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This introductory text points to some of the diverse tapestries of Hindu worldviews where scriptural revelation, logical argumentation, embodied affectivity, moral reasoning, and aesthetic cultivation constitute densely interwoven conceptual threads. It begins with an exploration of some classical iterations of the quest for a fundamental ontology amidst the diversities of the everyday world. This quest is often embedded in both a diagnosis of the human condition as structured by suffering and a therapy for recovery from worldly fragmentation. A crucial aspect of this therapeutic structure is the analysis of the means of knowledge and the categories of reality, since in order to know the nature of the world one must proceed along truth-tracking routes. Such dynamic mind-world encounters are mediated through language, and Hindu philosophical texts extensively discuss the motif of whether or not deep reality can be comprehended through linguistic structures. These philosophical exercises also shape reflections on themes such as aesthetics, social organization, the meaning of life, and so on. As Hinduism increasingly migrates to western locations through practices of yoga, meditation, and mindfulness, and along with sensibilities relating to vegetarianism, ecology, and pacifism, we encounter multiple translations of these classical motifs relating to the self, language, and consciousness.

OBJECTIVE To report outcomes of tacrolimus immunosuppression after penetrating keratoplasty (PK) in very young children. METHODS Retrospective, consecutive, cohort study of children undergoing PK at a tertiary children's hospital between 2005 and 2016. Oral tacrolimus immunosuppression was given for 2 years, followed by topical tacrolimus. RESULTS Fourteen children (20 eyes) had 24 PKs; nineteen eyes had primary PKs, five eyes had repeat PKs. Mean age at primary graft was 95 days (3.1 months) for anterior segment dysgenesis (ASD), 430 days (14.3 months) for non-ASD children. Eleven children (15 eyes) had ASD. Three children (five eyes) had non-ASD: two children (three eyes) had glaucoma-related corneal opacity and one child (two eyes) had congenital hereditary endothelial dystrophy (CHED). One-year rejection-free survival rates following primary PK was 80% for ASD (n = 15) and 100% for non-ASD (n = 4). At final review, 5/15 of primary grafts for ASD were clear. 10/15 failed after a mean of 19 months, specifically attributable to infection (n = 2), rejection (n = 2) and glaucoma (n = 2). 4/4 primary non-ASD grafts are clear at final review (mean follow-up = 77 months). All repeat grafts (n = 5), failed after a mean of 38.25 months. Considering all grafts, 15/24 (62.5%) failed: 5/15 due to infection, 2/15 due to rejection, 8/15 due to glaucoma, phthisis, perforation or vascularised with no rejection. At last review (mean = 58.1 months, range 28-84), overall cohort survival is 37.5%. Final visual acuities range between 0.86 and 2.4 LogMAR. CONCLUSION We compare our results to published literature: 1-year graft survival was higher than previously reported, with lower failure due to rejection. Overall infection rates did not increase, however, proportionally, severe infections were higher. Overall graft survival is at least comparable to reported literature.

Keratoconus is emerging as a new subspecialty in ophthalmology. The literature is booming with publications on the topic as we have better understanding of the pathophysiology, treatment and prognosis of the disease over the past two decades. Advances in diagnostic tools as well as genuine increase in prevalence have shifted perspective of the disease from being a rare one. Early diagnosis is of public health interest as early treatment arrests progression. With the view to encourage research, increase awareness and to reflect the evolution of knowledge related to keratoconus, the European Journal of Ophthalmology has dedicate a special section on keratoconus in its journal.

Vernal keratoconjunctivitis (VKC) is a form of ocular allergy primarily affecting children. Considered a rare disease in Europe, its prevalence varies by geographic region and is poorly studied in the United Kingdom. There is considerable national variation in the management of VKC within the United Kingdom, risking misdiagnosis and delays to treatment for some children. This can significantly impact their quality of life, with the potential for lasting negative consequences. Based on discussions between experienced clinicians from six large centers across the United Kingdom, this article describes best practice recommendations for United Kingdom settings, including principles for diagnosis, referral, initial and long-term management, and supportive care. Recommendations include guidance on referral timing, which should depend on VKC severity, and a stepwise approach to treatment. Joint management by primary care and secondary care is recommended and the importance of supportive care, including emotional support and outreach to schools, is highlighted. Because frequent flareups are common in VKC, it is essential that families have access to the information they need to manage the disease and routes to access rapid care if needed. A thorough understanding of the nature of VKC, its triggers, and how best to manage it, by both patients and their families, is critical to ensuring appropriate management and to improving patient outcomes. [ J Pediatr Ophthalmol Strabismus . 2023;60(1):6–17.]

OBJECTIVE Pachymetry plays a crucial role in the diagnosis and management of glaucoma and corneal diseases. There have been several outbreaks of epidemic ocular infections in ophthalmology clinics worldwide with reports of viral, parasitic, and prion disease. Contact pachymetry is a possible vehicle of transmission due to its risk of contamination. We aim to identify the types of pachymetry used and methods employed for cleaning and disinfection in eye units throughout the United Kingdom. METHODS A telephone survey was carried out, and a senior nurse or sister questioned based on the proforma created. A follow-up email was sent to units that did not respond with the questionnaire attached. RESULTS Of 109 responses, 10 eye units were unaware of the device name and 4 were unaware of the cleaning method used. Overall, 69/105 (66%) were cleaned with some form of alcohol wipe between patients, 12/105 (11%) used presept solution to soak the pachymetry head mainly 5 to 10 minutes, with 2 units soaking for 20 to 30 minutes. Milton solution was used by 4 units (4%) (10 s to 10 min). Three used a hydrogen peroxide solution for 10 minutes (3%). Three (3%) used an alcohol solution. Fifteen (14%) units used some chlorine-based solution (actichlor/chloraprep) for 5 to 10 minutes. Two (2%) units combined an alcohol-based wipe with solution to soak afterward. CONCLUSIONS There is a large variation in methods and duration of tip disinfection with only a few units following the Royal College of Ophthalmologists (RCOphth) guidelines on pachymeter disinfection. The majority of eye units use alcohol/chlorine-based wipes for cleaning the pachymetry heads which is against the current recommended guidelines. The average immersion time when solutions were used was 5 to 10 minutes.

Our essay is a thematic exploration of the malleability of idioms, imageries, and affectivities of Hindu bhakti across the borderlines of certain Indic worldviews. We highlight the theological motif of the feminine-feminised quest of the seeker (virahiṇī) for her divine beloved in some Hindu expressions shaped by the paradigmatic scriptural text Bhāgavata-purāṇa and in some Punjabi Sufi articulations of the transcendent God&rsquo, s innermost presence to the pilgrim self. The leitmotif that the divine reality is the &ldquo, intimate stranger&rdquo, who cannot be humanly grasped and who is yet already present in the recesses of the virahiṇī&rsquo, s self is expressed with distinctive inflections both in bhakti-based Vedānta and in some Indo-Muslim spiritual universes. This study is also an exploration of some of the common conceptual currencies of devotional subjectivities that cannot be straightforwardly cast into the monolithic moulds of &ldquo, Hindu&rdquo, or &ldquo, Muslim&rdquo, in pre-modern South Asia. Thus, we highlight the essentially contested nature of the categories of &ldquo, Hinduism&rdquo, and &ldquo, Indian Islam&rdquo, by indicating that they should be regarded as dynamic clusters of constellated concepts whose contours have been often reshaped through concrete socio-historical contestations, borrowings, and adaptations on the fissured lands of al-Hind.

While Gandhi and Ambedkar hold similar standpoints on the relation between religious orderings of the world and shapes of social existence, they sharply diverge, on certain occasions, regarding the question of what the crucial terms ‘caste’ and varņa refer to, so that they often seem to be talking past each other. Gandhi sought to cut through various traditional forms of Hindu socio-religious practices and develop a Hinduism which is grounded in the values of universal peace, love and benevolence. Ambedkar too rejected aspects of familiar historical varieties of Buddhism and configured a new vehicle whose goals were to be more specifically material than spiritual. However, while both Gandhi and Ambedkar thus sought to uncover the revitalizing impulses of religious ideals, they operated with different imaginations of the type of polity that would emerge from this social reconstruction. For Gandhi, the reinvigorated socio-religious whole would be structured by an ideal notion of varņa in which there would be no enmity among the interdependent units. For Ambedkar, in contrast, the vocabulary of varņa was irredeemably corrupted through its enmeshment in millennia-old structures of hierarchy, so that its employment would not generate sufficient momentum to break through entrenched systems of oppression.

A distinctive claim of some of the configurations of ‘modern Hinduism’ is that ancient Vedic wisdom foreshadows some contemporary scientific and technological advances, or provides us with a spirit...

Objective Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA). Methods Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months’ post-intervention. Results There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p Conclusion Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing. Clinical trial This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.

Objective: To determine the relative importance of the twelve roles of a teacher in defining a good medical teacher in the Asian context. Material and methods: This is a cross sectional, descriptive study using the questionnaire validated by Harden and Crosby. The 470 subjects comprise 369 preclinical and clinical medical students and 101 faculty members of the International Medical University, Malaysia. They were asked to choose, in order of importance, the three most important roles of a medical teacher from the twelve roles identified by Harden and Crosby. Their responses were rated on a Likert scale of 1-5 points and the data analyzed using SPSS version 21.0 using the Mann Whitney U-test. Results: The teacher as an information provider was rated the first choice by 49.5% of faculty and 68.0% of students. The teacher as a role model was rated the second choice by 39.7% of faculty and 12.2% of students. These two roles together accounted for 82.2% of the preference of faculty and students. The other roles of the teacher as facilitator, assessor, planner and resource developer had low scores. Collectively, these 4 roles had faculty and student scores of only 10.9% and 19.6% respectively. Both the faculty (36.6%) and students (34.1%) rated their clinical teachers highly. Conclusion: In an Asian society, the teacher is still highly valued as an information provider and a role model. Clinical teachers who are knowledgeable and good role models are highly rated by both faculty and students. Universities would be prudent to attract and retain such teachers with incentives.

The integrated curriculum has been introduced in the Dental faculty of the designated institution since 2008. This study was aimed to evaluate the application of anatomical knowledge of final year undergraduate dental students of integrated curriculum, and to assess the perception of the both dental students and their lecturer on clinical application of anatomy. A cross-sectional study was conducted for 4 weeks among 40 final year undergraduate dental students and 18 lecturers. Students underwent an examination that included 6 Objective Structured Practical Examination (OSPE) and 20 One Best Answer (OBA) questions to test their application knowledge in clinical settings. A semi-structured, self-administrated questionnaire was used to identify their perceptions on the application of anatomical knowledge. The data were analysed by using SPSS 17. The Spearman’s Correlation test reported a significant, strong, positive correlation between the scores of OSPE and OBA. The Mann-Whitney U-test revealed statistically significant associations regarding the perception of both dental students and lecturers in terms of Problem based learning (PBL), practical sessions, Self-directed Learning (SDL), the strong surface anatomy knowledge, the usefulness of cadaver and the confidence in applying the anatomical knowledge. The present curriculum needs more interactive face to face sessions, small group discussions in practical sessions and more SDL in order to provide the strong foundations for undergraduate dental students in clinical anatomy.

Both Sāṁkhya–Yoga and Advaita Vedānta grapple with a conceptual tension which informs their understandings of spiritual practice – that while embodied selves seek liberation from the structures of worldly suffering, they are essentially the immutable reality which is never subject to any empirical ills. Though the metaphysical visions of these systems sharply diverge, Advaitins such as Śaṁkara were able to appropriate from Sāṁkhya–Yoga certain practices geared toward the yogic purification of the mind while rejecting its ontological scheme outlining a dualism between puruṣa and prakṛti. By highlighting the complex relationship between Sāṁkhya–Yoga and Śaṁkara, we examine how it was creatively re-imagined by Ramana Maharshi who developed certain distinctive pedagogical styles centred around the liberating value of silence.

PURPOSE To assess the long-term visual outcomes of macular hole surgery and to correlate structural changes on spectral domain optical coherence tomography after surgery with long-term changes in the best-corrected visual acuity. METHODS A prospective study looking at 36 patients who underwent macular hole surgery between 2008 and 2010. The main outcome measure was change in the best-corrected visual acuity from 4 months to 6 months after surgery until the study visit. Changes in optical coherence tomography thickness and the morphology of the ellipsoid layer at the 4-month to 6-month scan were also analyzed. RESULTS Over a mean follow-up of 36 months, the best-corrected visual acuity continues to improve from a median of 20/63 at 4 months to 6 months postoperatively to a median of 20/47 at the final study visit (P < 0.01). There was a median gain of 6.5 letters (logMAR 0.13). Seven of 36 patients (20%) improved from nondriving visual acuity at 4 months to 6 months after surgery to driving visual acuity (≥20/40) at the final study visit. The presence of an intact ellipsoid layer at the 4-month to 6-month postoperative optical coherence tomography scan may represent a trend for long-term improvement in visual acuity (Fisher's exact test, P = 0.07). CONCLUSION The best-corrected visual acuity continues to improve beyond 4 months to 6 months after macular hole surgery. Reconstruction of the ellipsoid layer in the early postoperative period may help predict, which patients are likely to have subsequent long-term improvement in visual acuity. This information may help clinicians counsel patients appropriately and help explain cases of unsatisfactory visual improvement after surgery.

Objectives: Flipped classroom (FC) is a pedagogical model to engage students in learning process by replacing the didactic lectures. Using technology, lectures are moved out of the classroom and delivered online as means to provide interaction and collaboration. Poll Everywhere is an audience response system (ARS) which can be used in an FC to make the activities more interesting, engaging, and interactive. This study aims to study the perception of undergraduate pharmacy students on FC activity using Poll Everywhere ARS and to study the effectiveness of FC activity as a teaching-learning tool for delivering complementary medicine module in the undergraduate pharmacy program. Materials and Methods: In this nonrandomized trial on interrupted time series study, flipped class was conducted on group of 112 students of bachelor of pharmacy semester V. The topic selected was popular herbal remedies of the complementary medicine module. Flipped class was conducted with audio and video presentation in the form of a quiz using ten one-best-answer type of multiple-choice questions covering the learning objectives. Audience response was captured using web-based interaction with Poll Everywhere. Feedback was obtained from participants at the end of FC activity and debriefing was done. Results: Randomly selected 112 complete responses were included in the final analysis. There were 47 (42%) male and 65 (58%) female respondents. The overall Cronbach’s alpha of feedback questionnaire was 0.912. The central tendencies and dispersions of items in the questionnaire indicated the effectiveness of FC. The low or middle achievers of quiz session (pretest) during the FC activity were three times (95% confidence interval [CI] = 1.1–8.9) at the risk of providing neutral or negative feedback than high achievers (P = 0.040). Those who gave neutral or negative feedback on FC activity were 3.9 times (95% CI = 1.3–11.8) at the risk of becoming low or middle achievers during the end of semester examination (P = 0.013). The multivariate analysis of “Agree” or “Disagree” and “Agree” or “Strongly Agree” was statistically significant. Conclusion: This study provides insight on how the pharmacy students learn and develop their cognitive functions. The results revealed that the FC activity with Poll Everywhere is an effective teaching-learning method. Key message: Flipped classes (FC) drive active learning among the participants, resulting in better performance in students. FC for pharmacy students enabled instructors to engage the learners and helpthem towards self-directed learning. FC supported the fact that the quality (not necessarily the quantity) of student-teacher interaction was a compelling force in improving student performance.

Tuberculosis (TB) is one of the most common and deadly communicable diseases in the world, infecting approximately one-third of the total human race. The number of drug-resistant TB cases are increasing. The spectrum of resistance varies from single to multidrug and from multidrug to total drug resistance varieties. Human Immunodeficiency Virus (HIV) infection is also responsible for the recent re-emergence of tuberculosis infection worldwide. When drugs are becoming ineffective against Mycobacterium tuberculosis, there is a need to focus more on preventive strategies. Though Bacillus Calmette–Guerin (BCG) vaccine is efficient in preventing miliary and meningeal tuberculosis in children, it is not effective against pulmonary tuberculosis. For prevention of pulmonary tuberculosis, development of new vaccines is the need of time. Several new vaccines are under clinical trials either to replace old BCG or act as a booster for the current BCG vaccine. New vaccines include live Mycobacterial vaccines, its subunit, live vector-based vaccines and killed whole or fragmented vaccines. This review recaps the status of development of pre-clinical tuberculosis vaccines.

Purpose of the study To report an observational study of Acanthamoeba Keratitis (AK) in University Hospital Coventry & Warwickshire (UHCW), Coventry, UK and determine risk factors, outcomes as well as incidence rates. Methods A retrospective analysis was done of consecutive patients who were treated for AK by the corneal service at UHCW from January 2017 to January 2018. Cases were identified from 2 sources; the department of microbiology and the hospital pharmacy. Patient data was collected by 3 of the authors using both paper and electronic medical records. Information was also gathered over the telephone using a predefined questionnaire. The primary endpoint used for assessing duration of disease was time to resolution after the initial diagnosis. Results 9 eyes were identified over the 12-month period, a drastic increase from previous years. All were contact lens (CL) wearers and 3 used daily disposable CL’s. 8 out of 9 patients had an improvement in best corrected visual acuity (BCVA) which was consistent with their baseline levels pre-infection. The average length of treatment was 107.25 days for the 8 resolved cases. 1 case is still having ongoing treatment. No case has required surgical treatment. Several patients admitted to exposing their CL to unsterile water either via swimming, showering or tap water. All patients had purchased their lenses from contact lens practitioners. Conclusion Overall, our study shows excellent outcomes. Almost all patients had resolution of symptoms with medical treatment and an improvement in visual acuity. Several contributing factors have aided us in achieving this including early diagnosis, a robust treatment protocol and diagnostic modalities such as Polymer Chain Reaction (PCR) and Confocal Microscopy (CFM). However, the increased incidence compared to previous years is a worrying trend and there will be an ongoing analysis looking at patterns of incidence in the future.

Various Roman Catholic figures during the last hundred years have engaged with vedāntic themes relating to self-enquiry. Two Benedictine pioneers of these spiritual exercises, Bede Griffiths and Henri Le Saux (Swami Abhishiktananda), elaborated and practiced these themes through which they sought to articulate visions of the divine presence within humanity. This essay discusses one central aspect of their “experiments with truth,” namely, their experiential and conceptual struggles to point toward the “trinitarian mystery” with the terminology of Advaita Vedānta.

Background: Backwash or washback is a common phenomenon that exists in almost all the educational institutes in the world. It directly correlates itself to teaching, learning and student assessment. It’s a prevailing conception that conducting exams / tests could drive teachers to teach and students to learn (also called as measurement-driven instruction).Methods: A questionnaire based tool was developed and named the Backwash Assessment Questionnaire (BAQ). It was validated to evaluate backwash among medical students in Malaysia.A preliminary version, consisting of 15 structured items was developed based on an exhaustive and focused group discussion with students, content experts and extensive literature reviews. Multi-stage refinement narrowed it down to 10 items after the process of testing. The final version was analyzed using reliability testing. For testing, refinement and review process, 90 students and 10 lectures were selected to assess the acceptability, time-management and reliability of this questionnaire. A fresh sample of 105 undergraduate medical students from semester three to five from the same university was used for the test of the final version.Results: The overall internal reliability (Cronbach’s alpha) of the final version of the BAQ was found to be 0.874. The test-retest reliability from kappa statistics was found to be high with k=0.92 with P=0.0001*.Conclusion: The study showed that the BAQ was a valid, powerful and reliable tool for measuring backwash effects on education and assessment process. We found a high prevalence of backwash among the medical students in the undergraduate course.Keywords: BACKWASH, MEDICAL STUDENTS, ASSESSMENT, LEARNING, TEACHING

BACKGROUND: Acute sinusitis is a common reason for primary care encounters. It causes significant symptoms including facial pain, congested nose, headache, thick nasal mucus, fever, and cough and often results in time off work or school. Sinusitis treatment focuses on eliminating causative factors and controlling the inflammatory and infectious components. The frozen, dried, natural fluid extract of the Cyclamen europaeum plant delivered intranasally is thought to have beneficial effects in relieving congestion by facilitating nasal drainage, and has an anti‐inflammatory effect. OBJECTIVES: To assess the effectiveness of topical intranasal Cyclamen europaeum extract on clinical response in adults and children with acute sinusitis. SEARCH METHODS: We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, and trials registers (ClinicalTrials.gov; WHO ICTRP) in January 2018. We also searched the reference lists of included studies and review literature for further relevant studies and contacted trial authors for additional information. SELECTION CRITERIA: Randomised controlled trials comparing Cyclamen europaeum extract administered intranasally to placebo, antibiotics, intranasal corticosteroids, or no treatment in adults or children, or both, with acute sinusitis. Acute sinusitis was defined by clinical diagnosis and confirmed by nasal endoscopy or by radiological evidence. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included two randomised controlled trials that involved a total of 147 adult outpatients with acute sinusitis confirmed by radiology or nasal endoscopy who were assigned to Cyclamen europaeum nasal spray or placebo study arms for up to 15 days. The risk of selection and detection bias was unclear, as allocation concealment and blinding of outcome assessors were not reported in either study. Attrition was high (60%) in one study, although dropouts were balanced between study arms. Neither study reported our two primary outcomes: proportion of participants whose symptoms resolved or improved at 14 days and 30 days. No serious adverse events or complications related to treatment were reported; however, more mild adverse events such as nasal and throat irritation, mild epistaxis, and sneezing occurred in Cyclamen europaeum group participants (50%) compared to placebo group participants (24%) (risk ratio 2.11, 95% confidence interval 1.35 to 3.29); moderate‐quality evidence. AUTHORS' CONCLUSIONS: The effectiveness of Cyclamen europaeum for people with acute sinusitis is unknown. Although no serious side effects were observed, 50% of participants who received Cyclamen europaeum reported adverse events compared with 24% of those who received placebo.