The experiences and beliefs of people with severe haemophilia and healthcare professionals on pain management, and their views of using exercise as an aspect of intervention: a qualitative study

Purpose: To explore the experiences, views and beliefs of people with severe haemophilia and healthcare professionals (HCPs) on approaches for pain management, as well as their views on exercise being used as an aspect of management. Methods: Taking a qualitative inquiry approach using focus groups and semi-structured interviews, participants included people with severe haemophilia living with chronic pain and haemophilia HCPs. Data were analysed using reflexive thematic analysis. Results: Fourteen men with haemophilia with a median age of 47 (range 23–73) and six haemophilia HCPs agreed to participate. Of the people with haemophilia, 11 attended two focus groups and three were interviewed over telephone. Healthcare professionals were interviewed face-to-face. Two themes were conceptualised from the data: (i) haemophilia management and pain management is discordant (imbalance between good haemophilia care but poor pain management, historical medico-social influences on pain management, the need for trust); (ii) uncertain about exercise but clear on what matters (conflicting views on exercise, the need for proof of safety, personalised care). Conclusions: Options for effective pain management remain limited and what is used is heavily influenced by beliefs and experience. Exercise as a treatment option in pain management is conceptually acceptable for people with haemophilia. Effective pain management requires understanding of individual beliefs and fears, and a personalised approach supported by knowledgeable, trusted clinicians

Physiotherapy interventions for pain management in haemophilia: A systematic review

Purpose: Approximately 35%-50% of people with haemophilia (PWH) report living with chronic musculoskeletal pain. Although exercise based rehabilitation is effective for pain in other arthritises, there are no published guidelines for management of chronic pain in PWH. This review aims to evaluate and appraise the current evidence of effectiveness of physiotherapy interventions on (a) pain intensity, (b) quality of life (QoL) and (c) function in PWH. Methods: A systematic review of five databases AMED and CINAHL, EMBASE and MEDLINE and PEDro, as well as trial registries, grey literature and hand searching key journals was completed. Included studies were critically appraised and evaluated for risk of bias. The GRADE approach was used to rate the quality of the evidence. Results: Nine trials consisting of 235 participants met the inclusion criteria. All studies had an overall risk of bias with low methodological quality. Meta-analysis was not possible due to heterogeneity across trials. Studies comparing a range of physiotherapy interventions against no intervention showed no clear beneficial effect on pain intensity or QoL. Only one study, investigating hydrotherapy or land-based exercise against control, showed positive effect for pain intensity, but rated very low on GRADE assessment. Studies comparing one physiotherapy intervention against another showed no clear benefit on pain intensity, QoL or function. LASER with exercise and hydrotherapy were shown to have some positive effects on pain intensity, but no clear benefit on function. Conclusions: At present, there is limited evidence for the use of physiotherapy interventions in addressing the issue of pain in PWH. Better designed trials with higher quality and explicit methodology along with user involvement are needed to assess the efficacy of any proposed intervention

How does a lifetime of painful experiences influence sensations and beliefs about pain in adults with severe haemophilia? A qualitative study

Purpose: To explore the life experiences of pain in people with severe haemophilia and understand how such experiences influence beliefs and sensation of pain in adulthood. Methods: A qualitative inquiry approach using focus groups and semi-structured individual interviews was used. Participants included people with severe haemophilia living with chronic pain. Data were analysed using reflexive thematic analysis. Results: Fourteen men with a median age of 47 (range 23–73) agreed to take part. Eleven participated in two focus groups and three were interviewed over telephone. Two themes were conceptualised from the data: (i) haemophilia and pain – an evolving life biography (the personal narrative, historical, social, and medical context, continuous adaptation of activity choices, surveillance of pain and its meaning); (ii) “My normal isn’t normal” – identity and self-agency (pain as a feature of life and identify with severe haemophilia, loss of enjoyable activities balanced against staying active, barriers to participation). Conclusions: Pain is a constantly evolving, lifetime feature for many adults with haemophilia and it is viewed as part of their identity with their condition. Healthcare professionals working in haemophilia should try to better understand the influence of an individuals lived experience with their haemophilia on beliefs and behaviours of pai

Field evaluation of Musa germplasm for resistance against banana stem weevil, Odoiporus longicollis (Oliver) (Curculionidae: Coleoptera) in Kadapa district of Andhra Pradesh

Banana germplasm with 17 different accessions for resistance were screened against banana stem weevil, Odoiporous longicollis in Koduru region of Kadapa district (Andhra Pradesh). All the accessions had infestation of stem weevil but with varying percent infestation. The 17 accessions of germplasm had weevil infestation ranging from 10.0–100 percent in 2012 with maximum infestation of 100 percent in red banana (AAA genome) followed by Bontha selection-88.88 % (ABB), Karpuravalli-84.60% (AAB) and Ellakibale-64.7% (AB) and the lowest was inSugandhalu-10.00% (AAB). In the year 2013, the infestation was in the range of 13.00-90.40% and with respect to infestation levels in different accessions, and the trend remained same as the earlier year wherein the highest infestation was recorded in red banana-90.40% followed by Bontha selection with the damage of 83.50 %, Karpuravalli (79.80%), Ellakibale (70.00%) and least in Sugandhalu-13.0% (AAB). There was no correlation between number of adults observed and percent damage and similarly no relation can be drawn between percent infestation and height of oviposition, This implies that the infestation caused by the weevils varied in different genotypes and also this information will be further helpful in selecting the resistant germplasms for future

Exercise-based telerehabilitation for the management of chronic pain in people with severe haemophilia: a mixed-methods feasibility study.

Background: Chronic pain is reported by between 30 and 71% of people with haemophilia (PWH). Exercise is shown to be effective for pain management in other arthritis’s, but it remains unclear if such an approach is effective or acceptable to PWH. The aim of this study was to evaluate the feasibility and acceptability of a telerehabilitation exercise intervention for PWH living with chronic pain. Methods: This was a multisite, non-randomised, pre-post feasibility design, with a nested qualitative study. People with severe haemophilia>18 years, living with chronic pain, were recruited. The intervention comprised 12 low-impact/moderate intensity, individualised exercise sessions and 3 knowledge-sharing and discussion sessions. Primary objectives assessed according to predefined progression criteria were as follows: (a) recruitment rate (5 participants enrolled per site over 8 weeks), (b) adherence (≥75% participants would adhere to≥75% of sessions), (c) follow-up rate (≥75% completion of self-reported measures), (d) fidelity (intervention delivered as described in protocol) and (e) safety (≤30% participants would report adverse events). Acceptability was evaluated from thematic analysis of post-intervention participant interviews. Preliminary evaluation of self-reported pain, function and quality of life (QoL) was a secondary objective. Results were reported using descriptive statistics integrated with qualitative findings. Results: Ten PWH were recruited and completed the intervention. Nine agreed to be interviewed post intervention. Attendance at individual sessions was 84.5% compared to 52.1% for the group sessions. Outcome measures were successfully completed for 100% at baseline, 70% at intervention end and 60% at 3-month follow-up. No serious adverse events were recorded. Group median values in outcome measures (pain, function, QoL) showed minimal change post intervention. Participant interviews highlighted high levels of enjoyment, confidence in continuing exercises independently and positive views of virtual delivery and condition-specific exercise. Conclusions: Recruitment rate and safety met the predefined progression criteria. Fidelity partially met the progression criteria, but the follow-up rate for self-reported measures did not. The study was acceptable to both participants and physiotherapists. Further intervention development is needed to review approaches to outcome measure collection and refine the usefulness of the knowledge-sharing sessions

Using theory of change to co-create a programme theory for a telerehabilitation intervention for pain management in people with haemophilia

Background Improved approaches for chronic pain management are a clinical and research priority for people with haemophilia (PWH). Involving people with lived experience in the design of a complex rehabilitation intervention strengthens the credibility and plausibility of the intervention, particularly in relation to rare disorders. Here we describe using a ‘Theory of Change’ (ToC) dialogue-based stakeholder process to create a programme theory for a telerehabilitation intervention. Methods An online workshop was convened and stakeholders received a briefing document in advance. Five stakeholders took part (3 PWH and 2 physiotherapists). At the workshop the group first agreed the overall aim of the intervention. Discussions then identified the resources, activities, barriers and enablers needed to achieve this outcome. All discussions were recorded and annotated by the workshop moderator. Behaviour change techniques were mapped for inclusion in the theory. Results A programme theory and narrative report were produced. All stakeholders reviewed these for clarity and to ensure a true refection of the workshop discussions. Agreement was based on how meaningful, well-defined, do-able, plausible, credible, and testable each component was. Stakeholders highlighted the importance of issues unique to PWH. Key components included the need for physiotherapists to be knowledgeable of the condition, a range of exercises that were inclusive of all abilities, and the need for people to feel safe and supported whilst taking part. Conclusions Co-developed theory based approaches to intervention design offer an inclusive and transparent way to develop novel and meaningful interventions for people with complex health conditions. The ToC is wholly transparent in its design and content. Together with the identified behaviour change techniques, the theory informs the protocol for a feasibility study evaluating a telerehabilitation intervention. Importantly, it allows the opportunity to revise, adapt and improve the programme theory for further implementation and evaluatio

PYODERMA GANGRENOSUM SECONDARY TO TAKAYASU'S ARTERITIS

Pyoderma gangrenosum (PG) is an uncommon & noninfectious neutrophilic dermatosis commonly associated with underlying systemic disease in more than 50% of cases. About 20-30% of cases are commenced and aggravated by minor trauma or surgery, a phenomenon named pathergy. PG is associated with many systemic diseases, but association with Takayasu's arteritis (TA) / pulseless disease, which is chronic inflammatory and stenotic disease of large sized arteries is less common. These conditions responded well with systemic corticosteroids. The association of PG with TA has been less reported in the literature so far. KEYWORDS: Pyoderma gangrenosum; Takayasu's arteritis;Pulseless disease

TALENT ACQUISITION IN AMARA RAJA BATTRIES PVT LTD., TIRUPATI

The purpose of this study is to look into how the use of artificial intelligence (AI) has been applied to the recruitment and selection of job candidates. This study specifically looks at the use of AI technology throughout the employment process in terms of its degree, pace, and prospective application areas. Descriptive research design was used for examining an attrition rate. A questionnaire covering various aspects relating to the recruitment and selection in the company where focused. 120 samples were collected using the random sampling technique. Hypothesis for the study were tested using correlation, analysis of variance method. The result shows that Which media is ideal for recruitment efforts and Is there any bias in the selection of employees in the organization

Three Phase Modular Multilevel PV Inverter With Distributed MPPT for Grid-Connected Applications

In this paper a three - stage modular  cascaded  H-bridge multilevel inverter for a grid associated photovoltaic (PV) framework is depicted . To expand the solar energy  extraction of each PV string, an individual most extreme power point tracking (MPPT) control plan is connected, which permits the autonomous control of every dc-interface voltage. PV confuses may acquaint uneven power provided with the three-stage framework. To fathom this issue, a control plot with modulation compensession is proposed. The three-stage modular cascaded multilevel inverter model has been constructed. A fuzzy controller is actualized in this venture in the place of PI controller . Every H-bridge module is associated with a 185-W ssolar panel. Simulation results are exhibited to confirm the achievability of the proposed approach in MATLAB/SIMULINK environment

Nanoparticle-assisted optical tethering of endosomes reveals the cooperative function of dyneins in retrograde axonal transport

Dynein-dependent transport of organelles from the axon terminals to the cell bodies is essential to the survival and function of neurons. However, quantitative knowledge of dyneins on axonal organelles and their collective function during this long-distance transport is lacking because current technologies to do such measurements are not applicable to neurons. Here, we report a new method termed nanoparticle-assisted optical tethering of endosomes (NOTE) that made it possible to study the cooperative mechanics of dyneins on retrograde axonal endosomes in live neurons. In this method, the opposing force from an elastic tether causes the endosomes to gradually stall under load and detach with a recoil velocity proportional to the dynein forces. These recoil velocities reveal that the axonal endosomes, despite their small size, can recruit up to 7 dyneins that function as independent mechanical units stochastically sharing load, which is vital for robust retrograde axonal transport. This study shows that NOTE, which relies on controlled generation of reactive oxygen species, is a viable method to manipulate small cellular cargos that are beyond the reach of current technology.National Institutes of Health (U.S.) (DP2-NS082125)National Science Foundation (U.S.) (Award 1055112)National Science Foundation (U.S.) (Award 1344302