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Despite a reduction in maternal mortality in recent years, a high rate of anaemia and other nutrient inadequacies during pregnancy pose a serious threat to mothers and their children in the Global South. Using the framework of the WHO–Commission on Social Determinants of Health, this study examines the socioeconomic, programmatic and contextual factors associated with the consumption of iron and folic acid (IFA) tablets/syrup for at least 100 d (IFA100) and receiving supplementary food (SF) by pregnant women in India.
We analysed a nationally representative cross-sectional survey of over 190 898 ever-married women aged 15–49 years who were interviewed as part of the National Family Health Survey (NFHS) conducted during 2015–16, who had at least one live birth preceding 5 years of the survey.
All twenty-nine states and seven union territories of India.
Ever-married women aged 15–49 years.
Less than one-third of women were found to be consuming IFA100, and a little over half received SF during their last pregnancy. The consumption of IFA100 was likely to improve with women’s education, household wealth, early and more prenatal visits, and in a community with high pregnancy registration. Higher parity, early and more prenatal visits, contact with community health workers during pregnancy, belonging to a poor household and living in an aggregated poor community and rural area positively determine whether a woman might receive SF during pregnancy.
Continuous monitoring and evaluation of provisioning IFA and SF in targeted groups and communities is a key to expanding the coverage and reducing the burden of undernutrition during pregnancy.
To investigate the central electrode artefact effect of different ion chambers in the verification phantom using the dose calculation algorithms Analytical Anisotropic Algorithm (AAA) and Acuros XB.
Materials and methods:
The dosimetric study was conducted using an in-house fabricated polymethyl methacrylate head phantom. The treatment planning system (TPS)-calculated doses in the phantom with detectors were compared against the dummy detector fillets using AAA and Acuros XB algorithm. The planned and measured doses were compared for the study.
The mean percentage variation in volumetric-modulated arc therapy plans using Acuros XB and the measurement in the head phantom are statistically significant (p-value = 0.001) for FC65 and CC13 chambers. In small volume chambers (A14SL and CC01), the measured and TPS-calculated dose shows a good agreement.
The study confirmed the CT set of the phantom with detectors (FC65 and CC13) give more artefacts/heterogeneity caused a significant variation in dose calculation using Acuros XB. Therefore, the study suggests a method of using phantom CT set with the dummy detector for mean dose calculation for the Acuros XB algorithm.
To assess the coverage of the adolescent weekly iron and folic acid supplementation (WIFS) programme in rural West Bengal, India.
We conducted a population-based cross-sectional survey of intended WIFS programme beneficiaries (in-school adolescent girls and boys and out-of-school adolescent girls).
Birbhum Health and Demographic Surveillance System.
A total of 4448 adolescents 10–19 years of age participated in the study.
The percentage of adolescents who reported taking four WIFS tablets during the last month as intended by the national programme was 9·4 % among in-school girls, 7·1 % for in-school boys and 2·3 % for out-of-school girls. The low effective coverage was due to the combination of large deficits in WIFS provision and poor adherence. A large proportion of adolescents reported they were not provided any WIFS tablets in the last month: 61·7 % of in-school girls, 73·3 % of in-school boys and 97·1 % of out-of-school girls. In terms of adherence, only 41·6 % of in-school girls, 38·1 % of in-school boys and 47·4 % of out-of-school girls reported that they consumed all WIFS tablets they received. Counselling from teachers, administrators and school staff was the primary reason adolescents reported taking WIFS tablets, whereas the major reasons for non-adherence were lack of perceived benefit, peer suggestion not to take WIFS and a reported history of side effects.
The effective coverage of the WIFS programme for in-school adolescents and out-of-school adolescent girls is low in rural Birbhum. Integrated supply- and demand-side strategies appear to be necessary to increase the effective coverage and potential benefits of the WIFS programme.
One of the most challenging problems in biomedicine and genomics is the identification of disease biomarkers. In this study, proteomics data from seven major cancers were used to construct two weighted protein–protein interaction networks, i.e., one for the normal and another for the cancer conditions. We developed rigorous, yet mathematically simple, methodology based on the degeneracy at –1 eigenvalues to identify structural symmetry or motif structures in network. Utilizing eigenvectors corresponding to degenerate eigenvalues in the weighted adjacency matrix, we identified structural symmetry in underlying weighted protein–protein interaction networks constructed using seven cancer data. Functional assessment of proteins forming these structural symmetry exhibited the property of cancer hallmarks. Survival analysis refined further this protein list proposing BMI, MAPK11, DDIT4, CDKN2A, and FYN as putative multicancer biomarkers. The combined framework of networks and spectral graph theory developed here can be applied to identify symmetrical patterns in other disease networks to predict proteins as potential disease biomarkers.
Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.
Retrospective observational study.
Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.
Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).
Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.
To assess the strength of correlation and agreement between mid-upper arm circumference (MUAC) and BMI, and determine suitable MUAC cut-offs, to detect wasting and severe wasting among non-pregnant adult women in India.
Cross-sectional studies were conducted in five high-burden pockets of four Indian states.
Prevalence of malnutrition among women and children is very high in these pockets and the government plans to implement community-based pilot projects to address malnutrition in these areas.
Anthropometric measurements were carried out on 1716 women with children <5 years of age. However, analyses were conducted on 1538 non-pregnant adult women.
The results showed a strong correlation between MUAC and BMI in the non-pregnant women, with correlation coefficient of 0·860 (95 % CI 0·831, 0·883; P < 0·001). Cohen’s κ of 0·812 and 0·884 also showed good agreement between MUAC and BMI in identifying maternal wasting and severe wasting, respectively. The univariate regression model between MUAC and BMI explained 0·734 or 73 % of the variation in BMI. The MUAC cut-offs for wasting (BMI < 18·5 kg/m2) and severe wasting (BMI < 16·0 kg/m2) were calculated as 232 and 214·5 mm, respectively.
MUAC is a strong predictor of maternal BMI among non-pregnant women with children <5 years in high-burden pockets of four Indian states. In a resource-constrained setting where BMI may not be feasible, the MUAC cut-offs could reliably be used to screen wasting and severe wasting in non-pregnant women for providing appropriate care.
Numerical methods require tedious, cumbersome and repetitive arithmetic operations for large problems. It is almost impossible to do these cumbersome arithmetic operations manually. The development of information technology enhances the potential of these numerical techniques, and various software can handle algebra involved in these techniques in a very simple and sophisticated manner. Since most of the numerical techniques are algorithmic in nature and require repetitive cumbersome iterations, so it is practical to apply these algorithms to a computer. Of course, a computer must be given detailed and complete instructions for each step. During the formulation of any algorithm, we must keep in mind the following main features of the computer.
i) The computer is capable of performing only the basic arithmetic operations. Hence, each problem must be reduced to problems of these arithmetic operations. Numerical techniques provide these algorithms for a wide range of problems.
ii) The memory of the computer stores the algorithms and results of computations, and this enables the repetitive execution and results can be retrieved as per requirement.
iii) Computer's memory facilitates the alteration in the execution of instructions depending on results obtained during the execution.
A systematic stepwise set of instructions utilizing above features of the computer enables us to solve complicated and cumbersome problems. Our efforts aim at the search for such algorithms. We will see that for a specific type of problems, there are several algorithms (For example, to solve nonlinear equations, we can choose among various algorithms like Bisection, Regula–Falsi, Newton–Raphson, etc.). We have a lot of choices depending on our requirement for speed, accuracy, and convergence, etc. A combination of two algorithms can also be used. For example, we can find a close approximation to the root of an equation by Bisection method keeping in mind the convergence; and then continue with the Newton–Raphson method from this approximation onwards keeping in mind the speed of the method. For modest size problem, we can easily implement any algorithm with high configuration computer. But in the case of large-scale problems, slow algorithms need to be rejected.
So far, many algorithms are developed for different kinds of problems. As we discussed above, there are so many reasons to select an algorithm over others.