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Over 3 months, we provided monthly education to internal medicine residents and distributed resources regarding penicillin-allergy history taking. Allergy information in the electronic record was updated more often during the intervention compared to the period before the intervention (16.1% vs 10.9%; P = .02). Education and interdepartmental collaboration have the potential to affect provider behavior.
In 1956, Dalip Singh Saund was elected as Representative of California’s 29th district, becoming the first Asian American member of the US Congress. This chapter approaches Saund’s 1960 memoir Congressman from India with particular attention to his complicated role as a “representative,” in multiple senses of the term – as a representative in the US Congress, but also in his various embodiments as a Sikh, an Indian, and an American. Published during his second term, Congressman is a carefully calibrated performance, in which Saund narrates his story as a sort of proto-model minority tale and constructs the USA as a global ally to Asia during the Cold War. Despite the tale of immigrant achievement and his indefatigable optimism, racial inequality persists as a theme throughout, and this chapter examines two moments in the memoir where the politics of race play a key role: his 1956 campaign for Congress; and his tour through Asia as an ambassador one year later. In attending to these moments, this chapter asks, how did the pressures of Cold War ideology impact how Saund rendered his past and how he imagined American and Indian futures? And how did his narrative shape the climate for the wave of South Asian immigrants who would soon arrive in the USA with the passing of the Hart–Celler Act five years later?
The unorthodox estimation procedure, which Phillips (1958) adopted in his original paper, is examined using the Haar wavelet filter. The application of the Haar wavelet transform to Phillips’ original data shows that Phillips’ six pairs of mean coordinates display a striking similarity with the Haar scaling coefficients that represent averages with a period greater than 16 years. This is consistent with Desai’s (1975) intuition on the interpretation of the Phillips Curve. We show that the choice of sorting observations by ascending values of the unemployment rate is crucial for reaching the goal of estimating the eye-catching nonlinear hyperbolic shape of the wage–unemployment relationship that would be otherwise linear. Interestingly, the Haar filter can account not only for the facts characterizing the Phillips’ relationship up to the early 1960s but also for two important facts mostly debated among policymakers: the downward shift of the Phillips Curve and its flattening over time.
We introduce pinta, a pipeline for reducing the upgraded Giant Metre-wave Radio Telescope (uGMRT) raw pulsar timing data, developed for the Indian Pulsar Timing Array experiment. We provide a detailed description of the workflow and usage of pinta, as well as its computational performance and RFI mitigation characteristics. We also discuss a novel and independent determination of the relative time offsets between the different back-end modes of uGMRT and the interpretation of the uGMRT observation frequency settings and their agreement with results obtained from engineering tests. Further, we demonstrate the capability of pinta to generate data products which can produce high-precision TOAs using PSR J1909
3744 as an example. These results are crucial for performing precision pulsar timing with the uGMRT.
Pelvic congestion syndrome is another condition causing pelvic pain for which there is no consensus on diagnosis or treatment; moreover, some physicians don’t even believe it causes pelvic pain. Pain from pelvic congestion is multifactorial and may be caused by hypoxia and mechanical stretching of pelvic veins. It usually occurs after pregnancy (may be full term, ectopic, or miscarriage) and presents as a sensation of heaviness in the lower abdomen with upright body position. On the background of this sensation there is intermittent sharp lower pelvic pain. In our practice we diagnose pelvic pain based on symptoms but confirm it with transfundal venography preformed in the operating room immediately prior to surgery. We treat pelvic congestion syndrome either by referring the patient to interventional radiology for embolization of the pelvic veins or by surgical selective pelvic vein ligation. In this procedure we separate ovarian veins from arteries and legate them and then legate any significantly enlarged veins in the broad ligament. Outcomes from this treatment are effective; however, pain and congestion may return with time, especially if the patient becomes pregnant again.
Among the physicians who see patients for pelvic pain some feel that the only proper treatment is surgery and others that nonsurgical treatment should be the mainstay of therapy. The truth of course lies in the middle, and the most effective providers are not only excellent surgeons but also recognize the importance of physical therapy, pharmacological treatments, and psychological counseling. One of the problems with assessing the effectiveness of surgery and comparing outcomes between the providers is that there are different skill levels, and what one provider calls complete resection of endometriosis or adhesiolysis another may deem as incomplete. In the hands of good and qualified surgeons some procedures unequivocally are beneficial for patients. Resection of endometriosis has clearly been shown to be beneficial provided other causes of pain are also treated. In our practice patients with complete adhesiolysis also seem to have good improvement of pain. It is true that pain may return with time but patients may have few good years, after which they may be candidates for a repeat procedure. Hysterectomy for pain is of course controversial, especially in younger or nulligravid patients.
There are multiple causes of pelvic pain, and it is very important to acknowledge that in most women pelvic pain is not of gynecological origin. It is also important to remember that in most patients with pelvic pain there is more than one reason for pain and simply just treating endometriosis without addressing pelvic floor or bladder pain or associated emotional issues is not enough. History is by far the single most important part of the diagnostic process, with examination being less useful and radiological tests often not helpful at all. Three simple questions can probably diagnose most of the causes for pelvic pain: How did the pain start, what makes in better and what makes it worse? Patients whose pain began at menarche may have endometriosis, but cyclical pain does not always mean the diagnosis of endometriosis. Many pain symptoms may worsen during the menstrual period. Conversely, when pain begins after surgery or trauma to the pelvis it is almost certainly not endometriosis. Pain after delivery may be due to musculoskeletal issues (muscle spasm, nerve injury, incisional neuroma – episiotomy or laparotomy scar) but also result from congested pelvic veins. Pain that worsens with physical activity and improves with rest and use of a heating pad is almost always of musculoskeletal origin. Finally, pain with a full bladder may be consistent with interstitial cystitis/bladder pain syndrome but pain at the end of urination is often from spasm of pelvic floor muscles. Pain during intercourse is present in most of the conditions causing pelvic pain but in patients with pelvic floor muscle spasm this pain/pressure usually persists for hours to days after. Use of questionnaires such as the one developed by the International Pelvic Pain Society may be very useful to determine the cause of pain.
In this paper, a semi-flexible 2 × 1 array antenna is proposed with epoxy glass fiber and graphene as patch and ground, respectively. Microstrip patch antenna with a center parasitic patch of half-wavelength and slot in the radiating patch have been incorporated for the bandwidth enhancement in order of 79.56% (2.21–5.13 GHz). The antenna has an overall size of 0.30λ × 0.24λ at a lower frequency of operation (2.45 GHz). The incorporation of slotted Graphene in radiating element leads to a wideband regime with satisfactory gain values of 2.73 and 3.744 dBi at 2.40 and 4.0 GHz, respectively. Antenna radiation efficiency in the range of 78% with linear polarization makes the antenna appropriate for WLAN band and smart wireless devices application.
To determine the demographic pattern of juvenile-onset parkinsonism (JP, <20 years), young-onset (YOPD, 20–40 years), and early onset (EOPD, 40–50 years) Parkinson’s disease (PD) in India.
Materials and Methods:
We conducted a 2-year, pan-India, multicenter collaborative study to analyze clinical patterns of JP, YOPD, and EOPD. All patients under follow-up of movement disorders specialists and meeting United Kingdom (UK) Brain Bank criteria for PD were included.
A total of 668 subjects (M:F 455:213) were recruited with a mean age at onset of 38.7 ± 8.1 years. The mean duration of symptoms at the time of study was 8 ± 6 years. Fifteen percent had a family history of PD and 13% had consanguinity. JP had the highest consanguinity rate (53%). YOPD and JP cases had a higher prevalence of consanguinity, dystonia, and gait and balance issues compared to those with EOPD. In relation to nonmotor symptoms, panic attacks and depression were more common in YOPD and sleep-related issues more common in EOPD subjects. Overall, dyskinesias were documented in 32.8%. YOPD subjects had a higher frequency of dyskinesia than EOPD subjects (39.9% vs. 25.5%), but they were first noted later in the disease course (5.7 vs. 4.4 years).
This large cohort shows differing clinical patterns in JP, YOPD, and EOPD cases. We propose that cutoffs of <20, <40, and <50 years should preferably be used to define JP, YOPD, and EOPD.
This Element first reviews the limitations of the concepts of problems in childhood. It proposes a universal, comprehensive, and longitudinal conceptual framework of problems in childhood, their differential context, and their cyclical effects. Based on the linkages identified in the children's problems, they are divided into three levels, primary, secondary, and tertiary. The Element then reviews the concepts and the limitations of the prevalent service delivery approaches of child welfare, protection, and justice, because of which these services have not helped to break the cycle of problems in childhood. The Element identifies the rights-based comprehensive, preventive, and systemic approach for child welfare, at primary, secondary and tertiary prevention levels, in order to break this cycle of problems. Finally, the Element goes into details of the tertiary prevention level integrated service delivery for children facing socio-legal problems.
Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.
The Health and Family Welfare Department of the Government of Gujarat is implementing a program called Technology for Community Health Operation (TeCHO+) to address the state's priority health issues. This paper details the protocol for using health technology assessment to assess the impact of the TeCHO+ program on data quality, service delivery coverage, rates of morbidity and mortality, and cost effectiveness.
This mixed-method study will be conducted in five districts. Data will be validated in a phased manner over a three-year period, along with an assessment of key outcome indicators. Additionally, key informant interviews will be conducted and cost data will be gathered.
Early implementation of TeCHO+ has highlighted mixed impact at an operational level, with gaps in implementation. Despite some gaps in the available evidence, TeCHO+ solutions can significantly improve health service delivery through increased accuracy of data management, high-risk identification, and quality and accessibility of care. However, implementation challenges require even greater efforts to establish comprehensive systems for troubleshooting and corrective measures for improving data quality. Positive experiences encourage grassroots teams for continuing the use of TeCHO+.
TeCHO+ is expected to improve service coverage and reduce rates of morbidity and mortality by improving the population's nutritional status, the timeliness of care for high-risk cases, and the non-communicable disease profile of the community.
THE lady renegade of the Restoration period, Margaret Cavendish was known for her eccentricities and passion for education. Though largely ignored or derided in her own time, her theatrical work has gained critical attention in the centuries since her death. The rediscovery of her work by scholars has revealed an innovative feminist voice from the English Restoration. Part of the academic discourse that surrounds her work is involved in reintegrating Cavendish into the theatrical canon that has excluded her for so long. I argue that Cavendish herself was invested in this project and wrote her plays with this goal in mind. In particular, her play The Convent of Pleasure can be seen as a direct response to Ben Jonson's Epicene, or The Silent Woman. With this move, she both addresses the overtly misogynistic tone of the original and rewrites it with her own feminist agenda and figures herself as a successor to the Renaissance playwrights, securing her place in the canon.
Part of the reason that Cavendish's plays have stayed out of the limelight for so long is that they were never performed during her lifetime. Wary of the reception they would receive and the treatment she would have to endure, Cavendish chose to publish her plays herself rather than subject them to the whims of the theatrical scene. Even though they were not performed during the Restoration when they were written, Cavendish's plays were clearly meant to be performed. They have a highly theatrical quality, incorporating a variety of performance styles and genres. Following in the tradition of Renaissance plays, Cavendish's Restoration era dramas play with the line between audience and performance. A comparison of her play The Convent of Pleasure and the play Epicene, or The Silent Woman by one of the most famous Renaissance playwrights Ben Jonson shows the way that Cavendish incorporates Renaissance performance strategies.
Cavendish was writing during the Restoration, after the introduction of female actresses. However, the similarities between The Convent of Pleasure and Epicene, The Silent Woman are striking enough to invite a comparison of the way that Cavendish plays with the conventions of the Renaissance stage and the politics of Jonson. It is well documented that Cavendish was familiar with the works of Ben Jonson.
The relict intertidal deposits from the Kharod River Estuary, Gulf of Kachchh, and the distal end of Kori Creek are used to infer the Mid- to Late Holocene relative sea-level (RSL) change in western India. Employing sedimentology, geochemistry, palynology, ichnology, and optical and radiocarbon dating, the study suggests the dominance of fluvial activity between 16.5 ± 1.6 and 9.9 ± 0.7 ka. After ~7 ka (7.3 ± 0.4, 6.8 ± 0.5 ka), the sea level showed a positive tendency until 4.7 ± 0.2 ka. The tectonically corrected Mid-Holocene RSL change is estimated as 1.45 ± 0.33 m between ~7 and ~5 ka. The study suggests that the Mid-Holocene RSL high was due to the meltwater contribution from the Himalayan cryosphere, with subordinate contribution from glacio-isostatic adjustment and crustal subsidence. The Late Holocene tectonically corrected RSL change at ~1 ka (1.1 ± 0.1 ka and 1045 ± 175 cal yr BP) is estimated as 0.53 ± 0.43 m. This is ascribed to monsoon wind-driven tidal ingression that might have affected the tidal amplitude positively. The study suggests that the Mid-Holocene RSL change did not play a deterministic role in the abandonment of the Harappan coastal settlements.
There is a general consensus that COVID-19 is rapidly and radically transforming the democratic relationship between state and society. Focusing on political and legal arrangements, some argue that the virus gives a fillip to authoritarian tendencies by eroding constitutional checks and balances, while others suggest that it will reshape the state and its constitution owing to new understandings of mutual interdependence and solidarity.
We make a different argument here: Democracy is also being transformed by significant changes in the state’s fiscal arrangements and its political economy. We do so based on scrutiny of a specific type of fiscal vehicle that crystallizes and regulates state–society relationships: Special-purpose social welfare funds. These are collected pursuant to state law to tackle the vulnerability of specific social categories, such as unorganized migrant labor in the construction sector in India or the underdevelopment of certain regions in Italy. We argue that these funds are a site through which social actors, and especially the state, define social vulnerability, and more generally welfare.
The emphasis on team science in clinical and translational research increases the importance of collaborative biostatisticians (CBs) in healthcare. Adequate training and development of CBs ensure appropriate conduct of robust and meaningful research and, therefore, should be considered as a high-priority focus for biostatistics groups. Comprehensive training enhances clinical and translational research by facilitating more productive and efficient collaborations. While many graduate programs in Biostatistics and Epidemiology include training in research collaboration, it is often limited in scope and duration. Therefore, additional training is often required once a CB is hired into a full-time position. This article presents a comprehensive CB training strategy that can be adapted to any collaborative biostatistics group. This strategy follows a roadmap of the biostatistics collaboration process, which is also presented. A TIE approach (Teach the necessary skills, monitor the Implementation of these skills, and Evaluate the proficiency of these skills) was developed to support the adoption of key principles. The training strategy also incorporates a “train the trainer” approach to enable CBs who have successfully completed training to train new staff or faculty.
Affective symptoms are associated with cognition in mid-life and later life. However, the role of cardiometabolic risk in this association has not been previously examined.
To investigate how cardiometabolic risk contributes to associations between affective symptoms and mid-life cognition.
Data were used from the National Child Development Study (NCDS), a sample of people born in Britain during one week in 1958. Measures of immediate and delayed memory, verbal fluency and information processing speed and accuracy were available at age 50. Affective symptoms were assessed at ages 23, 33 and 42 years and a measure of accumulation was derived. A cardiometabolic risk score was calculated from nine cardiometabolic biomarkers at age 44. Path models were run to test these associations, adjusting for sex, education, socioeconomic position and affective symptoms at age 50.
After accounting for missing data using multiple imputation, path models indicated significant indirect associations between affective symptoms and mid-life immediate memory (β = −0.002, s.e. = 0.001, P = 0.009), delayed memory (β = −0.002, s.e. = 0.001, P = 0.02) and verbal fluency (β = −0.002, s.e. = 0.001, P = 0.045) through cardiometabolic risk.
These findings suggest that cardiometabolic risk may play an important role in the association between affective symptoms and cognitive function (memory and verbal fluency). Results contribute to understanding of biological mechanisms underlying associations between affective symptoms and cognitive ageing, which can have implications for early detection of, and intervention for, those at risk of poorer cognitive outcomes.
OBJECTIVES/GOALS: Achieving therapy for hepatocellular carcinoma (HCC) involves navigating through a complex cascade of care. Non-HCC cancer mortality has been associated with social determinants of health outside of cancer specific risk. Our objective is to explore the impact of social determinants on HCC outcomes. METHODS/STUDY POPULATION: Patients with HCC were enrolled from 3 hospitals form June, 1 2019 to December 1, 2019. A chart review was done to collect information on liver disease severity and cancer stage. Patients were interviewed to collect information on the following: 1) socioeconomic status (income, education, insurance status, and employment status), 2) literacy (Rapid Estimate of Adult Literacy in Medicine (REALM-R) and Brief Health Literacy Screening Tool (BREIF)), 3) social support (Patent Reported Outcome Measurement Information System (PROMIS) instrumental and information support tool), 4) quality of life (PROMIS global and mental health tool), 5) substance abuse, and 6) linkage to care. RESULTS/ANTICIPATED RESULTS: Data compiled on the social determinants of health revealed (n = 35): 1) 60.0% of patients had incomes below $30,000 per year, 60.0% of patients had not gone past high school for education, and 8.6% had full time employment, 2) the average BREIF score was 10.3 (range 3-15)(4-12 indicate limited literacy). The average REALM-R score was 5.5 (range 0-8) (<6 indicate at risk for poor literacy), 3) patients had strong instrumental (T score 61.4±7.1) and information social support (T score 64.6±4.7) (mean T scores calibrated to a general population mean of 50), 4) patients had poor mental (T score 43.7 ±6.5) and physical quality of life (T score 46.6 ±9.9), 5) 25.7% of patients reported alcohol use in the past 90 days 6) 80.0% of patients reported that their doctor had spoken to them about liver transplantation. DISCUSSION/SIGNIFICANCE OF IMPACT: This patient population was well linked to care with good social support. However their literacy, socioeconomic status, mental and global health was poor and substance use history complex. Continued follow up of this cohort is planned to determine how these factors might impact their ability to navigate through the care cascade as well as survival.