A persistent ultraviolet outflow from an accreting neutron star binary transient.

All disc-accreting astrophysical objects produce powerful disc winds. In compact binaries containing neutron stars or black holes, accretion often takes place during violent outbursts. The main disc wind signatures during these eruptions are blue-shifted X-ray absorption lines, which are preferentially seen in disc-dominated 'soft states'1,2. By contrast, optical wind-formed lines have recently been detected in 'hard states', when a hot corona dominates the luminosity3. The relationship between these signatures is unknown, and no erupting system has as yet revealed wind-formed lines between the X-ray and optical bands, despite the many strong resonance transitions in this ultraviolet (UV) region4. Here we report that the transient neutron star binary Swift J1858.6-0814 exhibits wind-formed, blue-shifted absorption lines associated with C IV, N V and He II in time-resolved UV spectroscopy during a luminous hard state, which we interpret as a warm, moderately ionized outflow component in this state. Simultaneously observed optical lines also display transient blue-shifted absorption. Decomposing the UV data into constant and variable components, the blue-shifted absorption is associated with the former. This implies that the outflow is not associated with the luminous flares in the data. The joint presence of UV and optical wind features reveals a multi-phase and/or spatially stratified evaporative outflow from the outer disc5. This type of persistent mass loss across all accretion states has been predicted by radiation-hydrodynamic simulations6 and helps to explain the shorter-than-expected duration of outbursts7.

Nine-hour X-ray quasi-periodic eruptions from a low-mass black hole galactic nucleus.

In the past two decades, high-amplitude electromagnetic outbursts have been detected from dormant galaxies and often attributed to the tidal disruption of a star by the central black hole1,2. X-ray emission from the Seyfert 2 galaxy GSN 069 (2MASX J01190869-3411305) at a redshift of z = 0.018 was first detected in July 2010 and implies an X-ray brightening by a factor of more than 240 over ROSAT observations performed 16 years earlier3,4. The emission has smoothly decayed over time since 2010, possibly indicating a long-lived tidal disruption event5. The X-ray spectrum is ultra-soft and can be described by accretion disk emission with luminosity proportional to the fourth power of the disk temperature during long-term evolution. Here we report observations of quasi-periodic X-ray eruptions from the nucleus of GSN 069 over the course of 54 days, from December 2018 onwards. During these eruptions, the X-ray count rate increases by up to two orders of magnitude with an event duration of just over an hour and a recurrence time of about nine hours. These eruptions are associated with fast spectral transitions between a cold and a warm phase in the accretion flow around a low-mass black hole (of approximately 4 × 105 solar masses) with peak X-ray luminosity of about 5 × 1042 erg per second. The warm phase has kT (where T is the temperature and k is the Boltzmann constant) of about 120 electronvolts, reminiscent of the typical soft-X-ray excess, an almost universal thermal-like feature in the X-ray spectra of luminous active nuclei6-8. If the observed properties are not unique to GSN 069, and assuming standard scaling of timescales with black hole mass and accretion properties, typical active galactic nuclei with higher-mass black holes can be expected to exhibit high-amplitude optical to X-ray variability on timescales as short as months or years9.

Chronic ethanol induces a pro-inflammatory switch in interleukin-1ß regulation of GABAergic signaling in the medial prefrontal cortex of male mice.

Neuroimmune pathways regulate brain function to influence complex behavior and play a role in several neuropsychiatric diseases, including alcohol use disorder (AUD). In particular, the interleukin-1 (IL-1) system has emerged as a key regulator of the brain's response to ethanol (alcohol). Here we investigated the mechanisms underlying ethanol-induced neuroadaptation of IL-1ß signaling at GABAergic synapses in the prelimbic region of the medial prefrontal cortex (mPFC), an area responsible for integrating contextual information to mediate conflicting motivational drives. We exposed C57BL/6J male mice to the chronic intermittent ethanol vapor-2 bottle choice paradigm (CIE-2BC) to induce ethanol dependence, and conducted ex vivo electrophysiology and molecular analyses. We found that the IL-1 system regulates basal mPFC function through its actions at inhibitory synapses on prelimbic layer 2/3 pyramidal neurons. IL-1ß can selectively recruit either neuroprotective (PI3K/Akt) or pro-inflammatory (MyD88/p38 MAPK) mechanisms to produce opposing synaptic effects. In ethanol naïve conditions, there was a strong PI3K/Akt bias leading to a disinhibition of pyramidal neurons. Ethanol dependence produced opposite IL-1 effects - enhanced local inhibition via a switch in IL-1ß signaling to the canonical pro-inflammatory MyD88 pathway. Ethanol dependence also increased cellular IL-1ß in the mPFC, while decreasing expression of downstream effectors (Akt, p38 MAPK). Thus, IL-1ß may represent a key neural substrate in ethanol-induced cortical dysfunction. As the IL-1 receptor antagonist (kineret) is already FDA-approved for other diseases, this work underscores the high therapeutic potential of IL-1 signaling/neuroimmune-based treatments for AUD.

An initiative to improve nutritional education among medical students.

BACKGROUND: India faces a double burden of Malnutrition-undernutrition and overnutrition. In the medical institutes of India, there are no practice-based teaching methods to instill a greater understanding of the concepts of nutrition and healthy cooking. Hence, we have focused on an initiative named "Diet Demonstration" (DD) that is being practiced in the Department of Community Medicine at a government medical college in New Delhi. METHODS: Diet Demonstration is conducted in batches of 30-40 students. This specific exercise was conducted in May 2018. A batch of 35 MBBS students was subdivided into five groups, with 7 students/group. Each group was given a scenario/person with certain health conditions. They formulated a 24-h balanced dietary plan for nutrients and devised a food menu according to the scenario provided to them. The groups procured the raw materials from local markets, prepared the food according to their menu in the home/hostel kitchens. The cooked foods, alongside the equivalent raw materials used for cooking the respective foods, were presented and explained by each group in front of the whole batch and the faculty of the department. RESULTS: majority of the students opined that it had helped them in understanding nutrition in a better way, practice healthy cooking methods, and to learn the associated practical difficulties while planning and cooking a balanced diet. CONCLUSION: Diet Demonstration can be an innovative, cost effective way of inculcating nutrition knowledge and healthy cooking practices among the budding doctors, which needs replicability and feasibility studies in other settings.

Prevalence of depression and the associated factors among the software professionals in Delhi: A cross-sectional study.

India is home to an estimated 57 million people (18% of the global estimate) affected by depression. We conducted a cross-sectional study to determine the prevalence of depression and associated factors among software professionals in Delhi National Capital Region, during 2017-2018 with a sample size of 310. Two-stage cluster sampling was used. A predesigned, pretested, semi-structured, English questionnaire was used. Patient Health Questionnaire 9, CAGE, CAGE Adapted to Include Drugs (CAGE-AID) questionnaire, Fagerstrom test for nicotine dependence questionnaire was used. Forty percent (124) of the participants were screened to have major depressive disorder. There was a statistically significant association between depression and marital status (P = 0.041), family type (P = 0.008), alcohol use (P < 0.001), substance use (P = 0.014), multiple roles in a project (P < 0.001), and shift of work (P < 0.008). Considering the high prevalence of depression, mental health screening program, sensitization, and promotion must be incorporated into the IT industry to prevent and detect depression early.

Safety assessment of an etidronate in a sodium hypochlorite solution: randomized double-blind trial.

AIM: To assess whether Dual Rinse HEDP, an etidronate that can be combined with NaOCl to create an endodontic irrigating solution containing both hypochlorite and a chelator in the form of 1-hydroxyethane 1,1-diphosphonic acid (HEDP), alters the clinical efficacy of NaOCl or adds any untoward clinical effects. METHODOLOGY: In this randomized controlled double-blind single-centre trial, a pure NaOCl solution was compared to a HEDP-containing counterpart regarding antimicrobial efficacy, postoperative pain, and the host response by means of changes in MMP-9 levels in periapical fluid. Sixty patients presenting with asymptomatic apical periodontitis (one tooth each) were randomly divided into two groups (N = 30) based on irrigation regime. Pre- and post-treatment microbial aerobic and anaerobic cultures and MMP-9/total protein (TP) periapical fluid samples were collected. Postoperative pain levels were assessed 24 h after treatment. Categorical data were compared between groups using the Fisher's exact test, continuous data using the Wilcoxon signed-rank test, α = 0.05. RESULTS: Irrigation with pure NaOCl rendered 40% canals free of culturable microorganisms, compared to 50% with the NaOCl/HEDP mixture (P = 0.60). As assessed by matrix-assisted laser desorption/ionization-time-of-flight analysis (MALDI-TOF), no apparent selection of aerobic or anaerobic taxa occurred in either group. One patient in the NaOCl group experienced moderate pain, whilst two patients in the NaOCl/HEDP group experienced mild postoperative pain. MMP-9/TP levels in periapical fluid declined significantly (P < 0.001) after 1 week with no medication in the root canal, without significant difference between treatment groups (P > 0.05). CONCLUSIONS: This trial found no influence of HEDP on clinical NaOCl effects.

Acaricidal, pediculicidal and larvicidal activity of synthesized ZnO nanoparticles using Momordica charantia leaf extract against blood feeding parasites.

The aim of the present study was to evaluate the acaricidal, pediculicidal and larvicidal effect of synthesized zinc oxide nanoparticles (ZnO NPs) using Momordica charantia leaf extract against the larvae of Rhipicephalus (Boophilus) microplus, adult of Pediculus humanus capitis, and the larvae of Anopheles stephensi, Culex quinquefasciatus. The ZnO NPs were characterized by using UV, XRD, FTIR and SEM-EDX. The SEM image confirms that the synthesized nanoparticles were spherical in shape with a size of 21.32 nm. The results of GC-MS analysis indicates the presence of the major compound of Nonacosane (C29H60) in the M. charantia leaf extract. Cattle tick, head lice and mosquito larvae were exposed to a varying concentrations of the synthesized ZnO NPs and M. charantia leaf extract for 24 h. Compared to the leaf aqueous extract, biosynthesized ZnO NPs showed higher toxicity against R. microplus, P. humanus capitis, An. stephensi, and Cx. Quinquefasciatus with the LC50 values of 6.87, 14.38, 5.42, and 4.87 mg/L, respectively. The findings revealed that synthesized ZnO NPs possess excellent anti-parasitic activity. These results suggest that the green synthesized ZnO NPs has the potential to be used as an ideal ecofriendly approach for the control of R. microplus, P. humanus capitis and the mosquito larvae of An. Stephensi and Cx. quinquefasciatus.

MicroRNA Regulation of Acute Lung Injury and Acute Respiratory Distress Syndrome.

The acute respiratory distress syndrome (ARDS), a severe form of acute lung injury (ALI), is a very common condition associated with critically ill patients, which causes substantial morbidity and mortality worldwide. Despite decades of research, effective therapeutic strategies for clinical ALI/ARDS are not available. In recent years, microRNAs (miRNAs), small non-coding molecules have emerged as a major area of biomedical research as they post-transcriptionally regulate gene expression in diverse biological and pathological processes, including ALI/ARDS. In this context, this present review summarizes a large body of evidence implicating miRNAs and their target molecules in ALI/ARDS originating largely from studies using animal and cell culture model systems of ALI/ARDS. We have also focused on the involvement of miRNAs in macrophage polarization, which play a critical role in regulating the pathogenesis of ALI/ARDS. Finally, the possible future directions that might lead to novel therapeutic strategies for the treatment of ALI/ARDS are also reviewed. J. Cell. Physiol. 231: 2097-2106, 2016. © 2016 Wiley Periodicals, Inc.

Accuracy of ringless casting and accelerated wax-elimination technique: a comparative in vitro study.

PURPOSE: The purpose of this study was to determine whether the ringless casting and accelerated wax-elimination techniques can be combined to offer a cost-effective, clinically acceptable, and time-saving alternative for fabricating single unit castings in fixed prosthodontics. MATERIALS AND METHODS: Sixty standardized wax copings were fabricated on a type IV stone replica of a stainless steel die. The wax patterns were divided into four groups. The first group was cast using the ringless investment technique and conventional wax-elimination method; the second group was cast using the ringless investment technique and accelerated wax-elimination method; the third group was cast using the conventional metal ring investment technique and conventional wax-elimination method; the fourth group was cast using the metal ring investment technique and accelerated wax-elimination method. The vertical marginal gap was measured at four sites per specimen, using a digital optical microscope at 100× magnification. The results were analyzed using two-way ANOVA to determine statistical significance. RESULTS: The vertical marginal gaps of castings fabricated using the ringless technique (76.98 ± 7.59 µm) were significantly less (p < 0.05) than those castings fabricated using the conventional metal ring technique (138.44 ± 28.59 µm); however, the vertical marginal gaps of the conventional (102.63 ± 36.12 µm) and accelerated wax-elimination (112.79 ± 38.34 µm) castings were not statistically significant (p > 0.05). CONCLUSIONS: The ringless investment technique can produce castings with higher accuracy and can be favorably combined with the accelerated wax-elimination method as a vital alternative to the time-consuming conventional technique of casting restorations in fixed prosthodontics.

A multicentre, multinational, randomized, placebo-controlled, double-blind, phase 3 trial to evaluate the efficacy and safety of gemigliptin (LC15-0444) in patients with type 2 diabetes.

AIM: This study was designed to assess the efficacy and safety of the dipeptidyl peptidase IV inhibitor gemigliptin (LC15-0444) 50 mg versus placebo in patients with type 2 diabetes. METHODS: We conducted a 24-week, randomized, double-blind, placebo-controlled phase III trial in 182 patients (74 from Korea and 108 from India) with type 2 diabetes. After an initial 2 weeks of a diet and exercise programme followed by 2 weeks of a single-blind placebo run-in period, eligible patients were randomized to gemigliptin 50 mg or placebo, receiving the assigned treatment for 24 weeks. HbA1c and fasting plasma glucose (FPG) were measured periodically, and oral glucose tolerance test was performed at baseline and weeks 12 and 24. RESULTS: At week 24, gemigliptin treatment led to significant reductions in HbA1c measurements compared to placebo (adjust mean after subtracting the placebo effect size: -0.71%, 95% confidence interval: -1.04 to -0.37%). A significantly greater proportion of patients achieved an HbA1c <7% with gemigliptin than with placebo. The placebo-subtracted FPG change from baseline at week 24 was -19.80 mg/dl. The overall incidence rates for adverse events were similar in the gemigliptin and placebo groups. CONCLUSIONS: This study showed the efficacy and safety of gemigliptin 50 mg administered once daily as a monotherapy for type 2 diabetes patients.

Oral manifestation of the monkeypox virus: a systematic review and meta-analysis.

Background: Mpox (formerly known as monkeypox) is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease epidemiology. Oral lesions among mpox cases have been poorly reported. Our aim was to estimate the overall prevalence of oral manifestations among patients with mpox globally. Methods: In this systematic review and meta-analysis, an extensive literature search in PubMed, Scopus, Web of Science, Embase, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessment of all published articles, conducted across the world, until Nov 15 2022 as per the PROSPERO registration protocol (CRD42022371249), was undertaken. Primary studies (case series, cross-sectional, retrospective, prospective designs) that reported the oral/oropharyngeal symptoms among laboratory-confirmed mpox cases were included. The characteristics of the study, information on the number of cases, and symptomatic status were extracted from the included studies. The quality of the included studies was assessed for bias. Random-effects meta-regression with DerSimonian & Laird estimator, and subgroup analyses were conducted using STATA (v17.0). The degree of funnel plot asymmetry was assessed using Egger's test when at least 10 estimates were available. The heterogeneity between studies was assessed using the I2 statistic. The primary outcome was the pooled prevalence of oral manifestations in the examined population. Findings: 19 studies were included with 4042 laboratory-confirmed patients with mpox for qualitative and quantitative synthesis. The pooled prevalence of oral manifestations in the investigated population was 36.75% (95% confidence interval [CI]: 23.77-50.65). Heterogeneity was found to be high in the current meta-analysis (I2 = 98.24%; p < 0.001). Subgroup analysis revealed a pooled prevalence of 39.96% (95% CI: 21.42-59.91) of sore throat, 24.80% (95% CI: 8.14-46.32) of mouth sore, 18.24% (95% CI: 0.34-52.54) of tonsillitis and 17.99% (95% CI: 15.66-20.43) of mouth rash from the included studies. Interpretation: Oral manifestations are common in patients with mpox, with variations in prevalence across the sites within the oral cavity, and geography of the studies. Healthcare workers should be wary of the oral signs and symptoms of mpox in endemic and high-risk areas. Funding: None.

Knowledge of mpox and its determinants among the healthcare personnel in Arabic regions: A multi-country cross-sectional study.

Background & aim: The monkeypox virus (MPXV), an Orthopoxvirus family member, is the zoonotic agent that causes mpox (formerly known as monkeypox). The ongoing mpox pandemic has caused cases across continents involving 110 countries. This study aimed to assess mpox knowledge and its determinants among healthcare personnel. Methods: This cross-sectional study was conducted from June 6 to June 25, 2022, among 17 Arab countries. The self-administered questionnaire consists of 53 questions assessing the knowledge about the monkeypox virus. Results: In total, 5874 medical students and clinical doctors from 17 Arab countries participated in this study. Only 13.8% (n = 812) of respondents have ever received information about mpox during their studies in medicine. The mean knowledge score was 13.84, and the median score was 15 (range 1-34). More than half (51.3%, n = 3012) have heard about mpox before. A low proportion of the participants had a good level of knowledge on mpox. Only 11.7% of respondents had correctly identified the natural host and the incubation period of mpox. More than half (58.9%) were aware of the signs and symptoms of mpox. Few respondents (28%) believed that mpox and smallpox have similar signs and symptoms. Specialist doctors had higher knowledge of mpox (AOR = 2.96, 95% CI = 2.24-3.92, p < 0.001) than other cadres. Conclusion: Mpox awareness among Arabic medical students and practitioners is low; hence immediate action in creating awareness among arab healthcare professionals is the need of the hour. This is crucial in the mpox early detection and prevention of its spread.

The mode of reproductive-derived Spink (serine protease inhibitor Kazal-type) action in the modulation of mammalian sperm activity.

The reproductive-derived serine protease inhibitor Kazal-type (Spink) has been identified in seminal plasma, and Spink-spermatozoa binding has been illustrated in many mammalian species including human. We used mice as experimental animal to study the mode of Spink action in the modulation of mammalian sperm activity. A Spink3-binding zone was cytochemically stained on the sperm head at apical hook separated from intact acrosome, whether the cells were capacitated or not. The Spink3-spermatozoa binding neither changed the population of cells in the uncapacitated, capacitated and acrosome-reacted status nor affected the capacitation-related protein phosphorylation and cell motility enhancement. Despite that, the Spink-spermatozoa interaction resulted in decreasing the intracellular calcium concentration ([Ca(2+)](i)) of the cell head and suppressing both the acrosome reaction induced by Ca(+2) ionophore A23187 and the cell fertility. Furthermore, Spink3 seen on the head of spermatozoa in the uterine cavity after coitus could be removed by the trypsin-like activity in the uterine fluid of oestrous females, and free Spink3 in the uterine cavity suppressed the protease activity. We integrated our data to shed light on the molecular mechanism of how Spink and its inhibiting protease are interplayed to modulate the activity of mammalian spermatozoa during their transit in the reproductive tract.

Mutual adaptation between mouse transglutaminase 4 and its native substrates in the formation of copulatory plug.

Formation of copulatory plugs by male animals is a common means of reducing competition with rival males. In mice, copulatory plugs are formed by the coagulation of seminal vesicle secretion (SVS), which is a very viscous and self-clotting fluid containing high concentration of proteins. In its native state, mouse SVS contains a variety of disulfide-linked high-molecular-weight complexes (HMWCs) composed of mouse SVS I-III, which are the major components of mouse SVS. Further, mouse SVS I-III are the substrates for transglutaminase 4 (TGM4), a cross-linking enzyme secreted from the anterior prostate. According to activity assays, mouse TGM4 prefers a mild reducing and alkaline environment. However, under these conditions, the activity of mouse TGM4 toward SVS I-III was much lower than that of a common tissue-type TGM, TGM2. On the other hand, mouse TGM4 exhibited much higher cross-linking activity than TGM2 when native HMWCs containing SVS I-III were used as substrates under non-reducing condition. By the action of TGM4, the clot of SVS became more resistant to proteolysis. This indicates that the activity of TGM4 can further rigidify the copulatory plug and extend its presence in the female reproductive tract. Together with the properties of TGM4 and the nature of its disulfide-linked SVS protein substrates, male mice can easily transform the semen into a rigid and durable copulatory plug, which is an important advantage in sperm competition.

Female with rash, acute kidney failure and rheumatoid arthritis.

This case describes a 42-year-old female with longstanding history of rheumatoid arthritis (RA) and Felty syndrome (FS). She presented with acute renal kidney failure, skin rash and hemoptysis. A clinical suspicion of small vessel vasculitis (SVV) was thought, serology was also positive for various markers of SVV. However, these serology markers could be false-positive in a patient of rheumatoid arthritis. A renal biopsy was performed that led to the final diagnosis of cryoglobulinemic vasculitis. Patient was managed according to the standard guidelines for therapy (plasmafiltration and immunosuppression). It is challenging to manage a patient of RA, in the presence of Felty syndrome-related granulocytopenia and thrombocytopenia. Patient initially showed signs of improvement, but finally succumbed to complications of therapy. The case provides insight into the diagnosis and management of such cases.

Telemedicine practice guidelines in India: Global implications in the wake of the COVID-19 pandemic.

Telemedicine is the delivery of healthcare services from a distance, by use of information and communication technology. There have been no statutory regulations or official guidelines in India specific for telemedicine practice and allied matters so far. For the first time, the government of India released telemedicine practice guidelines for Registered Medical Practitioners on March 25, 2020, amid the COVID-19 outbreak. This review would initiate the discussion on the features of the guidelines, their limitations, and their significance in times of the COVID-19 pandemic. The guidelines are with a restricted scope for providing medical consultation to patients, excluding other aspects of telemedicine such as research and evaluation and the continuing education of healthcare workers. The guidelines have elaborated on the eligibility for practicing Telemedicine in India, the modes and types of teleconsultations, delved into the doctor-patient relationship, consent, and management protocols, and touched upon the data security and privacy aspects of Teleconsultation. After releasing the guidelines, the telescreening of the public for COVID-19 symptoms is being advocated by the government of India. COVID-19 National Teleconsultation Centre (CoNTeC) has been initiated, which connects the doctors across India to All India Institute of Medical Sciences (AIIMS) in real-time for accessing expert guidance on the treatment of the COVID-19 patients.

La telemedicina es la prestación de servicios de salud a distancia, mediante el uso de las TIC. No ha habido regulaciones legales o pautas oficiales en India específicas para la práctica de la telemedicina y asuntos relacionados hasta el momento. Por primera vez, el gobierno de India publicó pautas de práctica de telemedicina para médicos registrados el 25 de marzo de 2020, en medio del brote de COVID­19. Esta revisión iniciaría la discusión sobre las características de las guías, sus limitaciones y su importancia en tiempos de la pandemia de COVID­19. Las pautas tienen un alcance restringido para brindar consultas médicas a los pacientes, excluyendo otros aspectos de la telemedicina, como la investigación y la evaluación y la educación continua de los trabajadores de la salud. Las pautas han detallado la elegibilidad para practicar Telemedicina en India, los modos y tipos de teleconsultas, profundizado en la relación médico­paciente, consentimiento y protocolos de gestión, y tocado los aspectos de seguridad y privacidad de datos de Teleconsulta. Después de publicar las pautas, el gobierno de la India aboga por la teleevaluación del público para detectar síntomas de COVID­19. Se ha iniciado el Centro Nacional de Teleconsulta COVID­19 (CoNTeC), que conecta a los médicos de toda la India con el Instituto de Ciencias Médicas de toda la India (AIIMS) en tiempo real para acceder a la orientación de expertos sobre el tratamiento de los pacientes con COVID­19.

Rural community health workers' readiness for mobile-phone based telemedicine uptake in India.

Objective: Healthcare services using mobile-phone based telemedicine provide simple technology that does not require sophisticated equipment. This study assessed community health workers' knowledge, attitude, and practice (i.e., their readiness) at the village level for uptake of mobile-phone based telemedicine. Materials and Methods: This cross-sectional study was conducted among 80 community health workers, including Auxiliary Nurse Midwives, Multipurpose Health Workers and Accredited Social Health Activists working in a rural health block of India. A pre-tested, semi-structured, interviewer-assisted, self-administered questionnaire was used to assess their mobile-phone based telemedicine readiness. Results: Sixty (75.0%) health workers owned mobile phones. The median readiness score for mobile-phone based telemedicine was 109.0. The Accredited Social Health Activists showed a better attitude toward mobile-phone based telemedicine than others. There was a significant moderate positive correlation (r=0.67) between knowledge and practice domains. Community health workers who had smartphones showed a significantly better attitude than those who did not. Conclusion: Training programs on telemedicine service delivery, focused on Auxiliary Nurse Midwives/ Multipurpose Health Workers, can improve their attitudes towards telemedicine. A better attitude of the Accredited Social Health Activists must be leveraged to initiate mobile-phone based telemedicine services on a pilot basis initially and later scaled up in other settings.

Lockdowns, Community Mobility Patterns, and COVID-19: A Retrospective Analysis of Data from 16 Countries.

OBJECTIVES: During the coronavirus disease 2019 (COVID-19) pandemic, countries around the world framed specific laws and imposed varying degrees of lockdowns to ensure the maintenance of physical distancing. Understanding changes in temporal and spatial mobility patterns may provide insights into the dynamics of this infectious disease. Therefore, we assessed the efficacy of lockdown measures in 16 countries worldwide by analyzing the relationship between community mobility patterns and the doubling time of COVID-19. METHODS: We performed a retrospective record-based analysis of population-level data on the doubling time for COVID-19 and community mobility. The doubling time for COVID-19 was calculated based on the laboratory-confirmed cases reported daily over the study period (from February 15 to May 2, 2020). Principal component analysis (PCA) of six mobility pattern-related variables was conducted. To explain the magnitude of the effect of mobility on the doubling time, a finite linear distributed lag model was fitted. The k-means clustering approach was employed to identify countries with similar patterns in the significant co-efficient of the mobility index, with the optimal number of clusters derived using Elbow's method. RESULTS: The countries analyzed had reduced mobility in commercial and social places. Reduced mobility had a significant and favorable association with the doubling time of COVID-19-specifically, the greater the mobility reduction, the longer the time taken for the COVID-19 cases to double. CONCLUSIONS: COVID-19 lockdowns achieved the immediate objective of mobility reduction in countries with a high burden of cases.