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Background The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PC&PNDT Act), 1994 was enacted to prevent sex determination and female feticide. As a mandatory statutory requirement, All India Institute of Medical Sciences, New Delhi, India has to renew its PC&PNDT license after every 5 years. Aim The current study was undertaken with an objective to delineate in detail, the process of PC&PNDT license renewal, and the challenges dealt with while submitting the renewal application. Methods and Material An observational descriptive study was conducted from February to July 2022. The renewal process was categorized into preapplication, application, and postapplication phases. The requisite documents and data were collected from the Hospital Establishment Section and Medical Records Department. Results The preapplication phase involved obtaining details from 24 departments, with 20 responding initially. Challenges included incomplete documents and deficient details. The application phase required consolidation, affidavits, form filling, and fee payment. Postapplication, an inspection was conducted, and the renewal certification was obtained. Conclusion The study highlights the complexities of renewal of PC&PNDT license of a large multispecialty tertiary care teaching hospital. Planning leads obtained during various phases could serve as a guiding template for other similar teaching hospitals. The study suggests the need for digitalization and streamlining of documentation process to ease out the renewal process and hence contribute to better patient care at large. [ABSTRACT FROM AUTHOR]

Owing to globalization, the popular indigenous products from various ethnical backgrounds are increasingly making their presence felt all over the world. This opens up a new arena for food technologists to conduct intensive research and developmental activities on the indigenous products. In this study, six popular Indian rice products viz. plain rice, pulao, kheer, idli, khichdi and pakoda were formulated and evaluated for their proximate composition, sensory attributes and textural parameters. Out of these, kheer with semi-fluid consistency had the highest moisture content and the lowest protein and fiber contents. Kheer is similar to rice pudding consumed in the U.S.A. and Europe. Fat content was the highest in pakoda being a crispy fried product. Khichdi being a cereal pulse combination product had the highest protein content. Khichdi is also the national dish of India. The overall acceptability scores were high for pakoda, pulao and kheer which were 8.60, 7.90 and 7.30, respectively. Electromyographic analysis was conducted for in vivo textural evaluation of formulated rice products. The analysis showed reproducible masticatory behavior of human subjects within an EMG session. Twenty-five masticatory parameters, which could establish significant (p < 0.05) differences between textural perceptions among the formulated rice products, were used for cluster analysis followed by principal component analysis (PCA). The PCA resulted in one principal component which could explain data variance of up to 93%. Further, significant positive correlations were found between EMG parameters and sensory textural attributes indicating applicability of electromyography for comprehensive textural evaluation of formulated rice products. [ABSTRACT FROM AUTHOR]

This position statement reviews the evidence and rationale for the management of severe peripartum infections with a special focus on tropical infections and is tailored for resource-limited settings. [ABSTRACT FROM AUTHOR]

Sepsis poses a significant global health challenge in low- and middle-income countries (LMICs). Several aspects of sepsis management recommended in international guidelines are often difficult or impossible to implement in resource-limited settings (RLS) due to issues related to cost, infrastructure, or lack of trained healthcare workers. The Indian Society of Critical Care Medicine (ISCCM) drafted a position statement for the management of sepsis in RLS focusing on India, facilitated by a task force of 18 intensivists using a Delphi process, to achieve consensus on various aspects of sepsis management which are challenging to implement in RLS. The process involved a comprehensive literature review, controlled feedback, and four iterative surveys conducted between 21 August 2023 and 21 September 2023. The domains addressed in the Delphi process included the need for a position statement, challenges in sepsis management, considerations for diagnosis, patient management while awaiting an intensive care unit (ICU) bed, and treatment of sepsis and septic shock in RLS. Consensus was achieved when 70% or more of the task force members voted either for or against statements using a Likert scale or a multiple-choice question (MCQ). The Delphi process with 100% participation of Task Force members in all rounds, generated consensus in 32 statements (91%) from which 20 clinical practice statements were drafted for the management of sepsis in RLS. The clinical practice statements will complement the existing international guidelines for the management of sepsis and provide valuable insights into tailoring sepsis interventions in the context of RLS, contributing to the global discourse on sepsis management. Future international guidelines should address the management of sepsis in RLS. [ABSTRACT FROM AUTHOR]

Background and purpose: Weaning from a mechanical ventilator is a milestone in the recovery of seriously ill patients in Intensive care. Failure to wean and re-intubation adversely affects the outcome. The method of mechanical ventilation (MV) varies between different ICUs and so does the practice of weaning. Therefore, updated guidelines based on contemporary literature are designed to guide intensivists in modern ICUs. This is the first ISCCM Consensus Statement on weaning complied by a committee on weaning. The recommendations are intended to be used by all the members of the ICU (Intensivists, Registrars, Nurses, and Respiratory Therapists). Methods: A Committee on weaning from MV, formed by the Indian Society of Critical Care Medicine (ISCCM) has formulated this statement on weaning from mechanical ventilators in intensive care units (ICUs) after a review of the literature. Literature was first circulated among expert committee members and allotted sections to each member. Sections of the statement written by sectional authors were peer-reviewed on multiple occasions through virtual meetings. After the final manuscript is accepted by all the committee members, it is submitted for peer review by central guideline committee of ISCCM. Once approved it has passed through review by the Editorial Board of IJCCM before it is published here as "ISCCM consensus statement on weaning from mechanical ventilator". As per the standard accepted for all its guidelines of ISCCM, we followed the modified grading of recommendations assessment, development and evaluation (GRADE) system to classify the quality of evidence and strength of recommendation. Cost-benefit, risk-benefit analysis, and feasibility of implementation in Indian ICUs are considered by the committee along with the strength of evidence. Type of ventilators and their modes, ICU staffing pattern, availability of critical care nurses, Respiratory therapists, and day vs night time staffing are aspects considered while recommending for or against any aspect of weaning. Result: This document makes recommendation on various aspects of weaning, namely, definition, timing, weaning criteria, method of weaning, diagnosis of failure to wean, defining difficult to wean, Use of NIV, HFOV as adjunct to weaning, role of tracheostomy in weaning, weaning in of long term ventilated patients, role of physiotherapy, mobilization in weaning, Role of nutrition in weaning, role of diaphragmatic ultrasound in weaning prediction etc. Out of 42 questions addressed; the committee provided 39 recommendations and refrained from 3 questions. Of these 39; 32 are based on evidence and 7 are based on expert opinion of the committee members. It provides 27 strong recommendations and 12 weak recommendations (suggestions). Conclusion: This guideline gives extensive review on weaning from mechanical ventilator and provides various recommendations on weaning from mechanical ventilator. Though all efforts are made to make is as updated as possible one needs to review any guideline periodically to keep it in line with upcoming concepts and standards. [ABSTRACT FROM AUTHOR]

Skeletal dysplasias (SKDs) are a heterogeneous group of more than 750 genetic disorders characterized by abnormal development, growth, and maintenance of bones or cartilage in the human skeleton. SKDs are often caused by variants in early patterning genes and in many cases part of multiple malformation syndromes and occur in combination with non‐skeletal phenotypes. The aim of this study was to investigate the underlying genetic cause of congenital SKDs in highly consanguineous Pakistani families, as well as in sporadic and familial SKD cases from India using multigene panel sequencing analysis. Therefore, we performed panel sequencing of 386 bone‐related genes in 7 highly consanguineous families from Pakistan and 27 cases from India affected with SKDs. In the highly consanguineous families, we were able to identify the underlying genetic cause in five out of seven families, resulting in a diagnostic yield of 71%. Whereas, in the sporadic and familial SKD cases, we identified 12 causative variants, corresponding to a diagnostic yield of 44%. The genetic heterogeneity in our cohorts was very high and we were able to detect various types of variants, including missense, nonsense, and frameshift variants, across multiple genes known to cause different types of SKDs. In conclusion, panel sequencing proved to be a highly effective way to decipher the genetic basis of SKDs in highly consanguineous families as well as sporadic and or familial cases from South Asia. Furthermore, our findings expand the allelic spectrum of skeletal dysplasias. [ABSTRACT FROM AUTHOR]

An important research area in education and technology is how the learners use e-learning. By exploring the various factors and relationships between them, we can get an insight into the learners' behaviors for delivering tailored e-content required by them. Although many tools exist to record detailed navigational activities, they don't explore the learners' usage patterns for an adaptive e-learning site. The previous web log data analyses, done so far, have been very limited in their scope as they lack detailed empirical results on the learning technology usage. This paper discusses the detailed results of a case study of web data mining in a specific e-learning application. The main objective of this study is to conduct research on usability and effectiveness of the e-content by analyzing the web log. For this, a suitable data set was retrieved from raw web log records, to which various web mining and statistical techniques could be applied. We have evaluated different features of e-content that can lead to better learning outcomes for the learners, by understanding their navigational behaviors, their interaction with system and their area of interest. We found, for example, what sequence of topics were the most liked and the least liked by the learners; we also found that these patterns lead us to hypothesize the correlation and regression analysis between the average time, test score and total attempts.

Basmati, a popularly grown rice cultivar in India has a well-balanced combination of alluring aroma, fluffy texture, and elongated grain. These cultivars are commonly subjected to pretreatments namely steaming and parboiling to increase profitability. However, these processes may expressively affect the cooked rice textural attributes which can subsequently have an impact on the consumer acceptability. An upcoming textural evaluation technique namely electromyography (EMG), which is an in vivo, innovative and non-invasive procedure, was applied in this study to comprehensively elucidate the effect of these pretreatments on the cooked rice texture. The effect of steaming and parboiling on the physico-chemical characteristics of rice cultivars were also examined. For this study, raw, steamed and parboiled samples of Pusa 1121 and Pusa 1509 were selected. Steaming, which is used as an artificial aging process, resulted in increase in length to breadth ratio (L/B) while L/B ratio decreased with parboiling. Fat and ash contents increased with steaming and parboiling whereas moisture, protein and fiber contents decreased after these two post-harvest processes. Steaming had negligible effect on color of rice of both the cultivars and resulted in improved sensory aroma, taste, appearance, texture and overall acceptability. On the other hand, parboiling of rice resulted in darker rice with very low sensory acceptability. The bioelectrical activities of the chewing muscles, as acquired by EMG, during mastication of cooked rice samples were found to be reproducible. Out of twenty three acquired EMG parameters, fifteen masticatory parameters could significantly (p < 0.05) detect textural differences among the cooked rice samples. To summarize the results, a cluster analysis followed by principal component analysis was conducted which reduced these fifteen EMG parameters to two meaningful principal components namely PC1 and PC2. These two principal components, PC1 and PC2, were found to explain a data variance of 49.3% and 36.4%, respectively. In nutshell, EMG parameters namely chew number, amplitude per chew, middle amplitude, cycle time, early burst duration and late muscle activity related significantly (p < 0.05) with cooked rice sensory textural parameters signifying EMG's applicability in successfully establishing the effect of steaming and parboiling on the textural attributes of cooked rice samples. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite low prevalence of tobacco smoking among women in India, smokeless tobacco (SLT) use constitutes a significantly higher burden. There is limited previous research in the field of tobacco use and quitting behavior particularly in older women in India. The study aims to ascertain the prevalence, patterns, and sociodemographic determinants of tobacco use and predictors of quit among older women in India. METHODS: Cross-sectional and nationally representative data from the first and second wave of WHO's Study on global Ageing and Adult Health (SAGE 2007 and 2015) were analyzed. Outcome variables included smoking and SLT use, with quit status assessed, while explanatory variables encompassed sociodemographic characteristics like age, education level, marital status, body mass index, religion, ethnicity, residence, wealth quintiles, and mother tongue. RESULTS: We observed a reduction in the prevalence of tobacco use in any form among women from 34.17% (SAGE-1) to 18.17% (SAGE-2). The prevalence of current tobacco use in any form was 9.89% (n=352; 95% CI: 8.74-11.17), tobacco smoking was 9.42% (n=331; 95% CI: 8.29-10.69), while the prevalence of current SLT use was 12.3% (n=454; 95% CI: 10.99- 13.72). Muslim women had significantly higher odds of using SLT compared to Hindu women (AOR=1.86; 95% CI: 1.24-2.69). Successful quit after initiation to SLT use was reported in only 7.62% of the women. Women from scheduled caste ethnicity were less likely to achieve a successful quit (AOR=0.70; 95% CI: 0.09-5.81) compared to other caste groups. CONCLUSIONS: Approximately one in five older women used tobacco, with higher prevalence than GATS data, underscoring the need for continued surveillance and focused public health efforts. Furthermore, quit rates in female SLT users continue to be very low suggesting the need for strengthening access, availability, and affordability of tobacco cessation services to promote successful quitting behavior. [ABSTRACT FROM AUTHOR]

Mushroom cultivation is a prevalent activity worldwide, although the domestication of native wild mushrooms is not fully recognised. For wild mushrooms to be economically feasible, they need to possess the ability to be cultivated. The objective of this study was to cultivate 18 wild mushrooms that were collected from their native environments utilising substrates that are readily available in the local area. Wild mushrooms were gathered and acquired using tissue cultures. All the wild mushrooms studied showed mycelial development on the substrates, except for Podaxis pistallris, Amanita solitaria, and Collybia platyphylla. Pleurotus sapidus and Pleurotus floridanus were able to produce fruit satisfactorily. The study revealed that specific wild mushrooms had the ability to produce fruiting bodies when grown on commercial substrates. While mushroom production was not seen in other natural cultures, these findings offer valuable information for improving growth circumstances in the future. Conducting surveys of natural habitats is crucial to guarantee the ongoing production of wild edible mushrooms, safeguarding endangered species and promoting a hopeful outlook for their sustainable utilisation. [ABSTRACT FROM AUTHOR]

Entrepreneurship plays a vital role in the process of wealth creation and improving the standard of living of the people through large-scale employment generation. So this study aims to identify the critical factors among the entrepreneurial framework conditions (EFC) and entrepreneurial behaviour and attitudes (EBAA) in enhancing the entrepreneurship climate in the United States of America (USA), China and India. The data for the study is collected from GEM (Global Entrepreneurship Monitor) on EBAA and EFC. Exploratory factor analysis was attempted initially to reduce the EBAA and EFC data into manageable factors. Further, confirmatory factor analysis was attempted to cross-validate the results. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hemoglobinopathies constitute an increasing health burden globally.β form of thalassemia is extremely common among Mediterranean people, and it is named after this geographical link. HPLC is an excellent tool for screening various haemoglobin variants including HbF and HbA2. AIMS AND OBJECTIVES: The present study was carried out to diagnose hemoglobinopathies and thalassemias using HPLC method in children on the basis of age, ethnicity and sociodemographic factors. MATERIALS AND METHODS: A prospective was carried out including 107 children, screened for the presence of hemoglobinopathies. All children under 5 years presenting with microcytic hypochromic anemia (MCV <80fl), (MCH <27pg), not responding to conventional treatment and with a clinical suspicion of hemoglobinopathy were included in the present study. Children with a recent history of transfusion(less than three months prior to sample collection) were excluded from the study. RESULTS: A total of 107 cases (66 men and 41 women) were included in the present study. Blood grouping, hemoglobin, peripheral smear, serum ferritin, serum bilirubin, ALP, SGOT, SGPT was done for every child. Out of 107 cases,66(61.7%) cases displayed normal Hb pattern, 29 cases (27.1%) were diagnosed as Beta thalassemia trait,5(4.7%) cases as Thalassemia major, 3 (2.8%) cases as Thalassemia intermedia and 1(0.9%) case each of HbS, HbD, HbE and HPFH . CONCLUSION: HPLC is an excellent tool for diagnosing hemoglobinopathies. It is a useful tool for screening hemoglobinopathies in country like India with a high prevalence of hemoglobinopathies.It also aids in prenatal diagnosis of hemoglobinopathies. [ABSTRACT FROM AUTHOR]

In this study, we report the discovery of novel Nigrospora species isolated from the extensively cultivated PUSA 44 rice variety in Punjab, India. Out of the 120 isolates examined, 6.6% and 5% isolates exhibited tolerance to high salinity and drought stress. Isolates 6OSFR2e and 7OSFS3a exhibited the highest indole acetic acid and gibberellic acid production, with 268.32 ± 08.10 and 25.72 ± 0.04 µg/mL. Additionally, isolates 7OSFS3a, 6OSFR2e and 6OSFL4c had highest antioxidant potential with IC50 345.45 ± 11.66, 391.58 ± 10.66, and 474.529 ± 11.08 µg/mL. The isolates 6OSFR2e and 6OSFL4c also exhibited phosphate solubilisation with a PI of 1.06 ± 0.00 and 1.04 ± 0.02. The highest cellulase and laccase production with EI 1.24 ± 0.00 and 1.16 ± 0.00 was observed by isolates 6OSFR2e and 6OSFL4c. Promising results were observed in the case of ammonia production. The isolates belonged to the same phylum, Ascomycota and were identified as Nigrospora zimmermanii (6OSFR2e) and Nigrospora oryzae (7OSFS3a), and Nigrospora sphaerica (6OSFL4c) using morpho-taxonomic and molecular identification. The present study provides a critical insight into the characteristics of these Nigrospora species, which could be used to develop a bio-consortium for the rejuvenation of PUSA-44 cultivation. [ABSTRACT FROM AUTHOR]

Caesalpinia crista belonging to family Caesalpiniaceae is found in the hotter parts of India. It is common in West Bengal and South India. It often grows as a hedge plant. It is commonly known as Fever nut or Latakaranja. Various parts of the plant like seeds, leaves, bark, flowers, root and oils are used in traditional system of medicine to treat fever, malaria, skin diseases and inflammation. It also possesses antidiarrheal, anthelmintic, antifertility, antidiabetic, analgesic, anticonvulsant, hepatoprotective, antioxidant, antitumour, wound healing, antipyretic and antiulcer activities. The major constituents isolated are diterpenoids of the cassane and norcassane types. The extracts also show the presence of flavonoids, tannins, alkaloids, saponins, coumarins, proteins, carbohydrates, reducing sugars, triterpenoids and fatty acids. [ABSTRACT FROM AUTHOR]

Background: The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes. Methods: We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 and 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure. Results: After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637). Conclusions: Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients' continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients. [ABSTRACT FROM AUTHOR]

The present investigation aimed to identify genome wide SNPs and to carry out diversity and population structure study using ddRAD-seq based genotyping of 58 individuals of six indigenous milch cattle breeds (Bos indicus) such as Sahiwal, Gir, Rathi, Tharparkar, Red Sindhi and Kankrej of India. A high percentage of reads (94.53%) were mapped to the Bos taurus (ARS-UCD1.2) reference genome assembly. Following filtration criteria, a total of 84,027 high quality SNPs were identified across the genome of 6 cattle breeds with the highest number of SNPs observed in Gir (34,743), followed by Red Sindhi (13,092), Kankrej (12,812), Sahiwal (8956), Tharparkar (7356) and Rathi (7068). Most of these SNPs were distributed in the intronic regions (53.87%) followed by intergenic regions (34.94%) while only 1.23% were located in the exonic regions. Together with analysis of nucleotide diversity (π = 0.373), Tajima's D (D value ranging from − 0.295 to 0.214), observed heterozygosity (HO ranging from 0.464 to 0.551), inbreeding coefficient (FIS ranging from − 0.253 to 0.0513) suggested for the presence of sufficient within breed diversity in the 6 major milch breeds of India. The phylogenetic based structuring, principal component and admixture analysis revealed genetic distinctness as well as purity of almost all of the 6 cattle breeds. Overall, our strategy has successfully identified thousands of high-quality genome wide SNPs that will further enrich the Bos indicus representation basic information about genetic diversity and structure of 6 major Indian milch cattle breeds which should have implications for better management and conservation of valuable indicine cattle diversity. [ABSTRACT FROM AUTHOR]

This study explores (i) the health status among the elderly in India; (ii) variation in the health status among the elderly by their socioeconomic characteristics; and, (Hi) the morbidity among the elderly from a different group of diseases. It used data collected by the National Sample Survey Organisation (NSSO) for its 75th round survey, namely 'Social Consumption in India-Health' which was conducted in the country between July 2017 and June 2018. The study employed age-adjusted logistic regression (OR) for finding the dependence of 'Poor overall health status' with background characteristics of the elderly. It was observed that poor perceived health status rose with the increase in the age of respondents and was comparatively higher among women, those who lived without their spouse, resided in urban areas and were economically dependent, than their counterparts. In the case of physical immobility as well, a substantial increase in the proportion of per sons suffer ing from this phenomenon was observed with an increase in age. It was also higher among women who lived without their spouses. The morbidity profile of the elderly found a high prevalence of chronic diseases, including cardiovascular diseases, endocrine, metabolic and nutritional group of diseases, and musculoskeletal ailments among the elderly. [ABSTRACT FROM AUTHOR]

Proteases play a significant role in milk and its products by affecting flavor, texture and longevity. The expression of endogenous proteases varies across different stages of lactation. The study was conducted to understand the transcriptional pattern of different classes of protease-pathways associated genes (CTSB, CTSD, CTSH, CTSL, CTSK, CTSS, CTSZ, PLAU, PLAT) and potential protease inhibitors (SERPIN E2 and SERPIN F2) in 40 milk somatic cells (MSC) samples isolated during early, peak, mid and late lactation stages of Sahiwal cows and Murrah buffaloes – the two most important dairy breeds of India. In Sahiwal cows, except CTSK and PLAU, the expression of other proteases class was not affected significantly (p > 0.05) across lactation stages. However, in Murrah buffaloes, the expression of different proteases increased as the lactation progressed. Most of the proteases showed lower expression during early and peak lactation stages while their expression tends to increase during mid to late lactation stages. The overall trend was somewhat similar in both the dairy species albeit the level of expression was higher in buffalo MSC as compared to cow MSC. The study has provided valuable information on expression kinetics of different proteases in milk somatic cells of two major dairy breeds of India. [ABSTRACT FROM AUTHOR]

Background: Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods: An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results: Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion: We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country. [ABSTRACT FROM AUTHOR]

Background: Research shows that both hypertension and prehypertension accelerate the decline in standardized global cognitive performance. Two important risk factors for development of elevated BP are stress and anxiety. Hence, the study also focuses on assessing stress and anxiety in undergraduate medical students using validated questionnaires. Aims and Objectives: Hypertension and prehypertension are on a rise in undergraduate medical students and are proposed to accelerate cognitive failure. This study aims to provide prevalence of hypertension, prehypertension, anxiety, stress, and its association with cognitive failure among 1st year medical students in a medical college in North India. Materials and Methods: The study is a cross-sectional study conducted in the Department of Physiology of a Medical College on 1st year medical students. Google form was given to the whole batch of 150 medical students. Out of them, 111 students voluntarily participated. Hence, we have included them in our study. Standard questionnaire prescribed by Cohen et al., Spitzer et al., and Broadbent et al., for stress, anxiety, and cognitive failure respectively was given to students. Google documents were used as a platform to create online questionnaires that were automatically posted through a unique URL. Password protected access to URL link and a unique study ID gave students round the clock access. Unique study ID ensured confidentiality of all self-reported data. Student's response was secured using a "cloud" database, where data were automatically sorted, scaled, and scored by custom Excel formulas. Blood pressure of all the students was measured and a Google form consisting of items from these three questionnaires was filled by the students. Data were organized and statistically analyzed by Chi-square test. Results: In the present study, the prevalence of prehypertension was 46.8% and hypertension was 7.2%. Perceived stress score was moderate in 71.2% of subjects and high in 10.8% of subjects. Moderate-to-severe anxiety was recorded in 21.6% of students. Cognitive failure score was high (>43) in 24.3% of students. A Chi-square test of independence was performed to examine the relation between blood pressure and cognitive failure. Relationship between these variables was significant χ² (1, n=111)=7.08, P=0.029. Patients with hypertension are likely to develop cognitive failure than those with normal blood pressure. Conclusion: The prevalence of prehypertension and hypertension is rising in medical students. Anxiety and stress being the major causes need to be addressed so as to maintain cognitive well-being of the undergraduate medical students. [ABSTRACT FROM AUTHOR]

Aim: Adequate vitamin B12 levels in infancy are crucial for normal psychomotor and cognitive development of infants. Our aim was to examine serum vitamin B12, folate and ferritin levels in exclusively breastfed healthy full‐term infants (age group: 1–6 months), and also investigate their correlation with maternal markers. Methods: A cross‐sectional study was conducted on 100 exclusively breastfed healthy full‐term infants (age group: 1–6 months) along with their lactating mothers. Serum vitamin B12, folate and ferritin levels were determined for each mother–infant dyad using enzyme‐linked immunosorbent assay. Results: The mean serum vitamin B12, folate and ferritin levels were 512 vs. 535 pg/mL, 15 vs. 12 ng/mL and 313 vs. 114 ng/mL in infants and mothers, respectively. Among 100 infants, 26 (26%) had lower vitamin B12 levels and 5 (5%) had inadequate folate levels. In addition, 22 (22%) of 100 lactating mothers were deficient in vitamin B12 levels and 14 (14%) had inadequate folate levels. We found a statistically significant positive correlation between infant and maternal vitamin B12 (r = 0.659, P < 0.001) and folate levels (r = 0.51, P < 0.001). Conclusion: Vitamin B12 deficiency was observed in 26% of infants and 22% of lactating mothers. Vitamin B12 and folate levels of infants were positively correlated with maternal levels in the state of Punjab, North‐West India. Our findings support that maternal vitamin B12 status can be used as a valuable predictor of infant vitamin B12 status. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. [ABSTRACT FROM AUTHOR]

Introduction: The information on the clinical outcome of renal transplant recipients getting COVID-19 infection is sparse. The aim of this study is to report a single-center experience of renal transplant recipients with COVID-19 from India. Methods: This was a retrospective study of 23 consecutive renal transplant recipients with COVID-19 infection presenting to our center from May 2020 to August 2020. Clinical parameters, laboratory values, imaging characteristics, and outcome of the patients were collected and analyzed. Results: Median follow-up duration was 36 (range: 10--110) days. Median age of patients was 54 (23--70) years, and 87% were male. Median duration since transplant was 69 (range: 15--132) months. The most common presenting feature was fever (82.6%), followed by breathlessness (43.5%) and cough (30.4%). Hospitalization rate was 52.2%, while 34.8% required ICU care. Severe to critical disease was seen in 39.1% of patients, and 17.4% required mechanical ventilation. Patients with severe disease had a higher incidence of lymphopenia (P = 0.005) when compared to the ones with mild to moderate disease. Acute kidney injury was seen in 39.1% of patients, and 13% required dialysis. Mortality rate was 13% overall, and 25% in those hospitalized. Conclusion: Renal transplant recipients with COVID-19 have a poor outcome. Although not all of them need hospitalization, they should be monitored closely. Immunosuppression minimization is an important part of the treatment strategy. [ABSTRACT FROM AUTHOR]

Genetic variations of the beta casein gene hold importance because of their probable association with human health. Comparative sequence analysis of β–casein gene across Indian native, crossbred and exotic breeds in India revealed 15 SNPs and 4 INDELs corresponding to 14 haplotypes. The frequency of A2 type haplotype was maximum (0.941) across all Indian native breeds. Among the 15 variants reported for taurine breeds, only three (A1, A2 and B) were observed in analysed populations. Allelic profiling of A1/A2 β–casein variants in ~ 4000 animals belonging to three cattle types and breeding bulls also revealed the predominance of A2 allele (0.95) in Indian cattle. The high proportion of A2 allele/haplotype indicates that Indian native cattle are the best suited to meet the demands for A2 milk globally. However, a higher percentage of heterozygous genotype (A1A2) in breeding bulls warrants the need to screen sire lines so as to drift the herd towards A2. [ABSTRACT FROM AUTHOR]

The transformation of mature (urbanized) phase of the ancient Indus civilisation between ∼4200 and 3800 years Before Present (yr BP) overlaps with the beginning of the Meghalayan Age (∼4200 ± 100 yr BP). Though exact cause(s) for decline of urbanized Indus phase are not yet clear, researchers continue to debate whether monsoonal dryness was the sole cause or several other regional factors manifested in a compounding manner. Here, we show a regional relative sea level fall in the downstream area of Indus habitation (south‐western Gujarat region) which initiated at 4150 ± 230 and continued up to 3625 ± 200 yr BP. We provide a multi‐proxy (chronological, sedimentological, mineralogical, isotopic and elemental abundance) data set from a well‐dated vertical sediment trench from Lothal (ancient dockyard area of Indus era) to support this inference. Chief proxies used for inferring the relative sea level fall were bulk sediment carbon and sulfur contents along with their stable isotopes (δ13C and δ34S) and foraminiferal assemblage. The conspicuous shifts in majority of proxies hint at a lowering of sea stand at the regional level that likely dried this ancient Harappan dockyard (used for sea trade). Findings of our study possess implications for Holocene climate changes and their plausible impact(s) on Harappan trade and culture. Additionally, it invites evidences for large scale geological changes at ∼4200 yr BP distinct to the Meghalayan era. Plain Language Summary: The Holocene epoch is known for stable climate and advent of organized lifestyle in human habitations. However, this time‐window experienced several abrupt climatic changes at ∼8.2 ka, ∼4.2 ka, Medieval climate warmth, Little Ice age etc. We continue to debate whether these climatic shifts impacted the contemporary human habitations. Geologists have recently rechristened the last 4200 year period as a distinct sub‐stage termed as the Meghalayan Age. The timing of the decline in trade and decentralization of the ancient Indus civilization coincides with the beginning of the Meghalayan Age; this provides an opportunity to revisit geological repositories of this timeframe to assess impact(s) of climate change on human culture. Meghalayan age is known to have begun with recurring monsoonal droughts. We provide here multi‐proxy evidence for a regional fall in coastal southwestern Gujarat (India) area. We posit this regional sea level fall at Lothal (Gujarat) might have adversely impacted ancient maritime Harappan trade and contributed to the declining/decentralizing Indus civilization during the end part of its mature phase. Key Points: Evidence of seawater withdrawal in the downstream area of Indus habitation (NW India) at the dawn of Meghalayan Age (4150 yr BP)The lowering of sea stand dried the ancient dockyard at Lothal impeding the ship movement which likely had an adverse impact on tradeCarbon‐sulfur contents, their stable isotopes and foraminiferal assemblage proved to be effective in establishing past sea stand [ABSTRACT FROM AUTHOR]

Micro, small and medium enterprises (MSMEs) are considered a crucial part of the Indian economy. They contribute significantly to the country's GDP and conduces social growth through inclusive development. The rural parts of India are getting an upliftment with the help of growing MSMEs. The Government of India (GoI) takes several initiatives to support the MSMEs, and one such step was taken in the year 2014. In respect to that, GoI proposed a framework in 2015 that would evaluate the ease of doing business (EoDB) among Indian states. The initiative was taken to create more favourable entrepreneurial ecosystem across all Indian states. This paper tries to analyse the impact of Business Reform Action Plans (BRAPs) on the increase/decrease of MSMEs in the top and emerging states. States ranked as top achievers and achievers in EoDB ranking (2016–2017 and 2017–2018) are considered the top performing states, and fast-moving states are considered emerging states for the analyses. Some states show a positive relation between BRAP scores and MSMEs count, but some have contrary results. BRAP actions of top and emerging states with no point scoring are studied to determine which actions contribute to growing MSMEs. For this, the reports of BRAP published by the Department for Promotion of Industry and Internal Trade were studied. The results revealed four major action plans: commercial dispute resolution enablers, construction permit enablers, labour regulation enablers and availability of land, influencing the increase/decrease of MSMEs in Indian states/union territories (UTs). [ABSTRACT FROM AUTHOR]

Cotton (Gossypium hirsutum L.) is an important fiber crop with high energy and C footprints. This study aimed at tracking C footprints through emission of greenhouse gases and energy flow nexus in cotton cultivation to frame policy to reduce C and energy footprints, while enhancing net ecosystem C budget and C sequestration in soils. We attempted to quantify and optimize C footprints and energy flow in cotton cultivation using integrated Life Cycle Assessment and Data Envelopment Analysis approach. The total input energy of 23,960 MJ ha−1 produced total output energy of 73,964 MJ ha−1. The energy use efficiency and energy productivity were 3.1 ± 0.1 and 0.083 ± 0.003 kg MJ ha−1, respectively. The Charnes–Cooper–Rhodes model based Data Envelopment Analysis approach elucidated 37 (out of total 65), while Banker–Charnes–Cooper model revealed 55 decision-making units as energy efficient. The energy footprints expressed as specific energy were significantly higher under current production situation (13.0 MJ kg−1), compared with optimum production situation (12.0 MJ kg−1). The Data Envelopment Analysis based optimized total energy input was significantly reduced by 1522 MJ ha−1 through chemical fertilizers (2.7–51.5%) and biocides (7.7–25.1%), which led to a significant reduction of ~9.2% of total C equivalent emissions having a technical mitigation potential of 114.3 kg CO2e ha−1. The negative values of net ecosystem C budget for efficient (− 4.04 Mg C ha−1) and inefficient (− 4.94 Mg C ha−1) decision making units revealed that these ecosystems act as net C source. The average technical efficiency of 0.87 ± 0.02 revealed that ~13% of total energy input could be saved without any impact on cotton productivity and environment. These results underpin the overwhelming significance of intensified extension efforts for efficient use of chemical fertilizers and discouraging farmers from unwarranted use of biocides in cotton in the north-western India. [ABSTRACT FROM AUTHOR]

Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, dueto the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months. [ABSTRACT FROM AUTHOR]

Aim: ABO-incompatible (ABOi) kidney transplantation overcomes immunological barrier of blood group incompatibility. There have been very few published experiences of ABOi kidney transplantation from India. We present our single-center experience of the first hundred ABOi kidney transplants. Material and Methods: This is a single-center retrospective study of consecutive first hundred ABOi kidney transplant with at least 6 months of follow-up. Results: During the study period (2011-2020), a total of 121 ABOi kidney transplants were performed. Of these, first hundred patients were analyzed. Median follow-up duration was 33 (10-101) months. Mean recipient and donor age were 41.5 ± 13 and 47.68 ± 11.25 years, respectively. Mean HLA mismatch was 4 ± 1.5. Median baseline anti-blood group antibody titer was 128 (2-1024). Most common recipient blood group was O. Patient and death censored graft survival was 93% and 94%, respectively, at median follow-up of 33 months. Biopsy-proven acute rejection (BPAR) rate was 17% with acute antibody-mediated rejection being 3%. Rate of infection was 37%, most common being urinary tract infection. Conclusion: ABOi kidney transplant patients had acceptable patient and graft survival as well as BPAR rates. With current preconditioning protocol, infection rate was high. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID‐19) pandemic led to a sudden drop in renal transplant numbers across India in the initial months of 2020. Although the transplant numbers increased with easing of lockdown, the outcome of these transplants remains unknown. Methods: This was a retrospective, observational, multi‐center study done across eight different transplant centers in India. All the transplants done from January 30, 2020 to December 31, 2020 were included. The primary outcomes studied were patient and death censored graft survival as well as incidence of COVID‐19 infection and its outcomes. Results: During the study period a total of 297 kidney transplants were done. After a median follow up of 265 days the patient and death censored graft survival was 95.3% and 97.6%, respectively. Forty‐one patients (13.8%) developed COVID‐19 post‐transplant. Majority (58.5%) were asymptomatic to mildly symptomatic and the case fatality ratio was 14.6%. On multivariable logistic regression analysis older age was associated with higher likelihood of COVID‐19 infection (odds ratio 1.038; CI 1.002–1.077). Conclusions: Patient and graft outcome of kidney transplants done during the COVID‐19 pandemic in India was acceptable. The incidence of COVID‐19 was 13.8% with a high case fatality ratio. [ABSTRACT FROM AUTHOR]

India expects a USD 2.5 trillion contribution from small and medium enterprises (SMEs) to its GDP by 2025. This would be about half of its targeted GDP. This implies an explosive growth performance expectation from the SMEs. Theresearch in the last three decades shows that the (traditional) marketing that works for large organizations might not be blindly duplicated for SMEs. This triggered the emergence of a newer field called entrepreneurial marketing (EM). There have been a few empirical studies conducted to verify the dimensions of EM. The dimensions of EM have not been found significant in all studies done so far. The objective of this study was twofold -- to verify the applicable dimensions of EM in SMEs in an emerging economy India and secondly find the effect, if any of EM on firm performance. A quantitative approach was used to explore the impact of Entrepreneurial Marketing on the overall firm performance of the Small and Medium Enterprises (SMEs). This study is based on a sample of 181 SMEs. The IBM software SPSS version 21 was used to conduct the regression analysis. The study identified the effective EM dimensions in the Indian context and was able to show the positive relationship between entrepreneurial marketing and SME firm performance. [ABSTRACT FROM AUTHOR]

Introduction: Renal replacement therapy (RRT) is utilized for patients admitted with acute kidney injury and is becoming indispensable for the treatment of critically ill patients. In low middle income and developing country like India, the epidemiological date about the practices of RRT in various hospitals setups in India are lacking. Renal replacement therapy although is being widely practiced in India, however, is not uniform or standardized. Moreover, the use of RRT beyond traditional indications has not only increased but has shifted from the ambit of the nephrologist and has come under the charge of intensivists. Aims and objectives: The goal of the study was to record perceptions and current practices in RRT management among intensivists across Indian intensive care units (ICUs). Materials and methods: A questionnaire including questions about hospital and ICU settings, availability of RRT, manpower availability, and RRT management in critically ill patients was formed by an expert panel of ICU physicians. The questionnaire was circulated online to Indian Society of Critical Care Medicine (ISCCM) members in October 2019. Results: The facilities in government setups are scarce and undersupplied as compared to private or corporate setups in terms of ICU bed strength and availability of RRT. High cost of continuous renal replacement therapy (CRRT) makes their use restricted. Conclusion: Resources of RRT in our country are limited, more in government setup. Improvement of the existing resources, training of personnel, and making RRT affordable are the challenges that need to be overcome to judiciously utilize these services to benefit critically ill patients. [ABSTRACT FROM AUTHOR]

Pharmacies have hit the internet and received a warm response. Against the traditional way of buying medicines from pharmacy stores after seeking a medical advice, people are getting adapted to buying medicines online. A common practice among the druggists is to provide a substitute medicine. Customers are highly concerned and sensitive about their health. People are well aware of the fact that medicines though cure, are accompanied with major or minor side effects. Online availability of medicines has brought revolution in the health sector. Online pharmacies in India are in a nascent stage right now but have immense potential for growth. Online medicine market is growing at an exponential rate. Indian consumers are welcoming the trend of online buying of medicines. Online pharmacies provide facilities like home delivery, easy access and reminders to customers along with pocket-friendly offers. For marketers, it becomes all the more important to cater to the mindset of customers. Existing literature in the Indian context is limited to online buying of drugs by consumers without being specific to generic or non-generic. This brings forward a research gap to explore the online buying behaviour of consumers with respect to generic as well as nongeneric medicines. [ABSTRACT FROM AUTHOR]

Aim: This study compared the efficacy of administering intrapleural streptokinase to children with multi-loculated empyema within 14 days or at any time after disease onset.Methods: We studied children under 12 years with multi-loculated empyema who were admitted to a teaching hospital in Chandigarh, India, from July 2013 to June 2017. They received antibiotics, pleural drainage and intrapleural streptokinase. The first group received three doses within 14 days of disease onset, the second received three doses regardless of time after onset and the third group received four to six doses regardless of time after onset. The three phases lasted 18, 18 and 12 months, respectively.Results: Of 195 children, 133 (68%) received streptokinase within 14 days, 46 (24%) beyond 14 days and 16 (8%) did not receive it. There was no difference in surgical decortication (14/133 versus 7/46, p > 0.05) and median hospitalisation duration (15 versus 14 days, p > 0.05) between administration before versus after 14 days. Median hospitalisation was shorter with four to six doses than three doses (11 versus 16 days, p < 0.01).Conclusion: Intrapleural streptokinase was effective for multi-loculated empyema even when it was administered more than 14 days after disease onset and four to six doses were superior to three doses. [ABSTRACT FROM AUTHOR]

Abstract: Ladakh is an important part of the Trans‐Himalayan region located between the Kunlun mountain range in the north and the main Great Himalayas to the south in the state of Jammu and Kashmir of India. The local cattle from Leh and Ladakh region, known as “Ladakhi cattle” is a unique germplasm having an excellent adaptation potential to high altitude hypobaric stress. In the present study, an effort was made to evaluate the transcriptional pattern of hypoxia inducing factor‐1 (HIF‐1) and several of its regulated genes in PBMCs of local Ladakhi cattle, Holstein Frisian crosses, Jersey (exotic) maintained at high altitude region and Sahiwal (Bos indicus) and Karan Fries (cross bred) cattle maintained in tropical environment. The combined data set indicated increased expression of HIF‐1 and its regulated genes viz., glucose transporter 1 (GLUT1), vascular endothelial growth factor (VEGF), and hexokinase (HK2) in high altitude cattle indicating their importance in maintaining cellular homeostasis during high altitude hypoxia. The data indicated that hypoxia associated genes accumulated under hypoxic conditions are part of an essential adaptive component for adaptation to the high altitude of the trans‐Himalayan region. In contrary, higher expression of molecular chaperons’ viz., HSP70 and HSP90 in tropically adapted cattle give tolerance to high ambient temperature prevalent in tropical condition. In conclusion, HIF‐1 and its regulatory genes could be termed as important candidates for producing homeostatic responses to hypoxia in cattle populations reared in higher altitudes of the Trans‐Himalayan region. [ABSTRACT FROM AUTHOR]

Introduction: More than 24% of the world's population, are infected with soil-transmitted helminth infection. Aim: To assess the helminthic load & efficacy and safety of various antiheliminthics. Methods: A total of 400 patients who met the inclusion criteria were recruited after proper consent. Subjects were divided into Four groups (100 each) randomly & receive different anti-helminthic drugs. Cure rate and egg reduction rate was used as a primary outcome measure. Three weeks later two more stool samples were analyzed by two methods 1) Direct Smear method & 2) Concentration method. On follow-up, each group were randomly assigned a single dose of albendazole (single 400 mg dose), mebendazole (100 mg, BD×3 days), pyrantel pamoate (11 mg/kg orally once) and ivermectin (0.2 mg/kg orally once) using a randomization procedure. The data was statistically analysed. Observations: Among 400 patients, 63% were 5-19 years of age, 68% were male, 73.5% were from rural areas, 71% were literate, 62% were in the low income group, 58% reported closed sanitation, 6.75% were having low BMI, 26.25% were having High Absolute Eosinophilic Count before treatment, 77.5% were non-anaemic. 92.5% did not have icterus. In the present study it was seen that the difference among the four drugs was statistically significant as per demographic variables. Significant decrease of worm load after treatment were comparable with each other. However, Presence of Worm across papillae seen after upper GI endoscopy and persistent biliary ascariasis was comparable in all the four drug groups. Overall, the efficacy of anthelmintic drugs was excellent and statistically significant (p<0.001). Conclusion: Albendazole and mebendazole having cure rates of 90% and also reducing the mean egg count by 90%. Also treatment of school children every 4 monthly may be necessary in high endemic areas, like ours. All these drugs which we used in our study are safe and no significant side effects were observed. [ABSTRACT FROM AUTHOR]

Objective: Analyze the profile and outcome of children with rhabdomyosarcoma from a pediatric-oncology unit. Design: Retrospective analysis of case records over 23 years (1990-2012). Setting: Government-run, tertiary-care, university hospital in Northern India. Participants: 159 children (<12-years) with a diagnosis of rhabdomyosarcoma were enrolled. The median age was 4 years; 13% were infants. Main outcome measure: Five-year event free survival. Results: The median symptom interval was 2-months. Head and neck region was the most frequent site (44%), followed by tumors in the extremity (15.7%). The majority (67%) of the tumors were located at 'unfavorable' sites; 68% were >5 cm in size. The most frequent (58%) pathological subtype was embryonal. Treatment was based on the 'Intergroup Rhabdomyosarcoma Study (IRS) Group' risk-stratification. 33% were 'low-risk' children, 11% were 'high-risk'. Treatment-refusal (18%) and abandonment (33%) were major impediments. The median ± SE five-year event free survival of those taking treatment was 43.6 ± 6%. Conclusions: Large sized tumors, tumors at unfavorable locations, and treatment refusal/abandonment contributed to inferior outcome in children with rhabdomyosarcoma. [ABSTRACT FROM AUTHOR]

• Introducing analytics in a low-tech waste collection environment. • Demonstrating a range of analytics-based solutions for truck routing. • Demonstrating solution time (heuristic) vs. solution quality (optimality) • Tactical evaluation of routes with nearest neighbor and MILP-based VRP. • Strategic evaluation of existing partition of nodes with MST and K-medoids. This paper describes an approach to introducing analytics through various algorithms and applications to users in a low-tech environment as a first step toward understanding such a context. The South Delhi Municipal Corporation (SDMC) of New Delhi, India, have partitioned their collection points into "wards" or clusters, each served by a dedicated truck depot and manually routing trucks for solid waste collection within each ward, with the waste from all wards going to a single landfill. To demonstrate analytics in tactical planning, we implemented the nearest neighbor algorithm mimicking the manual process to provide the baseline cost. Thus, we presented two very different vehicle routing algorithms: (1) a simple but fast revised nearest neighbor algorithm that decreased the baseline total routing cost by 1.57 % and (2) an optimal but time-intensive algorithm using a mixed-integer-linear programming model, which decreased the total cost by 4.05 %. To demonstrate strategic planning, we tested the efficacy of the cluster structure of collection points by comparing its total routing cost (using the revised nearest neighbor algorithm) to that of other partitions obtained with Minimum Spanning Tree (MST) and K-medoids clustering. The existing wards provided a lower waste pickup cost than the alternative clusters we created, showing SDMC that their existing ward structure was sound. [ABSTRACT FROM AUTHOR]

Introduction: The otologic surgeons need to be fully conversant with the anatomical details of middle ear and its bones so as to perform microsurgical maneuvers successfully. In India, data on normal anatomical parameters of the ossicles is limited. The present study attempts to provide the anatomical details of the three ossicles in North Indian Population in males and compare the parameters with those reported from different parts of the world. Methodology: The study was carried out on 100 sets of middle ear ossicles collected from adult male cadavers from the Department of Anatomy of various colleges of North India. The various measurements were taken with the help of digital verneir caliper. Results: Our study reveals no significant difference between morphometric measurements of the bones of right and left side except Incus in males. Conclusion: The precise measurements of the ossicles have been reported in the study in North Indian Population (males), which would be very helpful in designing the prosthesis in ossicular chain pathology in North Indians. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.Design/methodology/approach Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.Findings Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.Social implications By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.Originality/value The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population. [ABSTRACT FROM AUTHOR]

Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ... 2,04,787 (US$ 3,413) and ... 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ... 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care. [ABSTRACT FROM AUTHOR]

Aims: The aim was to compare biliary amylase, common channel, and gall bladder/liver histopathology between spherical and fusiform choledochal cysts. Materials and Methods: Children undergoing cyst excision with Roux-en-Y hepatico-jejunostomy over a 17 months period were prospectively studied. The common channel was assessed by three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP). Results: Among 22 patients (spherical = 10, fusiform = 12), there was a higher incidence of spherical cysts in infants (5/7-71.4%) and fusiform cysts in older children (10/15-66.7%) (P = 0.09). Common channel identified in 14 (64%) cases was long (>10 mm) in 5 (38.2%) (one spherical, four fusiform [P = 0.5]) with associated high biliary amylase levels (>500 IU/L) in four (one spherical, three fusiform) (P = 0.05). Exact point of junction of common bile duct with pancreatic duct was visible with coronal half-Fourier-acquisition single-shot turbo spin-echo and 3D sampling perfection with application with optimize contrast using different flip angle evolution sequence using a reformatted plane of axis, particularly coronal, and coronal oblique orientation. Biliary amylase was raised (>100 IU/L) in 4 (40%) in the spherical group, compared to 8 (67%) in the fusiform group. Mean biliary amylase was similar in gallbladder and cyst in spherical but higher in gallbladder in fusiform cysts. Mean biliary amylase was <500 IU/L in 85.7% infants. Five out of 7 infants had liver fibrosis or cirrhosis on histopathology (P = 0.05). There were no dysplastic changes in the gallbladder epithelium. Conclusion: Three-dimensional MRCP delineated the common channel in two-third cases especially in coronal and coronal oblique orientation. The long common channel may have an etiological role in fusiform cysts. Spherical cysts, especially in infants, have a higher incidence of obstructive cholangiopathy. [ABSTRACT FROM AUTHOR]

Background: Ageing being a global phenomenon, increasing number of elderly patients are admitted to Intensive Care Units (ICU). Hence, there is a need for continued research on outcomes of ICU treatment in the elderly. Objectives: Examine age-related difference in outcomes of geriatric ICU patients. Analyze ICU treatment modalities predicting mortality in patients >65 years of age. Materials and Methods: A retrospective observational study was conducted in 2317 patients admitted in a multi-specialty ICU of a tertiary care hospital over 2-year study period from January 1, 2011 to December 31, 2012. A clinical database was collected which included age, sex, specialty under which admitted, APACHE-II and SOFA scores, patient outcome, average length of ICU stay, and the treatment modalities used in ICU including mechanical ventilation, inotropes, hemodialysis, and tracheostomy. Patients were divided into two groups: <65 years (Control group) and >65 years (Geriatric age group). Results: The observed overall ICU mortality rate in the study population was 19.6%; no statistical difference was observed between the control and geriatric age group in overall mortality (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.573, 95% confidence interval [CI] =0.390-0.843) and use of inotropes (P = 0.018, OR = 0.661, 95% CI = 0.456-0.958) were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent ICU treatment modality predicting mortality in the geriatric age group (βcoefficient = 1.221, P = 0.000). Conclusion: Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation and inotropes during ICU stay. Only inotropic support could be identified as independent risk factor for mortality. [ABSTRACT FROM AUTHOR]

From 2010 to 2012, a team of academic and civil society researchers conducted extensive ethnographies of litigants, judges, lawyers, and courtroom personnel within multiple districts in three states: Maharashtra, Gujarat, and Himachal Pradesh. This Article provides an in-depth account of the everyday struggles these actors face in the pursuit of their respective objectives. The findings illustrate a complex matrix of variables-- including infrastructure, staffing, judicial training and legal awareness, costs and continuances, gender and caste discrimination, power imbalances, intimidation and corruption, miscellaneous delays, and challenges with specialized forums--impact access to justice in the lower tier. The results of this study offer competing yet complementary narratives. On one hand, there is immense despair, frustration, and anger among the various sets of respondents about the current state of the lower tier. At the same time, however, there is great hope and optimism among individuals who work in the judicial sphere, as well as litigants desperately seeking to gain relief from long-endured grievances, toward what the lower tier can offer. Indeed, if the lower tier is empowered with greater resources and certain perverse aspects of the legal system can be reformed, it has vast potential to promote social change that advances the socioeconomic status of India's most disadvantaged groups. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the clinical characteristics, management, and overall outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients to a tertiary care center in India. The study investigates selected patients under a prospective study conducted over a period of 10 months. The study concludes that morbidity and mortality was not able to improve in unselected patients and natural cohorts.

Aim: The aim of this study is to evaluate the role of 68Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) scan for the detection of bone metastases in pediatric neuroendocrine tumors (NETs) and to compare it with CT scan. Materials and Methods: A total of 30 patients (18 were males and 12 were females; age range: 1-18 years; mean age 7.6 years) with histologically confirmed NETs referred to our department were retrospectively analyzed. All patients underwent 68Ga-DOTATATE PET/CT scan at the time of diagnosis for primary staging. Contrast enhanced CT (CECT) performed at the time of PET scan acquisition was used for comparison with PET data. Imaging results were analyzed on a per-patient and on a per-lesion basis. Clinical follow-up of all patients and repeat PET/CT imaging ( n = 10) was taken as the reference standard. Results: Out of the 30 patients, 17 had no evidence of bone metastases on any imaging modality or on clinical follow-up while the rest of 13 patients showed evidence of bone metastases (nine showing positivity both on 68Ga-DOTATATE PET and CT scan while four showing positivity only on 68Ga-DOTATATE PET). Compared with CT scan, 68Ga-DOTATATE PET detected bone metastases at a significantly higher rate ( P = 0.0039). On a per lesion analysis, out of a total of 225 lesions detected by 68Ga-DOTATATE PET, only 84 lesions could be detected by CT scan. Conclusion: 68Ga-DOTATATE PET/CT scan is more useful than CECT scan for the early detection of bone metastases in pediatric NETs. [ABSTRACT FROM AUTHOR]