Gestational Diabetes Mellitus increased almost 30% in many countries, including underdeveloped countries and same in Nepal. Hospital-based studies in Nepal reported Gestational Diabetes Mellitus ...cases, with prevalence 2.48% in 2010 to 4.47% in 2019 emphasising on necessity of universal screening for Gestational Diabetes Mellitus.BACKGROUNDGestational Diabetes Mellitus increased almost 30% in many countries, including underdeveloped countries and same in Nepal. Hospital-based studies in Nepal reported Gestational Diabetes Mellitus cases, with prevalence 2.48% in 2010 to 4.47% in 2019 emphasising on necessity of universal screening for Gestational Diabetes Mellitus.As part of implementation of Electronic Decision support System for Antenatal Care, in formative study clinical vignettes on Gestational Diabetes Mellitus case presented to six healthcare providers ( Incharges, Auxiliary Nurse, Midwives and Lab Assistants) from 3 primary healthcare facilities in Kavre and Dolakha districts, Nepal from October-December 2019. 19 Auxiliary Nurse, Midwives from 19 HCF of 4 districts (Kavre, Dolakha, Sindhuli, and Sindhupalchok, including where clinical vignette were applied trained to perform Oral Glucose Tolerance Test for 4 hours. In-depth Interviews conducted with 16 Auxiliary Nurse, Midwives (8 trained and 8 peer coached from selected 4 HCF to explore their perception and experiences of conducting Oral Glucose Tolerance Test and continuing it for future. Clinical vigenttes compared with PEN protocol and IDIs analyzed thematically.METHODSAs part of implementation of Electronic Decision support System for Antenatal Care, in formative study clinical vignettes on Gestational Diabetes Mellitus case presented to six healthcare providers ( Incharges, Auxiliary Nurse, Midwives and Lab Assistants) from 3 primary healthcare facilities in Kavre and Dolakha districts, Nepal from October-December 2019. 19 Auxiliary Nurse, Midwives from 19 HCF of 4 districts (Kavre, Dolakha, Sindhuli, and Sindhupalchok, including where clinical vignette were applied trained to perform Oral Glucose Tolerance Test for 4 hours. In-depth Interviews conducted with 16 Auxiliary Nurse, Midwives (8 trained and 8 peer coached from selected 4 HCF to explore their perception and experiences of conducting Oral Glucose Tolerance Test and continuing it for future. Clinical vigenttes compared with PEN protocol and IDIs analyzed thematically.Only 4/6 HCPs made probable diagnosis of Gestational Diabetes Mellitus. 217 Oral Glucose Tolerance Test performed, 24 found to have Gestational Diabetes Mellitus. In-depth Interviews showed Auxiliary Nurse, Midwives enthusiasts on implementing tests for Gestational Diabetes Mellitus and to continue what has been learnt in training. Some challenges; clients hesitate to stay 2 hours at facilities due to unavailability of transport and household work. Oral Glucose Tolerance Test trained Auxiliary Nurse, Midwives seem more confident in counselling and conducting Oral Glucose Tolerance Test than those peer coached.RESULTSOnly 4/6 HCPs made probable diagnosis of Gestational Diabetes Mellitus. 217 Oral Glucose Tolerance Test performed, 24 found to have Gestational Diabetes Mellitus. In-depth Interviews showed Auxiliary Nurse, Midwives enthusiasts on implementing tests for Gestational Diabetes Mellitus and to continue what has been learnt in training. Some challenges; clients hesitate to stay 2 hours at facilities due to unavailability of transport and household work. Oral Glucose Tolerance Test trained Auxiliary Nurse, Midwives seem more confident in counselling and conducting Oral Glucose Tolerance Test than those peer coached.Administering Oral Glucose Tolerance Test seemed feasible in HCF settings despite some challenges. Training and continuing logistics supply from municipality level seems promising.CONCLUSIONSAdministering Oral Glucose Tolerance Test seemed feasible in HCF settings despite some challenges. Training and continuing logistics supply from municipality level seems promising.
Microorganisms with antimicrobial resistance (AMR) are prevalent among humans and animals, and also found in the environment. Though organisms with AMR can spread to humans via food from animal ...sources, the burden of AMR in food-producing animals remains largely unknown. Thus, we assessed the resistance pattern among Escherichia coli isolated from chicken cecum samples and explored issues contributing to AMR in animals in the Dhulikhel Municipality of Nepal. We conducted a mixed-methods study, comprising a cross-sectional quantitative component, with collection of chicken cecal samples from slaughter houses/shops. In addition, a descriptive qualitative component was undertaken, with a focus group discussion and key informant interviews among stakeholders involved in animal husbandry. Of the 190 chicken cecum samples collected, 170 (89%) were subjected to culture and drug sensitivity testing, of which E. coli was isolated from 159 (94%) samples. Of the 159 isolates, 113 (71%) had resistance to ≥3 antimicrobial class. Resistance to tetracycline (86%) and ciprofloxacin (66%) were most prevalent. Overuse of antimicrobials, easy availability of antimicrobials, and lack of awareness among farmers about AMR were major issues contributing to AMR. The high prevalence of resistance among E. coli in chicken cecal samples calls for rational use of antimicrobials, educating farmers, and multi-sectoral coordination.
Evidence-based decision-making to combat antimicrobial resistance (AMR) mandates a well-built community-based surveillance system for assessing resistance patterns among commensals and pathogenic ...organisms. As there is no such surveillance system in Nepal, we attempted to describe the antimicrobial resistance pattern in E. coli isolated from the fecal samples of apparently healthy individuals in Dhulikhel municipality and also explored the local drivers of AMR. We used a mixed-method design with a cross-sectional quantitative component and a descriptive qualitative component, with focus group discussion and key informant interviews as the data collection method. Fecal samples were collected from 424 individuals randomly selected for the study. E. coli was isolated from 85.9% of human fecal samples, of which 14% were resistant to ≥3 class of antimicrobials (multidrug resistant). Of the 368 isolates, resistance to ampicillin (40.0%), tetracycline (20.7%) and cefotaxime (15.5%) were most prevalent. The major drivers of AMR were: lack of awareness of AMR, weak regulations on sales of antimicrobials, poor adherence to prescribed medications, and incomplete dosage due to financial constraints. These findings indicate the need for strict implementation of a national drug act to limit the over-the-counter sales of antimicrobials. Additionally, awareness campaigns with a multimedia mix are essential for educating people on AMR.
This paper deals with the brush fault analysis in an Indian DC traction locomotive, monitoring the rectifier input current to the traction motor. The current input to the rectifier has been analysed ...using multi-resolution analysis of discrete wavelet transform-based statistical parameter analysis to identify the best fit solution for fault diagnosis in the system. Based on the optimized results, an algorithm has been built. Cross-validation of the assessment technique has been done using real field data analysis in professional software. The algorithm has been seen to work well for the practical case studies with less error in time of analysis. Also the operation time of the algorithm has been seen to be within 1.5 s from data acquisition to fault analysis, which is satisfactorily less and can be used for effective fault diagnosis in traction locomotives.
Microorganisms with antimicrobial resistance (AMR) are prevalent among humans and animals, and also found in the environment. Though organisms with AMR can spread to humans via food from animal ...sources, the burden of AMR in food-producing animals remains largely unknown. Thus, we assessed the resistance pattern among 'Escherichia coli' isolated from chicken cecum samples and explored issues contributing to AMR in animals in the Dhulikhel Municipality of Nepal. We conducted a mixed-methods study, comprising a cross-sectional quantitative component, with collection of chicken cecal samples from slaughter houses/shops. In addition, a descriptive qualitative component was undertaken, with a focus group discussion and key informant interviews among stakeholders involved in animal husbandry. Of the 190 chicken cecum samples collected, 170 (89%) were subjected to culture and drug sensitivity testing, of which 'E. coli' was isolated from 159 (94%) samples. Of the 159 isolates, 113 (71%) had resistance to >_3 antimicrobial class. Resistance to tetracycline (86%) and ciprofloxacin (66%) were most prevalent. Overuse of antimicrobials, easy availability of antimicrobials, and lack of awareness among farmers about AMR were major issues contributing to AMR. The high prevalence of resistance among 'E. coli' in chicken cecal samples calls for rational use of antimicrobials, educating farmers, and multi-sectoral coordination.
Aims: To assess the waste disposal practices and perception towards solid waste management in selected areas of Bangalore.
Study Design: Descriptive cross-sectional study.
Place and Duration of ...Study: Bangalore between November 2019- November 2020.
Methodology: Multi stage sampling technique was used. Using random sampling, respondents from 100 households were selected from each of the 3 study areas. Face to face interview and focus group discussions in all 3 areas were conducted. Semi structured questionnaires were used to collect data.
Results: The study revealed that only 35% of the respondents segregated their waste even though 64% of them had heard about it. 74.7% of them said waste van was available to collect their waste whereas few of them also resorted to open dumping and burning as method of waste disposal. 94% of the respondents said food waste was the commonly produced waste followed by plastics and papers. 14.3% respondents said garbage collection facility was not available in their area. About 72.6% of them were satisfied with the current solid waste management system. Availability of regular garbage collection facility was found to be significant with waste disposal practice.
Conclusion: The variables such as age, education, size of household, source of income and monthly income were found to be significant with waste segregation practices. The waste segregation practices were found to be highly significant with knowledge on waste segregation, education on solid waste management, and exposure to information.
Core Surgical Training (CST) is a competitive two-year postgraduate training program in the UK that is scored based on three equally weighted stations: management, clinical and portfolio. Preparing a ...surgical portfolio can start in medical school, however, there is limited guidance on what forms a competitive portfolio with the majority of advice coming from university resources and national societies which are variable throughout the country. Our aim was to assess the utility of a webinar to educate students and doctors on the CST portfolio to address this disparity.
Pre- and post-event questionnaires that included demographic data, 10-point Likert scales to self-report confidence on the understanding of the CST portfolio and its domains, and questions on utilising webinars were distributed to attendees. Pre- and post-event responses were paired, and scores were assessed for normality via the Shapiro-Wilk test; the Mann-Whitney U test was used to assess statistical significance. Cohen's d effect sizes were calculated to report standardised differences between pre-and post-event scores.
A total of 177 participants from over 24 countries responded to both questionnaires. A statistically significant improvement in awareness of how to score maximum points was demonstrated across all nine CST domains (p < 0.0001). Regardless of whether they were UK-based or international, approximately half of the participants stated a preference for a webinar over an in-person format. Interestingly, most attendees did not feel that their university had provided them with adequate information on preparing for a surgical career with over half of the attendees stating that they had to attend events by external organisations to obtain such information.
This study has demonstrated that a webinar can be effectively utilised to educate students and doctors on the various domains of the CST portfolio and how to maximise points in each section. Such events could address the variability of university resources and national societies across the country and provide equal opportunities for students. Further studies that directly compare webinars with in-person events and investigate long-term outcomes, such as success in CST applications, are required.
In this study, decellularized fish skin (DFS) scaffold decorated with silver nanoparticles was prepared for accelerating burn wound healing. The silver nanoparticles (AgNPs) synthesized by the green ...and facile method using Aloe vera leaf at different incubating times were characterized by using X-ray Diffraction (XRD), Fourier Transform Infrared (FT-IR) Spectroscopy, and Ultraviolet-Visible Spectroscopy (UV-Vis spectroscopy). The different characterizations confirmed that the sizes of AgNPs prepared by incubating for 6 hours and 12 hours were 29.1 nm and 35.2 nm, respectively. After that, the different concentrations of the smallest AgNPs were used to dope the DFS scaffold to determine the cell viability. Additionally, an agar well diffusion method was used to screen for antimicrobial activity. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were used to correlate the concentration of AgNPs with its bactericidal effect which was seen from 50 μg/ml. Then, the toxicity with human cells was investigated using a 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) assay with no significant cell viability from the concentration of 50 μg/ml to 200 μg/ml compared to the cocultured and commercial treatments.
An assessment of Varuna river basin of India was performed to study the various drainage parameters in GIS platform. The delineation of drainage network is possible either physically from topographic ...sheets or with the help data of Digital Elevation Model (DEM) by methods for calculation techniques. Extraction of the basin and sub-basins, stream network has been produced to evaluate the drainage characteristics in the study zone. The entire Varuna river basin has been subdivided into 3 sub-watersheds and 41 morphometric parameters have been computed under four broad categories i.e. drainage network, basin geometry, drainage texture, and relief characteristics. The morphometric analysis has been performed and different parameters have been correlated with each other to understand their underlying connection and their role over the basin hydro geomorphology. The study discloses different types of morphometric analysis and how they influence the soil and topography of the basin. The investigation and estimation of basin morphometry and relief parameters in GIS will be of massive utility in catchment area advancement, understanding the watershed for natural resource evaluation, planning and administration at any scale. The outcomes thus generated equip us with significant knowledge and may also provide an input that are essential in decision making for watershed planning and drainage development of the watershed.
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