To Pace Or Not To Pace! – Prevention Of Atrial Fibrillation After Coronary Artery Bypass Surgery

Atrial fibrillation (AF) is a very undesirable, but unfortunately a common arrhythmia following coronary artery bypass graft (CABG) surgery, occurring in up to 40% of patients. There is an increase in hospital stay and adds to the overall cost of the surgery. Atrial fibrillation occurrence may identify a subset of patients with reduced survival. Prevention of AF therefore would have a significant positive impact on patients undergoing CABG surgery. Based on the mechanism of postoperative AF, it seems likely that overcoming the slow atrial conduction with reduction in the dispersion of atrial refractoriness and suppression of the atrial ectopy should prevent AF. With these considerations atrial overdrive pacing to prevent post CABG AF has been evaluated with a number of randomized, controlled trials

Void Traversal for Guaranteed Delivery in Geometric Routing

Geometric routing algorithms like GFG (GPSR) are lightweight, scalable algorithms that can be used to route in resource-constrained ad hoc wireless networks. However, such algorithms run on planar graphs only. To efficiently construct a planar graph, they require a unit-disk graph. To make the topology unit-disk, the maximum link length in the network has to be selected conservatively. In practical setting this leads to the designs where the node density is rather high. Moreover, the network diameter of a planar subgraph is greater than the original graph, which leads to longer routes. To remedy this problem, we propose a void traversal algorithm that works on arbitrary geometric graphs. We describe how to use this algorithm for geometric routing with guaranteed delivery and compare its performance with GFG

The Changing Role of Auxiliary Nurse Midwife (ANM) in India: Implications for Maternal and Child Health (MCH)

The world’s democracy and its second most populous country, India was the first developing country to have a national family planning program and has implemented countrywide reproductive health programs such as RCH I. India’s primary health care and the family planning programs have come a long way after the independence in improving health indicators in general, yet it has high material and under five mortality rates. The country has developed an extensive network of primary health centers and sub- to provide basic medical care to huge (80%) rural population. In the rural health care system, the ANM is the key field level functionary who interacts directly with the community and has been the central focus of all the reproductive child health programs. In contrast with resident ANM of sixties who was providing delivery and basic curative services to the community, today’s commuting multi purpose worker is more involved in family planning and preventive services. This has implications on the implementation and coutcomes of maternal health programs in rural India. The midwifery role of the ANM should be restored if the goal of dcreasing maternal mortality has to be met. The priority will have to change from family planning immunization to comprehensive reproductive health including maternal and neonatal care. These changes will require sustained and careful planning/resource allocation. Increasing resources along with systemic reforms will improve health status for women and children who are the focus of Reproductive Child Health programs.

Strengthening Midwifery Services in India based on lessons learnt from Sweden and Sri Lanka

Objective: The objective of the paper is to know how India can strengthen midwifery services to reduce maternal mortality based on the lessons learnt from Sweden and Sri Lanka. Method: The paper is based mainly on the literature review, field visit to Sweden and interaction with maternal health experts from Sweden and Sri Lanka. Conclusion: High maternal mortality in India is due to absence of skilled attendance at the time of delivery and poor post-natal care. Seventy percent Indian population is rural and it is not possible to have doctors for all births. Adopting evidence-based interventions such as developing a skilled cadre of locally available midwives backed up by efficient referral and emergency obstetric care services like Sweden and Sri Lanka will help India achieve the goal of reducing maternal mortality with the existing resources. Analysis also shows that establishing quality training, independent regulating body and standardizing midwifery practices in India requires sustained efforts from government, professionals and society, and reorganization of health systems. Creating the scope for career advancement will help to improve status of midwifery as a profession.