Short-term limb immobilization results in skeletal muscle decline, but the underlying mechanisms are incompletely understood. This study aimed to determine the neurophysiologic basis of immobilization-induced skeletal muscle decline, and whether repetitive Transcranial Magnetic Stimulation could prevent any decline. Twenty-four healthy young males underwent unilateral limb immobilization for 72 h. Subjects were randomized between daily rTMS using six 20 Hz pulse trains of 1.5 s duration with a 60 s inter-train-interval delivered at 90% resting Motor Threshold, or Sham rTMS throughout immobilization. (...) Maximal grip strength, EMG activity, arm volume, and composition were determined at 0 and 72 h. Motor Evoked Potentials were determined daily throughout immobilization to index motor excitability. Immobilization induced a significant reduction in motor excitability across time. The rTMS intervention increased motor excitability at 0 h. Despite daily rTMS treatment, there was still a significant reduction in motor excitability, loss in EMG activity, and a loss of maximal grip strength after immobilization. Interestingly, the increase in biceps and posterior forearm skinfold thickness with immobilization in Sham treatment was not observed following rTMS treatment. Reduced MEPs drive the loss of strength with immobilization. Repetitive Transcranial Magnetic Stimulation cannot prevent this loss of strength but further investigation and optimization of neuroplasticity protocols may have therapeutic benefit. (shrink)

BackgroundImportance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not.MethodsTwo (...) cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2).ResultsParticipants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/aids patients, treating a minor, and reporting colleague’s errors.ConclusionsThis study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context. (shrink)

P¯an.ini’s grammar includes several types of metarules which determine how its operational rules apply. Among them are “traffic rules” which constrain how rules interact with each other in grammatical derivations. These are typically formulated as designating a rule or class of rules asiddha “not effected” (or asiddhavat “as if not effected”) with respect to another rule or class of rules. For economy, the rules so designated are grouped into several sections, whose headings collectively declare them to be asiddha(vat). The biggest (...) such section, under the famous heading 8.2.1 p ¯urvatr¯asiddham, extends from 8.2.1 through the end of the grammar (8.4.68), and is hence called the Trip¯ad¯ı ‘Three Sections’. (shrink)

COVID-19 forced lockdown in India, leading to the loss of job, crisis of food, and other financial catastrophes that led to the exodus migration of internal migrant workers, operating in the private sector, back to their homes. Unavailability of transport facilities led to an inflicted need to walk back to homes barefooted without lack of any other crucial resources on the way. The woeful state of internal migrant workers walking back, with all their stuff on their back, holding their children, (...) was trending on social media worldwide. Their problem continued even after reaching home, including misbehavior of villagers, indifferent mannerism of family members toward them, inability to fulfill family responsibility, and financial crisis, which led to stress, fear, and trauma for these internal migrant workers. The present paper aimed to assess the idiosyncratic stressors of internal migrant workers throughout the pandemic era and their responses toward those problems, which helped them cope with it. In-depth semistructured telephonic interviews were conducted with 25 internal migrant workers who were working in different cities in India before lockdown. The analyses revealed that multiple stressors include financial crisis, unavailability of food, inability to continue education, inability to pay house rent, lack of support from neighbors and family, and other psychological stressors that affected them. However, they also tried multiple strategies to deal with the problems, including a cognitive appraisal of the problem and making oneself psychologically competent to deal with the situation. Social support of family and friends played a vital role in enhancing hardiness and increasing the level of happiness at scarce times. At the same time, some of them could not deal with stressors and opted for psychiatric help to manage the physical symptoms of stress. (shrink)