Deciphering the mechanisms, hormonal signaling, and potential applications of endophytic microbes to mediate stress tolerance in medicinal plants.

The global healthcare market in the post-pandemic era emphasizes a constant pursuit of therapeutic, adaptogenic, and immune booster drugs. Medicinal plants are the only natural resource to meet this by supplying an array of bioactive secondary metabolites in an economic, greener and sustainable manner. Driven by the thrust in demand for natural immunity imparting nutraceutical and life-saving plant-derived drugs, the acreage for commercial cultivation of medicinal plants has dramatically increased in recent years. Limited resources of land and water, low productivity, poor soil fertility coupled with climate change, and biotic (bacteria, fungi, insects, viruses, nematodes) and abiotic (temperature, drought, salinity, waterlogging, and metal toxicity) stress necessitate medicinal plant productivity enhancement through sustainable strategies. Plants evolved intricate physiological (membrane integrity, organelle structural changes, osmotic adjustments, cell and tissue survival, reclamation, increased root-shoot ratio, antibiosis, hypersensitivity, etc.), biochemical (phytohormones synthesis, proline, protein levels, antioxidant enzymes accumulation, ion exclusion, generation of heat-shock proteins, synthesis of allelochemicals. etc.), and cellular (sensing of stress signals, signaling pathways, modulating expression of stress-responsive genes and proteins, etc.) mechanisms to combat stresses. Endophytes, colonizing in different plant tissues, synthesize novel bioactive compounds that medicinal plants can harness to mitigate environmental cues, thus making the agroecosystems self-sufficient toward green and sustainable approaches. Medicinal plants with a host set of metabolites and endophytes with another set of secondary metabolites interact in a highly complex manner involving adaptive mechanisms, including appropriate cellular responses triggered by stimuli received from the sensors situated on the cytoplasm and transmitting signals to the transcriptional machinery in the nucleus to withstand a stressful environment effectively. Signaling pathways serve as a crucial nexus for sensing stress and establishing plants' proper molecular and cellular responses. However, the underlying mechanisms and critical signaling pathways triggered by endophytic microbes are meager. This review comprehends the diversity of endophytes in medicinal plants and endophyte-mediated plant-microbe interactions for biotic and abiotic stress tolerance in medicinal plants by understanding complex adaptive physiological mechanisms and signaling cascades involving defined molecular and cellular responses. Leveraging this knowledge, researchers can design specific microbial formulations that optimize plant health, increase nutrient uptake, boost crop yields, and support a resilient, sustainable agricultural system.

Emission color tuning and dual-mode luminescence thermometry design in Dy3+/Eu3+co-doped SrMoO4phosphors.

The challenge of building a highly reliable contactless temperature probe with high sensitivity, good temperature-induced color discriminability, and economical synthesis has prompted the research community to work in the field of rare-earth-based luminescence thermometry. Moreover, the fast-growing market for optoelectronic devices has increased the demand for tunable color-emitting phosphors. In this study, Dy3+/Eu3+co-doped SrMoO4phosphors were developed as tunable color-emitting source and dual-mode luminescence thermometer. A facile and cost-effective auto-combustion method was used to synthesize the phosphors. Our work demonstrates a viable scheme for tailoring the emission of single-phase phosphors by precisely controlling the dopant concentrations and by modulating excitation wavelength. The overall emission is tuned from greenish-yellow to white and greenish-yellow to reddish-orange. A detailed energy transfer process from the host to the Ln3+ions and between the Ln3+ions is discussed. Further, anti-thermal quenching in the emission of Dy3+ion is observed when excited with 297 nm. The dual-mode luminescence thermometry has been studied by analyzing the fluorescence intensity ratio of Dy3+and Eu3+ions upon excitation at 297 nm. The maximum relative sensitivity value for 4% Eu3+co-doped SrMoO4:4%Dy3+phosphor is 1.46% K-1at 300 K. Furthermore, the configurational coordinate diagram is presented to elucidate the nature of temperature-dependent emission. Therefore, our research opens up new avenues for the development of color-tunable luminescent materials for various optoelectronic and temperature-sensing applications.

To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India.

BACKGROUND: In India, there are only a few studies done in the area of assessing the risk factors of Tuberculosis (TB) among the homeless population. The homeless population has quite a higher chance of developing Pulmonary Tuberculosis (PTB) as compared with the general population due to the presence of an inappropriate environment and high prevalence of risk factors. METHODS: This study was done among the homeless population in both males and females aged 18 years and above in areas of Delhi (Yamuna Pusta and Mansarovar Park). The participants were screened for TB symptoms and risk factors to diagnose active PTB in them. RESULTS: Out of 200 participants, 17 were diagnosed with active PTB. The overall occurrence of Tuberculosis among the studied homeless population was found to be 85 cases per 1000 population. The occurrence of behavioral habits such as smoking was found to be 41.2% (7/17), tobacco chewing at 47.1% (8/17), and alcohol at 47.1% (8/17) among the cases. The occurrence of HIV coinfection was 5.9% (1/17) and diabetes was 5.9% (1/17). The prevalence of TB among homeless females was 1.5 times higher than homeless males but out of 17 diagnosed patients, males had a higher prevalence of TB as compared to females. CONCLUSION: The occurrence of PTB in the homeless population is quite high as it is also reported in a study in the United States that the national incidence of tuberculosis in the homeless population was 36 cases/100,000 and it needs to be addressed to eliminate tuberculosis.7 Moreover, the risk factors such as tobacco, smoking, alcohol, coinfections, etc. might have played a major role in the development of PTB. Also, there is a need for larger studies with large sample sizes to provide evidence against the same.

Infection control and preventing the transmission of tuberculosis in high-risk centres - recovery shelter for homeless people.

The term "infection control" refers to the policies and practices used in hospitals and other healthcare facilities to limit the spread of illnesses with the primary goal of lowering infection rates. The objective is to reduce the chance of infection in patients and Healthcare workers (HCWs). This may be achieved by making all the HCWs to follow and practice the infection prevention and control (IPC) guidelines and by providing safe and quality healthcare. Because of more exposure to TB patients and insufficient TB infection prevention and control (TBIPC) procedures in a healthcare facility, healthcare workers (HCWs) working in TB centers are at an elevated risk of contracting TB. Although there are a number of TBIPC guidelines, there is limited knowledge of their contents, if they are applicable in the given situation, and whether they are being properly applied in TB centers. The purpose of this study was to observe the TBIPC guidelines' implementation in CES (Centre of equity studies) recovery shelters well as the elements that affect it. The percentage of public health care personnel who used proper TBIPC practices was low. The execution of TBIPC guidelines in tuberculosis (TB) centers was poor. It was impacted because TB treatment institutions and centers have unique health systems and TB disease burdens.

Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India.

Objectives: We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh. Materials and Methods: We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub. Statistical Analysis: The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design). Results: Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001). Conclusion: The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.

Inhibition of p21 activates Akt kinase to trigger ROS-induced autophagy and impacts on tumor growth rate.

Owing to its ability to induce cellular senescence, inhibit PCNA, and arrest cell division cycle by negatively regulating CDKs as well as being a primary target of p53, p21 is traditionally considered a tumor suppressor. Nonetheless, several reports in recent years demonstrated its pro-oncogenic activities such as apoptosis inhibition by cytosolic p21, stimulation of cell motility, and promoting assembly of cyclin D-CDK4/6 complex. These opposing effects of p21 on cell proliferation, supported by the observations of its inconsistent expression in human cancers, led to the emergence of the concept of "antagonistic duality" of p21 in cancer progression. Here we demonstrate that p21 negatively regulates basal autophagy at physiological concentration. Akt activation, upon p21 attenuation, driven ROS accumulation appears to be the major underlying mechanism in p21-mediated modulation of autophagy. We also find p21, as a physiological inhibitor of autophagy, to have oncogenic activity during early events of tumor development while its inhibition favors survival and growth of cancer cells in the established tumor. Our data, thereby, reveal the potential role of autophagy in antagonistic functional duality of p21 in cancer.

dNTP concentrations do not increase in mammalian cells in response to DNA damage.

A recent publication reported a uniform ∼5- to 6-fold increase in dNTP pools 30 min after exposure to ionizing radiation. Das et al. were not able to reproduce these results. Their data instead agree with earlier publications reporting no increase in dNTP pools in mammalian cells in response to DNA damage.

Corrigendum: Calliterpenone, a natural plant growth promoter from a medicinal plant Callicarpa macrophylla, sustainably enhances the yield and productivity of crops.

[This corrects the article DOI: 10.3389/fpls.2022.960717.].

The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India.

Background: The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. Purpose: To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. Method: We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. Conclusion: Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.

Ethical and legal issues concerning COVID 19 vaccinations in persons with mental illness in India.

Mental healthcare in India faces severe challenges amid the ongoing pandemic. India runs the largest vaccination drive globally, including booster doses to rapidly vaccinate its population of over a billion. As persons with mental illness are at greater risk of adverse outcomes from COVID 19, they need prioritized access and administration of these vaccines. This manuscript examines the current legislation and identifies how the legal and ethical frameworks can prioritize COVID 19 vaccinations for persons with mental illness in India through a review of the various legislations of India concerning persons with mental illness and judicial judgments concerning the pandemic and vaccination. Subsequently, we discuss ethical and legal challenges associated with vaccination in this vulnerable population and possible solutions. Based on the current review, the authors recommend the guidelines for capacity assessment for vaccination decisions and discuss existing legal frameworks relevant to the vaccination of persons with mental illness.

Calliterpenone, a natural plant growth promoter from a medicinal plant Callicarpa macrophylla, sustainably enhances the yield and productivity of crops.

The global population is rising at an alarming rate, which is threatening food and nutritional security. Although chemical fertilizers and pesticides are important for achieving food security, their excessive usage critically affects soil health and adds up residues in the food chain. There is an increasing interest in identifying eco-friendly farm inputs that can improve crop productivity through sustainable agricultural practices. One of the most common approaches to reducing chemical inputs in agriculture is the use of plant growth regulators (PGRs). Here, we demonstrate the benefits of a natural and novel plant growth enhancer "calliterpenone," isolated from Callicarpa macrophylla, a medicinal plant, for increasing crop productivity in six crops, viz., rice, wheat, potato, tomato, chickpea, and onion. Results revealed that the application of calliterpenone (foliar spraying or seed soaking) enhanced the yield of rice (28.89%), onion (20.63%), potato (37.17%), tomato (28.36%), and chickpea (26.08%) at 0.001 mM and of wheat (27.23%) at 0.01 mM concentrations in comparison to control. This enhancement in yield was reflected through improvements in its growth attributes, viz., spike length, tillers plant-1, seeds spike-1, plant height, and biomass. Furthermore, the exogenous application of calliterpenone could increase the endogenous level of indole-3-acetic acid (IAA) in all tested crops and decrease the content of abscisic acid (ABA) in a few. Trials conducted at farmers' fields showed an overall ~12% increase in rice yield (mean of 11 farmers' fields ranging from 3.48 to 19.63%) and ~10% increase in wheat yield (ranging from 3.91 to 17.51%). The 0.001 mM of calliterpenone was the best effective dose for most crops except wheat, where a concentration of 0.01 mM was found to be the most optimal. This study indicates that calliterpenone is a natural plant growth promoter that can be used in boosting the yields of multiple crops and would be an important input component of organic farming.

Perspectives and potential applications of endophytic microorganisms in cultivation of medicinal and aromatic plants.

Ensuring food and nutritional security, it is crucial to use chemicals in agriculture to boost yields and protect the crops against biotic and abiotic perturbations. Conversely, excessive use of chemicals has led to many deleterious effects on the environment like pollution of soil, water, and air; loss of soil fertility; and development of pest resistance, and is now posing serious threats to biodiversity. Therefore, farming systems need to be upgraded towards the use of biological agents to retain agricultural and environmental sustainability. Plants exhibit a huge and varied niche for endophytic microorganisms inside the planta, resulting in a closer association between them. Endophytic microorganisms play pivotal roles in plant physiological and morphological characteristics, including growth promotion, survival, and fitness. Their mechanism of action includes both direct and indirect, such as mineral phosphate solubilization, fixating nitrogen, synthesis of auxins, production of siderophore, and various phytohormones. Medicinal and aromatic plants (MAPs) hold a crucial position worldwide for their valued essential oils and several phytopharmaceutically important bioactive compounds since ancient times; conversely, owing to the high demand for natural products, commercial cultivation of MAPs is on the upswing. Furthermore, the vulnerability to various pests and diseases enforces noteworthy production restraints that affect both crop yield and quality. Efforts have been made towards enhancing yields of plant crude drugs by improving crop varieties, cell cultures, transgenic plants, etc., but these are highly cost-demanding and time-consuming measures. Thus, it is essential to evolve efficient, eco-friendly, cost-effective simpler approaches for improvement in the yield and health of the plants. Harnessing endophytic microorganisms as biostimulants can be an effective and alternative step. This review summarizes the concept of endophytes, their multidimensional interaction inside the host plant, and the salient benefits associated with endophytic microorganisms in MAPs.

Comparative study of analgesia of ketorolac, tramadol, and flupirtine in the management of third molar surgery.

Introduction: The most commonly performed surgical procedure in most oral and maxillofacial surgery practices is the removal of third molars. Postoperative pain is considered a form of acute pain due to surgical trauma with an inflammatory reaction. Materials and Methods: One hundred and fifty patients were included in the study which were divided into GROUP-A, B, and C-50 patients each; those who underwent third molar removal under local anesthesia. Local anesthesia was obtained by inferior alveolar, lingual, long buccal, posterior superior alveolar, and greater palatal nerve block injections after first complain of pain, all patients were prescribed analgesics (Ketorolac-10 mg), (Tramadol-50 mg), (Flupirtine-100 mg), and antibiotics co-amoxiclav-625 mg) T. D. S in all the three groups A, B, C, respectively, for 5 days and the timing noted in the patients assessment sheet. The statistical analysis was done using SPSS Version 15.0 statistical analysis software. Results: The flupirtine group has early onset and also had minimum side effects. All the groups showed similar trend in change in pain score from 3 h. P. O to different time intervals. It was observed the pain score increased significantly till 6 h. Post operative a decreased trend was found at 24 h, 48 h, 78 h, after 6 h. and this change was found to be statistically significant for all three groups. Conclusion: Flupirtine had faster onset and comparable pain management profile as compared to tramadol, it also had minimum side effects, hence the use of flupirtine might be recommended for postoperative pain management in cases undergoing third molar surgery.

Improvement in white light emission of Dy3+doped CaMoO4via Zn2+co-doping.

The research in developing a single ingredient phosphor for white-light emission is progressively increasing. It is well known that the4F9/2 â†’ 6H13/2(yellow) and4F9/2 â†’ 6H15/2(blue) transitions of Dy3+ions give near-white light emission. The white light emission of Dy3+ions can be enhanced via improving the crystallinity of the host phosphor via co-doping of transition metal ions. In this paper, we report a significant improvement in the white light emission of Dy3+doped CaMoO4by co-doping Zn2+ions. The x-ray diffraction pattern confirms the tetragonal phase of pure and doped CaMoO4phosphor. The peak broadening and a red-shift in the absorption peak are observed by UV-vis absorption analysis of Zn2+/Dy3+doped CaMoO4. From Photoluminescence studies, we have observed that in Dy3+doped CaMoO4, the 4% Dy3+doped CaMoO4exhibits maximum emission. The Zn2+ions are co-doped to further increase the luminescence intensity of CaMoO4:4%Dy3+and the maximum luminescence is obtained for 0.25% Zn2+concentration. Two intense emission peaks centered at 484 nm and 574 nm related to transitions4F9/2 â†’ 6H15/2and4F9/2 â†’ 6H13/2of Dy3+ion are observed for Dy3+doped phosphor. The4F9/2 â†’ 6H13/2transition is the forced electric dipole transition which is affected by its chemical environment. After Zn2+co-doping, the4F9/2 â†’ 6H13/2transition is affected due to a change in asymmetricity around the Dy3+ions. The 0.25% co-doping of Zn2+gives 34% enhancement in luminescence emission of 4% Dy3+doped CaMoO4. As a result, the CIE coordinates of chromaticity diagram and the color purity of the 0.25% Zn2+co-doped CaMoO4:4Dy3+show improvement in the overall white light emission. We have shown that with Zn2+co-doping, the non-radiative relaxations are reduced which results in improved white light emission of Dy3+ions.

Secondary infections modify the overall course of hospitalized patients with COVID-19: a retrospective study from a network of hospitals across North India.

Objective: To gain better insight into the extent of secondary bacterial and fungal infections in hospitalized patients in India, and to assess how these alter the course of coronavirus disease 2019 (COVID-19) so that control measures can be suggested. Methods: In this retrospective, multicentre study, the data of all patients who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on reverse transcriptase polymerase chain reaction (RT-PCR), admitted to hospital between March 2020 and July 2021, were accessed from the electronic health records of a network of 10 hospitals across five states in North India. Results: Of 19,852 patients testing positive for SARS-CoV-2 on RT-PCR and admitted to the study hospitals during the study period, 1940 (9.8%) patients developed secondary infections (SIs). Patients with SIs were, on average, 8 years older than patients without SIs (median age 62.6 vs 54.3 years; P<0.001). The risk of SIs was significantly (P<0.001) associated with age, severity of disease at admission, diabetes, admission to the intensive care unit (ICU), and ventilator use. The most common site of infection was urine (41.7%), followed by blood (30.8%) and sputum/bronchoalveolar lavage/endotracheal fluid (24.8%); the least common was pus/wound discharge (2.6%). Gram-negative bacilli (GNB) were the most common organisms (63.2%), followed by Gram-positive cocci (GPC) (19.6%) and fungi (17.3%). Most patients with SIs were on multiple antimicrobials. The most commonly used antibiotics against GNB were beta-lactam/beta-lactamase inhibitors (76.9%), carbapenems (57.7%), cephalosporins (53.9%), and antibiotics against carbapenem-resistant Enterobacteriaceae (47.1%). Empirical use of antibiotics against GPC was seen in 58.9% of patients with SIs, and empirical use of antifungals was observed in 56.9% of patients with SIs. The average length of hospital stay for patients with SIs was almost twice as long as that of patients without SIs (median 13 vs 7 days). Overall mortality among patients with SIs (40.3%) was more than eight times higher than that among patients without SIs (4.6%). Only 1.2% of patients with SIs with mild COVID-19 at admission died, compared with 17.5% of those with moderate COVID-19 at admission and 58.5% of those with severe COVID-19 at admission (P<0.001). The mortality rate was highest in patients with bloodstream infections (49.8%), followed by those with hospital-acquired pneumonia (47.9%), urinary tract infections (29.4%), and skin and soft tissue infections (29.4%). The mortality rate in patients with diabetes with SIs was 45.2%, compared with 34.3% in those without diabetes (P<0.001). Conclusions: SIs complicate the course of patients hospitalized with COVID-19. These patients tend to have a much longer hospital stay, a higher requirement for oxygen and ICU care, and a significantly higher mortality rate compared with those without SIs. The groups most vulnerable to SIs are patients with more severe COVID-19, elderly patients and patients with diabetes. Judicious empirical use of combination antimicrobials in these groups of vulnerable patients can save lives. It is desirable to have region- or country-specific guidelines for appropriate use of antibiotics and antifungals to prevent their overuse.

Non-invasive Estimation of Foliar Nitrogen Concentration Using Spectral Characteristics of Menthol Mint (Mentha arvensis L.).

Menthol mint (Mentha arvensis L., Family: Lamiaceae), popularly known as corn mint or Japanese mint, is an important industrial crop that is widely grown for its valued essential oil. Nitrogen (N) is an important macro-nutrient and an essential factor for optimizing the yield and quality of crops. Hence, rapid and accurate estimation of the N content is crucial for nutrient diagnosis in plants and to make precise N fertilizer recommendations. Generally, N concentration is estimated by destructive sampling methods; however, an indirect assessment may be possible based on spectral characteristics. This study aimed to compare the foliar N concentration based on non-destructive (reflectance) and destructive (laboratory analyses) methods in menthol mint. Foliar N concentration was measured through the Kjeldahl method and reflectance by Miniature Leaf Spectrometer C-710 (CID Bio-Science). Using reflectance data, several vegetation indices (VIs), that is, normalized difference red edge (NDRE), red edge normalized difference vegetation index (reNDVI), simple ratio (SR), green-red vegetation index (GRVI), canopy chlorophyll content index (CCCI), photochemical reflectance index (PRI), green chlorophyll index (CI Green ), red edge chlorophyll index (CI Red Edge ), canopy chlorophyll index (CCI), normalized pigment chlorophyll ratio index (NPCI), and structure insensitive pigment index (SIPI), were developed to determine the foliar N concentration. The highest correlation (r) between VIs and foliar N concentrations was achieved by NDRE (0.89), followed by reNDVI (0.84), SR (0.83), GRVI (0.78), and CCCI (0.76). Among the VIs, the NDRE index has been found to be the most accurate index that can precisely predict the foliar N concentration (R 2 = 0.79, RMSE = 0.18). In summary, the N deficiencies faced by the crop during its growth period can be detected effectively by calculating NDRE and reNDVI, which can be used as indicators for recommending precise management strategies for the application of nitrogenous fertilizers.

Hiccups and Acute Symptomatic Hyponatremia: A Rare Manifestation of COVID-19.

We report a rare case of a patient presenting with a very unusual manifestation of coronavirus disease 2019 (COVID-19). A 62-year-old male presented to the emergency department (ED) with complaints of headache, nausea, vomiting, and intractable hiccups for two days. Laboratory results showed that he had profound hyponatremia (Na+: 103 mEq/L) and hypokalemia (K+: 2.3 mEq/L) with a positive RT-PCR for COVID-19. He was treated with an intravenous (IV) bolus of 3% saline solution followed by continuous infusion. The patient was discharged after eight days when his electrolytes returned to normal, and a significant symptomatic relief was achieved.

Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached.

OBJECTIVE: Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings (n = 2150). The objective of this article is to give a brief overview of the initiative. METHODS: CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. RESULTS AND CONCLUSION: From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.

Criminal Responsibility in Geropsychiatry: Competence, Culpability, and Care.

Elderly persons can get involved in the criminal justice system as victims or as perpetrators. The interaction of elderly persons with mental illness at various cross-sections of the judicial process needs thoughtful consideration. Through this review, the authors approach this less studied aspect of forensic psychiatry. Concerning the evaluation of a prisoner, three scenarios need focused consideration: evaluation for fitness to stand trial before a competent court, evaluations for an insanity defense, and fitness for sentencing. At the same time, incarcerated elderly who developed dementia or a severe mental illness at any point of time during the trial or in prison need specific approaches. In this article, the authors discuss the acts and case laws relevant to navigating these legal scenarios. We discuss existing mental health care provisions for protecting the health interests of elderly care in prison.

Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India.

Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10 months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0-20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0-10). Total 20,909 patients were cared for in the 12 months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t = - 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.