Jejunal Perforation following Screening Colonoscopy

Colonoscopy is rarely associated with complications such as colonic perforation. Perforation of the small bowel is extremely rare, especially if the procedure is done without therapeutic interventions. Several factors are associated with this entity. Perforation of the ileum has been reported, but proximal jejunal perforation secondary to rupture of jejunal diverticulum during colonoscopy has not been reported. We present the case of an 88-year-old patient who developed abdominal pain after undergoing colonoscopy without any additional interventions. Urgent exploration revealed perforation of the proximal jejunum secondary to rupture of a jejunal diverticulum. No therapy or biopsies were undertaken during the colonoscopy, which are known predisposing factors

"Getting the water-carrier to light the lamps": Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India.

The government of India has, over the past decade, implemented the "integration" of traditional, complementary and alternative medical (TCAM) practitioners, specifically practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-rigpa, and Homoeopathy (collectively known by the acronym AYUSH), in government health services. A range of operational and ethical challenges has manifested during this process of large health system reform. We explored the practices and perceptions of health system actors, in relation to AYUSH providers' roles in government health services in three Indian states - Kerala, Meghalaya, and Delhi. Research methods included 196 in-depth interviews with a range of health policy and system actors and beneficiaries, between February and October 2012, and review of national, state, and district-level policy documents relating to AYUSH integration. The thematic 'framework' approach was applied to analyze data from the interviews, and systematic content analysis performed on policy documents. We found that the roles of AYUSH providers are frequently ambiguously stated and variably interpreted, in relation to various aspects of their practice, such as outpatient care, prescribing rights, emergency duties, obstetric services, night duties, and referrals across systems of medicine. Work sharing is variously interpreted by different health system actors as complementing allopathic practice with AYUSH practice, or allopathic practice, by AYUSH providers to supplement the work of allopathic practitioners. Interactions among AYUSH practitioners and their health system colleagues frequently take place in a context of partial information, preconceived notions, power imbalances, and mistrust. In some notable instances, collegial relationships and apt divisions of responsibilities are observed. Widespread normative ambivalence around the roles of AYUSH providers, complicated by the logistical constraints prevalent in poorly resourced systems, has the potential to undermine the therapeutic practices and motivation of AYUSH providers, as well as the overall efficiency and performance of integrated health services

Wind sea and swell characteristics off east coast of india during southwest Monsoon

The waves along the east coast of India during south-west monsoon have great importance due to the prevailing rough conditions. Significant Wave height (Hs) and other wave conditions are measured at a location of 20m water depth off east coast of India during south-west monsoon 2009. Wind-sea (Hsw) and swell (Hss) components are separated from the measured data, to look into the characteristics of the waves at the measured location. It is observed that the sea-state is dominated by swells arriving from south-east (SE) to south (S). The maximum measured Hs is 2.62 m. Good positive correlation of 0.84 is observed between Hss and Hs. The contribution of Hss to Hs is 63.2 and remaining is due to Hsw. Wave age shows the presence of young sea with significant occurrence of swell. The spectral band width parameter (e), calculated from the measured data indicates that the wave components cover wide range of frequencies. The high values of spectral narrowness parameter (v) and peakedness parameter (Qp) are observed during the study period

Low-temperature oxobis(2,2,6,6-tetramethyl-3,5-heptanedionato)vanadium(IV)

The coordination geometry around the V atom in the title complex, $[VO(C_{11}H_{19}O_2)_2]$ is square pyramidal with the basal plane defined by four O atoms from two chelating \beta- diketonate ligands and the axial position occupied by an oxo group