Trends in the profile of non hodgkins lymphoma in North and South India: a study from two tertiary care hospitals in India

Background: A number of environmental and chemical factors have been thought to been implicated in the occurrence of Non-Hodgkin’s Lymphomas (NHLs).To fill the knowledge gap in various aspect of the disease, this study was undertaken at this tertiary care centre in Delhi and Bangalore.Methods: This was a prospective observational study conducted in two defenses medical centre in India among patients of Non Hodgkins Lymphoma, registered at Command hospital Airforce Bangalore and Army Hospital (Research and Referral), New Delhi, between March 2016 and March 2019.Results: The disease showed a bimodal onset in both centres with 26 (26%) and 24 (24%) cases occurring in the age group of 31-40 years and 24 (24%) and 25 (25%) cases occurring in the age group of >60 years at CHAF (B) and AH (RR) respectively. B cell Lymphoma was the most common type of NHL seen in 85% and 89% patients, whereas T-cell lymphomas constituted 13% and 11% at CHAF (B) and AH (RR).  32(32%) patients presented with an Ann Arbor Stage 1 or 2 disease whereas 68(68%) patients were with Stage 3 or 4 disease at both the centers. IPI score was ≥3 in 45 % and 43% patients.Conclusions: NHL in India is a homogeneous and uniform disease. But there was increased detection of hepatosplenomegaly and associated hepatitis B/C in the southern part of India. Also, the occurrence of Cutaneous T cell lymphoma was only seen in the south India centre. The early stage NHLs has better survival and increase chance of complete response

Career decision making in undergraduate medical education

Background: It is unclear how medical students prioritize different factors when selecting a specialty. With rising under and unemployment rates a novel approach to career counselling is becoming increasingly important.  A better understanding of specialty selection could lead to improved career satisfaction amongst graduates while also meeting the health care needs of Canadians.  Methods: Medical students from the University of Toronto participated in a two-phase study looking at factors impacting specialty selection. Phase I consisted of focus groups, conducted independently for each year, and Phase II was a 21-question electronic survey sent to all students.  Results: Twenty-one students participated in the focus group phase and 95 in the survey phase.  Primary themes related to career selection identified in Phase I in order of frequency included personal life factors (36), professional life factors (36), passion/interest (20), changing interests (19) and hidden curriculum (15). The survey phase had similar results with passion (83), lifestyle (79), flexibility (75), employment opportunities (60) and family (50) being ranked as the factors most important in specialty selection. Conclusion: Personal factors, professional factors and passion/interest may be key themes for medical students when deciding which specialty to pursue. Targeting career counselling around these areas may be important.&nbsp

Advancements in the Representation of Cloud-Aerosol Microphysics in the GEOS-5 AGCM

Despite numerous challenges, the physical parameterization of cloud-aerosol interactions in atmospheric GCMs has become a top priority for advancement because of our need to simulate and understand past, current, and future indirect effects of aerosols on clouds. The challenges stem from the involvement of wide range of cloud-scale dynamics and aerosol activation physical processes. Cloud dynamics modulate cloud areal extent and condensate, while aerosol activation depends on aerosol mass load, size distribution, internal mixing state, and nucleating properties, and ultimately determines cloud optical properties via particle sizes. Both macro- and micro-scale processes are obviously important for cloud-radiation interactions. We will present the main features of cloud microphysical properties in the GEOS- 5 Atmospheric GCM (AGCM) as simulated by the McRAS-AC (Microphysics of Clouds with Relaxed Arakawa-Schubert and Aerosol-Cloud interaction) scheme. McRAS-AC uses Fountoukis and Nenes (2005) aerosol activation for liquid clouds, and has an option for either Liu and Penner (2005) or Barahona and Nenes (2008, 2009) aerosol activation for ice clouds. Aerosol loading (on-line or climatological) comes from GOCART, with an assumed log-normal size distribution. Other features of McRAS-AC are level-by-level cloud-scale thermodynamics, and Seifert-Beheng (2001)-type precipitation microphysics, particularly from moist convection. Results from Single-Column Model simulations will be shown to demonstrate how cloud radiative properties, lifetimes, and precipitation are influenced by different parameterization assumptions. Corresponding fields from year-long simulations of the full AGCM will also be presented with geographical distributions of cloud effective particle sizes compared to satellite retrievals. While the primary emphasis will be on current climate, simulation results with perturbed aerosol loadings will also be shown to expose the radiative sensitivity of the microphysical parameterization

Acute alcoholic myopathy, rhabdomyolysis and acute renal failure: A case report

A case of middle aged male who developed swelling and weakness of muscles in the lower limbs following a heavy binge of alcohol is being reported, lie had myoglobinuria and developed acute renal failure for which he was dialyzed, Acute alcoholic myopathy is not a well recognized condition and should be considered in any intoxicated patient who presents with muscle tenderness and weakness

Exploring the relationship between manufacturing practices, agile capabilities and organisational performance: a case of the Thai automotive parts industry

Contemporary manufacturers have to endure the challenges of a constantly changing economic environment that is increasingly competitive. Today’s business world has witnessed increasingly intense foreign competition, rapid technological change, shorter product life-cycles and customers frequently demanding new products. To deal with this dynamic and uncertain marketplace, firms are required to become more nimble, flexible and quickly responsive to competitive and pressure situations. Recognising this trend, the manufacturing sector has focused on becoming more agile. In business situations characterised by high uncertainty, agility is not just desirable but is quickly becoming a requirement for organisations’ success. Despite number of theories being developed on agility by many academics and practitioners, few businesses have implemented agility to its full potential. Most studies on the experiences in the manufacturing sector have documented events and processes in developed economies. To respond to these issues, this study explores the development of agility in the context of a developing economy, Thailand, and specifically, its automotive parts industry. This study develops and empirically tests a research model to capture the key enablers of agility and the impact of agile capabilities on organisational performance. The conceptual foundation of the research is grounded in the Resource-based View (RBV) and the Dynamic Capability View (DCV), and in a review of the operations strategy literature. The framework establishes the cause-and-effect relationships between manufacturing practices and agile capability and organisational performance outcomes. To do this, seven hypotheses are developed and tested. The research pursues a positivist paradigm by using Structural Equation Modelling (SEM) analysis. The psychometric properties of the research instrument are generated through a rigorous procedure of content validity. This is followed by a large-scale questionnaire survey involving the Industrial Estates Authority of Thailand, focusing on tier-1 automotive parts producers. The response rate in this study is 43% (n=297). The findings confirm that the manufacturing practices in which organisational resources are integrated and reintegrated to generate new capability positively influence the development of agility. The results confirm the positive impact of agile capabilities on a business organisation’s success, particularly with reference to operational performance.The research makes an original contribution to the operations strategy and agility literature by developing and validating the research model and the accompanying measurement instrument. In particular, the conception, measurement, hypotheses and empirical findings of the manufacturing practices and the agility construct represent a significant contribution in advancing the theoretical foundation and the empirical basis of agility in the context of developing economies. Finally, the research makes a practical contribution by offering a tool for a business organisation to assess and measure its agility initiative and progress, and to identify those areas where improvement is needed