Prediction of metabolic syndrome by visceral adiposity index, lipid accumulation product and model of adiposity index amongst infertile women with and without polycystic ovary syndrome

Background: This study was conducted to compare visceral adiposity index (VAI), lipid accumulation product (LAP) and model of adiposity index (MAOD) for prediction of metabolic syndrome (MS) amongst infertile women with and without PCOS. Methods: It was a case control, retrospective study performed in gynecology outpatient department of a tertiary care center. Total 143 infertile women with PCOS and 367 infertile women without PCOS were recruited in the study. Waist circumference (WC), BMI, waist hip ratio (WHR), insulin resistance, VAI, LAP, MOAD were assessed in both groups. Results: Significantly higher values of WC, WHR, systolic BP, insulin postprandial and all 3 adiposity indices were found among infertile women with PCOS as compared to women without PCOS. In hormonal profile, testosterone, AMH, FSH, prolactin, estradiol was found to be significantly higher in PCOS group. For predicting MS in PCOS women, VAI had the highest AUC 0.878 with a cut off value of 3.1, highest sensitivity of 88.9%, specificity of 90.7%, positive and negative predictive value of 76.2% and 96% respectively followed by LAP and MOAD. Conclusions: To conclude, all three adiposity indexes VAI, LAP and MOAD were significantly raised in PCOS women. VAI followed by LAP were the best indicators to predict metabolic syndrome in women with PCOS

Over‐the‐Counter Sale of Emergency Contraception: A Survey of Pharmacists in Delhi

AbstractIntroductionPharmacists play a key role while dispensing over‐the‐counter emergency contraception (EC) to the client.AimsThe study aims to evaluate the knowledge and over‐the‐counter services provided by the pharmacists in Delhi.MethodsA prestructured questionnaire‐based survey was conducted in Delhi, the capital city of India.ResultsOnly 60 out of 85 pharmacies approached agreed to participate in the study. Number of packs sold in a month per pharmacy varied from 2 to 500 packs/month. Sixty‐two percent of the pharmacists claimed that majority of the clients repeated use during the same month. Only 18% of the clients were referred by doctors while 82% directly approached the pharmacists. Nearly one third of the clients were adolescents. Sixty‐seven percent of the pharmacists had adequate knowledge about EC. Only 3.3% asked about the last menstrual period or the time elapsed since the last unprotected intercourse. No pharmacist inquired whether there were one or multiple unprotected acts of intercourse, if any regular contraceptive method was being used, or explored the reason for EC intake. There were 91.7% who explained the dosage schedule to clients. Only half of them explained that the client may experience side effects. None of the pharmacists advised their clients for a sexually transmitted disease screening, and 35% counseled the clients regarding regular contraception.ConclusionImproving the quality of services provided by the pharmacists can clear misconceptions of the clients and promote subsequent regular contraception along with precautions to avoid sexually transmitted diseases. Mishra A and Saxena P. Over‐the‐counter sale of emergency contraception: A survey of pharmacists in Delhi. Sex Med 2013;1:16–20

Forensic Analysis and Interpretation of Tool Marks

The forensic analysis and interpretation of tool marks raise for consideration key methods and advances in the field of tool marks in forensic science. This chapter shows how tool mark analysis can be utilized in the course of criminal investigations. The focus of the chapter is on bringing together as much scientific knowledge in the area as possible in an accessible manner. It covers all aspects of tool mark evidence from the crime scene to the courtroom. This chapter provides information about tool marks in an effort to assist tool mark examiners as well as people practicing forensic science, crime scene examiners, crime investigating officers and members of the legal profession. It includes information about the analysis of tool marks at the crime scene and in the laboratory, the interpretation and assessment of challenges for examination and interpretation and also the way in which tool mark evidence can be presented in a courtroom

User Satisfaction and Technology Adoption in Smart Homes: A User Experience Test

Using a mixed-methods approach, we examine the complex link between user happiness and technology adoption in the context of smart homes. Our tests show that user happiness and adoption are highly influenced by the versions of smart home technologies, with Version A producing better user satisfaction (7.2) and adoption rates (68%) than Version B (6.8, 62%). Furthermore, consumers engaging with Features A and C reported the greatest adoption rates (80%) and satisfaction (8.1), indicating that certain features, particularly when paired, have a significant influence on user pleasure. Extended training times resulted in higher user satisfaction and adoption rates of the technology; the 6-hour training group had the greatest adoption rate (84%), and the highest satisfaction (8.3%). Furthermore, user age demographics have a substantial impact on adoption and happiness; young adults have the greatest adoption rate (70%) and contentment (7.6). These results highlight the necessity of developing smart home technologies that are appropriate for various age groups, as well as the significance of feature customization, thorough training, and user-centric design in improving user satisfaction and encouraging technology adoption. Introductio

Leveraging clinical decision support tools to improve guideline-directed medical therapy in patients with atherosclerotic cardiovascular disease at hospital discharge

Background: Guidelines recommend moderate to high-intensity statins and antithrombotic agents in patients with atherosclerotic cardiovascular disease (ASCVD). However, guideline-directed medical therapy (GDMT) remains suboptimal. Methods: In this quality initiative, best practice alerts (BPA) in the electronic health record (EHR) were utilized to alert providers to prescribe to GDMT upon hospital discharge in ASCVD patients. Rates of GDMT were compared for 5 months pre- and post-BPA implementation. Multivariable regression was used to identify predictors of GDMT. Results: In 5985 pre- and 5568 post-BPA patients, the average age was 69.1 ± 12.8 years and 58.5% were male. There was a 4.0% increase in statin use from 67.3% to 71.3% and a 3.1% increase in antithrombotic use from 75.3% to 78.4% in the post-BPA cohort.  Conclusions: This simple EHR-based initiative was associated with a modest increase in ASCVD patients being discharged on GDMT. Leveraging clinical decision support tools provides an opportunity to influence provider behavior and improve care for ASCVD patients, and warrants further investigation