Factors governing the performance of Auxiliary Nurse Midwives in India: a study in Pune district

Background: The Auxiliary nurse midwife (ANM) cadre was created to focus on maternal and child health. ANMs are respected members of their communities and established providers of maternal and child health care within the community and at the facility level. Over time, additional roles and responsibilities have been added. Despite the importance of ANMs in the primary healthcare system in India, studies that consider factors governing the performance of ANMs in their workplaces are limited. We aimed to study factors governing performance of ANMs in Pune district, India. Methods: Semi-structured interviews were conducted with 13 purposely selected key informants at facility, district, state, and national levels. Focus group discussions were conducted with 41 ANMs and 25 members of the community. Non-participatory observations with eight ANMs provided information to expand on and scrutinise findings that emerged from the other lines of inquiry. A realist lens was applied to identify ANMs’ performance as a result of “mechanisms” (training, supervision, accountability mechanisms) within the given “context” (regulatory system, infrastructure and resources, ANMs’ expanded scope of work, gender roles and norms). Results: Weak enforcement of regulatory system led to poor standardisation of training quality among training institutions. Challenges in internal accountability mechanisms governing ANMs within the health system hierarchy made it difficult to ensure individual accountability. Training and supervision received were inadequate to address current responsibilities. The supervisory approach focused on comparing information in periodic reports against expected outputs. Clinical support in workplaces was insufficient, with very little problem identification and solving. Conclusion: Focusing on the tasks of ANMs with technical inputs alone is insufficient to achieve the full potential of ANMs in a changing context. Systematic efforts tackling factors governing ANMs in their workplaces can produce a useful cadre, that can play an important role in achieving universal health coverage in India

Primary Pulmonary Non-Hodgkin’s Lymphoma

A 48-year-old woman with an asymptomatic lung mass on a routine chest roentgenogram was found to have a primary non-Hodgkin’s lymphoma involving the lung. Extensive evaluation revealed no evidence of lymphoma at any other site. She required an open lung biopsy for definitive diagnosis and was found to have unresectable tumor at thoracotomy. The patient achieved a complete remission with combination chemotherapy and remains in clinical remission 14 months after completion of therapy

Long-Term Subcutaneous Infusion of Midazolam for Refractory Delirium in Terminal Breast Cancer

We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory to standard doses of drugs such as lorazepam, diazepam, and haloperidol. We report the use of a subcutaneous infusion of midazolam at home and its effectiveness in control of her delirium after other drugs had failed

Intra-and inter-seasonal variability of nutrients in a tropical monsoonal estuary (Zuari, India)

study was conducted to understand the intra- and inter-seasonal variability of dissolved oxygen and nutrients inatropical monsoon estuary (Zuariin Goa, India). We adopted a dual sampling approach with (a) daily or alternate day sampling at a fixed location in the mid-estuarine zone and (b) longitudinal transect sampling from fresh water end to mouth during spring and neap tides of each month for about a year. Multivariate statistical analyses of oxygen and nutrients were carried out to evaluate the hypotheses: (i) biogeochemical processes chiefly regulate their variability and (ii) anthropogenic inputs lead to material accumulation in the estuary. Multivariate statistical analyses helped identify the controlling factors of the oxygen and nutrient variability. Our results significantly revealed (i) physical forcings (freshwater discharge and tidal circulation, the seals of a cilitate sedimentary releases) are more important than biogeochemical processes in determining oxygen and nutrient variability in the water column and (ii) the monsoon driven regular annual flushing makes the system resilient to human interference as the Zuari estuary returns to normalcy by post monsoon every year. Our study identified the significance of subsurface discharges in transporting mining effluents from the river basin. Results also suggest that extrapolation of controlling factors of biogeochemical variables at a fixed location to the entire estuary is untenable since the relative dominance of forcings vary in time and space in the estuary

Implication of Dynamic Recrystallization Mechanism for the Exhumation of Lower Crustal Rocks:A Case Study in the Shear Zones of the Ambaji Granulite, NW India

Shear zones are important channels for the exhumation of lower crustal rocks. The Ambaji granulite of the Aravalli-Delhi mobile belt (ADMB) has been exhumed along several shear zones, and earlier studies have shown a two-stage exhumation process during a continuous compressional tectonic event, consisting of an initial phase of vertical flow that brought the granulites to the brittleductile transition zone and a successive phase during which the granulite underwent a lateral flow. In this contribution, we studied the microtectonics of granulites by analyzing the dynamic recrystallization behaviour of quartz, while the granulite was passing through the vertical flow regime to the horizontal flow regime. We show that the dynamic recrystallization process assists the flow pattern at different levels of exhumation. The vertical flow is dominated by grain boundary migration (GBM), registering high temperatures for recrystallization between 490 and 600°C and low flow stresses of 12-15 MPa. The horizontal flow at the brittle-ductile transition (BDT) is characterized by bulging (BLG) and subgrain rotation (SGR), which occurred at low temperatures of 390-490°C and high flow stresses of 18-26 MPa. Strain rates are between 1:20 × 10−12 and 7:26 × 10−14/s. For the ductile exhumation of the granulite, we suggest that at depths of ~22 km, the granulite exhumed in a vertical direction facilitated by GBM. Once the granulite reached the BDT, at ~16 km depth, the material flowed laterally assisted by BLG and SGR. Once an exhuming body reaches the BDT, the deformation mechanism changes to BLG-SGR, and the only direction in which the material can move further is in the horizontal plan

Acquisition, prevalence and clearance of type-specific human papillomavirus infections in young sexually active Indian women: A community-based multicentric cohort study.

In context of the ongoing multi-centric HPV vaccine study in India, unvaccinated married women (N = 1484) aged 18-23 years were recruited in 2012-2015 as age-matched controls to the vaccinated women and followed up yearly. We assess type-specific prevalence, natural history and potential determinants of human papillomavirus (HPV) infection in these unvaccinated women. Cervical samples were collected yearly for at least four consecutive years. A Multiplex Type-Specific E7-Based polymerase chain reaction assay was used to detect 21 HPV types. HPV prevalence was 36.4% during 6 years. Most common HPV types were 16 (6.5%) and 31 (6.1%). Highest persistence were observed for HPV 35 (62.5%) and 52 (25%). New HPV acquisition rate was 5.6/1000 person-months of observation (PMO), highest for HPV 16 (1.1/1000 PMO). Type-specific clearance rates ranged between 2.9-5.5/100 PMO. HPV 16 and/or 18 infections were 41% (95% CI 4-63%) lower among women with 2-<3 years between marriage and first cervical sample collection compared to those with <2 years. HPV prevalence and acquisition rates in young Indian women were lower than their Western counterparts. HPV 16 infections being most common shows the importance and potential impact of HPV vaccination in India. Women with 2-3 years exposure had reduced risk possibly due to higher infections clearance