Informetrics on accidents and trauma

MEDLINE database has been analysed for 1995-97 on index Accidents and Trauma. Publications output has been classified year-wise country-wise, journal-wise and other fine structure characteristics have been found. High frequency keywords have been identified. Other valuable data have been compiled. The value of informater for decision-making is brought out by this study and the comprehensive data compilation by MEDLINE is established

High Grade Muscle-Invasive Urinary Bladder Cancer in A 36 Year Old Male Patient: A Case Report & Review of Literature

We are reporting a case of urothelial bladder cancer in a 36 year old male patient with no history or exposure to any risk factors. The incidence of urothelial bladder cancer is very low in young individuals i.e. below 40 years of age with reported rate of incidence around 0.1-0.4 %. Most of the times, these young individuals present with non-muscle invasive bladder cancer with low grade and low stage. As the age increases, the incidence of high grade bladder cancer increases along with it. The index case presented with high grade muscle invasive bladder cancer at the time of diagnosis without any known risk factors. The 5-year survival of urothelial bladder cancer is better in young patients (93.8 %) as compared to older people(85.1 %). Cigarette smoking is responsible for development of bladder cancer in majority of patients followed by exposure to occupational carcinogens. Role of genetic alterations in development of bladder cancer is still under research and process of urothelial bladder carcinogenesis is unanswered in young individuals

Performance assessment of heterogeneous irrigation schemes in India

Most irrigation schemes in India are performing poorly as seen from the average irrigation efficiency in the range of 30-40% for these projects. Hence it is necessary to study the performance assessment of these schemes to investigate the reasons and improve the performance subsequently. There are different kinds of performance measures that may vary spatially over the irrigation scheme. Hence it is necessary to use a framework for finding out the final performance index (FPI) that combines important performance measures. Hence this study was undertaken. Mula Irrigation Scheme in Ahmednagar District of Maharashtra State, India was identified after verifying that most of the needed data was available. The six performance indicators viz. Productivity, Equity, Adequacy Reliability, Flexibility and Sustainability were identified as the important one for obtaining the information on the relative preference from the farmers and first three were considered for obtaining the allocation plans. The performance of different irrigation schemes is assessed with the help of Area and Water Allocation Model (AWAM). The performance measures viz. productivity, equity, adequacy and excess were obtained by formulating the irrigation strategies based on 1. Irrigation amount: Full depth irrigation (FDI), Fixed depth irrigation (FxDI) and Variable depth irrigation (VDI), 2. Irrigation frequency (14 days, 21 days, 28 days and 35 days), 3. Water distribution: Free water distribution (FWD), Equitable distribution of seasonal water (EDSW) and Equitable distribution of intra-seasonal water (EDIW) and 4. Cropping distribution (Free cropping distribution and Fixed cropping distribution). The yield response of crops to different criteria such as soil, irrigation interval, irrigation strategy and irrigation depth, were analysed. It is found for wheat grown on all considered soils, the variable irrigation depth strategy provided better performance of irrigation scheme in terms of productivity and results in higher irrigation water use efficiency. It is concluded though that the application of water according to the variable irrigation depth strategy is operationally and from a management point of view not convenient and in current situation may not be adoptable. Though the fixed depth irrigation strategy is found to be less productive based on this research for Mula irrigation scheme, it is more convenient for operation compared to other strategies as it does not involve adoption of separate schedules for different crops. In general the area and net benefit productivity values are higher in fixed depth irrigation followed by variable depth and then full depth. The productivity values are higher in case of free cropping distribution compared to fixed cropping distribution. The equitable water distribution resulted in lower productivity compared to free water distribution. No specific trend of equity with the irrigation interval was found. Equity values are higher in case of fixed depth of irrigation compared to full depth. The equity values are higher in case of fixed cropping distribution compared to free cropping. The equity values are as expected higher or unity for equitable water distribution compared to free water distribution. The adequacy values are higher in full depth of irrigation followed by variable depth irrigation and fixed depth irrigation. It is observed that the productivity and equity are almost inversely proportional to each other. Hence the hypothesis that productivity and equity conflicts with each other holds true. Further, Analytic Hierarchy Process (AHP) was used to assign weights of different performance measures by determining the farmers relative preference of different performance measures. The average weights of different performance measures (monetary productivity, equity in water distribution and adequacy) were obtained for farmers from different reaches from the weights obtained from AHP analysis, and considerable differences were found between the weights for the head, middle and tail reaches. The values of the performance indicators were obtained from the simulation-optimization modeling (AWAM model). The different indicators were combined into a final overall performance indicator (FPI) of irrigation management in an irrigation scheme from the farmers perspective. The FPI was computed for head, middle and tail reach farmers using the weights obtained from AHP by compromise programming. It is interesting to note that the strategies that best met the farmers preferences (highest FPI), were same for middle reach and tail reach farmers however it is different for head reach. It is also interesting to note that the preferences of the head, middle and tail reach farmers, irrespective of their relative location in irrigation scheme, were best met by strategies which include the equitable distribution of water. For middle and tail reach farmers, full depth irrigation would give the highest FPI, while for head reach farmers optimised fixed depth would be best. It is also seen that for head and middle reach farmers a strategy with fixed cropping distribution and free water distribution would be worst for meeting the preferences of head and middle reach farmers while for tail reach farmers a strategy with free water and free cropping distribution would be worst. The mean values of the weights for head, middle and tail reach farmers were Productivity = 0.33, Equity = 0.31 and Adequacy = 0.36. With these weights, the highest FPI (0.85) was obtained with an irrigation strategy of Full depth irrigation with free cropping and annual equity at irrigation interval of 35 days in winter and 28 days in summer . Considering the different depth of irrigations (FxDI, VDI and FDI) the VDI and FDI are practically difficult to execute due to the data required for calculations and operational requirements of the irrigation canals. Using FxDI, a strategy with high FPI (0.83) was identified as the best feasible irrigation strategy to implement for the entire irrigation scheme: Fixed depth irrigation with free cropping and annual equity at irrigation interval of 35 days in winter and 28 days in summer . It was found that this best feasible irrigation strategy for the entire scheme was not sensitive to the weights assigned to the performance measures

Implementation of Input Oriented Dynamic Voltage and Frequency Scaling for Multiplier on FPGA

This paper presents an Implementation of Dynamic voltage and frequency scaling according to input data. In the conventional method the power supply is fixed and independent on workload, so, voltage and area will be consumed unnecessary .Paper proposes the approach which focuses on making system dynamic for low power digital multiplier on reconfigurable device FPGA (Spartan III). For making system Dynamic input workload should be known and scanning is used to detect range of input so system can adjust voltage and frequency. Control signal generated from scanning which can dynamically change voltage and frequency for low power consumption according to input data

The psychological well-being and prenatal bonding of gestational surrogates

STUDY QUESTION How does the psychological well-being and prenatal bonding of Indian surrogates differ from a comparison group of mothers? SUMMARY ANSWER Surrogates had higher levels of depression during pregnancy and post-birth, displayed lower emotional connection with the unborn baby, and greater care towards the healthy growth of the foetus, than the comparison group of mothers. WHAT IS ALREADY KNOWN Studies in the West have found that surrogates do not suffer long-term psychological harm. One study has shown that surrogates bond less with the foetus than expectant mothers. STUDY, DESIGN, SIZE, DURATION This study uses a prospective, longitudinal and cross-sectional design. Surrogates and a matched group of expectant mothers were seen twice, during 4–9 months of pregnancy and 4–6 months after the birth. PARTICIPANTS/MATERIALS, SETTING, METHODS Semi-structured interviews and standardized questionnaires were administered to 50 surrogates and 69 expectant mothers during pregnancy and 45 surrogates and 49 expectant mothers post-birth. All gestational surrogates were hosting pregnancies for international intended parents. MAIN RESULTS AND THE ROLE OF CHANCE Surrogates had higher levels of depression compared to the comparison group of mothers, during pregnancy and post-birth (P < 0.02). Low social support during pregnancy, hiding surrogacy and criticism from others were found to be predictive of higher depression in surrogates post-birth (P < 0.05). Regarding prenatal bonding, surrogates interacted less with and thought less about the foetus but adopted better eating habits and were more likely to avoid unhealthy practices during pregnancy, than expectant mothers (P < 0.05). No associations were found between greater prenatal bonding and greater psychological distress during pregnancy or after relinquishment. LIMITATIONS, REASONS FOR CAUTION All surrogates were recruited from one clinic in Mumbai, and thus the representativeness of this sample is not known. Also, the possibility of socially desirable responding from surrogates cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS As this is the first study of the psychological well-being of surrogates in low-income countries, the findings have important policy implications. Providing support and counselling to surrogates, especially during pregnancy, may alleviate some of the psychological problems faced by surrogates. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Wellcome Trust [097857/Z/11/Z] and Nehru Trust, Cambridge. K.K. is the Medical Director of Corion Fertility Clinic. All other authors have no conflict of interest to declare

A longitudinal study of the experiences and psychological well-being of Indian surrogates

Study question: What is the psychological well-being of Indian surrogates during and after the surrogacy pregnancy? Summary answer: Surrogates were similar to a matched group of expectant mothers on anxiety and stress. However, they scored higher on depression during and after pregnancy. What is known already: The recent ban on trans-national commercial surrogacy in India has led to urgent policy discussions regarding surrogacy. Whilst previous studies have reported the motivations and experiences of Indian surrogates no studies have systematically examined the psychological well-being of Indian surrogates, especially from a longitudinal perspective. Previous research has shown that Indian surrogates are motivated by financial payment and may face criticism from their family and community due to negative social stigma attached to surrogacy. Indian surrogates often recruited by agencies and mainly live together in a “surrogacy house.” Study design, size, duration: A longitudinal study was conducted comparing surrogates to a matched group of expectant mothers over two time points: (a) during pregnancy (Phase1: 50 surrogates, 70 expectant mothers) and (b) 4–6 months after delivery (Phase 2: 45 surrogates, 49 expectant mothers). The Surrogates were recruited from a fertility clinic in Mumbai and the matched comparison group was recruited from four public hospitals in Mumbai and Delhi. Data collection was completed over 2 years. Participants/materials, setting, methods: Surrogates and expectant mothers were aged between 23 and 36 years. All participants were from a low socio-economic background and had left school before 12–13 years of age. In-depth faceto-face semi-structured interviews and a psychological questionnaire assessing anxiety, stress and depression were administered in Hindi to both groups. Interviews took place in a private setting. Audio recordings of surrogate interviews were later translated and transcribed into English. Main results and the role of chance: Stress and anxiety levels did not significantly differ between the two groups for both phases of the study. For depression, surrogates were found to be significantly more depressed than expectant mothers at phase 1 (p = 0.012) and phase 2 (p = 0.017). Within the surrogacy group, stress and depression did not change during and after pregnancy. However, a non-significant trend was found showing that anxiety decreased after delivery (p = 0.086). No participants reported being coerced into surrogacy, however nearly all kept it a secret from their wider family and community and hence did not face criticism. Surrogates lived at the surrogate house for different durations. During pregnancy, 66% (N = 33/50) reported their experiences of the surrogate house as positive, 24% (N = 12/50) as negative and 10% (N = 5/50) as neutral. After delivery, most surrogates (66%, N = 30/45) reported their experiences of surrogacy to be positive, with the remainder viewing it as neutral (28%) or negative (4%). In addition, most (66%, N = 30/45) reported that they had felt “socially supported and loved” during the surrogacy arrangement by friends in the surrogate hostel, clinic staff or family. Most surrogates did not meet the intending parents (49%, N = 22/45) or the resultant child (75%, N = 34/45). Limitations, reasons for caution: Since the surrogates were recruited from only one clinic, the findings may not be representative of all Indian surrogates. Some were lost to follow-up which may have produced sampling bias. Wider implications of the findings: This is the first study to examine the psychological well-being of surrogates in India. This research is of relevance to current policy discussions in India regarding legislation on surrogacy. Moreover, the findings are of relevance to clinicians, counselors and other professionals involved in surrogacy. Trial registration number: N/A

Indian egg donors’ characteristics, motivations and feelings towards the recipient and resultant child

This is the first study to examine characteristics, motivations and experiences of Indian egg donors. In-depth interviews were conducted with 25 egg donors who had donated during the previous 8 months at a fertility clinic in Mumbai. The semi-structured interviews were conducted in Hindi and English. In addition to demographic information, data were collected on donors’ motivations for donating, with whom they had discussed donation, and feelings towards the recipients. The response rate was 66%. All participants were literate and had attended school. Twenty (80%) egg donors had children and five (20%) did not. The most common motivation (19, 76%) for donating was financial need. Egg donors had discussed their donation with their husband or with close family/friends, with almost all mentioning that wider society would disapprove. The majority (20, 80%) had no information about the recipients and 11 (44%) preferred not to. The findings highlight the similarities and differences between egg donors from India and those from other countries and that egg donors are of a more varied demographic background than surrogates in India. Given that India has been a popular destination for fertility treatment, the findings have important implications for regulation and practice within India and internationally

A controlled diaphyseal expansion osteotomy for the implantation of a wagner cone prosthesis in a stenotic femoral canal encountered in a polio limb: a case report of the technique

Dysplastic hips pose a significant technical challenge to arthroplasty surgeons. Such deformed hips might be encountered either in congenital and developmental conditions or as sequel of neuromuscular disorders (like poliomyelitis), following infections, or after childhood surgical procedures of the hip. The scientific literature, focussing on total hip arthroplasty (THA), for coxarthrosis in patients with residual poliomyelitis, is relatively rare. Several anatomical distortions seen in dysplastic femurs are described, one of which includes an undersized diaphysis with a stenotic medullary canal. We present a case of a 28 years old male with residual poliomyelitis who underwent a cementless THA for a non united transcervical neck of femur fracture. The patient had an extremely narrow medullary canal which posed a formidable difficulty in the procedure. This was overcome by a novel diaphyseal expansion osteotomy, which enabled the implantation of Wagner Cone prosthesis. This technique, which has hitherto not been described in the literature, can significantly facilitate the implantation of an appropriately sized stem in an undersized femur while at the same time ensuring a good long-term result