Impact of Covid-19 on Yamuna River water quality: Possible ways to rejuvenate the riverine ecosystem in national capital of India

The water quality of Yamuna River was studied for four years from 2019 until August 2022. The period witnessed the onset of COVID-19 pandemic and government-imposed complete lockdown which caused slight improvement in the water quality. Five parameters pH, Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Dissolved Oxygen (DO) and Faecal Coliform (FC) monitored by Delhi Pollution Control Committee (DPCC) were analyzed to see the changes in water quality of Yamuna River in the Delhi stretch before the onset of COVID-19 (2019), during the COVID-19 (2020 and 2021) and after the pandemic (2022). Maximum improvement in some water quality parameters were observed only during the 1st lockdown in the year 2020 when government had imposed complete restriction on the movement of people and industries were not functioning at there maximum capacity. The water quality again declined in the year 2021 and further in the year 2022. Major cause of pollution was the untreated waste reaching the river from various drains. Therefore, it is extremely important to intersect all the major and minor drains through Sewage Treatment Plants (STPs). The floodplain of the river needs to be managed to keep the pollution in control

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study

Purpose: The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods: This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results: 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients ( n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion: This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Quality improvement by introduction of 72-hour admission pathway in Forest House Adolescent Unit (FHAU) for young people in crisis

AimsShort admissions for crisis management among young people suffering with Emotionally Unstable Personality Disorder (EUPD) as recommended in National Institute for Health and Care Excellence (NICE) 2009 guidelines are not routinely offered in the United Kingdom (UK). Our aim was to introduce crisis admissions lasting for 72 hours. During this brief admission the families of young people presenting with suicidal behaviour are offered an assessment and diagnosis of young person's difficulties, psychoeducation, and safety plan for future risky behaviour, in addition to respite.BackgroundThree-day Crisis admission was set up with the aim of reducing inappropriate long admissions in people who may have more negative effects from admission than positive ones. A need was felt for a brief admission pathway in order to be able to provide treatment for patients suffering from EUPD traits in keeping with NICE guidelines. NICE guidelines suggest that people with borderline personality disorder should be considered for acute psychiatric inpatient admission only for the management of crises involving significant risk to self or others that cannot be managed by other services. The guidelines also recommend ensuring that the decision is based on an explicit and joint understanding of the potential benefits and likely harm that may result from admission and agreeing to the length and purpose of the admission in advance.MethodA retrospective study comparing length of hospital stay in the 2018 (when this model was introduced) with previous years, the number of serious incidents was carried out to assess the impact of this new admission model. The rate of readmissions in the same year was also assessed. For qualitative feedback regarding the effectiveness of the crisis admission as an intervention, a survey was carried out to assess parent satisfaction and the nursing staff was asked for their views.ResultThere was a marked reduction in the number of serious incidents linked to suicide and length of hospital stay was reduced to half in the year when the crisis admissions were introduced as compared to the previous year. Only about 10-15% of patients required re-admission in the same year. About 90% of parents gave a positive feedback confirming the effectiveness of this intervention.Conclusion72-hour crisis admissions for adolescents are effective, appropriate, clinically indicated alternative to routine admissions with a high parent satisfaction.</jats:sec

A Novel Method of Image Denoising: New Variant of Block Matching and 3D

The demand of accurate and visually fair images is increasing with the passage of time and bang of the number of digital images especially in the domain of medical and healthcare systems. The visual image quality of modern cameras affected due to edges, textures and sharp structures noise. Though research community has introduced several techniques such as BM3D (Block Matching and 3D) for image denoising. However, edges and texture preservation capabilities remain issues due to hard thresholds values and captured image diversity. In order to address these issues, we propose a new variant of BM3D namely BM3DMA (Block Matching and 3D with Mahalanobis and Adaptive filter) which is employed through the use of Mahalanobis distance measure (for diversity coverage) and adaptive filter (for soft thresholds). We used two widely known datasets consist of set of standard and medical images. We observe 5% to 10% enhancement in the performance of BM3DMA as compared to BM3D in terms of improving the PSNR (Peak Signal to Noise Ratio) value. The promising experimental result indicates the effectiveness of BM3DMA in terms preserving the edge and texture image noise.</jats:p

Identification of Various Execution Modes and Their Respective Risks for Public&ndash;Private Partnership (PPP) Infrastructure Projects

The public&ndash;private partnership (PPP) based model for the execution of infrastructure projects originated from Anglo-Saxon countries and was initially used in 1977 by the United Kingdom (U.K). Since then, its popularity has increased worldwide. Earlier studies by researchers and many other professional sectors and departments have introduced PPP contracts into different execution modes like Build, Operate, and Transfer (BOT); Build, Own, Operate, and Transfer (BOOT); and Build, Lease, and Transfer (BLT), etc. All definitions of PPP contracts are different but have a few common characteristics and risks. Previously, numerous pieces of literature were available on these common risks for various execution modes of PPP contracts. However, each PPP mode still has unique risks that must be identified to understand and successfully implement the PPP projects properly. This paper fills the gap mentioned above and aims to identify various commonly used PPP execution modes in infrastructure projects and their corresponding risks after placing the different PPP execution modes into four (04) different categories. Identified risks for the corresponding PPP categories were also divided into seven (07) stages of the PPP life cycle. Semi-structured interviews were conducted to gather information from thirty-four (34) PPP experts worldwide. Accordingly, interviews are transcribed and processed for thematic analysis in academic NVIVO software. These identified risks are further placed in the respective PPP category for the convenience and better understanding of the study&rsquo;s outcome to the users and for the subsequent prioritization and allocation of these identified risks accordingly to the PPP parties during the finalization of the PPP execution mode

Enhancing Electric Discharge Machining Performance by Selecting Electrode Design and Geometrical Parameters for Square, Triangular, and Hexagonal Profiled Holes

Manufacturing of dies, molds, and their allied components requires the machining of holes with different profiles. Electric discharge machining (EDM) die-sinking is a crucial process used in the dies and molds manufacturing industry. By nature, EDM die-sinking is a relatively slow process in terms of material removal rate (MRR) and there are high amounts of tool material loss in terms of tool wear rate (TWR) which directly influence dimensional accuracies and surface roughness (SR). Therefore, the process is continuously evolving to address these limitations. The present research is aligned in this direction such as to bring improvements in MRR, TWR, and SR through modifications to the conventional electrode design and its geometrical parameters. Traditional designs of EDM electrodes have a uniform cross-section through the tool’s entire length and have only one geometrical parameter, i.e., the tool’s cross-section. To improve the EDM performance, traditional designs are completely modified by introducing several geometrical parameters such as relief angles, land thickness, cross-sectional area, shank height, circular relief, and non-circular relief, etc. Electrode designs are employed to mill non-circular profiles including triangular, square, and hexagonal shaped holes. The EDM performance measures strongly depend on the tool’s geometrical parameters (design type, relief angle, land thickness), machining profile (circular, square, triangle, hexagon), as well as the height/depth of the machining feature. By selecting proper tool designs and corresponding geometrical parameters, the EDM performance measures can be improved significantly