Concepts of circular economy for sustainable management of electronic wastes: challenges and management options.

The electronic and electrical industrial sector is exponentially growing throughout the globe, and sometimes, these wastes are being disposed of and discarded with a faster rate in comparison to the past era due to technology advancements. As the application of electronic devices is increasing due to the digitalization of the world (IT sector, medical, domestic, etc.), a heap of discarded e-waste is also being generated. Per-capita e-waste generation is very high in developed countries as compared to developing countries. Expansion of the global population and advancement of technologies are mainly responsible to increase the e-waste volume in our surroundings. E-waste is responsible for environmental threats as it may contain dangerous and toxic substances like metals which may have harmful effects on the biodiversity and environment. Furthermore, the life span and types of e-waste determine their harmful effects on nature, and unscientific practices of their disposal may elevate the level of threats as observed in most developing countries like India, Nigeria, Pakistan, and China. In the present review paper, many possible approaches have been discussed for effective e-waste management, such as recycling, recovery of precious metals, adopting the concepts of circular economy, formulating relevant policies, and use of advance computational techniques. On the other hand, it may also provide potential secondary resources valuable/critical materials whose primary sources are at significant supply risk. Furthermore, the use of machine learning approaches can also be useful in the monitoring and treatment/processing of e-wastes. HIGHLIGHTS: In 2019, ~ 53.6 million tons of e-wastes generated worldwide. Discarded e-wastes may be hazardous in nature due to presence of heavy metal compositions. Precious metals like gold, silver, and copper can also be procured from e-wastes. Advance tools like artificial intelligence/machine learning can be useful in the management of e-wastes.

Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic - A cross-sectional study.

OBJECTIVES: The primary outcome measures evaluated the financial toxicity and mental well-being of the oral cancer survivors. METHODS: A cross-sectional study of oral cancer survivors who were disease-free for more than 6 months after treatment and visited the hospital for a routine follow-up is included in the study. Mental well-being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale - 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST- Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre-pandemic era. RESULTS: A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full-time employment dropped from 83.5% in the pre-treatment period to 21.5% post-treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3-5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3-21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3-6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors (M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression (M = 16.4 ± 7.1, p = 0.06) and stress (M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment (p = 0.04) and treatment modality (p = 0.05) were significant factors impacting the financial toxicity. CONCLUSION: There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre-COVID era. There is significant financial toxicity among either unemployed or part-time workers. This calls for urgent public/government intervention to prevent the long-term impact of financial toxicity on survival and quality of life.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.

Early hemodynamic assessment using NICOM in patients at risk of developing Sepsis immediately after emergency department triage.

BACKGROUND: One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis. METHODS: Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in two outcome groupings: (1) admitted vs. dehydrated, febrile, hypovolemicdischarged patients; (2) infectious vs. non-infectious sources. Receiver operator characteristic (ROC) curves were calculated to determine whether the NICOM values predict hospital admission better than a serum lactate. RESULTS: 50 patients were enrolled, 32 (64 %) were admitted to the hospital. Mean age was 49.5 (± 16.5) years and 62 % were female. There were no significant associations between changes in hemodynamic variables and patient disposition from the ED or diagnosis of infection. Lactate was significantly higher in admitted patients and those with infection (p = 0.01, p = 0.01 respectively). The area under the ROC [95 % Confidence Intervals] for lactate was 0.83 [0.64-0.92] compared to 0.59 [0.41-0.73] for cardiac output (CO), 0.68 [0.49-0.80] for cardiac index (CI), and 0.63 [0.36-0.80] for heart rate (HR) for predicting hospital admission. CONCLUSIONS: CO and CI, obtained at two separate time points, do not help with early disease severity differentiation of patients at risk for severe sepsis. Although mean HR was higher in those patients who were admitted, a serum lactate still served as a better predictor of patient admission from the ED.

Assessment of understanding about human papilloma virus vaccination among undergraduate medical students in a developing country: Perspective from India.

BACKGROUND AND AIMS: Human papilloma virus (HPV) infection is the most common sexually transmitted infection responsible for cervical cancer in women. There is no cure for HPV but safe and effective vaccinations before sexual debut can definitely decrease the incidence of cervical cancer. This research aims to explore the basic understanding of medical students about cervical cancer, HPV and HPV vaccination. METHODS AND MATERIAL: This was a descriptive, questionnaire based cross-sectional study conducted among the undergraduate medical students of All India Institute of Medical Sciences, Jodhpur from April 2018 to May 2018. A total of 238 respondents participated in the study. For statistical analysis, 'Z' score was used for categorical data and student t test was used for normally distributed continuous data. RESULTS: Overall, 41% students had good knowledge about HPV infection and HPV vaccination while 44% students had average knowledge and 15% had poor knowledge. The majority of them (>80%) knew that HPV is responsible for cervical cancer and ano-genital warts but their awareness was not of the same order when it came to associating HPV with penile and oropharyngeal cancer (60%). Females had better knowledge as compared to males and this difference was statistically significant (P < 0.05). 88% of the students were willing to accept the vaccination while only 10% of females were previously vaccinated. CONCLUSION: Medical students, who are potential recipients of the HPV vaccine themselves, can play a unique role in promoting awareness about HPV vaccination in the future.

Socioeconomic disparities in layperson CPR training within a large U.S. city.

AIM OF THE STUDY: We sought to understand how individual factors and neighborhood characteristics are associated with a layperson's likelihood of being trained in CPR. We hypothesized that higher socioeconomic status (educational attainment, and median household income (MHI)) would be associated with a higher likelihood of previous CPR training. METHODS: Through the Mobile CPR Project, a program providing hands-only CPR and AED education in Philadelphia, we surveyed participants regarding socioeconomic factors and prior CPR training. Survey questions pertained to race, gender, education, prior CPR training, automated external defibrillator (AED) awareness, and residential area. Community MHI was extrapolated via residential address and census tract data. RESULTS: From 7/2016 to 4/2018, 1703 subjects completed surveys, including location information, prior to participating in a Mobile CPR Project training event. Of these, 70% were female, 70% were non-white, mean age was 42 ±â€¯20 years, and MHI was $39,318 [IQR $27,708-$60,795]. Subjects residing in census tracts with MHI below the cohort median were significantly less likely to have ever received CPR training (lowest quartile: OR 0.65, CI 0.49-0.85, p = 0.002). In multiple logistic regression controlling for age, race, gender, MHI, and education, higher educational attainment was associated with a higher likelihood of ever receiving CPR training (OR 7.96 Masters or Doctoral compared to less than high school, CI 5.24-12.11, p < 0.001). CONCLUSIONS: There is a strong association between socioeconomic factors (MHI and educational attainment) and likelihood of prior layperson CPR training.