Long-term application of agronomic management strategies effects on soil organic carbon, energy budgeting, and carbon footprint under rice-wheat cropping system.

In the plains of western North India, traditional rice and wheat cropping systems (RWCS) consume a significant amount of energy and carbon. In order to assess the long-term energy budgets, ecological footprint, and greenhouse gas (GHG) pollutants from RWCS with residual management techniques, field research was conducted which consisted of fourteen treatments that combined various tillage techniques, fertilization methods, and whether or not straw return was present in randomized block design. By altering the formation of aggregates and the distribution of carbon within them, tillage techniques can affect the dynamics of organic carbon in soil and soil microbial activity. The stability of large macro-aggregates (> 2 mm), small macro-aggregates (2.0-2.25 mm), and micro-aggregates in the topsoil were improved by 35.18%, 33.52%, and 25.10%, respectively, over conventional tillage (0-20 cm) using tillage strategies for conservation methods (no-till in conjunction with straw return and organic fertilizers). The subsoil (20-40 cm) displayed the same pattern. In contrast to conventional tilling with no straw returns, macro-aggregates of all sizes and micro-aggregates increased by 24.52%, 28.48%, and 18.12%, respectively, when conservation tillage with organic and chemical fertilizers was used. The straw return (aggregate-associated C) also resulted in a significant increase in aggregate-associated carbon. When zero tillage was paired with straw return, chemical, and organic fertilizers, the topsoil's overall aggregate-associated C across all aggregate proportions increased. Conversely, conventional tillage, in contrast to conservation tillage, included straw return as well as chemical and organic fertilizers and had high aggregate-associated C in the subsurface. This study finds that tillage techniques could change the dynamics of microbial biomass in soils and organic soil carbon by altering the aggregate and distribution of C therein.

Cost-Effective Home Mechanical Ventilation in Neurosurgery Patients: Case Series of Three Patients.

Background Neurological patients who are ventilator-dependent occupy scarce beds in the hospitals for prolonged periods of time. Most, if not all, can be discharged on home mechanical ventilation (HMV). However, due to lack of insurance and state support, it remains prohibitively expensive for the vast majority of those who require it most. Materials and Methods The authors discuss three patients admitted in the Department of Neurosurgery between January and August 2019, who were discharged on HMV after remaining on ventilator support for prolonged period in the hospital. Each patient was discharged with two units (one as standby) of AgVa home ventilator (AgVa Healthcare; New Delhi, India), one Ambu-bag, one pulse oximeter, and one backup power supply unit capable of supplying power to ventilator for a minimum of 24 hours. All the equipment were given free-of-cost through donations by hospital staffs and other donors. All patients were followed up telephonically from their homes and the incidence of complications, ventilator malfunction, and additional cost of HMV on the families were ascertained. Observation and Results Of the three patients, two were male and one female. Age ranged from 12 to 17 years. The duration of in-hospital ventilator support prior to discharge on HMV varied from 1 to 5 years. There was no insurance cover available for any of the patients with all expenses being "out of pocket." The equipment cost Indian Rupees (INR) 115,700 (USD 1,615: two units of AgVa home ventilator costing INR 100,000 [USD 1,396], one Ambu-bag costing INR 1,100 [USD 15], one pulse oximeter costing INR 1,600 [USD 22], and one backup power supply unit costing INR 13,000 [USD 182]). Discharge on HMV was planned on specific request from patients' families and informed consent was taken from all. All patients had tracheostomies. Mode of HMV was pressure support ventilation in all. Telephonic follow-up ranged from 1 to 7 months. The cost of disposables was INR 100 per month (USD 0.7) for all the patients. No complications occurred in any patient. There was no incidence of ventilator-associated pneumonia (VAP) or ventilator malfunction. Conclusions Availability of cost-effective indigenous ventilator like AgVa home has made HMV possible, even for poor patients with neurological diseases, and has the potential to improve quality of life, decrease VAP rates, and free up scarce ventilator beds in hospitals. Longer-term follow-up in larger number of patients will improve the data on safety and feasibility in developing countries like India.

Measuring quality of antenatal care: a secondary analysis of national survey data from India.

OBJECTIVE: To assess the coverage and adequacy of antenatal care services (ANC) available to women and examine the socio-economic determinants affecting service utilisation. DESIGN: Secondary data analysis of a population-based national survey. SETTING: India, 2015/16. SAMPLE: In all, 190 898 women between 15 and 49 years of age who had a live birth during the 5 years preceding the survey. METHODS: Ordinal logistic regression. MAIN OUTCOME VARIABLE: Adequacy of ANC services received was measured under four categories - delivery of services by skilled personnel, timely provision of services, sufficiency and appropriateness of content. Quality of care was categorised as adequate ANC, inadequate ANC and no ANC. RESULTS: Only 23.5% (95% CI 23.1-23.9%) of all women received adequate ANC, while 58.8% (95% CI 58.4-59.2%) received inadequate and 17.7% (95% CI 17.4-18.0%) received no ANC services. Regression analysis revealed that women belonging to the adolescent age group, illiterate women, and those in the poorest wealth quintile and in rural areas were less likely to receive any ANC. CONCLUSION: There is a need to improve the quality of ANC services. Currently, <25% of women of all ages receive adequate ANC. Socio-economic conditions play a vital part in determining the quality of care that women receive. TWEETABLE ABSTRACT: Nearly one out of four women in India received adequate ANC, nearly three in every five women received inadequate ANC and 18% lacked ANC for their recent live birth.

Epidemiology, Clinico-Haematological Profile and Management of Aplastic Anaemia: AIIMS Experience.

BACKGROUND: The incidence of aplastic anaemia (AA) is higher in Asia than in the West. The precise incidence of AA in India is not known due to lack of epidemiological study. 20-40% of pancytopenic patients in referral centres are of aplastic anaemia. PATIENTS AND METHODS: This was an analysis of 1501 patients diagnosed with aplastic anaemia over a period of seven and half years (January 2007- June 2014) attending the Aplastic clinic of department of haematology of All India Institute of Medical Sciences, New Delhi. The details regarding medical history, physical examination, complete blood count, bone marrow aspirate and biopsy, treatment received, were retrieved. Inherited bone marrow failure was screened in patients below 35 years. Treatment response was analysed for various treatment modalities. RESULTS: 1501 patients of AA from 20 different states of India were analysed. The bulk of patients were from Uttar Pradesh (28.7%), Bihar (23.6%), Delhi/NCR (20%) and Haryana (7%).The average number of new aplastic anaemia patients enrolled per year 214 (range: 101 -263). The median age at presentation was 25 years (range 2-83),with M;F - 2.3:1. Severity of AA revealed: severe (SAA): 75%, very severe (VSAA): 15%, non-severe (NSAA): 10%. Inherited bone marrow failure syndromes constituted 5% (75 patients) of all aplastic anaemia patients. The most common clinical presentations were pallor (97%), bleeding manifestations (69.6%) and fever (54%). The haematological parameters showed: median level of haemoglobin level: 5.9 gm/dL, WBC: 2700/mm3, ANC: 380/mm3, platelet: 1 0000/mm3. PNH clone was present in 13.5% of patients. 107 patients (7%) were lost to follow up or expired before any treatment was initiated. Only 69 patients (4.5%) received treatment with HLA-matched sibling stem cell transplantation and another 232 (15.5%) patients received ATG plus cyclosporine as immunosuppressive therapy. Seven hundred thirteenpatients (47.5%) received cyclosporine. The overall response to various treatment modalities was: HLA matched sibling haematopoietic stem cell transplant: 75.3%, Anti-thymocyte globulin plus cyclosporine: 58.7%, cyclosporine plus androgen: 45.6%, cyclosporine alone: 32.2%. CONCLUSION: Management of AA is a real challenge in developing countries.This is one of the largest case series from a single centre from India. It is our endeavour to reduce the detrimental outcome by increasing awareness among patients and referring physicians to reduce the delay between diagnosis and treatment.

Effect of low thermal budget annealing on surface passivation of silicon by ALD based aluminum oxide films.

Thermal ALD deposited Al2O3 films on silicon show a marked difference in surface passivation quality as a function of annealing time (using a rapid thermal process). An effective and quality passivation is realized in short anneal duration (∼100 s) in nitrogen ambient which is reflected in the low surface recombination velocity (SRV <10 cm s(-1)). The deduced values are close to the best reported SRV obtained by the high thermal budget process (with annealing time between 10-30 min), conventionally used for improved surface passivation. Both as-deposited and low thermal budget annealed films show the presence of positive fixed charges and this is never been reported in the literature before. The role of field and chemical passivation is investigated in terms of fixed charge and interface defect densities. Further, the importance of the annealing step sequence in the MIS structure fabrication protocol is also investigated from the view point of its effect on the nature of fixed charges.

Addressing maternal and child health in post-conflict Afghanistan: the way forward.

Afghanistan's maternal and child mortality rates are among the highest in the world. The country faces challenges to meet the Millennium Development Goals set for 2015 which can be attributed to multiple causes related to accessibility, affordability and availability of health-care services. This report addresses the challenges in strengthening maternal and child health care in Afghanistan, as well discussing the areas to be prioritized. In order to ensure sound maternal and child health care in Afghanistan, policy-makers must prioritize monitoring and surveillance systems, integrating maternal and child health care with rights-based family planning methods, building human resources, offering incentives (such as the provision of a conditional cash transfer to women) and promoting action-oriented, community-based interventions. On a wider scale, the focus must be to improve the health infrastructure, organizing international collaboration and expanding sources of funding.

Micropropagation of seedless lemon (Citrus limon L. cv. Kaghzi Kalan) and assessment of genetic fidelity of micropropagated plants using RAPD markers.

A micropropagation protocol was developed for multiplication of seedless lemon (Citrus limon L. cv. Kaghzi Kalan) using nodal explants. The maximum shoot regeneration was observed on low level of BAP (0.1 mg l(-1)) or kinetin (0.5 mg l(-1)). BA was recorded to be better than kinetin in terms of number of days taken to bud break. The maximum number of shoots per explant was observed on 0.1 mg l(-1) BA and 0.5 mg l(-1) kinetin. Shoot proliferation decreased with increasing concentration of BA alone, but in case of a combination of BA and NAA (0.1 mg l(-1) each), it increased with increasing concentration of BA up to 10.0 mg l(-1). None of the treatments including BA or kinetin alone or BA in combination with NAA produced significantly more shoots for commercial exploitation. In the case of a combination of BA + kinetin + IBA, the maximum (5.5 shoots per explants) proliferation was observed on MS medium containing 1.0 mg l(-1) BA + 0.5 mg l(-1) kinetin + 0.5 mg l(-1) IBA or 0.25 mg l(-1) BA + 1.0 mg l(-1) kinetin + 1.0 mg l(-1) IBA. Regenerated shoots showed root induction on MS basal medium or on MS medium containing 1.0 mg l(-1) IBA. It is concluded that a five-fold increase (1.0 mg l(-1) BA + 0.5 mg l(-1) kinetin + 0.5 mg l(-1) IBA) in axillary shoot proliferation, while seven-fold increase (0.25 mg/l mg l(-1) BA + 1.0 mg l(-1) kinetin + 1.0 mg l(-1) IBA) during the second cycle of multiplication could be obtained using the two plant growth regulator combinations. PCR amplification with 14 different random primers confirmed no somaclonal variant up to two cycles of shoot multiplication.

Profile of the dental therapy graduate at the University of KwaZulu-Natal.

INTRODUCTION: Dental Therapists were introduced to the oral health team of South Africa in the 1970s by the Department of Health in order to assist in reducing inequities in oral health service provision to disadvantaged communities. Training occurred at two historically disadvantaged universities viz. Medical University of Southern Africa (MEDUNSA) and the University of Durban-Westville (UDW). However, disparities in access to basic oral healthcare have continued, in contrast to the success of similar initiatives recorded by over fifty countries around the world. In 2006, the Department of Health recommended that, as Dental Therapists were critical to the provision of primary oral healthcare, their training must be offered by all dental schools. Further, the recommendation proposed that the number trained annually should be increased from 25 (in 2005) to 600 by 2009. In response, concern was expressed by the stakeholders such as the South African Dental Association (SADA) and the Committee of Dental Deans. The SADA position paper on dental therapy called for an immediate moratorium on the training of Dental Therapists until all stakeholders had debated these issues. It is clear that the issue has not been resolved and that additional data pertinent to the training and deployment of this echelon of oral healthcare workers is required. PURPOSE: The purpose of this study was to critically evaluate the application, enrolment and graduate profiles of the dental therapy classes and graduates over the period from 2001 to 2010 from the University of KwaZulu-Natal (UKZN), in order to provide baseline data for a larger study which is being conducted by the researcher on the role of the dental therapist in the healthcare system of South Africa. METHODOLOGY: Quantitative data was obtained from the Data Management Information system of UKZN on application, enrolment and graduate profiles. Data was analyzed using the Statistical Package for Social Sciences (SPSS) and Excel software. Basic measures of description such as tables, graphs and percentages were displayed. RESULTS: The applicant profile showed an exponential increase in number from 460 in 2001to 3 845 in 2010. The enrolment profile showed a linear increase from 8 in 1980 to 81 in 2010. The enrolments showed a preponderance of females, whilst all students on entrance were under 20 years of age. The racial breakdown revealed that up to 2007, more Indians than Africans were enrolled. After 2007, this trend was reversed. The graduate profile showed an upward shift around a mean of 16 graduates per year. Practice patterns showed that 47% of graduates worked in private practice, 19% went on to study dentistry, 10% worked in the public sector, 7% no longer worked in the dental profession. Nearly one fifth (16%) could not be traced. DISCUSSION AND CONCLUSION: Conflicting reports and opinions on the dental therapy profession exist among major stakeholders such as the Department of Health, the South African Dental Association and the Committee of Dental Deans. Before any decisions are made on the training of extended numbers of Dental Therapists, it is important to compile a comprehensive profile of the dental therapy graduate which will assist all the relevant stakeholders to make informed decisions about this profession.

Assessment of right ventricular diastolic function: does it predict post-operative course in tetralogy of Fallot.

BACKGROUND: In some cases of tetralogy of Fallot the post-operative course is characterized by episodes of low cardiac output, elevated central filling pressures and prolonged ventilation and inotropic support. This may be due to impaired diastolic function of the right ventricle despite preservation of biventricular systolic function. METHODS AND RESULTS: Sixty-four consecutive patients (mean age 7.06+/-4.9 years) undergoing repair of tetralogy of Fallot were prospectively studied to assess right ventricular diastolic function. 'Restrictive physiology' was defined as presence of laminar antegrade diastolic pulmonary artery flow (A wave) throughout the respiratory cycle, which was coincident with atrial systole. Right ventricle restriction was present in 45/64 (70%, Group 1) patients and absent in 19/64 (30%, Group 2) patients. There was a marked inspiratory augmentation of the pulmonary artery A wave velocity, flow integral and duration. Transtricuspid flow revealed significantly lower peak E velocity, lower E/A ratio, shorter E deceleration time and higher A velocity time integral in those with right ventricular restriction. Biventricular systolic function and transmitral flow were normal in all patients. Those with restrictive physiology had significantly longer mean inotrope support duration, longer ventilation and chest drainage times. Correspondingly, the mean intensive care unit stay (56.7+/-9.3 v. 34.7+/-5.38 hours, p<0.01) and mean hospital discharge time (9.3+/-2.3 v. 6.2+/-0.5 days, p <0.001) was also significantly longer in group 1. CONCLUSIONS: Right ventricular restriction (as seen by laminar antegrade diastolic pulmonary artery flow throughout the respiratory cycle) exists in a significant subset of patients with tetralogy of Fallot following operative repair. Following surgery, such patients have higher inotropic requirement, longer ventilation times and longer hospital stay.

Assessment of the protective activity of monisoamyl meso-2,3-dimercaptosuccinate against methylmercury-induced maternal and embryo/fetal toxicity in mice.

The protective activity of monoisoamyl meso-2,3-dimercaptosuccinate (Mi-ADMS), a new monoester of 2,3-dimercaptosuccinic acid (DMSA), on methylmercury-induced maternal and developmental toxicity was assessed in mice. A series of four Mi-ADMS injections was given s.c. at 0.25, 6, 24, and 48 h after oral administration of 25 mg/kg of methylmercury chloride (MMC) given on day 10 of gestation. Mi-ADMS effectiveness was tested at 0, 23.8, 47.6 and 95 mg/kg. Cesarean sections were performed on gestation day 18. All live fetuses were examined for external, internal, and skeletal abnormalities. Oral MMC administration resulted in an increase in the number of resorptions, and a decrease in fetal body weight, whereas the incidence of cleft palate, micrognathia, and skeletal variations was also increased in the fetuses of the MMC-treated groups. Although significant amelioration of MMC-induced embryolethality by Mi-ADMS was not noted at any dose, MMC-induced fetotoxicity was reduced by administration of this agent at 23.8, 47.6, and 95 mg/kg. However, the intrinsic toxicity of Mi-ADMS would be a restrictive factor for the possible therapeutic use of this chelator in pregnant women exposed to organic mercury.