Usability of OPAC in University Libraries

The present study describes the review of literature on the usability of card catalogue, OPAC and web OPAC such as visit of the Library, awareness and use of OPAC, learning, frequency of use of OPAC, purpose of use, use of various searching options while using OPAC, satisfaction level on the use of OPAC, problems faced while using OPAC, suggestions for the improvement of OPAC System and its various features. Some national and international levels of such studies have been reviewed in this article

A community survey of newborn care practices in rural India

Background: There are a high proportion of home deliveries in rural India. The present study was carried out to assess newborn care practices among home births and reasons for delivering at home.Methods: A community based cross sectional survey of recently delivered mothers (<6 months) with at least one living child was carried out in 28 districts of 14 states.Results: A total of 4274 women delivered at home and 45.9% deliveries were conducted by untrained personnel (dais 24.0%, relatives/friends/neighbors 21.9%), trained dais 48.2% and ANMs/LHVs/doctors 5.9%. New blade was used for cutting the cord by trained dai (80.7%), untrained dais (75.5%) whereas ANMs/LHVs/doctors used either new blade (64.7%) or scissors (14.7%). Use of boiled cord tie was reported among 98.8% deliveries conducted by ANMs/LHVs/doctors, 96.6% trained dais and 96.3% untrained dais. 32.5% ANMs/LHVs/doctors, 28.3% trained dais and 26.2% untrained dais left the cord dry without any application. Main reasons for delivering at home were ‘client/social/family' related (85.9%) and ‘facility/provider’ related (21.7%). Nearly 93.3% of the new borns were given their first bath within 24 hours of birth including 77.3% within 3 hours of birth. 38.2% mothers initiating breast feeding within 24 hours of birth and within one hour 6.0% mothers only.Conclusions: There is a need for improving community awareness to promote institutional deliveries and improve health system to satisfy demands of birthing women. When home birth is inevitable, families should be encouraged to engage skilled birth attendant to provide better newborn care

Is emergency cesarean section more risky than elective cesarean section in women with previous cesarean section?

Background: Cesarean section is one of the most performed surgical procedures all over the world, but unfortunately cesarean sections are associated with a great deal of maternal morbidity and mortality. In the past the rate of cesarean section has increased for many avoidable and unavoidable indications both in developed and developing countries. The objective of this study was to compare maternal morbidity and mortality in elective repeat cesarean section (El-RCS) and emergency repeat cesarean section Em-RCS.Methods: Prospective data was recorded on management practices, associated complications and morbidity and mortality on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/teaching hospitals for delivery.Results: Of the 15664 women with a previous cesarean section, 5399 (34.5%) women underwent elective repeat cesarean section, 7752 (49.5%) women who underwent emergency repeat cesarean section and 2513 (16.0%) had successful trial of labor (S-TOL). There was    failed trial of labor (F-TOL) in 1522 cases and requiring an emergency cesarean section for delivery of baby. Therefore, total no. of 7752 women had an emergency cesarean section. The overall maternal morbidity was 22.5%, 20.7% in Em-RCS and El-RCS respectively. Blood loss was more than 1000ml in 7.2% of Em-RCS where as in El-RCS it was 8.8%, blood transfusion was 7.5% in Em-RCS where as it was 6.5% in El-RCS, dehiscence of scar in Em-RCS was 4.7% as compared to 2.2% in El-RCS, uterine rupture was 1.2% in Em-RCS as compared to 0.7 % in El-RCS found statistically significant. Post-operative complication was 5.9% cases in Em-RCS where as in El-RCS was 5.8% (p=0.79 non-significant). Maternal mortality was reported in 12 (0.2%) cases of Em-RCS as compared to 5 (0.1%) cases in El-RCS (p=0.37) which was not statistically significant.  Conclusions: Maternal morbidity was found more in emergency repeat cesarean section than in elective repeat cesarean section. Complications and referral of women who are likely to undergo cesarean section should be diagnosed at an early stage so that the maternal   morbidity and mortality can be prevented.

Trail of labor versus elective repeat cesarean section: a comparison of morbidity and mortality at tertiary care teaching hospitals in India

Background: As cesarean birth rates continue to rise, more women are faced with the choice of planning a vaginal delivery or a repeat cesarean section after a previous cesarean section. The objective of this prospective study was to study the morbidities and mortality of women attempting a trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (El-RCS).Methods: Prospective data was recorded on management practices, associated complications and morbidity &amp; mortality for a period of 8 months on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/ teaching hospitals for delivery.Results: A trial of labor was planned in 25.8% (4035) women and 34.5% (5399) women underwent elective repeat cesarean section and rest had emergency repeat cesarean section. Overall maternal morbidity due to any cause was 20.7% among El-RCS as compared to 14.2% in TOLAC which was statistically significant (OR: 1.57, CI: 1.41-1.76, P=0.00). Blood loss of more than 1000ml was around 8.0% among TOLAC where as in El-RCS it was 8.8% (OR: 0.89, CI: 0.77-1.94, p=0.14 not statistically significant). Blood transfusion was given in 3.7% in TOLAC where as in El-RCS it was given in 6.5% (OR: 0.56, CI: 0.45-0.68, p=0.00 highly significant).  Complication like dehiscence of scar was similar in both groups. Post-operative complication were seen in 2.8% cases in TOLAC where as in El-RCS it was 5.8% (OR: 0.47, CI: 0.38-0.59, p=0.00 highly significant). Uterine rupture was 0.3% in TOLAC where as in El-RCS it was 0.7% (OR: 0.43, CI: 0.21-0.87, p=0.009 statistically significant). Maternal mortality was reported in 0.2% cases of TOLAC as compared to 0.1% cases in El-RCS (p=0.17) which was not statistically significant.Conclusions: Maternal morbidity was found to be more in elective repeat cesarean section than trial of labor after cesarean section

Knowledge, attitude and practice regarding smoking in school going adolescents of Kashmir, India: a cross-sectional study

Background: Cigarette smoking, in the developed world, has been the major habit among children for both boys and girls. They usually take to the habit while in school before the age of 18. In India, tobacco consumption in multiple forms presents an emerging, significant and growing threat to the health of the adolescents. As per  WHO Global Youth tobacco Survey GYTS (2009) India, 14.6% of students currently use any form of tobacco, 4.4%currently smoke cigarettes, 12.5% currently use some other form of tobacco. Objective was to assess the knowledge, attitude and practice of school going adolescents regarding smoking.Methods: A descriptive cross sectional study was taken in school going adolescents of Kashmir. The study included three districts from Kashmir valley and from each district, 2 government middle schools (1 girls and 1 boys), 2 government high schools (1 girls and 1 boys), 2 government higher secondary schools (1 girls and 1 boys) were selected. Also from the list of private schools one middle school, one high school and one higher secondary school (All  having co-education) were selected. Thus, a total of 27 schools, 9 from each selected district, were included in the study. A total of 1000 students participated in this study.Results: The current study included 464 males (46.4%) and 536 (53.6%) females. Among the study subjects, 523 (52.30%) belonged to the 12-15 year age bracket and 477 (47.70%) were between 16-18 years of age. Maximum of study participants belonged to nuclear family (63.10%) followed by joint family (36.90%). Majority of the study subjects belonged to socio-economic class IV (lower middle) 36.10% followed by class III (middle) 23.90% as per Modified BG Prasad’s classification.Conclusions: 75.9% opined that smoking tobacco is harmful to health in comparison to 89.1% of non-smokers, a difference found to be statistically highly significant (p value <0.001). Prevention of tobacco use in young people and the consumption of tobacco, among school students should be considered as a matter of great concern which requires holistic understanding

Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program\u27s findings

Purpose: As graduate medical education (GME) moves into the Next Accreditation System (NAS), programs must take a critical look at their current models of evaluation and assess how well they align with reporting outcomes. Our objective was to assess the impact on house staff evaluation scores when transitioning from a Dreyfus-based model of evaluation to a Milestone-based model of evaluation. Milestones are a key component of the NAS. Method: We analyzed all end of rotation evaluations of house staff completed by faculty for academic years 2010-2011 (pre-Dreyfus model) and 2011-2012 (post-Milestone model) in one large university-based internal medicine residency training program. Main measures included change in PGY-level average score; slope, range, and separation of average scores across all six Accreditation Council for Graduate Medical Education (ACGME) competencies. Results: Transitioning from a Dreyfus-based model to a Milestone-based model resulted in a larger separation in the scores between our three post-graduate year classes, a steeper progression of scores in the PGY-1 class, a wider use of the 5-point scale on our global end of rotation evaluation form, and a downward shift in the PGY-1 scores and an upward shift in the PGY-3 scores. Conclusions: For faculty trained in both models of assessment, the Milestone-based model had greater discriminatory ability as evidenced by the larger separation in the scores for all the classes, in particular the PGY-1 class

Moving forward in GME reform: a 4 + 1 model of resident ambulatory training

Traditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed. To compare the impact of a traditional ambulatory training model with a templated 4 + 1 model. A large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices. Residents, faculty, and administrative staff. Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously. A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents\u27 learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p \u3c 0.0001). Satisfaction with ambulatory training improved (p \u3c 0.0001). Self-reported empanelment also increased (p \u3c 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p \u3c 0.0001). A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes. (C) Society of General Internal Medicine 201

Characterization of protective epitopes in a highly conserved Plasmodium falciparum antigenic protein containing repeats of acidic and basic residues

The delineation of putatively protective and immunogenic epitopes in vaccine candidate proteins constitutes a major research effort towards the development of an effective malaria vaccine. By virtue of its role in the formation of the immune clusters of merozoites, its location on the surface of merozoites, and its highly conserved nature both at the nucleotide sequence level and the amino acid sequence level, the antigen which contains repeats of acidic and basic residues (ABRA) of the human malaria parasite Plasmodium falciparum represents such an antigen. Based upon the predicted amino acid sequence of ABRA, we synthesized eight peptides, with six of these (AB-1 to AB-6) ranging from 12 to 18 residues covering the most hydrophilic regions of the protein, and two more peptides (AB-7 and AB-8) representing its repetitive sequences. We found that all eight constructs bound an appreciable amount of antibody in sera from a large proportion of P. falciparum malaria patients; two of these peptides (AB-1 and AB-3) also elicited a strong proliferation response in peripheral blood mononuclear cells from all 11 human subjects recovering from malaria. When used as carrier-free immunogens, six peptides induced a strong, boostable, immunoglobulin G-type antibody response in rabbits, indicating the presence of both B-cell determinants and T-helper-cell epitopes in these six constructs. These antibodies specifically cross-reacted with the parasite protein(s) in an immunoblot and in an immunofluorescence assay. In another immunoblot, rabbit antipeptide sera also recognized recombinant fragments of ABRA expressed in bacteria. More significantly, rabbit antibodies against two constructs (AB-1 and AB-5) inhibited the merozoite reinvasion of human erythrocytes in vitro up to ∼90%. These results favor further studies so as to determine possible inclusion of these two constructs in a multicomponent subunit vaccine against asexual blood stages of P. falciparum

Characterization of protective epitopes in a highly conserved Plasmodium falciparum antigenic protein containing repeats of acidic and basic residues

The delineation of putatively protective and immunogenic epitopes in vaccine candidate proteins constitutes a major research effort towards the development of an effective malaria vaccine. By virtue of its role in the formation of the immune clusters of merozoites, its location on the surface of merozoites, and its highly conserved nature both at the nucleotide sequence level and the amino acid sequence level, the antigen which contains repeats of acidic and basic residues (ABRA) of the human malaria parasite Plasmodium falciparum represents such an antigen. Based upon the predicted amino acid sequence of ABRA, we synthesized eight peptides, with six of these (AB-1 to AB-6) ranging from 12 to 18 residues covering the most hydrophilic regions of the protein, and two more peptides (AB-7 and AB-8) representing its repetitive sequences. We found that all eight constructs bound an appreciable amount of antibody in sera from a large proportion of P. falciparum malaria patients; two of these peptides (AB-1 and AB-3) also elicited a strong proliferation response in peripheral blood mononuclear cells from all 11 human subjects recovering from malaria. When used as carrier-free immunogens, six peptides induced a strong, boostable, immunoglobulin G-type antibody response in rabbits, indicating the presence of both B-cell determinants and T-helper-cell epitopes in these six constructs. These antibodies specifically cross-reacted with the parasite protein(s) in an immunoblot and in an immunofluorescence assay. In another immunoblot, rabbit antipeptide sera also recognized recombinant fragments of ABRA expressed in bacteria. More significantly, rabbit antibodies against two constructs (AB-1 and AB-5) inhibited the merozoite reinvasion of human erythrocytes in vitro up to ~90%. These results favor further studies so as to determine possible inclusion of these two constructs in a multicomponent subunit vaccine against asexual blood stages of P. falciparum