Homogenization of a locally periodic oscillating boundary

This paper deals with the homogenization of a mixed boundary value problem for the Laplace operator in a domain with locally periodic oscillating boundary. The Neumann condition is prescribed on the oscillating part of the boundary, and the Dirichlet condition on a separate part. It is shown that the homogenization result holds in the sense of weak $L^2$ convergence of the solutions and their flows, under natural hypothesis on the regularity of the domain. The strong $L^2$ convergence of average preserving extensions of the solutions and their flows is also considered.Comment: 30 pages, 5 figures, 1 tabl

HOMOGENIZATION OF A NON-PERIODIC OSCILLATING BOUNDARY VIA PERIODIC UNFOLDING

This paper deals with the homogenization of an elliptic model problem in a two-dimensional domain with non-periodic oscillating boundary by the method of periodic unfolding. For the non-periodic oscillations, a modulated unfolding is used. The L-2 convergence of the solutions and their fluxes are shown, under natural hypotheses on the domain

Homogenization of Helmholtz equation in a periodic layer to study Faraday cage-like shielding effects

The work is motivated by the Faraday cage effect. We consider the Helmholtz equation over a 3D-domain containing a thin heterogeneous interface of thickness $\delta \ll 1$. The layer has a $\delta-$periodic structure in the in-plane directions and is cylindrical in the third direction. The periodic layer has one connected component and a collection of isolated regions. The isolated region in the thin layer represents air or liquid, and the connected component represents a solid metal grid with a $\delta$ thickness. The main issue is created by the contrast of the coefficients in the air and in the grid and that the zero-order term has a complex-valued coefficient in the connected faze while a real-valued in the complement. An asymptotic analysis with respect to $\delta \to 0$ is provided, and the limit Helmholtz problem is obtained with the Dirichlet condition on the interface. The periodic unfolding method is used to find the limit

Prescription to practice in hypertension: a community experience in central Kerala

Background: Control of blood pressure is a global challenge and non-adherence to hypertension medications is a public health concern. Patient, medication and system related factors can contribute to non-adherence. The study was to determine adherence to hypertension medications and to understand the barriers to adherence in an adult group in Pathanamthitta District of Central Kerala.Methods: A cross sectional study was conducted in a community setting in 2016, among 139 adults aged 30 years and above on treatment for hypertension for at least six months. Those with gestational hypertension, those having serious comorbid conditions and those unwilling to participate were excluded. The data sheet included basic demographic information and history related to hypertension. A content validated eight item questionnaire was used to assess reported adherence and scores classified level of adherence as good (8), moderate (6-<8) and poor (<6). The data was analyzed using SPSS. Chi square test of significance and multivariate regression analysis were done. P<0.05 was considered statistically significant.Results: The participants were in the age group 34-91 years, 50.4% belonging to 50-69 years, and 75.5% were females. Adherence to hypertension medications was good in 49.6%, moderate in 31.7% and poor in 18.7%. The most common factors reported to contribute to non-adherence were forgetfulness (70.5%), high cost of medications (51.8%), and symptom-free state (27.3%).Conclusions: Adherence was good in less than half the study participants and poor in almost one-fifth. Forgetfulness and high medication costs were the most commonly reported barriers. These findings highlight the importance of individuals, families and health service, joining hands to tackle the public health problem of non-adherence to hypertension medications

Nutritional status of older adults in a community in Pathanamthitta district of Kerala

Background: India is said to be shifting from an undernourished to over nourished population with advances in health, economy and medical care. But there is paucity of information regarding nutritional status of older adults in the country, who are socially and economically insecure. Hence the present study attempts to assess the nutritional status of people above 60 years of age, and to find the factors associated with it.Methods: A cross sectional study was conducted among 129 people aged above 60 years, residing in Pathanamthitta district, Kerala. Mini Nutritional Assessment tool (MNA) was used to classify the respondents as having ‘normal nutrition’ (score 23.5 and above), ‘at risk of malnutrition’ (17-23.5), ‘malnourished’ (<17). A 24-hour dietary recall was done to calculate per day calorie intake and compare with Recommended Daily Allowance (RDA). The results were interpreted as adequate or deficient. Descriptive statistics, chi-square and spearman’s correlation were done to find relationship between various sociodemographic variables, MNA status, BMI and calorie intake.Results: Females constituted 75.2%; 81.4% were unemployed; 62% belonged to rural area. Nutritional assessment showed 41.9% to be having normal nutrition, 46.5% at risk of malnutrition, and 11.6% malnourished. Caloric intake was less than the RDA in 89.1%. There was no association between calorie intake per day and MNA status. Education (p=0.025), place of residence (p=0.021), marital status (p=0.003), and family income (p=0.031) were factors significantly influencing nutritional status in elderly. There was significant correlation between MNA status and BMI (p<0.001, r=0.329).Conclusions: Malnutrition was seen in 11.6% of older adults in this study and another major proportion was at risk of malnutrition. Better nutritional status was significantly associated with good education, urban residence, married state, and higher family income. Dietary intake was inadequate among older adults. 24-hour dietary recall reflected nutritional status of only the malnourished. 

International medical schools have insufficient training addressing LGBTQ+ health needs.

Background: The LGBTQ+ community constitutes a significant proportion of society with unique health needs. However, healthcare services and doctors often inadequately address their needs, with insufficient training proposed as a major contributory factor. This international observational study aimed to investigate the level of training in LGBTQ+ medicine during medical school.Method: Following validation with LGBTQ+ organisations, a survey was created to assess medical students’ knowledge, sources of understanding, and areas for improvement for LGBTQ+ health issues in the curricula. The survey consisted of multiple-choice and Likertscale questions. Following a pilot, the online survey was disseminated at two medical schools in London and Singapore. Findings: 330 respondents completed the survey, with comparable absolute numbers from both universities. At least one-third of respondents were unclear on terminologies such as ‘out-of-the-closet’ and ‘men who have sex with men’. Additionally, respondents lacked knowledge of clinical topics such as conversion therapy. 84.2% of respondents expressed inadequacy in learning about LGBTQ+ medicine at university, with only 27.9% of respondents indicating they learnt general LGBTQ+ issues from medical curricula. Sexual health (90.9%) was well-learnt at medical schools, whilst many other topics such as genderaffirming care were not learnt (56.7%). Conclusions: This study highlights the lack of training surrounding LGBTQ+ medicine that medical schools provide for students, with much information gathered from outside sources. Medical school curricula should be reviewed to better incorporate important issues surrounding LGBTQ+ medicine. This would better equip the next generation of doctors to address the LGBTQ+ community’s health needs

Medical Students' Perceptions of LGBTQ+ Healthcare in Singapore and the United Kingdom

Introduction: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals have an increased scope of healthcare needs and face many barriers to accessing healthcare. However, LGBTQ+ healthcare education remains scarce, and students’ understanding of LGBTQ+ healthcare remains largely uncharacterised. This study investigated the knowledge of and attitudes toward LGBTQ+ healthcare among medical students in Singapore and the United Kingdom (UK), two culturally different countries. Methods: Medical students in two medical schools, one in Singapore and the other in the UK, completed self-administered cross-sectional surveys using multiple-choice, Likert scale, and free-text questions to explore their ideas, concerns, and expectations about LGBTQ+ healthcare education within their medical curricula. Results: From 330 responses, students’ knowledge levels were moderate overall, with pronounced gaps in certain areas, including terminology, sexual health, and conversion therapy. Deficiencies in knowledge were significantly greater among students in Singapore compared to the UK (p < 0.001), whilst LGBTQ+ students and non-religious students had more positive knowledge and attitudes than students not identifying. At least 78% of students had positive attitudes towards LGBTQ+ individuals, but 84% had not received LGBTQ+-specific medical education. Although junior UK students were more satisfied with the adequacy of teaching by their medical school’s incorporation of LGBTQ+ inclusive teaching in a newer curriculum, qualitative analyses suggested that students in both countries wanted to receive more training. Students further suggested improvements to the medical curriculum to meet their needs. Conclusion: Students in both schools lacked understanding of commonly-used terminology and topics such as sexual healthcare despite affirming attitudes towards LGBTQ+ healthcare. Although sociolegal contexts may affect students’ perspectives, differences were less than thought, and students were equally keen to provide affirmative care to their patients. They emphasised a need for more formal teaching of LGBTQ+ healthcare professions to overcome healthcare disparities in these communities

Imaging spectrum of extrapulmonary manifestations of COVID-19 infection- a multi-centre descriptive study from Southern India

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the causative agent for coronavirus disease 2019 (COVID-19) pandemic. While the primary organ of involvement in this disease is the lung, multiple other organ systems can be involved either due to direct viral cytopathic effects or due to thrombo-inflammation and immune system dysregulation. In this study we describe the spectrum of extrapulmonary imaging findings encountered in our patients with COVID-19.Methods: This was a retrospective observational study conducted in three tertiary care hospitals in the city of Chennai in southern India. All cross-sectional imaging studies (other than lung imaging studies) performed in patients who had proven COVID-19 infection by RT-PCR testing during the period from April 2020 to March 2021 were included as part of the study. Extrapulmonary findings in these imaging studies were recorded and collated system-wise.Results: A total of 96 non-lung imaging studies were performed in patients who had RT-PCR positivity for COVID-19 infection. Among these a total of 30 studies had extrapulmonary imaging findings. Vascular involvement was seen in 14 patients, central nervous system involvement in 13 patients, abdomen involvement in 2 patients, and cardiac involvement in 1 patient. Vascular manifestations included arterial and venous thrombosis. Neurological manifestations included stroke, encephalitis and demyelination. Abdominal manifestations included enteritis and acute kidney injury. Cardiac manifestation was in form of myocarditis.Conclusions: Extrapulmonary imaging findings in COVID-19 are uncommon but not rare. Multisystem thrombotic manifestations and central nervous system involvement account for majority of extrapulmonary imaging findings in COVID-19

A Case Report of Breast Cancer with Extensive Pulmonary Lymphovascular Tumor Emboli

We describe a patient with breast cancer who relapsed with an extensive pulmonary lymphovascular tumor embolism. A 38-year-old female, who previously received neoadjuvant chemotherapy and curative resection of breast cancer, underwent adjuvant chemotherapy and was referred to the emergency room because of sudden-onset pleuritic chest pain lasting for 10 days. Despite a trial of empirical antibiotics, the chest pain and the extent of consolidative lung lesion on chest radiographs rapidly aggravated. We performed an open lung biopsy to confirm the etiology. The histopathological review revealed a hemorrhagic infarction caused by lymphovascular tumor emboli from a metastatic breast carcinoma. Palliative first-line chemotherapy was administered, consisting of ixabepilone and capecitabine, and the lung lesion improved markedly

Blood groups in India

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37447/1/1330280405_ftp.pd