Neurocognition and Neurological Soft Signs in Children with Attention Deficit Hyperactivity Disorder

CONTEXT: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with wide repercussions. Since it is etiologically related to delayed maturation, neurocognition and neurological soft signs (NSS) could be a tool to assess this. Further the correlation of NSS and neurocognition with severity of ADHD and presence of Specific Learning Disability (SLD) would give further insight into it. AIM OF THE STUDY: To study neurological soft signs and neurocognition in children with ADHD and to correlate NSS and neurocognition with severity of ADHD and with co morbid Specific Learning Disability. SETTINGS AND DESIGN: The study was carried out in Institute of child health, Department of Child Psychiatry, Madras Medical College. It was a cross-sectional single interview study. Materials and Methods: 40 consecutive children diagnosed as having ADHD in each group were assessed for the presence of neurological soft signs using Revised Physical and Neurological Examination soft Signs scale (PANESS) and neurocognition using Trail Making Test, Stroop Test, Verbal Fluency, Verbal N Back Test and Continuous Performance Test. The ADHD was assesses by SNAP IV scale. Statistical Analysis: The data was analyzed using the t-test, chi-squared test and Pearson’s corelational analysis. RESULTS AND CONCLUSIONS: Neurological soft signs were more in ADHD with SLD, especially timed movements. As the severity of ADHD increased, neurological soft signs increased in numbers. ADHD with SLD performed poorly in attention, speed of processing and working memory and the performance worsened with increasing ADHD severity, especially inattention severity

A Novel Framework for Context Based Distributed Focused Crawler (CBDFC)

Focused crawling aims to search only the relevant subset of the WWW for a specific topic of user interest; leading to the necessity to decide about the relevancy of a document to the topic of interest; especially when the user is not perfect in specifying the exact context of the topic. This paper provides a novel framework of a context based distributed focused crawler that maintains an index of web documents pertaining to the context of keywords resulting in storage of more related documents

Sex Differences in the uptake of health care services in persons with disabilities. Identifying barriers to health care access

Background Evidence suggests that disability is more common among vulnerable populations which include women, elderly and children. And people with disabilities face widespread barriers in accessing services in relation to health, education, employment and transport. This study looks at the barriers women with disability face in accessing heath care services. The present study was undertaken in two states of India - Andhra Pradesh (Medak district) and Karnataka (Bidar). This is a descriptive study with a nested case control for comparison of access to health, education and employment status among those with and without disability The study was funded by CBM South Asia Regional Office (SARO) and was technically supported by CBM SARO Aim The main aim of the study was to look into whether women with disability have equitable access to health care in India and if there are disparities in access, the underlying causes and reasons for the same

Darned in 2013: inclusion of model organisms and linking with Wikipedia

DARNED (DAtabase of RNA EDiting, available at http://darned.ucc.ie) is a centralized repository of reference genome coordinates corresponding to RNA nucleotides having altered templated identities in the process of RNA editing. The data in DARNED are derived from published datasets of RNA editing events. RNA editing instances have been identified with various methods, such as bioinformatics screenings, deep sequencing and/or biochemical techniques. Here we report our current progress in the development and expansion of the DARNED. In addition to novel database features the DARNED update describes inclusion of Drosophila melanogaster and Mus musculus RNA editing events and the launch of a community-based annotation in the RNA WikiProject

Improved costs and outcomes with conscious sedation vs general anesthesia in TAVR patients: Time to wake up?

BackgroundTranscatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR.MethodsRecords for all adult patients undergoing TAVR at our institution between August 2012 and June 2016 were included using our institutional Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) registries. Cost data was gathered using the BIOME database. Patients were stratified into two groups according to whether they received general anesthesia (GA) or conscious sedation (CS) during the procedure. No-replacement propensity score matching was done using the validated STS predicted risk of mortality (PROM) as a propensity score. Primary outcome measure with survival to discharge and several secondary outcome measures were also included in analysis. According to our institution's data reporting guidelines, all cost data is presented as a percentage of the general anesthesia control group cost.ResultsOf the 231 patients initially identified, 225 (157 GA, 68 CS) were included for analysis. After no-replacement propensity score matching, 196 patients (147 GA, 49 CS) remained. Overall mortality was 1.5% in the matched population with a trend towards lower mortality in the CS group. Conscious sedation was associated with significantly fewer ICU hours (30 vs 96 hours, p = <0.001) and total hospital days (4.9 vs 10.4, p<0.001). Additionally, there was a 28% decrease in direct cost (p<0.001) as well as significant decreases in all individual all cost categories associated with the use of conscious sedation. There was no difference in composite major adverse events between groups. These trends remained on all subsequent subgroup analyses.ConclusionConscious sedation is emerging as a safe and viable option for anesthesia in patients undergoing transcatheter aortic valve replacement. The use of conscious sedation was not only associated with similar rates of adverse events, but also shortened ICU and overall hospital stays. Finally, there were significant decreases in all cost categories when compared to a propensity matched cohort receiving general anesthesia

THE FACTORS OF AN INDIANA BACKGROUND THAT INFLUENCE PRACTICE LOCATION CHOICE OF RESIDENCY AND FELLOWSHIP GRADUATES

poster abstractA shortage and unequal distribution of health care professionals in Indiana is increasingly restricting access to quality medical care for Indiana residents. There is a limited amount of research on the factors that predominate when residency and fellowship graduates choose their practice location. This pro-ject looks at the different factors affecting graduates’ choices of practice lo-cation, while specifically focusing on the connection of hometown, high school, college, and medical school locations to their decisions to practice in Indiana. Surveys were completed by 264 of the 383 graduating residents and fellows of the graduate medical education programs at Indiana Universi-ty School of Medicine during the exit interview process, yielding a response rate of 69%. The graduates responded to questions concerning demographic characteristics, assessment of their training, plans after graduation, intended practice location, and reasons for choosing their practice location. The larg-est contributor to choosing to practice in Indiana was graduating from a medical school in Indiana (80.6%). Having an Indiana hometown was the least contributing factor (76.1%), but the combination of hometown and medical school was the highest contributing factor (82.1%) to choosing to practice in Indiana. The top three reasons to stay in Indiana given by re-spondents who graduated from an Indiana medical school were “met my professional needs or preferences” (88.0%), “liked the people” (86.0%), and “met my personal needs or preferences” (76.0%). Also, factors concerning the needs of their spouse and family were only moderately important. This project’s data may assist admission committees when choosing graduates for their residency programs. By admitting more graduates who have deeper connections to Indiana, the number of health professionals in Indiana may increase, thus allowing more of Indiana’s residents to have access to quality health care

Does Attending a Regional Medical Campus Influence the Training Outcomes of Family Medicine Residents?

Introduction: Indiana University School of Medicine (IUSM) is the largest medical school in the nation, with its main campus located in Indianapolis and eight regional medical campuses (RMC) distributed across the state. In this study, we compared the survey responses of family medicine residents who had attended medical school at the main campus in Indianapolis versus an RMC to see if there were any noticeable differences in their residency training outcomes. Methods: From 2012 to 2017, in the spring of each year, a cross-sectional survey was administered to all final-year family medicine residents graduating from the eleven family medicine residency programs in Indiana. A total of 519 out of 520 residents completed the survey. Of whom, 132 respondents indicated they had graduated from IUSM; 45 reported they had attended the Indianapolis campus and 87 had attended one of the RMCs in the state. Our dataset for this study was comprised of these 132 respondents. Chi-square test or Fisher’s exact test were used to compare responses between groups. P-values ≤ 0.05 were considered statistically significant. Results: In the ACGME competency areas, the residents who attended an RMC versus the Indianapolis campus were significantly more likely to report being fully competent in Medical Knowledge (90% vs. 76%, p = 0.032) and Systems-Based Practice (83% vs. 64%, p = 0.019). Additionally, the residents who attended an RMC compared to their Indianapolis counterparts reported significantly higher rates of being trained to serve rural populations (73% vs. 52%, p = 0.017) as well as being fully competent to serve rural populations (69% vs. 42%, p = 0.003). However, the residents who attended an RMC were no more likely to establish a practice in a rural area than were the residents who attended Indianapolis (18% vs. 17%, p = 0.845). Conclusions: Based on these self-reported data, the family medicine residents who attended an RMC may perceive themselves to be better-prepared in a few core competency areas, as well as in serving rural populations, compared to those who attended the Indianapolis campus. These findings suggest that IUSM’s complex statewide system of medical education may offer some unique advantages in preparing students for residency, especially in family medicine

RP-HPLC METHOD FOR ESTIMATION OF TIAPRIDE RELATED SUBSTANCE IN TABLET FORMULATION

Objective: To develop a simple, precise, accurate related substance, reverse phase high-performance liquid chomatographic (RP-HPLC) method for the quantitative estimation of impurities which are present in dosage form of Tiapride Hydrochloride.Methods: The chomatographic separation was achieved with Inertsil C8 (250 × 4.6) mm, 5µ column with mobile phase containing a gradient mixture of 0.05 mM aqueous sodiumdihydrogen phosphate (KH2PO4)solution buffer: (with octanesulphonate and final pH of buffer was adjusted to 2.7 with Orthophosphoric acid): Acetonitrile: Methanol (800:150:50 v/v), flow rate of 1.5 ml/min and a detection wavelength of 240 nm.Results: The method exhibited linearity between range 0.125 to 1200 µg/ml, shows well resolved degradation products from Tiapride hydrochloride tablet with 0.063 µg/ml of LOD (limit of detection) and 0.125 µg/ml of LOQ (limit of Quantification). Forced degradation studies proved that the method is specific for Tiapride Hydrochloride and N-oxide Tiapride reported in European pharmacopeia and British pharmacopeia is one of the degradation impurity confirmed by liquid chromatography mass spectrometry (LC-MS) analysis.Conclusion: An accurate, precise, linear, robust and specific related substance RP-HPLC method was developed and validated for the quantitative estimation of impurities presented in pharmaceutical dosage form of Tiapride Hydrochloride as per ICH guidelines. The method is stability indicating used for separation of degradation products and can be used for the identification of process related impurity.Â

Provision of adolescent reproductive and sexual health services in India: Provider perspectives

The recently launched Rashtriya Kishor Swasthya Karyakram (RKSK) program seeks to enable all adolescents and youth to realize their full potential by making informed decisions concerning their health and well-being and by accessing the services and support they need to implement their decisions. To realize this vision, the RKSK framework acknowledges the strengthening of Adolescent Friendly Health Clinics (AFHCs) and providing correct knowledge and information through counseling services as two of its seven critical components. As the government makes an effort to roll out the RKSK program at scale across the country, reviewing the experiences of the AFHCs established under the National Adolescent Reproductive and Sexual Health Strategy, the predecessor of RKSK, can provide useful lessons. With this in view, at the request of the Ministry of Health and Family Welfare, the Population Council conducted an assessment of AFHCs from the perspectives of adolescents and youth and of health care providers in three states in India. This report presents the findings of the study conducted among health care providers

Heme Oxygenase Induction Suppresses Hepatic Hepcidin and Rescues Ferroportin and Ferritin Expression in Obese Mice

Hepcidin, a phase II reactant secreted by hepatocytes, regulates cellular iron levels by increasing internalization of ferroportin-a transmembrane protein facilitating egress of cellular iron. Chronic low-grade inflammatory states, such as obesity, have been shown to increase oxidative stress and enhance hepcidin secretion from hepatocytes and macrophages. Heme-heme oxygenase (HO) is a stress response system which reduces oxidative stress. We investigated the effects of HO-1 induction on hepatic hepcidin levels and on iron homeostasis in hepatic tissues from lean and obese mice. Obese mice exhibited hyperglycemia (p < 0.05); increased levels of proinflammatory cytokines (MCP-1, IL-6, p < 0.05); oxidative stress (p < 0.05); and increased hepatic hepcidin levels (p < 0.05). Enhancement of hepcidin was reflected in the reduced expression of ferroportin in obese mice (p < 0.05). However, this effect is accompanied by a significant decline in ferritin expression. Additionally, there are reduced insulin receptor phosphorylation and attenuation of metabolic regulators pAMPK, pAKT, and pLKB1. Cobalt protoporphyrin- (CoPP-) induced HO-1 upregulation in obese mice reversed these alterations (p < 0.05), while attenuating hepatic hepcidin levels. These effects of CoPP were prevented in obese mice concurrently exposed to an inhibitor of HO (SnMP) (p < 0.05). Our results highlight a modulatory effect of HO on iron homeostasis mediated through the suppression of hepatic hepcidin