Need for operational simplicity and timely disbursal of benefits-a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India.

BACKGROUND: Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme. METHODS: We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation. RESULTS: Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization. CONCLUSION: The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably.

Effectiveness of Tai Chi for Health Promotion of Older Adults: A Scoping Review of Meta-Analyses.

Background. Tai Chi is a form of exercise that is accessible to people from different socioeconomic backgrounds, making it a potentially valuable activity for health promotion of older adults. Purpose. The objective of this scoping review was to summarize the current knowledge about the effectiveness of Tai Chi for older adults across a range of general health outcomes from published, peer reviewed, unique meta-analyses. Methods. Meta-analyses were retrieved from Medline, Embase, AMED, CINAHL, SPORTDiscus, PsychINFO, Web of Science, PubMed Health, and the Cochrane Library from database inception to late August 2019. Multistage deduplication and screening processes identified eligible full-length meta-analyses. Two people independently appraised 27 meta-analyses based on the GRADE system and organized results into 3 appendices subsequently collated into heterogeneous, statistically significant, and statistically insignificant tables. Results. "High" and "moderate" quality evidence extracted from these meta-analyses demonstrated that practicing Tai Chi can significantly improve balance, cardiorespiratory fitness, cognition, mobility, proprioception, sleep, and strength; reduce the incidence of falls and nonfatal stroke; and decrease stroke risk factors. Conclusions. Health care providers can now recommend Tai Chi with high level of certainty for health promotion of older adults across a range of general health outcomes for improvement of overall well-being.

Correction: A photocatalytic chip inspired from the photovoltaics of polymer-immobilized surfaces: self-assembly and other factors.

Correction for 'A photocatalytic chip inspired from the photovoltaics of polymer-immobilized surfaces: self-assembly and other factors' by Periyamuthu Ramar et al., Chem. Commun., 2021, 57, 12964-12967, https://doi.org/10.1039/D1CC04381A.

Impact of an Antimicrobial Stewardship Intervention on Usage of Antibiotics in Coronavirus Disease-2019 at a Tertiary Care Teaching Hospital in India.

Background: There was evidence that antibiotic usage increased in hospitalized COVID-19 patients during the early days of the pandemic. Objective: We assessed the impact of stewardship interventions on antibiotic usage in these patients. Methods: We designed a quasi-experimental study using an interrupted time series. Patients were stratified according to the severity category of the illness - mild and moderate-to-severe (O2 saturation ≥94% and <93% respectively). Baseline antibiotic usage data was collected in the pre-intervention phase. Intervention was given in the form of focus group discussion (FGD) and followed up with feedback-audit during the post-intervention phase. Primary outcome was the change in days of therapy (DOT) per 1000 patient-days. Results: 361 adult patients were recruited in both phases during July to December, 2020. In the post-intervention phase, DOT per 1000 patient-days reduced from 589 to 523 (P=0.013) and from 843 to 585 (P <0.0001) in mild and moderate-to-severe categories, respectively. De-escalations at 48 hours increased significantly from 21% to 41% (P=0.0079) and from 31% to 62% (P=0.0006), respectively. No difference in mortality was observed. Conclusion: We found high usage of empirical antibiotics in adult patients hospitalized with COVID-19. FGD and feedback audits can successfully reduce antibiotic overuse in these patients.

Drug Repositioning: A Unique Approach to Refurbish Drug Discovery.

For a decade, it has been observed that there is a remarkable decrease in the quantum of novel clinically approved drugs, in spite of modernization in the research and development process. We have highlighted repositioning of drugs as a methodology that has found new therapeutic implications for clinically approved drugs but with different indications. This can be considered as an upbringing strategy to deliver timely and cost-effective solutions, which still need exploration for getting over the shortage of novel drugs reaching the market. This review focuses on an activity-based drug repositioning approach, which is used to explore new uses of known drugs that are already approved for specific indications and are now being used for other indications on the basis that a single drug interacts with multiple targets. It also includes current research trends related to drug repositioning, which depends on strong knowledge of medicinal chemistry and involves elucidation of mechanisms of action and validation of novel targets. The review highlights the importance of computational tools and databases of various forms for drug repositioning purposes, which have enhanced the ability to pose reasonable and testable hypotheses. The critical nature of this aspect is obvious in cases where data gathered from in vitro, or animal models do not confirm in subsequent clinical trials. Hence, considering the positive outcomes of drug repositioning, it can be surmised that this approach can serve as a promising one that can develop into a robust drug discovery strategy.

A photocatalytic chip inspired from the photovoltaics of polymer-immobilized surfaces: self-assembly and other factors.

Polymers and carbon nanomaterials for bulk heterojunction photovoltaic devices have been used to develop an efficient reusable photocatalytic chip. Interestingly, it is highly effective when the materials are self-assembled in a particular pattern at a particular concentration ratio (Movies in the ESI).

Iron Mineralizing Bacterioferritin A from Mycobacterium tuberculosis Exhibits Unique Catalase-Dps-like Dual Activities.

Mycobacterium tuberculosis ( Mtb) expresses heme binding protein nanocages, bacterioferritin A (BfrA), along with nonheme bacterioferritin B (BfrB). BfrA is unique to bacteria and, like BfrB, carries out ferroxidase activity to synthesize iron oxide biominerals. The expression of BfrA, in the presence of BfrB, indicates that Mtb may utilize it for some additional purpose apart from its natural iron storage activity. However, the mechanism of ferroxidase activity (iron biomineralization) in Mtb BfrA still remains unexplored. H2O2 is secreted by the host during host-pathogen interaction. In some bacteria, heme containing Bfr and/or Dps (DNA binding protein during starvation) detoxify H2O2 by utilizing it during their ferroxidase activity. Interestingly, Mtb lacks the gene for Dps which protects DNA from H2O2-induced oxidative cleavage. Therefore, the current work investigates the kinetics of O2/H2O2-dependent ferroxidase activity, DNA protection, and catalase-like activity of recombinant Mtb BfrA. Ferroxidase activity by Mtb BfrA was found to proceed via the formation of a transient intermediate and its initial rate exhibited sigmoidal behavior, with increasing Fe2+ concentration. Moreover, Mtb BfrA exhibited catalase-like activity by evolving O2 upon reaction with H2O2, which gets inhibited in the presence of catalase inhibitors (NaN3 and NaCN). In addition, Mtb BfrA protected plasmid DNA from Fenton reagents (Fe2+ and H2O2), similar to Dps, by forming BfrA-DNA complexes. Thereby, Mtb BfrA executes multiple functions (ferroxidase, catalase, and Dps-like activities) in order to cope with the host generated oxidative stress and to promote pathogenesis.

Dental Caries Experience, Dental Anomalies, and Morphometric Analysis of Canine among Monozygotic and Dizygotic Twins.

BACKGROUND: The study of twins is a well-known and a unique method that is used to investigate the genetic contributions to physical features and diseases in human. AIM: To estimate the relative contributions of genetic and environmental influence to observed variations in different dental features or traits. METHODOLOGY: Thirty twins in the age group of 15-30 years were selected for the study, and the dental caries experience scores, dental anomalies, and morphometric analysis of monozygotic (MZ) and dizygotic (DZ) twins were compared. RESULTS: MZ twins unlike DZ twins showed within-pair resemblance in decayed, decayed missing and filled teeth (DMFT), and molar relation. No morphometric analysis parameters and dental anomalies had significant mean difference between the groups. Decay, filling, DMFT, spacing, mandibular irregularity, open bite, and mesiodistal width of the right and left canine showed a higher positive correlation in MZ than DZ twins. Heritability estimate was low for morphometric analysis parameters. There is genetic dominance in decay, DMFT, spacing, molar relation, and diastema. Pearson's correlation revealed a positive and statistically significant correlation among all morphometric analysis parameters for MZ twins, but not DZ twins. Dental caries has a higher concordance rate (87.5%), correlation (71.6%), and heritability (87.8%). CONCLUSION: Most of the dental parameters are significantly heritable with up to 85% of the variance attributable to genetic factors. Environmental factors play a major role in developing malocclusion and causing dental caries. Morphology of canines can be used as a supplementary tool to determine zygosity.

Screening Mammography: A Pilot Study on Its Pertinence in Indian Population by Means of a Camp.

INTRODUCTION: Breast cancer incidence and related mortality is increasing in Indian women. Indian ladies hesitate to seek medical care for breast related issues. Screening mammography, proved to effectively reduce mortality, has been deemed not feasible in Indian context due to cost considerations. The suggested alternatives have not been proven to improve mortality rates. AIM: To find the relevance of screening mammography camp among Indian women. MATERIALS AND METHODS: A week long screening mammography camp was organized in a tertiary care hospital. Clinical examination was done followed by bilateral mammography. Mammograms were reported as per American College of Radiology-Breast Imaging Reporting and Data Systems (ACR-BIRADS) 5th edition specifications. Lesions deemed BIRADS 4 and 5 were biopsied. BIRADS 3 category findings were suggested short interval follow up. RESULTS: A total of 118 women, ranging from 35 to 64 years of age with mean age of 49.6 years underwent mammography. Thirty ladies with dense breast compositions further underwent sono-mammography. Six (5.1%) new cases of breast carcinomas were detected during this study and 28 (23.7%) cases with probably benign findings were advised short interval follow up. CONCLUSION: Mammography, being a proven screening modality effective in reducing mortality, needs incorporation into the nationwide program for breast cancer detection, inspite of financial considerations. Organizing mammography camps will help create awareness and encourage public to utilize services.

Quantitative analysis of chaperone network throughput in budding yeast.

The network of molecular chaperones mediates the folding and translocation of the many proteins encoded in the genome of eukaryotic organisms, as well as a response to stress. It has been particularly well characterised in the budding yeast, Saccharomyces cerevisiae, where 63 known chaperones have been annotated and recent affinity purification and MS/MS experiments have helped characterise the attendant network of chaperone targets to a high degree. In this study, we apply our QconCAT methodology to directly quantify the set of yeast chaperones in absolute terms (copies per cell) via SRM MS. Firstly, we compare these to existing quantitative estimates of these yeast proteins, highlighting differences between approaches. Secondly, we cast the results into the context of the chaperone target network and show a distinct relationship between abundance of individual chaperones and their targets. This allows us to characterise the 'throughput' of protein molecules passing through individual chaperones and their groups on a proteome-wide scale in an unstressed model eukaryote for the first time. The results demonstrate specialisations of the chaperone classes, which display different overall workloads, efficiencies and preference for the sub-cellular localisation of their targets. The novel integration of the interactome data with quantification supports re-estimates of the level of protein throughout going through molecular chaperones. Additionally, although chaperones target fewer than 40% of annotated proteins we show that they mediate the folding of the majority of protein molecules (∼62% of the total protein flux in the cell), highlighting their importance.