"Getting the water-carrier to light the lamps": Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India.

The government of India has, over the past decade, implemented the "integration" of traditional, complementary and alternative medical (TCAM) practitioners, specifically practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-rigpa, and Homoeopathy (collectively known by the acronym AYUSH), in government health services. A range of operational and ethical challenges has manifested during this process of large health system reform. We explored the practices and perceptions of health system actors, in relation to AYUSH providers' roles in government health services in three Indian states - Kerala, Meghalaya, and Delhi. Research methods included 196 in-depth interviews with a range of health policy and system actors and beneficiaries, between February and October 2012, and review of national, state, and district-level policy documents relating to AYUSH integration. The thematic 'framework' approach was applied to analyze data from the interviews, and systematic content analysis performed on policy documents. We found that the roles of AYUSH providers are frequently ambiguously stated and variably interpreted, in relation to various aspects of their practice, such as outpatient care, prescribing rights, emergency duties, obstetric services, night duties, and referrals across systems of medicine. Work sharing is variously interpreted by different health system actors as complementing allopathic practice with AYUSH practice, or allopathic practice, by AYUSH providers to supplement the work of allopathic practitioners. Interactions among AYUSH practitioners and their health system colleagues frequently take place in a context of partial information, preconceived notions, power imbalances, and mistrust. In some notable instances, collegial relationships and apt divisions of responsibilities are observed. Widespread normative ambivalence around the roles of AYUSH providers, complicated by the logistical constraints prevalent in poorly resourced systems, has the potential to undermine the therapeutic practices and motivation of AYUSH providers, as well as the overall efficiency and performance of integrated health services

Gene profiling of the erythro- and megakaryoblastic leukaemias induced by the Graffi murine retrovirus

<p>Abstract</p> <p>Background</p> <p>Acute erythro- and megakaryoblastic leukaemias are associated with very poor prognoses and the mechanism of blastic transformation is insufficiently elucidated. The murine Graffi leukaemia retrovirus induces erythro- and megakaryoblastic leukaemias when inoculated into NFS mice and represents a good model to study these leukaemias.</p> <p>Methods</p> <p>To expand our understanding of genes specific to these leukaemias, we compared gene expression profiles, measured by microarray and RT-PCR, of all leukaemia types induced by this virus.</p> <p>Results</p> <p>The transcriptome level changes, present between the different leukaemias, led to the identification of specific cancerous signatures. We reported numerous genes that may be potential oncogenes, may have a function related to erythropoiesis or megakaryopoiesis or have a poorly elucidated physiological role. The expression pattern of these genes has been further tested by RT-PCR in different samples, in a Friend erythroleukaemic model and in human leukaemic cell lines.</p> <p>We also screened the megakaryoblastic leukaemias for viral integrations and identified genes targeted by these integrations and potentially implicated in the onset of the disease.</p> <p>Conclusions</p> <p>Taken as a whole, the data obtained from this global gene profiling experiment have provided a detailed characterization of Graffi virus induced erythro- and megakaryoblastic leukaemias with many genes reported specific to the transcriptome of these leukaemias for the first time.</p

Experiences and meanings of integration of TCAM (Traditional, Complementary and Alternative Medical) providers in three Indian states: results from a cross-sectional, qualitative implementation research study.

OBJECTIVES: Efforts to engage Traditional, Complementary and Alternative Medical (TCAM) practitioners in the public health workforce have growing relevance for India's path to universal health coverage. We used an action-centred framework to understand how policy prescriptions related to integration were being implemented in three distinct Indian states. SETTING: Health departments and district-level primary care facilities in the states of Kerala, Meghalaya and Delhi. PARTICIPANTS: In each state, two or three districts were chosen that represented a variation in accessibility and distribution across TCAM providers (eg, small or large proportions of local health practitioners, Homoeopaths, Ayurvedic and/or Unani practitioners). Per district, two blocks or geographical units were selected. TCAM and allopathic practitioners, administrators and representatives of the community at the district and state levels were chosen based on publicly available records from state and municipal authorities. A total of 196 interviews were carried out: 74 in Kerala, and 61 each in Delhi and Meghalaya. PRIMARY AND SECONDARY OUTCOME MEASURES: We sought to understand experiences and meanings associated with integration across stakeholders, as well as barriers and facilitators to implementing policies related to integration of Traditional, Complementary and Alternative (TCA) providers at the systems level. RESULTS: We found that individual and interpersonal attributes tended to facilitate integration, while system features and processes tended to hinder it. Collegiality, recognition of stature, as well as exercise of individual personal initiative among TCA practitioners and of personal experience of TCAM among allopaths enabled integration. The system, on the other hand, was characterised by the fragmentation of jurisdiction and facilities, intersystem isolation, lack of trust in and awareness of TCA systems, and inadequate infrastructure and resources for TCA service delivery. CONCLUSIONS: State-tailored strategies that routinise interaction, reward individual and system-level individual integrative efforts, and are fostered by high-level political will are recommended

Sustainability of barefoot nurse (BFN) project—Screening NCD and ensuring livelihood: A randomized control trial

Cost-benefit analysis underlines the importance of screening non-communicable diseases (NCDs) and seeking treatment which can aid early detection, cutting expenses and averting deaths. The government of India NCD screening program leaves many to opportunistic screening whilst the health system is inadequate to deliver its goal due to short-staffing, underequipped, and incomplete data management. In order to ease the cost and convenience barrier faced by the Indian poor, we propose testing the efficacy and sustainability of Community Health Workers (CHW), referred to as Barefoot nurse (BFN) for screening NCD. The BFN intervention will be evaluated using a two-arm cluster randomized controlled trial. The participants of the study are residents of eight selected wards each of Doddabalapura and Hoskote respectively, North Bangalore, Karnataka. The intervention will be delivered by eight BFNs. The control area will receive usual care by the Auxiliary Nurse midwife (ANM). The primary outcome indicators are a) proportion of population screened for NCDs, b) proportion of population, diagnosed with NCDs repeated the screening, c) proportion of first-time detection and referral. The secondary outcome measures are a) average amount of money earned, b) timeliness and c) completeness of data entry. Cluster randomization will be done prior to recruitment of participants. Enrolment of cluster will ensure non-overlap of intervention and control wards. The net change in the key outcome measures will be assessed using the difference in difference (DID). Amidst huge NCD burden the proposed study seeks to test the efficacy of a self-sustainable CHW model in resource deficient areas

Bacterial Diversity in Cold Environments of Indian Himalayas

Not AvailableThe remote cold environments of Indian Himalayas are witnessed by extreme situations with a lot of variations in temperatures, low availability of water and nutrients and exposure to a lot of radiations. These extreme environments generally considered unfavourable to growth and survival of plants and animals are usually colonized by the microorganisms capable of growth and survivability under the prevailing severe conditions. Because of the extremophilic enzymes, proteins and biomolecules possessed by cold-adapted microorganism, they are of importance for industry, agriculture and biotechnology. In this chapter, (1) diversity of bacteria present in cold environments based on culturing and metagenomics approaches, (2) microorganisms from cold environments in agriculture, (3) novel bacteria from cold environments and (4) genome sequencing of bacteria from cold environments have been discussed. Bacteria affiliated to various phyla like Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, Acidobacteria, Gemmatimonadetes, Planctomycetes, Chlamydiae, Chlorobi, Chloroflexi, Dictyoglomi, Fibrobacteres, Nitrospirae and Verrucomicrobia have been reported from the Indian Himalayas. Microorganisms belonging to various genera for improving agriculture production under cold environment have been isolated and identified. Twenty-one novel species of bacteria have been isolated from different locations in the cold environments of the Himalayas. A genome of 18 strains isolated from these cold environments has been sequenced and published.Not Availabl