Where to deliver? Analysis of choice of delivery location from a national survey in India

<p>Abstract</p> <p>Background</p> <p>In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state.</p> <p>Methods</p> <p>Cross sectional analyses of the National Family Health Survey – 2 dataset.</p> <p>Setting</p> <p>Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery.</p> <p>Results</p> <p>A majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery.</p> <p>Conclusion</p> <p>As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.</p

Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation

Background: Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies.Methods and Results: One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in 35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 \uc2\ub1 3 h and 43 \uc2\ub1 3 h after ablation. At the first postprocedural sample, cTnI and CK-MB levels were found elevated in all 110 patients with a median value of 2.11 ng/mL and 8.95 ng/mL, respectively. Group B showed cTnI levels increased (median 5.96 ng/mL) compared to other groups (median Group A: 1.72 ng/mL, Group C: 1.54 ng/mL, Group D: 2.0 ng/mL; p < 0.001). Also CK-MB levels resulted higher in cryoablation (median 26.4 ng/mL) compared to other groups (median Group A: 6.40 ng/mL, Group C: 7.15 ng/mL, Group D: 6.50 ng/mL; p < 0.001). No significant association was observed between biomarker levels and recurrences of atrial fibrillation after a mean follow-up of 369 \uc2\ub1 196 days.Conclusions: Highest markers for myocardial injury were observed in the cryoballoon group. It is possible that a longer delivery energy duration and other factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown

The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab

Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure

Testing the cognitive effects of tadalafil. Neuropsychological secondary outcomes from the PASTIS trial

Cerebral small vessel disease (SVD) is a major cause of cognitive impairment in older people. As secondary endpoints in a phase-2 randomised clinical trial, we tested the effects of single administration of a widely-used PDE5 inhibitor, tadalafil, on cognitive performance in older people with SVD. In a double-blinded, placebo-controlled, cross-over trial, participants received tadalafil (20 mg) and placebo on two visits ≥ 7 days apart (randomised to order of treatment). The Montreal Cognitive Assessment (MOCA) was administered at baseline, alongside a measure to estimate optimal intellectual ability (Test of Premorbid Function). Then, before and after treatment, a battery of neuropsychological tests was administered, assessing aspects of attention, information processing speed, working memory and executive function. Sixty-five participants were recruited and 55 completed the protocol (N = 55, age: 66.8 (8.6) years, range 52–87; 15/40 female/male). Median MOCA score was 26 (IQR: 23, 27], range 15–30). No significant treatment effects were seen in any of the neuropsychological tests. There was a trend towards improved performance on Digit Span Forward (treatment effect 0.37, C.I. 0.01, 0.72; P = 0.0521). We did not identify significant treatment effects of single-administration tadalafil on neuropsychological performance in older people with SVD. The trend observed on Digit Span Forward may help to inform future studies

The PASTIS trial: testing tadalafil for possible use in vascular cognitive impairment

Introduction: There are few randomized clinical trials in vascular cognitive impairment (VCI). This trial tested the hypothesis that the PDE5 inhibitor tadalafil, a widely used vasodilator, increases cerebral blood flow (CBF) in older people with symptomatic small vessel disease, the main cause of VCI. Methods: In a double‐blind, placebo‐controlled, cross‐over trial, participants received tadalafil (20 mg) and placebo on two visits ≥7 days apart (randomized to order of treatment). The primary endpoint, change in subcortical CBF, was measured by arterial spin labelling. Results: Tadalafil increased CBF non‐significantly in all subcortical areas (N = 55, age: 66.8 (8.6) years) with greatest treatment effect within white matter hyperintensities (+9.8%, P = .0960). There were incidental treatment effects on systolic and diastolic blood pressure (–7.8, –4.9 mmHg; P &lt; .001). No serious adverse events were observed. Discussion: This trial did not identify a significant treatment effect of single‐administration tadalafil on subcortical CBF. To detect treatment effects may require different dosing regimens

Computationally Efficient Algorithm for Reducing PAPR in OFDM using Null Subcarriers

Abstract- A new algorithm is proposed which is used with existing null-data subcarrier switching method of Peak to Average Power Ratio (PAPR) reduction in OFDM to lower the computational complexity. This proposed algorithm is very simple and achieves significant reduction in computational overhead without sacrificing PAPR reduction capability of null-data subcarrier switching method. The proposed algorithm is compatible with the current commercial systems and it can be used with other existing algorithms to reduce the computational overhead further. The proposed algorithm is very useful in delay sensitive services. The effectiveness of the proposed algorithm is demonstrated by presenting simulation results of PAPR and computational time requirement. Index Terms—Bit error rate (BER), Multicarrier, Orthogonal frequency division multiplexing (OFDM), Peak to average power ratio (PAPR)

Influence of organizational capabilities and environmental factors on internationalization strategy of SMEs

The study discusses organizational capabilities in relation to entrepreneurial experience, innovation, networking and external environmental factors consisting of industry and market, international network relationship, international innovativeness and international market skill to explain internationalization of SMEs. The paper draws on theoretical push and pull framework to explain the constructs and present the intermediating factor between push and pull forces and internationalization of SMEs. The review of literature shows that international entrepreneurial orientation and export promotion program as intermediating variables in the model can increase or lessen the interactive forces of pull and push factors. The study discussed evidence of relationship between the research constructs and how the interactive forces influence the internationalization of SMEs

Changes in the Force Degradation of Orthodontic Elastomeric Chains Subjected to Different Formulations of Chlorhexidine Mouth Rinse: an in Vitro Study

Introduction: The aim of this study was to assess whether various formulations of chlorhexidine mouth rinses had an effect on force characteristics of the elastomeric chains. Methods: The sample consisted commercially available elastomeric chain of 3M Unitek with five commercially used chlorhexidine mouth rinses of different formulations. The e chain were stretched on artificial saliva .30 sec everyday exposure to different chlorhexidine formulation was tested by digital dynamometer and was statisticaly evaluated using ANOVA test. Conclusion: mouthwashes does not accelerate force degradation of elastomeric chains which could clinically affect their effectiveness. However, the results could be variable in the presence of other biological factors in the oral environment and their interactions between oral microorganisms with the host