Disrupted network architecture of the resting brain in attention‐deficit/hyperactivity disorder

Background Attention‐deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders of childhood. Neuroimaging investigations of ADHD have traditionally sought to detect localized abnormalities in discrete brain regions. Recent years, however, have seen the emergence of complementary lines of investigation into distributed connectivity disturbances in ADHD. Current models emphasize abnormal relationships between default network—involved in internally directed mentation and lapses of attention—and task positive networks, especially ventral attention network. However, studies that comprehensively investigate interrelationships between large‐scale networks in ADHD remain relatively rare. Methods Resting state functional magnetic resonance imaging scans were obtained from 757 participants at seven sites in the ADHD‐200 multisite sample. Functional connectomes were generated for each subject, and interrelationships between seven large‐scale brain networks were examined with network contingency analysis. Results ADHD brains exhibited altered resting state connectivity between default network and ventral attention network [ P  < 0.0001, false discovery rate (FDR)‐corrected], including prominent increased connectivity (more specifically, diminished anticorrelation) between posterior cingulate cortex in default network and right anterior insula and supplementary motor area in ventral attention network. There was distributed hypoconnectivity within default network ( P  = 0.009, FDR‐corrected), and this network also exhibited significant alterations in its interconnections with several other large‐scale networks. Additionally, there was pronounced right lateralization of aberrant default network connections. Conclusions Consistent with existing theoretical models, these results provide evidence that default network‐ventral attention network interconnections are a key locus of dysfunction in ADHD. Moreover, these findings contribute to growing evidence that distributed dysconnectivity within and between large‐scale networks is present in ADHD. Hum Brain Mapp 35:4693–4705, 2014 . © 2014 Wiley Periodicals, Inc .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107992/1/hbm22504.pd

Cost-effectiveness of therapeutic use of safety-engineered syringes in healthcare facilities in India

Background: Globally, 16 billion injections are administered each year of which 95% are for curative care. India contributes 25–30% of the global injection load. Over 63% of these injections are reportedly unsafe or deemed unnecessary. Objectives: To assess the incremental cost per quality-adjusted life-year (QALY) gained with the introduction of safety-engineered syringes (SES) as compared to disposable syringes for therapeutic care in India. Methods: A decision tree was used to compute the volume of needle-stick injuries (NSIs) and reuse episodes among healthcare professionals and the patient population. Subsequently, three separate Markov models were used to compute lifetime costs and QALYs for individuals infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Three SES were evaluated—reuse prevention syringe (RUP), sharp injury prevention (SIP) syringe, and syringes with features of both RUP and SIP. A lifetime study horizon starting from a base year of 2017 was considered appropriate to cover all costs and consequences comprehensively. A systematic review was undertaken to assess the SES effects in terms of reduction in NSIs and reuse episodes. These were then modelled in terms of reduction in transmission of blood-borne infections, life-years and QALYs gained. Future costs and consequences were discounted at the rate of 3%. Incremental cost per QALY gained was computed to assess the cost-effectiveness. A probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. Results: The introduction of RUP, SIP and RUP + SIP syringes in India is estimated to incur an incremental cost of Indian National Rupee (INR) 61,028 (US$939), INR 7,768,215 (US$119,511) and INR 196,135 (US$3017) per QALY gained, respectively. A total of 96,296 HBV, 44,082 HCV and 5632 HIV deaths are estimated to be averted due to RUP in 20 years. RUP has an 84% probability to be cost-effective at a threshold of per capita gross domestic product (GDP). The RUP syringe can become cost saving at a unit price of INR 1.9. Similarly, SIP and RUP + SIP syringes can be cost-effective at a unit price of less than INR 1.2 and INR 5.9, respectively. Conclusion: RUP syringes are estimated to be cost-effective in the Indian context. SIP and RUP + SIP syringes are not cost-effective at the current unit prices. Efforts should be made to bring down the price of SES to improve its cost-effectiveness

Comprehensive environmental impact assessment for designing carbon-cum-energy efficient, cleaner and eco-friendly production system for rice-fallow agro-ecosystems of South Asia

Not AvailableHigh energy consumption and carbon emission are the major components of environmental pollution. Reducing carbon-footprints and improving energy use efficiency in rice (Oryza sativa L.) - fallow production systems of South Asia is a great challenge. The present experiment was conducted for five consecutive years (2016?2020) with an aim to design the most carbon-cum-energy efficient, cleaner/safer and eco-friendly production systems for rice-fallows in eastern India. This split-plot experiment had crop establishment-cum-residue management (CERM) treatments in main-plots and post-rainy/winter season crops in sub-plots. The production systems selected for analysis included three crop establishment methods [(1) zero-till-direct-seeded rice (ZTDSR), (2) conventional-till direct-seeded rice (CTDSR), and (3) transplanted puddled rice (TPR)], and two residue management practices [(i) with residue, and (ii) without residue] in combination with five potential winter season crops i.e., chickpea (Cicer arietinum L.), lentil (Lens culinaris L.), safflower (Carthamus tinctorius L.), linseed (Linum usitatissimum L.), and mustard (Brassica juncea L.). Results revealed an increase in overall system productivity from 3.5 to 5.13 Mg ha?? 1 due to the diversification of rice-fallow systems with oilseed and pulse crops. Irrespective of residue management practices, ZTDSR increased the yield by 15 and 31% in chickpea, 15 and 34% in lentil, 33 and 50% in safflower, 9 and 19% in linseed, and 7 and 15% in mustard as compared to CTDSR and PTR, respectively. Moreover, adoption of ZTDSR reduced energy uses by 23.3%, while increased energy ratio and net returns by 14.3 and 10.9%, respectively, over TPR. Pulse based crop rotations (rice-lentil and rice-chickpea) under ZTDSR with surface crop residue yielded 21.5% higher system net returns as compared to rice-oilseed production systems. ZTDSR treatment also reduced carbon-footprint (C-footprint) by 2.8% compared to TPRbased production systems. Similarly, rice-oilseed systems had a 16.1% lower C-footprint in comparison to rice-pulse sequences. Hence, rice-chickpea, rice-lentil and rice-safflower production systems in combined with ZTDSR along with residue retention can be viable production systems with higher system productivity, better economic returns, higher energy ratio and lower C-footprint. These systems will ensure an efficient utilization of natural resources leading to long-term sustainability of the rice-fallow production systems of South Asia

NOTTO COVID-19 vaccine guidelines for transplant recipients

In December 2019, novel coronavirus (SARS-CoV-2) infection started in Wuhan and resulted in a pandemic within a few weeks' time. Organ transplant recipients being at a risk for more severe COVID-19 if they get SARS CoV-2 viral infection, COVID-19 vaccine has a significant role in these patients. The vaccine is a safer way to help build protection and would either prevent COVID-19 infection or at least diminish the severity of the disease. It would also reduce the risk of the continuing transmission and enhance herd immunity. Immuno-compromised patients should not receive live vaccines as they can cause vaccine-related disease and hence the guidelines suggest that all transplant recipients should receive age-appropriate 'inactivated vaccine' as recommended for general population. Though trials have not been undertaken on transplant recipients, efficacy and safety of COVID-19 vaccine have been scientifically documented for few vaccines among the general population