Radiation therapy accelerators require highly accurate dose deposition and the output must be monitored frequently and regularly. Ionization chambers are the primary tool for this control, but their ...size and fragility make them unsuitable for use during patient treatment. In collaboration with a French center for cancer treatment in Caen, we describe the development and testing of a low-cost radiotherapy dosimeter (SDM) based on scintillating fibers and signal processing to reduce the effect of Cerenkov radiation background. The employment of photodiodes for light collection reduces the cost relative to systems using photomultipliers (PMTs). However, we have also developed a highly sensitive system that uses PMTs for very low-dose deposition for Brachytherapy. Comparison with standard ionization chambers shows about a 1% difference over a range of 6- to 25-MV photons. This dosimeter is 1 mm in diameter and can be placed where ever required including inside the body. Its small size and flexibility make it useful for delimiting critical regions, where organs may be very radiation sensitive.
Radiotherapy accelerator requires high accuracy on dose deposition and their output has to be monitored on a frequent and regular basis. Ionization chambers are the main tool for this control, but ...their size and fragility make them unusable when performing a patient treatment. In collaboration with one of the French center for cancer treatment in Caen, we present the developments and tests of a low cost radiotherapy dosimeter (SDM) based on scintillating fiber and a signal processing for Cerenkov cancellation. The use of photodiodes for light collection insures a very low cost compared with system using PMTS. However we have also develop a high sensitivity version with PMTS for very "low dose deposition" for curietherapy or radiological exams. Comparison with standard ionization chamber has been performed showing about one percent difference from 6 to 25 MV photons. This dosimeter is 1 mm in diameter and can be located where ever is necessary even inside the body. Its small size and flexibility make it useful for delimiting critical area, where organs cannot be over-irradiated.
Abstract Background Red blood cell distribution width (RDW), a numerical measure of the variability in size of circulating erythrocytes, has recently been shown to be a strong predictor of adverse ...outcomes in patients with heart failure and in patients with prior myocardial infarction but no symptomatic heart failure at baseline, even after adjustment for hematocrit. However, there are no data in other cardiac populations, including patients with acute coronary syndromes (ACS). Methods The present study investigated the long-term prognostic significance of baseline RDW in a well-characterized cohort of 389 male patients who were referred to coronary angiography for a variety of indications. All patients were followed prospectively for all-cause mortality, and data regarding this endpoint was available for 97% of the population at 24 months. Results After controlling for a variety of baseline variables (including hemoglobin and the presence of heart failure), RDW (analyzed as a categorical variable comparing the upper tertile of baseline values to the lower two levels combined) was a strong and independent predictor of all-cause mortality using a Cox proportional hazards model hazard ratio (HR) 2.69, 95% confidence interval (CI) 1.50–4.84, p = 0.0008. In addition, baseline RDW was also an independent predictor of all-cause mortality in the non-anemic (HR 4.73, 95% CI 2.06–10.86, p = 0.0003) and ACS (HR 2.90, 95% CI 1.32–6.38, p = 0.0082) subpopulations of patients. Conclusions These data demonstrate that elevated RDW is a strong and independent predictor of all-cause mortality in an unselected population of male patients across a broad spectrum of risk (including ACS) referred for coronary angiography.
Masculine gender ideologies are thought to underlie alcohol use, intimate partner violence (IPV) perpetration, and sexual risk of HIV and other sexually transmitted infections (STIs). We extend on ...studies in the Indian context by examining the roles of masculine gender ideologies, alcohol use, and IPV on three outcomes of HIV risk (condom use, genital tract infection GTI symptoms, and GTI diagnosis). We applied logistic regression models to cross-sectional data of men and their wives in rural Maharashtra, India (n = 1,080 couples). We found that men with less masculine gender ideologies demonstrated greater odds of condom use (i.e., lower odds no condom use, odds ratio OR = 0.96, 95% confidence interval CI = 0.93, 0.98). IPV perpetration was associated with increased odds of reporting ≥1 GTI symptom (adjusted OR AOR = 1.56, 95% CI = 1.07, 2.26) and decreased GTI diagnosis (AOR = 0.28, 95% CI = 0.08, 0.97). Moderate alcohol consumption was associated with increased odds of reporting ≥1 GTI symptom (AOR = 1.51, 95% CI = 1.01, 2.25). Our findings have direct implications for men’s and women’s health in rural India, including targeted GTI diagnosis and treatment, integrated violence prevention in STI clinics, and targeted intervention on masculine gender ideologies.
Despite ongoing recommendations to increase male engagement and gender-equity (GE) counseling in family planning (FP) services, few such programs have been implemented and rigorously evaluated. This ...study evaluates the impact of CHARM, a three-session GE+FP counseling intervention delivered by male health care providers to married men, alone (sessions 1&2) and with their wives (session 3) in India.
A two-armed cluster randomized controlled trial was conducted with young married couples (N = 1081 couples) recruited from 50 geographic clusters (25 clusters randomized to CHARM and a control condition, respectively) in rural Maharashtra, India. Couples were surveyed on demographics, contraceptive behaviors, and intimate partner violence (IPV) attitudes and behaviors at baseline and 9 &18-month follow-ups, with pregnancy testing at baseline and 18-month follow-up. Outcome effects on contraceptive use and incident pregnancy, and secondarily, on contraceptive communication and men's IPV attitudes and behaviors, were assessed using logistic generalized linear mixed models. Most men recruited from CHARM communities (91.3%) received at least one CHARM intervention session; 52.5% received the couple's session with their wife. Findings document that women from the CHARM condition, relative to controls, were more likely to report contraceptive communication at 9-month follow-up (AOR = 1.77, p = 0.04) and modern contraceptive use at 9 and 18-month follow-ups (AORs = 1.57-1.58, p = 0.05), and they were less likely to report sexual IPV at 18-month follow-up (AOR = 0.48, p = 0.01). Men in the CHARM condition were less likely than those in the control clusters to report attitudes accepting of sexual IPV at 9-month (AOR = 0.64, p = 0.03) and 18-month (AOR = 0.51, p = 0.004) follow-up, and attitudes accepting of physical IPV at 18-month follow-up (AOR = 0.64, p = 0.02). No significant effect on pregnancy was seen.
Findings demonstrate that men can be engaged in FP programming in rural India, and that such an approach inclusive of GE counseling can improve contraceptive practices and reduce sexual IPV in married couples.
ClinicalTrials.gov NCT01593943.
Between 2014 and 2017, a program aimed at reducing HIV risk and promoting safe sex through consistent use of condoms sought to work through addressing social and economic vulnerabilities and ...strengthening community-led organizations (COs) of female sex workers (FSWs). This study examines if the program was effective by studying relationship between strengthening of COs, vulnerability reduction, and sustaining of consistent condom use behavior among FSWs. We used a longitudinal study design to assess the change in outcomes. A three-stage sampling design was used to select FSWs for the study. Panel data of 2085 FSWs selected from 38 COs across five states of India was used to examine the change in various outcomes from 2015 (Survey Round 1) to 2017 (Survey Round 2). The CO level program pillar measuring institutional development assessed performance of COs in six domains critical for any organization's functionality and sustainability: governance, project management, financial management, program monitoring, advocacy and networking, and resource mobilization. Overall, 32 indicators from all these domains were used to compute the CO strength score. A score was computed by taking mean of average dimension scores. The overall score was divided into two groups based on the median cutoff; COs which scored below the median were considered to have low CO strength, while COs which scored above or equal to median were considered to have high CO strength. Multivariable regression modeling techniques were used to examine the effect of program pillars on outcome measures. Analyses showed a significant improvement in the strength of the COs over time; percentage of COs having high strength improved from 50% in 2015 to 87% in Round 2. The improvement in CO's strength increased financial security (Adjusted Odds Ratio AOR: 2.18, p<0.01), social welfare security (AOR: 1.71, p<0.01), and socio-legal security (AOR: 2.20, p<0.01) among FSWs. Further, improvement in financial security led to significant increase in consistent condom use with client among FSWs (AOR: 1.69, p<0.01) who were members of COs having high strength. Sustained consistent condom use was positively associated with young age (<30 years), ability to negotiate with clients for condom use, membership in self-help groups, high self-efficacy, self-confidence, and client solicitation in streets and brothels. Improving financial security and strengthening FSW led CO can improve sustained and consistent condom use. In addition, the program should focus on enhancing ability of FSWs to negotiate with clients for condom use, promote membership in self-help groups and target FSWs who are 30 years or older, and soliciting from homes to sustain consistent condom use across all FSWs.
Community-led organizations (COs) have been an integral part of HIV prevention programs to address the socio-economic and structural vulnerabilities faced by female sex workers (FSWs). The current ...study examines whether strengthening of community-led organizations and community collectivization have been instrumental in reducing the financial vulnerability and empowering FSWs in terms of their self-efficacy, confidence, and individual agency in India.
This study used a panel data of 2085 FSWs selected from 38 COs across five states of India. Two rounds of data (Round 1 in 2015 and Round 2 in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security, community collectivization, and individual empowerment.
There was a significant improvement in CO strength and community collectivization from Round 1 to Round 2. High CO strength has led to improved financial security among FSWs (R2: 85% vs. R1: 51%, AOR: 2.5; 95% CI: 1.5-4.1) from Round 1 to Round 2. High collective efficacy and community ownership have improved the financial security of FSWs during the inter-survey period. Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy, and individual agency) among FSWs.
Institutional strengthening and community mobilization programs are key to address the structural issues and the decrease of financial vulnerability among FSWs. In addition, enhanced financial security is very important to sustain or improve the individual empowerment of FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment.
Qualitative evidence suggests that husbands’ inequitable gender equity (GE) ideologies may influence associations between husbands’ alcohol use and intimate partner violence (IPV) against wives. ...However, little quantitative research exists on the subject. To address this gap in the literature, associations of husbands’ elevated alcohol use and GE ideologies with wives’ reports of IPV victimization among a sample of married couples in Maharashtra, India, were examined. Cross-sectional analyses were conducted using data from the baseline sample of the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) study. Participants included couples aged 18 to 30 years (N = 1081). Regression models assessed the relationship between husbands’ elevated alcohol use and GE ideologies (using the Gender-Equitable Men GEM Scale) and wives’ history of physical and/or sexual IPV victimization ever in marriage. Husbands and wives were 18 to 30 years of age, and married on average of 3.9 years (SD ± 2.7). Few husbands (4.6%) reported elevated alcohol use. Husbands had mean GEM scores of 47.3 (SD ± 5.4, range: 35–67 out of possible range of 24–72; least equitable to most equitable). Approximately one fifth (22.3%) of wives reported a history of physical and/or sexual IPV. Wives were less likely to report IPV if husbands reported greater GE ideologies (adjusted odds ratio AOR: 0.97, 95% CI 0.95, 0.99), and husband’s elevated alcohol use was associated with increased risk of IPV in the final adjusted model (AOR: 1.89, 95% CI 1.01, 3.40). Findings from this study indicate the need for male participation in violence intervention and prevention services and, specifically, the need to integrate counseling on alcohol use and GE into such programming.
Abstract
Background
Go Nisha Go™ (GNG), is a mobile game combining behavioural science, human-centric design, game-based learning, and interactive storytelling. The model uses a direct-to-consumer ...(DTC) approach to deliver information, products, services, interactive learning, and agency-building experiences directly to girls. The game’s five episodes focus on issues of menstrual health management, fertility awareness, consent, contraception, and negotiation for delay of marriage and career. The game’s effectiveness on indicators linked to these issues will be measured using an encouragement design in a randomized controlled trial (RCT).
Methods
A two-arm RCT will be conducted in three cities in India: Patna, Jaipur, and Delhi-NCR. The first arm is the treatment (encouragement) arm (n = 975) where the participants will be encouraged to download and play the game, and the second arm (n = 975) where the participants will not receive any nudges/encouragement to play the game. They may or may not have access to the game. After the baseline recruitment, participants will be randomly assigned to these two arms across the three locations. Participants of the treatment/encouragement arm will receive continuous support as part of the encouragement design to adopt, install the game from the Google Play Store at no cost, and play all levels on their Android devices. The encouragement activity will continue for ten weeks, during which participants will receive creative messages via weekly phone calls and WhatsApp messages. We will conduct the follow-up survey with all the participants (n = 1950) from the baseline survey after ten weeks of exposure. We will conduct 60 in-depth qualitative interviews (20 at each location) with a sub-sample of the participants from the encouragement arm to augment the quantitative surveys.
Discussion
Following pre-testing of survey tools for feasibility of methodologies, we will recruit participants, randomize, collect baseline data, execute the encouragement design, and conduct the follow-up survey with eligible adolescents as written in the study protocol. Our study will add insights for the implementation of an encouragement design in RCTs with adolescent girls in the spectrum of game-based learning on sexual and reproductive health in India. Our study will provide evidence to support the outcome evaluation of the digital mobile game app, GNG. To our knowledge this is the first ever outcome evaluation study for a game-based application, and this study is expected to facilitate scalability of a direct-to-consumer approach to improve adolescent sexual and reproductive health outcomes in India.
Trial registration number:
ctri.nic.in: CTRI/2023/03/050447.
Much of the research on intimate partner violence (IPV) documents the negative impacts of violence on women, which are substantial. Less attention has been given to perceptions of the marital ...relationship given these experiences of violence. However, evidence suggests that many women affected by IPV within marriage remain in their relationships, particularly in contexts such as India, where divorce remains highly stigmatized. Understanding and supporting marital quality may need greater prioritization to support women who remain in relationships affected by violence. This study examines the association between IPV and marital quality among young married couples in rural India. We interviewed 1084 women and 1084 men at two time points (baseline, 18 months) in a western state in India and used multilevel mixed effects models to test the association between IPV and marital quality. We found that women’s experience of physical and sexual IPV was associated with poor marital quality at 18 months. Women’s experience of sexual IPV was also negatively associated with men’s self-reported marital quality at 18 months. Among men, spouse’s marital quality was positively associated with their own rating of marital quality. We also examined the reciprocal relationship between IPV and marital quality and found that women’s report of poor marital quality was associated with their future experience of physical IPV, sexual IPV, and emotional IPV. Taken together, these findings suggest that IPV interventions need to target marital quality to be effective. To do this, we would need to shift our lens from empowering individuals to empowering couples to work together to improve their relationships.
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