An impact of tropical cyclone on meiobenthic fauna of Chennai coast, Tamil Nadu, India: A case study of cyclone Mandous.

The meiofaunal diversity is used as an indicator to assess the complex and diverse impacts on the coastal environment during the natural calamities. The present study evaluates the effects of Mandous cyclone on ecologically two different stations, Pattinampakkam beach and Adyar estuary, which are located on Chennai coast, Tamil Nadu, India. The impact of the Mandous cyclone on physico-chemical parameters and meiobenthic faunal composition was investigated during, prior to, and after the cyclone. Thirty-nine species of meiofauna belonging to 15 taxa were recorded in both the stations. Nematoda, Oligochaeta and Harpacticoida taxa occurred with higher diversity and abundance than other meiofaunal taxa. Among these taxa, Polygastrophora sp. of Nematoda, Grania pusilla of Oligochaeta, and Arenosetella indica of Harpacticoida were the predominant species recorded during the study period. There was a prominent decline in the population density of meiofauna due to the Mandous cyclone, and thereafter, it took three weeks for recolonization and restoration to normalcy. Statistically, significant impact of the Mandous cyclone on the diversity, density, and evenness of the meiofaunal community with abiotic factors were observed through the Ecological indices and Canonical Correspondence Analysis. The Mandous cyclone assessment with special emphasis on meiofaunal communities allowed to fill the gap with knowledge regarding the diversity, abundance, composition, and distribution of meiofauna between pre- and post-Mandous cyclone, which helped in understanding the physico-chemical changes and response of meiofauna in a sandy beach and estuary.

Impact of anthropogenic accumulation on phytoplankton community and harmful algal bloom in temporarily open/closed estuary.

Spatio-temporal variation in phytoplankton community dynamics in a temporarily open/closed Swarnamukhi river estuary (SRE), located on the South East coast of India was investigated and correlated to that of the adjacent coastal waters. Understanding the seasonal variability of the phytoplankton community and influencing factors are essential to predicting their impact on fisheries as the river and coastal region serve as the main source of income for the local fishing communities. Downstream before the river meets the sea, an arm of the Buckingham Canal (BC), carrying anthropogenic inputs empties into the Swarnamukhi River (SR1). The impact of anthropogenic effects on the phytoplankton community at BC was compared to other estuarine stations SR2 (upstream), SR1 (downstream), SRM (river mouth) and coastal station (CS). In BC station, harmful algal blooms (HABs) of Chaetoceros decipiens (2940 × 103 cells L-1) and Oscillatoria sp. (1619 × 103 cells L-1) were found during the southwest monsoon and winter monsoon, respectively. These HABs can be linked to the anthropogenic input of increased nutrients and trace metals. The HABs of Oscillatoria sp. were shown to be induced by elevated concentrations of nitrate (10.18 µM) and Ni (3.0 ppm) compared to ambient, while the HABs of C. decipiens were caused by elevated concentrations of silicate (50.35 µM), nitrite (2.1 µM), and phosphate (4.37 µM). Elevated nutrients and metal concentration from the aquaculture farms, and other anthropogenic inputs could be one of the prime reasons for the recorded bloom events at BC station. During this period, observed bloom species density was found low at other estuarine stations and absent at CS. The formation of bloom events during the closure of the river mouth could be a major threat to the coastal ecosystem when it opens. During the Osillatoria sp. bloom, both the Cu and Ni levels were higher at BC. The elevated concentration of nutrients and metals could potentially affect the coastal ecosystem and in turn fisheries sector in the tropical coastal ecosystem.

Effect of multiple stressors on the functional traits of sub-tidal macrobenthic fauna: A case study of the southeast coast of India.

The use of functional information of taxa is a promising approach to uncover the underlying mechanism of ecosystem functioning. We used biological trait analysis (BTA) to assess the functional response of subtidal macrobenthos with multiple stressors. Seventeen environmental variables from 42 stations of five coastal districts were assessed along the southeast coast of India. Dominant fauna was assigned into 20 categories belonging to six functional traits. Additionally, we used five ecological groups (EG) of AMBI as a covariable trait to validate functional traits and EG relationship. The trait composition in the communities showed significant variation between undisturbed and disturbed areas. RLQ/Fourth corner combined approach illustrated the effects of stressors and isolated the corresponding species associated with different stressors. Smaller, short-lived, deposit-feeding, and discretely motile fauna occurred at the disturbed areas, whereas, larger, long-lived, and highly motile at the undisturbed area. Dissolved oxygen, organic enrichment, and metals concentration were the main environmental descriptors influencing the trait composition. The results highlight the importance of the BTA approach to uncover the response of the macrobenthic community to anthropogenic disturbances-driven impacts in multi-stressed near-shore coastal ecosystems.

Evaluation of factors influencing the trace metals in Puducherry and Diu coasts of India through multivariate techniques.

In recent years, urban and industrial development initiatives at Puducherry and Diu such as tourism, shipping, and fisheries have led to sediment contamination by trace metals, and contributed to this investigation that extended from 2016 to 2017. Strong factor loadings of Cd (0.94), Ni (0.84), Al (0.84), Cr (0.83), Co (0.82), and Fe (0.78) illustrated the variability at Puducherry, whereas Cr (0.88), Cd (0.86), Ni (0.83), Co (0.77), Cu (0.77), and Fe (0.77) showed variability at Diu. The mean rank order distribution of the top three metals in sediment was Fe > Al > Mn, which exhibited higher variability. The highest contamination factor was observed for Cd at Diu, whereas the lowest was observed at Puducherry for Al. Similarly, the risk index also exhibited considerable risk which could be attributed to Cd contamination in the sediment at Diu compared with that at Puducherry. The results obtained are essential to establish a reference for better comparison and management of the tropical environments.

Assessment of ecological health of Swarnamukhi river estuary, southeast coast of India, through AMBI indices and multivariate tools.

A combination of biotic indices, geo-accumulation (Igeo) index, and a multivariate approach were applied to assess the anthropogenic influence on the benthic community at five stations from 2018 to 2019 in the Swarnamukhi river estuary, Nellore, India. Non-metric multidimensional scaling and cluster analysis indicated that the Buckingham canal (BC) station showed azoic conditions and formed a separate cluster. Strong positive factor loadings of Cd (0.96), Al (0.93), Zn (0.91), Fe (0.90), Co (0.89), Cu (0.89), Ni (0.87), Pb (0.85), Cr (0.77), organic matter (0.94), Silt (0.92), and clay (0.93) and negative loading of sand (-0.90) showed the variability in sediment. AMBI results illustrated the disturbance status of each station and classified BC station as 'extremely disturbed' class, and M-AMBI assessed the ecological status as 'bad'. The Igeo index also revealed metal (Cd) contamination. The present study illustrated that the combined approach is effective for ecological assessment of coastal ecosystem.

Assessment of trace metal contamination in the marine sediment, seawater, and bivalves of Parangipettai, southeast coast of India.

Industrial and domestic discharge into the coastal environment has driven us to propose an integrated approach to delineate stations contaminated with metals on the Parangipettai coast by collecting sediment and seawater samples monthly at 18 stations from 2015 to 2017. Descriptive statistics revealed that the concentrations of some metals in the sediment and seawater samples were beyond the permissible level. Further, factor analysis showed a sampling adequacy of 0.90 with high positive loading for Ni (0.94), Cd (0.91), Co (0.90), Pb (0.89), and Zn (0.87) in sediment samples. The degree of contamination by metals was evaluated using pollution indices. The results of the contamination index revealed that some stations in the study area were moderately polluted, and those of the ecological index showed that open sea was under low risk while other stations were in the moderate-to-high-risk category. The results obtained are essential to establish the reference condition for a comparative study in similar environments in the tropical regions.

Evaluation of trace metals in seawater, sediments, and bivalves of Nellore, southeast coast of India, by using multivariate and ecological tool.

Urbanization in recent years has driven us to investigate metal contamination on Nellore coast by collecting seawater, sediment, and bivalve samples monthly at five stations from 2015 to 2017. Non-metric multidimensional scaling and cluster analysis indicated that open sea (OS) samples were markedly different from the samples collected at other stations. Strong factor loadings of Al (0.76), Mn (0.79), and Cd (0.78) showed variability in seawater, while those for Fe (0.76), Ni (0.77), Zn (0.85), and Pb (0.81) showed variability in sediment. The mean values of Fe (346 ppm) and Mn (21 ppm) were high in bivalves compared to the mean values of other metals. A higher contamination factor was observed for Cd at Buckingham Canal, while the lowest was observed for sediment in OS. The order of trace metals in sediments according to risk index was Cd > Pb > Cu > Cr > Zn. The results obtained are essential to establish a reference for better comparison of tropical environments.

Effectiveness of an mHealth-Based Electronic Decision Support System for Integrated Management of Chronic Conditions in Primary Care: The mWellcare Cluster-Randomized Controlled Trial.

BACKGROUND: The burden of noncommunicable diseases and their risk factors has rapidly increased worldwide, including in India. Innovative management strategies with electronic decision support and task sharing have been assessed for hypertension, diabetes mellitus, and depression individually, but an integrated package for multiple chronic condition management in primary care has not been evaluated. METHODS: In a prospective, multicenter, open-label, cluster-randomized controlled trial involving 40 community health centers, using hypertension and diabetes mellitus as entry points, we evaluated the effectiveness of mWellcare, an mHealth system consisting of electronic health record storage and an electronic decision support for the integrated management of 5 chronic conditions (hypertension, diabetes mellitus, current tobacco and alcohol use, and depression) versus enhanced usual care among patients with hypertension and diabetes mellitus in India. At trial end (12-month follow-up), using intention-to-treat analysis, we examined the mean difference between arms in change in systolic blood pressure and glycated hemoglobin as primary outcomes and fasting blood glucose, total cholesterol, predicted 10-year risk of cardiovascular disease, depression score, and proportions reporting tobacco and alcohol use as secondary outcomes. Mixed-effects regression models were used to account for clustering and other confounding variables. RESULTS: Among 3698 enrolled participants across 40 clusters (mean age, 55.1 years; SD, 11 years; 55.2% men), 3324 completed the trial. There was no evidence of difference between the 2 arms for systolic blood pressure (Δ=-0.98; 95% CI, -4.64 to 2.67) and glycated hemoglobin (Δ=0.11; 95% CI, -0.24 to 0.45) even after adjustment of several key variables (adjusted differences for systolic blood pressure: - 0.31 [95% CI, -3.91 to 3.29]; for glycated hemoglobin: 0.08 [95% CI, -0.27 to 0.44]). The mean within-group changes in systolic blood pressure in mWellcare and enhanced usual care were -13.65 mm Hg versus -12.66 mm Hg, respectively, and for glycated hemoglobin were -0.48% and -0.58%, respectively. Similarly, there were no differences in the changes between the 2 groups for tobacco and alcohol use or other secondary outcomes. CONCLUSIONS: We did not find an incremental benefit of mWellcare over enhanced usual care in the management of the chronic conditions studied. CLINICAL TRIAL REGISTRATION: URL: https://www. CLINICALTRIALS: gov. Unique identifier: NCT02480062.

Development of mWellcare: an mHealth intervention for integrated management of hypertension and diabetes in low-resource settings.

BACKGROUND: Cardiovascular diseases and diabetes are among the leading causes of premature adult deaths in India. Innovative approaches such as clinical decision support (CDS) software could play a major role in improving the quality of hypertension/diabetes care in primary care settings. OBJECTIVE: To describe the steps and processes in the development of mWellcare, a complex intervention based on mobile health (mHealth) technology. METHODS: The Medical Research Council framework was used to develop mWellcare in four steps: (1) identify gaps in usual care through literature review and health facility assessments; (2) identify the components of the intervention through discussions and consultations with experts; (3) develop intervention (clinical algorithms and mHealth system); and (4) evaluate acceptability and feasibility through pilot testing in five community health centers. RESULTS: Lack of evidence-based, integrated, and systematic management of chronic conditions were major gaps identified. Experts in information technology, clinical fields, and public health professionals identified intervention components to address these gaps. Thereafter, clinical algorithm contextualized to primary care settings were prepared and the mWellcare intervention was developed. During the 2-month pilot, 631 patients diagnosed with hypertension and/or diabetes were registered, with a follow-up rate of 36.2%. The major barrier was resistance to follow mWellcare recommended patient workflow, and to overcome it, we emphasized onsite training and orientation program to cover all health care team member in each CHC. CONCLUSION: A pilot-tested mWellcare intervention is an mHealth system with important components, i.e. integrated management of chronic conditions, evidence-based CDS, longitudinal health data and automated short-messaging service to reinforce compliance to drug intake and follow-up visit, which will be used by nurses at primary health care settings in India. The effectiveness and cost-effectiveness of the intervention will be tested through a cluster randomized trial (trial registration number NCT02480062).

Evaluation of the environmental quality of Parangipettai, Southeast Coast of India, by using multivariate and geospatial tool.

The anthropogenic pressure in recent years has driven us to investigate the environmental quality at 22 stations in Parangipettai by collecting seawater samples monthly from 2014 to 2015. The sampling stations were grouped into three different environments, namely, Vellar Estuary (VE), Coleroon Estuary (CE), and Open Sea (OS). Factor analysis showed a total variance of 65.63% and exhibited a strong factor loading for atmospheric temperature (0.914), water temperature (0.917), ammonia (0.767), inorganic phosphate (0.897), total phosphorus (0.783), and phytoplankton (0.829). The index value showed water quality was good in OS (74.18), whereas it was moderate in VE (69.73) and CE (68.47). The visual model developed using Geographical Information System (GIS) displayed a spatial pattern of water temperature and phytoplankton dispersion in a distinct manner. The results obtained through multivariate analysis and GIS-based model are imperative to establish reference for a comparative study with other similar ecosystem for better planning and management of tropical seawaters.

Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India.

INTRODUCTION: Rising burden of cardiovascular disease (CVD) and diabetes is a major challenge to the health system in India. Innovative approaches such as mobile phone technology (mHealth) for electronic decision support in delivering evidence-based and integrated care for hypertension, diabetes and comorbid depression have potential to transform the primary healthcare system. METHODS AND ANALYSIS: mWellcare trial is a multicentre, cluster randomised controlled trial evaluating the clinical and cost-effectiveness of a mHealth system and nurse managed care for people with hypertension and diabetes in rural India. mWellcare system is an Android-based mobile application designed to generate algorithm-based clinical management prompts for treating hypertension and diabetes and also capable of storing health records, sending alerts and reminders for follow-up and adherence to medication. We recruited a total of 3702 participants from 40 Community Health Centres (CHCs), with ≥90 at each of the CHCs in the intervention and control (enhanced care) arms. The primary outcome is the difference in mean change (from baseline to 1 year) in systolic blood pressure and glycated haemoglobin (HbA1c) between the two treatment arms. The secondary outcomes are difference in mean change from baseline to 1 year in fasting plasma glucose, total cholesterol, predicted 10-year risk of CVD, depression, smoking behaviour, body mass index and alcohol use between the two treatment arms and cost-effectiveness. ETHICS AND DISSEMINATION: The study has been approved by the institutional Ethics Committees at Public Health Foundation of India and the London School of Hygiene and Tropical Medicine. Findings will be disseminated widely through peer-reviewed publications, conference presentations and other mechanisms. TRIAL REGISTRATION: mWellcare trial is registered with Clinicaltrial.gov (Registration number NCT02480062; Pre-results) and Clinical Trial Registry of India (Registration number CTRI/2016/02/006641). The current version of the protocol is Version 2 dated 19 October 2015 and the study sponsor is Public Health Foundation of India, Gurgaon, India (www.phfi.org).

The Development of mWellcare, an mHealth System for the Integrated Management of Hypertension and Diabetes in Primary Care.

This paper describes development of mhealth application "mWellcare" for the integrated management of hypertension and diabetes in public primary health care settings. mWellcare application was developed in four phases: identifying gaps in usual care; identifying components of intervention; developing intervention; evaluating acceptability and feasibility through pilot testing. Final version of mWellcare application is capable of computing personalized evidence-based management plan for hypertension, diabetes and co-morbid conditions (depression and alcohol use disorder).

Geographic information systems and multivariate analysis to evaluate fecal bacterial pollution in coastal waters of Andaman, India.

Urbanization of coastal areas in recent years has driven us to consider a new approach for visually delineating sites that are contaminated with fecal bacteria (FB) in the coastal waters of the Andaman Islands in India. Geo-spatial analysis demarcated harbor, settlement, and freshwater/discharge influenced zones as hot spots for FB, while the open sea was demarcated as a cold spot. The land use types, such as developed and agriculture, with more anthropogenic activities increasing the FB counts while open sea showed the least FB. Box whisker plot indicated an increasing FB trend in the coastal waters during monsoon. Furthermore, principal component analysis revealed 67.35%, 78.62% and 70.43% of total variance at Port Blair, Rangat and Aerial bays, respectively. Strong factor loading was observed for depth (0.95), transparency (0.93), dissolved oxygen (0.93) and fecal streptococci (0.85). Distance proximity analysis revealed that fecal contaminations diluted significantly (P < 0.05) at the distance of 2.1 km toward the deeper or open sea water. This study demonstrates the effectiveness of an integrated approach in identifying the sources of fecal contamination and thus helping in better monitoring and management of coastal waters.

Finger Length Ratio (2D:4D) in Central India and an Attempt to Verify Fraternal Birth Order Effect: A Population Based Cross-Sectional Study.

INTRODUCTION: A normal physiology of a human being is not mere a series of functions occurring with specific intensities and timing. There are lot of factors that may change the normal physiological activity within normal limits. Finger length ratio is one of the markers of intrauterine androgen exposure and it is debated and contradicted by many authors. Digit ratio varies among the ethnicities. Many Indian studies show that there is considerable difference in finger length ratio in different population. Data regarding Central India was not found on extensive search. AIM: To find out the finger length ratio and explore the birth order effect on finger length ratio among the first two successive born in the said population. MATERIALS AND METHODS: We conducted a survey on 1500 volunteer persons (800 male and 700 female) over two years of time. We measured the length of the index finger (2D) and ring finger (4D) of both the hands and asked about their birth order history to find out the digit ratio for Central India population and any existing correlation of the same with birth order. T Test and Analysis of Variance (ANOVA) were used for the measure of significance and difference among the groups. The p< 0.05 was considered to be significant. RESULTS: Our study reports that, study population mean for right hand 2D:4D ratio was 0.976 (SD±0.031) and for left hand it was found to be 0.969 (SD±0.035). For males, mean finger length ratio for right hand was 0.967 (SD±0.033) and 0.963 (SD±0.037) for left hand. In females the mean Finger length ratio was 0.982 (SD±0.027) for right hand and 0.974 (SD±0.034) for the left hand respectively. Finger length ratio was found to be significantly less (p=0.03) in males for right hand. No significant (p=0.24) difference was observed for left hand. When assessed fraternal birth order effect among the eldest, second born with elder brother and second born with elder sister groups, no significant (p>0.05) variation for finger length ratio of right and left hands observed in both male and female population. CONCLUSION: Our study reports that the finger length ratio (2D:4D) for Central India population did not show significant association between finger length ratio and fraternal birth order among the first two successive born.

Water quality assessment using water quality index and geographical information system methods in the coastal waters of Andaman Sea, India.

Seawater samples at 54 stations in the year 2011-2012 from Chidiyatappu, Port Blair, Rangat and Aerial Bays of Andaman Sea, have been investigated in the present study. Datasets obtained have been converted into simple maps using coastal water quality index (CWQI) and Geographical Information System (GIS) based overlay mapping technique to demarcate healthy and polluted areas. Analysis of multiple parameters revealed poor water quality in Port Blair and Rangat Bays. The anthropogenic activities may be the likely cause for poor water quality. Whereas, good water quality was witnessed at Chidiyatappu Bay. Higher CWQI scores were perceived in the open sea. However, less exploitation of coastal resources owing to minimal anthropogenic activity indicated good water quality index at Chidiyatappu Bay. This study is an attempt to integrate CWQI and GIS based mapping technique to derive a reliable, simple and useful output for water quality monitoring in coastal environment.

Intra-household evaluations of alcohol abuse in men with depression and suicide in women: A cross-sectional community-based study in Chennai, India.

BACKGROUND: Harmful effects of alcohol abuse are well documented for drinkers, and adverse effects are also reported for the physical and emotional well-being of family members, with evidence often originating from either drinkers or their families in clinic-based settings. This study evaluates intra-household associations between alcohol abuse in men, and depression and suicidal attempts in women, in community-based settings of Chennai, India. METHODS: This community-based cross-sectional study of chronic disease risk factors and outcomes was conducted in n = 259 households and n = 1053 adults (aged 15 years and above) in rural and urban Chennai. The Alcohol Use Disorder Identification Test (AUDIT) score was used to classify alcohol consumption into 'low-risk', 'harmful', 'hazardous' and 'alcohol dependence' drinking and the Patient Health Questionnaire (PHQ-9) score to classify depression as 'mild', 'moderate', 'moderate-severe' and 'severe'. Multivariate logistic regression models estimated the association of depression in women with men's drinking patterns in the same household. RESULTS: A significant 2.5-fold increase in any depression (PHQ-9 ≥ 5) was observed in men who were 'alcohol-dependent' compared to non-drinkers (OR = 2.53; 95% CI: 1.26, 5.09). However, there was no association between men's drinking behavior and depression in women of the same household, although suicidal attempts approached a significant dose-response relationship with increasing hazard-level of men's drinking (p = 0.08). CONCLUSION: No significant intra-household association was observed between men's alcohol consumption and women's depression, though an increasing (non-significant) trend was associated with suicidal attempts. Complex relationships between suicidal attempts and depression in women and male abusive drinking require further exploration, with an emphasis on intra-household mechanisms and pathways.

Multivariate and geo-spatial approach for seawater quality of Chidiyatappu Bay, south Andaman Islands, India.

Chidiyatappu Bay is one of the least disturbed marine environments of Andaman & Nicobar Islands, the union territory of India. Oceanic flushing from southeast and northwest direction is prevalent in this bay. Further, anthropogenic activity is minimal in the adjoining environment. Considering the pristine nature of this bay, seawater samples collected from 12 sampling stations covering three seasons were analyzed. Principal Component Analysis (PCA) revealed 69.9% of total variance and exhibited strong factor loading for nitrite, chlorophyll a and phaeophytin. In addition, analysis of variance (ANOVA-one way), regression analysis, box-whisker plots and Geographical Information System based hot spot analysis further simplified and supported multivariate results. The results obtained are important to establish reference conditions for comparative study with other similar ecosystems in the region.

Enterococcus species diversity and molecular characterization of biomarker genes in Enterococcus faecalis in Port Blair Bay, Andaman and Nicobar Islands, India.

This study was performed to evaluate the abundance and diversity of Enterococcus sp. and the distribution of biomarker genes in Enterococcus faecalis in Port Blair Bay, Andaman and Nicobar Islands. The Enterococcus sp. densities at the seven sampling stations were highly influenced by tidal fluctuations and season. The distributions and diversities of species varied in the inner and outer regions of Port Blair Bay. Among the 1816 total isolates, the occurrence of fecal Enterococcus was high (1.78×10(4) CFU/100 mL) in Phoenix Bay. Moreover, 67.76% of the isolates were identified as Enterococcus, and the most frequently identified species were E. hirae, E. avium and E. faecalis. Assessments of antibiotic resistance and biomarker genes revealed the maximum occurrence in the Aberdeen Bay isolates. The most prevalent biomarker genes observed in the E. faecalis isolates were gelE and asa1, whereas cyl was not found among the isolates. In silico sequence analysis of biomarker genes of E. faecalis also revealed that they are evolutionarily well conserved with those of earlier reports. Further, multivariate analysis distinguished the JB, PB and OS stations from the other stations according to distinctive microbial densities and compositions. In addition, the Shannon-Wiener diversity indices and box-whisker plots further facilitated and supported the multivariate results.