The State of Education and Training for Antimicrobial Stewardship Programs in Indian Hospitals:A Qualitative and Quantitative Assessment

Background: To understand the role of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. Methods: Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public & private) were invited to participate in online survey and follow up qualitative interviews. Thematic analysis was applied to identify the key emerging themes from the interviews. The survey data were analyzed using descriptive statistics. Results: 60 healthcare professionals from 51 hospitals responded to the survey. Eight doctors participated in semi-structured telephone interviews. 69% (27/39) of the respondents received E&T on AMS during undergraduate or postgraduate training. 88% (15/17) had not received any E&T at induction or during employment. In the qualitative interviews three key areas of concern were identified: (1) need for government level endorsement of AMS activities; (2) lack of AMS programs in hospitals; and, (3) lack of postgraduate E&T in AMS for staff. Conclusion: No structured provision of E&T for AMS currently exists in India. Stakeholder engagement is essential to the sustainable design and implementation of bespoke E&T for hospital AMS in India

Molecular characterization of Fusarium oxysporum f. sp. ciceri causing wilt of chickpea

Thirty isolates of Fusarium oxysporum f. sp. ciceri were isolated from rhizosphere soil of chickpea from different locations in Northern India. The amount of genetic variation was evaluated by polymerase chain reaction (PCR) amplification with a set of 40 RAPD primers and 2 IGS primers. Less than 10% of the amplified fragments in each case were polymorphic. Genetic similarity between each of the isolates was calculated and results indicate that there was little genetic variability among the isolates collected from the different locations. At the 0.75 similarity index the isolates divides into three groups. Isolates Foc-A18, Foc-A19, Foc-A20 forming a similar group and far different from other isolates.Key words: Fusarium oxysporum f. sp. ciceri, Fusarium wilt of chickpea, RAPD, ITS, IGS

Taxonomy of hybridly polarized Stokes vortex beams

Structured beams carrying topological defects, namely phase and Stokes singularities, have gained extensive interest in numerous areas of optics. The non-separable spin and orbital angular momentum states of hybridly polarized Stokes singular beams provide additional freedom for manipulating optical fields. However, the characterization of hybridly polarized Stokes vortex beams remains challenging owing to the degeneracy associated with the complex polarization structures of these beams. In addition, experimental noise factors such as relative phase, amplitude, and polarization difference together with beam fluctuations add to the perplexity in the identification process. Here, we present a generalized diffraction-based Stokes polarimetry approach assisted with deep learning for efficient identification of Stokes singular beams. A total of 15 classes of beams are considered based on the type of Stokes singularity and their associated mode indices. The resultant total and polarization component intensities of Stokes singular beams after diffraction through a triangular aperture are exploited by the deep neural network to recognize these beams. Our approach presents a classification accuracy of 98.67% for 15 types of Stokes singular beams that comprise several degenerate cases. The present study illustrates the potential of diffraction of the Stokes singular beam with polarization transformation, modeling of experimental noise factors, and a deep learning framework for characterizing hybridly polarized beam

Percutaneous Coronary Intervention in Patients With a History of Gastrointestinal Bleeding (From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium)

Potent antithrombotic agents are routinely prescribed after percutaneous coronary intervention (PCI) to reduce ischemic complications. However, in patients who are at an increased bleeding risk, this may pose significant risks. We sought to evaluate the association between a history of gastrointestinal bleeding (GIB) and outcomes after PCI. We linked clinical registry data from PCIs performed at 48 Michigan hospitals between 1/2013 and 3/2018 to Medicare claims. We used 1:5 propensity score matching to adjust for patient characteristics. In-hospital outcomes included bleeding, transfusion, stroke or death. Post-discharge outcomes included 90-day all-cause readmission and long-term mortality. Of 30,206 patients, 1.1% had a history of GIB. Patients with a history of GIB were more likely to be older, female, and have more cardiovascular comorbidities. After matching, those with a history of GIB (n = 312) had increased post-procedural transfusions (15.7% vs 8.4%; p \u3c 0.001), bleeding (11.9% vs 5.2%; p \u3c 0.001), and major bleeding (2.8% vs 0.6%; p = 0.004). Ninety-day readmission rates were similar among those with and without a history of GIB (34.3% vs 31.3%; p = 0.318). There was no significant difference in post-discharge survival (1 year: 78% vs 80%; p = 0.217; 5 years: 54% vs 51%; p = 0.189). In conclusion, after adjusting for baseline characteristics, patients with a history of GIB had increased risk of post-PCI in-hospital bleeding complications. However, a history of GIB was not significantly associated with 90-day readmission or long-term survival

Study protocol for economic evaluation of probiotic intervention for prevention of neonatal sepsis in 0-2-month old low-birth weight infants in India: the ProSPoNS trial

Introduction: The ProSPoNS trial is a multicentre, double-blind, placebo-controlled trial to evaluate the role of probiotics in prevention of neonatal sepsis. The present protocol describes the data and methodology for the cost utility of the probiotic intervention alongside the controlled trial. Methods and analysis: A societal perspective will be adopted in the economic evaluation. Direct medical and non-medical costs associated with neonatal sepsis and its treatment would be ascertained in both the intervention and the control arm. Intervention costs will be facilitated through primary data collection and programme budgetary records. Treatment cost for neonatal sepsis and associated conditions will be accessed from Indian national costing database estimating healthcare system costs. A cost–utility design will be employed with outcome as incremental cost per disability-adjusted life year averted. Considering a time-horizon of 6 months, trial estimates will be extrapolated to model the cost and consequences among high-risk neonatal population in India. A discount rate of 3% will be used. Impact of uncertainties present in analysis will be addressed through both deterministic and probabilistic sensitivity analysis. Ethics and dissemination: Has been obtained from EC of the six participating sites (MGIMS Wardha, KEM Pune, JIPMER Puducherry, AIPH, Bhubaneswar, LHMC New Delhi, SMC Meerut) as well as from the ERC of LSTM, UK. A peer-reviewed article will be published after completion of the study. Findings will be disseminated to the community of the study sites, with academic bodies and policymakers. Registration: The protocol has been approved by the regulatory authority (Central Drugs Standards Control Organisation; CDSCO) in India (CT-NOC No. CT/NOC/17/2019 dated 1 March 2019). The ProSPoNS trial is registered at the Clinical Trial Registry of India (CTRI). Registered on 16 May 2019. Trial registration number: CTRI/2019/05/019197; Clinical Trial Registry

Analyzing microbes : manual of molecular biology techniques / Dilip Kumar Arora, Surajit Das, Mesapogu Sukumar, editors.

Includes bibliographical references and index.xi, 352 p.

Genetic Programming Based Approach for Synchronization with Parameter Mismatches in EEG

Effects of parameter mismatches in synchronized time series are studied first for an analytical non-linear dynamical system (coupled logistic map, CLM) and then in a real system (Electroencephalograph (EEG) signals). The internal system parameters derived from GP analysis are shown to be quite effective in understanding aspects of synchronization and non-synchronization in the two systems considered. In particular, GP is also successful in generating the CLM coupled equations to a very good accuracy with reasonable multi-step predictions. It is shown that synchronization in the above two systems is well understood in terms of parameter mismatches in the system equations derived by GP approach