Evaluation of quality certification programs for public health facilities in tribal villages of Dahod district, Gujarat

Background: Rural and tribal India poses significant challenges in addressing healthcare quality. Along with healthcare staff, beneficiaries’ perspectives nowadays play a crucial role. The Government Health system has started to implement various quality certification programs (QCPs) like National Quality Assurance Standards, Kayakalp etc. on a wider scale. So, it’s very crucial to measure the results and evaluate the impact of these QCPs on the health system. Aims & Objective: To investigate the impact of quality certification programs for public health facilities in tribal villages. Material and methods: A qualitative study was undertaken in 18 PHCs of one of the tribal blocks of Dahod district. The participants were selected using purposive sampling. The participants included staff working at healthcare facilities and patients who have availed services at those facilities. Qualitative data was collected using in-person in-depth interviews (IDI). A total of 19 health staff and 23 patient IDIs were conducted. The audio recording was done for the interviews. Later on, process of transcribed verbatim and manual thematic analysis was done. Result: The transcripts’ manual thematic analysis part produced 12 different categories, 6 different sub-themes and 3 major themes, while the staff part, yielded 16 different categories, 6 different sub-themes and 3 major themes. Beneficiaries were satisfied with a noticeable improvement in healthcare services. Staff found these programs helpful but predominantly raised concerns about the implementation of QCPs. Conclusion: QCPs have demonstrated a significant positive impact on healthcare services; it\u27s very promising specifically in the context of rural and tribal health facilities. These programs hold great promise as they enable and empower these facilities to achieve quality and higher standards with the availability of better care

Comparative study of patient-based versus case-based teaching in prescription writing skills of second year MBBS students

Background: Prescription writing errors can lead to deficiencies in healthcare. Although prescription writing is a part of the medical students' curriculum with traditional methods, their prescribing skills are still poor due to inadequate training. To fulfil the need for new educational interventions this study aims to compare patient-based teaching with case-based teaching in improving prescription writing skills of second year MBBS students.Methods: This prospective comparative study was carried out after orientation of participants to prescription writing as per WHO prescribing guidelines (n=71). Group A (n=37) and group B (n=34) were given patient-based teaching and case-based teaching respectively of prescription writing for the same five common clinical conditions. The prescription writing skill was assessed by evaluating the prescriptions written by both the groups and scored by 19-point scoring system. Feedback from the group A students was also taken.Results: Statistical analysis of mean scores of group A (15.90) and group B (13.14) was done by Mann-Whitney U test (p<0.001). Comparison of both the groups for the individual parameters was done by Chi-square test which found significant difference in writing some important parameters like doctor’s registration no., contacts of prescriber, name of the medicine, strength of drug, dosage form, dosing instructions, total quantity of medicine and duration of medication etc. Group A students’ feedback brought out the fact that patient-based teaching is a good tool for teaching and learning.Conclusions: Patient-based teaching for prescription writing improves students’ prescription writing skills in an effective way in comparison with traditional case-based teaching

A semic-automatic system for the syllabification and stress assignment of large lexicons

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1997.Includes bibliographical references (p. 115-116).by Aarati D. Parmar.M.Eng

Impact of different estrus induction and ovulation synchronization protocols in addressing infertility in buffaloes

The efficacy of six estrus induction/synchronization protocols, viz., Ovsynch, Ovsynch Plus, PRID/Triu-B, PRID+PMSG, Doublesynch and Estradoublesynch was compared for their estrus induction response, and conception rates at FTAI and overall of three cycles post-treatment including monitoring of plasma progesterone (P4) at different time intervals in postpartum anestrus and repeat breeding buffaloes (20 to 35 animals in each protocol) under field conditions. All infertile animals with average BCS were injected initially once with Inj. Ivermectin 100 mg s/c, Inj. organic phosphorus and Vit AD3E, 10 ml each i/m and multi-minerals 1 bolus orally for 7 days. The repeat breeders also received additional i/m Inj. of single shot Enrofloxacin 40 ml. Induction and synchronization of estrus with establishment of normal cyclicity was found in 100% animals with PRID, PRID+PMSG, Doublesynch, Estradoublesynch protocols, but the response with Ovsynch and Ovsynch Plus was 92 to 94 %. The conception rates obtained at induced estrus/FTAI in anestrus buffaloes under Ovsynch, Ovsynch Plus, PRID/Triu-B, PRID +PMSG, Doublesynch and Estradoublesynch protocols were 30.0, 21.7, 30.0, 45.0, 34.2 and 23.3%, respectively, with overall post-treatment 3 cycles’ conception rates of 53.3, 39.1, 70.0, 75.0, 57.9 and 40.0%, respectively. In repeat breeder buffaloes, the conception rates obtained at induced estrus/FTAI with Ovsynch, Ovsynch Plus, Doublesynch and Estradoublesynch protocols were 31.8, 20.0, 47.6 and 40.0%, respectively, and overall 3 cycles’ conception rates were 59.1, 46.7, 76.2 and 60.0%, respectively. Among untreated anestrus and repeat breeding control animals only 20% and 35% animals conceived over 60 to 90 days follow up. The basal level of plasma P4 in anestrus animals and higher one in repeat breeders on the day of initiation of treatment confirmed their reproductive status. The plasma P4 profile was significantly improved on day 7 to 9, i.e. just before last PGF2α injection and dropped significantly to the basal level in most of the animals in next 2 to 3 days with induced estrus. The plasma P4 was significantly higher in conceived than non-conceived animals on day 12 post-AI in all the groups suggesting anovulatory induced estrus and/or luteal insufficiency in non-conceived animals. Thus, it was concluded that the progestagen based protocols followed by Doublesynch and Ovsynch protocols were the best in anestrus animals, and doublesynch followed by Estradoublesynch and Ovsynch protocols in repeat breeders to economically improve the conception rates at induced estrus and overall of 3 cycles

Formation of dense partonic matter in relativistic nucleus-nucleus collisions at RHIC: Experimental evaluation by the PHENIX collaboration

Extensive experimental data from high-energy nucleus-nucleus collisions were recorded using the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). The comprehensive set of measurements from the first three years of RHIC operation includes charged particle multiplicities, transverse energy, yield ratios and spectra of identified hadrons in a wide range of transverse momenta (p_T), elliptic flow, two-particle correlations, non-statistical fluctuations, and suppression of particle production at high p_T. The results are examined with an emphasis on implications for the formation of a new state of dense matter. We find that the state of matter created at RHIC cannot be described in terms of ordinary color neutral hadrons.Comment: 510 authors, 127 pages text, 56 figures, 1 tables, LaTeX. Submitted to Nuclear Physics A as a regular article; v3 has minor changes in response to referee comments. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

A study of cutaneous adverse drug reactions in the outpatient department of Dermatology at a tertiary care center in Gujarat, India

Background: The data for adverse cutaneous drug reactions (ACDRs) is limited in Gujarat. The ACDRs are one of the frequent ADRs and cause of significant morbidity and mortality in patients of all areas of healthcare today. They are responsible for significant number of hospital admissions. Thus, the present study emphasises on the need and importance of an effective pharmacovigilance programme.Methods: A prospective study was undertaken in a 183 cases tertiary care teaching hospital of India. Male to female ratio, most common class of drug, individual drug causing ACDR, common types of ACDRs Parameters were studied. Other Parameters like Causality, preventability and severe or non-severe reactions were analyzed.Results: Majority of the patients (48%) with CADR belonged to the age group 25-44 followed by 45-64 (28%). Most frequent adverse cutaneous drug reactions reported were Urticaria (40%), Maculopapular rash (25%) & Fixed drug eruptions (21%) in decreasing order of frequency. Majority of reactions (96%) were Bizarre/Unpredictable in nature. As a group, antimicrobials (46%) were most frequently associated with CADR followed by NSAIDs (31%) and antiepileptics (11%).  Most of the reactions (93%) were mild-moderate and probable (77%) in nature. Approximately 60% of ACDRs reported in this study were preventable.Conclusions: There was slight male preponderance except acneiform eruptions. Cotrimoxazole being the most common offending drug then after Ibuprofen, Phenytoin among the anti-inflammatory, analgesics, antiepileptics class. Causality assessment resulted in high score 77% of probable category

Development of end-to-end low-cost IoT system for densely deployed PM monitoring network: an Indian case study

Particulate matter (PM) is considered the primary contributor to air pollution and has severe implications for general health. PM concentration has high spatial variability and thus needs to be monitored locally. Traditional PM monitoring setups are bulky, expensive, and cannot be scaled for dense deployments. This paper argues for a densely deployed network of IoT-enabled PM monitoring devices using low-cost sensors, specifically focusing on PM10 and PM2.5, the most health-impacting particulates. In this work, 49 devices were deployed in a region of the Indian metropolitan city of Hyderabad, of which 43 devices were developed as part of this work, and six devices were taken off the shelf. The low-cost sensors were calibrated for seasonal variations using a precise reference sensor and were particularly adjusted to accurately measure PM10 and PM2.5 levels. A thorough analysis of data collected for 7 months has been presented to establish the need for dense deployment of PM monitoring devices. Different analyses such as mean, variance, spatial interpolation, and correlation have been employed to generate interesting insights about temporal and seasonal variations of PM10 and PM2.5. In addition, event-driven spatio-temporal analysis is done for PM2.5 and PM10 values to understand the impact of the bursting of firecrackers on the evening of the Diwali festival. A web-based dashboard is designed for real-time data visualization

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant