Development of small and medium enterprises through clusters and networking : a comparative study of India, Pakistan and Sri Lanka

Clusters have several advantages. These include a high degree of networking which stimulates productivity, ability to diversify and to acquire the capacity to new products when the demand for existing products falls. The policy makers are searching ways to create new clusters. With an even more globalized world and increased competition the appeal of clusters has become stronger and more urgent. Yet, the formation and the sustenance of the clusters has somehow remained a mystery. There has been a limited research carried out in this direction. No doubt it is a complex area and no figurative results can be highlighted to show as to how the development of industrial clusters has taken place. The authors go about seeking answers to these questions by examining the experience of some of the prominent and successful clusters, their formation and sustenance in the three countries. The study further investigates various initiatives, the role and the results thereof in development of clusters.peer-reviewe

Analysis of waiting time for elective surgical procedures in neurosurgery department at a tertiary care teaching hospital in NCT, India

Background: Reported increases in waiting times for publicly-funded elective surgeries have intensified the need to decrease wait by healthcare providers and hence the study.Methods: Descriptive study done in neurosurgery department, to ascertain waiting times for its elective surgeries, included a retrospective analysis of admitted post-surgical patients and a prospective study using interviews with relevant stakeholders to do a process mapping.Results: Median time from decision of surgery to actual date of surgery was found to be 110.5 days. It was calculated that for optimum utilization of present available OTs, 19 extra beds are required and to address the existing load of patients waiting for their respective surgeries there is a need of 63 additional beds with 2 additional OTs functioning per day.Conclusions: The most common cause of waiting time was unavailability of vacant beds due to mismatch in demand-supply. The reason for postponement of surgery after admission was found to be lack of availability of theatre time followed by patient not being fit for surgery. Shortage of operating time was due to delayed start of operation theatre time. The study recommends improving admission process, restricting OPD time, standardized patient prioritization depending on relevant clinical criteria

Role of male behavior in cervical carcinogenesis among women with one lifetime sexual partner

Background: The role of male behavior in the genesis of cervical cancer was examined. In India, where the incidence of cervical cancer is among the highest in the world, promiscuity among women is virtually unknown. In this study, the authors investigated the role of male behavior in cervical carcinogenesis among Indian women who had one lifetime sexual partner. Methods: A case-control study was used. Results. Premarital sexual relationships (relative risk [RR], 1.9; confidence interval, 1.2-3.2) and extramarital sexual relationships (RR, 2.7; confidence interval, 1.5-4.9) of husbands were risk factors. When husbands had sexual relationships both before and during the marriage, their wives' risk of getting cervical cancer increased by 6.9 (CI, 2.3-20.7). Risk also increased with husbands having three or more extramarital sexual partners (RR, 3.05; CI, 1.25-12.6). Sexual contact with prostitutes before or after marriage, however, did not increase the risk. History of sexually transmitted disease before marriage (RR, 2.9) or after marriage (RR, 5.9) was an important risk factor, which persisted after controlling for other factors. Sexual abstinence for 40 or more days after a wife's giving birth or having an abortion provided protection. Sex with uncircumcised men or men circumcised after age 1 year increased the risk of cervical cancer (RR, 4.1). Bidi smoking (bidi is a cheap smoking stick of 4-8 cm, consisting of a rolled piece of dried temburni leaf [Diospyres melanoxylon] containing 0.15-0.25 g of coarsely ground tobacco) for more than 20 years was a significant risk factor (RR = 2.4), whereas cigarette smoking was not a risk factor. Conclusions: Male sexual partners play a role in cervical carcinogenesis

Association between Psychosocial Factors, Quality of Life and Atrial Fibrillation

Background: Atrial fibrillation (AF) is associated with cognitive and psychosocial comorbidities, and poorer quality of life (QOL). In this study, we aimed to study the association between cognition, psychosocial status and QOL at baseline and AF recurrence. Methods: We enrolled 222 symptomatic AF patients (64±10.0 years, 36% women) treated with a rhythm-control strategy. We performed cognitive, psychosocial, and QOL assessments using Montreal cognitive assessment (MOCA, cognitive impairment Results: A total of 123 (55%) participants experienced an AF recurrence over the 6-month follow-up period. Participants with an AF recurrence had higher rates of depression (31% vs.14%, p=0.022) and lower QOL (62±24 vs. 72±21, p=0.003) at baseline than did participants free from recurrence. In multivariable logistic regression models, lower baseline QOL, but not depression, anxiety, or cognition, was associated with a significantly higher odds of AF recurrence event (Odds Ratio: 0.98, CI 0.97-0.99). Conclusion: Lower AF-related QOL is associated with higher odds of AF recurrence over 6 months among symptomatic AF patients treated with rhythm control. Patient-reported variables have not previously been considered as risk factors for disease progression or prognosis. Our data suggests QOL may serve as a useful tool to aid clinicians in the management of AF patients

Genetic resources of pulse crops - present status and future plans

Plant genetic resources (PGR) are essential for a sound and successful crop improvement programme and insurance against nature's vagaries. India has been considered a p~imary centre of diversity for urdbean, mothbean and pige~pea; a secondary centre of diversity for cowpea, and regional (Asiatic) centre of diversity for crops like chickpea and mungbean. Several exploration missions have been undertaken for collection of available indigenous diversity in different legume crops especially in chickpea, pigeon pea, urdbean, mungbean, cowpea, peas, lentil, lathyrus, mothbean, horsegram and cowpea. About 42,425 accessions representing 26 pulse crops are stored at -20°C in long-term repository of. National Gene Bank of NBPGR. Evaluation of germplasm has led to the release of more than 60% of total pulse varieties as direct selection from the germplasm in India. PGRs are also being used in hybridization programmes for genetic upgradation of cultivars as well as creation of new varieties. So far, 434 varieties have been developed in different pulse crops following this approach. However, due to rapid agro-ecological changes, many species, old and primitive cultivars, land raceS and their wild relatives are being eroded. Hence, concerted and systematic efforts for collection, conservation, evaluation, and utilization of germpJasm need to be undertaken

MIXED INTESTINAL PARASITIC INFECTION IN KID: A CASE REPORT

A four months old female Black Bengal kid presented to post mortem examination, revealed heavy mixed infection of nematode (Trichuris sp.) and cestode (Moniezia sp.). The kid was reported anorectic, weak and unthrifty. After opening the carcass, moderate amount of sero-sanguineous fluid was found in the abdominal cavity along with inflamed intestine and enlarged, friable liver and distended gall bladder. In addition, there were adult parasites in intestine and microscopic examination of faeces showed characteristic parasitic eggs

Provider-Level Variation in Smoking Cessation Assistance Provided in the Cardiology Clinics: Insights From the NCDR PINNACLE Registry

Background: Studies show suboptimal provision of smoking cessation assistance (counseling or pharmacotherapy) for current smokers attempting to quit. We aimed to identify smoking cessation assistance patterns in US cardiology practices. Methods and Results: Among 328 749 current smokers seen between January 1, 2013, and March 31, 2016, in 348 NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence)-affiliated cardiology practices, we measured the rates of cessation assistance. We used multivariable hierarchical logistic regression models to determine provider-, practice-, and patient-level predictors of cessation assistance. We measured provider variation in cessation assistance using median rate ratio (the likelihood that the same patient would receive the same assistance at by any given provider; \u3e 1.2 suggests significant variation). Smoking cessation assistance was documented in only 34% of encounters. Despite adjustment of provider, practice, and patient characteristics, there was large provider-level variation in cessation assistance (median rate ratio, 6 [95% CI , 5.76-6.32]). Practice location in the South region (odds ratio [OR], 0.48 [0.37-0.63] versus West region) and rural or suburban location (OR, 0.92 [0.88-0.95] for rural; OR, 0.94 [0.91-0.97] for suburban versus urban) were associated with lower rates of cessation assistance. Similarly, older age (OR, 0.88 [0.88-0.89] per 10-year increase), diabetes mellitus (OR, 0.84 [0.82-0.87]), and atrial fibrillation (OR, 0.93 [0.91-0.96]) were associated with lower odds of receiving cessation assistance. Conclusions: In a large contemporary US registry, only 1 in 3 smokers presenting for a cardiology visit received smoking cessation assistance. Our findings suggest the presence of a large deficit and largely idiosyncratic provider-level variation in the provision of smoking cessation assistance

Assessing long term impact of nutrient management and rainfall variability on the agroecological resilience of maize (Zea mays)- wheat (Triticum aestivum) system in NW India

A long-term (2000-2010) field experiment was carried out in the lower Shiwalik foothills of Punjab to study the carry over effect of organic manures and fertilizers on the productivity of maize (Zea mays L.)- wheat (Triticum aestivum L.) cropping system for efficient N management and resource use under rainfed conditions and to develop predictive models describing relationship between yields and seasonal rainfall. N management strategies involving combined application of 15 kg N/ha either through compost or leucaena loppings along with 20 kg N/ha through inorganic fertilizer for maize-wheat cropping sequence utilized growth resources most efficiently and maintained stable yield performance culminating in significantly higher system productivity, better resource use efficiencies and sustainable yield index, suggesting partial N substitution through compost or locally available plant material. The regression models developed to predict the effects of N sources on crop yields using monthly rainfall would be of interest to estimate the yield at a given level of rainfall with the likely fluctuation (as error) particularly under rainfed conditions

Beta-Blocker Use Is Associated With Impaired Left Atrial Function in Hypertension

BACKGROUND: Impaired left atrial (LA) mechanical function is present in hypertension and likely contributes to various complications, including atrial arrhythmias, stroke, and heart failure. Various antihypertensive drug classes exert differential effects on central hemodynamics and left ventricular function. However, little is known about their effects on LA function. METHODS AND RESULTS: We studied 212 subjects with hypertension and without heart failure or atrial fibrillation. LA strain was measured from cine steady-state free-precession cardiac MRI images using feature-tracking algorithms. In multivariable models adjusted for age, sex, race, body mass index, blood pressure, diabetes mellitus, LA volume, left ventricular mass, and left ventricular ejection fraction, beta-blocker use was associated with a lower total longitudinal strain (standardized beta=-0.21; P=0.008), and lower LA expansion index (standardized beta=-0.30; P \u3c 0.001), indicating impaired LA reservoir function. Beta-blocker use was also associated with a lower positive strain (standardized beta=-0.19; P=0.012) and early diastolic strain rate (standardized beta=0.15; P=0.039), indicating impaired LA conduit function. Finally, beta-blocker use was associated with a lower (less negative) late-diastolic strain (standardized beta=0.15; P=0.049), strain rate (standardized beta=0.18; P=0.019), and a lower active LA emptying fraction (standardized beta=-0.27; P\u3c 0.001), indicating impaired booster pump function. Use of other antihypertensive agents was not associated with LA function. CONCLUSIONS: Beta-blocker use is significantly associated with impaired LA function in hypertension. This association could underlie the increased risk of atrial fibrillation and stroke seen with the use of beta-blockers (as opposed to other antihypertensive agents) demonstrated in recent trials