Psychology Case Record

ADJUSTMENT DISORDER: BORDERLINE INTELLIGENCE: Patient was apparently normal about a week prior to admission. Informants report that patient is not a good student and used to perform poorly in all his class exams. He was given pass marks by the school authorities in spite poor performance in all the exams. Once patient reached 10th standard, his school teacher apparently warned him that if he did not perform well in the forthcoming class tests, he would not be allowed to sit for his final exams. Following this, patient got very upset and was found to be sitting depressed the whole day and expressed fearfulness. He also had crying spells, decreased concentration in his studies. Patient also expressed suicidal ideas and was found to sleep very less at night. SUMMARY: Patient obtained an IQ score of 75 indicating Border line level of Intellectual functioning. SCHIZOPHRENIA: Patient was apparently alright about 4 years back. He reported that his colleagues at his work place have made a plan against him and trying to get him removed from the job. He also reported that his parents are against him and his mother does not take care of him properly. He accuses his mother of giving affection only for his elder brother and because of which he is in a very good position and become a lawyer. Patient also expressed suspiciousness that people in the neighboring streets talk about him and discuss about him. Parents report that patient would apparently pick up fights with a lot of people for this reason. He would be found smiling and muttering to himself at various times and would not have any explanation for the same. Parents also report that, patient would not take bath regularly, refuse to comb his hair, change clothes and had very poor personal hygiene. He has repeatedly changed jobs and has not held a single job for more than a month. Many times the patient was terminated from the job as he was not found to be efficient. He complained of disturbed sleep and parents reported that he would roam around in the night aimlessly. SUMMARY: Overall, testing showed the presence of formal thought disorder, possibly Schizophrenia. DISSOCIATIVE MOTOR DISORDER: Patient apparently got married about 9 months back. On the same day, she started complaining of having back pain which was of severe nature and lasting few minutes to 2 hours. She consulted many neurologists and orthopaedicians for the same. All the investigations were done and found to be normal. She was prescribed medications but she did not report any improvement in her back pain with them. Patient also had sleep disturbance for a week before coming to psychiatry OPD. She had told her family that she does to wish to live as she was unable to tolerate the pain. She was eating very little as she complained that intake of food worsened her pain. Two days before presentation to OPD, patient started having episodes of unresponsiveness for a few minutes. These episodes used to be accompanied by swirling movements of the body and patient was found lifting both her lower limbs. She reported complete amnesia for the episode. After 15 to 20 minutes patient used to become completely alright and no confusion was noticed. SUMMARY: Assessment is indicative of significant stressors in the form of unresolved conflicts. Affective symptoms are also present. Current dissociative symptoms can be possibly attributed to poor coping skills. RECURRENT DEPRESSIVE DISORDER: Patient was apparently normal about 5 days prior to admission. Her husband had been insisting that she should join for work, so she joined as a daily wager in a nearby mill. Following that, patient was found to have disturbed sleep. She was appearing sad all the time, not taking any interest in her daily routine work. She complained of feeling tired even on doing minimal work. Patient was not taking care of her children as before. She used to be preoccupied in her own thoughts and would be found sitting in the same place for long periods of time. She complained of hearing nonexistent voices which were commenting about her continuously. She expressed wishes to die on several occasions. Initially, patient was having less communication with family members but within two days she became completely mute, stopped eating food, after which she was brought to the hospital. SUMMARY: Overall, Testing is indicative of presence of Depressive features. DEMENTIA: Patient was apparently normal until 4 months back, following which, his family members noticed him to be repeating the same sentences many times. He had significant sleep disturbance and for the last two months, he stopped going for work. Family members report that many times he has failed to recognise his close friends and family members and has landed up calling them by some other name. On few occasions, he apparently forgot the way to his house and lost his way. He went on some other unfamiliar road and was brought back home by the family members. He talks irrelevantly at times saying that he is in his office when actually he would be elsewhere. At times he would apparently just sit in the same place and stare at the ground for long periods of time. Patient had to be repeatedly instructed by the family members to do his routine activities. He would ask for breakfast twice saying that he had not had it, when in fact, the family would have given the same some few minutes earlier. His sleep was found to be disturbed

The sunshine vitamin D: ubiquitous source, still so deficient in mother and baby duo

Background: Vitamin D is a fat-soluble vitamin, a sunshine vitamin. Vitamin D deficiency is now recognized as a pandemic. Fetus depends on mother for its need of vitamin D, thus there is growing concern for its impact on neonates. This study was designed to determine the correlation between 25-hydroxyvitamin D (vitamin D3) levels in maternal blood and in cord blood.Methods: A total 50 term pregnant women attending antenatal clinic at SVS medical college, Telangana and their neonates were included in the study. At term after taking written consent, maternal and cord blood vitamin D3 were measured, and values were correlated. Antenatal and neonatal complications were noted, and correlated with vitamin D3 levels.Results: In this study 80% of pregnant women and 88% of neonates were vitamin D3 deficient. Mean maternal blood vitamin D3 was 17.62±10.01 and cord blood vitamin D3 was 12.84±7.68. Maternal blood vitamin D3 correlated positively with cord blood vitamin D3 (r=0.951, p<0.001). Antenatal and neonatal complications were observed, but statistically significant association with vitamin D3 deficiency could not be established.Conclusions: This study has demonstrated a very high prevalence of vitamin D deficiency in apparently healthy, young, pregnant women despite abundant sunlight leading to deficiency in their neonates. To establish strong association between vitamin D3 deficiency and various antenatal and neonatal complications further studies with large subject groups are required

Influence of Dam and Foundation Discountinuities Using Discountinuum Approach — A Case Study

Dam-foundation interaction plays an important role in the design and analysis of concrete gravity dams as has been reviewed from the failures of dams in the literature. The objective of the study is to understand the behavior of a concrete gravity dam taking into account the effect of dam and foundation discontinuities using three-dimensional Distinct Element Code. Different models have been formulated considering the complexities involved in the modeling of the dam structure, dam-foundation system and the results have been compared. Modeling the dam with the discontinuity in the form of crack which runs through the concrete section has a complex phenomenon taking place at the interface where sliding and rotation deformation contribute to the overall stability. Modeling dam with discontinuities in the dam monoliths proved to be more realistic in the analysis of dam than considering a monolith dam with no dam discontinuities. Significant relative displacements between the monoliths and the permanent relative displacement at the end of seismic input have been observed at the discontinuities in this case. Modeling the foundation rock discontinuities represent the field conditions in the analysis more realistically. It is clearly indicated from the study that the interaction between dam monoliths and discontinuities in the foundation rock mass provide more realistic dam response

Situs inversus

Situs inversus is a rare condition with a genetic predisposition, where in organs are transposed from their normal location to the opposite side of the body with an incidence of 1 in 10000 live births. If Situs Inversus is associated with other congenital anomalies the survival rate is low. So prenatal diagnosis is essential to detect any associated anomalies. During routine fetal autopsies conducted in the department of anatomy, Mysore medical college, Mysore, a rare interesting case of still born baby with gestational age of 20 weeks was observed. Autopsy findings of external examination revealed kyphosis in thoracic region. Thoracotomy revealed heart on the right side (dextrocardia). Laparotomy revealed that the left lobe of liver was bigger than the right. The gall bladder was present on the visceral surface of the left lobe of liver, stomach was on right side, duodenum on left side, pancreas and spleen were on the right side. There was agenesis of right kidney, right ureter and both suprarenal glands. All the above findings correlate with the condition situs inversus. Situs inversus is a rare condition with a genetic predisposition, it’s etiology lies in the mutation of chromosome no 12, which is critical for recognition of right sidedness.1,2 Even though there is transposition of organs in situs inversus, the survival rate is good but if situs inversus is associated with other congenital anomalies the survival rate is low. So prenatal diagnosis is essential to detect any associated anomalies to bring down mortality rate

Male Genitoplasty for Intersex Disorders

Aim. To evaluate surgical procedures adopted for male genitoplasty in intersex disorders. Patients and Methods. Case records of intersex patients undergoing male genitoplasty from Pediatric Intersex clinic were studied. Results. Of 356 intersex cases undergoing urethroplasty from 1989–2007, the hypospadias was penoscrotal (68%), scrotal (17%) and perineal (15%). 351 patients underwent chordee correction for mild: moderate: severe chordee in 24 : 136 : 191 cases. Byars flaps were fixed upto the corona in 267 cases. Urethroplasty performed was Theirsch duplay in 335 cases, Snodgrass in 16 cases and Ducketts onlay graft in 5 cases that did not require chordee correction. Age at urethroplasty was 2.5 years—22 years (mean 11.5 years, median—5.6 years). Penoscrotal transposition correction and testicular prosthesis insertion were performed independently. Complications included fistula (45), recurrent fistula (11), stricture (12), baggy urethra (8) and recurrent infection due to persistent vaginal pouch (5). Additional distal urethroplasty was required in 15 patients for previous urethroplasty done upto the corona 5–15 years earlier. Conclusion. Hypospadias in intersex disorders is associated with severe chordee in most cases and requires an early chordee correction to allow phallic growth, staged urethroplasty and multiple surgeries to achieve good cosmetic and functional results

Testing the multipole structure and conservative dynamics of compact binaries using gravitational wave observations: The spinning case

In an earlier work [S. Kastha et al., PRD {\bf 98}, 124033 (2018)], we developed the {\it parametrized multipolar gravitational wave phasing formula} to test general relativity, for the non-spinning compact binaries in quasi-circular orbit. In this paper, we extend the method and include the important effect of spins in the inspiral dynamics. Furthermore, we consider parametric scaling of PN coefficients of the conserved energy for the compact binary, resulting in the parametrized phasing formula for non-precessing spinning compact binaries in quasi-circular orbit. We also compute the projected accuracies with which the second and third generation ground-based gravitational wave detector networks as well as the planned space-based detector LISA will be able to measure the multipole deformation parameters and the binding energy parameters. Based on different source configurations, we find that a network of third-generation detectors would have comparable ability to that of LISA in constraining the conservative and dissipative dynamics of the compact binary systems. This parametrized multipolar waveform would be extremely useful not only in deriving the first upper limits on any deviations of the multipole and the binding energy coefficients from general relativity using the gravitational wave detections, but also for science case studies of next generation gravitational wave detectors.Comment: 16 pages, 8 figures, Mathematica readable supplemental material file for all the inputs to calculate the parametrized waveform is with the sourc

Implementing a Public Private Partnership Model for Managing Urban Health in Ahmedabad

Governments in many developing countries acknowledge they are facing difficulties in their attempt to meet the basic health needs of their populations. They rely on contracting out to private (for-profit and not-for-profit) organizations as a strategy to meet the needs of underserved populations. For the most part, the public sector chooses to contract out primary healthcare services to the private sector to expand access, increase the availability of medicines and medical supplies, and improve the quality of care. In both urban and rural settings, private for-profit and non-profit health service providers serve both the rich and the poor. Communities often recognize private sector healthcare providers to be more responsive to their healthcare needs and preferences in terms of services available, suitable timings and geographical access etc. Private sector has always played a significant role in the delivery of health services in developing countries. Public-private-partnership (PPP) is an approach under which services are delivered by the private sector, while the responsibility for providing the resources rests with the government. Establishing a PPP requires a legal framework acceptable to all the partners, clarity on the commitment of resources, roles and responsibilities of each partner, as well as accountability to provide a given set of services at a desired level of quality and affordable user charges. Formalizing such an arrangement between partners requires conceptualising a framework for Public Private Partnership (PPP) to manage the delivery of health services. In this paper, we describe the design, development and implementation of a PPP for managing urban health services in Ahmedabad city, Gujarat. Our model has succeeded in bringing together compatible public and private partners to plan and deliver quality healthcare services to meet the community needs of Vasna ward, in Ahmedabad. The new Vasna Urban Health centre was inaugurated on July 23, by the Chief Minister of Guajarat. This new centre now serves about 120 outpatients everyday as against an average of 10 outpatients daily earlier.

Multiparameter tests of general relativity using multiband gravitational-wave observations

In this Letter we show that multiband observations of stellar-mass binary black holes by the next generation of ground-based observatories (3G) and the space-based Laser Interferometer Space Antenna (LISA) would facilitate a comprehensive test of general relativity by simultaneously measuring all the post-Newtonian (PN) coefficients. Multiband observations would measure most of the known PN phasing coefficients to an accuracy below a few percent---two orders-of-magnitude better than the best bounds achievable from even `golden' binaries in the 3G or LISA bands. Such multiparameter bounds would play a pivotal role in constraining the parameter space of modified theories of gravity beyond general relativity.Comment: 7 pages, 4 figures. v3: version published in PR