Ni doping induced property enhancement in laser ablated BaSnO3 films suitable for optoelectronic applications.

Pulsed laser deposition is a straightforward approach for preparing films with superconducting to dielectric properties with atomic layer precision. The deep-seated mechanisms involved in the particle transport from target to substrate and subsequent film formation still need to be fully comprehended. This manuscript reports the property enhancement observed in laser ablated perovskite BaSnO3 films with Ni doping. Films' crystallinity improvement is observed, and an intensity enhancement of 1150% is observed on 3 mol% Ni-doping. The optimum Ni-doping concentration in BaSnO3 is found to be 3 mol%. Herein, Ni-doped BaSnO3 films deposited by PLD showed an unusual increase in film thickness (i.e., from 615 nm in the pure film to 1317 nm in the film with 7 mol% Ni-doping as revealed by lateral SEM analysis and spectroscopic ellipsometry). We propose an "Induced Magnetic field-assisted Particle Convergence (IMPC)" effect for this superficial growth enhancement. The film's optical properties are modified with an increased nickel doping level, and the bandgap energy shows renormalization. All the films show excellent transmittance (80-90%) in the Vis.-NIR region. Hall-effect measurement reveals the increased carrier concentration by three orders (2.98 × 1011 to 3.50 × 1014 cm-3). In addition, the enhancement in mobility from 3.13 to 20.93 cm2V-1s-1 and a decrease in electrical resistivity by six orders (i.e., from 4.05 × 109 to 1.13 × 103 Ω cm) are observed on 7 mol% Ni doping. XPS measurements reveals that the Ba, Sn and Ni ions are at 2+, 4+ and 2+ oxidation states. Using spectroscopic ellipsometric method, we estimated the optical constants of the films, the refractive index, dielectric constant, and extinction coefficient show a normal dispersion behavior. The high crystallinity, high transmittance, suitable surface topography, and improved electrical performances of the Ni-doped BaSnO3 films make them excellent candidates for optoelectronic devices and solar cells.

Indole alkaloids from marine resources: Understandings from therapeutic point of view to treat cancers.

Cancer is the leading cause of mortality all over the world. Scientific investigation has demonstrated that disruptions in the process of autophagy are frequently interrelated with the emergence of cancer. Hence, scientists are seeking permanent solutions to counter the deadly disease. Indole alkaloids have been extensively studied and are acknowledged to exhibit several bioactivities. The current state of disease necessitates novel pharmacophores development. In recent decades, indole alkaloids have become increasingly significant in cancer treatment and are also used as adjuvants. A substantial amount of pharmacologically active molecules come from indole alkaloids, which are widely distributed in nature. Indole alkaloids derived from marine organisms show immense potential for therapeutic applications and seem highly effective in cancer treatment. A couple of experiments have been conducted preclinically to investigate the possibility of indole alkaloids in cancer treatment. Marine-derived indole alkaloids possess the ability to exhibit anticancer properties through diverse antiproliferative mechanisms. Certain indole alkaloids, including vincristine and vinblastine, were verified in clinical trials or are presently undergoing clinical assessments for preventing and treating cancer. Indole alkaloids from marine resources hold a significant functionality in identifying new antitumor agents. The current literature highlights recent advancements in indole alkaloids that appear to be anticancer agents and the underlying mechanisms.

Transmission across non-HermitianPT-symmetric quantum dots and ladders.

A non-Hermitian (NH) region connected to semi-infinite Hermitian lattices acts either as a source or as a sink and the probability current is not conserved in a scattering typically. Even aPT-symmetric region that contains both a source and a sink does not lead to current conservation plainly. We propose a model and study the scattering across a NHPT-symmetric two-level quantum dot (QD) connected to two semi-infinite one-dimensional lattices in a special way so that the probability current is conserved. Aharonov-Bohm type phases are included in the model, which arise from magnetic fluxes (ℏϕL/e, ℏϕR/e) through two loops in the system. We show that whenϕL=ϕR, the probability current is conserved. We find that the transmission across the QD can be perfect in thePT-unbroken phase (corresponding to real eigenenergies of the isolated QD) whereas the transmission is never perfect in thePT-broken phase (corresponding to purely imaginary eigenenergies of the QD). The two transmission peaks have the same width only for special values of the fluxes (being odd multiples ofπℏ/2e). In the broken phase, the transmission peak is surprisingly not at zero energy. We give an insight into this feature through a four-site toy model. We extend the model to aPT-symmetric ladder connected to two semi-infinite lattices. We show that the transmission is perfect in unbroken phase of the ladder due to Fabry-Pérot type interference, that can be controlled by tuning the chemical potential. In the broken phase of the ladder, the transmission is substantially suppressed.

Unraveling the Complexity of Nano-Dispersoids in the Oxide Dispersion Strengthened Alloy 617.

Nanocrystalline oxides are mainly responsible for Ni-base oxide dispersion strengthened (ODS) superalloys excellent thermo-mechanical properties. To establish the microstructural correlations between the metallic matrix and various oxide dispersoids, we report here the atomic-scale structure and chemistry of the complex nano-oxide dispersoids. Ultrahigh-resolution Cs-aberration-corrected scanning transmission electron microscopy (STEM) based techniques have been used to resolve nano-dispersoids in the Alloy 617 ODS. These nano-oxides, interestingly, possess a variety of high-angle annular dark-field (HAADF) contrasts, that is, bright, dark, and bi-phases. Both the light and heavy atoms have been found to be present in Y­Al­O complex-oxide nanostructures in varying quantities and forming a characteristic interface with the metallic matrix. In overcoming the limitation of conventional STEM-HAADF imaging, the integrated differential phase-contrast imaging technique was employed to investigate the oxygen atoms along with other elements in the dispersoids and its interface with the matrix. The most intriguing aspect of the study is the discovery of a few atoms thick Al2O3 interlayer (shell) around a monoclinic Y­Al­O core in the Ni-matrix. On the other hand, when the dispersoid is a hexagonal type Y­Al­O complex, the interface energy is already low, maintaining a semi-coherent interface and it was devoid of a shell.

Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19.

INTRODUCTION: There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids. METHODS: A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round. RESULTS: Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs. CONCLUSION: The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. HOW TO CITE THIS ARTICLE: How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.

Cellular and molecular immune response and production performance of Indian white shrimp Penaeus indicus (H. Milne-Edwards, 1837), reared in a biofloc-based system with different protein levels of feed.

The present study focuses on the immunity and growth of Penaeus indicus fed with varying protein levels (25%, 30%, and 35%) in a biofloc based rearing system. A 120 days growth trial was carried out using juvenile Penaeus indicus (0.71 ± 0.01) with dietary protein level, 25% (LP), 30% (MP), and 35% (HP), and a control diet-fed with 35% acted as control group resulting in 4 treatments each with four replicates and were randomly assigned 16 tank units (7500 L each). A combination of different carbon sources (molasses, wheat flour, and rice bran in 2:1:1 ratio), yeast and a probiotic (Bacillus sp.) consortium were used for the development of biofloc. At the end of the trial, the growth parameters of shrimps viz., initial weight, feed conversion ratio (FCR), and daily growth coefficient (DGC) were computed. The results indicated that shrimp fed with medium (30%) protein (MP) diet recorded significantly (P < 0.05) improved growth performance compared to high protein fed group (35%) and low protein (25%) fed group (LP) in a biofloc system and control group (35%). The immunological parameters such as hemagglutination activity (HA) assay, serum protein, lysozyme, phenol oxidase (PO), and inhibition of superoxide dismutase (SOD) activity were observed in serum, plasma, and hemocyte lysate supernatant (HLS). The HA activity, PO activity in plasma was found to be higher in high protein fed animals, whereas medium protein resulted in enhanced PO activity in serum. Similarly, lysozyme and SOD were inhibited well in high protein fed animals compared to the low protein fed group. The vital immune genes's mRNA profiling showed a potential rise in the expressional pattern in MP and HP treatments compared to LP and control. BGBP (beta-1,3-glucan binding protein) and hemocyanin mRNA transcript levels were highly upregulated in the HP (5 fold) and moderately expressed in MP (2 fold) and LP (1-2 fold). The transcripts of peroxinectin, antimicrobial peptides like crustin showed significant upregulation in HP followed by in MP and LP and control. Likewise, other immune genes, such as SOD, prophenoloxidase (proPO), showed a similar trend in a marginal way, indicating immunomodulation in the biofloc groups. This study suggested that biofloc with high protein (35%) supplementation can substantially enhance the immune response of shrimps, although medium protein level (30%) is optimum for improving the survival, growth, and in turn economic return in Indian white shrimp.

Climate services' role in safeguarding pastoral disaster communities.

Climate change due to increasing greenhouse gas (GHG) emissions is one of the most pressing issues facing society on a global scale. The growth of GHG emissions between 2000 and 2010 was higher than in each of the previous three decades, and each of the past four decades has been successively warmer than any preceding decades since 1850. Continued GHG emissions will cause further warming and changes in the climate system. Climate change affects livestock production in multiple ways, both directly and indirectly. Many of the impacts on the livestock sector result from increasing frequency and magnitude of weather and climate extremes such as droughts, flash floods, untimely rains, frost, hail and severe storms. This article describes some of the most vulnerable disaster communities in Asia, Africa, Australia, Europe and South America. It then describes the importance of meteorological information provided by national Meteorological and Hydrological Services to help Veterinary Services support sustainable management of livestock in vulnerable pastoral communities.

Le changement climatique dû à l'augmentation des émissions de gaz à effet de serre constitue l'un des problèmes les plus pressants auxquels la société est confrontée à l'échelle mondiale. L'augmentation des émissions de gaz à effet de serre a été plus élevée entre 2000 et 2010 qu'au cours des trois décennies précédentes, et chacune des quatre décennies écoulées a été successivement plus chaude que toutes les décennies antérieures depuis 1850. La persistance des émissions de gaz à effet de serre se traduira par une intensification du réchauffement climatique et par d'autres modifications du système climatique. Les changements climatiques ont des effets multiples sur la production animale et interviennent de plusieurs manières, à la fois directement et indirectement. Une grande partie de l'impact subi par le secteur de l'élevage est dû à la fréquence et à la magnitude croissantes des phénomènes climatiques et météorologiques extrêmes tels que sécheresses, crues soudaines, précipitations intempestives, gel, grêle et tempêtes violentes. L'auteur décrit certaines communautés sinistrées parmi les plus vulnérables en Asie, en Afrique, en Australie, en Europe et en Amérique du Sud. Il souligne ensuite l'importance des informations météorologiques fournies par les Services météorologiques et hydrologiques nationaux, grâce auxquelles les Services vétérinaires peuvent mieux soutenir les communautés pastorales vulnérables dans leurs efforts pour une gestion durable des cheptels.

El cambio climático causado por la creciente emisión de gases de efecto invernadero es uno de los problemas más acuciantes que afronta la sociedad a escala mundial. El aumento de las emisiones de gases de efecto invernadero entre 2000 y 2010 fue mayor que en los tres decenios anteriores. Asimismo, cada uno de los cuatro pasados decenios fue sucesivamente más cálido que cualquiera de los anteriores desde 1850. Las incesantes emisiones de gases de efecto invernadero traerán consigo un mayor calentamiento y más transformaciones del sistema climático. El cambio climático afecta a la producción ganadera por numerosas vías, tanto directas como indirectas. Muchos de sus efectos sobre el sector ganadero son fruto de la frecuencia y magnitud crecientes de fenómenos climáticos y meteorológicos extremos, como sequías, inundaciones súbitas, lluvias intempestivas, heladas, granizadas y fuertes tormentas. Tras referirse a algunas de las más vulnerables comunidades afectadas por desastres de Asia, África, Australia, Europa y Sudamérica, el autor explica la importancia de la información meteorológica que facilitan los Servicios Meteorológicos e Hidrológicos nacionales para ayudar a los Servicios Veterinarios a respaldar una gestión sostenible del ganado en comunidades vulnerables que viven del pastoreo.

Upshot of Concentration of Zirconium (IV) Oxynitrate Hexa Hydrate on Preparation and Analyses of Zirconium Oxide (ZrO2) Nanoparticles by Modified Co-Precipitation Method.

In the present work, pure nanocrystalline monoclinic Zirconia (ZrO2) has been successfully synthesized and optimized by the modified co-precipitation method. The concentration of raw material has been optimized with the fixed amount of precipitation agent (Potassium hydroxide KOH). The thermal history of the precursor has been examined through TG/DTA analysis. All the samples are subjected to study the structure, fingerprints of the molecular vibrations, and morphology analyses. The representative sample has been analyzed through Transmission Electron Microscope (TEM) and X-ray Photo Electron Spectroscopy (XPS) analyses. The as-prepared sample exhibits the better crystallinity and surface morphology with lesser particle size (190 nm) when the raw material concentration is 0.2 M. The as-prepared ZrO2 filler (0, 3, 6, 9, and 12 wt.%) is spread through the enhanced polymer electrolyte P(S-MMA) (27 Wt.%)-LiClO4 (8 wt.%)-EC + PC (1;1 of 65 wt.%) complex system via solution casting method. The as-synthesized electrolyte films are examined via complex impedance analysis. P(S-MMA) (27 wt.%)-LiCIO4 (8 wt.%)-EC + PC (1 ;1 of 65 wt.%)-6 wt.% of ZrO2 shows the high ionic conductivity 2.35 × 10-3 Scm-1. Temperature-dependent ionic conductivity studies obey the non-linear behavior. The enhanced ZrO2 has been expected to enhance the other electrochemical properties of the lithium secondary battery.

Extended-spectrum beta-lactamase (ESBL) producing and multidrug-resistant Escherichia coli in street foods: a public health concern.

Antimicrobial resistance (AMR) pattern and virulence genes of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli from foods of animal origin were evaluated. Based on combination disc method and ESBL E test, 42 of the 213 E. coli isolates were confirmed as ESBL producers where a high presence was observed in raw foods (60.62%), environmental samples (46.73%) and ready to eat foods (42.99%) of which 31(26.49%), 3(6.97%) and 7(15.21%) samples harbored ESBL E. coli, respectively. Higher contamination rates were observed in samples collected from meat vendors (54.36%), milk vendors (48.88%) and egg vendors (45.20%) of which 16.1%, 11.11% and 2.05%, respectively were ESBL E. coli. Among the 42 ESBL isolates, 85.71% (36/42) were multidrug-resistant. On polymerase chain reaction (PCR) analysis, expression of beta-lactamase genes viz., blaCTXM was noted in 69.04% (29/42) ESBL isolates, blaTEM in 66.66% (28/42) and blaOXA-1 in 19.04% (8/42) isolates, while blaSHV was not detected in any of the isolates. Other AMR genes viz., blaAmpC, sul1, sul2, tet(A), tet(B), catI, dhfrI, aac(3)-IIa(aacC2), aph(3')-Ia(aphA1), qnrB, qnrS were detected by PCR in 39, 28, 29, 3, 9, 5, 17, 11, 6, 6 and 33 isolates, respectively. None of the isolates harbored chloramphenicol (floR) and plasmid-mediated quinolone resistance (PMQR) (qnrA) genes. However, 21 isolates were positive for class I integron (int1), 5 for EPEC (eae) and 9 for ETEC (lt) while none were carrying bfp or stII genes. All ESBL producing isolates formed a single group when subjected to enterobacterial repetitive intergenic consensus (ERIC PCR) genotyping. The presence of multidrug-resistant ESBL E. coli in street foods of animal origin raises the issues of food safety and public health.

Advanced training in laparoscopic gastrointestinal surgical procedures using Genelyn®-embalmed human cadavers: A novel model.

BACKGROUND: Human cadaver is ideal for learning and acquiring new surgical skills. While cadavers preserved using Thiel's embalming method are commonly used for training in laparoscopic surgery, it is a cumbersome technique. We report our experience of using Genelyn®-embalmed cadavers for training in advanced laparoscopic gastrointestinal procedures. MATERIALS AND METHODS: A cross-sectional satisfaction survey corresponding to level 1 of the Kirkpatrick model for training evaluation was performed among 19 participants of advanced laparoscopy surgical skills training workshop, in December 2019, using Genelyn®-embalmed cadavers. Visual, haptic and tactile characteristics of the organs and tissues were assessed along with overall satisfaction of the workshop using Likert scale. RESULTS: Five Genelyn®-embalmed cadavers were used for the workshop. All the 19 participants perceived that the cadavers were odourless and allowed adequate insufflation for laparoscopic procedures. Most of the participants(n=16, 84%) agreed that the appearance and tactile fidelity of the solid organs, luminal structures and tissues in Genelyn®-embalmed cadavers were similar to that of a live patient. There was a strong agreement among participants that the workshop will help improve the laparoscopic skills(median Likert score-4). CONCLUSION: The participants of the surgical skill training workshop felt that the Genelyn®-embalmed cadavers were ideal for use in practicing advanced laparoscopic procedures.

Hyperspectral infrared microscopy with visible light.

Hyperspectral microscopy is an imaging technique that provides spectroscopic information with high spatial resolution. When applied in the relevant wavelength region, such as in the infrared (IR), it can reveal a rich spectral fingerprint across different regions of a sample. Challenges associated with low efficiency and high cost of IR light sources and detector arrays have limited its broad adoption. Here, we introduce a new approach to IR hyperspectral microscopy, where the IR spectral map is obtained with off-the-shelf components built for visible light. The method is based on the nonlinear interference of correlated photons generated via parametric down-conversion. In this proof-of-concept we demonstrate the chemical mapping of a patterned sample, where different areas have distinctive IR spectroscopic fingerprints. The method provides a wide field of view, fast readout, and negligible heat delivered to the sample, which opens prospects for its further development for applications in material and biological studies.

Changes in the levels of comet parameters before and after fluoxetine therapy in major depression patients.

Major depression belongs to mood disorders and characterized by worthlessness, no interest or happiness in any activity; lasting for atleast two weeks. Etio-pathological changes of major depression include oxidative stress leading to free radical synthesis which causes damage to carbohydrates, proteins, lipids and nucleic acids. Nucleic acid damage can be identified by either single or double strand breaks and for quantitative estimation of the same, neutral or alkaline comet assay is performed. Fluoxetine is the drug of choice for treatment of major depression having antioxidant function. In the current study eighty drug naïve major depression patients were recruited and comet parameters namely total comet length, head diameter and tail length were measured before starting the treatment and after completion of eight week fluoxetine therapy. The levels of comet parameters were higher in females than males suggesting higher prevalence of major depression among females. On categorizing into three age groups, the numbers of major depression patients belonging to 18-30 year age group were higher than 31-40 and 41-50 year age groups. All the parameters of deoxyribonucleic acid damage were reduced after eight week of fluoxetine therapy indicating that fluoxetine has anti-oxidant action along with its antidepressant properties, which cause reversal of oxidative stress induced damage occurring during major depression.

Nonadiabatic charge pumping across two superconductors connected through a normal metal region by periodically driven potentials.

Periodically driven systems exhibit resonance when the difference between an excited state energy and the ground state energy is an integer multiple of ℏ times the driving frequency. On the other hand, when a superconducting phase difference is maintained between two superconductors, subgap states appear which carry a Josephson current. A driven Josephson junction therefore opens up an interesting avenue where the excitations due to applied driving affect the current flowing from one superconductor to the other. Motivated by this, we study charge transport in a superconductor-normal metal-superconductor junction where oscillating potentials are applied to the normal metal region. We find that for small amplitudes of the oscillating potential, driving at one site reverses the direction of current at the superconducting phase differences when difference between the subgap eigenenergies of the undriven Hamiltonian is integer multiple of ℏ times the driving frequency. For larger amplitudes of oscillating potential, driving at one site exhibits richer features. We show that even when the two superconductors are maintained at same superconducting phase, a current can be driven by applying oscillating potentials to two sites in the normal metal differing by a phase. We find that when there is a nonzero Josephson current in the undriven system, the local peaks and valleys in current of the system driven with an amplitude of oscillating potential smaller than the superconducting gap indicates sharp excitations in the system. In the adiabatic limit, we find that charge transferred in one time period diverges as a powerlaw with pumping frequency when a Josephson current flows in the undriven system. Our calculations are exact and can be applied to finite systems. We discuss possible experimental setups where our predictions can be tested.

Bio-augmentation of heterotrophic bacteria in biofloc system improves growth, survival, and immunity of Indian white shrimp Penaeus indicus.

Effect of bio-augmentation of Bacillus spp in biofloc on growth, survival and immunity in Indian white shrimp Penaeus indicus was evaluated. Nine Bacillus strains were isolated and screened individually as well as in the form of a consortia. To maintain a C:N ratio of 12:1 a blend of carbohydrate sources was used. Bio-augmentation with bacterial consortium and Virgibacillus sp. produced improved growth and immunity. Shrimp survival ranged from 80 to 95% among treatments. Production was higher (35%) in the biofloc tanks with an average body weight (ABW) of 10.89 ± 1.2 g. On evaluating the immune responses, it was found that trypsin significantly (P < 0.05) enhanced Prophenoloxidase (PO) activity in Lysinibacillus, Bacillus cereus, Bacillus licheniformis and Bacillus subtilis bio-augmented groups. Laminarin induced PO activity was observed in groups supplemented with Oceanobacillus sp., Bacillus sp.and Bacillus megaterium. The lysozyme (LZ) activity was significantly (P < 0.05) higher in B. cereus and Microbial Consortia (MC), while other treatments were less effective. Total hemocyte count (THC) significantly (P < 0.05) increased in all treatment groups compared to the control. Hyaline hemocyte (HH) count was significantly (P < 0.05) higher in the control group (14.43%). Semi granular hemocytes (SGH) was higher in groups treated with Lysinibacillus, Bacillus sp., B. licheniformis and B. subtilis. The granular hemocyte (GH) count was significantly (P < 0.05) higher in Virgibacillus sp., B. cereus, B.megaterium and Oceanobacillus sp. The biofloc alone (BF), treated and augmented with B. megaterium significantly (P < 0.05) increased phagocytic activity. Highly significant phagocytic index (PI) was observed in bio-augmented groups, BF and MC. The relative expression levels of immune genes were found to be significantly up-regulated in shrimps grown in bio-augmented groups. Enhanced immunological parameters implies that bio-augmentation of biofloc with Bacillus spp. improved immunity in shrimps. Hence, bio-augmentation of probiotics in biofloc may be useful in improving culture conditions to produce P. indicus.

Stress and Burnout among Intensive Care Unit Healthcare Professionals in an Indian Tertiary Care Hospital.

Intensive care unit (ICU) healthcare professionals work under a stressful environment which can lead to burnout syndrome. We conducted this study to evaluate the prevalence of stress and burnout syndrome among doctors and other healthcare professionals in ICU. We also evaluated the individual contributing factors for stress and burnout syndrome among these ICU healthcare workers. The cross-sectional survey was conducted among the healthcare professionals (doctors, nurses, clinical pharmacists, respiratory therapists and physiotherapists) in the ICUs of multispecialty hospital in south India. The survey was conducted using well-accepted tools which included job satisfaction scale, perceived stress scale and Maslach burnout inventory-human service survey. Overall, 204 healthcare professionals completed the survey. The prevalence of high burnout in our study was 80% which included 6% (n = 12) of doctors and 69% (n = 140) of nurses. Our study showed statistically significant correlation between level of job satisfaction and the level of burnout. There was a significant correlation between the level of stress and the emotional exhaustion and depersonalization domains of Maslach burnout inventory. Critical care societies and institutional committees should step forward to draft policies and benchmarks to curb the causes of stress, reduce burnout and to increase the job satisfaction. HOW TO CITE THIS ARTICLE: Lakshmikanthcharan S, Sivakumar MN, Hisham M. Stress and Burnout among Intensive Care Unit Healthcare Professionals in an Indian Tertiary Care Hospital. Indian J Crit Care Med 2019;23(10):462-466.

Latex agglutination test for rapid on-site serodiagnosis of Japanese encephalitis in pigs using recombinant NS1 antigen.

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE) is a mosquitoe-borne viral zoonotic disease and globally around three billion people are at the risk of disease. The occurrence of JE cases has shown a rising trend during last decade in India. Pig is the amplifying host for JE virus and serves as a suitable sentinel model for the prediction of disease outbreak in humans. The development of a diagnostic test that is suitable for surveillance of JE in pigs is the need of the hour. The existing tests require elaborate laboratory facilities which make their application in rural settings difficult. Therefore, realizing the need for a rapid test, efforts were made to standardize a latex agglutination test (LAT) for serodiagnosis of JE in pigs. METHODS: Standardization of LAT by physical adsorption of recombinant NS1 (non-structural) protein of JE virus onto latex beads was done by altering six different variables, namely the antigen concentration, sensitization condition, surface blocking agent, blocking condition, particle concentration and reaction time. The standardized latex-protein complex was used for screening 246 pig serum samples under optimal conditions. RESULTS: The test was standardized with a diagnostic sensitivity and specificity of 82.24 and 87.83%, respectively. Screening of 246 field pig serum samples using standardized LAT showed a seropositivity of 50.4%. The results were available within 5 min after addition of test serum sample to the sensitized beads. INTERPRETATION & CONCLUSION: The findings of the study highlight the potential of LAT as a rapid on-site assay for JE diagnosis in pigs which would aid in predicting JE outbreaks in humans.

Virulent methicillin resistant Staphylococcus aureus (MRSA) in street vended foods.

Street foods are one of the important sources of foodborne infections and Staphylococcus aureus is an important infectious agent transmitted through various sources including street foods. The methicillin-resistant S. aureus (MRSA) are of public health significance, hence the study was taken to assess the street foods as a source of MRSA, for which 430 street vended foods of animal origin (meat, milk, eggs and their products) and associated environmental samples were processed for isolation and characterization. A total of 52 (12.1%) S. aureus were isolated and resistant was observed to oxacillin (36.5%), cefoxitin (25%) and penicillin G (82.7%) by disc diffusion test. On genotypic screening, mecA and blaZ have detected in 17.3% and 69.2% isolates, respectively. The virulence typing identified nuc, coa, clfA, spA, FnbA and enterotoxin A (sea) genes in 100%, 96.2%, 30.8%, 55.8, 50% and 7.7% isolates, respectively. Genetic diversity among the isolates was observed by enterobacterial repetitive intergenic consensus PCR with a D value of 0.77. The presence of virulent MRSA in street vended foods trigger the public health concern and emphasis to educate the consumers and street food vendors about quality and safety of such foods.

Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario.

BACKGROUND AND AIM: Intensive-care practices and settings differ for India in comparison to other countries. While guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to nutritional management of EN in dysglycemic patients, specific to patients in Indian critical care settings. Advisory board meetings were arranged to develop the practice guidelines specific to the Indian context, for the use of EN in dysglycemic critically ill patients and to overcome challenges in this field. MATERIALS AND METHODS: Two advisory board meetings were organized to review various existing guidelines, meta-analyses, randomized controlled trials (RCTs), controlled trials and review articles, for their contextual relevance and strength. Three rounds of Delphi voting were done to arrive at consensus on certain recommendations. A systematic grading of practice guidelines by the advisory board was done based on strength of the consensus voting and reviewed supporting evidences. RESULTS: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding prediction and assessment of dysglycemia (DG), acceptable glycemic targets in such settings, general nutritional aspects pertaining to DG nutrition, and nutrition in various superspecialty cases in critical care settings, where DG is commonly encountered. CONCLUSION: This paper summarizes the optimum EN practices for managing DG in critically ill patients. The practical solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance for EN management in dysglycemic critically ill patients. These guidelines also outline the model glycemic control task force and its roles in nutrition care as well as an intensive care unit DG nutrition protocol. HOW TO CITE THIS ARTICLE: Mehta Y, Mithal A, Kulkarni A, Reddy BR, Sharma J, Dixit S, et al. Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2019;23(12):594-603.

Ambidextrous techniques in cardiac surgery.

Ambidexterity is the state of being equally adept in the use of both the left and right hands. It is advantageous in surgeons, but the degree of ambidexterity found among them varies greatly. It is a very desirable attribute in laparoscopic surgery. It provides the surgeon with additional options for performing critical surgical steps when positioning and space are constrained, as is often the case in cardiac surgery and even more so in minimally invasive cardiac surgery. Mentoring for ambidexterity training can be initiated as early as during medical school.  In this tutorial we demonstrate ambidextrous surgical techniques such as the 'all in one hand' technique of using two forceps in one hand, Gilbert's technique of left internal mammary harvest, and a proximal anastomosis technique in aortocoronary bypass.

Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario.

BACKGROUND AND AIM: Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field. METHODS: Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines. RESULTS: Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices. CONCLUSION: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.