Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India

BACKGROUND: Efforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health. METHODS: The study combined qualitative data (project documents and 56 stakeholder interviews thematically analyzed) with quantitative data (2395 women's self-reported receipt of information on entitlements and use of services over 3 years of implementation monitored prospectively through household visits). Multivariable logistic regression examined delivery care seeking and equity. RESULTS: In the marginalised districts, women reported substantial increases in receipt of information of entitlements and utilization of antenatal and delivery care. In the marginalized and wealthier districts, a switch from private facilities to public ones was observed for the most vulnerable. Supportive implementation factors included a) alignment among NGO organizational missions, b) participatory development of project tools, c) repeated capacity building and d) government interest in improving utilization and recognition of NGO contributions. Initial challenges included a) confidence and turnover of volunteers, b) complexity of the monitoring tool and c) scepticism from both communities and providers. CONCLUSION: With capacity and trust building, NGOs supporting community based collectives to monitor health services and engage with health providers and local authorities, over time overcame implementation challenges to strengthen public sector services. These accountability efforts resulted in improvements in utilisation of public sector services and a shift away from private care seeking, particularly for the marginalised

Thermal and optical characterization of multiple hydrogen bonded liquid crystals derived from mesogenic and non-mesogenic compounds: experimental and theoretical (DFT) studies

A set of new cyclic multiple hydrogen bonded liquid crystals (HBLCs) have been designed and synthesized from citric acid (CA) and 4-dodecyloxybenzoic acid (12OBA). Intermolecular hydrogen bond (H-bond) between non-mesogenic and mesogenic compound has been confirmed from Fourier transform infrared (FT-IR), Nuclear magnetic resonance (NMR) spectroscopic and DFT studies. The hydrogen bonding interactions were explained from natural bond orbital (NBO) analysis using B3LYP/6-311G(d, p) level of theory. In addition to that the Mulliken atomic charges reveal the nature of charge distribution in HBLC complex. Dynamics of phase transitions and the corresponding stability factor has been evaluated using differential scanning calorimetry (DSC) and electrostatic potential (ESP) analysis. Highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) energies of CA+12OBA complex is theoretically calculated and experimentally verified. It is found that the variation in the mole ratio in mesogenic with non-mesogenic compound induces the stabilized nematic (N) and smectic X (Sm X) phases. Photo-catalytic activity of the CA+12OBA HBLC complex reveals that the usage of its optical applications.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Endometrial Stromal Sarcoma in a Young, Nulliparous Woman: A Case Report

Endometrial stromal tumours are tumours of endometrial stromal origin and are classified into Endometrial Stromal Nodule (ESN), Low-Grade Endometrial Stromal Sarcoma (LG-ESS), and High-Grade Endometrial Stromal Sarcoma (HG-ESS). LG-ESS and HGESS are rare tumours, accounting for 1% of uterine malignancies and 10% of uterine sarcomas. These tumours commonly occur in perimenopausal women between the ages of 45 and 50 years. Their incidence is rare in younger women. Endometrial stromal tumours are usually confused with leiomyoma, uterine Leiomyosarcoma (LMS), or other sarcomas. The authors here present a case report of a 28-year-old nulligravid patient who presented with a history of heavy menstrual bleeding and dysmenorrhea for a duration of six months. Ultrasonography of the abdomen and pelvis suggested fibroid with degenerative changes, and Magnetic Resonance Imaging (MRI) indicated leiomyoma variants such as: i) Stromal Tumours of Uncertain Malignant Potential (STUMP)/ atypical/cellular leiomyoma; ii) myxoid degeneration of leiomyoma. To arrive at a definitive diagnosis, myomectomy was performed considering the woman’s young age and nulliparity. Histopathology allowed for a differential diagnosis of LG-ESS, LMS, and cellular leiomyoma. Consequently, the patient underwent total abdominal hysterectomy with left salphingo opherectomy, right salpingectomy, and preservation of the right ovary. The definitive diagnosis is made by histopathological examination coupled with immunohistochemistry of the hysterectomy specimen. Hysterectomy is the definitive treatment of LG-ESS considering their ability to infiltrate and become malignant

Effect of Permeation Enhancer on Bioavailability of Formulated Patches of Amoxicillin

Objectives: The objective of this study is to extract Phytochemical constituent from Cinnamon Bark and to design and develop the transdermal patch of the herbal drug along with modern medicine Amoxicillin using solvent casting method to reduce the dose required to obtain same pharmacological the effect, also to reduce the toxicity of the drug. Methods: The Amoxicillin Transdermal patches were formulated by using the solvent casting method. The physical and chemical similarity of the medication and the base of patches were studied by Infrared Spectroscopy (FTIR). The outcomes recommended no physical and chemical properties incongruence between the medication and the patch base. The formulated transdermal patches were assessed for the weight difference, fatness, folding endurance, wetness, moisture captivation, ex vivo drug release, ex vivo drug absorption. Results: The diffusion examines were performed by utilizing the Franz diffusion cell and averted gut sac method. The best formulation F21 showed Thickness 0.210±0.134mm, Weight    uniformity 0.186±0.110 gm, % Moisture   uptake8.123±1.233Moisture content 6.045±0.321, % Drug content 82.80±0.233, Folding endurance 28±4.44. Formulation F21 exhibits the highest % cumulative drug release 77.21 ±1.43% in 8hrs and highest %Drug absorbed 4.315±0.41 in 120 min