Evolution of Responsiveness of Health System

Responsiveness is concerned with meeting the legitimate non health expectations of patients. The paper tries to explain the concept, domains and evolution of responsiveness. WHO concept of responsiveness has been criticized for using a single composite score for comparing responsiveness between countries. In spite of recognizing these issues and after much debate, no empirical research has been undertaken. Hence there is a need to recognize what constituents of responsiveness need to be reorganized, which other elements need to be added to existing WHO proposed elements of responsiveness in culturally, socially, politically different society. The paper through extensive study on responsiveness concludes the need to tailor responsiveness domains according to citizen’s priority in a particular background

Study of risk factors and tumor markers in ovarian malignancy in western part of Odisha: a prospective observational study

Background: Ovarian cancer represents one of the most frequently seen malignancies in women and it is the fifth most common cause of cancer-related death in women. The aim of the study to determine the risk factors leading to ovarian cancer in western part of Odisha, India and show the tumour markers in this population.Methods: This is a prospective observational study included 240 ovarian masses diagnosed at Department of Obstetrics and Gynaecology, V. S. S. Medical College, Burla, Sambalpur over 3 years based on preoperative clinical, biochemical (tumour markers) and imaging study and confirm through post-operative histopathology reports.Results: Surface epithelial tumours (68.33%) followed by germ cell tumours (30.83%) are the most common ovarian tumour. Incidence of ovarian cancer is 73.58% in ≤50 years of age group and more number of cases (16.65%) also found in younger age (≤30 year). Overall number of ovarian cancer cases rising. Bilateral tubal ligation is not a protective factor for ovarian cancer (p value >0.05) and consumption of alcohol and tobacco is not increase risk for ovarian cancer. Most of ovarian tumour commonly present with vague abdominal pain (75.83%) followed by mass per abdomen (55%). Ascites mainly a presentation of malignant tumour seen in 46(63.88%) cases. CA125 is the frequently detected tumour markers and all of the tumour markers were significantly within normal limit.Conclusions: Ovarian neoplasia is one of the most common and lethal malignancy in female reproductive tract. Though it is a disease of older age but now a day more no of cases also seen in younger age group. Since most of the ovarian cancer remain asymptomatic for long period so measure should be taken for early diagnosis for best outcome. So, assessment of each regions statistical information reflecting its own profile may be important for estimation of risk for development of ovarian cancer and so useful for early preventive measure before progress to advance stage where prognosis is worst. So, relationship between the profiles of patients and types of ovarian neoplasms may give an idea about the risk factors of the disease in its region. Additionally, distribution of tumour markers might be considered for the dis-criminating of the benign or malign characters of the ovarian neoplasia

Risk management and prevention of antibiotics resistance: The PREVENT IT project

Background: Globally, a significant increase in the emergence of antibiotic resistant (ABR) path-ogens has rendered several groups of antibiotics ineffective for the treatment of life-threatening infections. It is an endemic in hospital settings and a major concern while handling pathogens involved in an epidemic or pandemic. ABR is a matter of great concern due to its recusant impact on public health and cost to the healthcare system, especially in developing country like India. An indiscriminate and inappropriate usage of antimicrobials, poor infrastructure and sanitation are the major factors driving the evolution of ABR in such countries. Therefore, in addition to the devel-opment of novel therapeutics and safeguarding the efficacy of existing antibiotics, there is an ur-gent need for a programme focussed on the education in risk management and prevention of ABR. Aim: To promote qualitative teaching activities in academia and society to visualize a future where every individual is aware of ABR and empowered with right education to address the issue. Methods: The project ‘Risk Management and Prevention of Antibiotics Resistance - PREVENT IT’, funded by the ERASMUS+ Programme of the European Union, converges academicians and non-government organizations (NGOs) to inculcate a sense of awareness towards the increase in the frequency of ABR pathogens, judicial usage of antimicrobials and the economic/health burden of ABR, in students, academicians, clinicians and population at large. Expected outcome: The project commissioned envisages a behavioural change in individuals and attempts to support policymakers by executing stable changes in the curricula of institutes of higher education, developing advanced workshop modules for the training of academicians and disseminating ABR-related information through conferences/seminars, social media campaigns and an online platform dedicated to ABR. In addition, the project aims to develop a European-Indian network for the management of risk and prevention of ABR. &nbsp

Upper gut heat shock proteins HSP70 and GRP78 promote insulin resistance, hyperglycemia, and non-alcoholic steatohepatitis

A high-fat diet increases the risk of insulin resistance, type-2 diabetes, and non-alcoholic steato-hepatitis. Here we identified two heat-shock proteins, Heat-Shock-Protein70 and Glucose-Regulated Protein78, which are increased in the jejunum of rats on a high-fat diet. We demonstrated a causal link between these proteins and hepatic and whole-body insulin-resistance, as well as the metabolic response to bariatric/metabolic surgery. Long-term continuous infusion of Heat-Shock-Protein70 and Glucose-Regulated Protein78 caused insulin-resistance, hyperglycemia, and non-alcoholic steato-hepatitis in rats on a chow diet, while in rats on a high-fat diet continuous infusion of monoclonal antibodies reversed these phenotypes, mimicking metabolic surgery. Infusion of these proteins or their antibodies was also associated with shifts in fecal microbiota composition. Serum levels of Heat-Shock-Protein70 and Glucose-Regulated Protein78were elevated in patients with non-alcoholic steato-hepatitis, but decreased following metabolic surgery. Understanding the intestinal regulation of metabolism may provide options to reverse metabolic diseases

Clinical trials law and policy: human subjects protection and global dynamics

This thesis deals with the implications of clinical research specifically, clinical trials in terms of law and policy at the international level. Chapter One presents a comprehensive review of the literature relating to the law and policy of clinical trials, with a specific focus on their international dimension. Chapter Two describes the main rights touched upon by the conduction of and participation in clinical trials. Chapter Three describes the main stakeholders involved in clinical trials (human subjects, sponsors, and investigators) and how their interests align or collide in the face of the need to balance three traditional healthcare competing paradigms: access, cost, and quality. Chapter Four deals with the concerns raised by the globalization of clinical trials, building on one of the most renowned contributions in the field of clinical trials ethics literature. Chapter Five presents a comparative analysis of the European Union and United States clinical trial legal frameworks. Chapter Six focuses on the issue of clinical trials data transparency. The case for registration is taken into consideration because the global dimension of the issue is particularly relevant and the development of an in international set of standards in this context has been successfully achieved thanks to synergy between different stakeholders. Finally, Chapter Seven adopts a more practical approach. It introduces the results of several interviews conducted with clinical trials sponsors, patients and consumer organizations, and investigators and presents the findings of a simple empirical analysis focused on recruitment-dynamics

WriteSim TCExam - An open source text simulation environment for training novice researchers in scientific writing

BACKGROUND: The ability to write clearly and effectively is of central importance to the scientific enterprise. Encouraged by the success of simulation environments in other biomedical sciences, we developed WriteSim TCExam, an open-source, Web-based, textual simulation environment for teaching effective writing techniques to novice researchers. We shortlisted and modified an existing open source application - TCExam to serve as a textual simulation environment. After testing usability internally in our team, we conducted formal field usability studies with novice researchers. These were followed by formal surveys with researchers fitting the role of administrators and users (novice researchers) RESULTS: The development process was guided by feedback from usability tests within our research team. Online surveys and formal studies, involving members of the Research on Research group and selected novice researchers, show that the application is user-friendly. Additionally it has been used to train 25 novice researchers in scientific writing to date and has generated encouraging results. CONCLUSION: WriteSim TCExam is the first Web-based, open-source textual simulation environment designed to complement traditional scientific writing instruction. While initial reviews by students and educators have been positive, a formal study is needed to measure its benefits in comparison to standard instructional methods

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe