Patterns of antiplatelet agent use in the US

Background: The American Society of Gastrointestinal Endoscopy (ASGE) published updated guidelines in 2009 to help endoscopists manage the treatment of their patients who have been prescribed antiplatelet therapy (APT). Study aim: To assess the use of APT among endoscopists, and to identify factors guiding their use of APT while treating their patients. Method: A survey questionnaire was distributed to endoscopists at two national meetings to assess their usage of APT while treating patients during the peri-endoscopic period. Results: The survey was provided to 400 attendees of whom 239 (60 %) responded. Only 30 % of respondents followed the ASGE guidelines for treating their patients and 26 % percent of respondents withheld all APT before engaging in any patient procedure. Endoscopists’ decisions appeared to be influenced by their own particular experiences rather than any specific APT usage guidelines (46 % vs 22 %; P < 0.05). As expected, more endoscopists (P < 0.05) continued APT for patients who underwent low risk procedures (90 %) than for patients who underwent high risk procedures (47 %). Approximately 50 % of the respondents did not perform high risk procedures for patients prescribed aspirin therapy. Conclusions: About one-fourth of endoscopists surveyed discontinued APT treatment of patients who underwent any endoscopic procedure, and one-half of them discontinued use of non-steroidal anti-inflammatory drug treatment of patients who underwent a high risk endoscopic procedure. Inappropriate withdrawal of APT medications may expose patients to unnecessary risks, and efforts to improve endoscopists’ application of ASGE guidelines for the use of APT to treat patients during the peri-endoscopic period are warranted

The association of periodontal disease with oral malodor before and after antibiotic rinse using FITSCAN® breath checker: A clinical study

Context: The term "oral malodor" is used to describe a foul or offensive odor emanating from oral cavity. Dentist is the first professional whom individuals turn up for help. Gram-negative anerobic pathogens implicated in periodontal disease have also been linked to oral malodor. A semi-conductor, hand-held gas sensor with 6 levels of display, brand name FITSCAN® Breath Checker (Tanita Corporation, USA) used to detect oral malodor. Antibiotics are now being tried and used to treat oral malodor and periodontal disease. Aims: To evaluate the association between malodor and periodontal status of patients before and after antibiotic rinse. Materials and Methods: Systemically healthy subjects were divided into three groups - control group, gingivitis group, periodontitis group. Measurement of oral malodor was done by FITSCAN® Breath Checker. Antibiotic rinse preparation containing metronidazole was given to patients. An association between oral malodor and periodontal disease status of patients was determined. Statistical analysis used: For intragroup analysis paired "t" test and for intergroup analysis of halitosis and gingival index "Kruskal-Wallis test" and "Mann-Whitney U test" were applied. Results: Intragroup - Statistical significant decrease in halitosis, Gingival Index (GI) at baseline and 14 days in persons with gingivitis and periodontitis group, no statistical significant decrease in pocket depth before and after antibiotic rinse. Intergroup - Statistical significant decrease in Gingival Index status at baseline and 14 days in both gingivitis andperiodontitisgroups. Conclusion: Strong correlation exists between malodor and periodontal status and antibiotic rinse is effective in reducing oral malodor

Enhancing linearity in I–V characteristics by B/N doping in graphene for communication devices

To explore communication applications, a study towards achieving linearity in the I–V characteristics through increasing concentrations of Boron (B) / Nitrogen (N) doping on pristine graphene sheet is investigated. Individual B/N doping of 6.25, 12.50, 18.75 and 25% has been done in the same sub lattice using Density Functional Theory (DFT) along with Non Equilibrium Greens Function (NEGF) calculations. The modification in the electronic and transport properties of graphene sheet are also investigated. In comparison to the variation of band gap from 0.35 to 1.183 eV and 0.36 to 1.149 eV for B and N respectively, an insignificant variation in effective mass is reported. Apart from linearity, variation in conductance in doped structures is seen. B doping increases conductivity and yields ON current of 610 µA while N doping gives ON current of 310 µA for maximum doping concentrations. In this work, the sustained carrier mobility and high gain linear characteristics of doped graphene obtained will help to utilise a graphene channel for different communication device applications

The Response of Coastal Systems to Anthropogenic Climate Change

Over the coming century, coastal systems around the Pacific Islands will be the subject to the effects of global climate change, notably sea-level rise and extreme precipitation events, and the associated impacts caused by a combination of these events. This study investigates the likely effects of rising sea levels and increased fluvial flood magnitudes in different emissions scenarios on the coastal systems. The study is focused on coastal systems in Nadi, Fiji Islands. The aim of this thesis is to explore the impacts of future projected changes driven by climate change, that is, sea-level rise and fluvial discharge changes that would a result of precipitation changes, in order to understand more fully the vulnerability and response of coastal systems to the effects of climate change. The vulnerability of the coastal systems is studied using high-resolution aerial imagery that has recorded shoreline change for the past three decades, flood-inundation maps, digital elevation models, hydrological modelling, and conceptual models. These data and models are used to establish past shoreline changes, and flood extents generating predictions of projected future sea-level rise (0.25 m, 0.5 m, 0.75 m, 1 m, and 1.25 m) and changes in flood discharge magnitudes and frequencies (2, 5, 10, 20, 30, 50, and 100-year ARI) for three different climate change emissions scenarios (Current Emissions, Future Low Emissions or RCP2.6, and Future High Emissions or RCP8.5). The impacts of these combined changes on coastal systems are explored by overlaying land-use and cover mapping on modelled future shoreline change and flood-hazard maps. First, the results of this study indicate that the coastal system in Nadi has experienced net shoreline retreat during the last few decades. The land most susceptible to retreat are northern Nadi Delta and the delta areas close to the Nadi River mouth, as well as areas north and south of Nadi Bay. Significant wetland loss has also been observed in Nadi Delta over the past three decades. The history of retreat and loss of wetlands suggests that the existence of coastal processes will allow continued shoreline retreat in these areas as sea level rises in future. Second, based on a high-resolution digital elevation model, the study suggests sealevel rises from 0.25 m up to 1.25 m will, unsurprisingly, result in progressively greater areas of inundation, but more importantly the increase in inundation area is likely to be non-linear, with the greatest increase in inundation area predicted from 0.5 m to 0.75 m, and from 0.75 m to 1 m sea-level rise. The results also indicate that while sealevel rise of up to 0.25 m does not have a significant impact on the Nadi Delta, the Nadi Delta is very vulnerable to sea-level rise of 0.5 m and more. In addition to this, the wetland communities, consisting of mangrove and marsh, were the most susceptible land cover and vegetation type to rising sea levels. Third, the results of hydraulic modelling suggest that the biggest impacts of future emissions scenarios, in terms of degree of change and the land cover types affected, are going to occur as a result of the highest frequency events, that is, the 2- and 5-year ARI events. The analysis for the combined effects of fluvial flooding and sea-level rise suggests that the increase in the area inundated by fluvial flooding when sea-level rise is factored in ranges from around 2.5% up to 17%. The general trend of the combined impact on inundation extent is non-linear, where the greatest impacts are observed with sea-level rise of 0.5 to 1.0 m when compounded with fluvial flooding. Furthermore, these combined events impact both high-value land uses, such as agricultural, dense commercial, industrial, residential, as well as important natural vegetation communities, such as mangroves and marshes. Finally, the results and the conceptual understanding achieved from this study and other empirical studies were used to develop a conceptual model of delta response to future climate change. The stability of deltas is dependent on sediment flux and the condition of the wetland communities present on the deltas, which are influenced by sediment trapping, fluvial flooding, sea-level rise and mangrove management. It is essential that wetland communities are proactively managed around coastal systems to improve their resilience, and sediment flux is improved to lower catchment areas to minimise the effects of climate change. The results of this thesis, thus provide observations of hypothetical situations and the general patterns of change across a broad range of sea-level rise, discharge and emissions scenarios, and indicate the potential flood-hazard areas in anticipation of future climate change. It also highlights the importance of active catchment management actions to reduce the vulnerability of coastal systems to climate change

Iodine nutritional status in Himachal Pradesh state, India

Introduction: Iodine deficiency (ID) is the preventable causes of mental retardation worldwide. Himachal Pradesh (HP) state is a known endemic region to ID. Objective: the objective was to assess the current status of iodine nutrition in a population of HP, India. Methodology: There are three regions in HP namely: Kangra, Mandi, and Shimla. In each region, one district was selected namely: Kangra, Kullu, and Solan. In each district, 30 clusters were identified by utilizing population proportional-to-size cluster sampling methodology. A total of 5748 school-age children (SAC) (Kangra; 1864, Kullu; 1986, Solan: 1898), 1711 pregnant mothers (PMs) (Kangra; 647, Kullu; 551, Solan: 513), and 1934 neonates (Kangra; 613, Kullu; 638, Solan: 683), were included in study. Clinical examination of thyroid of each child and PM was conducted. Casual urine samples were collected from children and PMs. Cord blood samples were collected for estimation of thyroid stimulating hormone (TSH) among neonates. Results: In SAC, total goiter rate (TGR) was 15.8% (Kangra), 23.4% (Kullu), and 15.4% (Solan). Median urinary iodine concentration (UIC) level was 200 μg/l (Kangra), 175 μg/l (Kullu), and 62.5 μg/l (Solan). In PMs, TGR was 42.2% (Kangra), 42.0% (Kullu), and 19.9% (Solan). Median UIC level was 200 μg/l (Kangra), 149 μg/l (Kullu), and 130 μg/l (Solan). In Neonates, TSH levels of > 5 mIU/L were found in 73.4 (Kangra), 79.8 (Kullu), and 63.2 (Solan) percent of neonates. Conclusion: As per, UIC level (<100 μg/l) in SAC, ID was found in district Solan. In Kullu and Solan districts, there were ID (UIC level < 150 μg/l) among PMs. TSH levels indicated ID in all districts surveyed

Role of hunger hormone “Ghrelin” in long-term weight loss following laparoscopic sleeve gastrectomy

Introduction: Laparoscopic sleeve gastrectomy (LSG) has become a popular weight loss technique in morbidly obese patients. The aim of our study was to evaluate the changes in plasma ghrelin levels in relation to weight loss following LSG and to study the efficacy of LSG in terms of long‑term glycemic control and resolution of diabetes.Methodology: The study was conducted on 70 morbidly obese patients (body mass index [BMI] &gt;40 kg/m2) or severely obese patients (BMI &gt;35 kg/m2) with comorbidities who underwent LSG in Dayanand Medical College and Hospital, Ludhiana, India. Ghrelin levels were measured preoperatively and postoperatively at 1 week, 3 months, and 6 months along with measurements of various weight loss parameters and glycosylated hemoglobin.Results: A significant decrease in plasma ghrelin levels was observed in relation to the mean weight and percentage excess weight loss at 3 months postoperatively. However, at 6 months, fall in ghrelin reached a plateau phase while weight loss was still sustained and significant. There was a significant fall in glycosylated hemoglobin levels with patients achieving good control/resolution of diabetes Type II.Conclusion: LSG is an effective weight loss surgery and brings about excellent weight loss in morbidly obese individuals in addition to achievement of good glycemic control in diabetic individuals. Serum levels of ghrelin fall significantly after sleeve gastrectomy. However, long term implications of ghrelin induced weight loss cannot be elucidated.Keywords: Ghrelin, laparoscopic sleeve gastrectomy, morbid obesity surger

The supply is there. So why can't pregnant and breastfeeding women in rural India get the COVID-19 vaccine?

Despite COVID-19 vaccines being available to pregnant women in India since summer 2021, little is known about vaccine uptake among this high need population. We conducted mixed methods research with pregnant and recently delivered rural women in northern India, consisting of 300 phone surveys and 15 in-depth interviews, in November 2021. Only about a third of respondents were vaccinated, however, about half of unvaccinated respondents reported that they would get vaccinated now if they could. Fears of harm to the unborn baby or young infant were common (22% of unvaccinated women). However, among unvaccinated women who wanted to get vaccinated, the most common barrier reported was that their health care provider refused to provide them the vaccine. Gender barriers and social norms also played a role, with family members restricting women's access. Trust in the health system was high, however, women were most often getting information about COVID-19 vaccines from sources that they did not trust, and they knew they were getting potentially poor-quality information. Qualitative data shed light on the barriers women faced from their family and health care providers but described how as more people got the vaccine that norms were changing. These findings highlight how pregnant women in India have lower vaccination rates than the general population, and while vaccine hesitancy does play a role, structural barriers from the health care system also limit access to vaccines. Interventions must be developed that target household decision-makers and health providers at the community level, and that take advantage of the trust that rural women already have in their health care providers and the government. It is essential to think beyond vaccine hesitancy and think at the system level when addressing this missed opportunity to vaccinate high risk pregnant women in this setting