OLANZAPINE COMBINED WITH STANDARD ANTIEMETIC REGIMENS FOR PREVENTION OF CHEMOTHERAPY THERAPY-INDUCED NAUSEA AND VOMITING: A SINGLE-CENTER EXPERIENCE FROM SOUTH INDIA

  Objectives: Olanzapine, an antipsychotic agent, exhibits significant antiemetic properties due to its inhibitory activity on neurotransmitters at multiple receptors involved in chemotherapy-induced nausea and vomiting (CINV). CINV can have an immensely negative impact on patient's quality of life (QOL) and daily activities. Our objectives were to determine the effectiveness of adding olanzapine to standard antiemetic regimens for the prevention of CINV in cancer patients and to compare the QOL of such patients with those receiving standard antiemetic regimens.Methods: A prospective, observational, cohort study was done on patients receiving either highly or moderately emetogenic chemotherapy (MEC). The patients who received only the standard antiemetic regimens were considered as the control group and those who received 10 mg of olanzapine once daily on days 1-5 of chemotherapy in addition to the standard antiemetic regimens were considered to be the study group. The patients were assessed for grades of nausea and vomiting using National Cancer Institute common terminology criteria for adverse events and for QOL using European Organization in Research and Treatment of Cancer QOL questionnaire.Results: Patients were evaluated for a total of 168 cycles of chemotherapy. Compared to the control group, the study group patients showed significant improvement in response to acute nausea (p=0.02) but not in acute vomiting (p=0.09). However, response to delayed nausea and vomiting improved significantly (p=0.004 and p=0.05, respectively). The QOL of study group patients showed significant improvement in functional scales and symptom scales (p<0.02). Global health status also increased significantly (p=0.02) in the study group patients.Conclusion: Olanzapine containing pre-medication regimens can reduce acute and delayed nausea and delayed vomiting and improve the QOL of cancer patients receiving highly or moderately emetogenic chemotherapeutic agents as compared to the standard pre-medication regimens

A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India

Background: A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. Methods: An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre- (2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. Results: The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. Conclusions: MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas

Short-Lived Trace Gases in the Surface Ocean and the Atmosphere

The two-way exchange of trace gases between the ocean and the atmosphere is important for both the chemistry and physics of the atmosphere and the biogeochemistry of the oceans, including the global cycling of elements. Here we review these exchanges and their importance for a range of gases whose lifetimes are generally short compared to the main greenhouse gases and which are, in most cases, more reactive than them. Gases considered include sulphur and related compounds, organohalogens, non-methane hydrocarbons, ozone, ammonia and related compounds, hydrogen and carbon monoxide. Finally, we stress the interactivity of the system, the importance of process understanding for modeling, the need for more extensive field measurements and their better seasonal coverage, the importance of inter-calibration exercises and finally the need to show the importance of air-sea exchanges for global cycling and how the field fits into the broader context of Earth System Science

Chapter 7: Uncertainty quantification

Random parameters Probability density function Hyperbolic conservation law a b s t r a c t We develop a probabilistic approach to quantify parametric uncertainty in first-order hyperbolic conservation laws (kinematic wave equations). The approach relies on the der-ivation of a deterministic equation for the cumulative density function (CDF) of a system state, in which probabilistic descriptions (probability density functions or PDFs) of system parameters and/or initial and boundary conditions serve as inputs. In contrast to PDF equa-tions, which are often used in other contexts, CDF equations allow for straightforward and unambiguous determination of boundary conditions with respect to sample variables. The accuracy and robustness of solutions of the CDF equation for one such system, the Saint– Venant equations of river flows, are investigated via comparison with Monte Carlo simulations.! 2012 Elsevier Inc. All rights reserved. 1