Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management.

BACKGROUND: Type 2 diabetes (T2DM) poses an enormous global health care challenge, especially among rural communities. Healthcare in these areas can be inadequate and inaccessible due to socio-demographic barriers. To overcome this situation, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. OBJECTIVE: This cross-sectional study aimed to evaluate the proficiency of CHWs involved in diabetes screening and management in rural South India by identifying the existing practice behaviours and knowledge gaps. METHODS: Employing a customised questionnaire, developed through inputs from experts and government officials, we assessed practice behaviours and the corresponding knowledge base of 275 CHWs. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. RESULTS: The study showcased significant deficiencies in both practice behaviours (97%) and knowledge (95%) with current mean levels ranging from 48 to 50%, respectively, among the participants. The identified areas of insufficiency were broadly representative of the core competencies required for effective diabetes management, encompassing diabetes diagnosis and referral, HbA1c testing, diabetes diet, diabetes type and self-management, microvascular complications and their screening, peripheral neuropathy management, and diabetes risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management, and calculation of diabetes risk assessment. CONCLUSION: This study highlights widespread deficiencies (97% CHWs) in diabetes management practices and knowledge (95% CHWs). To overcome these deficiencies, a thorough needs assessments is vital for effective CHW training. Training of CHWs should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.

Pyrrole: A Decisive Scaffold for the Development of Therapeutic Agents and Structure-Activity Relationship.

An overview of pyrroles as distinct scaffolds with therapeutic potential and the significance of pyrrole derivatives for drug development are provided in this article. It lists instances of naturally occurring pyrrole-containing compounds and describes the sources of pyrroles in nature, including plants and microbes. It also explains the many conventional and modern synthetic methods used to produce pyrroles. The key topics are the biological characteristics, pharmacological behavior, and functional alterations displayed by pyrrole derivatives. It also details how pyrroles are used to treat infectious diseases. It describes infectious disorders resistant to standard treatments and discusses the function of compounds containing pyrroles in combating infectious diseases. Furthermore, the review covers the uses of pyrrole derivatives in treating non-infectious diseases and resistance mechanisms in non-infectious illnesses like cancer, diabetes, and Alzheimer's and Parkinson's diseases. The important discoveries and probable avenues for pyrrole research are finally summarized, along with their significance for medicinal chemists and drug development. A reference from the last two decades is included in this review.

Object detection using YOLO: challenges, architectural successors, datasets and applications.

Object detection is one of the predominant and challenging problems in computer vision. Over the decade, with the expeditious evolution of deep learning, researchers have extensively experimented and contributed in the performance enhancement of object detection and related tasks such as object classification, localization, and segmentation using underlying deep models. Broadly, object detectors are classified into two categories viz. two stage and single stage object detectors. Two stage detectors mainly focus on selective region proposals strategy via complex architecture; however, single stage detectors focus on all the spatial region proposals for the possible detection of objects via relatively simpler architecture in one shot. Performance of any object detector is evaluated through detection accuracy and inference time. Generally, the detection accuracy of two stage detectors outperforms single stage object detectors. However, the inference time of single stage detectors is better compared to its counterparts. Moreover, with the advent of YOLO (You Only Look Once) and its architectural successors, the detection accuracy is improving significantly and sometime it is better than two stage detectors. YOLOs are adopted in various applications majorly due to their faster inferences rather than considering detection accuracy. As an example, detection accuracies are 63.4 and 70 for YOLO and Fast-RCNN respectively, however, inference time is around 300 times faster in case of YOLO. In this paper, we present a comprehensive review of single stage object detectors specially YOLOs, regression formulation, their architecture advancements, and performance statistics. Moreover, we summarize the comparative illustration between two stage and single stage object detectors, among different versions of YOLOs, applications based on two stage detectors, and different versions of YOLOs along with the future research directions.

Kinesin-14 motors participate in a force balance at microtubule plus-ends to regulate dynamic instability.

Kinesin-14 molecular motors represent an essential class of proteins that bind microtubules and walk toward their minus-ends. Previous studies have described important roles for Kinesin-14 motors at microtubule minus-ends, but their role in regulating plus-end dynamics remains controversial. Kinesin-14 motors have been shown to bind the EB family of microtubule plus-end binding proteins, suggesting that these minus-end-directed motors could interact with growing microtubule plus-ends. In this work, we explored the role of minus-end-directed Kinesin-14 motor forces in controlling plus-end microtubule dynamics. In cells, a Kinesin-14 mutant with reduced affinity to EB proteins led to increased microtubule lengths. Cell-free biophysical microscopy assays were performed using Kinesin-14 motors and an EB family marker of growing microtubule plus-ends, Mal3, which revealed that when Kinesin-14 motors bound to Mal3 at growing microtubule plus-ends, the motors subsequently walked toward the minus-end, and Mal3 was pulled away from the growing microtubule tip. Strikingly, these interactions resulted in an approximately twofold decrease in the expected postinteraction microtubule lifetime. Furthermore, generic minus-end-directed tension forces, generated by tethering growing plus-ends to the coverslip using λ-DNA, led to an approximately sevenfold decrease in the expected postinteraction microtubule growth length. In contrast, the inhibition of Kinesin-14 minus-end-directed motility led to extended tip interactions and to an increase in the expected postinteraction microtubule lifetime, indicating that plus-ends were stabilized by nonmotile Kinesin-14 motors. Together, we find that Kinesin-14 motors participate in a force balance at microtubule plus-ends to regulate microtubule lengths in cells.

Depression, suicidal ideation, and suicidal behaviors among dental students of Neo-state capital region in India.

BACKGROUND: The challenges of dental education place students at high risk of stress. Because dental education is a highly demanding and challenging course, placing heavy demands on the mental resources of the students, making them vulnerable to high levels of stress, this study aimed to determine the prevalence of depression, suicidal ideation, and suicidal behaviors in dental students. MATERIALS AND METHODS: A descriptive cross-sectional study was done on a convenience sample of 388 dental students in a teaching dental institution. Data were collected using standard, prevalidated, self-administered questionnaires (Patient Health Questionnaire-9 and Suicidal Behaviours Questionnaire-Revised [SBQ-R]). Analysis was done using SPSS version 20. Descriptive statistics, Chi-square test, and logistic regression were performed. RESULTS: At least half of the students were in major depression with different levels of severity. When students from different years were analyzed, majority from each year fell under II and III categories (P < 0.001). Most of the students reported that they do not have any suicidal ideation or behavior (SBQ-R). Nearly 16% of the students either presented the threat of suicidal attempt or likelihood of suicidal behavior in future. Almost 13% of the dental students thought of killing themselves in the past year for at least two times. Around 16% of them expressed to someone about their thought of committing suicide. CONCLUSION: Even though depression and suicidal tendencies were not prominent in dental students, there is a need to shed light on those who responded positively and take necessary reforms to relieve academic stress.

1800 121 2096 Diabeteshelp - A toll free helpline for people with diabetes.

People with diabetes mellitus require long-term care that is timely, patient-centered, community-based and sustainable. Any deficiency in care increases the risk of developing complications like Diabetic Retinopathy. Patients or their carers also have numerous questions and doubts during this long-period of care. This increases the pressure on health systems that are struggling with a lack of skilled human resources. One option is to provide counseling support using a dedicated helpline. Over the last five years a major initiative to tackle visual impairment due to diabetes was rolled out in India by the Public Health Foundation of India supported by the Queen Elizabeth Diamond Jubilee Trust, UK. One component of the initiative was establishing a toll-free helpline (1800 121 2096) to address the lack of awareness and to empower people with diabetes in Telangana and Andhra Pradesh states in India. Over a 1-year period, the helpline received 4406 calls, making a case for a national service for people with diabetes.

Retinopathy of prematurity: Overview and highlights of an initiative to integrate prevention, screening, and management into the public health system in India.

Purpose: In India, more than 800 special newborn care units (SNCUs) have been established since 2008 in government facilities. More preterm infants are now surviving and blindness from retinopathy of prematurity (ROP) is increasing. The aim of the Queen Elizabeth Diamond Jubilee Trust's initiative (2012-1019) was to improve the quality of neonatal care and integrate ROP services into the government health system using expertise in the government and nongovernment sector in four states in a sustainable and scalable manner. Methods: State Ministries of Health were engaged and collaboration was established between three government programs (Ministry of Health and Family Welfare, Rashtriya Bal Swasthya Karyakram, and blindness prevention) and relevant professionals. Extensive training took place and equipment was provided. Implementation was guided by a multidisciplinary National Task Force and was monitored by state coordination committees. The Task Force appointed technical expert groups to support implementation through advocacy, information, education and communication materials, operational guidelines, a competency-based training curriculum, and an online database and website. Results: Twenty-two ophthalmologists in government facilities were trained to screen for ROP and nine to treat ROP. Almost 13,500 preterm infants were screened in 17 SNCUs and 86% of the 456 infants with sight-threatening ROP were treated. An educational resource using latest pedagogy based on key domain areas for best practices for small and preterm neonates including ROP has been developed and pilot tested and is being evaluated and scaled up. Conclusion: All four states are scaling up services or have plans to scale up, and several other states have started the initiatives.

Establishing support groups to support parents of preterm babies with retinopathy of prematurity: A pilot study.

India has the highest number of preterm births in the world, which along with low birth weight, are significant risk factors for retinopathy of prematurity (ROP). One of the challenges in combating visual loss from ROP is the lack of information and awareness among parents of preterm babies. The objective of establishing ROP parent support groups was to support parents of children with ROP by counseling, information and resource sharing, and general guidance. As part of a major initiative to combat ROP across four states in India, a strategy to develop parent support groups was developed and a pilot project was implemented in three cities. In collaboration with identified eye institutes, five ROP parent support group sessions were conducted in these cities. The concept is still in its initial stages of implementation and data are not yet available on the impact of the support groups. However, the overall turnout for the meetings was low as only 30% of parents invited attended meetings. Initial learning and experiences suggest that parent support groups could have a significant role to play in providing many benefits especially in improving awareness, knowledge, and compliance, alleviating anxiety, and empowering parents.

Non-enzymatic Activity of the α-Tubulin Acetyltransferase αTAT Limits Synaptic Bouton Growth in Neurons.

Neuronal axons terminate as synaptic boutons that form stable yet plastic connections with their targets. Synaptic bouton development relies on an underlying network of both long-lived and dynamic microtubules that provide structural stability for the boutons while also allowing for their growth and remodeling. However, a molecular-scale mechanism that explains how neurons appropriately balance these two microtubule populations remains a mystery. We hypothesized that α-tubulin acetyltransferase (αTAT), which both stabilizes long-lived microtubules against mechanical stress via acetylation and has been implicated in promoting microtubule dynamics, could play a role in this process. Using the Drosophila neuromuscular junction as a model, we found that non-enzymatic dαTAT activity limits the growth of synaptic boutons by affecting dynamic, but not stable, microtubules. Loss of dαTAT results in the formation of ectopic boutons. These ectopic boutons can be similarly suppressed by resupplying enzyme-inactive dαTAT or by treatment with a low concentration of the microtubule-targeting agent vinblastine, which acts to suppress microtubule dynamics. Biophysical reconstitution experiments revealed that non-enzymatic αTAT1 activity destabilizes dynamic microtubules but does not substantially impact the stability of long-lived microtubules. Further, during microtubule growth, non-enzymatic αTAT1 activity results in increasingly extended tip structures, consistent with an increased rate of acceleration of catastrophe frequency with microtubule age, perhaps via tip structure remodeling. Through these mechanisms, αTAT enriches for stable microtubules at the expense of dynamic ones. We propose that the specific suppression of dynamic microtubules by non-enzymatic αTAT activity regulates the remodeling of microtubule networks during synaptic bouton development.

Membrane bound GSK-3 activates Wnt signaling through disheveled and arrow.

Wnt ligands and their downstream pathway components coordinate many developmental and cellular processes. In adults, they regulate tissue homeostasis through regulation of stem cells. Mechanistically, signal transduction through this pathway is complicated by pathway components having both positive and negative roles in signal propagation. Here we examine the positive role of GSK-3/Zw3 in promoting signal transduction at the plasma membrane. We find that targeting GSK-3 to the plasma membrane activates signaling in Drosophila embryos. This activation requires the presence of the co-receptor Arrow-LRP5/6 and the pathway activating protein Disheveled. Our results provide genetic evidence for evolutionarily conserved, separable roles for GSK-3 at the membrane and in the cytosol, and are consistent with a model where the complex cycles from cytosol to membrane in order to promote signaling at the membrane and to prevent it in the cytosol.

Cannabis dependence: Effects of cannabis consumption on inter-regional cerebral metabolic relationships in an Indian population.

BACKGROUND: The effects of cannabis consumption on neurophysiological function have been a matter of considerable debate. With the legalization of medical marijuana, understanding the consequences of cannabis dependence has become extremely important. AIM: We attempted to understand the influence of cannabis on cerebral glucose metabolism in certain predetermined regions of interest (ROIs). Furthermore, we also explored inter-regional metabolic relationships between ROIs forming the "addiction" and "cognitive dysmetria" circuit. MATERIALS AND METHODS: 2-fluoro, 2-deoxy-glucose positron emission tomography (FDG PET) scans were carried out in 16 male patients (age: 25.3±10.38 years) with cannabis dependence, 8-12 hours after the last cannabis consumption. Resting glucose uptake in 14 pre-determined ROIs was compared with glucose uptake in 16 non-drug using volunteers (age: 29.2±8.39 years). RESULTS: The two groups differed in their lateral and medial temporal glucose uptakes by approximately 16-24%. The relationships between inter-regional glucose uptakes in the two circuits were compared using the Chow Test. Significant differences in inter-regional correlations in the medial temporo-frontal and parieto-thalamic were noted between the two groups. CONCLUSION: The altered metabolic relationships among various brain regions can have potentially important implications for understanding cannabis dependence and cannabis-induced psychopathology.