Lightning protection for a temporary structure in open area

The current lightning protection systems are well proven and widely deployed for general situation. However, the methodology may be inadequate when applied to various situations especially in open area because the current BS EN and international standards do not cover guidance or procedures for lightning protection in open areas. The fundamental principle of lightning safety is ‘No place outside is safe when thunderstorms are in the area!’ The purpose of this research is to provide an outline of the lightning protection system strategy for the protection of life, livestock, sensitive equipment and property in open areas. The research proposes alternative methodology that can be used in open area for safety rather than the No-Notice personal backcountry lightning risk reduction process. Based on the results a suitable protection mechanism shall be developed to concept stag

Autopolypectomy of a Vocal Cord Polyp

Introduction Vocal cord polyps commonly occur in those with a history of vocal abuse. Patients with large lesions generally undergo microlaryngeal surgery under general anaesthesia. This unique case report highlights a strange scenario where the patient coughed out a fleshy mass during his morning walk and which was later confirmed as a vocal cord polyp.  Case Report A 62 year old male with a history of hoarseness of voice for 3 months presented to the ENT OPD holding a chunk of tissue which was apparently coughed out by him during his morning walk. After the incident, his symptoms had immediately improved. A videolaryngoscopy showed a congested spot on the right vocal cord being the probable site of origin of the lesion. On Histopathological examination, the tissue was reported as a vocal cord polyp.  The patient was managed conservatively but the lesion recurred at the same site after a month for which a microlaryngeal excision was performed. Discussion Vocal cord polyps are fairly common in ENT practice and usually present to the clinic with hoarseness of voice. Polyps that are small are usually managed conservatively by voice therapy alone whereas large polyps require surgical excision. This unique case report highlights a strange clinical scenario where the patient coughed out a large vocal cord polyp (Auto-polypectomy) during a bout of acute cough. This event saved him a surgery at the first instance, but eventually had a recurrence and had to undergo an excision under GA

Scavenger receptor B1 facilitates the endocytosis of \u3ci\u3eEscherichia coli\u3c/i\u3e via TLR4 signaling in mammary gland infection

SCARB1 belongs to class B of Scavenger receptors (SRs) that are known to be involved in binding and endocytosis of various pathogens. SRs have emerging role in regulating innate immunity and host–pathogen interactions by acting in co-ordination with Toll-like receptors.Query Little is known about the function of SCARB1 in milk-derived mammary epithelial cells (MECs). This study reports the role of SCARB1 in infection and its potential association in TLR4 signaling on bacterial challenge in Goat mammary epithelial cells (GMECs). The novelty in the establishment of MEC culture lies in the method that aims to enhance the viability of the cells with intact characteristics upto a higher passage number. We represent MEC culture to be used as a potential infection model for deeper understanding of animal physiology especially around the mammary gland. On E.coli challenge the expression of SCARB1 was signifcant in induced GMECs at 6 h. Endoribonuclease-esiRNA based silencing of SCARB1 affects the expression of TLR4 and its pathways i.e. MyD88 and TRIF pathways on infection. Knockdown also affected the endocytosis of E.coli in GMECs demonstrating that E.coli uses SCARB1 function to gain entry in cells. Furthermore, we predict 3 unique protein structures of uncharacterized SCARB1 (Capra hircus) protein. Overall, we highlight SCARB1 as a main participant in host defence and its function in antibacterial advances to check mammary gland infections

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Autopolypectomy of a Vocal Cord Polyp

Introduction Vocal cord polyps commonly occur in those with a history of vocal abuse. Patients with large lesions generally undergo microlaryngeal surgery under general anaesthesia. This unique case report highlights a strange scenario where the patient coughed out a fleshy mass during his morning walk and which was later confirmed as a vocal cord polyp.  Case Report A 62 year old male with a history of hoarseness of voice for 3 months presented to the ENT OPD holding a chunk of tissue which was apparently coughed out by him during his morning walk. After the incident, his symptoms had immediately improved. A videolaryngoscopy showed a congested spot on the right vocal cord being the probable site of origin of the lesion. On Histopathological examination, the tissue was reported as a vocal cord polyp.  The patient was managed conservatively but the lesion recurred at the same site after a month for which a microlaryngeal excision was performed. Discussion Vocal cord polyps are fairly common in ENT practice and usually present to the clinic with hoarseness of voice. Polyps that are small are usually managed conservatively by voice therapy alone whereas large polyps require surgical excision. This unique case report highlights a strange clinical scenario where the patient coughed out a large vocal cord polyp (Auto-polypectomy) during a bout of acute cough. This event saved him a surgery at the first instance, but eventually had a recurrence and had to undergo an excision under GA

Inside Out: Role of Body Painting in Learning Human Anatomy-An experience from a Public and Private Medical College

Objective: This study was planned to evaluate the role of body painting in short-term retention of knowledge and to assess students’ perception of this activity in a public and private medical college. Methods: This interventional study was conducted in a private and public medical college in the month of September and October 2023. The students of MBBS 1st year from the 2 colleges were invited to participate in the study and those who volunteered were randomly divided by the balloting method into 2 equal groups: control and intervention. The control group was given a traditional lecture with the help of a Power point presentation, on the course and markings of the nerves and vessels of the hand and forearm. The intervention group was given an interactive body painting demonstration, with hands-on practice of painting the same vessels and nerves on each other. At the end of these sessions, the students attempted a multiple-choice-question paper and the results were compared using SPSS version 21.00. A questionnaire was also filled by the intervention group to pro- vide the students’ perception of the activity. Results: There was no significant difference between the mean multiple-choice-question scores of the control and intervention group. More than 85% of the students from both the colleges strongly agreed that the session was enjoyable and interesting and also 80% and beyond of students also believed that the exercise would help them to retain knowledge. Conclusion: The study concluded that there was a negligible difference in knowledge retention be- tween the intervention group and the control group. However, the results of the questionnaire strongly suggested the use of the body painting technique in anatomy curricular teaching as it has proven to stimulate knowledge retention by enhancing students’ interest, active participation and peer learning

Comparison of landslide susceptibility models and their robustness analysis: a case study from the NW Himalayas, Pakistan

Machine learning methods are considered as most effective approaches to accomplish landslide susceptibility analysis around the globe. Landslide susceptibility maps (LSMs) have been frequently executed by statistical models in NW Himalaya. However, the comparison and applications of the statistical models with modern machine learning techniques has not been fully explored in this region. Hence, this study aims to compare the predicted performance of statistical and popular machine learning models to explore robust landslide prediction model in the landslide-prone area of NW Himalaya and investigate the compensations and limitations of these models to grasp a more precise and consistent result. This study presented machine learning approaches based on the artificial neural network (ANN), support vector machine (SVM) and logistic regression (LR) and the statistical methods based on the frequency ratio (FR), information value (InfoV) and weight of evidence (WoE). For this purpose, first an inventory map of 1507 landslides was prepared and randomly divided into training (70%) and testing (30%) dataset. Furthermore, 12 landslide conditioning factors (LCFs) were extracted from geospatial dataset to prepare thematic layers in ArcGIS. Thereafter, factor analysis was performed to eliminate colinear and least important variables which can mislead the results. The results showed that all selected LCFs are noncolinear and have significant contribution on landslides initiation, however, lithology, slope angle, annual rainfall and landuse were most influential factors. For modeling purpose, landslide inventory was correlated against all LCFs and trained into six models to produce respective LSMs. Finally, the performance of produced LSM models was validated and compared through area under receiver operating characteristic curve (AUROC), Accuracy, Recall, F1-score and Cohen’s Kappa coefficients to assess the robustness of employed models. The results exhibit that the performance scores of machine learning models were considerably superior than statistical models. While, the AUROC values based on validation dataset indicate that LR (0.89) has better prediction ability followed by SVM (0.86), ANN (0.84), FR (0.83), InfoV (0.82) and WoE (0.81) in this study. Therefore, it is reasoned out that the machine learning methods are more reliable in generating adequate LSMs. However, the LR is recommended as most efficient model for predicting landslide susceptible zones in study region and thus can be considered as robust model for landslide susceptibility assessment in similar geo-environmental regimes