Emotional Intelligence and Occupational Stress Among Nursing Professionals in Tertiary Care Hospitals of Bangalore: A Multicentric, Cross-Sectional Study.

Background: Nursing profession requires strength and resilience not just physically, but emotionally as well which requires them to adapt in stressful situations that they are often exposed to in their work environment. Objective: To determine the prevalence and associated factors of emotional intelligence (EI) and occupational stress (OS) among the nursing professionals from selected tertiary care hospitals in Bangalore, India. Methods: This was a multi-centric, cross-sectional study done among nurses with more than 1year of work experience and they were randomly selected from four tertiary care hospitals in Bangalore. The EI and OS were assessed using the Emotional intelligence scale (EIS) and Occupational Stress Index (OSI). Data was collected, both online and offline, owing to the ongoing COVID-19 pandemic. The data was analyzed using SPSS v21.0 to calculate the mean, associations, and regression. Results: Out of the total 294, the mean age of the study participants was 27±4.92years. A total of 75 (25.5%) nurses had poor EI and 245 (83.3%) had moderate OSI. None of the participants had high OSI. There was a significant association between the severity grades of EI and OSI (P = 0.010) and a binary logistic regression showed that those staff with high EI had a lesser odd (OR 0.531, 95% CI 0.282-0.999) of developing occupational stress as compared to those with low EI. Conclusion: EI plays a significant role in reversing the effect of one's occupational stress. Thereby, the training curriculum should include skills and measures of resilience to facilitate their EI improvement.

Immunogenicity of SARS-CoV-2 vaccines BBV152 (COVAXIN®) and ChAdOx1 nCoV-19 (COVISHIELD™) in seronegative and seropositive individuals in India: a multicentre, nonrandomised observational study.

Background: There are limited global data on head-to-head comparisons of vaccine platforms assessing both humoral and cellular immune responses, stratified by pre-vaccination serostatus. The COVID-19 vaccination drive for the Indian population in the age group 18-45 years began in April 2021 when seropositivity rates in the general population were rising due to the delta wave of COVID-19 pandemic during April-May 2021. Methods: Between June 30, 2021, and Jan 28, 2022, we enrolled 691 participants in the age group 18-45 years across four clinical sites in India. In this non-randomised and laboratory blinded study, participants received either two doses of Covaxin® (4 weeks apart) or two doses of Covishield™ (12 weeks apart) as per the national vaccination policy. The primary outcome was the seroconversion rate and the geometric mean titre (GMT) of antibodies against the SARS-CoV-2 spike and nucleocapsid proteins post two doses. The secondary outcome was the frequency of cellular immune responses pre- and post-vaccination. Findings: When compared to pre-vaccination baseline, both vaccines elicited statistically significant seroconversion and binding antibody levels in both seronegative and seropositive individuals. In the per-protocol cohort, Covishield™ elicited higher antibody responses than Covaxin® as measured by seroconversion rate (98.3% vs 74.4%, p < 0.0001 in seronegative individuals; 91.7% vs 66.9%, p < 0.0001 in seropositive individuals) as well as by anti-spike antibody levels against the ancestral strain (GMT 1272.1 vs 75.4 binding antibody units/ml [BAU/ml], p < 0.0001 in seronegative individuals; 2089.07 vs 585.7 BAU/ml, p < 0.0001 in seropositive individuals). As participants at all clinical sites were not recruited at the same time, site-specific immunogenicity was impacted by the timing of vaccination relative to the delta and omicron waves. Surrogate neutralising antibody responses against variants-of-concern including delta and omicron was higher in Covishield™ recipients than in Covaxin® recipients; and in seropositive than in seronegative individuals after both vaccination and asymptomatic infection (omicron variant). T cell responses are reported from only one of the four site cohorts where the vaccination schedule preceded the omicron wave. In seronegative individuals, Covishield™ elicited both CD4+ and CD8+ spike-specific cytokine-producing T cells whereas Covaxin® elicited mainly CD4+ spike-specific T cells. Neither vaccine showed significant post-vaccination expansion of spike-specific T cells in seropositive individuals. Interpretation: Covishield™ elicited immune responses of higher magnitude and breadth than Covaxin® in both seronegative individuals and seropositive individuals, across cohorts representing the pre-vaccination immune history of most of the vaccinated Indian population. Funding: Corporate social responsibility (CSR) funding from Hindustan Unilever Limited (HUL) and Unilever India Pvt. Ltd. (UIPL).

Anemia burden in pregnancy and birth outcomes among women receiving antenatal care services from a secondary level hospital in South India: A record review.

Introduction: Anaemia in pregnant women is a major public health problem and is associated with adverse outcomes both in pregnant mothers and new-borns. According to NFHS-5, 45.7% of women in urban India were affected by anaemia during their pregnancy. The objectives of this study were to estimate the proportion of pregnant women who were anaemic and its effect on maternal and birth outcomes, and additionally, to assess the various socio-economic factors contributing to anaemia during pregnancy. Methodology: Data was collected by reviewing records between December 2018 and December 2021 of 302 pregnant women who had received antenatal care at a secondary level health facility in Krishnagiri, Tamil Nadu. The data included details of socio-economic parameters, parity, haemoglobin levels, mode of delivery, pregnancy related complications during the antenatal period and during delivery, including need for blood transfusions in mothers. Birth-related outcomes like miscarriages, intra-uterine death, low birth weight (LBW), need for NICU admission and congenital defects were also analysed. Variables in the study are described as frequencies and proportions. Appropriate tests were used to check for association and a P- value of less than 0.05 was considered as statistically significant. Results: The mean age of the women was 24 ± 3.72 years and the mean Haemoglobin level during the first trimester was 10.5 ± 1.12 gm/dl. The proportion of women with anaemia in the first trimester was 174 (57.6%). Among the anaemics, 15 (8.6%) required treatment in the form of injectable iron and 29 (16.7%) required blood transfusion. Gestational diabetes mellitus (GDM) (31.6%) (P < 0.05), preeclampsia (38.9%) (P < 0.02) less among anaemic. Hyperemesis (66.7%) (P = 0.58), risk of miscarriage (57.8%) (P = 0.94), postpartum haemorrhage (PPH) (80.0%) (P = 0.15) was higher in the anaemic group. Adverse Neonatal-related outcomes such as low birth weight babies (52.0%) (P = 0.54), meconium aspiration (72.7%) (P = 0.25) and need for NICU admission (75.0%) (P = 0.25) was higher in babies born to anaemic pregnant women. Conclusions: The proportion of anaemic women was 57.6%. There was no significant difference in maternal demographic characteristics or obstetric factors between anaemic and non-anaemic pregnant women. GDM, pre-eclampsia was less prevalent among anaemic women. Hyperemesis, risk of abortion, postpartum haemorrhage and low birth weight (LBW) infants was higher in anaemic pregnancies. The need for providing education regarding iron supplementation and early detection of anaemia during pregnancy should be emphasised to avoid complications.

Polyfunctional CD4 T-cells correlating with neutralising antibody is a hallmark of COVISHIELDTM and COVAXIN® induced immunity in COVID-19 exposed Indians.

Detailed characterisation of immune responses induced by COVID-19 vaccines rolled out in India: COVISHIELDTM (CS) and COVAXIN® (CO) in a pre-exposed population is only recently being discovered. We addressed this issue in subjects who received their primary series of vaccination between November 2021 and January 2022. Both vaccines are capable of strongly boosting Wuhan Spike-specific neutralising antibody, polyfunctional Th1 cytokine producing CD4+ T-cells and single IFN-γ + CD8+ T-cells. Consistent with inherent differences in vaccine platform, the vector-based CS vaccine-induced immunity was of greater magnitude, breadth, targeting Delta and Omicron variants compared to the whole-virion inactivated vaccine CO, with CS vaccinees showing persistent CD8+ T-cells responses until 3 months post primary vaccination. This study provides detailed evidence on the magnitude and quality of CS and CO vaccine induced responses in subjects with pre-existing SARS-CoV-2 immunity in India, thereby mitigating vaccine hesitancy arguments in such a population, which remains a global health challenge.

Emotional intelligence and tertiary care nurses of Bangalore, India - A cross-sectional study.

BACKGROUND: Nursing profession requires diverse skills, and emotional intelligence (EI) plays a role in helping them adapt to adverse situations as a part of their work environment. The study objective was to determine the prevalence of EI with its associated factors among the nursing professionals from selected four tertiary care hospitals in Bangalore. MATERIALS AND METHODS: This was a multicentric, cross-sectional study done among nurses with more than 1 year of work experience, who were randomly selected from tertiary care hospitals in Bangalore. Data was collected, both online and offline, owing to the ongoing COVID-19 pandemic, and the Emotional Intelligence Scale was used following obtaining informed consent. Data analysis included mean, associations, and regression. RESULTS: Out of the total 294, the mean age of the study participants was 27 ± 4.92 years. A total of 75 (25.5%) had poor EI. Although there were not any significant association between the specialty and EI subscales, a significant association was found to be present between total years of work experience and all five subscales of EI: self-awareness (P = 0.009), social regulation (P = 0.004), motivation (P = 0.012), social awareness (P = 0.008), and social skills (P = 0.049), respectively. Logistic regression showed a significant finding where nursing staff with more work experience had a higher EI (OR 0.012, 95% CI 1.288-8.075) than those with less work experience. CONCLUSION: The prevalence of poor EI among nursing professionals was 25%, and EI scores increased with increasing work experience, and this was found to be significant. Thereby, EI building workshops/training, as a part of the nursing curriculum, may help improve their quality of care and resilience in demanding work environments.

Morbidity Profile and Cholinesterase Levels among Sprayers in Selected Tea Plantations in South India.

Background: The tea plantation industry is composed of a complex chain of workers whose functions often overlap. There has been an extensive use of pesticides in this sector, and in the long term, these can have detrimental effects on the chemical sprayers working in the tea plantations. Aims: To assess the morbidities related to pesticide toxicity and document the most recent plasma cholinesterase levels among the pesticide sprayers working in selected tea plantations in South India. Methods: A cross-sectional study was conducted among 290 chemical sprayers in selected tea plantations in South India after approval from the Institutional Ethics Committee and permission from the plantations. A structured interview schedule was administered by face-to-face interview with the selected sample. The blood cholinesterase detection done at the Estate Hospital was documented by the interviewer. Results: The mean age of the participants was 45.6 ± 8.5 years and all of them were males. About 35.2% of the participants had reported at least one symptom of organophosphorus toxicity. The most common symptom was headache (21.7%) followed by itching of the eyes (20%) and watering of the eyes (16.2%). The blood cholinesterase values were normal in most of the sprayers in the study and only four (1.4%) sprayers had values less than the reference range. There was a significant association between the duration of work, method of spraying, and the blood cholinesterase levels indicating that greater duration of exposure and more direct contact with the chemical raise the cholinesterase levels significantly. Conclusion: The symptoms of pesticide toxicity were reported among the sprayers. The blood cholinesterase levels were normal for most of them.

Impact of Self-Help Groups among Persons With Disabilities in Rural Karnataka - A Comparative, Cross-Sectional Study.

Background: The prime concern for an individual with disability is independence. Self-help groups (SHGs) provide opportunities for those with such needs. Objectives: The objectives of the study were (i) to assess the impact of SHGs on the livelihood, social inclusion, and community participation of those with disability and (ii) to evaluate the self-esteem and assess the role of such SHGs among those with disability. Materials and Methods: This was a community-based, cross-sectional study. An interview schedule captured responses to standardized questionnaires (community-based rehabilitation assessment tool, Rosenberg's self-esteem score, and Social Inclusion Scale). Responses were scored and compared among the two groups of those with disability (member or nonmember of SHGs). Results: The median scores for all our outcome variables were found to be more among those with disabilities enrolled in SHGs than those who were not with a significant association in the component of empowerment, sociocommunity participation, social inclusion, and self-esteem. Conclusion: SHGs improve social and community participation of individuals with disability. It empowers them to lead independent lives and also contributes to social inclusion.

A Decade's Experience in Pediatric Chromosomal Microarray Reveals Distinct Characteristics Across Ordering Specialties.

Chromosomal microarray (CMA) is a testing modality frequently used in pediatric patients; however, published data on its utilization are limited to the genetic setting. We performed a database search for all CMA testing performed from 2010 to 2020, and delineated the diagnostic yield based on patient characteristics, including sex, age, clinical specialty of providers, indication of testing, and pathogenic finding. The indications for testing were further categorized into Human Phenotype Ontology categories for analysis. This study included a cohort of 14,541 patients from 29 different medical specialties, of whom 30% were from the genetics clinic. The clinical indications for testing suggested that neonatology patients demonstrated the greatest involvement of multiorgan systems, involving the most Human Phenotype Ontology categories, compared with developmental behavioral pediatrics and neurology patients being the least. The top pathogenic findings for each specialty differed, likely due to the varying clinical features and indications for testing. Deletions involving the 22q11.21 locus were the top pathogenic findings for patients presenting to genetics, neonatology, cardiology, and surgery. Our data represent the largest pediatric cohort published to date. This study is the first to demonstrate the diagnostic utility of this assay for patients seen in the setting of different specialties, and it provides normative data of CMA results among a general pediatric population referred for testing because of variable clinical presentations.

Experience and Perceptions Regarding Menopause among Rural Women: A Cross-Sectional Hospital-Based Study in South Karnataka.

BACKGROUND: There is a culture of silence around menopause in India, more so among rural women. This study was conducted to assess the prevalence of menopausal symptoms, factors associated with the severity of menopausal symptoms, and perceptions regarding menopause among rural perimenopausal women. METHODOLOGY: A cross-sectional study was conducted at a rural hospital, among women aged 40 years or more, having experienced at least one menstrual cycle in the past 1 year. Structured interview schedule was administered to capture perceptions of menopause. Symptoms of menopause and severity were assessed using the Menopause Rating Scale (MRS) and participants screened for depression using patient health questionnaire-9. RESULTS: Among 200 women, the prevalence of symptoms of menopause was 70%. Commonly reported symptoms were somatic symptoms: Joint/muscular pain, hot flushes, and psychological symptoms: Physical/mental exhaustion, anxiety. Median overall MRS score was low (4 [interquartile range = 1, 7]), pointing out to lesser severity. Significant association was found between MRS score and higher body mass index (P = 0.007), tobacco-chewing (P = 0.023), and depression (P < 0.001). Perception of menopause was generally positive, but we also documented some myths and misconceptions regarding menopause that indicate a need for health awareness in this population. CONCLUSION: This study found high prevalence but low severity of menopausal symptoms. Our findings point to a need for mitigating symptoms of menopause through diet, physical activity, tobacco cessation, and counseling for depression. Targeted interventions using community women's groups and village-level health workers are recommended to provide not only awareness regarding menopause but also an opportunity to screen for comorbidities with appropriate referrals.

Quality of sleep among patients diagnosed with tuberculosis-a cross-sectional study.

PURPOSE: Tuberculosis (TB) can affect sleep and can predispose patients to chronic diseases like diabetes mellitus. On the other hand, sleep deprivation and diabetes mellitus can worsen tuberculosis. The aim of this study was to assess sleep quality, to estimate the prevalence of poor sleepers and those at risk for restless legs syndrome (RLS) and to evaluate the knowledge and practices regarding sleep hygiene among patients diagnosed with TB. METHODS: In a cross-sectional study, a semi-structured questionnaire was administered to patients diagnosed with TB in Bengaluru, India. The questionnaire was comprised of sections including demography, knowledge and practice regarding sleep hygiene, the international restless leg study group consensus diagnostic criteria to diagnose RLS, the Pittsburgh sleep quality index, the Epworth sleepiness scale, and history of adverse drug reactions (ADRs). RESULTS: Of 206 participants enrolled, 125 men (61%), mean (SD) age was 41.0 (16.2) years, and 121 (59%) had pulmonary TB while the remaining 85 (41%) had extrapulmonary TB. The prevalence (95% confidence intervals) of poor quality sleepers was 17% (12, 23%), those with poor knowledge of sleep hygiene (< 6 marks) 33% (27, 40%), those at risk for RLS 32% (26, 39%), and those with excessive daytime sleepiness (EDS) 12% (8, 17%). CONCLUSION: Prevalence of poor quality sleepers and those at risk for RLS are higher than normal population, thus making sleep quality assessment important in patients diagnosed with TB. Prevalence of those at risk for EDS was comparable to normal population.

Sleep quality and restless leg syndrome among antenatal women attending government healthcare facilities in urban bangalore.

INTRODUCTION: Sleep changes are more common in pregnancy and lack of sleep in antenatal women can lead to hypertension, postpartum depression, abortions, and preterm babies. OBJECTIVES: 1. To assess sleep quality and daytime sleepiness among pregnant women attending government health care facilities in Urban Bangalore. 2 To measure the association between sleep quality, daytime sleepiness with restless leg syndrome (RLS) in the same study population. METHODOLOGY: A cross-sectional study was conducted in March and April 2018 among all antenatal women attending the Government District Hospital, Anekal Taluk and Primary Health Centre, Sarjapur, in Urban Bangalore. The calculated sample size was 255 and we interviewed 260 women using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale and RLS rating scale along with details on socio-demography. RESULTS: According to PSQI, 83.1% had good sleep quality, 14.2% had daytime sleepiness and 21.9% had RLS. The RLS was significantly associated (P < 0.05) with trimester, sleep onset position, sleep quality, and daytime sleepiness. On logistic regression, there are 3.6 times the chances of having RLS when the sleep quality is bad and 5.3 times more chances of having RLS when there is daytime sleepiness. CONCLUSION: RLS is significantly associated with daytime sleepiness and sleep quality in antenatal women. Health education on the importance of sleep and about RLS should be included during antenatal visits.

Decoding the evolutionary response to prostate cancer therapy by plasma genome sequencing.

BACKGROUND: Investigating genome evolution in response to therapy is difficult in human tissue samples. To address this challenge, we develop an unbiased whole-genome plasma DNA sequencing approach that concurrently measures genomic copy number and exome mutations from archival cryostored plasma samples. This approach is applied to study longitudinal blood plasma samples from prostate cancer patients, where longitudinal tissue biopsies from the bone and other metastatic sites have been challenging to collect. RESULTS: A molecular characterization of archival plasma DNA from 233 patients and genomic profiling of 101 patients identifies clinical correlations of aneuploid plasma DNA profiles with poor survival, increased plasma DNA concentrations, and lower plasma DNA size distributions. Deep-exome sequencing and genomic copy number profiling are performed on 23 patients, including 9 patients with matched metastatic tissues and 12 patients with serial plasma samples. These data show a high concordance in genomic alterations between the plasma DNA and metastatic tissue samples, suggesting the plasma DNA is highly representative of the tissue alterations. Longitudinal sequencing of 12 patients with 2-5 serial plasma samples reveals clonal dynamics and genome evolution in response to hormonal and chemotherapy. By performing an integrated evolutionary analysis, minor subclones are identified in 9 patients that expanded in response to therapy and harbored mutations associated with resistance. CONCLUSIONS: This study provides an unbiased evolutionary approach to non-invasively delineate clonal dynamics and identify clones with mutations associated with resistance in prostate cancer.

Single-Cell Circulating Tumor Cell Analysis Reveals Genomic Instability as a Distinctive Feature of Aggressive Prostate Cancer.

PURPOSE: Aggressive variant prostate cancer (AVPC) represents a clinical subset distinguished by therapy resistance and poor prognosis, linked to combined losses of the tumor suppressor genes (TSG) PTEN, RB1, and TP53. Circulating tumor cells (CTC) provide a minimally invasive opportunity for identification and molecular characterization of AVPC. We aimed to evaluate the incidence and clinical significance of compound (2+)TSG losses and genomic instability in prostate cancer CTC, and to expand the set genomic biomarkers relevant to AVPC. EXPERIMENTAL DESIGN: Genomic analysis of chromosomal copy-number alterations (CNA) at single-cell resolution was performed in CTC from patients with and without AVPC before initiating chemotherapy with cabazitaxel or cabazitaxel and carboplatin. We evaluated associations between single-CTC genomics and clinical features, progression-free survival, and overall survival. RESULTS: A total of 257 individual CTC were sequenced from 47 patients (1-22 CTC/patient). Twenty patients (42.6%) had concurrent 2+TSG losses in at least one CTC in association with poor survival and increased genomic instability, inferred by high large-scale transitions scores. Higher LST in CTC were independent of CTC enumerated, clinically more indicative of aggressive behavior than co-occurring TSG losses, and molecularly associated with gains in chromosomal regions including PTK2, Myc, and NCOA2; increased androgen receptor expression; and BRCA2 loss. In 57 patients with matched cell-free tumor DNA data, CTC were more frequently detectable and evaluable for CNA analysis (in 73.7% vs. 42.1%, respectively). CONCLUSIONS: Our findings suggest that genomic instability in CTC is a hallmark of advanced prostate cancer aggressiveness, and support single-CTC sequencing as a compelling tool to noninvasively characterize cancer heterogeneity.

Tackling Corona Virus Disease 2019 (COVID 19) in Workplaces.

Coronaviruses are zoonotic viruses and six species of Coronaviruses are known to cause human disease such as cause common cold, severe acute respiratory syndrome and the Middle East Respiratory Syndrome. In January 2020, scientists in Wuhan, China isolated a novel coronavirus (SARS-CoV-2), responsible for an outbreak of unknown pneumonia that had not been previously reported among humans. This virus spreads from person to person, through respiratory droplets, close contact, and by touching surfaces or objects contaminated by the virus. The incubation period varies between 2 days and 14 days. Symptoms usually include fever, cough, difficulty in breathing, pneumonia, severe acute respiratory syndrome. Older age and co-morbid conditions increase the fatality. Any person with a history of travel to and from COVID-19 affected countries in the past 14 days or any person who has had close contact with a laboratory confirmed COVID-19 are suspect cases and needs evaluation. Currently no vaccine is available and treatment is mainly supportive. Measures at workplace should include- avoiding non-essential travel, identifying and isolating sick employees at the earliest, hand hygiene, respiratory hygiene, environmental hygiene and social distancing.

Cabazitaxel plus carboplatin for the treatment of men with metastatic castration-resistant prostate cancers: a randomised, open-label, phase 1-2 trial.

BACKGROUND: Taxane-platinum combinations have shown promising activity in metastatic castration-resistant prostate cancers in single-group clinical studies but not in randomised trials. Distinct biological subsets of the disease might derive the greatest benefit from the addition of platinum. We aimed to determine whether adding carboplatin to cabazitaxel would improve the outcomes of men with metastatic castration-resistant prostate cancer. METHODS: We did a phase 1-2, open label, randomised study at two centres in men with progressive metastatic castration-resistant prostate cancer. In phase 1, patients received intravenous cabazitaxel 20-25 mg/m2 and intravenous carboplatin area under the curve (AUC) 3-4 mg/mL per min every 21 days. The maximum tolerated dose was defined as the highest dose cohort studied in which one of six or fewer patients experienced a dose-limiting toxicity. In phase 2, patients were randomly assigned (1:1) centrally by a computerised algorithm to intravenous cabazitaxel 25 mg/m2 with or without intravenous carboplatin AUC 4 mg/mL per min. All patients received growth factor support and oral prednisone 10 mg daily. The primary endpoints were the maximum tolerated dose of the combination in phase 1 and investigator-assessed progression-free survival in phase 2. This trial is registered at ClinicalTrials.gov, number NCT01505868. FINDINGS: Between Aug 17, 2012, and May 11, 2015, nine patients completed phase 1 as planned, and 160 were randomly assigned to cabazitaxel (n=79) or cabazitaxel plus carboplatin (n=81) in phase 2. During phase I, grade 3 adverse events were anaemia (n=2), fatigue (n=1), thrombocytopenia (n=1), hypomagnesaemia (n=1), diarrhoea (n=1), hypokalaemia (n=1), anorexia (n=1), and dehydration (n=1), and no grade 4 adverse events occurred. No dose-limiting toxicities were observed, therefore, a maximum tolerated dose of cabazitaxel of 25 mg/m2 and carboplatin of AUC 4 mg/mL per min was selected for phase 2. At a median follow-up of 31·0 months (IQR 20·5-37·1), the combination improved the median progression-free survival from 4·5 months (95% CI 3·5-5·7) to 7·3 months (95% CI 5·5-8·2; hazard ratio 0·69, 95% CI 0·50-0·95, p=0·018). In the phase 2 study, the most common grade 3-5 adverse events were fatigue (7 [9%] of 79 in the cabazitaxel group vs 16 [20%] of 81 in the combination group), anaemia (3 [4%] vs 19 [23%]), neutropenia (3 [4%] vs 13 [16%]), and thrombocytopenia (1 [1%] vs 11 [14%]). There were no treatment-related deaths. INTERPRETATION: Carboplatin added to cabazitaxel showed improved clinical efficacy compared with cabazitaxel alone for men with metastatic castration-resistant prostate cancer. Although adverse events were more common with the combination, the treatment was safe and generally well tolerated. Our data suggest that taxane-platinum combinations have a clinically beneficial role in advanced prostate cancer and a randomised phase 3 study is planned. FUNDING: Sanofi Genzyme, University of Texas MD Anderson Cancer Center Prostate Cancer Moon Shot Program, and Solon Scott III Prostate Cancer Research Fund.

Extremely low-coverage whole genome sequencing in South Asians captures population genomics information.

BACKGROUND: The cost of Whole Genome Sequencing (WGS) has decreased tremendously in recent years due to advances in next-generation sequencing technologies. Nevertheless, the cost of carrying out large-scale cohort studies using WGS is still daunting. Past simulation studies with coverage at ~2x have shown promise for using low coverage WGS in studies focused on variant discovery, association study replications, and population genomics characterization. However, the performance of low coverage WGS in populations with a complex history and no reference panel remains to be determined. RESULTS: South Indian populations are known to have a complex population structure and are an example of a major population group that lacks adequate reference panels. To test the performance of extremely low-coverage WGS (EXL-WGS) in populations with a complex history and to provide a reference resource for South Indian populations, we performed EXL-WGS on 185 South Indian individuals from eight populations to ~1.6x coverage. Using two variant discovery pipelines, SNPTools and GATK, we generated a consensus call set that has ~90% sensitivity for identifying common variants (minor allele frequency ≥ 10%). Imputation further improves the sensitivity of our call set. In addition, we obtained high-coverage for the whole mitochondrial genome to infer the maternal lineage evolutionary history of the Indian samples. CONCLUSIONS: Overall, we demonstrate that EXL-WGS with imputation can be a valuable study design for variant discovery with a dramatically lower cost than standard WGS, even in populations with a complex history and without available reference data. In addition, the South Indian EXL-WGS data generated in this study will provide a valuable resource for future Indian genomic studies.

Effort-Reward Imbalance and its Association with Health among Pluckers in a Tea Plantation in South India.

CONTEXT: Work-related stress is associated with cardiovascular diseases, musculoskeletal disorders, psychological ailments, and work-related injuries. Imbalance between high effort and low reward at work can lead to work stress among plantation workers. AIMS: To assess the effort-reward imbalance (ERI) among pluckers in tea plantations in South India and its association on chronic health problems, substance abuses, and workplace injuries. SETTINGS AND DESIGN: A cross-sectional study was conducted among 346 tea pluckers from May to June 2015 in six selected tea plantations in Anamalai, South India. PATIENTS AND METHODS: A short version of ERI questionnaire was used to assess the work-related stress among them. Along with ERI questionnaire, sociodemographic details, chronic diseases, substance abuses, and workplace injuries were ascertained. STATISTICAL ANALYSIS USED: Sociodemographic variables were described as frequency and measures of central tendency. Tests of association, such as Chi-square test, were applied. RESULTS: Among the study population, 322 (93.1%) reported more effort, 23 (6.6%) reported more reward, and one (0.3%) had no imbalance between effort and reward. Those in older age group (≥51 years) experienced more effort compared to those in younger age group (≤50 years) (Fisher's exact = 21.905, P = 0.001). Educational status (Fisher's exact = 15.639, P = 0.027) and work experience (Fisher's exact = 23.122, P = 0.003) increased the effort rather than increasing the reward associated with work. No significant association was found between ERI and any chronic diseases, substance abuses, or injuries. CONCLUSIONS: Majority of pluckers in tea plantation experienced more effort compared to reward.

Predictors of survival in patients with sarcoma admitted to the intensive care unit.

BACKGROUND: Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown. METHODS: The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival. RESULTS: We identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9-29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9-37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5-9) in ICU survivors and 10 (IQR, 6.5-14) in ICU non-survivors. Increase in SOFA scores ≥6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023-1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141-1.283, p < 0.0001) correlated with overall survival. CONCLUSIONS: Our results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.

Shift work disorder and related health problems among nurses working in a tertiary care hospital, Bangalore, South India.

INTRODUCTION: Shift Work Disorder (SWD) is a sleep disorder characterized by sleepiness and insomnia, which can be attributed to the person's work schedule. Awareness of the mechanisms behind shift work related health problems could be essential to schedule the shift work, employment routines, clinical treatment, and selection of employees. OBJECTIVE: To assess the prevalence of SWD and to identify related health problems among nurses in a tertiary care hospital in Bangalore. MATERIALS AND METHODS: We conducted a descriptive cross-sectional study in a tertiary care hospital in Bangalore between May and September 2014. Based on simple random sampling, 130 nurses were selected for the study. After obtaining written informed consent from the participants, structured interview schedule using Standard Shift Work Index and Bergen Shift Work Sleep Questionnaire (BSWSQ) was administered. RESULTS: The mean age of the 130 nurses was 27.4 ± 2.64 years. The prevalence of SWD was found to be 43.07%. Headache, back pain, gastritis, and menstrual disorders were the most common complaints, which are found in 78 (60.0%), 75 (57.6%), 42 (32.3%), and 39 (30.0%) cases, respectively. Anxiety and depression was found in 23 (17.6%) and 31 (23.8%) individuals, respectively. We also found a significant association of SWD with increasing age, more number of nights worked in a year, and longer duration of working hours. According to the BSWSQ, 70 (53.8%) nurses were found to have sleep problems. CONCLUSION: A high prevalence of SWD symptoms calls for a focus on the antecedents of work related sleep problems and appropriate intervention, such as behavioral changes, clockwise rotating shifts, and treatment.