An autonomous laboratory for the accelerated synthesis of novel materials.

To close the gap between the rates of computational screening and experimental realization of novel materials1,2, we introduce the A-Lab, an autonomous laboratory for the solid-state synthesis of inorganic powders. This platform uses computations, historical data from the literature, machine learning (ML) and active learning to plan and interpret the outcomes of experiments performed using robotics. Over 17 days of continuous operation, the A-Lab realized 41 novel compounds from a set of 58 targets including a variety of oxides and phosphates that were identified using large-scale ab initio phase-stability data from the Materials Project and Google DeepMind. Synthesis recipes were proposed by natural-language models trained on the literature and optimized using an active-learning approach grounded in thermodynamics. Analysis of the failed syntheses provides direct and actionable suggestions to improve current techniques for materials screening and synthesis design. The high success rate demonstrates the effectiveness of artificial-intelligence-driven platforms for autonomous materials discovery and motivates further integration of computations, historical knowledge and robotics.

Indian Society of Critical Care Medicine Consensus Statement for Prevention of Venous Thromboembolism in the Critical Care Unit.

Deep vein thrombosis (DVT) is a preventable complication of critical illness, and this guideline aims to convey a pragmatic approach to the problem. Guidelines have multiplied over the last decade, and their utility has become increasingly conflicted as the reader interprets all suggestions or recommendations as something that must be followed. The nuances of grade of recommendation vs level of evidence are often ignored, and the difference between a "we suggest" vs a "we recommend" is overlooked. There is a general unease among clinicians that failure to follow the guidelines translates to poor medical practice and legal culpability. We attempt to overcome these limitations by highlighting ambiguity when it occurs and refraining from dogmatic recommendations in the absence of robust evidence. Readers and practitioners may find the lack of specific recommendations unsatisfactory, but we believe that true ambiguity is better than inaccurate certainty. We have attempted to comply with the guidelines on how to create guidelines.1 And to overcome the poor compliance with these guidelines.2 Some observers have expressed concern that DVT prophylaxis guidelines may cause more harm than good.3 We have placed greater emphasis on large randomized controlled trials (RCTs) with clinical end point and de-emphasized RCTs with surrogate end points and also de-emphasized hypothesis generating studies (observational studies, small RCTs, and meta-analysis of these studies). We have de-emphasized RCTs in non-intensive care unit populations like postoperative patients or those with cancer and stroke. We have also considered resource limitation settings and have avoided recommending costly and poorly proven therapeutic options. How to cite this article: Jagiasi BG, Chhallani AA, Dixit SB, Kumar R, Pandit RA, Govil D, et al. Indian Society of Critical Care Medicine Consensus Statement for Prevention of Venous Thromboembolism in the Critical Care Unit. Indian J Crit Care Med 2022;26(S2):S51-S65.

First principles modeling of polymer encapsulant degradation in Si photovoltaic modules.

An outstanding issue in the longevity of photovoltaic (PV) modules is the accelerated degradation caused by the presence of moisture. Moisture leads to interfacial instability, de-adhesion, encapsulant decomposition, and contact corrosion. However, experimental characterization of moisture in PV modules is not trivial and its impacts can take years or decades to establish in the field, presenting a major obstacle to designing high-reliability modules. First principles calculations provide an alternative way to study the ingress of water and its detrimental effect on the structure and decomposition of the polymer encapsulant and interfaces between the encapsulant and the semiconductor, the metal contacts, or the dielectric layer. In this work, we use density functional theory (DFT) computations to model single chain, crystalline and cross-linked structures, infrared (IR) signatures, and degradation mechanisms of ethylene vinyl acetate (EVA), the most common polymer encapsulant used in Si PV modules. IR-active modes computed for low energy EVA structures and possible decomposition products match well with reported experiments. The EVA decomposition energy barriers computed using the Nudged Elastic Band (NEB) method show a preference for acetic acid formation as compared to acetaldehyde, are lowered in the presence of a water solvent or hydroxyl ion catalyst, and match well with reported experimental activation energies. This systematic study leads to a clear picture of the hydrolysis-driven decomposition of EVA in terms of energetically favorable mechanisms, possible intermediate structures, and IR signatures of reactants and products.

Transcatheter and Surgical Aortic Valve Replacement Outcomes for Patients with Chronic Heart Failure.

OBJECTIVES: To determine in-hospital outcomes and assess high-risk groups among chronic heart failure (CHF) patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). DESIGN: A retrospective analysis of the Nationwide Inpatient Sample database from January 2012 to September 2015 was performed. SETTING: Hospitals across the United States that offer TAVRs or SAVRs. PARTICIPANTS: Adults with a diagnosis of CHF and AS. INTERVENTIONS: The patients underwent either TAVR or SAVR. MEASUREMENTS AND MAIN RESULTS: Totals of 5,871 and 4,008 CHF patients underwent TAVR and SAVR, respectively. TAVR patients were significantly older, more were female, and had a higher comorbidity burden. No significant differences in in-hospital mortality were noted between TAVR and SAVR. However, mean length of stay was significantly longer by 3.5 days in the SAVR group, as was the mean total cost. With the exception of complete heart block, permanent pacemaker implantation, and vascular complications, the majority of postoperative events were higher among the SAVR group. Multivariate regression analysis identified postoperative cardiac, respiratory and renal complications as significant predictors of in-hospital mortality for both groups. Additionally, age ≥75 years and vascular complications were significant predictors of mortality for patients undergoing TAVR. CONCLUSIONS: Among CHF patients with symptomatic AS, TAVR had similar in-hospital mortality rate compared with SAVR despite higher comorbidity burden. TAVR patients are at a lower risk of cardiovascular, respiratory, and renal complications and might lead to reduced length of hospital stay and cost. Hence, TAVR may be a safer option in this population.

Evaluation of bioefficacy potential of entomopathogenic fungi against the whitefly (Bemisia tabaci Genn.) on cotton under polyhouse and field conditions.

The whitefly, Bemisia tabaci Gennadius (Hemiptera: Aleyrodidae), is becoming a serious problem on Bt cotton. It causes enormous crop loss through its direct feeding and as a vector of cotton leaf curl virus. Chemical-dependent management is harming the environment and increased insecticide resistance is often observed in the fields. Identification of most virulent strains of entomopathogenic fungi (EPF) is essential to serve as an important component of an IPM program for management of B. tabaci. Compared to B. tabaci adults, the nymphal stage is reported to be more susceptible to entomopathogens, and targeting nymphs also helps vector management. We evaluated the bioefficacy of EPF and chemical pesticides against nymphs of B. tabaci on Bt cotton under polyhouse and field conditions. The bioefficacy index (BI) was considered as a mechanism to select the most effective EPF strains for field evaluation. The highest nymphal mortality under polyhouse conditions was recorded for Metarhizium anisopliae NA-01299 (86.7%), Beauveria bassiana MT-4511 (85.1%), Cordyceps javanica IT-10498 (81.1%), IT-10499 (81%), and B. bassiana NA-0409 (78.2%) relative to other EPF strains, spiromesifen (69.6%), buprofezin (62.2%) and pyriproxyfen (52.7%) at 7-days-post-spray treatment (DAS). However, among all the EPF, the highest BI was recorded in C. javanica IT-10499 (77%), IT-10495 (75.4%), Fusarium verticillioides IT-10493 (74.6%), and B. bassiana MT-4511 (73.1%). The pooled data of two-year field trials (2017-18 & 2018-19) revealed that the highest nymphal mortality was recorded for MT-4511 (85%), IT-10499 (83.2%), and pyriproxyfen 10% EC (78.6%) at 7-DAS. The BI-based selection of EPF proved to be a useful predictor of field efficacy. A sequential spray of the selected EPF would be a vital approach for resilient and sustainable integrated management of the B. tabaci nymphal population under field conditions.

Indian medical graduates in New Zealand: does anyone win?

Medical migration has become a global phenomenon, partly led by easier air travel, economic factors and the expansion of medical technology. New Zealand has gradually evolved from being 'bicultural' to a multicultural, multitextured society. The movement of the Indian people, particularly Indian physicians, will be the focus of this paper. In the last three decades, migration eligibility in New Zealand has changed from countries of origin or ability to speak English, to profession and skills. Despite struggling with its own issues, New Zealand has proven to be a preferred destination for Indian medical graduates (IMGs). India is widely recognised as the largest 'donor country' for doctors, many of whom go on to establish themselves as leaders and prominent figures in their field. This migration involves three parties: India as a donor country, New Zealand as a recipient country and IMGs as the drivers of this process. Factors behind this growing phenomenon are examined and recommendations are made so that all three parties can benefit from it.

Psychological and Behavioral Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis.

BACKGROUND: During the current ongoing COVID-19 pandemic, psychological problems like anxiety, depression, irritability, mood swings, inattention and sleep disturbance are fairly common among quarantined children in several studies. A systematic review of these publications to provide an accurate burden of these psychiatric/behavioral problems is needed for planning mitigating measures by the health authorities. METHODS: Different electronic databases (MEDLINE, EMBASE, Web of Science, CENTRAL, medRxiv and bioRxiv) were searched for articles describing psychological/behavioral complications in children/adolescents with/without pre-existing behavioral abnormalities and their caregivers related to the COVID-19 pandemic. Only original articles with/without comparator arms and a minimum sample size of 50 were included in the analysis. The pooled estimate of various psychological/behavioral problems was calculated using a random-effect meta-analysis. RESULTS: Fifteen studies describing 22 996 children/adolescents fulfilled the eligibility criteria from a total of 219 records. Overall, 34.5%, 41.7%, 42.3% and 30.8% of children were found to be suffering from anxiety, depression, irritability and inattention. Although the behavior/psychological state of a total of 79.4% of children was affected negatively by the pandemic and quarantine, at least 22.5% of children had a significant fear of COVID-19, and 35.2% and 21.3% of children had boredom and sleep disturbance. Similarly, 52.3% and 27.4% of caregivers developed anxiety and depression, respectively, while being in isolation with children. CONCLUSION: Anxiety, depression, irritability, boredom, inattention and fear of COVID-19 are predominant new-onset psychological problems in children during the COVID-19 pandemic. Children with pre-existing behavioral problems like autism and attention deficit hyperactivity disorder have a high probability of worsening of their behavioral symptoms.

Rising cesarean deliveries in India: medical compulsions or convenience of the affluent?

From 2005-06 to 2015-16, proportion of cesarean deliveries in total deliveries has almost doubled in India. In this paper, we study changes in prevalence of cesarean deliveries across different social-economic groups and study factors affecting odds of undergoing cesarean delivery. The present paper was based on National Family Health Surveys and employs logistic regression. We find that rise in cesarean deliveries has been across social groups, religions, urban/rural India, wealth groups, though increase has not been uniform. Further, many economically affluent states have high proportion of cesarean deliveries. We find that women delivering at private hospitals had significantly higher odds of opting for cesarean delivery. Further, women belonging to rich households were more likely to go through surgery for birth. In case of earlier terminated pregnancies, odds were higher too. The higher odds of cesarean sections in the relatively affluent geographic regions, richer households and private institutions indicate that these procedures may be driven by non-medical reasons in many cases, pointing toward the use of surgical procedures for the convenience.

Indian Antimicrobial Prescription Guidelines in Critically Ill Immunocompromised Patients.

How to cite this article: Kulkarni AP, Sengar M, Chinnaswamy G, Hegde A, Rodrigues C, Soman R, Khilnani GC, Ramasubban S, Desai M, Pandit R, Khasne R, Shetty A, Gilada T, Bhosale S, Kothekar A, Dixit S, Zirpe K, Mehta Y, Pulinilkunnathil JG, Bhagat V, Khan MS, Narkhede AM, Baliga N, Ammapalli S, Bamne S, Turkar S, Bhat KV, Choudhary J, Kumar R, Divatia JV. Indian Journal of Critical Care Medicine 2019;23(Suppl 1): S64-S96.

Pilot Study of Kano "Attractive Quality" Techniques to Identify Change in Emergency Department Patient Experience.

STUDY OBJECTIVE: We describe the use of the Kano Attractive Quality analytic tool to improve an identified patient experience gap in perceived compassion by emergency department (ED) providers. METHODS: In phase 1, point-of-service surveying assessed baseline patient perception of ED provider compassion. Phase 2 deployed Kano surveys to predict the effect of 4 proposed interventions on patient perception. Finally, phase 3 compared patients receiving standard care versus the Kano-identified intervention to assess the actual effect on patient experience. RESULTS: In phase 1, 193 of 200 surveys (97%) were completed, showing a baseline median score of 4 out of 5 (interquartile range [IQR] 3 to 5), with top box percentage of 33% for patients' perception of receiving compassionate care. In phase 2, 158 of 180 surveys (88%) using Kano-formatted questions were completed, and the data predicted that increasing shared decisionmaking would cause the greatest improvement in the patient experience. Finally, in phase 3, 45 of 49 surveys (92%) were returned and demonstrated a significant improvement in perceived concern and sensitivity, 5 (IQR 5 to 5) versus 4 (IQR 3 to 5) with a difference of 1 (95% CI 0.1-1.9) and a top box rating of 79% versus 35% with a difference of 44% (95% CI 12-66) by patients who received dedicated shared decisionmaking interventions versus those receiving standard of care. CONCLUSION: Kano analysis is likely predictive of change in patient experience. Kano methods may prove as useful in changing management of the health care industry as it has been in other industries.

Is it Time to Rethink the Use of Steroids for Pulmonary Leptospirosis?

Pulmonary involvement is a fairly common complication of leptospirosis. A high dose of steroids is often used in the treatment of pulmonary leptospirosis. Here we report two cases who developed severe invasive fungal infections following the use of steroids for pulmonary leptospirosis. Routine use of steroids for pulmonary leptospirosis may do more harm than good as the evidence for this practice is sparse.

Effects of Bt cotton on Thrips tabaci (Thysanoptera: Thripidae) and its predator, Orius insidiosus (Hemiptera: Anthocoridae).

Laboratory studies were conducted to investigate tritrophic transfer of insecticidal Cry proteins from transgenic cotton to an herbivore and its predator, and to examine effects of these proteins on the predator's development, survival, and reproduction. Cry1Ac and Cry2Ab proteins from the bacterium Bacillus thuringiensis (Bt) produced in Bollgard-II (BG-II, Event 15985) cotton plants were acquired by Thrips tabaci Lindeman (Thysanoptera: Thripidae), an important sucking pest of cotton, and its generalist predator, Orius insidiosus (Say) (Hemiptera: Anthocoridae). The average protein titers in BG-II cotton leaves were 1,256 and 43,637 ng Cry1Ac and Cry2Ab per gram fresh leaf tissue, respectively. At the second trophic level, larvae of T. tabaci reared on BG-II cotton for 48-96 h had 22.1 and 2.1% of the Cry1Ac and Cry2Ab levels expressed in leaves, respectively. At the third trophic level, O. insidiosus that fed on T. tabaci larvae had 4.4 and 0.3% of the Cry1Ac and Cry2Ab protein levels, respectively, expressed in BG-II plants. O. insidiosus survivorship, time of nymphal development, adult weight, preoviposition and postoviposition periods, fecundity, and adult longevity were not adversely affected owing to consumption of T. tabaci larvae that had fed on BG-II cotton compared with non-Bt cotton. Our results indicate that O. insidiosus, a common predator of T. tabaci, is not harmed by BG-II cotton when exposed to Bt proteins through its prey. Thus, O. insidiosus can continue to provide important biological control services in the cotton ecosystem when BG-II cotton is used to control primary lepidopteran pests.

The comparison of species diversity and abundance of insect natural enemies in the domesticated species of cotton using the yellow pan trap method.

India is the world's largest cotton producer and the only country that grows all four cultivated cotton species. There have been very few studies on the diversity and abundance of natural enemies of cotton insect pests in these cultivated cotton species. Therefore, the current study (2016-2018) was conducted to assess the diversity and abundance of natural enemies that cultivated cotton species harbour. Phule Dhanwantari, Suraj, Suvin, RCH-2, and DCH-32 were the five genotypes used in the study, each with a distinct genetic background. Using the adiv 2.0.1 and vegan R packages, we identified significant differences in natural enemies in terms of species diversity, richness, evenness, and abundance. Analysis of Similarity (ANOSIM) and Non-metric Multidimensional Scaling (NMDS) indicated substantial differences in the natural enemy community structure among the examined genotypes. A total of 17,279 natural enemies were collected and identified across genotypes from seven predatory families and five parasitoid families. The percentage share of these natural enemy families across genotypes and years, in descending order, is Coccinellidae (28.23%) < Tachinidae (19.23%) < Braconidae (12.68%) < Chrysopidae (11.65%) < Chalcididae (9.41%) < Aphelinidae (6.33%) < Pentatomidae (3.29%) < Ichneumonidae (2.37%) < Syrphidae (2.33%) < Vespidae (1.81%) < Asilidae (1.79%) < Geocoridae (0.89%). Coccinellidae, Tachinidae, Braconidae, Chrysopidae, Chalcididae, and Aphelinidae are the six major families that account for more than 85% of all recorded natural enemies. These six families have a higher percentage share in Phule Dhanwantary (90%) compared to the other genotypes. The conservation and better utilization of these natural enemies are crucial for the ecological and safe management of insect pests in the cotton ecosystem.

Investigating the second whitefly population outbreak within a decade in the cotton growing zone of North India.

The whitefly, Bemisia tabaci (Gennadius), is a polyphagous and major pest of cotton worldwide. Both adults and nymphs of B. tabaci affect the crop by causing direct and indirect damage. A severe whitefly outbreak was experienced during 2015 on cotton in North India and this was followed by a profound infestation during 2022. The present research rigorously examined whether the proliferation in the whitefly population was an outbreak or the result of a multi factor resurgence. During 2015, whitefly counts remained above the economic threshold level (ETL) between 28th and 35th Standard Meteorological Week (SMW). However, during 2022 above ETL population was observed in 27th SMW and it persisted until 36th SMW. The peak incidence of the whitefly was noticed during 31st and 29th SMW in 2015 and 2022, respectively. The early pest build up in 2022 and longer persistence (≥10 weeks) over the cotton season resulted in more damage to cotton crop. Additionally, pest survillence across the zone on the farmers' fields during 2022 revealed 44.4 per cent spots (585 out of 1,317 locations) above ETL while the corresponding locations in 2015 was 57% (620 out of 1,089). Thus, in 2022 infestation was not uniform in the entire zone wherein only few blocks of Punjab, Haryana and Rajasthan states of India experienced severe infestations of the whitefly. This study reports the complex of factors including weather, delayed sowing, use of tank mixtures/ subleathal doses of insecticides, pest resurgence etc. that might have possibly contributed to these upsurges in whitefly on cotton in north India.

Cl alloying improves thermal stability and increases luminescence in iodine-rich inorganic perovskites.

The inorganic perovskite CsPbI3 shows promising photophysical properties for a range of potential optoelectronic applications but is metastable at room temperature. To address this, Br can be alloyed into the X-site to create compositions such as CsPbI2Br that are stable at room temperature but have bandgaps >1.9 eV - severely limiting solar applications. Herein, in an effort to achieve phase stable films with bandgaps <1.85 eV, we investigate alloying chlorine into iodine-rich triple-halide CsPb(I0.8Br0.2-x Cl x )3 with 0 < x < 0.1. We show that partial substitution of iodine with bromine and chlorine provides a path to maintain broadband terrestrial absorption while improving upon the perovskite phase stability due to chlorine's smaller size and larger ionization potential than bromine. At moderate Cl loading up to ≈5%, X-ray diffraction reveals an increasingly smaller orthorhombic unit cell, suggesting chlorine incorporation into the lattice. Most notably, this Cl incorporation is accompanied by a significant enhancement over Cl-free controls in the duration of black-phase stability of up to 7× at elevated temperatures. Additionally, we observe up to 5× increased steady state photoluminescence intensity (PL), along with a small blue-shift. In contrast, at high loading (≈10%), Cl accumulates in a second phase that is visible at grain boundaries via synchrotron fluorescence microscopy and negatively impacts the perovskite phase stability. Thus, replacing small fractions of bromine for chlorine in the iodine-rich inorganic perovskite lattice results in distinct improvement thermal stability and optoelectronic quality while minimally impacting the bandgap.

Comparative demography of two commensal macaques in India: implications for population status and conservation.

Rhesus and bonnet macaques are among the most common primates found in India and have been categorised as being of Least Concern by the IUCN. Despite the wealth of information on their ecology and behaviour, little attention has been paid to their demography or population status. We studied the demographic status of the two species along their common distribution zone in western, central and south-eastern India. Bonnet macaques were largely found in forest areas whereas rhesus macaques were observed more often in human-dominated habitats. The troop sizes of the two species also tended to be largest in different habitats, bonnet macaques in forested areas and rhesus macaques in urban areas. We suggest that the presence of large numbers of rhesus macaques in anthropogenic areas in south-eastern India is not a natural phenomenon but has been caused by human intervention. The bonnet macaque population has decreased in number in the common distribution zone, and as this species, unlike the rhesus macaque, is endemic to India, we strongly recommend the need to reassess its conservation status.

A selective literature review exploring the role of the nicotinic system in schizophrenia.

Nicotine use is more prevalent in patients with psychiatric disorders, especially those diagnosed with psychotic illnesses. Previously, this higher prevalence has been partially attributed to the potential ameliorative effects of nicotine on symptom severity and cognitive impairment. Some healthcare professionals and patients perceive there is a beneficial effect of nicotine on mental health. Emerging data show that the harm associated with nicotine in the population of patients with mental health conditions outweighs any potential benefit. This paper will review the evidence surrounding the nicotinic system and schizophrenia, with a focus on any causality between nicotine and psychosis.

Divergent proinflammatory immune responses associated with the differential susceptibility of cattle breeds to tuberculosis.

Tuberculosis (TB) in the bovine is one of the most predominant chronic debilitating infectious diseases primarily caused by Mycobacterium bovis. Besides, the incidence of TB in humans due to M. bovis, and that in bovines (bovine TB, bTB) due to M. tuberculosis- indicates cattle as a major reservoir of zoonotic TB. While India accounts for the highest global burden of both TB and multidrug-resistant TB in humans, systematic evaluation of bTB prevalence in India is largely lacking. Recent reports emphasized markedly greater bTB prevalence in exotic and crossbred cattle compared to indigenous cattle breeds that represent more than one-third of the total cattle population in India, which is the largest globally. This study aimed at elucidating the immune responses underlying the differential bTB incidence in prominent indigenous (Sahiwal), and crossbred (Sahiwal x Holstein Friesian) cattle reared in India. Employing the standard Single Intradermal Tuberculin Test (SITT), and mycobacterial gene-targeting single as well as multiplex-PCR-based screening revealed higher incidences of bovine tuberculin reactors as well as Mycobacterium tuberculosis Complex specific PCR positivity amongst the crossbred cattle. Further, ex vivo mycobacterial infection in cultures of bovine peripheral blood mononuclear cells (PBMC) from SITT, and myco-PCR negative healthy cattle exhibited significantly higher intracellular growth of M. bovis BCG, and M. tuberculosis H37Ra in the crossbred cattle PBMCs compared to native cattle. In addition, native cattle PBMCs induced higher pro-inflammatory cytokines and signaling pathways, such as interferon-gamma (IFN-γ), interleukin-17 (IL-17), tank binding kinase-1 (TBK-1), and nitric oxide (NO) upon exposure to live mycobacterial infection in comparison to PBMCs from crossbred cattle that exhibited higher expression of IL-1ß transcripts. Together, these findings highlight that differences in the innate immune responses of these cattle breeds might be contributing to the differential susceptibility to bTB infection, and the resultant disparity in bTB incidence amongst indigenous, and crossbred cattle.