Exploring Knowledge of Cognitive Disposition to Respond in Clinical Decision-Making among Early Clinical Learners.

Introduction: Background: Errors in clinical medicine are a constant occurrence leading to litigations. Cognitive disposition to respond (CDR) was considered the underlying cause of errors in the decision-making process. The rapid thinking system used by early clinical learners leads to cognitive errors. The scenario gets compounded by a limited awareness and lack of exposure to cognitive dispositions to respond (CDRs) in the formal medical graduate curriculum. Variation in the frequency of occurrence in a real-life context, contradictory claims over the influence of clinical expertise, specialty, and methods of teaching about cognitive biases led to this exploratory study among early clinical learners. Methods:In the present research, subjects' recruitment was based on voluntary participation of medical graduates, interns, and residents, who were assigned to equal groups of 30. All study groups were first exposed to six commonly occurring CDRs as role-play-based videos, followed by a case scenario-based exposure to 13 uncommon CDRs in the clinical setting. Participants were then asked to reflect on the experience. Data was analyzed by descriptive and thematic analysis. Results:Among the 19 tested biases, 75.6% of participants identified Hindsight bias. The sunk cost was found out by 34.4% of participants only. Information processing bias was identified more frequently than psychological processing bias. Intergroup variability showed that residents were not identifying biases as frequently as medical graduates and interns. The role play video with reflective writing was voiced as the suitable training method for cognitive bias. Conclusion:The study concludes that medical graduates must be sensitized to CDRs using role-play-based reflection methods.

Vaccination and associated factors among tribal children of 1 year age in nine Indian districts: A cross-sectional study.

OBJECTIVE: To report on vaccination status by 12 months of age among tribal children from nine districts of India. METHODS: Cross-sectional study of 2631 tribal women having a child aged 12 months or below from nine Indian districts with a considerable proportion of the tribal population. Socio-demographic details, reception of various vaccines by 12 months of age, mother's antenatal care utilisation and health system-related details were collected through a pre-tested, interviewer-administered questionnaire from mothers. Multiple logistic regression analysis was used to identify the factors associated with complete vaccination by 12 months of age. RESULTS: Only 52% of children were fully vaccinated by the age of 12 months among the tribal populations; 11% did not receive any vaccine, and 37% of the tribal children received some vaccines. The age-appropriate vaccination was unsatisfactory as only 75% of the infants received all birth dose vaccines, and only 60.5% received all doses by 14 weeks. Only 73% were vaccinated against measles. Illness of the child, home births and communication gaps concerning vaccination were the main reasons for an infant not being vaccinated appropriately. Frequency of health worker's visits to the village, hospital birth, reception of advice on vaccination and educational status of the head of the households were significantly associated with full vaccination status. CONCLUSION: A relatively low proportion of children were fully vaccinated among the tribal populations. Health systems factors, mainly the outreach services and advice by the health workers, were positively and significantly associated with a child being fully vaccinated by 12 months of age. Improving outreach services is crucial to improve vaccination coverage in tribal areas, and there is a need to address the social determinants in the long run.

Role of dietary habits and personal hygiene on nutritional status of school-going adolescents: A cross-sectional study in selected schools located in slum areas of Nagpur City, Maharashtra.

Purpose: Adolescence is a nutritionally vulnerable time when rapid physical growth increases nutrient demand. Addressing the nutrition needs of adolescents could be an important step toward breaking the vicious cycle of intergenerational malnutrition. Under the healthy school initiative, a baseline assessment was carried out to assess the nutritional status, dietary habits, and personal hygiene of school-going adolescents to plan the future interventions at school level. Materials and Methods: A cross-sectional study was conducted in two government-aided schools for 6 months among 814 students of Class VI-IX to assess their dietary habits and personal hygiene by using the GSHS( Global School based student Health Survey) -2007(Indian version) tool. Anthropometric measurement was taken by standard technique. Results: The study found the proportion of thinness, stunting, and overweight/obesity as 40%, 20%, and 4.2%, respectively. Male students were found more thin (61.1% vs. 38.8%) and stunted (55.6% vs. 44.4%) as compared to female students. Less than one-fourth (13.7%) of the students reported <5 servings of fruits and vegetables. In multivariable analysis, male students, children of homemaker mother, skipping breakfast on all days of week, consumption of fast food ≥3 times/week, consumption of high sugary ready to use food, and infrequent handwashing after toilet were found to be predictors of thinness. Conclusion: Dietary habits and personnel hygiene were found to be important factors of undernutrition; promoting health behavior through school health policy with involvement of teachers, students, and parents is highly recommended to reduce the problem of undernutrition among adolescents.

Résumé Objectif: L'adolescence est une période de vulnérabilité nutritionnelle pendant laquelle une croissance physique rapide augmente la demande en nutriments. Répondre aux besoins nutritionnels des adolescents pourrait constituer une étape importante vers la rupture du cercle vicieux de la malnutrition intergénérationnelle. Dans le cadre de l'initiative pour une école saine, une évaluation de base a été réalisée pour évaluer l'état nutritionnel, les habitudes alimentaires et l'hygiène personnelle des adolescents scolarisés afin de planifier les futures interventions au niveau de l'école. Matériels et Méthodes: Une étude transversale a été menée dans deux écoles subventionnées par le gouvernement pendant 6 mois auprès de 814 élèves des classes VI à IX pour évaluer leurs habitudes alimentaires et leur hygiène personnelle à l'aide du GSHS (Enquête mondiale sur la santé des élèves en milieu scolaire) -2007 (version indienne) outil. La mesure anthropométrique a été prise par la technique standard. Résultats: L'étude a révélé que la proportion de maigreur, de retard de croissance et de surpoids/obésité était de 40 %, 20 % et 4,2 %, respectivement. Les étudiants de sexe masculin se sont révélés plus minces (61,1 % contre 38,8 %) et rabougris (55,6 % contre 44,4 %) que les étudiantes. Moins d'un quart (13,7 %) des élèves ont déclaré <5 portions de fruits et légumes. Dans une analyse multivariée, les étudiants de sexe masculin, les enfants d'une mère au foyer, le fait de sauter le petit-déjeuner tous les jours de la semaine, la consommation de restauration rapide ≥ 3 fois/semaine, la consommation d'aliments prêts à l'emploi riches en sucre et le lavage peu fréquent des mains après la toilette se sont révélés être des prédicteurs de minceur. Conclusion : Les habitudes alimentaires et l'hygiène du personnel se sont révélées être des facteurs importants de dénutrition ; la promotion de comportements sains par le biais d'une politique de santé scolaire avec la participation des enseignants, des élèves et des parents est fortement recommandée pour réduire le problème de la dénutrition chez les adolescents Mots-clés: Adolescent, habitudes alimentaires, hygiène personnelle, dénutrition.

Wafer scale manufacturing of high precision micro-optical components through X-ray lithography yielding 1800 Gray Levels in a fingertip sized chip.

We present a novel x-ray lithography based micromanufacturing methodology that offers scalable manufacturing of high precision optical components. It is accomplished through simultaneous usage of multiple stencil masks made moveable with respect to one another through custom made micromotion stages. The range of spectral flux reaching the sample surface at the LiMiNT micro/nanomanufacturing facility of Singapore Synchrotron Light Source (SSLS) is about 2 keV to 10 keV, offering substantial photon energy to carry out deep x-ray lithography. In this energy range, x-rays penetrate through resist materials with only little scattering. The highly collimated rectangular beam architecture of the x-ray source enables a full 4″ wafer scale fabrication. Precise control of dose deposited offers determined chain scission in the polymer to required depth enabling 1800 discrete gray levels in a chip of area 20 mm2 and with more than 2000 within our reach. Due to its parallel processing capability, our methodology serves as a promising candidate to fabricate micro/nano components of optical quality on a large scale to cater for industrial requirements. Usage of these fine components in analytical devices such as spectrometers and multispectral imagers transforms their architecture and shrinks their size to pocket dimension. It also reduces their complexity and increases affordability while also expanding their application areas. Consequently, equipment based on these devices is made available and affordable for consumers and businesses expanding the horizon of analytical applications. Mass manufacturing is especially vital when these devices are to be sold in large quantities especially as components for original equipment manufacturers (OEM), which has also been demonstrated through our work. Furthermore, we also substantially improve the quality of the micro-components fabricated, 3D architecture generated, throughput, capability and availability for industrial application. Manufacturing 1800 Gray levels or more through other competing techniques is either limited due to multiple process steps involved or due to unacceptably long time required owing to their pencil beam architecture. Our manufacturing technique presented here overcomes both these shortcomings in terms of the maximum number of gray levels that can be generated, and the time required to generate the same.

Social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic: A cross-sectional study from central India.

Background: In the present COVID-19 pandemic, social distancing measures have been advised to protect elderly from infection which might have led to poor mental health state. Objective: A cross-sectional study was carried out to assess the magnitude of social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic in Central India. Methods: The estimated sample size was 1535. The sample was equally distributed among rural, semiurban, and urban strata of districts. Social isolation was measured using Lubben's Social Network Scale-Revised, and psychological distress was assessed using Kessler K10 Psychological Distress Scale. Other parameters such as a history of COVID-19 illness and COVID-19 vaccination were assessed. Results: The prevalence of social isolation was higher at 23.6% during the COVID-19 pandemic compared to before the pandemic period (15.0%). The majority perceived a high level of social support during the pandemic (55.3%) and 39.9% received moderate support. Overall, 18.4% of the respondents had psychological distress. Out of them, 56.2% had mild distress, 20.1% had moderate distress, and 23.7% had severe distress. Significant predictors of psychological distress were female gender, lower socioeconomic status, history of COVID-19 disease among the participants, social isolation, and lack of social support. Conclusion: Social isolation and lack of social support were significant predictors of psychological distress among the elderly during the pandemic.

A wireless and battery-free wound infection sensor based on DNA hydrogel.

The confluence of wireless technology and biosensors offers the possibility to detect and manage medical conditions outside of clinical settings. Wound infections represent a major clinical challenge in which timely detection is critical for effective interventions, but this is currently hindered by the lack of a monitoring technology that can interface with wounds, detect pathogenic bacteria, and wirelessly transmit data. Here, we report a flexible, wireless, and battery-free sensor that provides smartphone-based detection of wound infection using a bacteria-responsive DNA hydrogel. The engineered DNA hydrogels respond selectively to deoxyribonucleases associated with pathogenic bacteria through tunable dielectric changes, which can be wirelessly detected using near-field communication. In a mouse acute wound model, we demonstrate that the wireless sensor can detect physiologically relevant amounts of Staphylococcus aureus even before visible manifestation of infection. These results demonstrate strategies for continuous infection monitoring, which may facilitate improved management of surgical or chronic wounds.

Beyond 'cure' and 'treatment success': quality of life of patients with multidrug-resistant tuberculosis.

SETTING: Two drug-resistant tuberculosis (DR-TB) sites (MSF Clinic, Jupiter Hospital) in Mumbai, India. OBJECTIVE: To assess health-related quality of life (HRQoL) and associated factors among DR-TB patients and explore their perspectives about HRQoL. DESIGN: We used a mixed-methods design: a quantitative cross-sectional questionnaire (the World Health Organization's Quality of Life Brief Questionnaire [WHOQoL-BREF]); and qualitative in-depth interviews for purposively selected patients. Assessments were conducted between April and November 2016. RESULTS: Ninety-five patients completed WHOQoL-BREF; 12 were interviewed. The psychological and physical health domains were the most affected (mean scores 56.2 ± standard deviation [SD] 18.3, and 56.5 ± SD 15.1, respectively; maximum 100). The social relations and environmental domains mean scores were respectively 68.6 (SD ±21.1) and 60.3 (SD ±15.9). Loss of jobs due to TB adversely affected the social relations and environmental domains. Qualitative analysis showed that support was the most important theme affecting quality of life. Other themes were physical factors (e.g., treatment adverse events), psychological factors (e.g., depression), social functioning (e.g., fear of stigmatisation) and environmental factors (e.g., health systems). CONCLUSION: HRQoL was lower among study participants, but not as low as previously reported among TB patients. Support was the main factor that positively affected HRQoL, although both disease and treatment were physically and socially challenging.

Is rule of halves still an occurrence in South India: Findings from community-based survey in a selected urban area of Puducherry.

BACKGROUND: The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening. METHODOLOGY: We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014-15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg. RESULTS: Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%-35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%-16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension. CONCLUSION: In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.

Is it possible to find presence of lactose in pharmaceuticals? - Preliminary studies by ATR-FTIR spectroscopy and chemometrics.

Lactose and saccharose have the same molecular formula; however, the arrangement of their atoms is different. A major difference between lactose and saccharose with regard to digestion and processing is that it is not uncommon for individuals to be lactose intolerant (around two thirds of the population has a limited ability to digest lactose after infancy), but it is rather unlikely to be saccharose intolerant. The pharmaceutical industry uses lactose and saccharose as inactive ingredients of drugs to help form tablets because of their excellent compressibility properties. Some patients with severe lactose intolerance may experience symptoms of many allergic reactions after taking medicine that contains this substance. People who are specifically "allergic" to lactose (not just lactose intolerant) should not use tablets containing this ingredient. Fourier Transform Infrared (FTIR) spectroscopy has a unique chemical fingerprinting capability and plays a significant important role in the identification and characterization of analyzed samples and hence has been widely used in pharmaceutical science. However, a typical FTIR spectrum collected from tablets contains a myriad of valuable information hidden in a family of tiny peaks. Powerful multivariate spectral data processing can transform FTIR spectroscopy into an ideal tool for high volume, rapid screening and characterization of even minor tablet components. In this paper a method for distinction between FTIR spectra collected for tablets with or without lactose is presented. The results seem to indicate that the success of identifying one component in FTIR spectra collected for pharmaceutical composition (that is tablet) is largely dependent on the choice of the chemometric technique applied.

Prevalence of under-nutrition, associated factors and perceived nutritional status among elderly in a rural area of Puducherry, South India.

BACKGROUND: Under-nutrition among elderly goes undetected, despite their nature of vulnerability to it. Majority of the available literature assessed under nutrition in the facility based settings. We aimed to determine the prevalence of under-nutrition and its associated factors among elderly, in a rural setting. METHODS: A community based cross sectional survey was conducted among elderly in one of the randomly selected sub centre catchment area in rural Puducherry, south India. Information on socio demographic characteristics, morbidities and perception on their nutritional status were obtained. Anthropometric measures such as weight and arm span were measured by trained medical graduate as per the standard guidelines. Bodymass index (BMI) less than 18.5kg/m(2) was considered as under-nutrition. RESULTS: Of total 296 elderly in the study setting, 271 (92%) participated in the study. The prevalence of under nutrition among the elderly was 24.8% (95% CI: 19.7-30.3). More than half of the elderly (58.7%) perceived their nutritional status as poor; of them 28.9% were actually under-nourished. Mean (SD) BMI scores were higher for elderly women compared to that of men [elderly women vs men: 22 (4.6)kg/m(2) vs 21 (3.8)kg/m(2), p=0.03]. In multivariate analysis, being an elderly male, age more than 70 years and per capita income less than 1000 INR were found to be significantly associated with under-nutrition. CONCLUSION: In this rural area, one fourth of elderly were under nourished. Urgent inter-sectoral measures including food security programs are required to address this huge nutritional problem in this vulnerable group.

Development and implementation of healthy workplace model in a selected industry of Puducherry, South India.

BACKGROUND: The workplace is increasingly being used as a setting for health promotion and preventive health activities; not only to prevent occupational injury, but to assess and improve people's overall health. OBJECTIVE: This study aims at developing and implementing a healthy workplace model in a software industry of Puducherry. METHODS: Operations research was carried out in a purposively selected industry in Puducherry. The study was planned in four phases-baseline assessment and risk profiling, intervention, final evaluation and dissemination of results. Baseline evaluation of employees (n = 907) was done by a self-administered questionnaire to collect sociodemographic variables and risk factor profile using noncommunicable diseases (NCDs) LITE Proforma. RESULTS: Healthy workplace committee comprising of several stakeholders was formed, and a formal launch of the health awareness campaign was organized. Broad themes for health education sessions and support activities were identified. Risk profiling of employees showed high levels of risk factors and morbidity-more than 15% were found to be hypertensive and around 55% were obese. Stress and back ache were reported by almost half of the respondents. Modifications in the workplace targeting physical and psychosocial work environment were suggested to the committee, as part of the initiative. This study has demonstrated the feasibility of developing and implementing a healthy workplace model in South India. This model can be replicated or adapted in other industries for health promotion and prevention of NCDs. CONCLUSION: Dedicated and concerted efforts of the management consistent with the requirements of safety, health and environment at work place with appropriate support from the health system can improve the quality of work and working life.

Development and use of retinal pigmented epithelial cell line from zebrafish (Danio rerio) for evaluating the toxicity of ultraviolet-B.

Danio rerio retinal pigmented epithelial (DrRPE) cell line, derived from the RPE tissue, was established and characterized. The cells were able to grow at a wide range of temperatures from 25°C to 32°C in Leibovitz's L-15 medium. The DrRPE cell line consists of epithelial cells with a diameter of 15-19 µm. The cell line was characterized by mitochondrial 12S rRNA gene, immunocytochemical analysis, and karyotyping. DrRPE cells treated with 10 µM of all-trans-retinol for 24 h readily formed lipid droplets. DrRPE cells were irradiated with narrowband ultraviolet-B (UV-B) radiation at different time periods of 0, 10, 20, and 40 min. The cells were subsequently examined for changes in morphology, cell viability, phagocytotic activity, mitochondrial distribution, nuclei morphology, generation of reactive oxygen species, and expression of apoptotic-related genes p53 and Cas3 by quantitative polymerase chain reaction. The results demonstrate that UV-B radiation can cause a considerable decrease in DrRPE cell viability as well as in phagocytotic activity. In addition, the results demonstrate that UV-B radiation can induce the degradation of mitochondria and DNA in cultured DrRPE cells.

Adriamycin induced spermatogenesis defect is due to the reduction in epididymal adipose tissue mass: a possible hypothesis.

Adriamycin is an anthracycline antibiotic used as anticancer drug since past few decades. Though effective against cancer, it is cardiotoxic, nephrotoxic, hepatotoxic and also toxic for reproductive system. Although a number of potential toxic mechanisms have been identified following exposure to adriamycin, the major pathogenic mechanism appears to be the generation of toxic reactive oxygen species (ROS). Animals treated with adriamycin have shown a decrease in total sperm count. This implies that adriamycin impairs the process of spermatogenesis. Epididymal white adipose tissue (EWAT) is necessary for normal spermatogenesis, and decrease in the EWAT causes disturbance in spermatogenesis. Factor X is an unknown molecule synthesized by EWAT that plays crucial role in spermatogenesis. Adriamycin inhibits Kruppel-like factor 4 (KLF-4) and thus downregulates the adipogenesis process needed to maintain the EWAT mass. Apart form adipocytes, KLF-4 and peroxisome proliferator-activated receptor gamma (PPAR-γ) are also found in spermatogonium and testis, implying its vital role in spermatogenesis. Adriamycin treatment inhibits KLF-4 and thus PPAR-γ in EWAT and spermatogonium. Reduction of EWAT might cause a decrease in Factor X level. Declining of Factor X level, KLF-4 and PPAR-γ together will lead to disturbance in spermatogenesis process.

Spermidine may decrease ER stress in pancreatic beta cells and may reduce apoptosis via activating AMPK dependent autophagy pathway.

The risk for diabetes increases with increasing BMI<25. Insulin resistance is the key factor for type 2 diabetes; studies revealed that endoplasmic reticulum stress is the main factor behind this disease. With increase in ER stress, pancreatic beta cells start to undergo apoptosis, leading to a decline in the pancreatic beta cell population. The ER stress arises due to unfolded protein response. Recently, spermidine get importance for increasing the longevity in most of the eukaryotes including yeast, Caenorhabditis elegans, Drosophila and human peripheral blood mononuclear cells via induction of autophagy pathway. Autophagy is also involved in regulation of scavenging of proteins. One of the major cellular pathways for scavenging the aggregated intracellular protein is autophagy. Hence spermidine can be a candidate for the treatment type 2 diabetes. Autophagy genes are regulated by mTOR (mammalian Target Of Rapamycin) dependent or independent pathway via AMPK. Hence either inhibition of mTOR or activation of AMPK by spermidine will play two crucial roles, first being the activation of autophagy and secondly the reduction of endoplasmic reticulum stress which will reduce beta cell death by apoptosis and thus can be a novel therapeutic candidate in the treatment of insulin resistance in type 2 diabetes and preserving pancreatic beta cell mass.

Multichannel Fourier-transform interferometry for fast signals.

Multichannel Fourier transform interferometry to measure the spectrum of arbitrarily short pulses and of fast time-varying signals was achieved using a micro/nanomanufactured multimirror array. We describe the performance of a demonstrator FTIR that works in the mid-infrared (MIR) range of 700-1400 cm(-1) and reaches a spectral resolution of 10 cm(-1) taking into account apodization. Spectral measurements down to pulse lengths of 319 µs were carried out using a mechanical camera shutter. Arbitrarily short pulses are expected feasible provided the source can deliver enough photons to overcome the noise equivalent number of photons.

All-metal self-supported THz metamaterial--the meta-foil.

Modern metamaterials face functional constraints as they are commonly embedded in or deposited on dielectric materials. We provide a new solution by microfabricating a completely free-standing all-metal self-supported metamaterial. Using upright S-string architecture with the distinctive feature of metallic transverse interconnects, we form a locally stiff, globally flexible space-grid. Infrared Fourier transform interferometry reveals the typical double-peak structure of a magnetically excited left-handed and an electrically excited right-handed pass-band that is maintained under strong bending and heating, and is sensitive to dielectrics. Exploiting UV/X-ray lithography and ultimately plastic moulding, meta-foils can be mass manufactured cost-effectively to serve as optical elements.

Free-standing THz electromagnetic metamaterials.

Using micromanufactured S-shaped gold strings suspended in free space by means of window-frames, we experimentally demonstrate an electromagnetic meta-material (EM(3)) in which the metallic structures are no longer embedded in matrices or deposited on substrates such that the response is solely determined by the geometrical parameters and the properties of the metal. Two carefully aligned and assembled window-frames form a bi-layer chip that exhibits 2D left-handed pass-bands corresponding to two different magnetic resonant loops in the range of 1.4 to 2.2 THz as characterized by Fourier transform interferometry and numerical simulation. Chips have a comparably large useful area of 56 mm(2). Our results are a step towards providing EM(3) that fulfill the common notions of a material.