Early evidence of implementation of District Residency Programme: experiences and challenges of residents in Rajasthan, India.

BACKGROUND: District Residency Programme (DRP) was introduced by National Medical Commission as mandatory three-months training program for postgraduate residents. The program was for the first time implemented in April 2023 in Rajasthan. However, it ran into several teething problems, especially for residents. With a lack of any precedence, this study was planned to explore experiences and challenges of residents posted in DRP. METHODS: Cross-sectional study was conducted at 12 DRP sites attached to SMS Medical College, Jaipur between August-October 2023. A self-administered questionnaire was used to collect information from residents who had completed DRP. Questions were scored on a five-point Likert scale. Mann-Whitney U test and Kruskal-Wallis H test was used to show association. RESULTS: Only around 17% residents felt that the learning objectives of DRP were fulfilled and nearly 60% residents felt isolated from academic activities and parent department. Over half of the residents were never posted with their concerned specialty services. Around four-fifth residents felt concerned about safety at least sometimes and more than three-fourth residents were dissatisfied with basic amenities. Kruskal-Wallis and Mann-Whitney tests showed significant association of gender and specialisation strata with multiple outcome variables. CONCLUSION: The study finds high degree of dissatisfaction among residents towards learning objectives, academic learning, and basic amenities during DRP. There was also a clear lack of specialty-exposure and high concerns of safety, especially for female residents. The study findings should alarm and inform policymakers and administrators to improve DRP implementation so as to better achieve laid objectives.

Urinary Tract Infections in Patients Undergoing Invasive Urodynamic Study: A Prospective Observational Study at a Tertiary Care Centre in Eastern India.

OBJECTIVE: The aim of the study was to find the estimate of the prevalence of urinary tract infections following invasive urodynamic studies (UDS) in a hospital setup and to identify the risk factors related to it. METHOD: A total of 100 patients were enrolled in this prospective observational study after standard preoperative work, which included both urine analysis and culture procedure. The study was carried out from April 2022 to April 2023 at the Department of Urology, Indira Gandhi Institute of Medical Sciences, India. Three days following the UDS test, all the patients underwent repeat urine analysis and culture, besides screening for any lower urinary tract symptoms, abdominal pain, and fever. RESULT: Among all, 14 patients (i.e., 6.1% of 85 individuals) had significant bacteriuria, and six patients (4.7%) developed symptoms of UTI. However, a strong association was observed between the maximal detrusor pressure during voiding (Pdet at Q max) and post-void residue (PVR), which were >20 mL before UDS, along with positive urine cultures after UDS, which was significant at <0.05. CONCLUSION: The study demonstrated that the risk of UTIs with this diagnostic technique is minimal and that prophylactic antibiotic medication is not necessary prior to UDS in all patients.

A Randomized Controlled Trial Evaluating Postoperative Port Site Infections Among Patients Undergoing Laparoscopic Cholecystectomy Either via Umbilical or Epigastric Port.

BACKGROUND AND OBJECTIVES:  Laparoscopic cholecystectomy (LC) is a keyhole surgical procedure considered a gold standard treatment for benign gallbladder (GB) diseases. GB retrieval is done per the surgeon's choice through an umbilical or epigastric port. However, postoperative port site infection (PSI) and pain were major complications of this technique. The study aimed to compare the postoperative PSI between epigastric and umbilical ports among patients undergoing LC. METHODS:  A prospective randomized controlled trial was conducted among 50 patients who underwent LC for benign GB disease at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, for 6 months. Participants were randomized into epigastric port (n=25) and umbilical port (n=25). Postoperatively, PSI on a postoperative day (POD) of 10 and 30, retrieval difficulty score, Postoperative pain (POP) using a visual analog scale (VAS), and port site scar appearance after 6 months were assessed. RESULTS:  This study divided 50 LC patients into epigastric and umbilical ports (n=25). Among them, 31 were females (62%), 19 males (38%), and mean ages of 43.5 ± 10.7 and 40.7 ± 12.6 years were observed for the epigastric and umbilical ports; group age was similar (p=0.37). The gender distribution was similar between groups (p=0.9 for males, p=0.7 for females). The epigastric port displayed a mean body mass index (BMI) of 22.3 ± 1.01, while the umbilical port had a significantly higher mean BMI of 23.7 ± 1.10 (p=0.04). Patients with symptomatic cholelithiasis as the primary reason for surgery were common in both groups (p=0.2 for GB stones, p=0.4 for GB polyps). The mean hospital stays and surgical duration were similar (p=0.7 and 0.99). Epigastric ports had 8% postoperative PSI on POD 10 (vs. 12%, p=0.07) and 0% on POD 30 (vs. 4%, p=1.0), compared to umbilical ports. Umbilical port patients were more satisfied with scar appearance (92% vs. 76%, p=0.11) and less dissatisfied (8% vs. 24%, p=0.02) 6 months post-surgery. Compared to the umbilical port, patients with epigastric ports had significantly higher VAS pain scores at multiple postoperative time points (p-values <0.001 to 0.03). It was also harder to retrieve epigastric port GB (p=0.01). CONCLUSION:  The current study highlights the importance of port site selection among patients who underwent LC, as it can notably impact postoperative outcomes. While the umbilical port may be associated with lower PSI rates and better cosmetic outcomes, GB retrieval through the epigastric port may result in lower postoperative port site pain. Surgeons should carefully consider these factors when choosing the port site for LC procedures. Further research, including larger multicenter trials, is needed to validate and expand upon these results, ultimately enhancing patient care in GB surgery.

Missing Piece in Colloidal Stability─Morphological Factor of Hydrophobic Nanoparticles.

Hydrophobic nanoparticles (NPs) in water were considered unstable because they lack the repulsive electrostatic interaction and steric effect to prevent aggregation. In this study, porous hydrophobic NPs of two star-shaped giant molecules, POSS-(R)8, were found to be stable in water and able to retain their kinetic stability in a wide range of temperatures, pH values, and ionic strengths. Unlike the solid hydrophobic NPs that aggregate even with the negative zeta potential (ζ) induced by surface-structured hydrogen-bonded (SHB) water, the porous morphology of POSS-(R)8 NPs reduces the entropically driven hydrophobic effect to prevent aggregation. With the porous morphology, the hydrophobic NPs are stable without the hydrophilic or charged surface functional groups and demonstrate good encapsulation capability. The morphological factor of colloids is thus one of the missing pieces in the theory of colloidal stability that extends our understanding of colloidal science.

Angry email to Reviewer #2.

Thank you for submitting your review comments on my diligently drafted manuscript. I appreciate the opportunity to evaluate your review but unfortunately (highlighted so you get the gist of this email and don't jump for joy prematurely), your reviews seem to lack the optimism I was looking for.

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Density of Health Workforce Correlates to Disease Outcomes: Evidence From Global Data in Otolaryngology.

Objective: To better understand the impact of the otolaryngology-specific workforce on the burden of related diseases. Study Design: Retrospective analysis of existing workforce density data as compared with the incidence, mortality, and morbidity data for 4 otolaryngologic diseases. Setting: An overall 138 countries with known otolaryngology-head and neck surgery workforce and epidemiologic data. Methods: We obtained raw data on workforce estimates of ear, nose, and throat surgical specialists from the World Health Organization. Disease burdens for 4 conditions were estimated via 2 ratios, the mortality:incidence ratio (MIR) and YLD:incidence ratio (years lost to disability), as specified in the Global Burden of Disease database. These were correlated to country-specific otolaryngologist density data in univariate and multivariate analyses. Results: Increased density of the ear, nose, and throat workforce correlated with better outcomes for otolaryngologic-treated surgical diseases. A 10% increase in otolaryngology workforce density was associated with a 0.27% reduction in YLD:incidence ratio for chronic otitis media, a 0.94% reduction in MIR for lip and oral cavity cancer, a 1.46% reduction in MIR for laryngeal cancer, and a 1.34% reduction in MIR for pharyngeal cancer (all P < .001)-an effect that remained after adjustment for health systems factors for all conditions but chronic otitis media. Conclusion: The density of the surgical workforce is assumed to affect disease outcomes, but ours is the first analysis to show that increased workforce density for a specific surgical specialty correlates with improved disease outcomes. While there is a consensus to increase access to health care providers, quantifying the effect on disease outcomes is an important metric for those performing health economics modeling, particularly where resources are limited.

Water-Induced Self-Assembly of Amphiphilic Discotic Molecules for Adaptive Artificial Water Channels.

Inspired by the induced-fit mechanism in nature, we developed the process of water-induced self-assembly (WISA) to make water an active substrate that regulates the self-assembly and function of amphiphilic discotic molecules (ADMs). The ADM is an isotropic liquid that self-assembles only when in contact with water. Characterization results indicate that water fits into the hydrophilic core of the ADMs and induces the formation of a hexagonal columnar phase (Colh), where each column contains a hydrated artificial water channel (AWC). The hydrated AWCs are adaptive rather than static; the dynamic incorporation/removal of water results in the reversible assembly/disassembly of the adaptive AWCs (aAWCs). Furthermore, its dynamic characteristics can enable water to act as an orientation-directional guest molecule that controls the growth direction of the aAWCs. Well-aligned aAWC arrays that showed the ability of water transport were obtained via a "directional WISA" method. In WISA, water thus governs the supramolecular chemistry and function of synthetic molecules as it does with natural materials. By making water an active component in adaptive chemistry and enabling host molecules to dynamically interact with water, this adaptive aquatic material may motivate the development of synthetic molecules further toward biomaterials.

Synthesis, structural, thermal, photophysical and vibrational spectroscopic studies of potassium-polynitrile based 3D coordination polymer.

Among various interactions (such as H-bonding, π - π stacking interaction) which are responsible for the fascinating metallo-architectures, cation - π interaction has emerged as a significantly important force. Moreover, it has now been observed that this interaction is found to be presented ubiquitous across several fields of contemporary interest, such as chemistry, material science, and biology. In this work, we have focused on the design and synthesis of a pentacyano organic anion and potassium cation based 3D coordination polymer (5CNP). The single-crystal XRD structure revealed fascinating structural arrangements due to the existence of several intra and interionic interaction. To the best of our knowledge, such polycyano aromatic system based 3D coordination polymer is not reported. In addition to single crystal X-ray diffraction (SCXRD), we have employed confocal Raman microscopic techniques to understand the structural aspects, particularly the pentacyano functional groups which are Raman active. Considering the prospect of 5CNP as a material, thermal stability, and structyral properties have been studied, in addition to detailed photophysical aspects. The photophysical responses in solid and in solution have been studied by steady and time-resolved fluorescence spectroscopy. Interesting photophysical observation is noted when studied in a binary mixture of THF-toluene. Scanning electron microscopy (SEM) studies have also been done for comprehensive understanding. In the end, cytotoxicity studies have been undertaken to evaluate the toxicity of 5CNP in our cells.

Vesicular Membrane with Structured Interstitial Water.

Self-assembled vesicles with structured (tetrahedral order with strong hydrogen bonds) interstitial water are reported. The vesicles, known as MCsome, are assembled from metal carbonyl compounds, FpR (Fp = (Cp)Fe(PPh3)(CO)(CO-), Cp = cyclopentadiene, R = C3Bithiophene, C6Pyrene or C6) with the Fp heads exposed to water. The R groups are surrounded by the interstitial water with the hydrogen bonding strength variable depending on the hydrophobicity of R groups. The structure of the interstitial water is responsible for the integrity of the membrane and swelling behavior of the vesicles. This constructional role of water opens new concepts for the creation of aqueous assemblies with water-mediated functions.

Linear, mixed-valent homocatenated tri-tin complexes featuring Sn-Sn bonds.

A series of tri-tin complexes (LPhSn)3X with triple-decker structures (LPh = 2,5-di(o-pyridyl)-3,4-diphenylpyrrolate; X = Cl, AlCl4, OTf, and PF6) was synthesized by reducing LPhSnCl with LiBsBu3H and subsequent reactions. Structural characterization of (LPhSn)3Cl revealed a Sn-Sn-Sn core, and DFT calculations suggest that its HOMO is primarily σ-bonding along the tri-tin framework. (LPhSn)3Cl reacts with W(CO)5THF to afford (LPhSn)2(W(CO)5)2 and LPhSnCl, implying that (LPhSn)3Cl may exhibit dynamic behavior in solution.

Global cardiovascular care: an overview of high-level political commitment.

BACKGROUND: Six billion people worldwide lack access to safe, timely, and affordable cardiac surgical and interventional care when needed. Cardiovascular diseases are the leading cause of mortality and morbidity around the world, and include a significant surgical backlog of rheumatic and congenital heart diseases. Here, we review the political commitment by the WHO, the UN, and the World Bank to build and strengthen healthcare services for cardiovascular diseases, with a particular focus on cardiac surgical and interventional cardiology services around the world. METHODS: A literature search was performed in the WHO, UN, and World Bank Governing Body databases to identify policy documents mentioning curative cardiovascular disease care. The Governing Body documentation, the Institutional Repository for Information Sharing database of the WHO, and the Official Document System of the UN were used. Documents only discussing prevention of cardiovascular diseases were excluded. RESULTS: Fifty-nine unique documents were identified, including 56 from the WHO, 3 from the World Bank, and none from the UN; 12 (20.4%) documents mentioned cardiac surgery, and 6 (10.2%) contained some actionable language to incorporate cardiac surgical services, but none was explicitly dedicated to cardiac surgical services. CONCLUSION: Although growing, high-level political commitment for curative cardiovascular health services remains minimal. Increased awareness is needed to develop comprehensive cardiovascular care that is necessary to mitigate the increasing burden of premature morbidity and mortality from cardiac disease, and to work towards the Sustainable Development Goals and Universal Health Coverage.

Polarizability tensor invariants of H2, HD, and D2.

We report an exhaustive compilation of wavelength-dependent matrix elements over the mean polarizability (α¯) and polarizability anisotropy (γ) operators for the rovibrational states of the H2, HD, and D2 molecules together with an accompanying computer program for their evaluation. The matrix elements can be readily evaluated using the provided codes for rovibrational states with J = 0-15 and v = 0-4 and for any laser wavelengths in the interval 182.25-1320.6 nm corresponding to popular, commercially available lasers. The presented results substantially extend the scope of the data available in the literature, both in respect of the rovibrational transitions analyzed and the range of covered laser frequencies. The presented detailed tabulation of accurate polarizability tensor invariants is essential for successful realization of our main long-term goal: developing a universal standard for determining absolute Raman cross sections and absolute Raman intensities in experimental Rayleigh and Raman scattering studies of molecules.

Non-equilibrium electrokinetic micro/nano fluidic mixer.

We propose a new type of micro/nano fluidic mixer based on non-equilibrium electrokinetics and demonstrate its mixing performance. We fabricate the device with two-step reactive ion etching, one for nanochannels and one for microchannels. Mixing is achieved by strong vortex structures formed near the micro/nano channel interface. We expect the proposed device to be beneficial in the development of micro total analysis systems, since it is simple in its design with minimal fabrication complications.