High Power, Continuous-wave Supercontinuum Generation in Highly Nonlinear Fibers Pumped with High Order, Cascaded Raman Fiber Amplifiers

A novel method for efficient generation of high power, equalized continuous-wave supercontinuum source in an all conventional silica fiber architecture is demonstrated. Highly nonlinear fiber (HNLF) is pumped in its anomalous dispersion region using a novel, high power, L-band laser. The L-band laser encompasses a 6th order cascaded Raman amplifier which is pumped with a high power Ytterbium doped fiber laser and amplifies a low-power, tunable L-band seed source. The supercontinuum generated 35W of power with ~40% efficiency. The Supercontinuum spectrum was measured to have a high degree of flatness of better than 5 dB over 400 nm of bandwidth (1.3 - 1.7 micron, limited by spectrum analyzer range) and a power spectral density in this region of >50 mW/nm. The extent of the SC spectrum is estimated to be upto 2 micronComment: 6 pages, 5 figure

High Power, Tunable, Continuous-Wave Fiber Lasers in the L-band using Cascaded Raman Amplifiers

We demonstrate a high power, all-fiber, tunable laser source that can operate in the L-band region. A low power, tunable input laser is amplified with a recently proposed, high efficiency, 6th order cascaded Raman amplifier. The proposed system is scalable and overcomes the limitations of Erbium and Erbium-Ytterbium co-doped fiber lasers for power scaling. A tunable Erbium-Ytterbium co-doped fiber ring laser generating ~0.5W of power and tunable in the 1560-1590 nm wavelength range is utilized as the seed source. The output from the seed laser is amplified to ~24 W using 6th order cascaded Raman amplification. A high power Yb laser operating at 1117nm is used as the pump laser for driving the Raman conversions. The operating wavelength of the demonstrated laser in the eye-safe, atmospherically transparent region enables high power free-space applications. In addition, this source enables other interesting applications such as high power supercontinuum generation with conventional silica fibers.Comment: 6 pages, 5 figure

Is low amniotic fluid index an indicator of fetal distress and hence delivery?

Background: Amniotic fluid Index (AFI) is an indicator of fetal well-being. Low AFI is considered to be one of the indications for delivery as it may be associated with fetal distress and birth asphyxia. We sought to determine whether low AFI is an indicator of fetal compromise and an indication to deliver.Methods: This prospective, observational study was conducted at Department of Obstetrics & Gynecology, KMC, Manipal University, India, between August 2013 and Aug 2014. A total of 150 subjects that had induced labor or direct caesarean section for various indications and also having low-normal (5-8) / low (<5) AFI, were recruited. Subjects with fetal anomalies were excluded. Outcome variables studied were, fetal distress in labor, thick meconium stained amniotic fluid, mode of delivery in induced labor, perinatal asphyxia, and respiratory distress syndrome.Results: Out of 150 subjects, 68 (45.4%) had low and 82 (54.6%) had low-normal AFI. Both the groups were matched for demographic characteristics and confounding factors for neonatal outcome. In low AFI group the incidence of Low APGAR (11.7%), perinatal asphyxia (11.7%) and RDS (16.1%) were significantly higher compared to those in low-normal group (3.6%, 1.2% and 2.4% respectively) p = 0.057, 0.006 and 0.002. There was no significant difference between the groups with respect to mode of delivery when labor was induced.Conclusions: Low AFI, especially when it is <5, is an indicator of fetal compromise and one may anticipate perinatal asphyxia and RDS. Hence it is prudent to contemplate delivery when the AFI is between 5 and 8

A study on anxiolytic activity and locomotor behavior of Curcuma amada rhizomes using Wistar albino rats

Background: Global burden of disease statistics indicate that 4 of 10 most important causes of disease worldwide are psychiatric in origin. Anxiety affects 1/8th of total population of the world and is a very important area of research interest in psychopharmacology. Medicinal plants and plant products are the oldest tried health-care products. Their importance is growing not only in developing countries but in many developed countries. Curcuma amada Roxb. (CA) commonly known as Mango Ginger is a rhizomatous aromatic herb which is used in this country for culinary purposes and also to treat various diseases. The rhizomes of Curcuma amada was screened for anxiolytic activity and locomotor behavior in Wistar albino rats.Methods: Wistar albino rats were divided into three groups as control (Distilled water with 0.1% CMC), standard (Diazepam - 1mg/kg) and test - Ethanolic Extract of Curcuma amada Rhizome (EECAR-250 mg/kg). They were administered drugs orally for a period of 10 days, and screened for anxiolytic activity using Light dark arena model and Actophotometer for assessing the locomotor behavior on the 10th day. The number of crossings and time spent in light arena for anxiolytic activity, and the number of movements in Actophotometer was noted. Data was analyzed by one way ANOVA followed by Tukey Kramer multiple comparison test using GraphPad InStat software.Results: Curcuma amada (250mg/kg) showed increased time spent in light arena and decreased locomotor behavior which was statistically significant.Conclusions: Curcuma amada possesses significant anxiolytic with CNS depressant activity

Rickettsial neglected zoonoses: prevalence of scrub typhus at central Karnataka

Background: Fever of unknown Origin (FUO) has many multiple causes such as enteric fever, malaria, dengue, tuberculosis, brucellosis. But scrub typhus is less known cause in Indian scenario. The present study reports the prevalence of scrub typhus at central Karnataka and compares the sensitivity and specificity of Weil-Felix test and the IgM ELISA in the detection of infection.Methods: 368 serum samples of FUO cases were collected. Weil-Felix test was performed and also analyzed for IgM antibodies to Orienta tsutsugamushi by IgM ELISA test along with haematological and biochemical investigations.Results: Out of 368 patients of fever of unknown origin, 94 cases were positive by OXK antigens by Weil Felix test and 61 were positive by ELISA test for ST IgM antibodies. Fever was the most common clinical presentation occurring in ST IgM ELISA positive cases, followed by myalgia in 90.1% cases, headache in 77%, hepatomegaly in 65.5%, splenomegaly in 62.2% and rashes were seen in 29.5% patients. Eschar was seen in 13.1% patients, pneumonia in 3.2% and meningo-encephalitis in 1.6%. Sensitivity and specificity of WFT in relation to IgM ELISA at a titre of 160 was 81.97% and 85.67% respectively.Conclusions: With the growing number of cases detected in India, scrub typhus is fast emerging as a public health threat and also due to limited diagnostics leading to underreporting, Weil Felix test could be used in adjunct with Enzyme-linked immunosorbent assay and blood parameters in the diagnosis of rickettsial diseases

Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia

Background: Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia. Methods/Design: This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan. The economic evaluation comprises both a within-trial cost-effectiveness analysis (mean 2.5 years follow up) and a microsimulation model-based cost-utility analysis (life-time horizon). Effectiveness measures include multiple risk factor control (achieving HbA1c \u3c 7% and blood pressure \u3c 130/80 mmHg and/or LDL-cholesterol\u3c 100 mg/dl), and patient reported outcomes including quality adjusted life years (QALYs) measured by EQ-5D-3 L, hospitalizations, and diabetes related complications at the trial end. Cost measures include direct medical and non-medical costs relevant to outpatient care (consultation fee, medicines, laboratory tests, supplies, food, and escort/accompanying person costs, transport) and inpatient care (hospitalization, transport, and accompanying person costs) of the intervention compared to usual diabetes care. Patient, healthcare system, and societal perspectives will be applied for costing. Both cost and health effects will be discounted at 3% per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon. Outcomes will be reported as the incremental cost-effectiveness ratios (ICER) to achieve multiple risk factor control, avoid diabetes-related complications, or QALYs gained against varying levels of willingness to pay threshold values. Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs (95% CIs) across public vs. private settings and using conservative estimates of effect size (95% CIs) for multiple risk factor control. Costs will be reported in US$ 2018. Discussion: We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes, thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings

Characteristics and Programme-Defined Treatment Outcomes among Childhood Tuberculosis (TB) Patients under the National TB Programme in Delhi

Childhood tuberculosis (TB) patients under India's Revised National TB Control Programme (RNTCP) are managed using diagnostic algorithms and directly observed treatment with intermittent thrice-weekly short-course treatment regimens for 6–8 months. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram) that are lower than current World Health Organization (WHO) guidelines for some patients.The main aim of our study was to describe the baseline characteristics and treatment outcomes reported under RNTCP for registered childhood (age <15 years) TB patients in Delhi. Additionally, we compared the reported programmatic treatment completion rates between children treated as per WHO recommended anti-TB drug doses with those children treated with anti-TB drug doses below that recommended in WHO guidelines.For this cross-sectional retrospective study, we reviewed programme records of all 1089 TB patients aged <15 years registered for TB treatment from January to June, 2008 in 6 randomly selected districts of Delhi. WHO disease classification and treatment outcome definitions are used by RNTCP, and these were extracted as reported in programme records.Among 1074 patients with records available, 651 (61%) were females, 122 (11%) were <5 years of age, 1000 (93%) were new cases, and 680 (63%) had extra-pulmonary TB (EP-TB)—most commonly peripheral lymph node disease [310 (46%)]. Among 394 pulmonary TB (PTB) cases, 165 (42%) were sputum smear-positive. The overall reported treatment completion rate was 95%. Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO. Further studies are needed to assess the reasons for the low proportion of under-5 years of age TB case notifications, address challenges in reaching all childhood TB patients by RNTCP, the accuracy of diagnosis, and the clinical validity of reported programme defined treatment completion

Association between full service and fast food restaurant density, dietary intake and overweight/obesity among adults in Delhi, India

Abstract Background The food environment has been implicated as an underlying contributor to the global obesity epidemic. However, few studies have evaluated the relationship between the food environment, dietary intake, and overweight/obesity in low- and middle-income countries (LMICs). The aim of this study was to assess the association of full service and fast food restaurant density with dietary intake and overweight/obesity in Delhi, India. Methods Data are from a cross-sectional, population-based study conducted in Delhi. Using multilevel cluster random sampling, 5364 participants were selected from 134 census enumeration blocks (CEBs). Geographic information system data were available for 131 CEBs (n = 5264) from a field survey conducted using hand-held global positioning system devices. The number of full service and fast food restaurants within a 1-km buffer of CEBs was recorded by trained staff using ArcGIS software, and participants were assigned to tertiles of full service and fast food restaurant density based on their resident CEB. Height and weight were measured using standardized procedures and overweight/obesity was defined as a BMI ≥25 kg/m2. Results The most common full service and fast food restaurants were Indian savory restaurants (57.2%) and Indian sweet shops (25.8%). Only 14.1% of full service and fast food restaurants were Western style. After adjustment for age, household income, education, and tobacco and alcohol use, participants in the highest tertile of full service and fast food restaurant density were less likely to consume fruit and more likely to consume refined grains compared to participants in the lowest tertile (both p < 0.05). In unadjusted logistic regression models, participants in the highest versus lowest tertile of full service and fast food restaurant density were significantly more likely to be overweight/obese: odds ratio (95% confidence interval), 1.44 (1.24, 1.67). After adjustment for age, household income, and education, the effect was attenuated: 1.08 (0.92, 1.26). Results were consistent with further adjustment for tobacco and alcohol use, moderate physical activity, and owning a bicycle or motorized vehicle. Conclusions Most full service and fast food restaurants were Indian, suggesting that the nutrition transition in this megacity may be better characterized by the large number of unhealthy Indian food outlets rather than the Western food outlets. Full service and fast food restaurant density in the residence area of adults in Delhi, India, was associated with poor dietary intake. It was also positively associated with overweight/obesity, but this was largely explained by socioeconomic status. Further research is needed exploring these associations prospectively and in other LMICs

Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

OBJECTIVE We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. METHODS A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. RESULTS The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain. CONCLUSION Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations