In India, acute respiratory illnesses, including pneumonia, are the leading cause of early childhood death. Emergency medical services are a critical component of India's public health ...infrastructure; however, literature on the prehospital care of pediatric patients in low- and middle-income countries is minimal. The aim of this study is to describe the demographic and clinical characteristics associated with 30-day mortality among a cohort of pediatric patients transported via ambulance in India with an acute respiratory complaint.
Pediatric patients less than 18 years of age using ambulance services in one of seven states in India, with a chief complaint of "shortness of breath", or a "fever" with associated "difficulty breathing" or "cough", were enrolled prospectively. Patients were excluded if evidence of choking, trauma or fire-related injury, patient was absent on ambulance arrival, or refused transport. Primary exposures included demographic, environmental, and clinical indicators, including hypoxemia and respiratory distress. The primary outcome was 7 and 30-day mortality. Multivariable logistic regression, stratified by transport type, was constructed to estimate associations between demographic and clinical predictors of mortality.
A total of 1443 patients were enrolled during the study period: 981 (68.5%) were transported from the field, and 452 (31.5%) were interfacility transports. Thirty-day response was 83.4% (N = 1222). The median age of all patients was 2 years (IQR: 0.17-10); 93.9% (N = 1347) of patients lived on family incomes below the poverty level; and 54.1% (N = 706) were male. Cumulative mortality at 2, 7, and 30-days was 5.2%, 7.1%, and 7.7%, respectively; with 94 deaths by 30 days. Thirty-day mortality was greatest among those 0-28 days (N = 38,17%); under-5 mortality was 9.8%. In multivariable modeling prehospital oxygen saturation <95% (OR: 3.18 CI: 1.77-5.71) and respiratory distress (OR: 3.72 CI: 2.17-6.36) were the strongest predictors of mortality at 30 days.
This is the first study to detail prehospital predictors of death among pediatric patients with shortness of breath in LMICs. The risk of death is particularly high among neonates and those with documented mild hypoxemia, or respiratory distress. Early recognition of critically ill children, targeted prehospital interventions, and diversion to higher level of care may help to mitigate the mortality burden in this population.
Professional wellness is critical to developing and maintaining a health care workforce. Previous work has identified burnout as a significant challenge to professional wellness facing emergency ...medical technicians (EMTs) in many countries worldwide. Our study fills a critical gap by assessing the prevalence of burnout among emergency medical technicians (EMTs) in India.
This was a cross-sectional survey of EMTs within the largest prehospital care organization in India. We used the Maslach Burnout Inventory (MBI) to measure wellness. All EMTs presenting for continuing medical education between July-November 2017 from the states of Gujarat, Karnataka, and Telangana were eligible. Trained, independent staff administered anonymous MBI-Medical Personnel Surveys in local languages.
Of the 327 EMTs eligible, 314 (96%) consented to participate, and 296 (94%) surveys were scorable. The prevalence of burnout was 28.7%. Compared to EMTs in other countries, Indian EMTs had higher levels of personal accomplishment but also higher levels of emotional exhaustion and moderate levels of depersonalization. In multivariate regression, determinants of burnout included younger age, perceived lack of respect from colleagues and administrators, and a sense of physical risk. EMTs who experienced burnout were four times as likely to plan to quit their jobs within one year.
This is the first assessment of burnout in EMTs in India and adds to the limited body of literature among low- and middle-income country (LMIC) prehospital providers worldwide. Burnout was strongly associated with an EMT's intention to quit within a year, with potential implications for employee turnover and healthcare workforce shortages. Burnout should be a key focus of further study and possible intervention to achieve internationally recognized targets, including Sustainable Development Goal 3C and WHO's 2030 Milestone for Human Resources.
•This article discusses the effect of temperature and the applied magnetic field strength, through SQUID-VSM studies, on the magnetic behavior of the cobalt nickel ferrites nano powders.•The magnetic ...behavior is studied through BH curves, BH Vs H curves, ZFC and FC curves.•These powders synthesized by a simple and environmentally benign method were further characterized to study their structural and optical behavior of the samples through XRD, TEM, RAMAN and DRS studies.•Thus it gives and elaborate study on these magnetic samples and their possible applications.
Spinel ferrites have come a long way in their versatile applications. The ever growing applications of these materials demand detailed study of material properties and environmental considerations in their synthesis. In this article, we report the effect of temperature and applied magnetic field strength on the magnetic behavior of the cobalt nickel ferrite nano powder samples. Basic structural properties of spinel ferrite nano particles, that are synthesized by an environmentally benign method of auto combustion, are characterized through XRD, TEM, RAMAN spectroscopy. Diffuse Reflectance Spectroscopy (DRS) is done to understand the nickel substitution effect on the optical properties of cobalt ferrite nano particles. Thermo magnetic studies using SQUID in the temperature range 5 K to 400 K and room temperature (300 K) VSM studies are performed on these samples. Fields of 0Oe (no applied field: ZF), 1 kOe (for ZFC and FC curves), 5 kOe (0.5 T), 50 kOe (5T) (for M-H loop study) are used to study the magnetic behavior of these nano particles. The XRD,TEM analysis suggest 40 nm crystallites that show changes in the cation distribution and phase changes in the spinel structure with nickel substitution. Raman micrographs support phase purity changes and cation redistributions with nickel substitution. Diffuse reflectance study on powder samples suggests two band gap values for nickel rich compounds. The Magnetic study of these sample nano particles show varied magnetic properties from that of hard magnetic, positive multi axial anisotropy and single-magnetic-domain structures at 5 K temperature to soft magnetic core shell like structures at 300 K temperature. Nickel substitution effect is non monotonous. Blocking temperature of all the samples is found to be higher than the values suggested in the literature.
The quantity of floating plastic debris (FPD) is continuously being increased in the oceans. To assess their size, structure, and composition along the eastern Arabian Sea (EAS), FPD samples were ...collected by using a surface plankton net. The microplastic size fraction (0.5–5 mm) was the most prevalent accounting for >50% of the total, followed by mesoplastics (5–25 mm; ~40%) and macroplastics (>25 mm; ~10%). The collected FPDs were categorized into five different types and eight colours. Attenuated Total Reflectance-Fourier Transform Infrared Spectrometry (ATR-FTIR) analysis of the plastics revealed that polypropylene, polyethylene, and nylon were the most dominant polymers, and these comprised mostly of fibre/fishing line. The abundance of FPD in the EAS (0.013 ± 0.012 no.s/m3) was found to be very low compared to elsewhere. The prevalent microplastics presence in the oceans might have occurred mainly by the degradation of larger items. It increases bioavailability, and hence, is a risk to marine ecosystems.
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•Basic data regarding the characterization of plastic debris along the EAS.•The microplastic size fraction (0.5-5mm) was the most prevalent accounting for >50% of the total, followed by mesoplastic and macroplastic.•The prevalent microplastic presence in the oceans might have occurred mainly via the degradation of larger items.•Polypropylene, polyethylene and nylon were the most dominant polymers.•Plastics comprised mostly of fibre/fishing line.•The plastic debris in the EAS (0.013 ± 0.012 no.s/m3) was found to be very low comparied to elsewhere.
Advanced Trauma Life Support field triage utilizes the Glasgow Coma Scale (GCS) to assess the level of consciousness. However, prehospital care providers in low- and middle-income countries (LMICs) ...often use the Alert, Verbal, Pain, and Unresponsive (AVPU) scale to assess the level of consciousness. This study aimed to determine whether prehospital AVPU categorization correlates with mortality rates in trauma victims, similarly to GCS.
In this cross-sectional study conducted between November 2015 and January 2016, we enrolled a convenience sample of prehospital trauma-related field activations. The primary outcome measure was the probability of death within 48 h for each category of AVPU.
In a convenience sample of 4514 activations, 1606 (35.6%) met exclusion criteria, four did not have AVPU, and four did not have GCS, leaving 2900 (64.2%) trauma activations with both AVPU and GCS available for analysis. Forty-eight-hour follow-up data were available for 2184 (75.3%) activations out of these 2900. The 48-h mortality rates for each category of AVPU were 1.1% (Alert), 4.3% (Verbal), 17.9% (Pain), 53.2% (Unresponsive); and, for each GCS-based injury severity category, they were 0.9% (Mild, GCS 13–15), 8.1% (Moderate, GCS 9–12), 43.5% (Severe, GCS ≤ 8). Overall, there was a statistically significant difference in GCS for each category of AVPU (p < 0.001) except between patients responding to verbal commands and those responding to pain (p = 0.18). The discriminative ability of AVPU (AUC 79.7% (95% CI 73.4–86.1)) and GCS (AUC 81.5% (95% CI 74.8–88.2)) for death within 48-h following hospital drop-off were comparable.
EMT assessments of AVPU and GCS relate to each other, and AVPU predicts mortality at 48 h. Future studies using AVPU to assess the level of consciousness in prehospital trauma protocols may simplify their global application without impacting the overall quality of care.
Women in South Asia face the highest lifetime prevalence of intimate partner violence in the world, which is just one form of violence against women (VAW). In India, few women seek help after ...experiencing violence, particularly from formal resources, such as physicians or the police. While many studies have investigated the impact of survivor characteristics and patterns of violence on help-seeking behaviors, there is scant research on support service characteristics and their impact on help-seeking. The introduction of a novel crisis helpline in Gujarat, India provided an opportunity to better understand how successful help-seeking can be driven by the perceived and experienced characteristics of the helpline. We conducted in-depth interviews with helpline users to identify factors and pathways that promoted or discouraged help-seeking in general, help-seeking from a formal source, and help-seeking from this particular helpline. We analyzed 32 interviews of women who used the helpline. Participants were from eight districts across the state, representing a diverse range of sociodemographic backgrounds. After conducting a thematic analysis, we found that action-oriented service, timeliness, and women-focused staff influenced (positively and negatively) participants’ feelings of safety, empowerment, and trust in the helpline, which ultimately impacted their decision to seek help from the helpline or even to seek help at all. This study illuminates how service characteristics, in and of themselves, can influence the likelihood that survivors will seek help, emphasizing the need for survivors to have a voice in the growth and refinement of VAW support services. Consequently, these areas must be a focus of future research and initiatives to improve help-seeking by VAW survivors.
The detection of DMMP (dimethyl methylphosphonate, a simulant of nerve agent sarin) was performed by using
p
-hexafluoroisopropanol phenyl (HFIPP) functionalized graphene (GR)
via
hydrogen bond ...interactions. For this, the HFIPP moiety was covalently functionalized on the surface of GR by a diazo reaction. The HFIPP-GR film-modified QCM electrodes were fabricated and their sensing characteristics towards DMMP were investigated. The proposed sensor showed good response towards sensing DMMP vapor at room temperature. In order to see the effect of HFIPP derivatives on DMMP vapor sensing, a comparative study was also conducted with unfunctionalized graphene. The sensitivity and detection limit of the HFIPP-GR sensor against DMMP vapors were 12.24 Hz ppm
−1
and 150 ppb respectively. The HFIPP-GR coated sensors showed good selectivity towards sensing DMMP vapors when compared with common organic vapors.
The hexafluoroisopropanol moiety was grafted onto graphene and used as a sensing layer for the detection of a nerve agent simulant using QCM.
Millions of children in low- and middle-income countries (LMICs) experience illness or trauma amenable to emergency medical interventions, but local resources are not sufficient to treat them. ...Emergency medical services (EMS), including ambulance transport, bridge the gap between local services and higher-level hospital care, and data collected by EMS could be used to elucidate patterns of paediatric health care need and use. Here we conducted a retrospective observational study of patterns of paediatric use of EMS services by children who used EMS in India, a leader in maternal and child EMS development, to inform public health needs and system interventions to improve EMS effectiveness.
We analysed three years (2013-2015) of data from patients <18 years of age from a large prehospital EMS system in India, including 1 101 970 prehospital care records across 11 states and a union territory.
Overall, 38.3% of calls were for girls (n = 422 370), 40.5% were for adolescents (n = 445 753), 65.9% were from rural areas (n = 726 154), and most families were from a socially disadvantaged caste or lower economic status (n = 834 973, 75.8%). The most common chief complaints were fever (n = 247 594, 22.5%), trauma (n = 231 533, 21.0%), and respiratory difficulty (n = 161 120, 14.6%). However, transport patterns, including patient sex and age and type of destination hospital, varied by state, as did data collection.
EMS in India widely transports children with symptoms of the leading causes of child mortality and provides access to higher levels of care for geographically and socioeconomically vulnerable populations, including care for critically ill neonates, mental health and burn care for girls, and trauma care for adolescents. EMS in India is an important mechanism for overcoming transport and cost as barriers to access, and for reducing the urban-rural gap found across causes of child mortality. Further standardisation of data collection will provide the foundation for assessing disparities and identifying targets for quality improvement of paediatric care.
In healthcare professions, soft skills contribute to critical thinking, decision-making, and patient-centered care. While important to the delivery of high-quality medical care, soft skills are often ...underemphasized during healthcare training in low-and-middle-income countries. Despite South Asia’s large population, the efficacy and viability of a digital soft skills curriculum for South Asian healthcare practitioners has not been studied to date. We hypothesized that a web-based, multilingual, soft skills course could aid the understanding and application of soft skills to improve healthcare practitioner knowledge, confidence, attitudes, and intent-to-change clinical practice.In September 2019 a needs assessment observing soft skills practices was conducted in several Indian states. We developed a communication-focused soft skills curriculum that comprised seven 10-minute video lectures, recorded in spoken English and Hindi. Participants consisted of any practicing healthcare professionals and trainees in select South Asian countries age 18 and over. Participant knowledge, confidence, attitudes, and intent-to-change clinical practice were evaluated using pre- and post-course tests and surveys. Statistical analyses were performed using STATA and SPSS.From July 26, 2021 to September 26, 2021, 5750 registered and attempted the course, 2628 unique participants completed the pre-test, and 1566 unique participants completed the post-test. Participants demonstrated small but statistically significant gains in confidence (𝑝<0.001), attitudes toward course topics relevance (𝑝<0.001), and intent-to-change clinical practice (𝑝<0.001). There was no statistically significant gain in knowledge. A digital soft-skills massive open online course for healthcare practitioners in South Asia could serve as a viable approach to improve the quality of soft skills training in low-to-middle income countries.
Exploring the significant role of natural polymers in developing drug delivery systems has been a promising area of research interest. The current investigation uses a D-optimal quadratic mixture ...design to design and evaluate neem and tamarind gum-based vildagliptin extended-release matrix tablets. Studying the combination effect of gums is one of the major objectives. Initial screening studies were performed to select the factors and their levels. The variables selected at different levels in mg/tablet are neem gum, tamarind gum, polyvinylpyrrolidone, and lactose monohydrate. Based on the screening experiments with both gums, the polymer content of 165 mg was chosen as the highest level in the DOE. Nineteen runs were generated to screen the desired parameters as responses. The total weight of the formulation was kept constant at 275 mg. Time (hours) required for 50 %, 90 % and 100 % of drug release and tablet hardness were selected as the responses for each run. The wet granulation method was adopted, and the critical variables were optimised using the design of experiments following Design Expert software. Statistical analysis was conducted, and the optimised formulations were prepared and evaluated to compare with the predicted responses. Stability studies were performed for the optimised batches. Results indicated that the prepared batches met the compendial limits and confirmed the application of neem and tamarind gum in the development of extended-release tablets of vildagliptin for 24 h. An optimised formulation comprising of 16.52 mg of neem gum and 148.48 mg of tamarind gum with a hardness of 7.5–8.5 kp produced 50 %, 90 % and 100 % drug release in 12, 22 and 25 h.
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