QI initiative to improve utilization of centchroman: a non-steroidal contraceptive

Background: The nonsteroidal contraceptive centchroman is manufactured in India. It was included in family welfare programme in April 2016 by the Ministry of Health and Family Welfare, Government of India. However, national statistics indicated its low utilization at all levels of healthcare. Objective was to identify the reasons for underutilization of centchroman in the family planning clinic, and in the postpartum period, and to implement corrective measures to improve its utilization at a tertiary hospital.Methods: The study was conducted in the department of obstetrics and gynecology at a tertiary care hospital from September 2019 to January 2022. A quality improvement action team was constituted to undertake root cause analysis. Important corrective factors were insufficient focused counselling for centchroman as contraceptive, insufficient sensitization of doctors and nurses, inconsistent supply of tablets, lack of clarity about side effects of centchroman among healthcare workers. Tablets were not readily available to postpartum women at home, which was also a contributing factor. There were the following changes implemented: sensitization of the healthcare workers, daily focused FP counselling of women in outpatient clinics and postnatal wards, and measures to ensure a continuous supply of tablets. At discharge, eligible postpartum women were given a three-month supply of tablets for ready access. ASHA (accredited social health activist) workers who are engaged in other governmental health initiatives were included in the loop to maintain contact and supply tablets to women initiated on centchroman.Results: Contraceptive utilization increased from 0.5-0.7% at beginning of the study to 29% by incorporating the solutions. Failure of contraception occurred in one user. Pearl index for centchroman in our study was 0.22%.Conclusions: Simple, practical solutions identified through quality improvement initiatives resulted in improved coverage and utilization of contraceptive. This study can be an important example for problem solving of challenges in low resource settings

Decision support tool for dynamic workforce scheduling in manufacturing environments \

Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2013.Cataloged from PDF version of thesis.Includes bibliographical references (pages 113-116).Scheduling for production in manufacturing environments requires an immense amount of planning. A large number of factors such as part availability, production cost, space constraints and labor supply must be taken into account. Considering these factors, tasks are scheduled into shifts and allocated the required human resources. However, when actual production begins, the original schedule must be updated regularly due to the dynamic nature of the environment. An enormous challenge in these rapidly changing environments is the reallocation of workers to tasks in real-time due to events such as worker absences, emergent tasks and unanticipated delays. The focus of this thesis is the development of a decision support tool that can assist shift supervisors to rapidly generate new worker-task assignments during a shift to ensure that production stays on track. This research discusses the systems engineering development process of the aforementioned decision support tool including the initial planning and analysis, the interface design, and the resource allocation algorithm. The development process was iterative, with evaluations and feedback at every step facilitating the refinement of the tool. Emphasis was laid on creating a collaborative framework between the human operator and the automated planning algorithm. While automated planning algorithms are a critical component of resource allocation systems since they can solve complex multivariate scheduling problems much faster than humans, they are inherently brittle and unable to respond to uncertainties in dynamic environments. Thus, in this system, the human operator is given high-level planning tasks and the ability to set goals, while the automation handles the creation of the detailed planning and scheduling assignments. Another factor that was stressed was the inclusion of ergonomic risk. Worker-task assignments that do not take into account ergonomic risk exposure can lead to repetitive stress injuries over time, causing manufacturing plants to incur substantial medical expenses. Any system that allocates (or re-allocates) workers to tasks must take into account the ergonomic risk that workers are subjected to due to the tasks they perform in the given shift. The system was evaluated through extensive interactions with individuals from an aircraft production line, including senior level management and representative users from the production floor. The evaluations yielded positive results. Both the management and the representative users were able to identify the applicability of the tool immediately, and all individuals agreed that the system could be very useful in real production environments. The shift supervisors from the shop floor affirmed that the tool captured all major pieces of information they consider while making re-planning decisions. To better assess the potential of the tool and to refine it further, future research should initiate pilot studies to compare the proposed tool with current methods used for decision-making, which are paper schedules and best judgment of human operators.by Radhika Malik.M. Eng

Cryo-EM structure of translesion DNA synthesis polymerase ζ with a base pair mismatch

[EN] The B-family multi-subunit DNA polymerase ζ (Polζ) is important for translesion DNA synthesis (TLS) during replication, due to its ability to extend synthesis past nucleotides opposite DNA lesions and mismatched base pairs. We present a cryo-EM structure of Saccharomyces cerevisiae Polζ with an A:C mismatch at the primer terminus. The structure shows how the Polζ active site responds to the mismatched duplex DNA distortion, including the loosening of key protein-DNA interactions and a fingers domain in an “open” conformation, while the incoming dCTP is still able to bind for the extension reaction. The structure of the mismatched DNA-Polζ ternary complex reveals insights into mechanisms that either stall or favor continued DNA synthesis in eukaryotes.This work was funded by grants R01-GM124047 (A.K.A and L.P) and R35-GM13170 (A.K.A) from the National Institutes of Health (NIH). I.U.-B was supported by a grant PID2019-104423GB-I00/AEI/10.13039/501100011033 from the Spanish State Research Agency and by the Basque Excellence Research Centre program. Most of the cryo-EM work was performed at the Simons Electron Microscopy Center and National Resource for Automated Molecular Microscopy, located at the New York Structural Biology Center, supported by grants from the Simons Foundation (SF349247), NYSTAR, and the NIH National Institute of General Medical Sciences (GM103310), with additional support from Agouron Institute (F00316), NIH (OD019994) and NIH (RR029300). Computing resources needed for this work were provided in part by the High Performance Computing facility of the Icahn School of Medicine at Mount Sinai. Molecular graphics and analyses were performed with UCSF Chimera, developed by the Resource for Biocomputing, Visualization, and Informatics at the University of California, San Francisco, with support from NIH P41-GM103311

A study to compare ramosetron and ondansetron for prevention of post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia

Background: The incidence of nausea and vomiting following laparoscopic cholecystectomy is very high. 5-hydroxytryptamine receptor antagonists are drug of choice for prevention of post-operative nausea and vomiting (PONV) because of their good efficacy and very few side effects in comparison to other antiemetics. Aims and Objectives: This study was undertaken to compare the efficacy and safety of intravenous ramosetron 0.3 mg and ondansetron 8 mg for prevention of PONV in patients undergoing laparoscopic cholecystectomy under general anesthesia. Materials and Methods: One hundred patients between 18 and 70 years of age with American Society of Anesthesiology Grade I and II scheduled for elective laparoscopic cholecystectomy were randomly divided into two groups of 50 patients each. Group A patients were given injection ondansetron 8 mg and Group B patients were given injection ramosetron 0.3 mg approximately 5 min just before the induction of general anesthesia. Results: Difference in Nausea, vomiting/retching, and PONV score assessed at 4, 8, 12, and 24 h interval postoperatively in both groups was found to be statistically insignificant (P>0.05). The severity of nausea was assessed by visual analogue scale at various time intervals and use of rescue antiemetics in both the groups were found statistically insignificant. Incidence of side effects was also comparable in both the groups. Conclusion: Ramosetron and ondansetron are equally effective for prevention of PONV in patients who underwent elective laparoscopic cholecystectomy under general anesthesia when used prophylactically. Both drugs are safe and have low incidence of side effects

Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System A Report From the Workshop Convened by the World Heart Federation

Major scholars in the field, based on a 3-day consensus, created an in-depth review of current knowledge on the role of diet in CVD, the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries, age/race/ethnicity/socioeconomic groups suggest the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps are highlighted. There are large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries (LMIC), particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however major gaps exist both in dietary pattern research and ways to change diets and food systems. Based on the current evidence, the traditional Mediterranean-type diet, including plant foods/emphasizing plant protein sources, provides a well-tested healthy dietary pattern to reduce CV

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Introduction to C++

This course is designed for undergraduate and graduate students in science, social science and engineering programs who need to learn fundamental programming skills quickly but not in great depth. The course is ideal for undergraduate research positions or summer jobs requiring C++. It is not a class for experienced programmers in C++. Students with no programming background are welcome. Topics include control structures, arrays, functions, classes, objects, file handling, and simple algorithms for common tasks. This course is offered during the Independent Activities Period (IAP), which is a special 4-week term at MIT that runs from the first week of January until the end of the month