Assessment of Tibot® Artificial Intelligence Application in Prediction of Diagnosis in Dermatological Conditions: Results of a Single Centre Study.

OBJECTIVE: To analyze the accuracy of Tibot artificial intelligence (AI) application tool in predicting the diagnosis of dermatological conditions. MATERIAL AND METHODS: In this prospective, observational study photographs of dermatological lesions with other details of patients having different skin conditions were fed in the AI application for the diagnosis. Predictions given by the Tibot AI application were compared with diagnosis done by the dermatologist. The performance of AI application was evaluated using accuracy, precision, and recall. RESULTS: Data of 398 patients were included in the application of whom 159 (39.9%) had fungal infections. Other conditions included eczema 36 (9%), alopecia 28 (7%), infestations 27 (6.8%), acne 25 (6.3%), psoriasis 19 (4.8%), benign tumors 7 (1.8%), bacterial infection 19 (4.8%), viral infection 15 (3.8%), and pigmentary disorders 20 (5%). The prediction accuracy (ability to get diagnosis in top three conditions) for alopecia, fungal infections, and eczema was 100%, 95.6%, and 91.7%, respectively. Mean prediction accuracy for correct diagnosis in the predicted top three diagnoses was 85.2%, and for correct diagnosis was 60.7%. Sensitivity and specificity of the application were approximately 86% and 98%, respectively. The sensitivity and positive predictive value of the application to diagnose alopecia was 100% and for fungal infections it was 96.85% and 90.05%, respectively. CONCLUSION: In the preliminary stages, AI application tool showed promising results in diagnosing skin conditions. The accuracy and predictive value of the test may improve with the expansion of the database.

Building Capacity for Evidence-Informed Priority Setting in the Indian Health System: An International Collaborative Experience.

India's rapid economic growth has been accompanied by slower improvements in population health. Given the need to reconcile the ambitious goal of achieving Universal Coverage with limited resources, a robust priority-setting mechanism is required to ensure that the right trade-offs are made and the impact on health is maximised. Health Technology Assessment (HTA) is endorsed by the World Health Assembly as the gold standard approach to synthesizing evidence systematically for evidence-informed priority setting (EIPS). India is formally committed to institutionalising HTA as an integral component of the EIPS process. The effective conduct and uptake of HTA depends on a well-functioning ecosystem of stakeholders adept at commissioning and generating policy-relevant HTA research, developing and utilising rigorous technical, transparent, and inclusive methods and processes, and a strong multisectoral and transnational appetite for the use of evidence to inform policy. These all require myriad complex and complementary capacities to be built at each level of the health system . In this paper we describe how a framework for targeted and locally-tailored capacity building for EIPS, and specifically HTA, was collaboratively developed and implemented by an international network of priority-setting expertise, and the Government of India.

Utility of the microcolony method for evaluation of multidrug-resistant tuberculosis patients in Karachi, Pakistan.

OBJECTIVE: To compare the microcolony method (MCM) with the reference culture method to evaluate culture conversion in multidrug-resistant tuberculosis (MDR-TB) patients.MATERIAL AND METHODS: Adult patients with Mycobacterium tuberculosis culture-positive MDR-TB undergoing second-line anti-tuberculosis treatment were recruited from two tertiary care chest clinics from January 2013 to October 2014. The MCM was performed in addition to MGIT™ and Löwenstein-Jensen medium (reference method) on sputum samples submitted on a monthly basis.RESULTS: Of 140 patients, culture conversion could be evaluated in 95 patients. The MCM showed 100% agreement with the reference M. tuberculosis culture in 83 of 95 patients who achieved culture conversion. In smear-positive and smear-negative cases, the mean time to positivity was 9.1 and 11.4 days for the MCM and 16.1 and 23.2 days for the reference M. tuberculosis culture respectively. The contamination rate for the MCM was 4.5% in comparison with 6.1% for the reference M. tuberculosis culture. The cost of MCM was estimated to be 30% that of the reference method.CONCLUSION: The MCM can be used in non-urban laboratories as a safe, rapid and cost-effective substitute for the reference M. tuberculosis culture to assess culture conversion in MDR-TB patients.Note: Abstract has been published in International Journal of Mycobacteriology 2015; 4: 159-160.

India's integrated child development services scheme: challenges for scaling up.

BACKGROUND: India had around 158 million children under the age of 6 and about 26 million births in 2015. In the same year, India's Integrated Child Development Services Scheme served about 82 million children under 6 years and over 19 million pregnant women and lactating mothers. These 102 million beneficiaries received services in about 1.3 million centres. METHOD: This paper reviews the growth of the Scheme and considers challenges to scaling up quality with equity based on results of large-scale national or multistate studies. RESULTS: The Scheme is associated with decreased malnutrition and better child development. The size and diversity of the country, the policy context, funding mode and lack of community awareness and engagement have hindered scaling up access while the approach to service delivery, low institutional capacity and poor infrastructure have impeded scaling up of implementation quality. CONCLUSIONS: This review illustrates the challenges associated with scaling-up access and implementation quality of a multicomponent, integrated early childhood programme in a large, diverse country. The future success of the Integrated Child Development Services will depend on how well it adheres to quality standards and how well it evolves to address current weaknesses.

In vitro and physiologically-based pharmacokinetic based assessment of drug-drug interaction potential of canagliflozin.

AIMS: Canagliflozin is a recently approved drug for use in the treatment of type 2 diabetes. The potential for canagliflozin to cause clinical drug-drug interactions (DDIs) was assessed. METHODS: DDI potential of canagliflozin was investigated using in vitro test systems containing drug metabolizing enzymes or transporters. Basic predictive approaches were applied to determine potential interactions in vivo. A physiologically-based pharmacokinetic (PBPK) model was developed and clinical DDI simulations were performed to determine the likelihood of cytochrome P450 (CYP) inhibition by canagliflozin. RESULTS: Canagliflozin was primarily metabolized by uridine 5'-diphospho-glucuronosyltransferase 1A9 and 2B4 enzymes. Canagliflozin was a substrate of efflux transporters (P-glycoprotein, breast cancer resistance protein and multidrug resistance-associated protein-2) but was not a substrate of uptake transporters (organic anion transporter polypeptide isoforms OATP1B1, OATP1B3, organic anion transporters OAT1 and OAT3, and organic cationic transporters OCT1, and OCT2). In inhibition assays, canagliflozin was shown to be a weak in vitro inhibitor (IC50 ) of CYP3A4 (27 µmol l -1 , standard error [SE] 4.9), CYP2C9 (80 µmol l -1 , SE 8.1), CYP2B6 (16 µmol l-1 , SE 2.1), CYP2C8 (75 µmol l -1 , SE 6.4), P-glycoprotein (19.3 µmol l -1 , SE 7.2), and multidrug resistance-associated protein-2 (21.5 µmol l -1 , SE 3.1). Basic models recommended in DDI guidelines (US Food & Drug Administration and European Medicines Agency) predicted moderate to low likelihood of interaction for these CYPs and efflux transporters. PBPK DDI simulations of canagliflozin with CYP probe substrates (simvastatin, S-warfarin, bupropion, repaglinide) did not show relevant interaction in humans since mean areas under the concentration-time curve and maximum plasma concentration ratios for probe substrates with and without canagliflozin and its 95% CIs were within 0.80-1.25. CONCLUSIONS: In vitro DDI followed by a predictive or PBPK approach was applied to determine DDI potential of canagliflozin. Overall, canagliflozin is neither a perpetrator nor a victim of clinically important interactions.

A novel method for identifying SNP disease association based on maximal information coefficient.

To improve single-nucleotide polymorphism (SNP) association studies, we developed a method referred to as maximal information coefficient (MIC)-based SNP searching (MICSNPs) by employing a novel statistical approach known as the MIC to identify SNP disease associations. MIC values varied with minor allele frequencies of SNPs and the odds ratios for disease. We used a Monte Carlo-based permutation test to eliminate the effects of fluctuating MIC values and included a sliding-window-based binary search whose time-cost was 0.58% that of a sequential search to save time. The experiments examining both simulation and actual data demonstrated that our method is computationally and statistically feasible after reducing the resampling count to 4 times the number of markers and applying a sliding-window-based binary search to the method. We found that our method outperforms existing approaches.

Nanotechnology in food processing sector-An assessment of emerging trends.

Use of nanoscience based technology in the food industry is fast emerging as new area for research and development. Several research groups including private companies in the industry have initiated research programmes for exploring the wide scope of nanotechnology into the value chain of food processing and manufacturing. This paper discusses the current focus of research in this area and assesses its potential impacts. Using the developed relational database framework with R&D indicators like literature and patent documents for assessment of the potential of nanotechnology in food sector, a model to organize and map nanoresearch areas to the food processing sector was developed. The study indicates that the about five basic categories of nanotechnology applications and functionalities currently in the development of food sector, include food processing, packaging, nutraceuticals delivery, food safety and functional foods.

Vapor-induced phase transformations in docetaxel.

Vapor-induced transformations of docetaxel anhydrous (form D(A)) under ambient conditions have been studied using methanol, ethanol, and water as the solvent media. The online vapor-induced transformations were monitored by powder X-ray diffractometry. New solid forms (solvates/hydrates/anhydrous) of docetaxel anhydrous were obtained in stoichiometric ratios which were characterized completely using powder X-ray diffraction, differential scanning calorimeter, thermogravimetric analysis, and spectroscopic ((13)C solid-state nuclear magnetic spectroscopy, solution (1)H NMR, and Fourier transform infrared) techniques. The new forms namely methanol solvate (D(M)), ethanol solvate (D(E)), monohydrate (D(MH)), trihydrate (D(TH)), and anhydrous (D(AN-I) and D(AN-II)) were identified through structural analysis.

Assessment of pollutants and gaseous emissions in sewer network in NCT of Delhi.

The NCT of Delhi in India handles domestic sewage through a long sewerage networks. The network is into eight divisions. The aim of the present study is to arrive at a correlation between sewage quality and gas emissions in the sewer network of various divisions. This will aid in forewarning the sewer workers about the safety precautions. The health effects due to toxic sewer gases exposure and assessment of hazardous conditions and hazard potential are discussed. The study areas were broadly classified as residential, commercial, industrial and mix (combination of residential & commercial) for comparison. Sewage samples were collected from 1020 sites and analyzed for 10 different physicochemical parameters. The analytical data revealed wide variation in the chemical composition of sewage flowing at various sewerage network sites. Based on comparison with the regulatory standard for discharge in sewers, 89 sites with higher values of BOD and sulphate were marked as critical sites. Subsequently, the concentrations of CH4 and H2S in sewer emissions were determined for the 89 critical sites through onsite monitoring. Samples from 22 sites had significantly higher concentration of CH4 than the LEL and those from 40 sites showed concentrations higher than the LFL. On the other hand, samples from 38 locations showed significantly high H2S concentration, more than permissible limit of 10 ppm. The sewer workers in North East, North West and West region of the metropolis were exposed to hazards from excessive CH4 and H2S emissions, whereas those under South and South West regions were more vulnerable to H2S related risks. The sewer network under North, Central and South poses relatively less hazard with regard to gaseous emissions.

Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study.

AIMS: South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. METHODS: A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies' 2 and QRISK2 were used to estimate CVD risk. RESULTS: At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10-year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54-0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57-0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64-0.75). CONCLUSIONS: A high prevalence of modifiable risk factors for CVD was detected in the population screened.

Chemical characteristics of groundwater and assessment of groundwater quality in Varaha River Basin, Visakhapatnam District, Andhra Pradesh, India.

Study on chemical characteristics of groundwater and impacts of groundwater quality on human health, plant growth, and industrial sector is essential to control and improve the water quality in every part of the country. The area of the Varaha River Basin is chosen for the present study, where the Precambrian Eastern Ghats underlain the Recent sediments. Groundwater quality is of mostly brackish and very hard, caused by the sources of geogenic, anthropogenic, and marine origin. The resulting groundwater is characterized by Na(+) > Mg(2+) > Ca(2+) : [Formula: see text] > Cl(-) > [Formula: see text], Na(+) > Mg(2+) > Ca(2+) : [Formula: see text] > Cl(-) > [Formula: see text] > [Formula: see text], Na(+) > Mg(2+) > Ca(2+) : [Formula: see text] > Cl(-), and Na(+) > Mg(2+) > Ca(2+) : Cl(-) > [Formula: see text] > [Formula: see text] facies, following the topographical and water flow-path conditions. The genetic geochemical evolution of groundwater ([Formula: see text] and Cl(-)-[Formula: see text] types under major group of [Formula: see text]) and the hydrogeochemical signatures (Na(+)/Cl(-), >1 and [Formula: see text]/Cl(-), <1) indicate that the groundwater is of originally fresh quality, but is subsequently modified to brackish by the influences of anthropogenic and marine sources, which also supported by the statistical analysis. The concentrations of total dissolved solids (TDS), TH, Mg(2+), Na(+), K(+), [Formula: see text], Cl(-), [Formula: see text], and F(-) are above the recommended limits prescribed for drinking water in many locations. The quality of groundwater is of mostly moderate in comparison with the salinity hazard versus sodium hazard, the total salt concentration versus percent sodium, the residual sodium carbonate, and the magnesium hazard, but is of mostly suitable with respect to the permeability index for irrigation. The higher concentrations of TDS, TH, [Formula: see text], Cl(-), and [Formula: see text] in the groundwater cause the undesirable effects of incrustation and corrosion in many locations. Appropriate management measures are, therefore, suggested to improve the groundwater quality.

Genetically engineered virus-resistant plants in developing countries: current status and future prospects.

Plant viruses cause severe crop losses worldwide. Conventional control strategies, such as cultural methods and biocide applications against arthropod, nematode, and plasmodiophorid vectors, have limited success at mitigating the impact of plant viruses. Planting resistant cultivars is the most effective and economical way to control plant virus diseases. Natural sources of resistance have been exploited extensively to develop virus-resistant plants by conventional breeding. Non-conventional methods have also been used successfully to confer virus resistance by transferring primarily virus-derived genes, including viral coat protein, replicase, movement protein, defective interfering RNA, non-coding RNA sequences, and protease, into susceptible plants. Non-viral genes (R genes, microRNAs, ribosome-inactivating proteins, protease inhibitors, dsRNAse, RNA modifying enzymes, and scFvs) have also been used successfully to engineer resistance to viruses in plants. Very few genetically engineered (GE) virus resistant (VR) crops have been released for cultivation and none is available yet in developing countries. However, a number of economically important GEVR crops, transformed with viral genes are of great interest in developing countries. The major issues confronting the production and deregulation of GEVR crops in developing countries are primarily socio-economic and related to intellectual property rights, biosafety regulatory frameworks, expenditure to generate GE crops and opposition by non-governmental activists. Suggestions for satisfactory resolution of these factors, presumably leading to field tests and deregulation of GEVR crops in developing countries, are given.

Cohort study on patient response to botulinum toxin cosmetic therapy.

BACKGROUND: Botulinum toxin (BTX) therapy is currently the most popular cosmetic procedure in the United States. However, few studies exist regarding post-procedure perceptions of the patients' BTX therapy. OBJECTIVE: The aim of this cohort study was to determine patients' responses from pre- to post-BTX treatment experience. METHODS AND MATERIALS: One hundred twenty-three BTX patients of six different dermatologic cosmetic practices in various boroughs of New York and Long Island in the state of New York completed the questionnaire. Six hundred eighty-three surveys were sent out, and 123 completed surveys were obtained. Numerous questions were asked regarding how patients felt and responded towards the overall procedure of their BTX therapy. RESULTS: Eighty-eight percent of patients were satisfied or extremely satisfied with their dermatologists. Sixty-five percent of patients felt over 60% improvement in areas treated. Fifty-eight percent of patients anticipated making repeat visits, whereas the biggest concern for returning was due to the expensive cost of BTX. CONCLUSION: Our study correlated with previous studies done on retention rate of BTX cosmetic patients and satisfaction level on areas treated. The cost of BTX remained one of the primary concerns for repeat visits. Most patients were happy with their visits to the dermatology offices for BTX procedure, although things can be done to further enhance their visits and the likelihood that they will return.

Anaerobic treatment of wastewater with high suspended solids from a bulk drug industry using fixed film reactor (AFFR).

Studies were carried out on the treatment of wastewater from a bulk drug industry using an anaerobic fixed film reactor (AFFR) designed and fabricated in the laboratory. The chemical oxygen demand (COD) and total dissolved solids (TDS) of the wastewater were found to be very high with low biochemical oxygen demand (BOD) to COD ratio and high total suspended solid (TSS) concentration. Acclimatization of seed consortia and startup of the reactor was carried out by directly using the wastewater, which resulted in reducing the period of startup to 30 days. The reactor was studied at different organic loading rates (OLR) and it was found that the optimum OLR was 10 kg COD/m(3)/day. The wastewater under investigation, which had a considerable quantity of SS, was treated anaerobically without any pretreatment. COD and BOD of the reactor outlet wastewater were monitored and at steady state and optimum OLR 60-70% of COD and 80-90% of BOD were removed. The reactor was subjected to organic shock loads at two different OLR and the reaction could withstand the shocks and performance could be restored to normalcy at that OLR. The results obtained indicated that AFFR could be used efficiently for the treatment of wastewater from a bulk drug industry having high COD, TDS and TSS.

Anaerobic treatment of wastewater with high suspended solids from a bulk drug industry using fixed film reactor (AFFR).

Studies are carried out on the treatment of wastewater from a bulk drug industry using an anaerobic fixed film reactor (AFFR) designed and fabricated in the laboratory. The chemical oxygen demand (COD) and total dissolved solids (TDS) of the wastewater are found to be very high with low Biochemical oxygen demand (BOD) to COD ratio and high total suspended solid (TSS) concentration. Acclimatization of seed consortia and start up of the reactor is carried out by directly using the wastewater, which resulted in reducing the period of startup to 30 days. The reactor is studied at different organic loading rates (OLR) and it is found that the optimum OLR is 10 kg COD/m3/day. The wastewater under investigation, which is having considerable quantity of SS, is treated anaerobically without any pretreatment. The COD and BOD of the reactor outlet wastewater are monitored and reduction at steady state and optimum OLR is observed to be 60-70% of COD and 80-90% of BOD. The reactor is subjected to organic shock loads at two different OLR and it is observed that the reactor could withstand shocks and performance could be restored to normalcy at that OLR. The results obtained indicated that AFFR could be used efficiently for the treatment of wastewater from a bulk drug industry having high COD, TDS and TSS.

Countertransference. Its continued importance in psychiatric education.

Psychotherapy is likely to play a minor or nonexistent role in the future general psychiatrist's training and practice. However, the component skills of recognition and management of the countertransference will remain important. Because psychotherapy training and supervision have been the venues for countertransference learning, the field is in danger of losing its teaching laboratory and hence losing these skills. The authors examine the concept of countertransference and discuss its importance in four increasingly significant areas: managed care, psychopharmacological treatment, emergency intervention, and the management of professional boundaries regarding sexual misconduct. Methods are discussed for enhancing residents' countertransference skills through supervision, training groups, and the resident's personal psychotherapy.

Social marketing and diffusion-based strategies for communicating with unique populations: HIV prevention in San Francisco.

We conducted a 2-year investigation of the extent to which strategies based on social marketing and diffusion of innovations concepts are used in preventive health communication with unique (highly ostracized) populations. Of the 49 organizations in San Francisco that operate HIV prevention programs (N = 100), programs that most highly targeted unique populations were surveyed. Personal interviews were then conducted with 38 staff leaders who operated the most and least effective programs. Audiotapes and transcripts were content analyzed to identify the strategies used by program staff. Strategies based on social marketing concepts were more prevalent than strategies based on the diffusion of innovations: More effective programs were characterized by emphasis on homophily, audience segmentation, compatibility-based strategies, and interorganizational collaboration.

Irrigated agriculture and female work participation.

PIP: This study uses 1981 India Census data to examine the relationship between female agricultural work and use of irrigation in farming. Analysis pertains to 146 taluks in 15 districts in Karnataka state in India. Five districts that had high proportions of females in non-farm work are excluded. The work force participation rates (WPR) in 1981 in rural Karnataka were 57% for males and 22% for females. In 33% of taluks female agricultural workers represented 70% of the total female work force. In 70% of taluks women were mostly engaged in agricultural jobs. Among the three groups of workers, women were primarily agricultural laborers, followed by cultivators. Female agricultural labor was lower in owner-cultivator households that had mainly male cultivators and were economically better off. Districts are distinguished by the percentage of male cultivators. Generally, the percentage of male cultivators varied inversely with the percentage of noncultivating landless households. Farm size varied inversely with the percentage of male cultivators. Female cultivators resided mostly in owner-cultivator households. Female agricultural laborers lived in both cultivating and noncultivating households. Southern districts, Hassan, Mandya, Tumkur, and Mysore had a high percentage of male cultivators, a low percentage of landless households, small farm sizes, and low female WPR. Regression findings indicate farm size was positively related to total female WPR and explained over 33% of the variation. The percentage of scheduled castes and tribes was also positive and explained 7% of the variation. The percentage of male cultivators and population density had a negative effect and explained little of the variation. However, the percentage of male cultivators explained 17% of the variation in female cultivators and 63% of the variation in female agricultural laborers. Irrigation had a small positive effect on female laborers and no effect on female cultivators or total female WPR.^ieng

Incidence and management of cataracts in Vogt-Koyanagi-Harada syndrome.

Of 65 consecutive patients (130 eyes) with Vogt-Koyanagi-Harada syndrome, 26 (40%) developed cataracts (49 eyes, 38%). Twenty-eight cataracts were posterior subcapsular, six nuclear, 14 combined nuclear and posterior subcapsular, and one anterior cortical. Risk factors for the development of cataracts included age (P = .003), long-standing recurrent anterior segment inflammation (P < .001), and systemic corticosteroid therapy for six months or more (P < .001). After at least three months of minimal to no intraocular inflammation, 19 eyes underwent cataract extraction, of which 11 also had posterior chamber intraocular lens implantation. Median visual acuity improved significantly from 20/400 to 20/40 (P < .01) after a median follow-up time of 13 months. Route of preoperative corticosteroids, pars plana vitrectomy, and glaucoma surgery did not markedly affect visual prognosis. If preoperative intraocular inflammation is rigorously controlled, cataract surgery can be performed safely and can result in significant visual improvement in patients with Vogt-Koyanagi-Harada syndrome.