RESUMO
INTRODUCTION: Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India. METHODS: Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach. RESULTS: Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions. CONCLUSION: This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms.
RESUMO
BACKGROUND: Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India. METHODS: Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model. RESULTS: Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional. CONCLUSION: These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.
RESUMO
Intense cultivation with narrow row spacing in wheat, a common practice in the Indo-Gangetic plains of South Asia, renders the crop more susceptible to lodging during physiological maturity. This susceptibility, compounded by the use of traditional crop cultivars, has led to a substantial decline in overall crop productivity. In response to these challenges, a two-year field study on the system of wheat intensification (SWI) was conducted. The study involved three different cultivation methods in horizontal plots and four wheat genotypes in vertical plots, organized in a strip plot design. Our results exhibited that adoption of SWI at 20 cm × 20 cm resulted in significantly higher intercellular CO2 concentration (5.9-6.3%), transpiration rate (13.2-15.8%), stomatal conductance (55-59%), net photosynthetic rate (126-160%), and photosynthetically active radiation (PAR) interception (1.6-25.2%) over the existing conventional method (plant geometry 22.5 cm × continuous plant to plant spacing) of wheat cultivation. The lodging resistance capacity of both the lower and upper 3rd nodes was significantly higher in the SWI compared to other cultivation methods. Among different genotypes, HD 2967 demonstrated the highest recorded value for lodging resistance capacity, followed by HD 2851, HD 3086, and HD 2894. In addition, adoption of the SWI at 20 cm × 20 cm enhanced crop grain yield by 36.9-41.6%, and biological yield by 27.5-29.8%. Significantly higher soil dehydrogenase activity (12.06 µg TPF g-1 soil hr-1), arylsulfatase activity (82.8 µg p-nitro phenol g-1 soil hr-1), alkaline phosphatase activity (3.11 n moles ethylene g-1 soil hr-1), total polysaccharides, soil microbial biomass carbon, and soil chlorophyll content were also noted under SWI over conventional method of the production. Further, increased root volumes, surface root density and higher NPK uptake were recorded under SWI at 20×20 cm in comparison to rest of the treatments. Among the tested wheat genotypes, HD-2967 and HD-3086 had demonstrated notable increases in grain and biological yields, as well as improvements in the photosynthetically active radiation (PAR) and chlorophyll content. Therefore, adoption of SWI at 20 cm ×20 cm (square planting) with cultivars HD 2967 might be the best strategy for enhancing crop productivity and resource-use efficiency under the similar wheat growing conditions of India and similar agro-ecotypes of the globe.
Assuntos
Solo , Triticum , Triticum/genética , Água/análise , Clorofila , Biomassa , Grão Comestível/químicaRESUMO
The current work describes a facile synthesis of spinel-type ZnCo2O4 along with an additional phase, Co3O4, by simply maintaining a non-stoichiometric ratio of Zn and Co precursors. Pure ZnCo2O4 and Co3O4 were also synthesized using the same method to compare results. The obtained morphologies of samples show that small-sized nanoparticles are interconnected and form a porous nanosheet-like structure. When used as anode materials for Li-ion batteries, the ZnCo2O4/Co3O4 nanocomposite electrode exhibits a highly stable charge capacity of 1146.2 mA h g-1 at 0.5C after 350 cycles, which is superior to those of other two pure electrodes, which can be attributed to its optimum porosity, synergistic effect of ZnCo2O4 and Co3O4, increased active sites for Li+ ion diffusion, and higher electrical conductivity. Although the pure Co3O4 electrode displayed a much higher rate capability than the ZnCo2O4/Co3O4 nanocomposite electrode at all investigated current rates, the Co3O4 morphology apparently could not withstand long-term cycling, and the electrode became pulverized due to the repeated volume expansion/contraction, resulting in a rapid decrease in the capacity.
RESUMO
Despite having a higher burden of health problems, transgender persons face challenges in accessing healthcare in India. Most studies on healthcare access of transgender persons in India focus only on HIV related care, mental healthcare, gender affirmative services or on the ethno-cultural communities or transgender women. This study fills this gap by focusing on diverse gender identities within the transgender community with a specific focus on experiences in accessing general or routine healthcare services. A qualitative descriptive approach was used in this study. 23 in-depth interviews and 6 focus group discussions were conducted virtually and in-person with a total of 63 transgender persons in different regions of India between May and September 2021. The study used a community-based participatory research approach and was informed by the intersectionality approach. Thematic analysis was conducted to analyze the data. Four key themes emerged: (i) intersectional challenges in accessing healthcare start outside of the health system, continue through cisgender-binary-normative health systems that exclude transgender persons; and at the interface with individuals such as health professionals, support staff and bystanders; (ii) the experiences negatively impact transgender persons at an individual level; (iii) in response, transgender persons navigate these challenges across each of the levels: individual, health system level and from outside of the health system. This is a first of its kind qualitative participatory study focusing on routine healthcare services of transgender persons in India. The findings indicate the need to move conversations on trans-inclusion in healthcare from HIV and gender affirmative services to routine comprehensive healthcare services considering the higher burden of health problems in the community and the impact of poor access on their lives and well-being.
RESUMO
Herein, a mesoporous MnCo2O4/Co3O4 nanocomposite was fabricated using a polyvinylpyrrolidone (PVP)-assisted hydrothermal synthesis method by maintaining only the non-stoichiometric ratio of Mn and Co (2 : 6), leading to an extra phase of Co3O4 coupled with MnCo2O4. Microstructural analysis showed that the obtained sample has a uniform nanowire-like morphology composed of interconnected nanoparticles. The stoichiometric ratio (2 : 4) was maintained to synthesize pure MnCo2O4 for comparative analysis. However, the obtained structure of pure MnCo2O4 was found to be irregular and fragile. After their employment as anode-active materials, the nanocomposite electrode showed superior high rate capability (1043.8 mA h g-1 at 5C) and long-term cycling stability (773.6 mA h g-1 after 500 cycles at 0.5C) in comparison to the pure MnCo2O4 electrode (771.5 mA h g-1 at 5C and 638.9 mA h g-1 at 0.5C after 500 cycles). It was believed that the extra phase of Co3O4 may also participate in the electrochemical reactions due to its high electrochemically active nature. Benefiting from the appealing architectural features and striking synergistic effect, the integrated MnCo2O4/Co3O4 nanocomposite anode exhibits excellent electrochemical properties and high cycle stability for LIBs.
RESUMO
In autoimmune rheumatic diseases, immune hyperactivity and chronic inflammation associate with immune dysregulation and the breakdown of immune self-tolerance. A continued, unresolved imbalance between effector and regulatory immune responses further exacerbates inflammation that ultimately causes tissue and organ damage. Many treatment modalities have been developed to restore the immune tolerance and immmunoregulatory balance in autoimmune rheumatic diseases, including the use of peptide-based therapeutics or the use of nanoparticles-based nanotechnology. This review summarizes the state-of-the-art therapeutic use of peptide-based therapies in autoimmune rheumatic diseases, with a specific focus on lupus.
RESUMO
Introduction: Transgender persons in India, who are one of the most vulnerable groups, were particularly impacted by the COVID-19 pandemic. Increased risk of COVID-19, challenges with continuing livelihood, uncertainty, and anxiety around the pandemic over pre-existing social discrimination and exclusion pose risk of a mental health impact as well. To investigate this further, this component of a larger study on experiences in healthcare of transgender persons in India during COVID-19 and looks into the question "How did the COVID-19 pandemic impact the mental health of transgender persons in India". Methods: 22 In-depth interviews (IDI) and 6 focus group discussions (FGD) were conducted virtually and in-person with persons self-identifying as transgender or belonging to ethnocultural transgender communities from different parts of India. Community based participatory research approach was used by ensuring representation from the community in the research team and through a series of consultative workshops. Purposive sampling with snowballing was used. The IDIs and FGDs were recorded, transcribed verbatim and analyzed using an inductive thematic analysis. Results: Mental health of transgender persons were affected in the following ways. Firstly, COVID-19, its associated fear and suffering combined with pre-existing inaccessibility of healthcare and reduced access to mental health care affected their mental health. Secondly, unique social support needs of transgender persons were disrupted by pandemic linked restrictions. Thirdly, pre-existing vulnerabilities such as precarious employment and underlying stigma were exacerbated. Finally, gender dysphoria was a key mediating factor in the impact of COVID-19 on mental health with a negative and positive impact. Conclusions: The study reiterates the need to make systemic changes to make mental healthcare and general healthcare services trans-inclusive while also recognizing the essential nature of gender affirmative services and the need to continue them even during emergencies and disaster situations. While this brings out how public health emergencies can exacerbate vulnerabilities, it also shows how the lived mental health experience of transgender person is intricately linked to the way work, travel and housing is structured in our society and therefore points to the structural nature of the linkage between mental health and gender.
RESUMO
BACKGROUND: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission's formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders - the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME. METHODS: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020. RESULTS: The response rate was 76% (60/79), of which 40% (24/60) were senior residents and 60% (36/60) were faculty. Around 55% (n=33) felt bioethics and clinical ethics are not synonymous; 53% (n=32) believed ethics education can be accomplished in a large group setting; 75% (n=45) believed it should be the responsibility of the physiology faculty, rather than the clinical faculty, and 61.7% (n=37) wanted it to be included in the formative assessment. The respondents shared ethical concerns that should be included in the physiology curriculum and the best candidates to teach them to achieve integration. Despite the challenges, the majority 65% (n=39) felt ethics in the physiology CBME should be an inseparable part of teaching in all instructional modalities. CONCLUSION: Early clinical exposure was considered preferable to the Attitude, Ethics, and Communication (AETCOM) programme. Using the five W's and one H method, we talk about how our findings can be used as a road map to help physiologists teach ethics to medical students in the new CBME.
Assuntos
Currículo , Educação de Graduação em Medicina , Humanos , Estudos de Viabilidade , Estudos Transversais , Ética Médica , Índia , EnsinoRESUMO
Intersex people are viewed from the medicalised lens of having a "disorder" of sex development rather than a difference in sex development. This inherent indifference to diversity is also visible in LGBTQIA+ advocacy, as they were initially excluded from the Yogyakarta Principles promoting the human rights of sexual and gender minorities. This paper attempts to explore the issues of discrimination, social exclusion, and unnecessary medical treatments through the lens of the Human Rights in Patient Care framework to advance the human rights of the intersex community and highlight the need for the state to take responsibility. The discussion touches upon intersex people's right to bodily integrity; the right to freedom from torture and cruel, inhuman, and degrading treatment; the right to the highest attainable standard of health; and the right to legal and social recognition. The concept of human rights in patient care moves beyond the traditional philosophical principles of bioethics as it applies legal norms in a patient care context derived from judicial interpretations and international conventions upholding human rights at the intersection of cure and care. As socially accountable health professionals, it is our duty to defend the human rights of intersex people who are marginalised within the marginalised community.
Assuntos
Transtornos do Desenvolvimento Sexual , Direitos Humanos , Humanos , Transtornos do Desenvolvimento Sexual/terapiaRESUMO
THE ISSUE: The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. OBSERVATIONS: Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care. APPROACH: Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. CONCLUSION: We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.
Assuntos
Educação Médica , Melhoria de Qualidade , HumanosRESUMO
A tandem (two-step) particle swarm optimization (PSO) algorithm is implemented in the argyrodite-based multidimensional composition space for the discovery of an optimal argyrodite composition, i.e., with the highest ionic conductivity (7.78 mS cm-1 ). To enhance the industrial adaptability, an elaborate pellet preparation procedure is not used. The optimal composition (Li5.5 PS4.5 Cl0.89 Br0.61 ) is fine-tuned to enhance its practical viability by incorporating oxygen in a stepwise manner. The final composition (Li5.5 PS4.23 O0.27 Cl0.89 Br0.61 ), which exhibits an ionic conductivity (σion ) of 6.70 mS cm-1 and an activation barrier of 0.27 eV, is further characterized by analyzing both its moisture and electrochemical stability. Relative to the other compositions, the exposure of Li5.5 PS4.23 O0.27 Cl0.89 Br0.61 to a humid atmosphere results in the least amount of H2 S released and a negligible change in structure. The improvement in the interfacial stability between the Li(Ni0.9 Co0.05 Mn0.05 )O2 cathode and Li5.5 PS4.23 O0.27 Cl0.89 Br0.61 also results in greater specific capacity during fast charge/discharge. The structural and chemical features of Li5.5 PS4.5 Cl0.89 Br0.61 and Li5.5 PS4.23 O0.27 Cl0.89 Br0.61 argyrodites are characterized using synchrotron X-ray diffraction, Raman spectroscopy, and X-ray photoelectron spectroscopy. This work presents a novel argyrodite composition with favorably balanced properties while providing broad insights into material discovery methodologies with applications for battery development.
RESUMO
Professionalism and communication were formally introduced in India's Competency-Based Curriculum (CBC) as part of the five roles of an Indian medical graduate and 10 core competencies in the Bachelor of Science Nursing program. It may be challenging to teach the complexity of clinical medical ethics to undergraduate students at a young age in the absence of direct patient interaction. Trigger films (TFs) are brief (3-10 min) clips that have been used in the West to provoke debate, promote reflection, and assist trainees in dealing with ethical dilemmas. The aim of this study was to determine whether TFs can be used to teach professionalism and ethics to undergraduate medical and nursing students as an innovative and interesting tool and to see whether this results in any changes in knowledge. A 2-h module supported by an introductory PowerPoint presentation and using four TFs on the four pillars of ethics (beneficence, nonmaleficence, autonomy, and justice) was developed and piloted in the foundation course for the new cohort of medical and nursing students. Quantitative, open-ended feedback was taken from learners after module delivery, and knowledge was assessed with a retrospective pre-post questionnaire. The majority of students found TFs an innovative and interesting tool to teach medical ethics. There was a gain in knowledge of autonomy (52%), beneficence (48%), nonmaleficence (46%), and justice (38%). TFs can be effective tools to impart core competencies in ethics and professionalism to both nursing and medical students in the new CBC.NEW & NOTEWORTHY Teaching ethics is an important part of the medical curriculum, and since first-year students are not in direct contact with patients it is necessary to think of innovative methods that can be used to teach. We have done the pilot testing for the same, using trigger films among undergraduate medical and nursing students.
Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Estudantes de Enfermagem , Currículo , Educação de Graduação em Medicina/métodos , Ética Médica , Humanos , Profissionalismo , Estudos RetrospectivosRESUMO
The All India Institute of Medical Sciences (AIIMS), New Delhi published guidelines, titled "Report of the Expert Group for framing Guidelines for admission of candidates with benchmark disabilities in postgraduate courses at AIIMS, New Delhi", for doctors with disabilities seeking postgraduate admissions to the Institutions of National Importance. The expert group, which lacked representation of people with disabilities, in general, and doctors with disabilities, in particular, puts immense effort into justifying why trainees with disabilities must not join AIIMS, at times in bold and/or capital letters, and at other places, in an outright ableist language. In addition, there is blatant plagiarism from well-known advisories and guidelines which are known for promoting the inclusion of trainees with disabilities. Attitudinal barriers and biases remained incorrigible as sections of these documents were selectively abridged to justify prevailing exclusion practises. We link the connection of these members to the controversial National Medical Council guidelines for undergraduate admission of persons with specified disabilities, which were successfully challenged in courts, as well as to the identification of posts for employment at AIIMS. We justify disability accommodations by citing inclusive court interventions from India to emphasise that the notion of inclusive equality includes the provision for reasonable accommodations. It is high time that the motto "Nothing about us, without us" becomes a locus classicus for immediate change of these discriminatory guidelines, as well as the prescribing powers of such experts.
RESUMO
BACKGROUND: Disability competencies were included, for the first time, in India's new undergraduate competency-based curriculum as a result of physician-led advocacy in 2019; the regulatory body also recommended the use of the humanities in medicine. OBJECTIVE: To use tools from the health humanities to impart disability competencies and help students appreciate the social and human rights issues associated with disability. METHODS: A module was developed and piloted in the foundation course on the new cohort of students. The tools included storytelling, visual art, poetry, narratives, and Forum Theatre; many facilitators were doctors and patients with disabilities. Learners were introduced to the concept of universal design through a field visit. Quantitative and open-ended feedback was taken from learners after module delivery; reflections were sought after four months. RESULTS: The data revealed that the humanities tools used in the module had the potential to help learners explore struggle and oppression and to expose discriminatory attitudes. Learners were able to think beyond the hegemony of normalcy, and show an understanding of diversity, dignity, autonomy, disableism, social inclusion, equity, and universal design. They admitted to the misconceptions they carried and showed keenness to advocate for change. CONCLUSION: This study piloted a novel disability competencies module using tools from the health humanities and found that learners were able to engage with and show an understanding of the social and human rights issues associated with disability. Conversations by, for, and with people with disabilities must be part of such interventions in developing and delivering disability courses.
Assuntos
Pessoas com Deficiência , Educação de Graduação em Medicina , Estudantes de Medicina , Currículo , Ciências Humanas , HumanosRESUMO
A novel KGaS2 phosphor host that emits a cyan light was discovered to fill the cyan gap in the visible spectrum of phosphor-converted white light-emitting diodes (pc-wLEDs). KGaS2, belonging to the chalcogenometallates of the type ABQ2, was synthesized via a solid-state route with compositions optimized to achieve a phosphor host that would achieve the best photoluminescence (PL) properties. The activation with Eu2+ gave rise to PL in the cyan region of the spectrum with a PL maximum at â¼498 nm, as measured under the near-UV (420 nm) and blue (450 nm) excitations. The PL properties at the near-UV excitation are found to be much better, as compared to those obtained at the blue excitation. The Rietveld analysis, using high resolution synchrotron X-ray diffraction calibrated at a wavelength of 1.522 Å and selected area electron diffraction (SAED) pattern analysis of the composition optimized with the highest PL intensity, revealed a centrosymmetric monoclinic structure in the C2/c space group. The stoichiometry of the optimized composition, as estimated using Rietveld refinement, was revealed as KGa0.921S1.882:Eu2+. The decay curve measurement, using time-resolved spectroscopy, yielded a 10% decay time of 0.41 µs, which is much smaller compared with the decay time of the commercially available ß-SIALON phosphor that has a 10% decay time of 1.71 µs. The white pc-LED, fabricated with a cyan phosphor, had a higher value on the color rendering index and a lower value for color correlated temperatures, as compared with the version fabricated without a cyan phosphor, which makes this novel phosphor suitable for applications as a pc-wLED.
RESUMO
Bordetella pertussis and Bordetella parapertussis are Gram-negative, aerobic, and pathogenic bacteria and cause pertussis disease (whooping cough) in humans. Genomic island analysis indicated the presence of an important protein bifunctional methylenetetrahydrofolate dehydrogenase/methenyltetrahydrofolate cyclohydrolase (BMD/MC) in both B. pertussis and B. parapertussis. BMD/MC is associated with carbon fixation, folate pathway, and microbial metabolism in a diverse environment. Sequence comparison analysis indicates two amino acid variations between BMD/MC of B. pertussis and B. parapertussis and this difference reflects a good extent of variation in their 3D model. After refinement, BMD/MC model assessment result shows that 96.77% residue of B. pertussis and 97.49% residues of B. pertussis belong to the favored region of the Ramachandran plot, indicating a good quality model. During structural alignment, chain A of BMD/MC for B. pertussis and B. parapertussis shows the RMSD of 0.058 angstroms between 281 pruned atom pairs. Cavity analysis predicts a single cavity with an area (362.723 Å2) and volume (216.631 Å3) in the BMD/MC of B. pertussis, whereas the area and volume of cavity in B. parapertussis is 479.689 Å2 and 350.982 Å3 respectively. Several residues in the predicted cavity of both organisms are common with a good extent of variation in their area and volume. The average value of RMSD, RMSF, the radius of gyration, and principal component analysis (eigenvectors) for the BMD/MC model (B. parapertussis) was found smaller as compared to B. pertussis, which indicates that the B. parapertussis model is comparatively better than B. pertussis. MDS analysis suggests that both modeled structures are stable, good quality, and a compact model with a small degree of motions.