A pilot program in rural telepsychiatry for deaf and hard of hearing populations

Background: Access to mental health care in deaf communities is limited by cultural considerations, availability of translators, and technological considerations. Telepsychiatry can mitigate the deaf community’s lack of access to care by allowing for deaf individuals in remote communities access to care with facilities that cater to their needs. Methods: Community Behavioral Health, Arundel Lodge, and Gallaudet University worked in conjunction to test three hypotheses: 1. Telepsychiatry will be as effective as traditional face-to-face psychotherapy with deaf adults who have chronic mental illness. 2. Patients living in remote locations will report an improvement in accessibility to mental health services. 3. Patients who receive telepsychiatry will report a comparable level of satisfaction of services to those receiving traditional services. The patient sample consisted of 24 participants, 13 women, 11 men. Telepsychiatry sessions were scheduled based on each patient’s individual treatment plan against a control group who saw their providers face to face. Results: The telepsychiatry and in-person groups were slightly different at baseline. Analysis of the data revealed no significant difference in coping abilities and psychiatric symptoms between those receiving face-to-face psychotherapy and those receiving telepsychiatry. Interpretation The quality and outcome of care was equal to in-person for the telepsychiatry in deaf patients. Since telepsychiatry does not compromise the quality of care, it is a good means of reaching out to members of the deaf community that cannot readily access mental health resources that meet their needs

Humoral response to viral vector COVID-19 vaccine in hemodialysis patients

Background The coronavirus disease 2019 (COVID-19) vaccine is not readily available in many countries where dosing interval is spaced more than ideal. Patients with chronic kidney disease, especially those on maintenance hemodialysis, have a tendency for a reduced immune response. This study was undertaken to demonstrate the distinct humoral immune response to the viral vector COVID-19 vaccine in patients with kidney failure receiving maintenance hemodialysis. Methods The study was carried out with two cohorts: 1) patients receiving maintenance hemodialysis and 2) healthcare workers from the same dialysis center as controls, each group with 72 subjects. Participants received a dose of Covishield ChAdOx1 nCoV-19 coronavirus vaccine. The humoral immunological response was determined using electrochemiluminescence immunoassay which quantitatively measures antibodies to the severe acute respiratory syndrome coronavirus 2 spike protein receptor-binding domain. Results All study subjects in the control group developed a humoral response (antibody titer of ≥0.8 U/mL), while only 64 of 72 in the dialysis group (88.9%) were responders. Age (ρ = –0.234, p = 0.04) and sodium level (ρ = 0.237, p = 0.04) correlated with low antibody titer in bivariate analysis. In multivariate analysis, only age (odds ratio, 1.10; 95% confidence interval, 1.01–1.22; p = 0.045)was associated with nonresponders. Conclusion Our study demonstrated a weak antibody response of hemodialysis patients to the viral vector COVID-19 vaccine. Older age was associated with nonresponders. Evaluation of both humoral and cellular immunity after the second vaccine dose and serial antibody titers can help determine the need for booster shots

The combined effects of electrojet strength and the geomagnetic activity (<I>K_p</I>-index) on the post sunset height rise of the F-layer and its role in the generation of ESF during high and low solar activity periods

International audienceSeveral investigations have been carried out to identify the factors that are responsible for the day-to-day variability in the occurrence of equatorial spread-F (ESF). But the precise forecasting of ESF on a day-to-day basis is still far from reality. The nonlinear development and the sustenance of ESF/plasma bubbles is decided by the background ionospheric conditions, such as the base height of the F-layer (h'F), the electron density gradient (dN/dz), maximum ionization density (Nmax), geomagnetic activity and the neutral dynamics. There is increasing evidence in the literature during the recent past that shows a well developed Equatorial Ionization Anomaly (EIA) during the afternoon hours contributes significantly to the initiation of ESF during the post-sunset hours. Also, there exists a good correlation between the Equatorial Ionization Anomaly (EIA) and the Integrated Equatorial ElectroJet (IEEJ) strength, as the driving force for both is the same, namely, the zonal electric field at the equator. In this paper, we present a linear relationship that exists between the daytime integrated equatorial electrojet (IEEJ) strength and the maximum elevated height of the F-layer during post-sunset hours (denoted as peak h'F). An inverse relationship that exists between the 6-h average Kp-index prior to the local sunset and the peak h'F of the F-layer is also presented. A systematic study on the combined effects of the IEEJ and the average Kp-index on the post-sunset, peak height of the F-layer (peak h'F), which controls the development of ESF/plasma bubbles, is carried out using the ionosonde data from an equatorial station, Trivandrum (8.47° N, 76.91° E, dip.lat. 0.5° N), an off-equatorial station, SHAR (13.6° N, 79.8° E, dip.lat. 10.8° N) and VHF scintillations (244 MHz) observed over a nearby low-latitude station, Waltair (17.7° N, 83.3° E, dip.lat. 20° N). From this study, it has been found that the threshold base height of the F-layer at the equator for the development of plasma bubbles is reduced from 405 km to 317 km as the solar activity decreases from March 2001 (mean Rz=113.5) to March 2005 (mean Rz=24.5). This decrease in threshold height with the decreasing solar activity is explained on the basis of changes in the local linear growth rate of the collisional Rayleigh-Taylor instability, due to the variability of various terms such as inverse density gradient scale length (L?1), ion-neutral collision frequency (?in) and recombination rate (R) with the changes in the solar activity

Does selection index application for highly heritable traits need revisiting – A comprehensive study with bodyweight and shank length in Vanaraja male line chicken

Selection index (SI) is one of the best methods for estimating the breeding value of an animal combining all sources of information on the animal and its relatives. In the present study, the SI was constructed utilizing the five generations data of Vanaraja male line (PD-1) for body weight (BW-6) and shank length (SL-6) at 6 weeks of age with variance, covariance estimates and heritability of both the traits. The SI was employed on three generations data on simulation basis and the selection parameters were estimated and compared with the mass selection (MS) actually practiced in the population. The least squares mean of SL-6, the primary trait of selection increased from 76.63±0.002 (G-I) to 82.85 ±0.002 mm (G-II), and subsequently reduced to 80.17±001 mm (G-III). The BW-6 also followed similar trend. Generation had significant effect on both SL-6 and BW-6. The heritability estimates for SL-6 and BW-6 were moderate with 0.21 to 0.28 for SL-6 and 0.22 to 0.27 for BW-6. The two traits exhibited high degree of positive association with 0.87 to 0.92 correlation coefficient. The economic value estimated for weight and shank length was 1:8.95. Thus, the selection index constructed was I= 0.2260*BW6, g + 0.7717*SL6, mm. Selection differential was higher in SI method on pooled basis compared to MS in all three generations for the primary trait, SL-6. The response to selection and selection intensity was also higher in SI method compared to MS. A similar trend was observed for BW-6 with respect to selection differential and response to selection. The study concluded that SI was superior to mass selection based on the results in Vanaraja male line chicken

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Karakterisering av Tätningsytan för Statiska Tätningar

Leakages from seals are one of the important factors that are taken into consideration while designing any machining element. This is because leakages can affect the performance of any component and can also turn into a catastrophe. If looked into it, many parameters can be pointed out that can enhance leakages within the system, some of them may be pressure, temperature, clamping force and bolt distance etc. But the main parameter is the surface roughness, higher the roughness more the leakage and vice-versa. Thus, in this thesis an attempt has been made how the surface roughness can affect the performance of the sealing concept for metal bounded gasket with above four mentioned parameters. Also how leak proof surface can be defined using standard tribological parameters is the aim of this thesis. This report includes the results for methodologies implemented during the thesis and track down the leakages. The leaked surfaces were carefully studied and analyzed using different standards compared with the non leaked surfaces’ roughness parameters.Läckagerisk från tätande förband är en av de viktigaste faktorerna som beaktas vid utformning av konstruktionsartiklar. Detta på grund av att konsekvenserna kan bli förödande. Det tätande förbandet påverkas av många olika parametrar såsom till exempel tryck, temperatur, klämkraft, skruvavstånd och val av packning. En viktig faktor är ytans beskaffenhet; Generellt läcker en grov yta och vågig yta mer än en fin och plan yta. Således har i denna avhandling ytans beskaffenhet studerats tillsammans med en packning av typen metallburen gummipackning för att påvisa täthetfunktionen som en funktion av tryck, temperatur, klämkraft och skruvavstånd. Denna rapport innehåller resultat och analys av olika standardmetoder för de ytor som ingick i utredningen

Actuators placement using genetic algorithm and active vibration control of a smart truss structure

A Genetic Algorithm that follows natural selection procedure and Darwin's survival of fittest principle is implemented to find the optimal location of piezoelectric actuators. Active damping introduced by the distributed actuators is considered as the governing criteria to decide the actuator locations. A finite element procedure involving piezoelectric coupling is developed with 2 node Timoshenko beam element to idealise the smart truss structures. Further, the Genetic Algorithm is coded in MATLAB as M-Files to enable the control analysis to use other in-built functions. A 20 member smart truss with d(31) based extension-bending piezoelectric actuators is modelled and four optimal actuator locations are found using the developed procedures