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Malaria is a public health emergency in India and Odisha. The national malaria elimination programme aims to expedite early identification, treatment and follow-up of malaria cases in hot-spots through a robust health system, besides focusing on efficient vector control. This study, a result of mass screening conducted in a hot-spot in Odisha, aimed to assess prevalence, identify and estimate the risks and develop a management tool for malaria elimination. Through a cross-sectional study and using WHO recommended Rapid Diagnostic Test (RDT), 13221 individuals were screened. Information about age, gender, education and health practices were collected along with blood sample (5 μl) for malaria testing. Altitude, forestation, availability of a village health worker and distance from secondary health center were captured using panel technique. A multi-level poisson regression model was used to analyze association between risk factors and prevalence of malaria, and to estimate risk scores. The prevalence of malaria was 5.8% and afebrile malaria accounted for 79 percent of all confirmed cases. Higher proportion of Pv infections were afebrile (81%). We found the prevalence to be 1.38 (1.1664-1.6457) times higher in villages where the Accredited Social Health Activist (ASHA) didn't stay; the risk increased by 1.38 (1.0428-1.8272) and 1.92 (1.4428-2.5764) times in mid- and high-altitude tertiles. With regard to forest coverage, villages falling under mid- and highest-tertiles were 2.01 times (1.6194-2.5129) and 2.03 times (1.5477-2.6809), respectively, more likely affected by malaria. Similarly, villages of mid tertile and lowest tertile of education had 1.73 times (1.3392-2.2586) and 2.50 times (2.009-3.1244) higher prevalence of malaria. Presence of ASHA worker in villages, altitude, forestation, and education emerged as principal predictors of malaria infection in the study area. An easy-to-use risk-scoring system for ranking villages based on these risk factors could facilitate resource prioritization for malaria elimination.

The 2-D edge plasma fluid transport code, UEDGE has been used to simulate the edge and scrape-off layer regions of circular limiter plasmas of ADITYA-U. The computational mesh defining the limiter geometry of ADITYA-U has been introduced in the UEDGE code through an in-house developed routine. It has successfully been integrated with the UEDGE code and the measured radial profile of electron density ( ) in the edge region is modelled using the simulations. The plasma discharge for the present study has plasma current 130 kA, duration 150 ms, chord-averaged electron density 1.3 , and central electron temperature 270 eV has been observed. The maximum toroidal magnetic field is 1.2 T. It has been found that an inward convective velocity, 1.5 m/s is required in addition to the constant perpendicular diffusion coefficient, 0.2 /s to adequately match the measured profile in typical discharges of ADITYA-U. The value of 0.2 /s is found to lie between the estimated neoclassical diffusivity and Bohm diffusivity.

Large area X-ray propositional counter (LAXPC) instrument on AstroSat is aimed at providing high time resolution X-ray observations in 3–80 keV energy band with moderate energy resolution. To achieve large collecting area, a cluster of three co-aligned identical LAXPC detectors, is used to realize an effective area in access of ∼ 6000 cm 2 at 15 keV. The large detection volume of the LAXPC detectors, filled with xenon gas at ∼ 2 atmosphere pressure, results in detection efficiency greater than 50%, above 30 keV. In this article, we present salient features of the LAXPC detectors, their testing and characterization in the laboratory prior to launch and calibration in the orbit. Some preliminary results on timing and spectral characteristics of a few X-ray binaries and other type of sources, are briefly discussed to demonstrate that the LAXPC instrument is performing as planned in the orbit.

We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar 1+ line emissions at 472.69 nm (3p 4 4s 2 P 3/2 –3p 4 4p 2 D 3/2 ), 473.59 nm (3p 4 4s 4 P 5/2 –3p 4 4p 4 P 3/2 ), 476.49 nm (3p 4 4s 2 P 1/2 –3p 4 4p 2 P 3/2 ), 480.60 nm (3p 4 4s 4 P 5/2 –3p 4 4p 4 P 5/2 ) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar 13+ line emission at 18.79 nm (2s 2 2p 2 P 3/2 –2s2p 2 2 P 3/2 ) and Ar 14+ line emission at 22.11 nm (2s 2 1 S 0 –2s2p 1 P 1 ). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar 1+ emission and the line intensity ratio of Ar 13+ and Ar 14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m 2 /s and ~ 0.3 m 2 /s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.

The present study focuses on analyzing the seasonal changes in aerosol characteristics using a classification scheme proposed by Gobbi et al. (2007). This scheme is based on the correlation between the Ångström exponent (α) in the 440–870 nm range and the difference in α values [dα = α (440–675 − α(675–870)] including the size of fine-mode particles (Rf) and the fine-mode fraction (η). The classification scheme can therefore provide information on the aerosol characteristics and their modification in transit. Spectral aerosol measurements using the Microtops-II sun photometer (MT-II) have systematically been conducted in Hyderabad, India during April 2009–March 2010 and analysed to study the seasonal effects. The results reveal a seasonal dependence, i.e. the presence of fine-mode aerosols under turbid atmospheres in winter and post-monsoon, a mixture of fine and coarse aerosol types in pre-monsoon and a significant influence of marine mixed with dust air masses during the monsoon season. The identification of the aerosol source type and the modification processes are discussed along with clustered air-mass trajectory analysis. Furthermore, we have also checked the consistency of this scheme with the findings arrived from the columnar size distributions (CSDs) computed by numerical inversion of spectral AOD using King's inversion algorithm and the scatter plot between AOD and spectral α. The comparison clearly demonstrates the usefulness of the classification scheme and highlights its advantages for the monitoring and study of seasonal variation of the aerosol types and the modification processes in the atmosphere.

Background: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. Methods: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I–V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. Results: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II–V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression ( P <0.05), with diabetes only in multivariable regression ( P =0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression ( P <0.05). Conclusions: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

Introduction/BackgroundUnselected population-based BRCA-testing enables application of genomics on a population-scale to maximise primary-prevention for breast-&-ovarian cancer. We present factors affecting uptake and long-term follow-up results of the GCaPPS-trial comparing population-based and Family-History (FH)/Clinical-criteria based BRCA-testing.MethodologyDesign: Randomised-Controlled-Trial (ISRCTN73338115) GCaPPS, with two-arms: (a)Population-Screening (PS); (b)FH/Clinical-criteria based testing.Setting: North-London Ashkenazi-Jewish(AJ) population.Population-based RCT (1:1). Participants recruited through self-referral, from North-London AJ-population.Inclusion-criteria: AJ women/men >18years. Exclusion-criteria: prior BRCA-testing or first-degree-relatives of BRCA-carriers.Interventions: Pre-test counselling for BRCA-testing through recruitment-clinics (clusters). Genetic-testing for Jewish BRCA founder-mutations: 185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT), for (a)all participants in PS-arm; (b)those fulfilling FH/clinical-criteria in FH-arm. Validated questionnaires (HADS/MICRA/HAI/SF12) analysed psychological well-being/quality-of-life outcomes at baseline, 1-year, 2-years and 3-years follow-up. Linear mixed-models and appropriate contrast-tests analysed the impact of BRCA-testing on psychological and quality-of-life outcomes over 3-years. Socio-demographic/family-history/knowledge/psychological well-being data along-with benefits/risks/cultural-influences (18-item-questionnaire measuring ‘attitude’) were collected. Logistic-regression models evaluated factors affecting uptake/interest/intention-to undergo BRCA-testing.Results1034 (women=691/men=343) participants randomized to PS (n=530) or FH (n=504) arms. There was a statistically significant decrease in anxiety(p=0.046) and total anxiety-&-depression scores(p=0.0.012) in the PS-arm compared to FH-arm over 3years. No significant difference was observed between FH/PS arms for depression, health-anxiety, distress, uncertainty, quality-of-life or experience scores associated with BRCA-testing.18/30(60%) BRCA-carriers identified did not fulfil BRCA-testing clinical-criteria. The total BRCA-prevalence= 2.9%(CI:1.97%,4.12%) (BRCA1=1.55%(CI:0.89%,2.5%); BRCA2=1.35%(CI:0.74%,2.26%)). The BRCA-testing uptake was 88%. Being married/cohabiting had four-fold higher-odds for BRCA-testing uptake(p=0.009). Reduced uncertainty/reassurance were the most important factors affecting decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional-impact/inability to prevent cancer/marriage-ability/ethnic-focus/stigmatization) were significantly associated with lower-odds of undergoing BRCA-testing, discriminating between acceptors and decliners.ConclusionPopulation-based AJ BRCA-testing has high acceptability, doesn’t adversely affect long-term psychological well-being or quality-of-life, decreases anxiety and could identify up-to 150% additional BRCA-carriers. Pre-test counselling increases awareness of disadvantages/limitations of BRCA-testing, influencing final cost-benefit perception and decision-making on undergoing testing.DisclosureIJ and UM have a financial interest in Abcodia, Ltd., a company formed to develop academic and commercial development of biomarkers for screening and risk prediction. IJ is a member of the board of Abcodia Ltd, a Director of Women’s Health Specialists Ltd and received consultancy from Beckton Dickinson. RM declares research funding from The Eve Appeal and Cancer Research UK into population testing and from Barts & the London Charity and Rose Trees Trust outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honorarium for advisory board membership from Astrazeneca/MSD. RM is supported by an NHS Innovation Accelerator (NIA) Fellowship for population testing. The other authors declare no conflict of interest.

Introduction/BackgroundAutopsy studies report inguinal metastasis in up to 3% of patients with advanced ovarian cancer. Metastasis occurs via a minor lymphatic drainage pathway running through the round ligament of the uterus toward the inguinal region. Postoperative complications after inguinal surgery performed through an incision crossing over Scarpa´s triangle extending to the anterior superior iliac spine, are common (seroma/lymphocele 6–40%, dehiscence 17–65%, infection 6–20%, lymphoedema 22–80%), debilitating and harbour considerable socioeconomic costs. To reduce surgical morbidity, an alternative approach per abdomen has been proposed in patients with ovarian cancer with metastatic inguinal lymphadenopathy.MethodologyA fifty-four year old woman underwent primary cytoreductive surgery for histologically proven metastatic high grade serous carcinoma of tubo-ovarian origin. CT/MRI had revealed bilateral inguinal lymphadenopathy with a 16 mm right external iliac lymph node (FIGO stage IVB). Surgery involved a midline-laparotomy, total omentectomy, enbloc resection of appendix/recto-sigmoid/uterus/cervix/both tubes and ovaries/pelvic peritoneum and excision of enlarged right external iliac lymph node and enlarged bilateral inguinal nodes. R0 resection achieved.Using an abdominal approach, Scarpa´s fascia was identified and the nodal bundle dissected from inferior surface of Scarpa. External oblique fascia identified and nodal tissue dissected, preserving the long saphenous vein. Nodal tissue removed within femoral triangle medial to femoral artery and vein with inguinal ligament superiorly.ResultsOperative time was 12 minutes per side. Drain anterior to rectus sheath was removed on the seventh postoperative day. No postoperative complications were observed. Histology confirmed bilateral tumour infiltration in the inguinal nodes which measured 35 x 15 x 12 mm on the left and 55 x 30 x 20 mm on the right.ConclusionAn abdominal approach to inguinal node dissection in metastatic ovarian cancer has the potential to reduce surgical morbidity and reduce operating time when compared to the standard approach without compromising complete cytoreduction.DisclosureFG, AF, AL, EB, ARJ, SP declare no conflict of interest. RM declares research funding from The Eve Appeal and Cancer Research UK into population testing and from Barts & the London Charity and Rose Trees Trust outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honorarium for advisory board membership from Astrazeneca/MSD. RM is supported by an NHS Innovation Accelerator (NIA) Fellowship for population testing.

Introduction/Background*Ovarian cancer (OC) in BRCA mutation-carriers is typically diagnosed clinically at >=stage 3c, with consequent poor prognosis. Risk-reducing salpingo-oophorectomy (RRSO) is recommended for BRCA mutation-carriers as the only proven method of OC prevention. Women who defer RRSO to permit child-bearing/prevent premature menopause would benefit from surveillance which can downstage OC occurring prior to RRSO. We wanted to establish the ‘real world’ performance of OC surveillance which we have previously shown downstages OC in clinical trials.Methodology875 female BRCA mutation-carriers were recruited at 13 UK centres and via a media campaign and underwent 4-monthly surveillance with the Risk of Ovarian Cancer Algorithm (ROCA) blood test. They had a 6 week repeat test if their ROCA score was >1 in 1000, and a transvaginal scan (TVS) in addition, if their risk was > 1 in 500. Women with a score >1 in 33 or those with concerning TVS were referred to a rapid access clinic to rule out OC. RRSO was encouraged throughout the program. Participants were followed via questionnaires, notification by centres/GPs and direct contact. Surveillance performance was calculated after censoring 4 months after prior screen, with modelling of occult cancers detected at RRSO. Incremental cost-effectiveness was calculated using a Markov population cohort simulation.Result(s)*8 OCs occurred during 1277 women screen years; 2 occult OCs at RRSO (both stage 1a), 6 screen-detected OCs (3 prevalent; stage 2a, 3aii and 3c, 3 incident; stage 1a, 3b and 4b). 4 of 6 (67%) screen-detected OCs were diagnosed at stages <3c. 7 of 8 (87.5%) screen-detected cancers were completely cytoreduced. There were no interval cancers. Modelled sensitivity, specificity, PPV and NPV for OC were 87.5% (CI, 47.3–99.7), 99.9%(99.9–100), 75%(34.9–96.8) and 99.9%(99.9–100) respectively. Economic modelling indicated that surveillance would be cost-saving within the UK National Health Service.Conclusion*OC surveillance for women declining RRSO in a ‘real-word’ setting is feasible and equally effective as in research trials, resulting in successful downstaging with likely clinical benefit and healthcare cost savings. Whilst RRSO remains the recommended management for BRCA-carriers, ROCA-based surveillance is a viable interim option for those who defer such surgery.