Private individual ambulatory health care providers in Madhya Pradesh province, India

Background: Ambulatory health care services are a major contributor to the large and inequitable health financing burdens (largely out-of-pocket) faced by households in India. The private sector has a virtual monopoly over ambulatory curative services in rural and urban India. Despite this, there is little knowledge about who these providers are, their numbers, distribution, and activities. Aim: This study describes the numbers, gender, distribution, and characteristics of private individual ambulatory care providers in Madhya Pradesh (60.4 million people), one of India’s largest provinces. It discusses the suitability of this provider mix to deal with maternal and child health, a major health priority in the province. Method: A survey enlisting all health care providers was conducted in the 52,117 villages and 394 towns of the province. Results: There were 14,046 private qualified physicians (12.5% women), 57,684 qualified paramedics (3.4% women), and 89,090 unqualified providers (10% women) providing ambulatory services in individual setups. In addition, 55,393 traditional birth attendants provided home-based intranatal care. The macro organization of these providers in this setting is presented. Given the high levels of maternal and child mortality in the province, excessive reliance is placed on less than competent providers as these present lower access barriers. Conclusion: Given the public health priorities in this province (maternal and child health), the provider mix is not optimally suited to the populations’ needs. There is a lack of competent qualified care required to deal with the major causes of morbidity and mortality, particularly in rural areas. Access to qualified women providers is low. The lack of a cadre of qualified midwives possibly contributes to some of the high maternal mortality observed in this province

Quantum Field Theory with Classical Sources - Linearized Quantum Gravity

In a previous work and in terms of an exact quantum-mechanical framework, $\hbar$-independent causal and retarded expectation values of the second-quantized electro-magnetic fields in the Coulomb gauge were derived in the presence of a conserved classical electric current. The classical $\hbar$-independent Maxwell's equations then naturally emerged. In the present work, we extend these considerations to linear gravitational quantum deviations around a flat Minkowski space-time in a Coulomb-like gauge. The emergence of the classical causal and properly retarded linearized classical theory of general relativity with a conserved classical energy-momentum tensor is then outlined. The quantum-mechanical framework also provides for a simple approach to classical quadrupole gravitational radiation of Einstein and microscopic spontaneous graviton emission and/or absorption processes

Antibiotic prescribing in two private sector hospitals; one teaching and one non-teaching: A cross-sectional study in Ujjain, India

BACKGROUND: The worldwide increase in antibiotic resistant bacteria is of great concern. One of the main causes is antibiotic use which is likely to be high but is poorly described in India. The aim was to analyze and compare antibiotic prescribing for inpatients, in two private sector tertiary care hospitals; one Teaching and one Non-teaching, in Ujjain, India. METHODS: A cross-sectional study with manual data collection was carried out in 2008. Antibiotic prescribing was recorded for all inpatients throughout their hospital stay. Demographic profile of inpatients and prescribed antibiotics were compared. WHO Anatomical Therapeutic Chemical (ATC) classifications for antibiotics was used and Defined Daily Doses (DDD) were calculated per patient day. RESULTS: A total of 8385 inpatients were admitted during the study period. In the Teaching hospital (TH) 82% of 3004 and in the Non-teaching hospital (NTH) 79% of 5381 patients were prescribed antibiotics. The most commonly prescribed antibiotic groups were; fluoroquinolones and aminoglycosides in the TH and, 3rd generation cephalosporins and combination of antibiotics in the NTH. Of the prescriptions, 51% in the TH and 87% in the NTH (p<0.001) were for parenteral route administration. Prescribing by trade name was higher in the NTH (96%) compared with the TH (63%, p<0.001). CONCLUSIONS: The results from both hospitals show extensive antibiotic prescribing. High use of combinations of antibiotics in the NTH might indicate pressure from pharmaceutical companies. There is a need to formulate and implement; based on local prescribing and resistance data; contextually appropriate antibiotic prescribing guidelines and a local antibiotic stewardship program

Effects of soil sample pretreatments and standardised rewetting as interacted with sand classes on Vis-NIR predictions of clay and soil organic carbon

Numerous studies have examined the soil analytical potential of diffuse reflectance spectroscopy in the near infrared range, alone or combined with the visible range (Vis-NIR). Soil organic matter (SOM), soil organic carbon (SOC) and clay content are the most commonly and successfully predicted parameters, but predictions are quite variable due e.g. to the range of soil types covered by the calibrations. Especially organic matter predictions are also suggested to be influenced by for example soil moisture content and inclusion of the visible range in the calibration. Excess quartz sand is also suggested to have a negative influence. This study was undertaken to examine the effect of a selection of standardised sample pretreatment procedures, including rewetting, on predictions of clay and SOC content. A subset of 400 samples was selected from a dataset of 3000 Swedish agricultural soils to cover clay and organic matter contents without co-variation. The selected samples were analysed by NIR and Vis-NIR on air-dry samples, either carefully mixed to avoid stratification of particle size classes or shaken to promote separation, resulting in predominantly larger particles being analysed. Unshaken samples were also analysed immediately after standardised additional drying at 35°C for 12 hours and stepwise volumetric rewetting up to 30%. Shaking and additional drying had small negative effects on clay predictions, while drying only had small positive effects on SOC predictions. Volumetric rewetting to 20 or 30% before scanning reduced clay prediction errors by up to 15%, RMSEP reduced from 5.4 % clay to 4.5 % clay, and SOC prediction errors by up to 30%, from 0.9 % SOC to 0.6 % SOC, indicating that standardised rewetting should be considered. The mechanisms concerned could not be specifically identified, but known bands for water, hydroxyl and clay mineral-dependent absorption near 1400, 1900 and 2200 nm were involved in the improved clay calibrations and bands near 1700, 2000, 2300 and 2350 nm in the improved SOC calibrations. The SOC predictions were most inaccurate for soils with a high sand content. For these samples the average prediction error was more than twice as high as those for less sandy samples. Rewetting eliminated this bias, largely explaining the positive effects of rewetting

Monitoring of bed material in a biomass fluidized bed boiler using an electronic tongue

The thermal conversion of biomass fuel mixes in fluidized beds can cause agglomeration. To counteract agglomeration, bed material is gradually exchanged with virgin bed material, and this results in increased disposal of used bed material. Furthermore, the bed material exchange represents a costly option, as it involves a cost for virgin bed material, for landfill, and for unplanned downtime of the plant. This paper presents a novel method for the evaluation of bed material quality: the electronic tongue (ET). Evaluation of bed material quality can contribute toward decreasing the cost of unnecessary exchanges of bed material. The proposed method was tested on bed material sampled on an almost daily basis from a commercial fluidized bed boiler during several months of operation. A two-electrode ET was used for the evaluation of the bed material quality. The analysis relied on pulsed voltammetry measurements and multivariate data analysis with Principal Component Analysis (PCA). The results suggest that it is possible to follow bed material changes and that the ET, after further development, may be used to optimize the material flows connected to the bed material. Further research is being conducted to optimize the ET\u27s performance and its application in monitoring bed material

Rhinitis phenotypes correlate with different symptom presentation and risk factor patterns of asthma

SummaryBackgroundAsthma and rhinitis frequently coexist, but no population study has previously determined the relationship between nasal comorbidities and symptom expression and risk factors of asthma.MethodsIn 2008, a postal questionnaire on respiratory health was sent to 30 000 randomly selected subjects aged 16–75 years in West Sweden; 29218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, rhinitis, chronic rhinosinusitis, respiratory symptoms and possible determinants.ResultsPrevalence of allergic rhinitis in asthma was 63.9% and of asthma in allergic rhinitis 19.8%. Prevalence of chronic rhinosinusitis in asthma was 8.4% and of asthma in chronic rhinosinusitis 24.4%. Asthma subjects with chronic rhinitis, or chronic rhinosinusitis, had more symptoms of asthma and bronchitis than those without rhinitis (p < 0.001). There was an obvious trend of higher ORs for various environmental exposures including occupational exposure to dust, gases and fumes (OR 2.32 vs. OR 1.44), visible mould at home (OR 1.72 vs. OR 1.27) and water damage at home (OR 1.82 vs. OR 1.06) for asthma with chronic rhinosinusitis than for asthma with allergic rhinitis. Family history of allergy yielded a higher OR for asthma with allergic rhinitis than with asthma with chronic rhinosinusitis (OR 7.15 vs. OR 4.48).ConclusionConsiderable overlap between asthma and nasal comorbidities was documented, confirming a close relationship between nasal disease and asthma. Allergic rhinitis, chronic rhinitis and chronic rhinosinusitis were associated with different risk factor patterns and symptom expression of asthma. Thus, different nasal comorbidities may reflect different phenotypes of asthma