CLINICAL EVALUATION OF VIRECHANA THERAPY IN AMAVATA WITH SPECIAL REFERENCE TO RHEUMATOID ARTHRITIS

Amavata is a disease of chronic joint and body pain, accompanied by a swelling of some or all of the synovial joints. These symptoms are typically accompanied by stiffness of joints, loss of appetite, indigestion, lack of enthusiasm, feeling of heaviness and fever. Among Shodhna therapy described in Ayurveda, Virechana is mostly used in the disorders originated from vitiated Pitta. Along with this, it is also useful in the disorders in which Pitta is associated with Vata or Kapha dosha. It has direct effect on the Agni Adhishthan and also works on Kapha and Vata Adhishsthan. Thus, it rectify not only Pitta but Vata and Kapha Dosha also.A clinical study of 20 registered cases of Amavata revealed that Virechana karma is a very effective treatment of Amavata. This study proved the significance of Virecana karma on classical symptom of Amavata i.e., Angamarda, Aruchi, Trishna, Jwara, Shoth, etc. It reflects that Virechana karma is a potent Shroto-vishodhna, a good anti-inflammatory and pain relieving in patients of R.A.Statistically significant results were found in Morning stiffness (83.02%, P<0.001), Swelling (81.67% , P<0.001), Trishna (56%, P<0.001), Aruchi (80.00%, P<0.001), Gaurava (85.37% P<0.001) and Apaka (81.39%). This study reveals that Virechana therapy is a very effective Panchakarma procedure with potent Sroto Shodhana effect to produce good anti- inflammatory and pain reducing feature in patients of R.A

CLINICAL EVALUATION OF ARAGHVADHADI VIRECHANA YOGA IN THE MANAGEMENT OF HYPOTHYROIDISM

Thyroid gland is the most important gland of the endocrine system. Thyroid hormones manage the metabolic activity of the body. When the secretion of these hormones gets hampered, the thyroid gland fails to complete the metabolic need of the body. This condition is called as hypothyroidism. This problem is a great challenge for both developing as well as developed countries. It is seen 7 to 8 times more common in females than males. The only treatment available is levo-thyroxine tablets which patients have to take lifelong. Due to high prevalence of the disease in the society, the present study was taken to evaluate the efficacy of the management by Ayurvedic principles. In Ayurvedic literature there is no direct reference of this disease. It may be considered due to the disfunctioning of Jatharagni which may leads to the manifestation of this disease. According to the symptoms of this disease, dominance of Dosha may be understand as Pittaand Kapha. Virechana is the best treatment for the Pitta Dusthi and also an effective treatment for the Kapha Dosha. Hence, in present study, total 20 patients of hypothyroidism with TSH more than 5.0 mIU/ml irrespective of the level of serum T3 and T4 were selected and treated with Virechana karma with Araghvadhadi yoga. Effect of Virechana karma was seen extremely significant on symptoms like fatigue, dry and coarse skin, unexplained weight gain, muscle ache, puffiness of face and breathlessness. After the treatment, the average TSH value reduced from 153.03 to 138.41. This is observed that the TSH level was reduced up to 9.88%

INFORMER and Potassium Values: A system to enhance detection, notification, and action upon a threat to patient safety in the emergency department [abstract]

Computational Infrastructure and Informatics Poster SessionBackground: Quick remediation should occur after critically abnormal potassium levels are detected by the medical laboratory in blood from emergency department (ED) patients. Critical potassium levels can be elevated (“HyperK+“) or decreased (“HypoK+“). HyperK+ and HypoK+ can both lead to avoidable patient harm by causing heart rhythm problems, which can be harmful or lethal. Also, Continuous Quality Improvement (CQI) could be enhanced by the creation of an electronic “audit trail” to track these remediations, which involve detection, notification, action-upon, and documentation steps (D1-N-A-D2). HyperK+ and HypoK+ are a logical first target to ameliorate inefficiencies of D1-N-A-D2, because of the frequency of occurrence of these problems in the ED, because the appropriate rapid ED response is clear, and because failures of D1-N-A-D2. can hurt or kill patients. Hypothesis: An automated D1-N-A-D2, plus audit path, can be created, then merged with a to-be-created standing ED order set, to hasten the treatment of HyperK+ and HypoK+. Methods: (1) A standing order set will be adopted, to permit nurses to administer appropriate treatments to patients with either HyperK+ or HypoK+, without prior physician notification. Oral or intravenous potassium, as appropriate, will remediate HypoK+, Administration of insulin plus glucose, calcium, sodium bicarbonate, and sodium polystyrene resin will ameliorate HyperK+. Order sets will be created after input from physician and nursing personnel. (Re-obtaining of blood from patients in whom HyperK+ is thought to be a false positive result, due to hemolysis of the blood sample, will be permitted). (2) “Electronic loop”: Engineers will create an electronic pathway to enable the rapid electronic notification of appropriate medical personnel, after critical HyperK+ or HypoK+ have been detected. This will enable and drive nurses to action. Actions can be electronically audited via review of digital PyxisTM medication administration machine records, matching medication withdrawals for specific patients to specific incidences of HyperK+ and HypoK+. Time to nurse action will be documented. Data during implementation of D1-N-A-D2 will be compared to prior historical control data, to determine whether the newly created process delivers appropriate care more quickly to patients with critically abnormal K+ values. (In addition, it is anticipated that electronic review of laboratory data for the historical controls will reveal total system failures for some patients; some patients with HyperK+ and/or HypoK+ might not have been treated at all for their potassium abnormality during their time in the ED.) Results: Time to treatment for HyperK+ and HypoK+ patients, and % of patients with HyperK+ and HypoK+ who represent total system failures, before vs. after implementation of the pervasive computing protocol, will be determined. Conclusion: It is anticipated that a pervasive computing environment can be created to facilitate implementation of a standing medication order set, to enable more rapid D1-N-A-D2 after critical values of HyperK+ or HypoK+ are detected in the blood of emergency department patients. Also, this environment will decrease the failure-to-treat rate for critical HyperK+ and HypoK+

INFORMER: A System for Immediate and Direct Notification of Critical Data for Patient Care [abstract]

Computational Infrastructure and Informatics Poster SessionEfficient and timely delivery of healthcare requires constant improvements in the quality while keeping the cost of delivery under control. One of the important requirements for such delivery system is the timely notification of patient related data (For example notification of laboratory results on metabolites, circulating levels of certain medications, etc) to doctors, nurses, and other medical professionals for prescribing necessary action. Currently, in nearly all hospitals and laboratories, laboratory or nursing staff are responsible for manually transmitting such information. They take the information verbally or written on a piece of paper, on a pad or on some other media to the recipient in one or multiple hops. Such approach, although serves the purpose, has a number of ordinary to serious limitations such as a higher error rate, incorrect destination, security breach, etc., that could endanger patients life. For example, it is quite possible that the person responsible for notification may forget or delay, for a variety of reasons, to notify the doctor or medical staff or may miscommunicate the results; for example instead of sodium of 150, he or she may orally communicate it as 160. It is also possible that the dispatcher may deliver the information to wrong person (security breach), or take too long to deliver the information. These issues are likely to have serious consequences, in particular for institutions that deal with human subjects such as emergency department of the hospitals where rapid notification is essential for saving lives of critically ill patients. For results communication, paging is a commonly used notification methods but it also involves human and any inadvertent delays in reporting critical data to the physician and other medical staff or to the patient can have serious consequences. We claim that automation in data notification will (a) eliminate or minimize such undesirable consequences, (b) will keep the cost down and (c) improve patient care. We are in the process of designing a pervasive system, referred here as “Informer” to automate the notification process. The system will (a) compose the information (test results, recommendations, etc.) to be dispatched in a easy to read format, (b) identify and notify the critical results to the right medical professionals, (b) maintain an active log of automation process for immediate reference, (c) guarantee accurate data delivery, (d) keep the cost down, (e) provide necessary security, (f) work equally well with wired and wireless network, and (g) offer a high scalability. It will be (a) an independent system with plug and play capability, (b) can port to any system (window, Mac, Linux, etc.), and (c) easy to configure for specific needs

Trade Credit Policies for Supplier, Manufacturer, and Retailer: An Imperfect Production-Inventory System with Rework

In this study, we developed a trade credit policy for a three-layer supply chain consisting of a supplier, a manufacturer and a retailer. We propose an optimal production rate and selling price for the manufacturer and the retailer under an imperfect production system. The suggested coordination policy optimizes the profit of each supply chain member. Two models were formulated for two real-life strategies respectively. The first one is a collaborative (integrated) system and the second one is a Stackelberg leadership system. Both strategies were analyzed for various credit periods, respectively offered by the supplier to the manufacturer, by the manufacturer to the retailer, and by the retailer to the customers, by considering price-sensitive demand and a certain replenishment rate. Finally, we concluded which strategy will be better for inventory management under the given restrictions in the form of propositions. The concavity property for the net profit function was established with respect to the selling price and the production rate, which was also described graphically and analyzed by numerical examples

Trade Credit Policies for Supplier, Manufacturer, and Retailer: An Imperfect Production-Inventory System with Rework

In this study, we developed a trade credit policy for a three-layer supply chain consisting of a supplier, a manufacturer and a retailer. We propose an optimal production rate and selling price for the manufacturer and the retailer under an imperfect production system. The suggested coordination policy optimizes the profit of each supply chain member. Two models were formulated for two real-life strategies respectively. The first one is a collaborative (integrated) system and the second one is a Stackelberg leadership system. Both strategies were analyzed for various credit periods, respectively offered by the supplier to the manufacturer, by the manufacturer to the retailer, and by the retailer to the customers, by considering price-sensitive demand and a certain replenishment rate. Finally, we concluded which strategy will be better for inventory management under the given restrictions in the form of propositions. The concavity property for the net profit function was established with respect to the selling price and the production rate, which was also described graphically and analyzed by numerical examples

A CLINICAL TRIAL OF AROGYA VARDHINI VATI AND LEKHANIYA MAHAKASHAYA IN THE MANAGEMENT OF OBESITY

Obesity is a condition in which there is an excessive accumulation of fat in the body which is a risk to health. The WHO now considers obesity to be a global epidemic and public health problem. Globally an estimated 300 million adults are now obese and many are overweight. A person with a BMI of 30 or more is generally considered obese. The problem is due to calorie imbalance resulting from an excessive food intake coupled with inadequate exercise. It is associated with increased mortality by predisposing to the development of important diseases like diabetes, hypertension, atherosclerosis, heart diseases, arthritis, infertility etc and diminishes the efficacy and happiness of affected. As per Ayurveda, Acharya charaka has counted Sthoulya under the eight varieties of impediments which are designated as Ninditapurusha. As Chikitsa sutra of Sthoulya, Lekhan karma is an important therapeutic measure said by Acharya charaka. Moreover, drugs of Arogya vardhini vati and Lekhaniya mahakashaya are most effective in the management of Sthoulya. To assess the effect of Lekhan karma, 20 patients were selected for this study from the OPD and IPD of Uttarakhand Ayurved University, Gurukul Campus Hospital, Haridwar. The effect of the therapy was assessed statically based on the performa prepared

Blockchain-Based Transaction Validation Protocol for a Secure Distributed IoT Network

Funding Agency: 10.13039/501100010418-Institute for Information and Communications Technology Promotion (IITP), Ministry of Science and ICT (MSIT); 10.13039/501100003621-Korea Government;Peer reviewedPublisher PD

Widespread Climate Change in the Himalayas and Associated Changes in Local Ecosystems

Background: Climate change in the Himalayas, a biodiversity hotspot, home of many sacred landscapes, and the source of eight largest rivers of Asia, is likely to impact the well-being of $\sim$20% of humanity. However, despite the extraordinary environmental, cultural, and socio-economic importance of the Himalayas, and despite their rapidly increasing ecological degradation, not much is known about actual changes in the two most critical climatic variables: temperature and rainfall. Nor do we know how changes in these parameters might impact the ecosystems including vegetation phenology. Methodology/Principal Findings: By analyzing temperature and rainfall data, and NDVI (Normalized Difference Vegetation Index) values from remotely sensed imagery, we report significant changes in temperature, rainfall, and vegetation phenology across the Himalayas between 1982 and 2006. The average annual mean temperature during the 25 year period has increased by 1.5$^\circ$C with an average increase of 0.06$^\circ$C yr$^{−1}$. The average annual precipitation has increased by 163 mm or 6.52 mmyr$^{−1}$. Since changes in temperature and precipitation are immediately manifested as changes in phenology of local ecosystems, we examined phenological changes in all major ecoregions. The average start of the growing season (SOS) seems to have advanced by 4.7 days or 0.19 days yr$^{−1}$ and the length of growing season (LOS) appears to have advanced by 4.7 days or 0.19 days yr$^{−1}$, but there has been no change in the end of the growing season (EOS). There is considerable spatial and seasonal variation in changes in climate and phenological parameters. Conclusions/Significance: This is the first time that large scale climatic and phenological changes at the landscape level have been documented for the Himalayas. The rate of warming in the Himalayas is greater than the global average, confirming that the Himalayas are among the regions most vulnerable to climate change

Rangelands, conflicts, and society in the Upper Mustang Region, Nepal

Rangelands are considered critical ecosystems in the Nepal Himalayas and provide multiple ecosystem services that support local livelihoods. However, these rangelands are under threat from various anthropogenic stresses. This study analyzes an example of conflict over the use of rangeland, involving two villages in the Mustang district of Nepal. This prolonged conflict over the use of rangeland rests on how use rights are defined by the parties, that is, whether they are based on traditional use or property ownership. Traditionally, such conflicts in remote areas were managed under the Mukhiya (village chief) system, but this became dysfunctional after the political change of 1990. The continuing conflict suggests that excessive demand for limited rangelands motivates local villagers to gain absolute control of the resources. In such contexts, external support should focus on enhancing the management and production of forage resources locally, which requires the establishment of local common property institutions to facilitate sustainable rangeland management.<br /