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Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)–Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013–2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women’s and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013–2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013–14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.

Background Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are not well described. To the best of our knowledge, this is the first case report of a renal transplant patient with stage IV melanoma treated with a programmed cell death protein 1 checkpoint inhibitor that led to both treatment failure and renal graft rejection. Case presentation We present a case of a 58-year-old white man with a long-standing cadaveric renal transplant who was diagnosed with a B-Raf Proto-Oncogene, Serine/Threonine Kinase wild-type metastatic melanoma. He was treated with first-line pembrolizumab but experienced subsequent graft failure and rapid disease progression. Conclusions This case highlights the risks associated with the administration of checkpoint inhibitors in patients with a renal transplant and on immunosuppressive therapy. More specifically, it adds to the literature indicating that, compared with the cytotoxic T-lymphocyte-associated protein 4 inhibitor ipilimumab, anti-programmed cell death protein 1 agents are more likely to lead to renal graft failure. Additionally, these novel immunotherapeutics may be ineffective in transplant patients; therefore, clinicians should be very aware of those risks and carefully consider selection of agents and full disclosure of the risks to their patients.

Background & introduction Poor sitting posture has been implicated in the development and perpetuation of chronic nonspecific neck pain symptoms. The Cervical spine is surrounded by a complex arrangement of muscles that contribute to control of the head & neck. The deep cervical short flexor muscle group(longus colli, longus capitis,rectus capitis anterior & lateralis) is considered to be an important stabilizer of head on neck posture.The present study, which consist of twenty subjects with chronic, nonspecific chronic nonspecific neck pain were enrolled in this study. Single group experimental which received craniocervical flexion exercise. The outcomes of chronic nonspecific neck pain and disability were measured through Numerical Rating Scale (NRS) and Neck Disability Index (NDI). The forward head posture was measured from the Digital Photograph method. The study consisted of treatment sessions of five weeks with five times in a week.The Results shows that the single experimental groups, (CCF training), the Mean ± SD values were calculated. Groups were compared Using ANOVA (Analysis of variance).The results of the study suggest that F - values for Craniovertebral angle for experimental Group 14.54(P

Topological insulators (TIs) are bulk insulators with exotic 'topologically protected' surface conducting modes. It has recently been pointed out that when stacked together, interactions between surface modes can induce diverse phases including the TI, Dirac semimetal, and Weyl semimetal. However, currently a full experimental understanding of the conditions under which topological modes interact is lacking. Here, working with multilayers of the TI Sb₂Te₃ and the band insulator GeTe, we provide experimental evidence of multiple topological modes in a single Sb₂Te₃-GeTe-Sb₂Te₃ structure. Furthermore, we show that reducing the thickness of the GeTe layer induces a phase transition from a Dirac-like phase to a gapped phase. By comparing different multilayer structures we demonstrate that this transition occurs due to the hybridisation of states associated with different TI films. Our results demonstrate that the Sb₂Te₃-GeTe system offers strong potential towards manipulating topological states as well as towards controlledly inducing various topological phases., T.-A.N., D.B., D.A.R. and V.N. acknowledge funding from the Leverhulme Trust, UK, T.-A.N., D.B., A.S., R.M., C.B., D.A.R. and V.N. acknowledge funding from EPSRC (UK). G.M., M.L. and D.G. acknowledge financial support from the DFG-funded priority programme SPP1666.

We report the development of a simple and reliable, front-sided-only fabrication technique for n-type ohmic contacts to two-dimensional electron gases (2DEGs) in undoped GaAs/AlGaAs quantum wells. We have adapted the well-established recessed ohmic contacts/insulated metal gate technique for inducing a 2DEG in an undoped triangular well to also work reliably for undoped square quantum wells. Our adaptation involves a change in the procedure for etching the ohmic contact pits to optimise the etch side-wall profile and depth. As an application of our technique, we present a front-side-gated ambipolar field effect transistor (FET), where both 2D electron and hole gases can be induced in the same quantum well. We present results of low-temperature (0.3 K - 4 K) transport measurements of this device, including assessment of the n-type ohmic contact quality. On the basis of our findings, we discuss why the fabrication of these contacts is difficult and how our technique circumvents the challenges.

The reactions of Ph3SbCl2 and SbCl3 with semicarbazone and thiosemicarbazone ligands resulted in Ph3SbCl2(L) and SbCl3(L) (L = semicarbazone and thiosemicarbazone ligands). These complexes were characterized by elemental analyses, IR, 1H and 13C {1H} NMR spectral data, and conductometric measurements. On the basis of spectroscopic data, a seven-coordinate and a five-coordinate antimony with ligand coordination through oxygen/sulfur and azomethine nitrogen have been suggested for Ph3SbCl2(L) and SbCl3(L), respectively. These compounds show antifungal and antibacterial activities. Thermal behavior of some of the adducts have been studied by thermogravimetric analyses. Thermal decomposition of Ph3SbCl2(L) and SbCl3(L) resulted in micron size Sb and Sb2S3 particles. The materials obtained were characterized by powder X-ray diffraction patterns, scanning electron microscopy, and energy dispersive X-ray analysis (EDAX).

Objectives Oral lichen planus is a T-cell-mediated mucosal disease of unknown etiology. Numerous predisposing factors have been put forward in the etiology of this disease. This includes stress, drugs, genetic susceptibility, certain viruses, and bacterial infections. Recently, there have been studies published on possible role of Helicobacter pylori infection in pathogenesis of mucocutaneous diseases including oral lichen planus (OLP). The aim of this study was to detect immunohistochemically the presence of Helicobacter pylori in oral lichen planus. Materials and methods Paraffin-embedded tissue blocks of 50 cases of OLP and 10 cases of normal buccal mucosal biopsies and 6 endoscopic biopsies of patients with peptic ulcer (control group) were sectioned and stained by hematoxylin and eosin. Serial sections of same were stained immunohistochemically using Anti-Helicobacter pylori antibody and observed under microscope for presence or absence of Helicobacter pylori. Results Except for the control group, none of the cases of OLP and normal buccal mucosal biopsies showed positivity for Helicobacter pylori. Conclusion As we did not detect the presence of Helicobacter pylori in any of the OLP cases, we question the role of these organisms in the pathogenesis of OLP planus if any.

Background: Adherence to antiretroviral therapy (ART) is a principal determinant of virologic suppression. A variety of factors: including formulation of medicine, dose frequencing, drug toxicities, child’s age, as well as psychosocial, behavioral, and sociodemographic characteristics of children and caregivers have been associated with nonadherence. Still no consistent predictors of either good or poor adherence in children have been consistently identified.Methods: Data was collected from the ART Centre. Record based data from the year 2008 to 2018 April of pediatric age group i.e. from 0-18 years. All the cases registered at the center whose data were available were included for the study. Adherence was assessed calculating the average monthly consumption of ARV assessed by pill count as per NACO guidelines.Results: At the ART Centre, 139 (73.5%) were on treatment i.e. 75.7% of boys registered and 70.9% of registered girls. Average monthly adherence and treatment interruptions among the 73 children alive on ART, majority i.e. 90.4% were on good adherence with 8.2% on less than 80% adherence.Conclusions: Overall a good adherence indicates efficient functioning of the programme and determined efforts from the ART Centre.

There is much current interest in combining superconductivity and spin-orbit coupling in order to induce the topological superconducting phase and associated Majorana-like quasiparticles which hold great promise towards fault-tolerant quantum computing. Experimentally these effects have been combined by the proximity-coupling of superconducting leads and high spin-orbit materials such as InSb and InAs, or by controlled Cu-doping of topological insulators such as Bi2Se3. However, for practical purposes, a single-phase material which intrinsically displays both these effects is highly desirable. Here we demonstrate coexisting superconducting correlations and spin-orbit coupling in molecular-beam-epitaxy-grown thin films of GeTe. The former is evidenced by a precipitous low-temperature drop in the electrical resistivity which is quelled by a magnetic field, and the latter manifests as a weak antilocalisation (WAL) cusp in the magnetotransport. Our studies reveal several other intriguing features such as the presence of two-dimensional rather than bulk transport channels below 2 K, possible signatures of topological SC, and unexpected hysteresis in the magnetotransport. Our work demonstrates GeTe to be a potential host of topological SC and Majorana-like excitations, and to be a versatile platform to develop quantum information device architectures.

We review some of our recent experimental studies on low-carrier concentration, mesoscopic two-dimensional electron gases (m2DEGs). The m2DEGs show a range of striking characteristics including a complete avoidance of the strongly localised regime even when the electrical resistivity $\rho >> h/e^2$, giant thermoelectric response, and an apparent decoupling of charge and thermoelectric transport. We analyse the results and demonstrate that these observations can be explained based on the assumption that the charge carriers retain phase coherence over the m2DEG dimensions. Intriguingly, this would imply phase coherence on lengthscales of up to 10 $\mu$m and temperature $T$ up to 10 K which is significantly greater than conventionally expected in GaAs-based 2DEGs. Such unprecedentedly large phase coherence lengths open up several possibilities in quantum information and computation schemes., Engineering and Physical Sciences Research Council, Leverhulme Trust, This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.crhy.2016.08.012

Background Pregnancy-related vital registration is important to inform policy to reduce maternal, fetal and newborn mortality, yet few systems for capturing accurate data are available in low-middle income countries where the majority of the mortality occurs. Furthermore, methods to effectively implement high-quality registration systems have not been described. The goal of creating the registry described in this paper was to inform public health policy makers about pregnancy outcomes in our district so that appropriate interventions to improve these outcomes could be undertaken and to position the district to be a leader in pregnancy-related public health research. Methods We created a prospective maternal and newborn health registry in Belgaum, Karnataka State, India. To initiate this registry, we worked with the Ministry of Health to first establish estimated birth rates and define the catchment areas of the clusters, working within the existing health system and primary health centers. We also undertook household surveys to identify women likely to become pregnant. We then implemented monitoring measures to ensure high quality and completeness of the maternal newborn health registry. All pregnant women in the catchment area were identified, consented and enrolled during pregnancy, with follow-up visits to ascertain pregnancy outcomes and mother/infant status at 42-days postpartum. Results From 2008 through 2014, we demonstrated continued improvements in both the coverage for enrollment and accuracy of reporting pregnancy outcomes within the defined catchment area in Belgaum, India. Nearly 100% of women enrolled had follow-up at birth and 99% had 42-day follow-up. Furthermore, we facilitated earlier enrollment of women during pregnancy while achieving more timely follow-up and decreased time of reporting from the date of the pregnancy event. Conclusions We created a pregnancy-related registry which includes demographic data, risk factors, and outcomes allowing for high rates of ascertainment and follow-up while working within the existing health system. Understanding the elements of the system used to create the registry is important to improve the quality of the results. Tracking of pregnancies and their outcomes is an important step toward reducing maternal and perinatal mortality.

BACKGROUND: To describe quantitative data quality monitoring and performance metrics adopted by the Global Network´s (GN) Maternal Newborn Health Registry (MNHR), a maternal and perinatal population-based registry (MPPBR) based in low and middle income countries (LMICs). METHODS: Ongoing prospective, population-based data on all pregnancy outcomes within defined geographical locations participating in the GN have been collected since 2008. Data quality metrics were defined and are implemented at the cluster, site and the central level to ensure data quality. Quantitative performance metrics are described for data collected between 2010 and 2013. RESULTS: Delivery outcome rates over 95% illustrate that all sites are successful in following patients from pregnancy through delivery. Examples of specific performance metric reports illustrate how both the metrics and reporting process are used to identify cluster-level and site-level quality issues and illustrate how those metrics track over time. Other summary reports (e.g. the increasing proportion of measured birth weight compared to estimated and missing birth weight) illustrate how a site has improved quality over time. CONCLUSION: High quality MPPBRs such as the MNHR provide key information on pregnancy outcomes to local and international health officials where civil registration systems are lacking. The MNHR has measures in place to monitor data collection procedures and improve the quality of data collected. Sites have increasingly achieved acceptable values of performance metrics over time, indicating improvements in data quality, but the quality control program must continue to evolve to optimize the use of the MNHR to assess the impact of community interventions in research protocols in pregnancy and perinatal health. Fil: Goudar, Shivaprasad S.. KLE University. Jawaharlal Nehru Medical College; India Fil: Stolka, Kristen B.. Research Triangle Institute International; Estados Unidos Fil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos Fil: Honnungar, Narayan V.. KLE University. Jawaharlal Nehru Medical College; India Fil: Mastiholi, Shivanand C.. KLE University. Jawaharlal Nehru Medical College; India Fil: Ramadurg, Umesh Y.. S. Nijalingappa Medical College; India Fil: Dhaded, Sangappa M.. KLE University. Jawaharlal Nehru Medical College; India Fil: Pasha, Omrana. Aga Khan University; Pakistán Fil: Patel, Archana. Indira Gandhi Government Medical College and Lata Medical Research Foundation; India Fil: Esamai, Fabian. University School of Medicine; Kenia Fil: Chomba, Elwyn. University of Zambia; Zambia Fil: Garces, Ana. Universidad de San Carlos; Guatemala Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Carlo, Waldemar A.. University of Alabama at Birmingahm; Estados Unidos Fil: Goldenberg, Robert L.. Columbia University; Estados Unidos Fil: Hibberd, Patricia L.. Massachusetts General Hospital for Children; Estados Unidos Fil: Liechty, Edward A.. Indiana University; Estados Unidos Fil: Krebs, Nancy F.. University of Colorado School of Medicine; Estados Unidos Fil: Hambidge, Michael K.. University of Colorado School of Medicine; Estados Unidos Fil: Moore, Janet L.. Research Triangle Institute International; Estados Unidos Fil: Wallace, Dennis D.. Research Triangle Institute International; Estados Unidos Fil: Derman, Richard J. Christiana Care Health Services; Estados Unidos Fil: Bhalachandra, Kodkany S.. KLE University. Jawaharlal Nehru Medical College; India Fil: Bose, Carl L.. University of North Carolina; Estados Unidos

Motor vehicle activity is growing rapidly in Indian cities, as in other Asian cities, with serious impacts, including deteriorating urban air quality. Motorized two-wheeled (M2W) vehicles, which provide affordable mobility to millions, form the bulk of the motor vehicle fleet and contribute significantly to transport emissions. Vehicle and fuel technologies are important and have been vastly improved since the 1990s. However, on the basis of an in-depth survey of vehicle users and an analysis of emerging trends in consumer preferences, policies, and industry plans, this paper demonstrates various important ways in which user preferences and choices relating to vehicle purchase, operation, and maintenance, interacting with institutional and technological factors, contribute to emissions and affect policy implementation, particularly with reference to M2W vehicles in India. The paper highlights the importance of considering the interaction of these factors, and how users and other actors are affected by and respond to policies, in more effectively addressing emissions from M2W vehicles and other vehicles, especially given in-use realities and constraints.

Carotid bodies are monitors of oxygen and glucose delivery to the brain. Faced with the threat of hypoxia or hypoglycemia carotid bodies initiate responses to counter the threat. General corrective action is to improve the perfusion by increasing the arterial blood pressure. Specific corrective actions are to stimulate ventilation to improve oxygen availability or to induce insulin resistance to raise blood glucose levels. Inappropriateness of response caused by misreading of hypoxia as hypoglycemia and hypoglycemia as hypoxia is observed experimentally and clinically. The response to all four types of hypoxia, namely, hypoxic, anemic, histotoxic and ischemic (or stagnant) hypoxia, is stimulation of ventilation and elevation of blood pressure. Ischemia produced by narrowing of the artery to the carotid body activates the carotid bodies. The activation produces hypertension, stimulation of ventilation and insulin resistance that manifests as non-insulin dependent diabetes mellitus. There is epidemiologic and necropsy evidence for the onset of atherosclerotic changes in childhood. Early atherosclerotic changes occurring in the region of carotid arteries and their bifurcation narrows the lumen of the arteries to the carotid bodies and produce hypo-perfusion of the carotid bodies. This ischemic hypoxia is a causative, or at least a permissive factor for hypertension and/or non-insulin dependent diabetes mellitus. It is suggested that neither non-insulin dependent diabetes mellitus causes hypertension nor hypertension causes diabetes mellitus, but both are caused by dysfunctional carotid bodies.

Two simple protocols for the synthesis of the easily separable trans/cis‐octahydroacridines are reported. These involve intramolecular aza‐Diels‐Alder reaction of N‐arylimines produced in situ from citronellal and aryl amines, either in the presence of 10 mol% TiCl3 or in trifluoroethanol without any additional catalyst.

Intramolecular reductive deoxygenation of ethylene-dioxy tethered symmetrical and unsymmetrical aromatic bis(carbonyl) ethers with the low-valent titanium (LVT) reagent (TiCl 4 -Zn-THF) yielded chromatographically separable E/Z-isomers of corresponding cyclic stilbenes which were further dealkylated to obtain geometrically pure hydroxystilbenes. The intramolecular McMurry coupling of the tethered bis(carbonyl) ethers with TiCl 3 -Li-THF, on the other hand, directly provided both symmetrical and unsymmetrical phenanthrenes via in situ dealkoxylation of the phenol function. This is the first report of the synthesis of unsymmetrical phenanthrenes by the LVT route.

Chronic hypoxia induces polycythemia, pulmonary hypertension, right ventricular hypertrophy, and weight loss. Hypoxia-inducible factor 1 (HIF-1) activates transcription of genes encoding proteins that mediate adaptive responses to hypoxia, including erythropoietin, vascular endothelial growth factor, and glycolytic enzymes. Expression of the HIF-1α subunit increases exponentially as O2 concentration is decreased. Hif1a–/– mouse embryos with complete deficiency of HIF-1α due to homozygosity for a null allele at the Hif1a locus die at midgestation, with multiple cardiovascular malformations and mesenchymal cell death. Hif1a+/– heterozygotes develop normally and are indistinguishable from Hif1a+/+ wild-type littermates when maintained under normoxic conditions. In this study, the physiological responses of Hif1a+/– and Hif1a+/+ mice exposed to 10% O2 for one to six weeks were analyzed. Hif1a+/– mice demonstrated significantly delayed development of polycythemia, right ventricular hypertrophy, pulmonary hypertension, and pulmonary vascular remodeling and significantly greater weight loss compared with wild-type littermates. These results indicate that partial HIF-1α deficiency has significant effects on multiple systemic responses to chronic hypoxia. J. Clin. Invest. 103:691–696 (1999)

Hypoxia-inducible factor 1 (HIF-1) mediates adaptive responses to hypoxia by activating the transcription of hundreds of target genes. The expression and activity of HIF-1 are oxygen-regulated, which provides a direct mechanism for transducing changes in cellular oxygenation to changes in gene expression. HIF-1 regulates the expression of genes encoding proteins that play key roles in mediating the switch to glycolytic metabolism, the induction of angiogenesis, and the production of survival factors that block ischemia-induced apoptosis. Induction of HIF-1 activity or administration of survival factors encoded by HIF-1 target genes may be of therapeutic benefit in patients with acute stroke.

Background: Interplay between wound resistance factors and bacterial innoculum determines the risk of surgical infection. Since cautery causes more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery than to infect wounds made with a scalpel. Methods: Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation current. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and abscess. Results: Coagulation current causes more inflammation, necrosis, and abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only after contamination reached 10 5 . Above this threshold most wounds were infected in all groups. Conclusions: Electric coagulation current should be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use are difficult to identify.

The hereditary disease Cockayne syndrome (CS) is a complex clinical syndrome characterized by arrested post-natal growth as well as neurological and other defects. The CSA and CSB genes are implicated in this disease. The clinical features of CS can also accompany the excision repair-defective hereditary disorder xeroderma pigmentosum (XP) from genetic complementation groups B, D or G. The XPB and XPD proteins are subunits of RNA polymerase II (RNAP II) transcription factor IIH (TFIIH). We show here that extracts of CS-A and CS-B cells, as well as those from XP-B/CS cells, support reduced levels of RNAP II transcription in vitro and that this feature is dependent on the state or quality of the template.

Exposure of rats to hypoxia (7% O2) markedly increased the level of heme oxygenase-1 (HO-1) mRNA in several tissues. Accumulation of HO-1 transcripts was also observed after exposure of rat aortic vascular smooth muscle (VSM) cells to 1% O2, and this induction was dependent on gene transcription. Activation of the mouse HO-1 gene by all agents thus far tested is mediated by two 5'-enhancer sequences, SX2 and AB1, but neither fragment was responsive to hypoxia in VSM cells. Hypoxia-dependent induction of the chloramphenicol acetyltransferase (CAT) reporter gene was mediated by a 163-bp fragment located approximately 9.5 kilobases upstream of the transcription start site. This fragment contains two potential binding sites for hypoxia-inducible factor 1 (HIF-1). A role for HIF-1 in HO-1 gene regulation was established by the following observations: 1) HIF-1 specifically bound to an oligonucleotide spanning these sequences, 2) mutation of these sequences abolished HIF-1 binding and hypoxia-dependent gene activation in VSM cells, 3) hypoxia increased HIF-1alpha and HIF-1beta protein levels in VSM cells, and 4) hypoxia-dependent HO-1 mRNA accumulation was not observed in mutant hepatoma cells lacking HIF-1 DNA-binding activity. Taken together, these data demonstrate that hypoxia induces HO-1 expression in animal tissues and cell cultures and implicate HIF-1 in this response.