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As a result of the COVID-19 pandemic crisis, Online-learning has become a necessary feature in all educational establishments such as schools, colleges and universities. The educations sector in India is deeply affected by this. To fight back the disruption and damage, educational institutes across the country embraced the digital mode of education as a solution to fill the void left by classroom teaching. Online education is conducted in two ways. The first is through the use of recorded classes, which, when opened out to public, are referred to as Massive Open Online Course (MOOCs). The second one is via live online classes conducted as webinars, or zoom sessions. This review has identified five important strategies that could be incorporated into a best practice framework for online education.1) As e-learning becomes the "new normal", the authorities have been taking steps to make digitisation of education accessible and affordable for all. 2) Training in educational technologies and their effective use should be available to faculty and students who need it.3)The Indian education system has to transit to online learning without creating a digital divide, the Centre and state governments must raise the spending on education.

The usage of probiotics is becoming more common because of the mounting body of research demonstrating its advantages for human health. Of late probiotics have transitioned to a highly promising prophylactic measure that affords colonization resistance against multitude of pathogens. A crucial defence mechanism in the human body against numerous illnesses, especially urogenital ones, is the vaginal microbiota. The present study focuses on screening and isolation of culturable vaginal commensal microbiota from 54 healthy Indian women, and explore its putative probiotic traits such as coaggregation, antagonistic action against uropathogens, ability to form biofilms, antibiotic sensitivity, adhesion properties, etc. In addition, how oestradiol might affect isolated vaginal probiotics in both planktonic and biofilm states were also explored. The purpose of this work was to build a preliminary probiotics topography, specifically a Lactobacilli cartography, from a healthy Indian women cohort, characterize them at the molecular level, and interpret the key activities which were needed for the design and use probiotics as an antimicrobial sparing therapy to curtail UTI infection on the face of rising antimicrobial resistance. Our long-term goal of this work is to develop feminine hygiene product that is incorporated with probiotics to protect against pathogen colonisation without creating dysbiosis and improve women's quality of life.

The purpose of this study is to examine the finite sample aspects of estimates of the parameters of the weighted Lindley distribution derived by four estimation methods: maximum likelihood, method of moments, ordinary least squares, and weighted least squares, using Monte Carlo simulations. As a comparison criterion, bias and mean-squared error are used. In both small and large samples, the Cramer-von Mises approach is found to be very competing with the maximum likelihood method. To substantiate the conclusion, a statistical analysis of a real data set related to weather is performed.

Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.

Background: Tobacco use not only increases mortality, but also causes enormous burden to the Nation’s health and economy. The WHO -Framework Convention on Tobacco Control implemented “MPOWER”, comprising of an important entity of ‘offering help to tobacco users’ to quit. Quitline provides evidence-based treatment services to tobacco users and advertising those services has the potential to increase their utilisation. Objectives: Our objective was to assess the awareness and utilisation of the newly introduced quitline on tobacco packs among tobacco users. Materials and Methods: After obtaining Ethics Committee approval, this cross-sectional study was conducted from March-June 2019 in a purposive sample of tobacco users aged 18 years and above at the point of sale with prior informed consent. The questionnaire included questions on the users’ knowledge and utilisation of the quitline. Results: Most of the tobacco users (84.6 %) had not observed the quitline on tobacco pack. Amongst those who observed the quitline, 65.5% were smokers, while the smokeless tobacco users who comprised half of the study population were unaware of the quitline. More than 97% of illiterates were unaware of the quitline. Only three tobacco users who were aware of quitline had tried using it. Conclusion: Most of the tobacco users had basic education but were not aware of the quitline on the tobacco packs and only a very few of them used the services, highlighting the need to increase its awareness for effective tobacco control.

Introduction Although most of the disease burden internationally is due to tobacco smoking, smokeless tobacco (SLT) use contributed to an estimated 76 000 deaths in 2017. We have studied the potential risk factors for SLT use among adolescents in South India. Methods A cross-sectional questionnaire survey of all students in grades 6–8 in schools in the Udupi district of Karnataka State ascertained SLT use status and potential determinants of SLT uptake. Ever SLT use was defined as any reported consumption of any SLT products, currently or at any time in the past. Independent effects on ever SLT use status were estimated using multiple logistic regression. Results Of 46 706 students from 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever SLT use was reported by 775 (2.0%) participants and in a mutually adjusted model was significantly related to age, male sex, family use, or friend’s use of SLT, low socioeconomic status, high rebelliousness, and low self-esteem. After controlling for these effects, the odds of ever-SLT use were significantly higher among students who had least awareness of the harmful effects of tobacco use (odds ratio 3.7, 95% confidence interval [2.9, 4.7]) and significantly lower among those not exposed to tobacco advertising (odds ratio 0.7, 95% confidence interval [0.5, 0.8]). Conclusions The prevalence of SLT use among children in Karnataka is relatively low when compared with other studies in India. The significant potential risk factors of SLT use include low awareness of the harmful effects of tobacco and tobacco control policies and exposure to tobacco advertising. Implications The prevalence of SLT use among school going adolescents in South India is relatively low. The potential risk factors for SLT use among adolescents in southern India are similar to those for smoked tobacco. It includes age, male gender, family or friend’s use of SLT, low socioeconomic status, high rebelliousness, low self-esteem, exposure to tobacco advertisement and least awareness about the harmful effects of tobacco and of tobacco control policies. The present study lays emphasis regarding creating awareness about tobacco harms and control policies for further reducing tobacco use among adolescents.

Background: Well-being is increasingly emerging as an important determinant of teacher effectiveness. Aim and objective: To assess the predictors of psychological well-being in Southern India. Settings and design: A cross-sectional study was conducted among 460 high school teachers from government and private schools in Udupi district. Methods and materials: Ryff’s psychological well-being scale (1989) was used. Statistical analysis used: Predictors were identified using logistic regression and p

Being a tree crop of commercial importance, the productive performance of cashew is greatly influenced by how best its canopy is architectured for harnessing maximum benefits in terms of yield. The initial training is crucial for the development of photosynthetically efficient canopy in cashew as in other perennial fruit trees. Pruning of dead wood and crisscross branches can alone increase the yield by 30-40 per cent. The dwarf rootstocks also play a role in manipulating the canopy in cashew, wherein, canopy containment and yield were influenced by such rootstocks. By resorting to soil application of growth retardants like paclobutrazol, cashew canopy could be successfully contained to suit high density planting system. The studies on planting geometry has indicated the advantage of high density planting in enhancing profitability of cashew orchards in the initial years of plantation. The advantages of rejuvenation as well as top working techniques are also discussed in this aper.

Dadimashtaka choorna is one of the classical ayurvedic polyherbal powder formulation explained in the context of Atisara chikitsa (treatment of gastrointestinal conditions such as diarrhoea), in the text of Astangahridaya. The formulation is mainly indicated for digestive disorders. Even though many researches have brought out the anti-bacterial activity of each component of the formulation, no studies were done to identify the activity of the compound formulation on any specific bacterial strains. Therefore, an attempt was made to accurately understand the action of the preparation against certain selected strains of bacterias. The formulation was prepared according to the classical method of preparation for choorna kalpana. As per the standard norms mentioned in Ayurvedic Pharmacopoeia of India, the concentrated extract of the medicament was prepared. The study was undertaken to evaluate the anti-bacterial activity of concentrated extract of Dadimashtaka choorna against selected microorganisms namely, Salmonella typhi (gram -ve), Escherichia coli (gram -ve), and Bacillus species (gram +ve), using agar well diffusion method and also to compare with the standard drug, ciprofloxacin. It was found that the concentrated extract of Dadimashtaka choorna has significant anti-bacterial activity against the bacterial strain, Bacillus (gram +ve). The study confirmed the anti-bacterial potential of the formulation Dadimashtaka choorna against Bacillus species(gram+ve), which supports the fact that the compound formulation is a promising remedy to curb the gastrointestinal disorders caused by the gram +ve bacterial strains.

Background: The Government of Karnataka banned loose cigarettes sale effect from September 2017 and is punishable under Cigarettes and Other Tobacco Products Act (COTPA) with fine and imprisonment in case of violation. Aim & Objective: Study aims to assess awareness, perceptions and practices about ban among tobacco vendors and smokers. Methods and Material: Cross sectional survey was carried using pre-tested questionnaire to collect information regarding awareness about ban among vendors and smokers. Data were analyzed using SPSS version 15.0. Results: Ninety-five percent of the tobacco vendors continued to sell loose cigarettes despite the ban. Among vendors, 49.7%, were aware of ban and of them 53.5% knew it is a punishable offense. Vendors opined that they would stop selling loose cigarettes if ban is strictly enforced with frequent checks on periodical basis. One-fourth smokers opined they will reduce cigarettes consumption with few making an attempt to quit. Conclusions: Awareness about ban on sale of loose cigarettes was unsatisfactory among vendors and smokers including lack of knowledge regarding legal actions in case of violation. However, vendors responded favorably towards obeying the law. Smokers are likely to reduce or even quit smoking if the law is strictly enforced which highlights the need for creating awareness drives and strong enforcement of the policy.

Objectives: This study aimed to find the incidence, prevalence, and clinical management of poisoning cases in Telangana state region. Methods: It was a prospective and observational study done for 9 months and the data were obtained from the case sheets of 600 patients admitted in tertiary care hospital with poisoning. Data were analyzed according to age, gender, type and route of poisoning, treatment of poisoning, and mortality and morbidity rate. Results: Out of 600 cases admitted, female patients were 312 (52%) and males were 288 (48%) and the age group ranged from 6 months to 70 years of age. The most common route of exposure was ingestion (oral) (91.5%) followed by topical (dermal) (8%), and the agents which were used included organophosphate (33%) in most of the cases followed by chemical poisoning (24%). The average duration of therapy till the discharge of the patients was 1–5 day. About 80% of the cases were from the low socioeconomic background. More or less, the treatment is restricted to symptomatic and supportive care if the poisonous agent is unknown. A specific antidote is given, where there is enough information regarding the poison. Conclusion: The present study revealed increasing incidence of poisoning cases from rural areas and below the poverty line due to lack of knowledge, easy availability, stress, depression, and familial disharmony. By providing educational, awareness programs, and establishing a poison information center, there is a possibility for a decline in the incidence of poisoning.

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, we are seeing widespread disease burden affecting patients of all ages across the globe. However, much remains to be understood as clinicians, epidemiologists, and researchers alike are working to describe and characterize the disease process while caring for patients at the frontlines. We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease, who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms. The patient was treated per treatment guidelines, with intravenous immunoglobulin and high-dose aspirin, and subsequently defervesced with resolution of her clinical symptoms. The patient’s initial echocardiogram was normal, and she was discharged within 48 hours of completion of her intravenous immunoglobulin infusion, with instruction to quarantine at home for 14 days from the date of her positive test results for COVID-19. Further study of the clinical presentation of pediatric COVID-19 and the potential association with Kawasaki disease is warranted, as are the indications for COVID-19 testing in the febrile infant.

BackgroundCervical cancer continues to be a leading cancer among women in India. Despite availability of various screening techniques, majority of Indian women remain unscreened for cancer cervix. The increasing incidence could be attributed to the lack of awareness regarding cervical cancer screening and paucity of organized screening facilities in the country. This study assessed the knowledge, attitude and practices (KAP) towards cervical cancer screening among tribal women of coastal Karnataka, southern India.MethodsA community-based cross-sectional study was conducted among 1140 women aged 20–65 years from three tribes. Information on their KAP towards cervical cancer screening was collected using a semi-structured questionnaire.ResultsMean age of the participants was 39.8 ± 10.1 years. Although 82.9% of the participants reported to have heard of cervical cancer, 51% were aware that the disease could be prevented, and only 2.3% knew that it can be detected at an early stage. Over 75% of the participants did not have adequate knowledge regarding cervical cancer. However, majority of them (99.9%) had a favourable attitude towards cervical cancer screening. None of them had undergone cervical cancer screening prior to the study. The knowledge scores were significantly associated with age group, marital status, education level, socioeconomic status and tribal community of the participants (p ConclusionOverall knowledge regarding cervical cancer among the surveyed women was poor, though they exhibited a positive attitude. This calls for a sustained health education and screening program to create awareness and improve the uptake of cervical cancer screening among these women.

Expenditure on diabetes mellitus is increasing worldwide and is determined by multiple factors and knowledge about these factors may help to improve patient management and reduce health-care cost. The present study aims to determine the factors influencing the expenditure incurred by patients with type 2 diabetes mellitus (T2DM). A cross-sectional survey was conducted among 809 patients with T2DM from a coastal community in Southern India. Expenditure incurred for the management of T2DM in the previous year was collected using a predesigned survey tool. Duration of disease, source of diabetes care, presence of comorbidities, hospitalization, and adherence to medications were studied as potential cost predictors. Age, gender, education, occupation, and socioeconomic status as key determinants were evaluated. Expenditure incurred by patients with T2DM was estimated to be INR 5041 (2516-11,224) annually while the presence of comorbidities led to higher expenditure, INR 9133 (4034-19,053). Medication and hospitalization were the major drivers of direct cost. Subjects visiting private health facilities had a higher median cost with respect to diabetes-related care. Advancing age, male gender, high socioeconomic status, higher literacy, and longer duration of diabetes were identified as significant independent predictors of cost on multivariate analysis. The high cost of diabetes supports the need for strengthening public and private primary care facilities to provide standard care for diabetes.

Background Exploring the cultural context of intergenerational continuity of warm and harsh parenting informs parents motivations to adopt specific parenting behaviours. Objective Parents’ perceptions of being parented in the past and their current parenting as well as adolescents’ perceptions of current parenting were explored applying a multi-method approach. Methods Following written informed consent, a total of 24 interviews with 10 families (dyads of 14 parents and ten adolescents) from Udupi taluk in southern India was conducted. In the first stage, in-depth interviews were conducted with parent participants (Generation 1 (G1)) and in the second stage, adolescents (Generation 2 (G2)) participated in the photovoice component. Multiple forms of data including photographs, journals and interviews facilitated using the SHOWeD model were collected and were analysed thematically using ATLAS.ti(v.8). Results Subtle changes in reinforcing culture-specific gender norms between generations were elicited. Differences in communication, granting autonomy to female adolescents, and in disciplining methods between G1 and G2 were observed. Warm parenting was transmitted between generations while harsh parenting in G1 in the presence of external social support was discarded in favor of warm parenting in G2. Conclusion We provide evidence for perceptions of parenting and adolescent behaviors across two generations. Transmission of warm parenting and interruption in the cycle of harsh parenting in the presence of external social support were significant findings. Related theoretical and methodological applications are discussed.

BACKGROUND Behavioral economics–based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient portals are a key tool for facilitating patient engagement in their health, and interventions deployed via patient portals have been effective in improving utilization of preventive health services. OBJECTIVE We examined the impacts of behavioral economics–based nudge health maintenance reminders on appointment scheduling through a patient portal and appointment completion for 2 preventive services: Medicare wellness visits and Pap smear. METHODS We conducted a retrospective observational study using electronic health record data from an integrated health care system in Northern California. Nudge health maintenance reminders with behavioral economics–based language were implemented for all sites in November 2017 for Medicare wellness visits and for selected sites in February 2018 for Pap smears. We analyzed 125,369 health maintenance reminders for Medicare wellness visits, and 585,358 health maintenance reminders for Pap smear sent between January 2017 and February 2020. The primary outcomes were rate of appointments scheduled through the patient portal and appointment completion rate. We compared the outcomes between those who received the new, behavioral economics–based health maintenance reminders (the nudge group) and those who received the original, standard health maintenance reminders (the control group). We used segmented regression with interrupted time series to assess the immediate and gradual effect of the nudge for Medicare wellness visits, and we used logistic regression to assess the association of nudge health maintenance reminders, adjusting for the propensity to receive a nudge health maintenance reminder, for Pap smear. RESULTS The rates of appointments scheduled through the patient portal were higher for nudge health maintenance reminder recipients than those for control health maintenance reminder recipients (Medicare wellness visits—nudge: 12,537/96,839, 13.0%; control: 2,769/28,530, 9.7%, PPPP=.30). There was a marginally gradual effect of nudge on number of appointments scheduled through the patient portal for the overall Medicare wellness visits sample (at a monthly rate of 0.26%, P=.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, P=.04). For Pap smear, nudge health maintenance reminders were positively associated with number of appointments scheduled through the patient portal (overall sample: propensity adjusted odds ratio [OR] 1.62; 95% CI 1.50-1.74; among scheduled appointments: propensity adjusted OR 1.61, 95% CI 1.47-1.76) and with appointment completion (propensity adjusted OR 1.07; 1.04-1.10). CONCLUSIONS Nudges, a behavioral economics–based approach to providing health maintenance reminders, imcreased the number of appointments scheduled through the patient portal for Medicare wellness visits and Pap smear. Our study demonstrates that a simple approach—framing and modifying language in an electronic message—can have a significant and long-term impact on patient engagement and access to care.

To explore the experiences of parents and their adolescent children, specifically the dimension of parental involvement in the lives of their adolescent children and how adolescents perceived it. Following informed consent, a total of nine families with 22 participants took part in the study including nine adolescents, aged between 14 and 16 y, and 13 parents. One-on-one in-depth interviews were conducted at their homes following informed consent. Following transcription, the data was coded and themes were identified using Atlas.ti software. A grounded theory approach was undertaken in analysing the data. Two main themes were identified including perceptions of parental involvement in the lives of their adolescent children and family strategies to improve bonding. Adolescents’ concerns centered on reduced interaction time with their family members. Concerns were also raised over the adolescents’ increasing academic burden and parents particularly emphasized the increasing use of media and mobile technology by adolescents as deterrents to interaction. Though mothers functioned as primary caregivers, fathers also took on more active roles in the rearing of their children, stepping away from the traditionally viewed role of being a distant patriarchal provider. To improve interaction, parents devised creative strategies to increase time spent interacting with family members such as having dinner, performing household chores, playing games, or visiting places together. The increasing academic burden and access to digital media were perceived as factors leading to reduced interaction between the parent-adolescent dyad. Creative parenting strategies to increase interaction were sought as a solution.

Background Cervical cancer is a major contributor to mortality and morbidity in women. Naked eye visual screening (NE test) and Pap test are commonly used for cervical cancer screening. Both tests have inherent limitations like low sensitivity (Pap test) and subjectivity in interpretation, lack of permanent record and overestimation (NE test). Here, Smart Scope® visual screening test (SS test) was compared with NE and Pap tests. Smart Scope® is a small, hand-held device that captures cervical images attached to a tablet to store data. Objective To compare SS test with Pap and NE tests. Study design This prospective observational study was conducted at a tertiary care hospital in India, over 16 months. A total of 509 women in the age group of 25 to 65 years were included in the study as per the inclusion criteria. All the participants underwent Pap test, NE test and SS test. Screen positives on any one test were advised colposcopy and biopsy. Results Out of 154 screen-positive women, 49 visited for follow-up colposcopy-guided biopsy. Nine incidental biopsies of screen-negative women were included in the data. Thus, statistical analysis was carried out based on 58 available histopathology results. Out of 58 biopsies, 8 were normal, 30 were benign lesions, 18 were precancerous and 2 were cancerous lesions. SS test was found to have a sensitivity and NPV of 100% each, PPV of 45.4% and a specificity of 36.8%. Sensitivity and specificity of NE test was 90% and 39.5% respectively, PPV was 43.9% and NPV was 88.2%. Pap smear had a sensitivity of 25% and specificity of 84.2%, PPV of 45.5% and NPV of 68.08%. Conclusion SS test has great potential to be a primary screening test in low-resource settings due to its better sensitivity and NPV as compared to NE and Pap tests. .

Pneumonia is the leading cause of death among children globally. Most pneumonia deaths in low-income and middle-income countries (LMICs) occur among children with HIV infection or exposure, severe malnutrition, or hypoxaemia despite antibiotics and oxygen. Non-invasive bubble continuous positive airway pressure (bCPAP) is considered a safe ventilation modality that might improve child pneumonia survival. bCPAP outcomes for high-risk African children with severe pneumonia are unknown. Since most child pneumonia hospitalisations in Africa occur in non-tertiary district hospitals without daily physician oversight, we aimed to examine whether bCPAP improves severe pneumonia mortality in such settings.This open-label, randomised, controlled trial was done in the general paediatric ward of Salima District Hospital, Malawi. We enrolled children aged 1-59 months old with WHO-defined severe pneumonia and either HIV infection or exposure, severe malnutrition, or an oxygen saturation of less than 90%. Children were randomly assigned 1:1 to low-flow nasal cannula oxygen or nasal bCPAP. Non-physicians administered care; the primary outcome was hospital survival. Primary analyses were by intention-to-treat and interim and adverse events analyses per protocol. This trial is registered with ClinicalTrials.gov, number NCT02484183, and is closed.We screened 1712 children for eligibility between June 23, 2015, and March 21, 2018. The data safety and monitoring board stopped the trial for futility after 644 of the intended 900 participants were enrolled. 323 children were randomly assigned to oxygen and 321 to bCPAP. 35 (11%) of 323 children who received oxygen died in hospital, as did 53 (17%) of 321 who received bCPAP (relative risk 1·52; 95% CI 1·02-2·27; p=0·036). 13 oxygen and 17 bCPAP patients lacked hospital outcomes and were considered lost to follow-up. Suspected adverse events related to treatment occurred in 11 (3%) of 321 children receiving bCPAP and 1 (1%) of 323 children receiving oxygen. Four bCPAP and one oxygen group deaths were classified as probable aspiration episodes, one bCPAP death as probable pneumothorax, and six non-death bCPAP events included skin breakdown around the nares.bCPAP treatment in a paediatric ward without daily physician supervision did not reduce hospital mortality among high-risk Malawian children with severe pneumonia, compared with oxygen. The use of bCPAP within certain patient populations and non-intensive care settings might carry risk that was not previously recognised. bCPAP in LMICs needs further evaluation before wider implementation for child pneumonia care.BillMelinda Gates Foundation, International AIDS Society, Health Empowering Humanity.