Need to Adopt a Patient Centered Approach for Obtaining Favourable Results of Non- Pharmacological Interventions among Knee Osteoarthritis Patients in Out Patient Department Settings

Knee osteoarthritis (KOA) is one of the common causes of disability. Long-term effects of early to moderate KOA can be managed through non-surgical interventions. But due to overcrowding in Orthopaedic OPDs, doctors don’t have enough time for explaining non pharmacological interventions (NPIs) in detail to KOA patients. Hence, desired impact of NPIs is not evident among KOA patients. This study elaborates the degree of patient centered approach adopted during doctor patient interactions in the Orthopedics OPD of a tertiary care hospital of India. The study was conducted in 2012-2015. Eligible KOA patients (N=123) were divided into two groups for the RCT. The patients aged 40-65 years of either gender without significant deformity or co-morbidities needing surgery (e.g. meniscus tears etc) were enrolled. An intervention room was established in Physical and Rehabilitation Medicine (PRM) department of the hospital. Doctors of Orthopaedics and PRM departments were requested to send grade 1, 2, 3 KOA patients as per Kellgren Lawrence scale to intervention room after initial work up. A referral system was established for this. Interviews of the diagnosed patients (N=31) suffering from mild and moderate KOA were conducted. Textual analysis was done for qualitative data. Patients are unable to comprehend ‘capsule form’ of advice provided in OPDs. This results in non-adherence. For better outcomes physicians must talk to patients. They need to understand the patient’s underlying concerns, against their cultural background, and life history. Hence, patient centred approach is needed for obtaining the desired impact of NPIs in KOA patients reporting to Orthopaedics OPD in Indian hospitals

Capability assessment of Army spare parts replenishment system: Suitability for a dynamic time separated lean-agile supply

Purpose The purpose of this paper is to identify the strengths and weaknesses of the current spare parts replenishment system of the Army. This exercise is being done with an aim to assess the capability of the current system to implement a time separated lean-agile system of spare parts replenishment. Design/methodology/approach The paper is based on a survey conducted on people in managerial ranks, working in the field of military logistics. The survey is thereafter summarised to ascertain the current status of spare parts replenishment system in the Army. The findings of the survey are elaborated at the end of the paper. Findings The strengths of the current spare parts replenishment system are highlighted. This is followed with the weaknesses of the system in implementing a dynamic lean-agile replenishment system. Originality/value The paper is aimed at assessing the capability of the current spare parts replenishment system and its ability to adapt to a novel replenishment system that is lean in peacetime to save money and agile during war to increase reliability of equipment achieved by a certainty of supply. The survey conducted on the persons actually involved in this logistics reveals areas that need emphasis in order to achieve such a time separated lean-agile replenishment system. This is the author accepted manuscript. The final version is available from Emerald Publishing via https://doi.org/10.1108/BIJ-11-2015-011

A dynamic relationship between mucosal T helper type 17 and regulatory T-cell populations in nasopharynx evolves with age and associates with the clearance of pneumococcal carriage in humans

Pneumococcal carriage is common in young children, which may account for the high incidence of disease in this age group. Host factors determining the clearance of carriage in humans remain unclear. We aimed to study the relationships between T helper type 17 (Th17) and Foxp3(+) regulatory T (Treg) cells in nasopharynx-associated lymphoid tissue (NALT) and carriage in children and adults. Frequencies of Th17 and Treg cells in NALT were analysed by flow cytometry in association with age and pneumococcal carriage status. Cytokine responses following pneumococcal stimulation were analysed by cytometric beads array. The frequencies of Th17 and Treg cells in NALT were inversely correlated (R -0.60). Whereas Treg cell frequency decreased with age (R -0.63), both Th17 and the Th17: Treg ratio increased with age (R 0.62 and R 0.64, respectively). Also, the Th17: Treg ratio was higher in carriage-negative than in carriage-positive children (p <0.01). Pneumococcal stimulation of tonsillar cells increased both Th17 and Treg cell numbers, but the Th17: Treg ratio and pattern of cytokine responses differed between carriage-negative and carriage-positive children. The former showed markedly higher Th17: Treg and interleukin-17A: interleukin-10 ratios than in the latter (p <0.01). Pneumococcal stimulation also induces Th17, although the capacity of this Th17 differentiation from naive T cells of young children was low, but increased with age. We demonstrated a dynamic relationship between Th17 and Treg cells in human nasopharynx that evolves with age. The balance between Th17 and Treg cells in NALT appears to be a major host factor closely associated with the clearance of Streptococcus pneumoniae from the nasopharynx

Impact of Maternal Air Pollution exposure on children's lung health: An Indian perspective

© 2018 by the authors. Air pollution has become an emerging invisible killer in recent years and is a major cause of morbidity and mortality globally. More than 90% of the world's children breathe toxic air every day. India is among the top ten most highly polluted countries with an average PM 10 level of 134 μg/m 3 per year. It is reported that 99% of India's population encounters air pollution levels that exceed the World Health Organization Air Quality Guideline, advising a PM 2.5 permissible level of 10 μg/m 3 . Maternal exposure to air pollution has serious health outcomes in offspring because it can affect embryonic phases of development during the gestation period. A fetus is more prone to effects from air pollution during embryonic developmental phases due to resulting oxidative stress as antioxidant mechanisms are lacking at that stage. Any injury during this vulnerable period (embryonic phase) will have a long-term impact on offspring health, both early and later in life. Epidemiological studies have revealed that maternal exposure to air pollution increases the risk of development of airway disease in the offspring due to impaired lung development in utero. In this review, we discuss cellular mechanisms involved in maternal exposure to air pollution and how it can impact airway disease development in offspring. A better understanding of these mechanisms in the context of maternal exposure to air pollution can offer a new avenue to prevent the development of airway disease in offspring

Apoptosis signal-regulating kinase 1 inhibition attenuates human airway smooth muscle growth and migration in chronic obstructive pulmonary disease

© 2018 The Author(s). Increased airway smooth muscle (ASM) mass is observed in chronic obstructive pulmonary disease (COPD), which is correlated with disease severity and negatively affects lung function in these patients. Thus, there is clear unmet clinical need for finding new therapies which can target airway remodeling and disease progression in COPD. Apoptosis signal-regulating kinase 1 (ASK1) is a ubiquitously expressed mitogen-activated protein kinase (MAPK) kinase kinase (MAP3K) activated by various stress stimuli, including reactive oxygen species (ROS), tumor necrosis factor (TNF)-α, and lipopolysaccharide (LPS) and is known to regulate cell proliferation. ASM cells from COPD patients are hyperproliferative to mitogens in vitro. However, the role of ASK1 in ASM growth is not established. Here, we aim to determine the effects of ASK1 inhibition on ASM growth and pro-mitogenic signaling using ASM cells from COPD patients. We found greater expression of ASK1 in ASM bundles of COPD lung when compared with non-COPD. Pre-treatment of ASM cells with highly selective ASK1 inhibitor, TC ASK 10 resulted in a dose-dependent reduction in mitogen (FBS, PDGF, and EGF; 72 h)-induced ASM growth as measured by CyQUANT assay. Further, molecular targetting of ASK1 using siRNA in ASM cells prevented mitogen-induced cell growth. In addition, to anti-mitogenic potential, ASK1 inhibitor also prevented TGFβ1-induced migration of ASM cells in vitro. Immunoblotting revealed that anti-mitogenic effects are mediated by C-Jun N-terminal kinase (JNK) and p38MAP kinase-signaling pathways as evident by reduced phosphorylation of downstream effectors JNK1/2 and p38MAP kinases, respectively, with no effect on extracellular signal-regulated kinase (ERK) 1/2 (ERK1/2). Collectively, these findings establish the anti-mitogenic effect of ASK1 inhibition and identify a novel pathway that can be targetted to reduce or prevent excessive ASM mass in COPD

Gold Nanoparticles Based Enzyme Biosensor for the Detection of Chloramphenicol

Chronic use of chloramphenicol (CAM) antibiotic leads to anaemia and bone marrow suppression resulting in 40 – 50% mortality. Hence, there is a need to develop an economical, fast and convenient method to detect CAM in milk, honey, shrimp and other aquaculture products. In the current method, coenzyme A was used to indirectly quantify CAM (since it is the cofactor product of the acetylation reaction of CAM). Coenzyme A (CoASH) was used to stabilize gold nanoparticles which were characterized by studying their extinction spectra. The reductant concentration and synthesis time were optimized. With optimized parameters the proposed system could detect CoASH up to 0.1 nM in buffer, with a linear range of detection from 0.1 μM to 1 mM

Uterine selection of human embryos at implantation

Human embryos frequently harbor large-scale complex chromosomal errors that impede normal development. Affected embryos may fail to implant although many first breach the endometrial epithelium and embed in the decidualizing stroma before being rejected via mechanisms that are poorly understood. Here we show that developmentally impaired human embryos elicit an endoplasmic stress response in human decidual cells. A stress response was also evident upon in vivo exposure of mouse uteri to culture medium conditioned by low-quality human embryos. By contrast, signals emanating from developmentally competent embryos activated a focused gene network enriched in metabolic enzymes and implantation factors. We further show that trypsin, a serine protease released by pre-implantation embryos, elicits Ca2+ signaling in endometrial epithelial cells. Competent human embryos triggered short-lived oscillatory Ca2+ fluxes whereas low-quality embryos caused a heightened and prolonged Ca2+ response. Thus, distinct positive and negative mechanisms contribute to active selection of human embryos at implantation

Transmit Power Minimization for MIMO Systems of Exponential Average BER with Fixed Outage Probability

This document is the Accepted Manuscript version of the following article: Dian-Wu Yue, and Yichuang Sun, ‘Transmit Power Minimization for MIMO Systems of Exponential Average BER with Fixed Outage Probability’, Wireless Personal Communications, Vol. 90 (4): 1951-1970, first available online on 20 June 2016. Under embargo. Embargo end date: 20 June 2017. The final publication is available at Springer via https://link.springer.com/article/10.1007%2Fs11277-016-3432-4This paper is concerned with a wireless multiple-antenna system operating in multiple-input multiple-output (MIMO) fading channels with channel state information being known at both transmitter and receiver. By spatiotemporal subchannel selection and power control, it aims to minimize the average transmit power (ATP) of the MIMO system while achieving an exponential type of average bit error rate (BER) for each data stream. Under the constraints on each subchannel that individual outage probability and average BER are given, based on a traditional upper bound and a dynamic upper bound of Q function, two closed-form ATP expressions are derived, respectively, which can result in two different power allocation schemes. Numerical results are provided to validate the theoretical analysis, and show that the power allocation scheme with the dynamic upper bound can achieve more power savings than the one with the traditional upper bound.Peer reviewe