Statistical Measures to Determine Optimal Structure of Decision Tree: One versus One Support Vector Machine

In this paper, one versus one optimal decision tree support vector machine (OvO-ODT SVM) framework is proposed to solve multi-class problems where the optimal structure of decision tree is determined using statistical measures, i.e., information gain, gini index, and chi-square. The performance of proposed OvO-ODT SVM is evaluated in terms of classification accuracy and computation time. It is also shown that proposed OvO-ODT SVM using all the three measures is more efficient in terms of time complexity for both training and testing phases in comparison to conventional OvO and support vector machine binary decision tree (SVMBDT). Experiments on University of California, Irvine (UCI) repository dataset illustrates that ten crossvalidation accuracy of our proposed framework is comparable or better in comparison to conventional OvO and SVM-BDT for most of the datasets. However, the proposed framework outperforms the conventional OvO and SVM-BDT for all the datasets in terms of both training and testing time.Defence Science Journal, 2010, 60(4), pp.399-404, DOI:http://dx.doi.org/10.14429/dsj.60.50

On production and abatement time scales in sustainable development. Can we loosen the sustainability screw ?

In this paper we carry out a preliminary exploration of a time scales' conjecture, which postulates that "reasonable" notions of sustainability must include a suitable synchronisation of time scales of both the processes of human development and those of the natural environment. We perform our analysis within a coarse, ?ve variable, model of man-nature interactions expressed as a system of differential equations where production and human capital are coupled with both renewable and non-renewable natural resource. We demonstrate a phenomenon that we name the "sustainability screw" that describes a spiral like trajectory of the three key variables: non-renewable and renewable resources as well as the production capital. Under many plausible scenarios, this spiral tends unacceptably fast to an undesirable equilibrium. However, we also show that by adjusting the ratio of "intensity of production effort" and "intensity of abatement effort", parameters of the relative time scales of production and natural recovery processes can be altered in a manner that produces, arguably, more sustainable trajectories.sustainable optimization systems, viability, multiple time scale

Antimicrobials associated adverse drug reaction profiling: a four years retrospective study (Pharmacovigilance study)

Background: All drugs profoundly modify our biological processes and may manifest as adverse drug reactions (ADRs), which are unpredictable and inevitable consequences. Antibiotics are a common cause of ADR, necessitating stopping or change of antibiotics. The incidence of ADRs increases with the number of drugs prescribed in a prescription, and antibiotics are rarely prescribed as monotherapy.Aim: The study aimed to assess frequency, class of antibiotics, symptoms, causality, the severity of antimicrobial-associated ADRs, and see the demographic distribution.Methods: ADRs were collected and filled in suspected ADR forms and sent via vigiflow to the National Coordination Centre-Pharmacovigilance Programme of India (NCC-PvPI). These ADR reports, termed individual case safety reports (ICSRs), were analyzed from Jan 2016 to Dec 2019.Results: A total of 414 (54.33%) ICSRs of 762 were identified as antimicrobial-associated. Adults in the age group 19–65 years accounted for 345 (83.09%) of ADRs. A total of 192 (46.38%) were males, and 222 (53.14%) were females. Skin and subcutaneous tissue System organ class was involved in 54% of cases. In the causality assessment, 268 (64.49%) were “probable,” 123 (29.71%) were “possible,” and 23 (5.56%) were “certain.” On severity assessment, 256 ADRs (61.83%) were mild, 133 (32.12%) were moderate, and 25 (6.03%) were severe. A total of 54 antimicrobial agents, excluding anti-tubercular drugs, were identified, and antibacterial accounted for 268 (64.73%) ADRs, followed by antiviral 90 (21.73%), antiprotozoal agents 33 (7.97%) antimalarials anti-scabicidal, antifungal accounting for the remaining.Conclusion: Antimicrobials play a crucial role in treating infections, and utmost vigilance during antimicrobials prescription reduces the frequency and severity of the ADRs, thereby reducing the morbidity and mortality and the pharmacoeconomic burden to the health care system. Pharmacovigilance must be boosted to ensure the safe and effective use of antibiotics and reduce the occurrence of ADRs

Status of package insert guidelines for drugs accessible as over the counter drugs

Background: As per Indian pharmacopoeia, package inserts are part of a label that provides information on the article. It may be the sole source of information for drugs, which are available in the pharmacies without the prescription and it may include both prescription and over the counter (OTC) drugs. So, to aid in safety and efficacy of these drugs, package inserts must follow the standard guidelines (The Drugs and Cosmetics rule, 1945). The objective of this study was to observe the status of the standard guidelines for package insert in drugs accessible as OTC drugs.Methods: Based on the inquiries made with pharmacies, list of drugs commonly bought without prescription was made. 256 drugs were evaluated. Their package inserts were observed for the extent to which the guidelines given by The Drugs and Cosmetics rule 1945, section 6.2 and 6.3 are being followed. Secondary objectives were made to assess if package inserts are physician friendly or patients friendly.Results: Package inserts were missing in 180 (70%) of the drugs.  Therapeutic indications were present in 71% of the available package inserts (76). Pharmaceutical information was given in 57% of the package inserts. English was the preferred language and medicinal terms were used. Only one package insert was patient friendly.Conclusions: Package inserts should be made available in every drug. There should be a separate patient oriented package insert guideline, as per US food and drug administration (FDA), in India as well. This will aid in their safe and effective use

Escherichia coli as uropathogen: antibiotic susceptibility profiling

Background: Empirically chosen antibiotics based on the local resistance pattern of uropathogens remain the principle treatment of urinary tract infections (UTI).Methods: Antibiogram of most frequent uropathogen was determined. Based on the antibiogram result, authors compared effectiveness of drugs recommended for UTI by National centre for disease control (NCDC), India, and assessed age and gender based variability in the effectiveness of these drugs.Results: 1278 urine samples were accounted, of which 405 samples showed significant growth. E. coli was the most common uropathogen (n=146, 36%) followed by enterococcus species (31%) and Klebsiella pneumoniae (10%). Using McNemar’s test authors found that nitrofurantoin (90% sensitivity) was statistically the most effective drug among drugs recommended by NCDC for uncomplicated cystitis. Furthermore, authors used Fisher’s exact test on adults and paediatrics and found that significant difference in effectiveness was observed for nitrofurantoin (p-value <0.001) and cotrimoxazole (p-value 0.034). Using logistic regression, authors found that with age, effectiveness of ciprofloxacin and cotrimoxazole deteriorate significantly (p-value 0.021 and 0.002 respectively). Additionally, authors observed that cotrimoxazole has significantly better efficacy in males compared to females (p-value 0.022).Conclusions: In accordance with present study, nitrofurantoin can be used as first line treatment for uncomplicated cystitis. Age and gender should be considered while prescribing empirical treatment for UTI. Periodic surveillance should be carried out to identify the on-going pattern of antibiogram to update the guideline for empirical therapy

Addressing Dissociative Trance Disorder Patients in India: An Interpretative Phenomenological Analysis of Adolescent Girls\u27 Help-Seeking and Encounters with Inaccurate Medical Information

Background: Dissociative Trance Disorder (DTD), is a complex psychological condition characterized by abrupt trance-like states and altered consciousness, commonly seen in young women throughout various regions of India. Currently, there is a lack of research on the experiences of Indian adolescent girls with DTD and how inaccurate medical information affects their quest for suitable care. This study aims to develop a thorough comprehension of the help-seeking patterns and experiences of adolescent girls with DTD, specifically concerning encountering medical misinformation. By identifying the obstacles, they face and the cultural beliefs that shape their decision-making, this research seeks to guide interventions and initiatives aimed at enhancing care and support for this group. Method: Six adolescent girls and young women, who sought therapy at a district hospital in Sikkim were recruited for the study. They were interviewed extensively and their interview data were transcribed verbatim and analyzed using interpretative phenomenological analysis. Result: Three super-ordinate themes that emerged were: challenges in seeking diagnosis and treatment; emotional and psychological struggles; support and healing journey. Conclusion: Misinformation surrounding DTD in India impacts the help-seeking behaviours of adolescent girls, leading to delays in diagnosis and inadequate treatment. Cultural beliefs, reliance on exorcism, and insufficient healthcare professional training contribute to this problem. Awareness campaigns are necessary to correct misconceptions and misinformation and promote accurate understanding among parents, communities, and healthcare providers. Culturally sensitive approaches, accurate information dissemination, and collaboration among stakeholders are crucial for improving care and support for individuals affected by DTD in India. Additionally, it is acknowledged that certain religious beliefs resist empirical evidence, but it is vital to recognize that not all religious beliefs are misinformation solely based on scientific evidence. As we address the impact of cultural beliefs, it is essential to strike a balance between respecting individual faith and promoting evidence-based interventions

Knowledge, attitude and practice toward adverse drug reaction reporting among practicing clinicians at a tertiary care hospital

Background: Pharmacovigilance has evolved as an important tool for dealing with Adverse Drug Reactions (ADRs) both in pre-marketing and post-marketing scenario. Underreporting of ADRs at our Adverse drug reaction Monitoring Centre (AMC) led us to conduct this study to assess Knowledge, Attitude and Practice (KAP) of the practicing clinicians at our tertiary care Pt. J.N.M. Medical College associated Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, India, towards ADRs reporting.Methods: This was a cross-sectional study using pretested questionnaires consisting of 29 questions related to KAP of the practicing clinicians at Pt. J.N.M. Medical College associated Dr. B.R.A.M.  Hospital, Raipur towards ADRs reporting. The percentage of responders for each question was calculated. All statistical analysis was performed in Microsoft Office Excel 2007.Results: Out of 135 questionnaires distributed only 100 were considered for analysis, so the overall response rate was 74.07%. We calculated the result from the 100 responders. Overall 77% responders were aware of existence of ADR monitoring system in India, while only 40% were aware of its existence at their hospital. Only 8% responders had reported ADRs to the National Pharmacovigilance Centre and 10% to the Adverse drug reaction Monitoring Centre (AMC) at their hospital. Lack of knowledge about where, how and whom to report ADRs, lack of time, inability to decide what to report (known or unknown ADRs) and unavailability of ADR reporting form were the important factors discouraging them reporting ADRs.Conclusions: Creating awareness regarding ADR reporting through CMEs among practicing clinicians and early sensitization at medical undergraduate level for medical students may improve the current ADR reporting rate. 

Knowledge, Attitude and Practice on Biologicals and Biosimilars among Clinicians in Radiotherapy Department

Background: The decoding of human genome helped to design pharmacological agents like Biologicals and Biosimilars which can target the affected etiological aberrations. Biological agents are large complex molecules produced by recombinant techniques in a living system for therapeutic or diagnostic uses and have revolutionized treatment of many diseases. Patent expiry of Biologicals has led to the development of Biosimilars which are similar in efficacy & safety and have no clinically meaningful differences, but are not identical to Biologicals and undergo fewer clinical trials than their reference biologicals. Clinicians’ in- depth knowledge of these agents is important to optimize the use of cost-effective & easily accessible options. Methods: This is a cross sectional observational study conducted between Feb-March 2020 in Radiotherapy/Chemotherapy Oncology Department of Dr B.R.A.M. Hospital & Pt. J. N. M. Medical College, Raipur, Chhattisgarh, using a self-administered, structured questionnaire consisting of 15-question among 30 clinicians prescribing Biologicals and Biosimilars. Results: 83.3% of clinicians were familiar with the term ‘Biologicals’ & ‘Biosimilars’. 60% believed that Biosimilars are same as Generic Medicines and have the same potency as Biologicals. 53% assumed that Biologicals & Biosimilars can be switched. 50% were able to explain the difference or similarity between Biologicals and Biosimilars. Conclusion: The findings reveal that the clinicians had good knowledge about Biologicals and Biosimilars but lacked application of this knowledge in clinical practice. This highlights a need for regular educational initiative to reduce the knowledge deficit & its application in clinical practice. Further, there must be a National Treatment Guidelines on use of Biologicals  and Biosimilars

Characteristics of Craniofacial Trauma in a Rural Hospital in South India

Background/Purpose: Purpose of this study was to evaluate the population characteristics of patients with both head injury and facial fractures in rural centre. Methods: This study was a retrospective study performed at Justice K.S. Hegde Charitable Hospital, Deralakatte (Mangalore) and a total of 36 patients were reviewed. Type of fracture, mechanism, clinical features and pattern of injuries were noted. All patients who sustained both cranial and facial injuries were included in this study. Results: Mean age was 32.64 years (range, 4 years to 70 years) with a male to female ratio of 35:1. Motor vehicular accidents (44.4%) were most common cause of injury followed by fall (22.2%). Most common areas involved were upper face (36.1%) and lower face (25%) followed by combination of upper and middle face (11.1%) other areas were less commonly involved. Headache and vomiting were most common clinical features followed by loss of consciences. Closed head injuries were the most common neurological injury (14 cases) followed by skull fractures (5 cases). Most patients with upper facial fractures or combination of it had associated injuries. There was no mortality in the present series. Conclusion: This study further supports that injury patterns in developing countries particularly in rural area are no different from developed countries and needs to follow similar preventive and counseling measures.Fond/But: Le but de cette \ue9tude \ue9tait d'\ue9valuer les caract\ue9ristiques de population des malades avec les blessures cr\ue2niens et les ruptures faciales au centre rural. M\ue9thodes: Cette \ue9tude \ue9tait une \ue9tude r\ue9trospective r\ue9alis\ue9e \ue0 l'H\uf4pital Charitable de la Justice K. S. Hegde, Deralakatte (Mangalore) et un total de 36 malades ont \ue9t\ue9 pass\ue9s en revue. Le type de rupture, le m\ue9canisme, les dispositifs cliniques et le mod\ue8le des blessures ont \ue9t\ue9 not\ue9s. Tous les malades qui ont soutenu des blessures cr\ue2niens et faciaux ont \ue9t\ue9 inclus dans cette \ue9tude. R\ue9sultats: L'\ue2ge moyen \ue9tait de 32,64 ans (gamme, 4 ans \ue0 70 ans) avec un rapport de \ue0 femelle de 35:1. Les accidents v\ue9hiculaires de moteur (44,4%) \ue9taient la cause la plus commune des blessures suivie de la chute (22,2%). La plupart des parties de corps communes impliqu\ue9es \ue9taient le visage sup\ue9rieur (36,1%) et le visage inf\ue9rieur (25%) suivi de combinaison de visage sup\ue9rieur et moyen (11,1%) autres parties \ue9taient moins impliqu\ue9 g\ue9n\ue9ralement. La c\ue9phal\ue9e et le vomissement \ue9taient la plupart des dispositifs cliniques communs suivis de la perte de consciences. Les blessures cr\ue2niens ferm\ue9es \ue9taient les blessures neurologiques les plus communs (14 cas) suivis des ruptures de cr\ue2ne (5 cas). La plupart des malades pr\ue9sentant des ruptures faciales sup\ue9rieures ou sa combinason avaient des blessures associ\ue9es. Il n'y avait aucune mortalit\ue9 de la s\ue9rie actuelle. Conclusion : Cette \ue9tude soutient de plus le fait que les mod\ue8les de blessures dans les pays en voie de d\ue9veloppement en particulier dans le secteur rural ne sont pas diff\ue9rents des pays d\ue9velopp\ue9s et aussi les besoins de suivre les mesures pr\ue9ventives et conseillantes semblables