Estimating the Reliability and Validity of the Quadrant Hop Test in the Assessment of the Functional Stability of the Knee.

Background Many sporting activities demand multidirectional skills and movements, emphasizing the importance of various fitness components such as functional stability, strength, power, endurance, and range of motion. These aspects must be thoroughly assessed before athletes can return to sports safely following an injury. Although the single-leg hop test (SHT) is widely used as the gold standard for evaluating joint stability, it has limitations in assessing multidirectional movements. Therefore, further research is necessary to explore whether increasing the dynamicity of the hop test in different directions enhances its sensitivity in assessing knee joint stability across all four directions. The objective of this study was to investigate the applicability of a new functional assessment tool, the quadrant hop test (QHT), for evaluating lower limb functional stability. Methodology One hundred nineteen amateur sportsmen who are in the age group of 18-25 years with a limb symmetry index of the lower limb calculated through SHT of >80% were included. All the participants performed the SHT, a triple hop test (THT), a crossover hop test (CHT), and the QHT on two different days, with two investigators assessing the QHT on different days and then recording the measurements of Hop distance. Results The mean difference between SHT, THT, and CHT with QHT was 4.59%, with a moderate correlation between all the hop tests. The Cronbach's alpha revealed good intra-rater (0.917) and inter-rater reliability (0.912) of the QHT. Conclusion The QHT proves to be a reliable and valid measure for assessing the functional stability of the lower limb and is 4.59% more sensitive than SHT, THT, and CHT in assessing knee stability and in return to sports criteria.

A National Cancer Grid pooled procurement initiative, India.

In health systems with little public funding and decentralized procurement processes, the pricing and quality of anti-cancer medicines directly affects access to effective anti-cancer therapy. Factors such as differential pricing, volume-dependent negotiation and reliance on low-priced generics without any evaluation of their quality can lead to supply and demand lags, high out-of-pocket expenditures for patients and poor treatment outcomes. While pooled procurement of medicines can help address some of these challenges, monitoring of the procurement process requires considerable administrative investment. Group negotiation to fix prices, issuing of uniform contracts with standardized terms and conditions, and procurement by individual hospitals also reduce costs and improve quality without significant investment. The National Cancer Grid, a network of more than 250 cancer centres in India, piloted pooled procurement to improve negotiability of high-value oncology and supportive care medicines. A total of 40 drugs were included in this pilot. The pooled demand for the drugs from 23 centres was equivalent to 15.6 billion Indian rupees (197 million United States dollars (US$)) based on maximum retail prices. The process included technical and financial evaluation followed by contracts between individual centres and the selected vendors. Savings of 13.2 billion Indian Rupees (US$ 166.7million) were made compared to the maximum retail prices. The savings ranged from 23% to 99% (median: 82%) and were more with generics than innovator and newly patented medicines. This study reveals the advantages of group negotiation in pooled procurement for high-value medicines, an approach that can be applied to other health systems.

Lorsque les systèmes de santé reçoivent peu de fonds publics et que leurs processus d'achat sont décentralisés, le prix et la qualité des médicaments contre le cancer ont un impact direct sur l'accès aux traitements efficaces contre la maladie. Des facteurs tels que l'application de prix différenciés, les négociations en fonction des volumes ainsi que la confiance placée dans des génériques bon marché dont la qualité n'a pas été évaluée peuvent entraîner des décalages entre l'offre et la demande, d'énormes dépenses non remboursables pour les patients et de piètres résultats thérapeutiques. Bien que les acquisitions groupées de médicaments puissent contribuer à résoudre certains de ces problèmes, le suivi du processus d'achat requiert un engagement considérable au niveau administratif. Les négociations collectives en vue de fixer les tarifs, l'établissement de contrats types assortis de conditions générales standardisées, mais aussi les achats effectués par des hôpitaux en particulier peuvent également faire baisser les coûts et améliorer la qualité sans nécessiter d'importants investissements. Le National Cancer Grid, un réseau réunissant plus de 250 centres d'oncologie en Inde, a testé un dispositif d'achat groupé visant à assurer une meilleure négociabilité pour des médicaments et soins de soutien essentiels contre le cancer. Au total, 40 substances ont été prises en compte dans ce projet pilote. La demande groupée en médicaments émise par 23 centres équivalait à 15,6 milliards de roupies indiennes (197 millions de dollars américains) d'après le prix maximal de vente au détail. Ce processus prévoyait une évaluation technique et financière, puis des contrats entre chaque centre et les distributeurs sélectionnés. Des économies de 13,2 milliards de roupies indiennes (166,7 millions de dollars américains) ont pu être réalisées par rapport au prix maximal de vente au détail. Ces économies étaient comprises entre 23 et 99% (médiane: 82%) et concernaient davantage les médicaments génériques que les marques et les médicaments récemment brevetés. La présente étude révèle les avantages que représentent les négociations collectives lors des achats groupés de médicaments essentiels, une approche applicable à d'autres systèmes de santé.

En los sistemas sanitarios con escasa financiación pública y procesos de adquisición descentralizados, el sistema de fijación de precios y la calidad de los medicamentos contra el cáncer afectan directamente al acceso a una terapia eficaz contra dicha enfermedad. Factores como los diferentes sistemas de determinación de precios, la negociación en función del volumen y la dependencia de genéricos de bajo precio sin evaluación de su calidad pueden generar retrasos en la oferta y la demanda, elevados gastos para los pacientes y malos resultados en el tratamiento. Aunque la adquisición conjunta de medicamentos puede ayudar a abordar algunos de estos retos, el seguimiento del proceso de adquisición requiere una inversión administrativa considerable. La negociación colectiva a la hora de determinar los precios, la emisión de contratos unificados con términos y condiciones estandarizados y la adquisición por parte de algunos hospitales también reducen los costes y mejoran la calidad sin necesidad de realizar una gran inversión. La Red Nacional de Cáncer, una red que cuenta con más de 250 centros oncológicos en la India, puso a prueba la adquisición conjunta con el fin de mejorar la negociabilidad de medicamentos oncológicos y de tratamiento complementario que resultaban costosos. En esta prueba piloto se incluyó un total de 40 medicamentos. La demanda conjunta de medicamentos por parte de 23 centros fue equivalente a 15 600 millones de rupias indias (197 millones USD) según los precios minoristas máximos. El proceso incluyó una evaluación técnica y financiera, así como contratos entre centros independientes y proveedores seleccionados. Se logró un ahorro de 13 200 millones de rupias indias (166,7 millones USD) en comparación con los precios minoristas máximos. El ahorro osciló entre el 23 y el 99% (media: 82%) y fue más alto con los medicamentos genéricos que con los de marca y los recién patentados. Este estudio pone de manifiesto las ventajas de la negociación colectiva en lo que respecta a la adquisición conjunta de medicamentos costosos, un enfoque que se puede aplicar a otros sistemas sanitarios.

Intubating Conditions of two Different Doses of Rocuronium At 60 Seconds; by Clinical Assessment; and with T.O.F Response of Adductor Pollicis Muscle.

BACKGROUND: At 60 seconds, 2xED95 dose (0.6mg/kg) of rocuronium is frequently used for intubation. Some studies suggest 3XED95 (0.9mg/kg body weight) dose in achieving excellent intubating conditions. In this context, present study aimed at comparing intubating conditions with these two doses of rocuronium, using clinical criteria by cooper's score; assisted with adductor pollicis T.O.F response. MATERIALS AND METHODS: Present prospective randomized comparative clinical study was conducted on 60 patients subjected for general anaesthesia. Induction was done with fentanyl (1mcg/kg body weight) and propofol (2mg/kg body weight) and relaxation achieved with Rocuronium 0.6 mg/kg (Group A-30 cases); 0.9mg/kg (Group B- 30 cases). (n=30) intubation was done at 60 seconds. Intubating conditions were assessed clinically by cooper's score.T.O.F responses of AP by visual and tactile means. RESULTS: Intubating conditions clinically were excellent in 16 cases (53%), good in 12 cases (40%), and fair in 2 cases (7%) respectively in Group-A. In group-B excellent in 29 cases (97%) and good in 1case (3%). In group A in no case TOF-0 achieved. TOF 1, 2, 3, and 4 were observed in 1 case (3%), 7 cases (23%) 16 cases (54%) and 6 cases (20%) respectively. Whereas in group B, TOF 0, 1, 2, 3 were observed in 18 cases (61%), 4 cases (13%), 7 cases (23%) and 1 case (3%). In no case TOF-4 observed. Chi square test (p<0.0001) confirmed a highly significant statistical difference with respect to elicited TOFcounts, and intubating conditions achieved. CONCLUSION: 3xED95 dose of Rocuronium achieves more intense NMB and better conditions for intubation at 60 seconds than 2ED 95 dose.

Modeling of protein conformational fluctuations in pKa predictions.

A method is presented to account for conformational fluctuations of a protein in predicting the pK(a) values of its titrating groups. Conformations of the protein are generated by conventional molecular dynamics or Monte Carlo simulations, in which the protonations of the titrating groups are fixed. For each protein conformation, the electrostatic free energies required to add a proton charge to a titrating group while other groups are either unprotonated or protonated are calculated within a dielectric continuum model. These are used to determine the mean protonations of the titrating groups in the conformation at a series of pH values. The mean protonations are then used to determine the relative weight of the particular conformation with the titrating groups having all possible protonations. A conformationally averaged mean protonation for each titrating group is finally obtained by the weighted sum of the group's mean protonations in all the conformations. This method is applied to yeast iso-1-ferricytochrome c. The predicted pK(a) values are in general agreement with experimental results.