Erosion of Trust in the Medical Profession in India : Time for Doctors to Act

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction

Методическая работа в дошкольной образовательной организации как условие повышения информационно-коммуникационной компетентности педагогов

Тема работы актуальна. В ВКР представлены условия, способствующие развитию компонентов ИКК педагогов. Работа имеет практическую значимост

Simulations of the 2004 North American Monsoon: NAMAP2

The second phase of the North American Monsoon Experiment (NAME) Model Assessment Project (NAMAP2) was carried out to provide a coordinated set of simulations from global and regional models of the 2004 warm season across the North American monsoon domain. This project follows an earlier assessment, called NAMAP, that preceded the 2004 field season of the North American Monsoon Experiment. Six global and four regional models are all forced with prescribed, time-varying ocean surface temperatures. Metrics for model simulation of warm season precipitation processes developed in NAMAP are examined that pertain to the seasonal progression and diurnal cycle of precipitation, monsoon onset, surface turbulent fluxes, and simulation of the low-level jet circulation over the Gulf of California. Assessment of the metrics is shown to be limited by continuing uncertainties in spatially averaged observations, demonstrating that modeling and observational analysis capabilities need to be developed concurrently. Simulations of the core subregion (CORE) of monsoonal precipitation in global models have improved since NAMAP, despite the lack of a proper low-level jet circulation in these simulations. Some regional models run at higher resolution still exhibit the tendency observed in NAMAP to overestimate precipitation in the CORE subregion; this is shown to involve both convective and resolved components of the total precipitation. The variability of precipitation in the Arizona/New Mexico (AZNM) subregion is simulated much better by the regional models compared with the global models, illustrating the importance of transient circulation anomalies (prescribed as lateral boundary conditions) for simulating precipitation in the northern part of the monsoon domain. This suggests that seasonal predictability derivable from lower boundary conditions may be limited in the AZNM subregion.open131

Sound Radiated by a Supercritical Airfoil Operating in the Incompressible Regime

Measurements of far-field sound radiated by two and three-dimensional supercritical airfoils (ONERA OAT 15A) placed in a low Mach number flow were performed in an anechoic open-jet facility. The chord-based Reynolds numbers were between 156,000 and 468,000, while the Mach numbers ranged between 0.04 and 0.13. For the three-dimensional airfoil, two different aspect ratios (span-to-chord ratio) of 1.0 and 1.5 were considered. For comparison, the sound radiated by a symmetric NACA 0012 and cambered NACA 2412 airfoil was also measured under the same conditions. The noise from the two-dimensional airfoil was found to scale on the fifth power of Mach number. The noise generated by the cross-flow across the tip was the dominant noise source for the three-dimensional airfoils, particularly under high-lift conditions where it exceeds the noise from the mid-span portion across the considered frequency range. The tip noise spectra for the supercritical airfoils exhibit a prominent peak that scales with the free-stream velocity, but its frequency is a weak function of the lift on the airfoil and the aspect ratio. No such peak was observed for the NACA profiles even for higher lift conditions. The beamformed source maps for NACA profiles reveal an intense high-frequency noise source near the tip leading-edge which is much weaker for the supercritical airfoil due to differences in the curvature of the profiles. The tip noise spectra for the supercritical airfoil can be scaled on the fourth power of Mach number and the length-scale associated with the spectral peak. The tip noise peak magnitude and frequencies were found to be nearly independent of the airfoil aspect ratio; however, a reduction in AR was found to shift the tip noise source region further inboard. Stereo particle image velocimetry (PIV) measurements performed in a cross-plane behind the three-dimensional airfoils show that this is because a reduction in AR also shifts vortex core towards the mid-span. The PIV results were also used to quantify the meander of the tip vortex and it is shown that the amplitude of vortex meandering is independent of the angle of attack and the aspect ratio with a value between 0.5 – 0.6% of the chord-length for all cases considered

Determination of the breakpoint and molecular diagnosis of a common α-thalassaemia-1 deletion in the Indian population

The previously described South African type α-thalassaemia-1 mutation was identified in Indian HbH patients using a polymerase chain reaction (PCR) strategy. A multiplex PCR assay was devised to detect heterozygotes and homozygotes. This α-thalassaemia-1 mutation was found to be the commonest determinant causing HbH disease in this population. In one family this mutation was found in combination with a novel splice donor mutation α2 IVS I-1 (G→A). Characterization of the breakpoint junction sequence revealed, in addition to a 23 kb deletion, that there was an addition of ~160 bp bridging the breakpoints. Similar to other deletions in the α-globin gene cluster, there is an Alu repeat-mediated mechanism for the origin of the deletion

Nucleophile-Catalyzed Additions to Activated Triple Bonds. Protection of Lactams, Imides, and Nucleosides with MocVinyl and Related Groups

Additions of lactams, imides, (S)-4-benzyl-1,3-oxazolidin-2-one, 2-pyridone, pyrimidine-2,4-diones (AZT derivatives), or inosines to the electron-deficient triple bonds of methyl propynoate, tert-butyl propynoate, 3-butyn-2-one, N-propynoylmorpholine, or N-methoxy-N-methylpropynamide in the presence of many potential catalysts were examined. DABCO and, second, DMAP appeared to be the best (highest reaction rates and E/Z ratios), while RuCl3, RuClCp*(PPh3)2, AuCl, AuCl(PPh3), CuI, and Cu2(OTf)2 were incapable of catalyzing such additions. The groups incorporated (for example, the 2-(methoxycarbonyl)ethenyl group that we name MocVinyl) serve as protecting groups for the above-mentioned heterocyclic CONH or CONHCO moieties. Deprotections were accomplished via exchange with good nucleophiles: the 1-dodecanethiolate anion turned out to be the most general and efficient reagent, but in some particular cases other nucleophiles also worked (e.g., MocVinyl-inosines can be cleaved with succinimide anion). Some structural and mechanistic details have been accounted for with the help of DFT and MP2 calculations

Regional carbon fluxes and the effect of topography on the variability of atmospheric CO2.

Using a mesoscale atmospheric circulation model, it is shown that relatively modest topography height differences of ∼500 m over 200 km near Zotino (60°N, 89°E) in central Siberia may generate horizontal gradients in CO<inf>2</inf> concentration in the order of 30 ppm. In a case study for 15 and 16 July 1996, when Lloyd et al. (2001) conducted a convective boundary layer budget experiment in the area, we show that advection of these gradients disturbs the relation between diurnal concentration changes in the boundary layer and the surface fluxes. This demonstrates that mesoscale atmospheric heterogeneity may have severe impact on the applicability of methods to derive the regional-scale fluxes from CO<inf>2</inf> concentrations measurements, such as the convective boundary layer budget method or inverse modeling. It is shown that similar mesoscale gradients are likely to occur at many long-term observation stations and tall towers. We use the modeled concentration fields to quantify the horizontal and vertical variability of carbon dioxide in the atmosphere. In future observation campaigns, mesoscale processes may be best accounted for by measuring horizontal variability over a few hundred kilometers and by attempting to quantify the representation errors as a function of mesoscale conditions. Copyright 2007 by the American Geophysical Union

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Targeting inflammation: a potential approach for the treatment of depression.

Major depressive disorder (MDD) or Depression is one of the serious neuropsychiatric disorders affecting over 280 million people worldwide. It is 4th important cause of disability, poor quality of life, and economic burden. Women are more affected with the depression as compared to men and severe depression can lead to suicide. Most of the antidepressants predominantly work through the modulation on the availability of monoaminergic neurotransmitter (NTs) levels in the synapse. Current antidepressants have limited efficacy and tolerability. Moreover, treatment resistant depression (TRD) is one of the main causes for failure of standard marketed antidepressants. Recently, inflammation has also emerged as a crucial factor in pathological progression of depression. Proinflammatory cytokine levels are increased in depressive patients. Antidepressant treatment may attenuate depression via modulation of pathways of inflammation, transformation in structure of brain, and synaptic plasticity. Hence, targeting inflammation may be emerged as an effective approach for the treatment of depression. The present review article will focus on the preclinical and clinical studies that targets inflammation. In addition, it also concentrates on the therapeutic approaches' that targets depression via influence on the inflammatory signaling pathways. Graphical abstract demonstrate the role of various factors in the progression and neuroinflammation, oxidative stress. It also exhibits the association of neuroinflammation, oxidative stress with depression