Pattern of anti-diabetic drugs prescribed for type 2 diabetes mellitus patients in a tertiary care hospital of India: an observational study

Background: Type 2 diabetes mellitus (T2DM) is a leading cause of significant morbidity and mortality in developing countries. Evaluation of anti-diabetic drug use pattern guides the healthcare professionals to identify early signals of irrational prescribing and to plan interventions to optimize the benefits of pharmacotherapy.Methods: Observational descriptive study was conducted on 500 prescriptions of T2DM patients collected from Outpatient department of a tertiary care hospital. Prescriptions were analysed for type, number, generic/brand names, fixed dose combinations (FDCs) of anti-diabetic drugs and anti-diabetic drugs prescribed from within National List of Essential Medicines (NLEM) 2015.Results: Average number of anti-diabetic drugs per prescription was 2.5. Of these 49% were from within NLEM and only 39% were prescribed by their generic names. Among all the anti-diabetic groups of drugs used, biguanide (32.85%) was the most frequently prescribed followed by insulins (25.4%) and DPP-4 inhibitors (13.75%). Combined drug therapy was more prevalent than monotherapy (70% versus 30%). Metformin+sitagliptin and metformin+linagliptin were most commonly prescribed fixed dose combinations.Conclusions: Recent trend of anti-diabetic drug use included newer anti-diabetic drugs in combination with metformin to achieve better euglycemia and to minimize complications of T2DM

Three Papers on Gendered Inequities of Refugee Women’s Health and Well-being -- Multi-level factors associated with intimate partner violence experiences, contraceptive use, and economic engagement among women refugees living in Malaysia and Jordan

Refugee women face several health and well-being risks in conflict settings. Intimate partner violence (IPV), military violence, poor sexual and reproductive health (SRH), early marriage, and unemployment are some of the competing challenges that refugee women face globally. IPV has been associated with mental health problems,1–3 unwanted pregnancy, pregnancy complications, STIs, and unsafe abortion practices,4 HIV,5–8 long term disabilities, chronic pain, and increased mortality and morbidity in refugee settings.9–12 Likewise, low, inconsistent, and ineffective use of modern spacing methods (MSM) of contraceptive has been linked to unplanned pregnancies, risk of abortions and unsafe abortions, maternal, infant and child morbidity and mortality, human immunodeficiency viruses (HIV), sexually transmitted infections (STIs), and obstetric complications as well as high fertility and poverty. Similarly, low economic engagement and/or unemployment of refugee women has proven to cause significant social, economic and health cost.13 Refugee women’s health and well-being are associated with individual, interpersonal, and societal level factors such as their age, education, social norms around fertility, household size, and age at marriage, contraceptive use, decision-making agency, socio-economic conditions, access to and affordability of health services and care, and acculturation in host countries among other factors. This dissertation examines how some of these multi-level factors influence women’s IPV experiences, contraceptive use, and economic engagement in income-generating activities. The first dissertation paper examines the prevalence of lifetime IPV among a sample of 191 health-care seeking women refugees and asylum seekers in Malaysia. Using Bronfenbrenner’s socio-ecological framework and integrated theory of gender and power, I examine multilevel factors associated with lifetime IPV. I also examine the relationship between contraceptive use and lifetime IPV. About one-third (28.30 %) of refugee women reported having experienced lifetime IPV. My hypotheses were partially supported in this study. There were significant associations between marital status, household size, contraceptive use, and food insecurity and lifetime IPV experiences in the bivariate analysis. Age, education, gender-based violence, time spent in Malaysia, and clinic were women were recruited from were not significant in the bivariate analysis. There were no associations between socio-demographic variables like age, education, household size, time spent in Malaysia and the clinic in the unadjusted as well as adjusted models. However, there were significant relationships found between marital status, contraceptive use, and food insecurity and lifetime IPV experiences in the adjusted model. Widowed, separated, and divorced refugee women were significantly more likely to report lifetime IPV experiences relative to women who reported themselves as married at time of survey [OR: 2.56, 95% CI: 1.09, 6.03] compared to women did not report lifetime IPV experience in the adjusted multivariable logistic model, rejecting my hypothesis. Also, in line with my hypothesis, women who reported using permanent methods of contraceptives were significantly more likely to report lifetime IPV experiences than no contraceptive use [0R: 8.70, 95% CI: 1.95, 38.64] compared to women who did not report lifetime IPV experiences in the adjusted multivariable logistic model. In line with my hypothesis, women who reported themselves as being food insecure were more likely to report lifetime IPV experiences than no food insecurity [OR: 0.40, 95% CI: 0.18, 0.89] compared to women who did not report lifetime IPV experiences in the adjusted multivariable logistic model. The second dissertation paper examines the prevalence of types of MSM of contraceptive use (female controlled MSM of contraceptives such as intrauterine devices (IUDs), implants, injectables, oral contraceptives (OC); male involved MSM of contraceptives such as condoms; and no contraceptives) among a sample of 307 married Syrian refugee women in Jordan. Using Bronfenbrenner’s socio-ecological framework and integrated theory of gender and power, I examine multilevel factors associated with MSM of contraceptive use. I also examine the relationship between early marriage and contraceptive use and the relationship between past-year IPV and contraceptive use. About two-fifth (38.44%) of women reported using female controlled MSM (IUDs, injectables, pills, and implants), a little more than one-tenth (11.73%) reported using male involved contraceptives (male condoms), and half of them (49.84%) reported using no contraceptives (includes natural methods and no forms of contraceptive methods). My hypotheses were partially supported in this study. Socio-demographic variables such as age, head of household, and reproductive health care services received in the past six months were significant in the bivariate association between socio-demographic variables and types of MSM of contraceptive use. And early marriage, education, children under the age of five, past-year IPV experience, Syrian governorate, and time in Jordan (acculturation) were not significant in the bivariate analysis. Women who were married prior to the age of 18 years were significantly more likely to report female controlled MSM of contraceptive use than no MSM of contraceptive use at time of survey [RRR: 1.83, 95% CI: 1.07, 3.13] compared to women who were married past 18 years of age in the adjusted multinomial logistic model. Women with children under the age of five were less likely to report male involved MSM of contraceptive use than no MSM of contraceptive use [RRR: 0.32, 95% CI: 0.12, 0.84] compared to women with children older than five years of age in the adjusted multinomial logistic model. Women who reported reproductive health care services received in the past six months were significantly more likely to report female controlled MSM of contraceptive use than no MSM of contraceptive use [RRR: 2.21, 95% CI: 1.98, 3.80] compared to women who reported not receiving reproductive health care services in the past six months in the adjusted multinomial logistic model. Contrary to my hypothesis, women who reported themselves as head of household were less likely to report female controlled MSM of contraceptive use than no MSM of contraceptive use [RRR: 0.40, 95% CI: 0.18, 0.89] compared to women who reported their husbands or family members as head of households in the adjusted multinomial logistic model. No associations between socio-demographic variables like age, education, past-year IPV, Syrian governorate, time spent in Jordan and MSM of contraceptive use in the adjusted multinomial logistic regression model were found. The third dissertation paper examines the prevalence of husbands’ no opposition to wives’ economic activity among a sample of 344 married Syrian refugee women living in non-camp settings in Jordan. Using Bronfenbrenner’s socio-ecological framework and integrated theory of gender and power, I examine multilevel factors associated with husbands’ no opposition to wives’ economic activity. I also examine the association between no lifetime IPV and husbands’ no opposition to wives’ economic activity and the association between head of the households and husbands’ no opposition to wives’ economic activity. I further examine if the relationship between no lifetime IPV and husbands’ no opposition to wives’ economic activity is moderated by women’s agency measured by if they reported themselves as head of the household. About one-third (65.12 %) of women reported husbands’ no opposition to wives’ economic activity. My hypothesis was partially supported in bivariate and multivariable logistical regression analysis. Age, education, previous work experience, head of the household, no lifetime IPV, and time in Jordan were significant in the bivariate analysis between multi-level/socio-demographic variables and husbands’ no opposition to wives’ economic activity. Of the less than half (44.77%) of women who did not experience lifetime IPV, more than one-third (70.8 %) of women reported husbands’ no opposition to wives’ economic activity relative to those who reported lifetime IPV experience (70.78 % versus 29.22 %; P=0.05). Of the more than one-fifth (22.97 %) of women who reported themselves as head of household, more than four-fifth (83.54 %) of women reported husbands’ no opposition to wives’ economic activity relative to those who did not report themselves as head of the households (83.54 % versus 16.46 %; P=0.000). In line with my hypothesis, in unadjusted (OR=1.58 95% confidence interval, CI=1.00-2.48) and adjusted (aOR=1.60, 95% CI=0.98-2.563) models, not experiencing lifetime IPV were associated with increased odds of husbands’ no opposition to wives’ economic activity. Similarly, in both the unadjusted (OR=3.44 95% confidence interval, CI=1.80-6.54) and adjusted (aOR=2.65, 95% CI=1.33-5.29) models, women who reported themselves as head of the households were associated with increased odds of husbands’ no opposition to wives’ economic activity, supporting my hypothesis. Likewise, in both the unadjusted (OR=7.97 95% confidence interval, CI=2.40-26.40) and adjusted (aOR=5.82, 95% CI=1.66-20.40) models, women who reported no IPV experiences as well as who reported themselves as head of the households were associated with increased odds of husbands’ no opposition to wives’ economic activity relative to women who reported lifetime IPV experiences and who did not report themselves as the head of the households, supporting my hypothesis. Age and education were also significant in the adjusted model. These findings affirm that IPV, contraceptive use, and women’s economic engagement are serious health and well-being issues. Results fill in the literature gaps on multilevel factors associated with IPV, contraceptive use, and women’s economic engagement. The first study contributes to the literature on how contraceptive behavior, refugee women’s marital status, and food insecurity, measured as a proxy of poverty influences refugee women’s IPV experiences. The second study contributes to the literature on how marrying at an early age, having children in the households, and receiving reproductive health services influences refugee women’s contraceptive behavior. Third paper contributes to the literature on how refugee women’s lack of IPV experiences and their improved agency/household decision making power influences their economic engagement in the host country. These findings have potential to inform health, sexual and reproductive health, social norms, and economic empowerment interventions. The implications of these findings for social policy, practice, and future research for each paper are discussed in relevant sections as well as in the conclusion section

Energy-Aware Computation in Mobile Devices

The booming of mobile devices and applications has a significant social and economic impact. However, new data intensive applications, which are continuously emerging in daily routines of mobile users, continuously increase the demand for wireless resources. Although bandwidth is traditionally considered as the primary scarce resource in wireless networks, the developments in communication theory shifts the focus from bandwidth to other scarce resources including processing power, energy, memory, and human participation. In this thesis, we specifically focus on processing power and energy bottlenecks of mobile devices, and develop and evaluate energy-aware computation framework using real mobile devices

Role of <i style="">Rubia cordifolia</i> Linn. in radiation protection

620-625The radioprotective potential of alcoholic extract of root of R. cordifolia, was studied by survival, hemopoietic cell protection and micronucleus assay. The LD50 value for the alcoholic root extract was found to be 1200 mg/kg body weight at 72 hr post irradiation. A significant radiation protection (67%) as assessed by increased animal survival was observed when R. cordifolia (RC) extract was administered intraperitoneally, 90 min. before the radiation exposure. Besides, the extract also inhibited radiation induced lipid peroxidation measured by the inhibition of thiobarbituric acid reactive substance (TBARS). The RC extract at a selected dose of 460 mg/kg body weight was effective in protecting the radiation induced suppression of endogenous colony forming units in spleen. A significant inhibition of radiation (2 Gy) induced micronuclei formation was observed when RC extract was administered 90 min prior to irradiation. Thus, it appears that the alcoholic root extract of R. cordifolia provides significant protection against radiation induced lipid peroxidation, hemopoietic injury and genotoxicity. The mechanism of action of RC extract appears to be through its anti-oxidant, metal chelation and anti-inflammatory property

<span style="font-size: 21.0pt;mso-bidi-font-size:14.0pt;font-family:"Times New Roman","serif"">Effect of <i><span style="font-size:21.5pt;mso-bidi-font-size:14.5pt; font-family:"Times New Roman","serif"">Semecarpus anacardium </span></i><span style="font-size:21.0pt;mso-bidi-font-size:14.0pt;font-family:"Times New Roman","serif"">nuts on lipid peroxidation </span></span>

798-801<span style="font-size: 16.0pt;mso-bidi-font-size:9.0pt;font-family:" times="" new="" roman","serif""="">Alcoholic extract of pericarp showed significant protection against FeSO4 induced lipid peroxidation, as compared with whole native nut and seeds. Mechanism of action may be through metal chelation or activation of endogenous antioxidant enzymes, because the ex tract did not show hydroxyl and super oxide anion scavenging property. Further <span style="font-size:15.5pt; mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">in vitro experiments against FeSO4 ,it did not maintain the level of reduced glutathione. </span

Offline signature verification using geometric and orientation features with multiple experts fusion

This paper reports a weighted fusion of multiple classifiers for offline signature verification using geometric and orientation features. The proposed system uses three different classifiers for identity verification, namely, Gaussian empirical rule, Mahalanobis and Euclidean distance metrics. Initially, Geometric global and local features are extracted from signature image. Further, a novel feature extraction technique is applied to signature image for extraction of orientation features. These feature sets are then fused and make a concatenated feature set which is then passed through the three classifiers. Matching scores obtained from these three classifiers are finally fused using weighted sum rule. The proposed system is tested on IIT Kanpur signature database which consists of 1800 offline signatures. The experimental results are found to be convincing and encouraging. The aim of the proposed system is to provide such a system which can overcome the problem of skilled forgery detection efficiently with less computational complexity

Palmprint verification using Lagrangian decomposition and invariant interest points

This paper presents a palmprint based verification system using SIFT features and Lagrangian network graph technique. We employ SIFT for feature extraction from palmprint images whereas the region of interest (ROI) which has been extracted from wide palm texture at the preprocessing stage, is considered for invariant points extraction. Finally, identity is established by finding permutation matrix for a pair of reference and probe palm graphs drawn on extracted SIFT features. Permutation matrix is used to minimize the distance between two graphs. The propsed system has been tested on CASIA and IITK palmprint databases and experimental results reveal the effectiveness and robustness of the system