, considering resources, security, and other facilities, are clearly visible, and specific steps must be adopted to protect both systems from violence.

Entangling microwaves with light

Quantum entanglement is a key resource in currently developed quantum technologies. Sharing this fragile property between superconducting microwave circuits and optical or atomic systems would enable new functionalities, but this has been hindered by an energy scale mismatch of >10⁴ and the resulting mutually imposed loss and noise. In this work, we created and verified entanglement between microwave and optical fields in a millikelvin environment. Using an optically pulsed superconducting electro-optical device, we show entanglement between propagating microwave and optical fields in the continuous variable domain. This achievement not only paves the way for entanglement between superconducting circuits and telecom wavelength light, but also has wide-ranging implications for hybrid quantum networks in the context of modularization, scaling, sensing, and cross-platform verification.

Predictors of Neonatal Mortality: A Retrospective Cross-Sectional Study From the Special Newborn Care Unit of a Tertiary Care Hospital

Background In India, a significant number of newborns die each year, with Madhya Pradesh having the highest neonatal mortality rate. However, there is a lack of information on factors that can predict neonatal mortality. Objective This study aimed to examine the factors influencing neonatal mortality among neonates admitted to a tertiary care centre's special newborn care unit (SNCU). Methods This retrospective record-based observational study was done at a tertiary care centre, where data from the special newborn care unit (SNCU) from 1st January 2021 to 31st December 2021 was used. We included data of all newborns who were treated in SNCU during the said period and excluded those who got referred or left against medical advice. We abstracted data on age at admission, gender, category, maturity status, birth weight, place of delivery, mode of transport, type of admission, indication of admission, duration of stay and outcome. Qualitative variables were described using frequency and percentage. The chi-square test was used to find out the association of different variables with the outcome, while multivariate logistic regression was conducted to identify risk factors of neonatal mortality. A p-value of <0.05 was considered significant. Results We finalized data of 1052 neonates for analysis. Among them, 846 neonates were successfully discharged while 206 neonates were deceased. The major cause of admission was perinatal asphyxia followed by prematurity. The major cause of mortality in this study was sepsis followed by respiratory distress syndrome, birth asphyxia, and prematurity. Mortality of neonates was significantly associated with maturity status, birth weight, place of delivery, age during admission and duration of stay. Prematurity (OR=3.762, 95% CI:1.93-7.33), birth weight 1000-1499g (OR=4.78, 95% CI:2.21-10.32), birth weight <1000g (OR=25.11, 95% CI:5.71-110.24), age at admission <1-day (OR=2.312, 95% CI:1.03-5.19), duration of stay 1-3-days (OR=12.98, 95% CI:7.48-22.52) and <1-day (OR=1271.88, 95% CI:121.39-13325.69) were significant predictors of mortality in our study. Conclusion Our study emphasizes monitoring and addressing risk factors like maturity status, birth weight, and age at admission to reduce neonatal mortality, with a focus on early management of preterm births and low birth weight.

The Agreement Between Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and Rapid Antigen Test (RAT) in Diagnosing COVID-19

Background

False-negative results derived from RT-PCR tests for diagnosing coronavirus disease (COVID-19) have raised questions about whether to consider them the gold standard for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Using an imperfect gold standard to assess other diagnostic tests would never let the other tests show better diagnostic performance. The best strategy in such cases is to do an agreement analysis, and this study aims to estimate the agreement between real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and rapid antigen test (RAT) for COVID-19 detection.

Methods

A retrospective study was done using paired data of individuals tested for COVID-19, both by RT-PCR and RAT, obtained from the virology laboratory of Government Bundelkhand Medical College, Sagar, Madhya Pradesh, India. A sample size of 93 was calculated, and the data were abstracted in a data abstraction sheet. Variables included were results of RT-PCR and RAT, age, gender, presence of symptoms, test kit used, and the time duration between sampling for RT-PCR and RAT. Apart from descriptive statistics, keeping in mind the binary outcome of RT-PCR and RAT, Cohen’s kappa was calculated for agreement analysis. A p-value of <0.05 was considered significant.

Results

The data on 100 participants suspected to be infected with COVID-19 (58 male and 42 female) with a mean age of 39.8 (±19.0) years were analysed. The number of discordant pairs was eight. Cohen’s kappa showed substantial agreement between RT-PCR and RAT, κ=0.646, (95% CI 0.420 to 0.871), p<0.001.

Conclusion

Considering the ease of conducting RAT with quick results and substantial agreement with RT-PCR, RAT could be a better choice in detecting SARS-CoV-2 and, hence, COVID-19 disease on a large scale.

Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers

BACKGROUND

Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs.

METHODS

We completed semi-structured interviews and focus group discussions with adolescents (n  =  191), parents (n  =  9), teachers (n  =  78), school counsellors (n  =  15), clinical psychologists/psychiatrists (n  =  7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers.

RESULTS

All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents.

CONCLUSION

SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.

Congenital paediatric atlantoaxial dislocation: clinico-radiological profile and surgical outcome

INTRODUCTION

Congenital atlantoaxial dislocation (AAD) is the most common bony abnormality affecting the craniovertebral junction. The paediatric population has specific problems like preoperative diagnostic difficulties, precise neurological examination, radiological diagnosis, surgical problems including physical fitness to tolerate surgery (including problems of anaesthesia), technical difficulties in surgery and problems related to immobilization.

MATERIAL AND METHODS

A total of 229 consecutive paediatric (≤18 years) patients of AAD visited our centre from the period of January 1997 to August 2011. Twenty-nine cases were excluded from the study as these cases were diagnosed as CVJ tuberculosis, 31 cases were excluded as they were traumatic and the remaining 169 cases were retrospectively analysed. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The preoperative and the postoperative clinical evaluation of the patient was done by the Kumar and Kalra myelopathic scoring system. The score was recorded in the preoperative period, at the time of discharge, at 3 months follow-up and at 6 months follow-up.

RESULTS

Ninety-four were males and 75 were females. The age range was 4 to 18 years with mean age 9.96±3.78 years. The follow-up ranged from 3 to 120 months with mean follow-up being 39.03±13.38 months. One hundred five cases were of fixed/irreducible AAD, and 64 were cases of mobile/reducible AAD. Majority of these cases presented with features of pyramidal tract involvement, and 108 cases had compromised pulmonary function test. One hundred thirty-seven cases had improved outcome, and 18 cases were in the same grade in the postoperative period with only 14 cases either deteriorated or died.

CONCLUSIONS

Congenital paediatric AAD are a different subset of abnormalities and have a satisfactory outcome. Preoperative evaluation must also include identification of various syndromes associated with paediatric AAD and respiratory reserve. Cormack-Lehane grade can be helpful in selecting borderline cases for postoperative need of tracheostomy. Majority of the cases have a good outcome, and therefore, surgery should be offered even in severe grade.

Mandibular canal variant: a case report

The mandibular canal transmits the inferior alveolar artery, vein and the inferior alveolar nerve. From an embryological perspective, there might be three inferior dental nerves innervating three groups of mandibular teeth. During rapid prenatal growth and remodeling in the ramus region there is spread of intramembranous ossification that eventually forms the mandibular canal. Occurrence of bifid/trifid mandibular canals in some patients is secondary to incomplete fusion of these three nerves. Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal.

Bivariate- distribution for transition matrix elements in Breit-Wigner to Gaussian domains of interacting particle systems

Interacting many-particle systems with a mean-field one-body part plus a chaos generating random two-body interaction having strength lambda exhibit Poisson to Gaussian orthogonal ensemble and Breit-Wigner (BW) to Gaussian transitions in level fluctuations and strength functions with transition points marked by lambda = lambda c and lambda = lambda F, respectively; lambda F >> lambda c. For these systems a theory for the matrix elements of one-body transition operators is available, as valid in the Gaussian domain, with lambda > lambda F, in terms of orbital occupation numbers, level densities, and an integral involving a bivariate Gaussian in the initial and final energies. Here we show that, using a bivariate-t distribution, the theory extends below from the Gaussian regime to the BW regime up to lambda = lambda c. This is well tested in numerical calculations for 6 spinless fermions in 12 single-particle states.

Single-particle entropy in (1+2)-body random matrix ensembles

Random matrix ensembles defined by a mean-field one-body plus a chaos generating random two-body interaction (called embedded Gaussian orthogonal ensembles of (1+2)-body interactions[EGOE(1+2)]) predict for the entropy defined by the occupation numbers of single-particle states, in the chaotic domain, an essentially one parameter Gaussian form for their energy dependence. Numerical embedded ensemble calculations are compared with the theory. In addition, it is shown that the single-particle entropy, thermodynamic entropy defined by the state density and information entropy defined by wave functions in the mean-field basis for EGOE(1+2) describe the results known for interacting Fermi systems such as those obtained from nuclear shell model.

Heavy metal pollution of river Yamuna in the industrially developing state of Haryana

Heavy metal concentrations viz. Fe, Ni, Pb, Cd, Co, Zn in the river Yamuna flowing along the state of Haryana through Delhi have been reported selecting 16 stations covering the upstream and downstream stations for major industrial complexes of the state. While Fe, Ni and Co concentrations exceeded the maximum permissible limits prescribed for drinking all along the river, the Cd concentrations crossed the acceptable standards in Delhi downstream. The Pb concentrations declined in the eutrophicated Delhi downstream while Zn concentrations remained within desirable limits throughout. Peak concentrations were recorded in Delhi downstream for Fe and at Sonepat-Gohana downstream for Ni, Co & Zn, which matched with the type of industrial inputs viz. Iron-works and the electroplating, galvanizing & cycle industries, respectively. The status of heavy metal pollution of the river has been discussed with respect to possible impacts on human health and aquatic life.

Structure of wave functions in (1+2)-body random matrix ensembles

Random matrix ensembles defined by a mean-field one body plus a chaos generating random two-body interaction [called embedded ensembles of (1+2)-body interactions] predict for wave functions, in the chaotic domain, an essentially one-parameter Gaussian forms for the energy dependence of the number of principal components (NPC) and the localization length l(H) (defined by information entropy), which are two important measures of chaos in finite interacting many-particle systems. Numerical embedded ensemble calculations and nuclear shell-model results, for NPC and l(H), are compared with the theory. These analyses clearly point out that for realistic finite interacting many-particle systems, in the chaotic domain, wave-function structure is given by (1+2)-body embedded random matrix ensembles.

Theory for matrix elements of one-body transition operators in the quantum chaotic domain of interacting particle systems

Demonstrating the equivalence between the recent theory of Flambaum and collaborators which is based on smoothed strength functions, with the much earlier formulation due to French and collaborators which is based on embedded random matrix ensembles and smoothed transition strength densities, we derive a theory for matrix elements of one-body transition operators in the quantum chaotic domain of isolated finite interacting particle systems with a mean-field and a chaos generating two-body interaction (V). The role of the bivariate correlation coefficient (zeta) arising out of the noncommutability of V and the transition operator (in the theory of Flambaum et al., zeta=0) is tested in numerical embedded ensemble calculations with a one- plus two-body Hamiltonian generating order-chaos transitions.