Assessment of Safe Drinking Water Handling Practices in Households of Northern India: A Cross-Sectional Study.

Background Waterborne diseases are the most common form of infectious disease, spreading from contaminated water, especially in a developed country. These diseases are a major concern for the environment and public health. The living conditions in developing countries like India affect the water-handling practices, which make the population vulnerable to waterborne diseases. The inability to access safe drinking water also adds to this. Water safety for a community relies on water collection, treatment, storage, and handling in the household setting. Therefore, the burden of waterborne disease can be reduced by treating point-of-use drinking water, including improving handling and transport. Objectives The aim was to assess the safe drinking water handling practices in households. The objectives were to assess the safe drinking water-handling practices, namely, treatment, storage, lid status of the storage vessel, and water drawing technique, and to estimate the sources of safe drinking water. Methods This cross-sectional study was conducted in the Etawah district on a total of 312 eldest female family members actively working in the kitchen. Descriptive analysis and Chi-Square test were applied to the collected data and a p-value <0.05 at 95% confidence interval (CI) was taken as statistically significant. Results Overall, 135 (85.9%) households in urban areas relied on public supply. However, in rural areas mostly 130 (83%) households depended on private supply. In water-handling practices, 276 (88.4%) used some method to purify drinking water, a total of 209 (67%) households kept the lid of the storage container covered, and 249 (79.8%) households drew water either by pouring or scooping with a long handle. Conclusion The study concluded that both private and public sources were used for drinking water. Regarding water-handling practices, most households drank purified water, kept their containers covered, and drew water either by scooping or pouring from storage containers. Those who drank purified water mostly belonged to nuclear families and had private sources of drinking water.

An introduction to digital determinants of health.

In recent years, technology has been increasingly incorporated within healthcare for the provision of safe and efficient delivery of services. Although this can be attributed to the benefits that can be harnessed, digital technology has the potential to exacerbate and reinforce preexisting health disparities. Previous work has highlighted how sociodemographic, economic, and political factors affect individuals' interactions with digital health systems and are termed social determinants of health [SDOH]. But, there is a paucity of literature addressing how the intrinsic design, implementation, and use of technology interact with SDOH to influence health outcomes. Such interactions are termed digital determinants of health [DDOH]. This paper will, for the first time, propose a definition of DDOH and provide a conceptual model characterizing its influence on healthcare outcomes. Specifically, DDOH is implicit in the design of artificial intelligence systems, mobile phone applications, telemedicine, digital health literacy [DHL], and other forms of digital technology. A better appreciation of DDOH by the various stakeholders at the individual and societal levels can be channeled towards policies that are more digitally inclusive. In tandem with ongoing work to minimize the digital divide caused by existing SDOH, further work is necessary to recognize digital determinants as an important and distinct entity.

Corporate Social Responsibility Framework: An Innovative Solution to Social Determinants of Health in the USA.

PURPOSE: Expand firms' corporate social responsibility (CSR) framework to systematically address social determinants of health (SDOH) in their communities and improve firms' performance (FP). GAP: The U.S. healthcare system has struggled to improve population health outcomes while enhancing delivery performance. An oft-overlooked contributor to this deficit is SDOH inequities, accounting for 25-60% of deaths in the USA annually. Ironically, most healthcare firms do not view investment in SDOH, a neglected phenomenon, to develop sustainable healthy communities as their direct responsibility due to the "wrong pocket problem." Although extant literature theorizes the CSR construct, there is a paucity of research on SDOH integration with the CSR framework. DESIGN: We integrate a quantitative and qualitative study with supplementary literature on CSR and SDOH using the grounded theory method by researching fourteen health plan firms across the USA. FINDINGS: Research reveals early efforts undertaken by top-performing healthcare insurers to address SDOH and provides evidence that such measures can be integrated profitably under CSR as a competitive advantage. ORIGINALITY: Contributes to CSR theory and practice by providing an empirical model and expanding its framework to address SDOH systematically. Key implications are as follows: (1) healthcare firms to link with unconventional partners, such as housing authorities, food banks, employment agencies, and schools; (2) the entire healthcare supply chain to collaborate with social enterprises and regulators to develop sustainable communities; (3) policymakers must incentivize firms to align social equity and corporate goals; and (4) long-term view on CSR, SDOH, and healthy living (HL) will in-turn eliminate social inequities while enhancing FP.

Hospital-Based Retrospective Cross-sectional Study to Analyse the Causes of Maternal Deaths at a Tertiary Health Care Facility.

Context: Maternal mortality is considered a key health indicator of Maternal and Child Health. Considering the fact that complications are preventable and most of them are modifiable, the study has been planned to analyse maternal deaths in order to suggest recommendations for preventing it. There are various delays according to the three-delay model at primary and secondary level; therefore, interventions are needed at those levels to prevent maternal deaths. Aims: To determine the various direct and indirect causes of maternal deaths, analyse the association of medical and social factors with maternal deaths and ^to determine the predictors of maternal deaths. Settings and Design: Hospital-based retrospective cross-sectional study of all the maternal deaths occurring in the last 4 years at a tertiary health care facility. Methods and Material: Data were collected from the Facility Based Maternal Death Review forms. Statistical Analysis Used: Data were entered and analysed by IBM SPSS version 25.0 software. Results: For maternal deaths, direct obstetric causes were responsible in 128 (74.4%) and indirect causes in 45 (26.2%) cases followed by unspecified causes in 78 (45.3%) and 1 (0.6%) coincidental cause. Statistically significant associations were observed between maternal death and period of gestation, mode of delivery and outcome of delivery (P = 0.12, P = 0.04 and P < 0.001, respectively). Conclusions: The health professionals of primary and secondary level should be well equipped to diagnose the complications and to manage it as early as possible. Thus, maternal mortality rates can be decreased to significant level.

Far wall plaque segmentation and area measurement in common and internal carotid artery ultrasound using U-series architectures: An unseen Artificial Intelligence paradigm for stroke risk assessment.

Stroke risk assessment using deep learning (DL) requires automated, accurate, and real-time risk assessment while ensuring compact model size. Previous DL paradigms suffered from challenges like memory size, low speed, and complex in nature lacking multi-ethnic, and multi-institution databases. This research segments and measures the area of the plaque far wall of the common carotid (CCA) and internal carotid arteries (ICA) in B-mode ultrasound using four types of solo, namely, UNet, UNet+, UNet++, and UNet+++, and three types of hybrids, namely, Inception-UNet, Fractal-UNet, and Squeeze-UNet, architectures. These seven models are benchmarked against autoencoder-based solution. Three kinds of databases, namely, CCA, ICA, and combined CCA + ICA were implemented using K5 cross-validation protocol. This was validated using unseen Hong Kong data. The CCA database consisted of 379 Japanese images from low-to medium-risk, while the ICA database consisted of 970 Japanese images taken from 97 medium-to high-risk patients. Using the coefficient of correlation (CC) metric between automated measured area and manually delineated area, seven deep learning solo and hybrid models for CCA yielded 0.96, 0.96, 0.98, 0.95, 0.96, and 0.96 respectively, whereas ICA yielded 0.99, 0.99, 0.98, 0.99, 0.98, 0.98, and 0.98 respectively. Area under the receiver operating characteristics curve values for CCA images was 0.97, 0.969, 0.974, 0.969, 0.962, 0.969, and 0.960 respectively, whereas for ICA images were 0.99, 0.989, 0.988, 0.989, 0.986, 0.989, and 0.988, respectively (p < 0.001). The percentage improvement in offline memory size, training time and training parameters for Squeeze-UNet compared to UNet++ were 569%, 122.46%, and 569%, respectively.

Ex Vivo Assessment of Different Oral Anticoagulant Regimens on Pump Thrombosis in a HeartWare Ventricular Assist Device.

BACKGROUND: In light of decreased intracranial hemorrhage with direct oral anticoagulants and concerns about their safety in continuous flow left ventricular assist devices, we conducted an ex vivo study of thrombus formation using multiple anticoagulation agents. METHODS: A continuous flow left ventricular assist device (HeartWare ventricular assist device) hemocompatibility loop was run using human blood under 7 conditions: control (no anticoagulation or antiplatelet); in vitro addition of aspirin; in vitro addition of apixaban at low dose (equivalent 2.5 mg twice daily); addition of apixaban at high dose (equivalent 5 mg twice daily); patients on warfarin; patients on apixaban (5 mg twice daily); and patients on dabigatran (150 mg twice daily). The primary outcome was time to formation of intrapump thrombosis. Secondary outcomes were reduction in clotting times over 1 hour, hemolysis, reduced platelet aggregation, and von Willebrand activity. RESULTS: Twenty-one runs were completed. Times to thrombosis in median (interquartile range) were control, 131 (127-134.5); in vitro aspirin, 124 (114.5-137); and patients on dabigatran, 131 (130.5-135.5) minutes, respectively. Times in patients on warfarin were, 137 (136.5-143.5); in vitro low-dose apixaban, 141 (138.5-142); and patients on apixaban, 140 (138-142.5) minutes, respectively. No thrombus formed in the in vitro high-dose apixaban group. There were no significant differences between the individual groups. When all apixaban groups were compared with nonapixaban groups, the time to thrombosis formation was significantly longer, 143 (137-150) versus 133.5 (128.5-140) minutes, P=0.02. There were similar changes in lactate dehydrogenase levels and other secondary end points. CONCLUSIONS: In an in vitro study of anticoagulation using human blood in a mock loop with a HeartWare HVAD, we demonstrated similar thrombosis times for apixaban and warfarin. Time to clotting was longer in the combined apixaban groups compared with combined other groups, but thrombosis times between individual groups were not significantly different.

Assessment of Biomedical Waste Management in Health Facilities of Uttar Pradesh: An Observational Study.

Background Biomedical waste management has recently emerged as an issue of major concern for every health facility and healthcare provider due to human and environmental hazards. As per government guidelines, every health facility, either large medical institutes or small clinics, should ensure appropriate biomedical waste management at their facilities level. Objective To assess biomedical waste management in various health care facilities of Etawah district. Methodology It was a facility-based cross-sectional assessment that included government and private health facilities. The selection of facilities was done based on a simple random sampling method. All the people in charge of concerned health care facilities were interviewed to know the current biomedical waste management situation concerning health facilities and the problems they face in biomedical waste management. Health care professionals' knowledge was also assessed. Results A total of 56 health care facilities (HCFs) from both government and private sectors were selected. Biomedical waste guidelines are mainly available at tertiary care centers (93%) and secondary care centers (51.5%). Awareness among doctors related to hazards and prevention of hazards (<0.001), knowledge of unused sharps (0.048), contact with a blood-related product (0.003), hazardous waste (<0.001), and need for training (<0.001) are statistically significant with respect to nurses. Conclusions Government of India guidelines on biomedical waste management (BMW) are in place, but the use of guidelines currently is not up to the mark or at a satisfactory level. Spreading awareness of the BMW guidelines and their strict implementation is the need of the hour.

Assessment of luteolin isolated from Eclipta alba leaves in animal models of epilepsy.

CONTEXT: Eclipta alba (Linn) Hassk. (Asteraceae) has been reported to be a nerve tonic and has been used to treat epilepsy in folk medicine. OBJECTIVE: The present study isolates and characterizes luteolin from E. alba and evaluates its antiepileptic potential in chemically induced acute and chronic models in mice. MATERIALS AND METHODS: The methanol extract (16.85% w/w) of E. alba leaves was subjected to fractionation for isolation of luteolin. In acute pentylenetetrazole (PTZ) model, luteolin (5, 10, 20 mg/kg, i.p.) was administered 30 min prior to PTZ injection (100 mg/kg) in Swiss albino mice. Kindling was induced by chronic administration of PTZ (35 mg/kg) on every alternate day (48 days). Luteolin was investigated on the course of kindling development and oxidative stress markers [reduced glutathione (GSH) and malondialdehyde (MDA)] in kindled mice. RESULTS: Single-dose pretreatment with luteolin (10 and 20 mg/kg, i.p.) was found to be effective in an acute PTZ model (100% protection from mortality) and it did not exhibit any effect on motor coordination at the same doses. PTZ-induced kindling was significantly (p < 0.001) prevented by luteolin (5, 10, 20 mg/kg, i.p.) in a dose-dependent manner. Luteolin restored levels of reduced GSH (p < 0.001) and decreased the level of MDA (p < 0.001), a marker of lipid peroxidation. DISCUSSION AND CONCLUSION: The results of the present study demonstrated that luteolin had an anticonvulsant effect in an acute PTZ model. Luteolin exhibited and inhibitory effect on the course of kindling and associated oxidative stress and hence could be a potential molecule in the treatment of epilepsy.

PCA-based polling strategy in machine learning framework for coronary artery disease risk assessment in intravascular ultrasound: A link between carotid and coronary grayscale plaque morphology.

BACKGROUND AND OBJECTIVE: Percutaneous coronary interventional procedures need advance planning prior to stenting or an endarterectomy. Cardiologists use intravascular ultrasound (IVUS) for screening, risk assessment and stratification of coronary artery disease (CAD). We hypothesize that plaque components are vulnerable to rupture due to plaque progression. Currently, there are no standard grayscale IVUS tools for risk assessment of plaque rupture. This paper presents a novel strategy for risk stratification based on plaque morphology embedded with principal component analysis (PCA) for plaque feature dimensionality reduction and dominant feature selection technique. The risk assessment utilizes 56 grayscale coronary features in a machine learning framework while linking information from carotid and coronary plaque burdens due to their common genetic makeup. METHOD: This system consists of a machine learning paradigm which uses a support vector machine (SVM) combined with PCA for optimal and dominant coronary artery morphological feature extraction. Carotid artery proven intima-media thickness (cIMT) biomarker is adapted as a gold standard during the training phase of the machine learning system. For the performance evaluation, K-fold cross validation protocol is adapted with 20 trials per fold. For choosing the dominant features out of the 56 grayscale features, a polling strategy of PCA is adapted where the original value of the features is unaltered. Different protocols are designed for establishing the stability and reliability criteria of the coronary risk assessment system (cRAS). RESULTS: Using the PCA-based machine learning paradigm and cross-validation protocol, a classification accuracy of 98.43% (AUC 0.98) with K=10 folds using an SVM radial basis function (RBF) kernel was achieved. A reliability index of 97.32% and machine learning stability criteria of 5% were met for the cRAS. CONCLUSIONS: This is the first Computer aided design (CADx) system of its kind that is able to demonstrate the ability of coronary risk assessment and stratification while demonstrating a successful design of the machine learning system based on our assumptions.

A rapid, efficient, and economical inverse polymerase chain reaction-based method for generating a site saturation mutant library.

With the development of deep sequencing methodologies, it has become important to construct site saturation mutant (SSM) libraries in which every nucleotide/codon in a gene is individually randomized. We describe methodologies for the rapid, efficient, and economical construction of such libraries using inverse polymerase chain reaction (PCR). We show that if the degenerate codon is in the middle of the mutagenic primer, there is an inherent PCR bias due to the thermodynamic mismatch penalty, which decreases the proportion of unique mutants. Introducing a nucleotide bias in the primer can alleviate the problem. Alternatively, if the degenerate codon is placed at the 5' end, there is no PCR bias, which results in a higher proportion of unique mutants. This also facilitates detection of deletion mutants resulting from errors during primer synthesis. This method can be used to rapidly generate SSM libraries for any gene or nucleotide sequence, which can subsequently be screened and analyzed by deep sequencing.

A comparative assessment of KAP regarding tuberculosis and RNTCP among government and private practitioners in District Gwalior, India: an operational research.

BACKGROUND: Tuberculosis is one of the oldest diseases known to mankind. However, still practitioners are unaware of various facts associated with it. OBJECTIVES: (1) To assess the knowledge, attitude and practices adopted by practitioners of both government and private sectors in diagnosis and management of TB patients. (2) To assess the views of practitioners in strengthening the RNTCP programme. METHODOLOGY: 200 allopathic practitioners from both government and private sectors providing their services in Gwalior District were interviewed using pre-designed pre-tested structured questionnaire. RESULTS: The mean score of knowledge related to tuberculosis and RNTCP was higher among government practitioners (9.8) compared to private practitioners (6.1). All practitioners were having positive attitude towards regular up gradation of knowledge while statistically significant differences were noted on issues related to management of TB patients as per RNTCP guidelines. X-ray was the most preferred modality for diagnosis and follow up among private practitioners compared to sputum examination among government practitioners. Referral of poor and serious patients was also very low among private practitioners. CONCLUSION: The present study hereby concludes that there is a large gap in Knowledge, Attitude and Practices on TB and RNTCP among the practitioners of both the sectors. There is an urgent need for upgrading the knowledge on various issues and regular Continuing Medical Education (CME) involving various professional bodies.