Health inequities around gender, disability and internal migration: are local governments doing enough.

SETTING: The Kerala health system in India has more than 25 years of decentralised implementation experience. Decentralization could assist in addressing health disparities such as gender, disability, and migration. OBJECTIVE: To explore how inequity issues comprising gender, disability and internal migrations were being addressed at present by the decentralised Kerala health system. DESIGN: Our approach was qualitative, using document review, key informant interviews and in-depth interviews with policy makers, health staff and other stakeholders. RESULTS: Gender aspects were incorporated into planning and budgeting, with 10% funds earmarked for women. Projects were gender-specific to women, and within conventional social roles of livelihood, welfare or reproductive health. Recently, transgender focused projects were also initiated. Schemes for people with disabilities remained welfare-centric and driven by top-down policies. The local governments performed beneficiary identification and benefit disbursal. Migrant health aspects were focused on infectious diseases surveillance and later living conditions of migrant workers. CONCLUSION: The importance that health systems place on socioeconomic determinants of health and fundamental human rights is reflected in the health interventions for marginalised communities. In Kerala, there is now a passive application of central rules and a reluctance to utilise local platforms. Changing this is a necessary condition for achieving equal development.

CONTEXTE: Le système de santé du Kérala en Inde possède plus de 25 ans d'expérience de mise en œuvre décentralisée. La décentralisation pourrait aider à lutter contre les disparités en matière de santé, telles que le genre, le handicap et la migration. OBJECTIF: Examiner comment les questions d'inégalité, notamment le genre, le handicap et les migrations internes, sont actuellement abordées par le système de santé décentralisé du Kérala. MÉTHODES: Notre approche qualitative s'est appuyée sur une analyse documentaire, des entretiens avec des informateurs clés et des entretiens approfondis avec des décideurs politiques, du personnel de santé et d'autres parties prenantes. RÉSULTATS: Les aspects liés au genre ont été intégrés dans la planification et les prévisions budgétaires, en réservant 10 % des fonds aux femmes. Les projets s'adressaient uniquement aux femmes et s'inscrivaient dans le cadre des rôles sociaux conventionnels de subsistance, de bien-être ou de santé génésique. Récemment, des projets axés sur les transsexuels ont également été lancés. Les programmes destinés aux personnes porteuses de handicaps restaient axés sur l'aide sociale et dictés par des politiques descendantes. Les gouvernements locaux se chargeaient de l'identification des bénéficiaires et du versement des prestations. Les aspects de la santé des migrants étaient axés sur la surveillance des maladies infectieuses, puis sur les conditions de vie des travailleurs migrants. CONCLUSION: L'importance accordée par les systèmes de santé aux déterminants socio-économiques de la santé et aux droits fondamentaux de l'homme se reflète dans les interventions sanitaires destinées aux communautés marginalisées. Au Kérala, on constate aujourd'hui une application passive des règles centrales et une réticence à utiliser les plateformes locales. Changer cet état de fait est une condition nécessaire pour parvenir à un développement égalitaire.

Reducing Perinatal Mortality in India: Two-Years Results of the IRIA Fetal Radiology Samrakshan Program.

Aim The aim of the study is to determine improvements in perinatal mortality at the end of the first 2 years from the initiation of the Samrakshan program of the Indian Radiological and Imaging Association. Methods Samrakshan is a screening program of pregnant women that uses trimester-specific risk assessment protocols including maternal demographics, mean arterial pressure, and fetal Doppler studies to classify women as high risk or low risk for preterm preeclampsia (PE) and fetal growth restriction (FGR). Low dose aspirin 150 mg daily once at bedtime was started for pregnant women identified as high risk in the 11-13 6/7 weeks screening. The third-trimester screening focused on the staging of FGR and protocol-based management for childbirth and risk assessment for PE. Outcomes of childbirth including gestational age at delivery, development of PE, and perinatal mortality outcomes were collected. Results Radiologists from 38 districts of 16 states of India participated in the Samrakshan program that screened 2,816 first trimester, 3,267 second trimester, and 3,272 third trimester pregnant women, respectively. At 2 years, preterm PE was identified in 2.76%, preterm births in 19.28%, abnormal Doppler study in 25.76% of third trimester pregnancies, and 75.32% of stage 1 FGR delivered at term. The neonatal mortality rate was 9.86/1,000 live births, perinatal mortality rate was 18.97/1,000 childbirths, and maternal mortality was 58/100,000 live births compared with 29.5, 36, and 113, respectively in 2016. Conclusion Fetal Doppler integrated antenatal ultrasound studies in Samrakshan led to a significant reduction in preterm PE rates, preterm birth rates, and a significant improvement in mean birth weights. Perinatal, neonatal, and maternal mortality rates are significantly better than the targets for 2030 set by the Sustainable Development Goals-3.

Goat as the ideal climate-resilient animal model in tropical environment: revisiting advantages over other livestock species.

In the agriculture sector, livestock are considered extremely resilient to climate change and are tipped to play a significant role in ensuring food security to meet the increased demands of growing human population by 2050. Compared to other domestic species, goats are considered the ideal animal model for climate change due to its high thermal and drought resilience, ability to survive on limited pastures, and high disease resistance. This review is therefore a revisit to the advantages of rearing goats over other livestock species under current and future trends of changes in climate, particularly to cope with recurrent multiple stressors such as heat load, and lack of water and feed. In summary, goats, also called as poor man's cow, are preferred by the small-scale landless farmers due to their low input and assured higher output system, as they require low initial investment, with minimum specialized facilities and labors. Furthermore, they perceive goats as better resilient animal to cope with multiple stressors such as heat load, and water and feed scarcity, and possess better skills to cope with bush, when compared with sheep and cattle. The unique capacity for employing behavioral plasticity and morphological features of goats gives them clear advantage over sheep and cattle, when coping with seasonal biotopes, and experiences of water and feed shortage. When facing with low-quality feed, they also are superior to cattle and sheep to digest dry matter and to recycle nitrogen. Additionally, goats have superior ability to desiccate feces and concentrate urine, when compared with sheep and cattle. These advantages make goat the go-to species for efficiently countering the adversities associated with climate change and to optimize appropriate economic return through sustained production. Therefore, goats are tipped to be the future animals with extreme potential to counter the projected alarming climate change impacts and expected to play a significant role in ensuring food security to meet the demands of the growing human population by the end of this century.

Analysis of carcass traits and quantitative expression patterns of different meat quality governing genes during heat stress exposure in indigenous goats.

A study was conducted to assess the impact of heat stress on various carcass traits, meat quality variables and gene expression patterns which governs meat quality in indigenous female Kodi Aadu breed. The study was conducted for 45 days in climate chamber with 12 animals randomly allocated into two groups of six animals each, KC (n = 6; Female; Control), KHS (n = 6; Female; heat stress). Majority of the major carcass traits and meat quality variables remained intact between KC and KHS groups. The myostatin (MSTN), calpain 1 (CAPN1) and Diacylglycerol Acyltransferase 1 (DGAT1) mRNA expression patterns were significantly (P < 0.01) lower in KHS group as compared to KC group. However, the calpain 2 (CAPN2), calpastatin (CAST) and Crytallin alpha (CRYA) mRNA expression patterns were significantly (P < 0.05) higher in KHS group. Thus, the study established that the major carcass traits and meat quality variables remained intact after heat stress exposure in female Kodi Aadu goats. Further, MSTN, HSP27, CRYA and HSP90 genes were identified as biomarkers for reflecting meat quality during heat stress exposure in female Kodi Aadu breed.

Influence of reduced graphene oxide on flow behaviour, glass transition temperature and secondary crystallinity of plasticized poly(vinyl chloride).

Understanding the rheological behaviour of thermoplastic nanocomposites is important to obtain a concrete knowledge of their processability. The viscoelastic properties of nanocomposites are a reflection of their morphology. The study of flow and deformation of nanocomposites provides essential information related to prevalent interactions in the system as well as contribution from the dispersion of incorporated nanofillers. In the present study, plasticized polyvinyl chloride/reduced graphene oxide nanocomposites (PPVC/RGO) were fabricated using melt mixing technique with different filler concentration. Flow behaviour of the nanocomposites was analyzed using small amplitude oscillatory shear (SAOS) measurements and it indicated an enhancement in the storage modulus (G'), loss modulus (G'') and complex viscosity (η*) with RGO content. This can be attributed to very good dispersion and reinforcing effect of RGO in PPVC matrix as supported by TEM and FTIR results. Weak gel model is used to fit the rheological parameters and is found to be in excellent agreement with the SAOS experiments. Thermal history of the prepared nanocomposites was learned using differential scanning calorimetry. A shift in glass transition temperature (T g) to higher temperature region could be seen, that manifest the effect of RGO in the amorphous portion of PPVC. An interesting property called secondary crystallinity was also found in these materials.

RTI v medical ethics: some questions arising from the recent decision of the Chief Information Commissioner under the RTI Act.

Medical ethics attaches the utmost priority to the confidentiality of medical records. Hence, the decision of the Chief Information Commissioner (CIC) rendered on April 10, 2015 in Case No: CIC/KY/A/2014/001348SA Ms Jyoti Jeena v. PIO, Institute of Human Behaviour & Allied Science (hereinafter referred to as Jyoti Jeena), that the wife-applicant is entitled to get copies of the medical records of her estranged husband has raised many eyebrows.

Rapid non-destructive quantitative estimation of urania/thoria in mixed thorium uranium di-oxide pellets by high-resolution gamma-ray spectrometry.

A non-destructive technique using high-resolution gamma-ray spectrometry has been standardised for quantitative estimation of uranium/thorium in mixed (ThO2-UO2) fuel pellets of varying composition. Four gamma energies were selected; two each from the uranium and thorium series and the time of counting has been optimised. This technique can be used for rapid estimation of U/Th percentage in a large number of mixed fuel pellets from a production campaign.

Coronary artery spasm induced by anesthesia: a case report and review of the literature.

Anesthesia-induced coronary vasospasm has been reported only rarely. We report a case, without previous cardiac history, in which immediately after anesthesia induction a marked ST elevation was noted on the EKG monitor. Premature ventricular contractions as well as non-sustained ventricular tachycardia were noted. These changes resolved immediately after nitroglycerin infusion and 75 mg of lidocaine were given. A coronary angiogram revealed normal coronary arteries and left ventriculogram. Ergonovine stimulation was not performed. The patient was discharged home on calcium entry blockers and nitrates. Exercise stress test two weeks after discharge was negative for ischemia. Induction of anesthesia triggering coronary spasm has been reported rarely, and to our knowledge never in the presence of angiographically normal coronary anatomy. Coronary vasospasm with typical EKG changes--namely, ST elevation and ventricular arrhythmias--has to be included as a possible complication of general anesthesia. Recognition of this syndrome allows prompt treatment and prevention of future episodes.

Severe leukopenia and thrombocytopenia secondary to quinidine.

A case of severe thrombocytopenia and leukopenia secondary to quinidine is presented. The white cell count and platelet count returned to normal within five days after initiation of corticosteroid therapy and cessation of quinidine. Of interest is the fact that the patient had developed a purpuric rash twelve months earlier after drinking gin and tonic.

Peaceful pyrolysis-a novel method for the decomposition of metal-perchlorate complexes of organic ligands.

Perchlorate complexes of vanadium(IV), iron(III), dysprosium, yttrium, copper(II) and nickel with the organic ligands dimethyl sulphoxide, antipyrine, 4-aminoantipyrine, 4-(2-hydroxynaphthyl)-azoantipyrine, and 4-(2,4-dihydroxyphenyl)azoantipyrine have been prepared and analysed for their metal content after decomposition by a non-explosive pyrolytic technique, viz. heating with ammonium chloride. The results obtained agree with those obtained by the standard methods. This pyrolytic technique is found to be very convenient, rapid and accurate.