Subjective Verification of Refraction- A Quality Indicator: A Cross-sectional Study

Introduction: Subjective refraction helps in establishing the suitable lens for a patient. But it also needs a patient’s cooperation for the proper estimation of the refractive error. Aim: To determine the impact of counselling of Optometrists on subjective refraction and spectacle prescription to patients attending Ophthalmology Out Patient Department (OPD) at their first visit. Materials and Methods: This was a cross-sectional study conducted for a period of two months from June 2020 to July 2020. All patients attending the OPD at Department of Ophthalmology at R L Jalappa Hospital and Research Centre, Tamaka, Karnataka, India, were included in the study. A total of 120 patients, whose vision was <6/9, were included in each group. Group A, before counselling the Optometrists and Group B, after counselling the Optometrists by systemic random sampling method. The number of patients who required spectacle correction and those who were given spectacle prescriptions at their first visit were identified. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: In Group A, out of 120 patients only 62 patients (51.7%), had undergone subjective refraction along with spectacle prescription at their first visit. In Group B, (88.3%) 106 patients out of 120, underwent subjective refraction and spectacle correction was given on their first visit. Conclusion: This study shows a clear positive impact of counselling to Optometrists and the importance of counselling in achieving patient’s satisfaction

Dark halo baryons not in ancient halo white dwarfs

Having ruled out the possibility that stellar objects are the main contributor of the dark matter embedding galaxies, microlensing experiments cannot exclude the hypothesis that a significant fraction of the Milky Way dark halo might be made of MACHOs with masses in the range 0.5-0.8 \msun. Ancient white dwarfs are generally considered the most plausible candidates for such MACHOs. We report the results of a search for such white dwarfs in a proper motion survey covering a 0.16 sqd field at three epochs at high galactic latitude, and 0.938 sqd at two epochs at intermediate galactic latitude (VIRMOS survey), using the CFH telescope. Both surveys are complete to I = 23, with detection efficiency fading to 0 at I = 24.2. Proper motion data are suitable to separate unambiguously halo white dwarfs identified by belonging to a non rotating system. No candidates were found within the colour-magnitude-proper motion volume where such objects can be safely discriminated from any standard population as well as from possible artefacts. In the same volume, we estimate the maximum white dwarf halo fraction compatible with this observation at different significance levels if the halo is at least 14 gigayears old and under different ad hoc initial mass functions. Our data alone rules out a halo fraction greater than 14% at 95% confidence level. Combined with two previous investigations exploring comparable volumes pushes the limit below 4 % (95% confidence level) or below 1.3% (64% confidence), this implies that if baryonic dark matter is present in galaxy halos, it is not, or it is only marginally in the form of faint hydrogen white dwarfs.Comment: accepted in Astronomy and Astrophysics (19-05-2004

Process evaluation protocol for a cluster randomised trial of a complex, nurse-led intervention to improve hypertension management in India.

INTRODUCTION: India has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled 'm-Power Heart Project' is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial's process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research. METHODS AND ANALYSIS: The process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick's model for training evaluation. Key process evaluation indicators (number of patients recruited and retained; concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelli et al's framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations. TRIAL REGISTRATION NUMBER: NCT03164317; Pre-results

Personal Drug Selection: Problem-Based Learning in Pharmacology: Experience from a Medical School in Nepal

BACKGROUND: At the Manipal College of Medical Sciences, Pokhara, Nepal, Pharmacology is taught during the first four semesters of the undergraduate medical course. Personal or P-drug selection is an important exercise. The present study was carried out to obtain student opinion about the P-drug learning sessions, the assessment examinations, and on the small group dynamics. METHOD: The practical sessions on P-drug selection are carried out in small groups. Student feedback about the session was obtained using focus group discussions. The focus groups were selected to represent both genders and the three main nationalities, Nepalese, Indians, and Sri Lankans. There were four Nepalese, five Indians, and three Sri Lankans. Within each nationality and gender category the students were randomly selected. The respondents were explained the objectives of the study and were invited to participate. Written informed consent was obtained. The discussion lasted around two hours and was conducted in the afternoon in two groups of six students each. The first author (PRS) acted as a facilitator. The responses were recorded and analyzed qualitatively. RESULTS: The overall student opinion was positive. Around 25% (3 respondents) of respondents were confused about whether P-drugs were for a disease or a patient. Group consensus was commonly used to give numerical values for the different criteria. The large number of brands created problems in calculating cost. The students wanted more time for the exercise in the examination. Formative assessment during the learning sessions may be considered. The group members usually got along well. Absenteeism was a problem and not all members put in their full effort. The physical working environment should be improved. CONCLUSIONS: Based on what the students say, the sessions on P-drugs should be continued and strengthened. Modifications in the sessions are required. Sessions during the clinical years and internship training can be considered

Comparative effectiveness of dipeptidyl peptidase-4 (DPP-4) inhibitors and human glucagon-like peptide-1 (GLP-1) analogue as add-on therapies to sulphonylurea among diabetes patients in the Asia-Pacific region: a systematic review

The prevalence of diabetes mellitus is rising globally, and it induces a substantial public health burden to the healthcare systems. Its optimal control is one of the most significant challenges faced by physicians and policy-makers. Whereas some of the established oral hypoglycaemic drug classes like biguanide, sulphonylureas, thiazolidinediones have been extensively used, the newer agents like dipeptidyl peptidase-4 (DPP-4) inhibitors and the human glucagon-like peptide-1 (GLP-1) analogues have recently emerged as suitable options due to their similar efficacy and favorable side effect profiles. These agents are widely recognized alternatives to the traditional oral hypoglycaemic agents or insulin, especially in conditions where they are contraindicated or unacceptable to patients. Many studies which evaluated their clinical effects, either alone or as add-on agents, were conducted in Western countries. There exist few reviews on their effectiveness in the Asia-Pacific region. The purpose of this systematic review is to address the comparative effectiveness of these new classes of medications as add-on therapies to sulphonylurea drugs among diabetic patients in the Asia-Pacific countries. We conducted a thorough literature search of the MEDLINE and EMBASE from the inception of these databases to August 2013, supplemented by an additional manual search using reference lists from research studies, meta-analyses and review articles as retrieved by the electronic databases. A total of nine randomized controlled trials were identified and described in this article. It was found that DPP-4 inhibitors and GLP-1 analogues were in general effective as add-on therapies to existing sulphonylurea therapies, achieving HbA1c reductions by a magnitude of 0.59–0.90% and 0.77–1.62%, respectively. Few adverse events including hypoglycaemic attacks were reported. Therefore, these two new drug classes represent novel therapies with great potential to be major therapeutic options. Future larger-scale research should be conducted among other Asia-Pacific region to evaluate their efficacy in other ethnic groups

Expression of Regulatory Platelet MicroRNAs in Patients with Sickle Cell Disease

Background: Increased platelet activation in sickle cell disease (SCD) contributes to a state of hypercoagulability and confers a risk of thromboembolic complications. The role for post-transcriptional regulation of the platelet transcriptome by microRNAs (miRNAs) in SCD has not been previously explored. This is the first study to determine whether platelets from SCD exhibit an altered miRNA expression profile. Methods and Findings: We analyzed the expression of miRNAs isolated from platelets from a primary cohort (SCD = 19, controls = 10) and a validation cohort (SCD = 7, controls = 7) by hybridizing to the Agilent miRNA microarrays. A dramatic difference in miRNA expression profiles between patients and controls was noted in both cohorts separately. A total of 40 differentially expressed platelet miRNAs were identified as common in both cohorts (p-value 0.05, fold change>2) with 24 miRNAs downregulated. Interestingly, 14 of the 24 downregulated miRNAs were members of three families - miR-329, miR-376 and miR-154 - which localized to the epigenetically regulated, maternally imprinted chromosome 14q32 region. We validated the downregulated miRNAs, miR-376a and miR-409-3p, and an upregulated miR-1225-3p using qRT-PCR. Over-expression of the miR-1225-3p in the Meg01 cells was followed by mRNA expression profiling to identify mRNA targets. This resulted in significant transcriptional repression of 1605 transcripts. A combinatorial approach using Meg01 mRNA expression profiles following miR-1225-3p overexpression, a computational prediction analysis of miRNA target sequences and a previously published set of differentially expressed platelet transcripts from SCD patients, identified three novel platelet mRNA targets: PBXIP1, PLAGL2 and PHF20L1. Conclusions: We have identified significant differences in functionally active platelet miRNAs in patients with SCD as compared to controls. These data provide an important inventory of differentially expressed miRNAs in SCD patients and an experimental framework for future studies of miRNAs as regulators of biological pathways in platelets. © 2013 Jain et al

Seeking legitimacy through CSR: Institutional Pressures and Corporate Responses of Multinationals in Sri Lanka

Arguably, the corporate social responsibility (CSR) practices of multinational enterprises (MNEs) are influenced by a wide range of both internal and external factors. Perhaps most critical among the exogenous forces operating on MNEs are those exerted by state and other key institutional actors in host countries. Crucially, academic research conducted to date offers little data about how MNEs use their CSR activities to strategically manage their relationship with those actors in order to gain legitimisation advantages in host countries. This paper addresses that gap by exploring interactions between external institutional pressures and firm-level CSR activities, which take the form of community initiatives, to examine how MNEs develop their legitimacy-seeking policies and practices. In focusing on a developing country, Sri Lanka, this paper provides valuable insights into how MNEs instrumentally utilise community initiatives in a country where relationship-building with governmental and other powerful non-governmental actors can be vitally important for the long-term viability of the business. Drawing on neo-institutional theory and CSR literature, this paper examines and contributes to the embryonic but emerging debate about the instrumental and political implications of CSR. The evidence presented and discussed here reveals the extent to which, and the reasons why, MNEs engage in complex legitimacy-seeking relationships with Sri Lankan institutions

Ribosome-Dependent ATPase Interacts with Conserved Membrane Protein in Escherichia coli to Modulate Protein Synthesis and Oxidative Phosphorylation

Elongation factor RbbA is required for ATP-dependent deacyl-tRNA release presumably after each peptide bond formation; however, there is no information about the cellular role. Proteomic analysis in Escherichia coli revealed that RbbA reciprocally co-purified with a conserved inner membrane protein of unknown function, YhjD. Both proteins are also physically associated with the 30S ribosome and with members of the lipopolysaccharide transport machinery. Genome-wide genetic screens of rbbA and yhjD deletion mutants revealed aggravating genetic interactions with mutants deficient in the electron transport chain. Cells lacking both rbbA and yhjD exhibited reduced cell division, respiration and global protein synthesis as well as increased sensitivity to antibiotics targeting the ETC and the accuracy of protein synthesis. Our results suggest that RbbA appears to function together with YhjD as part of a regulatory network that impacts bacterial oxidative phosphorylation and translation efficiency

Cost of Dry Eye Treatment in an Asian Clinic Setting

10.1371/journal.pone.0037711PLoS ONE76