Assessment of Ration Scales of the Armed Forces Personnel in Meeting theNutritional Needs at Plains and High Altitudes–I

Adequate nutrition is very essential, especially for the Armed Forces, to buildup their nutritional reserveswhile deriving maximum benefits of training/peak performances in operational situations by keeping theirmorale high. The present study reviews/examines the adequacy of the existing ration scales of the ArmedForces personnel stationed under different terrain conditions of the country/recruits at various training centres.Food samples were collected from different strategic locations during different seasons of the year and analysedfor their nutrient composition like proximal constituents, vitamins A, E, B1, B2, C, and dietary fibre. Basedon the data generated, the daily nutrients/energy consumption by the soldiers/recruits, were calculated separatelyboth for personnel in plains and at high altitudes. Soldiers in plains, on an average consumed protein 124.2+ 13.0 g, fat 98.8 + 29.6 g and energy 3632+317 kcal/person/day, while their counterparts at high altitudesconsumed protein 120.4 + 11.2 g, fat 120.1 + 31.1 g, and energy 3906 + 423 kcal/person/day. The study clearlyindicate that the present ration scales for the Service personnel, both in plains and at high altitudes (9000 ftto 15000 ft) is adequate wrt their nutrient density. It is however suggested to ensure adequate supply of goodquality fresh vegetables, fruits, and meat, which inturn would not only help to keep the morale of the soldiers,high and cheerful, especially at high altitudes, but will also enable adequate micronutrient availability. Thefibre levels in the diets of these soldiers have also been found to be well within the limits (20 -35 g/ person/day) recommended for optimal health.Defence Science Journal, 2008, 58(6), pp.734-744, DOI:http://dx.doi.org/10.14429/dsj.58.170

Energy Expenditure and Nutritional Status of Sailors and Submarine Crew of the Indian Navy

Nutritional requirements of sailors and submariners are different from those of ground forces as they work under confined environment as well as due to logistic constraints of cooking and storage of food. Study was conducted for a period of three months at Eastern Naval Command to evaluate nutrient requirements, nutritional status of Indian Navy personnel and adequacy of the existing ration scales. The study volunteers were from crew of two warships (n = 35) and submariners (n = 20) who were attached to their mother ships during time of data collection and offshore during rest of the period. Energy expenditure, nutrient intake, level of nutrients in body, and urinary excretion were measured along with changes in body composition. All variables were analysed before and after three months of nutritional monitoring. Energy expenditure at ship was in the range of 2449-4907 kcal/day with a mean of 3313 + 578 kcal/day, while in the case of submariners, it was 3168 + 282 (2606-3907) kcal/day. The energy intake in the case of sailors and submariners was not different either on shore establishment or at ship. Energy intake was found to be 3518 + 286 kcal/day. The energy contribution from carbohydrates, fats, and protein was 59.9 per cent, 27.8 per cent and 12.3 per cent, respectively. No sign and symptoms of any nutritional deficiency were observed either initially or after three months. Status of micronutrients present in their blood and in their urinary excretions along with body composition were maintained, indicating adequacy of existing ration scales of Indian Navy.Defence Science Journal, 2011, 61(6), pp.540-544, DOI:http://dx.doi.org/10.14429/dsj.61.93

Fibroblast Extracellular Matrix Remodeling: Differences in Idiopathic and Normal Pulmonary Fibrosis

Pulmonary fibrosis is a chronic lung disease that occurs when lung tissue becomes damaged as a result of injury or inflammation. The main effector cell in fibrosis is the fibroblasts, which causes remodeling of extracellular matrix (ECM) leading to a scar-like tissue, increased lung stiffness, reduced lung elasticity, and decreased gas exchange. A severe form of lung fibrosis is Idiopathic Pulmonary Fibrosis (IPF), which is characterized by progressive, non-resolving accumulation of ECM and has a survival of only 2-5 years after diagnosis. While the cause of IPF is unknown, it is thought to be the result of repetitive injuries to the alveolar epithelium that cause fibroblast differentiation and activation into a myofibroblast phenotype. Recent studies using scRNA sequencing have transcriptomically identified a variety of different fibroblast subpopulations; however, understanding the role of these various fibroblast subsets in remodeling ECM has not been determined. In order to measure fibroblast functions, we used confocal reflectance microscopy to quantitatively characterize ECM structure and remolding by fibroblasts isolated from normal and IPF patients. Primary human IPF and normal fibroblasts were seeded on 45 uL bovine collagen gels at a density of 10,000 cells/mL and allowed to compact and reorganize collagen fibers. The collagen gels were comprised of two layers. The first layer was 20 uL of bovine collagen that was placed in a 37 degrees C incubator for 2 hours. The second layer was then added which contained a cell and collagen mix with a volume of 25 uL. Gels were imaged 24 hours post seeding using a Leica Stellaris 5 confocal laser scanning microscope configured to collect images in reflectance mode using a 63x oil-immersion objective and a 488-nm argon laser. Images were collected with a step size of 0.3 um for 50 steps to create a z stack of images. Outlines of cells were used to calculate cell area and circularity in each slice and histograms of pixel intensity in each slice were analyzed for standard deviation as a measure of fiber bundling (i.e. lower standard deviation indicates more bundling). Results: After 24 hours, normal fibroblasts were circular in shape and small collagen fibers were uniformly distributed throughout the gel with some bundling around cells and moderate alignment of fibers in between cells. In contract, IPF fibroblasts had a highly elongated morphology with highly aligned fibers in between cells. Measurements of cell area and circularity confirm elongated morphology in IPF fibroblasts and measurements of collagen distribution confirm increased bundling (lower standard deviation) in IPF seeded gels. Interestingly, reflectance intensity was lower in IPF seed gels indicating possible uptake and degradation. Conclusions: These results show that IPF fibroblasts overall exhibit more remodeling of the ECM than normal fibroblasts. The larger cell area and circularity of the IPF fibroblasts shows that they are more active because of their elongated shape. The histograms demonstrate that the normal fibroblasts have a more even distribution of collagen than the IPF fibroblasts, which is further evidence that the IPF cells are bundling up or degrading the collagen at a higher rate than the normal cells. Future studies will use this system to investigate how genomic changes in fibroblasts sub-population alter their collagen remodeling capabilities. The significance of this work is a quantitative platform that can assess fibroblast remodeling that can be used in future studies to better understand how different sub-populations of fibroblasts isolated from pulmonary fibrosis patients influence the ECM remodeling that leads to disease.NIHOSU Pre AcceleratorAcademic Major: Biomedical Engineerin

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study.

BACKGROUND: How to harness the private sector to improve population health in low-income and middle-income countries is heavily debated and one prominent strategy is social franchising. We aimed to evaluate whether the Matrika social franchising model-a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians-could improve the quality and coverage of health services along the continuum of care for maternal, newborn, and reproductive health. METHODS: We did a quasi-experimental study, which combined matching with difference-in-differences methods. We matched 60 intervention clusters (wards or villages) with a social franchisee to 120 comparison clusters in six districts of Uttar Pradesh, India. The intervention was implemented by two not-for-profit organisations from September, 2013, to May, 2016. We did two rounds (January, 2015, and May, 2016) of a household survey for women who had given birth up to 2 years previously. The primary outcome was the proportion of women who gave birth in a health-care facility. An additional 56 prespecified outcomes measured maternal health-care use, content of care, patient experience, and other dimensions of care. We organised conceptually similar outcomes into 14 families to create summary indices. We used multivariate difference-in-differences methods for the analyses and accounted for multiple inference. FINDINGS: The introduction of Matrika was not significantly associated with the change in facility births (4 percentage points, 95% CI -1 to 9; p=0·100). Effects for any of the other individual outcomes or for any of the 14 summary indices were not significant. Evidence was weak for an increase of 0·13 SD (95% CI 0·00 to 0·27; p=0·053) in recommended delivery care practices. INTERPRETATION: The Matrika social franchise model was not effective in improving the quality and coverage of maternal health services at the population level. Several key reasons identified for the absence of an effect potentially provide generalisable lessons for social franchising programmes elsewhere. FUNDING: Merck Sharp and Dohme Limited

The effect of report cards on the coverage of maternal and neonatal health care: a factorial, cluster-randomised controlled trial in Uttar Pradesh, India.

BACKGROUND: Report cards are a prominent strategy to increase the ability of citizens to express their view, improve public accountability, and foster community participation in the provision of health services in low-income and middle-income countries. In India, social accountability interventions that incorporate report cards and community meetings have been implemented at scale, attracting considerable policy attention, but there is little evidence on their effectiveness in improving health. We aimed to evaluate the effect of report cards, which contain information on village-level indicators of maternal and neonatal health care, and participatory meetings targeted at health providers and community members (including local leaders) on the coverage of maternal and neonatal health care in Uttar Pradesh, India. METHODS: We conducted a repeated cross-sectional, 2 × 2 factorial, cluster-randomised controlled trial, in which each cluster was a village (rural) or ward (urban). The clusters were randomly assigned to one of four groups: the provider group, in which we shared report cards and held participatory meetings with providers of maternal and neonatal health services; the community group, in which we shared report cards and held participatory meetings with community members (including local leaders); the providers and community group, in which report cards were targeted at both health providers and the community; and the control group, in which report cards were not shared with anyone. We generated these report cards by collating data from household surveys and shared the report cards with the recipients (as determined by their assigned groups) in participatory meetings. The primary outcome was the proportion of women who had at least four antenatal care visits (ie, attended a clinic or were visited at home by a health-care worker) during their last pregnancy. We measured outcomes with cross-sectional household surveys that were taken at baseline, at a first follow-up (after 8 months of the intervention), and at a second follow-up (21 months after the start of the intervention). Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN11070792. FINDINGS: We surveyed eligible women for the baseline survey between Jan 13, and Feb 5, 2015. We then randomly assigned 44 clusters to the provider group, 45 clusters to the community group, 45 clusters to the provider and community group, and 44 clusters to the control group. Report cards of collated survey data were provided to recipient groups, as per their random allocation, in October, 2015, and in September, 2016. We ran the first follow-up survey between May 16 and June 10, 2016. We ran the second follow-up survey between June 18 and July 18, 2017. We measured the primary outcome in 3133 women (795 in the provider group, 781 in the community group, 798 in the provider and community group, and 759 in the control group) who gave birth during implementation of the intervention, between Feb 1, 2016, and July 18, 2017 (the end of the second follow-up survey). The report card intervention did not significantly affect the proportion of women who had at least four antenatal care visits (provider vs non-provider: odds ratio 0·85, 95% CI 0·65-1·13; community vs non-community: 0·86, 0·65-1·13). INTERPRETATION: Maternal health report cards containing information on village performance, targeted at either the community or health providers, had no detectable effect on the coverage of maternal and neonatal health care. Future research should seek to understand how the content of information and the delivery of report cards affect the success of this type of social accountability intervention. FUNDING: Merck Sharp and Dohme

Process evaluation of a social franchising model to improve maternal health: evidence from a multi-methods study in Uttar Pradesh, India.

BACKGROUND: A prominent strategy to engage private sector health providers in low- and middle-income countries is clinical social franchising, an organisational model that applies the principles of commercial franchising for socially beneficial goals. The Matrika programme, a multi-faceted social franchise model to improve maternal health, was implemented in three districts of Uttar Pradesh, India, between 2013 and 2016. Previous research indicates that the intervention was not effective in improving the quality and coverage of maternal health services at the population level. This paper reports findings from an independent external process evaluation, conducted alongside the impact evaluation, with the aim of explaining the impact findings. It focuses on the main component of the programme, the "Sky" social franchise. METHODS: We first developed a theory of change, mapping the key mechanisms through which the programme was hypothesised to have impact. We then undertook a multi-methods study, drawing on both quantitative and qualitative primary data from a wide range of sources to assess the extent of implementation and to understand mechanisms of impact and the role of contextual factors. We analysed the quantitative data descriptively to generate indicators of implementation. We undertook a thematic analysis of the qualitative data before holding reflective meetings to triangulate across data sources, synthesise evidence, and identify the main findings. Finally, we used the framework provided by the theory of change to organise and interpret our findings. RESULTS: We report six key findings. First, despite the franchisor achieving its recruitment targets, the competitive nature of the market for antenatal care meant social franchise providers achieved very low market share. Second, all Sky health providers were branded but community awareness of the franchise remained low. Third, using lower-level providers and community health volunteers to encourage women to attend franchised antenatal care services was ineffective. Fourth, referral linkages were not sufficiently strong between antenatal care providers in the franchise network and delivery care providers. Fifth, Sky health providers had better knowledge and self-reported practice than comparable health providers, but overall, the evidence pointed to poor quality of care across the board. Finally, telemedicine was perceived by clients as an attractive feature, but problems in the implementation of the technology meant its effect on quality of antenatal care was likely limited. CONCLUSIONS: These findings point towards the importance of designing programmes based on a strong theory of change, understanding market conditions and what patients value, and rigorously testing new technologies. The design of future social franchising programmes should take account of the challenges documented in this and other evaluations

Energy Expenditure and Nutritional Status of Sailors and Submarine Crew of the Indian Navy

Nutritional requirements of sailors and submariners are different from those of ground forces as they work under confined environment as well as due to logistic constraints of cooking and storage of food. Study was conducted for a period of three months at Eastern Naval Command to evaluate nutrient requirements, nutritional status of Indian Navy personnel and adequacy of the existing ration scales. The study volunteers were from crew of two warships (n = 35) and submariners (n = 20) who were attached to their mother ships during time of data collection and offshore during rest of the period. Energy expenditure, nutrient intake, level of nutrients in body, and urinary excretion were measured along with changes in body composition. All variables were analysed before and after three months of nutritional monitoring. Energy expenditure at ship was in the range of 2449-4907 kcal/day with a mean of 3313 + 578 kcal/day, while in the case of submariners, it was 3168 + 282 (2606-3907) kcal/day. The energy intake in the case of sailors and submariners was not different either on shore establishment or at ship. Energy intake was found to be 3518 + 286 kcal/day. The energy contribution from carbohydrates, fats, and protein was 59.9 per cent, 27.8 per cent and 12.3 per cent, respectively. No sign and symptoms of any nutritional deficiency were observed either initially or after three months. Status of micronutrients present in their blood and in their urinary excretions along with body composition were maintained, indicating adequacy of existing ration scales of Indian Navy.Defence Science Journal, 2011, 61(6), pp.540-544, DOI:http://dx.doi.org/10.14429/dsj.61.93

Pten regulates collagen fibrillogenesis by fibroblasts through SPARC.

Collagen deposition contributes to both high mammographic density and breast cancer progression. Low stromal PTEN expression has been observed in as many as half of breast tumors and is associated with increases in collagen deposition, however the mechanism connecting PTEN loss to increased collagen deposition remains unclear. Here, we demonstrate that Pten knockout in fibroblasts using an Fsp-Cre;PtenloxP/loxP mouse model increases collagen fiber number and fiber size within the mammary gland. Pten knockout additionally upregulated Sparc transcription in fibroblasts and promoted collagen shuttling out of the cell. Interestingly, SPARC mRNA expression was observed to be significantly elevated in the tumor stroma as compared to the normal breast in several patient cohorts. While SPARC knockdown via shRNA did not affect collagen shuttling, it notably decreased assembly of exogenous collagen. In addition, SPARC knockdown decreased fibronectin assembly and alignment of the extracellular matrix in an in vitro fibroblast-derived matrix model. Overall, these data indicate upregulation of SPARC is a mechanism by which PTEN regulates collagen deposition in the mammary gland stroma