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Student doctor method of clinical training or clinical clerkship provides students with exposure to the entire longitudinal illness of the patient. The students participate in patient care as a part of treating team and can refine their clinical, communication and procedural skills. It provides them with an opportunity to work with the faculty and experience the future workplace. Although the graduate medical education regulations (GMER) provide for student doctor method of training, the time provided is too little and opportunistic. Electives have also been recently added to the new curriculum for the first time. We propose a model to deliver the electives using the clerkship method, so as to consolidate what students learn from the ongoing clerkship. This model is feasible, practical and can be introduced in the current GMER for Indian medical undergraduates without any major disruptions.

Purpose In the past four decades, substantial air traffic growth has triggered enthusiasm in the aviation sector. At the same time, this growth has posed challenges to its financial and environmental sustainability commitments. A buzz has been centered on introducing and supporting aviation sustainability initiatives. These challenges have led to acknowledging the need to reduce aviation fuel consumption, a function of multiple factors. The different stakeholders having a diverse type of interplay govern the effective implementation of the factors at different decision levels (strategic, tactical and operational). Thus, the present study aims to critically examine various decision levels involved to understand opportunities and requirements related to aviation sustainability. Design/methodology/approach In this study, the best–worst method is used to quantify different decision levels’ role on various factors affecting aviation fuel consumption. Findings The results of this study signify that tactical-level decisions are most influential in reducing aviation fuel consumption with the highest impact (0.41) followed by operational-level decisions (0.30) and strategic-level decisions (0.29), respectively. Research limitations/implications The results point toward the critical role of middle-level hierarchy, i.e. aircraft manufacturers, airlines and others in the aviation industry’s sustainable growth. Thus, middle-level stakeholders must be inspired and empowered to act, being at the center they link the other two levels. Originality/value This study has added to the body of knowledge by exploring the decision-making competencies needed by different aviation sector stakeholders. It also presents the possible options available in the sector and the role of stakeholders at different levels in exploiting and implementing the sustainable aviation sector changes.

Background: Neonatal skin care practices that are often guided by personal experience and preferences result in substantial variation in the practices being followed across hospital settings. The objective of this consensus recommendations was to provide guidance to health care practitioners on evidence-based neonatal skin care practices for adoption in hospitals: from delivery to discharge.Methods: A Scientific Advisory Board meeting on “Evidence-based Neonatal Skin Care Practices and Protocols” was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynaecologists and a pediatric dermatologist were invited. A comprehensive literature search was performed using the PubMed and Google Scholar databases to source relevant evidence.Results: Recommendations were developed on critical aspects of skin care in healthy full-term neonates, including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, use of cleansers and emollients, and the criteria to choose appropriate skin care products. The newborn’s first bath should occur only once cardiorespiratory and thermal stability have been achieved, anywhere between 6 to 24 hours after birth. Bathing with water alone or water with a mild liquid cleanser demonstrated appropriate for newborn does not impact the developing skin barrier. The use of emollients to maintain and enhance skin barrier function was encouraged for neonates with risk factors that can affect skin barrier integrity. Skin assessment should become an integral part of routine neonatal care. Skin Care Advice with “Do’s and Don’ts” should be a part of the neonatal discharge checklist. The importance of rigorous quality control, high-quality clinical trials to evaluate the safety and efficacy of baby products, usage of products that contain only ingredients and which are formulated appropriately for newborn babies, and full label transparency for baby products were highlighted. The panel further identified gaps in the existing literature and discussed the scope for future research. Conclusions: The consensus recommendations may help standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings. This may also improve the quality of care that the neonates receive in the hospital and facilitate improvement in overall neonatal health outcomes.

Framing an appropriate research question is the most critical and fundamental part of a study. This helps in developing a hypothesis, formulating aims and objectives and methodological execution of the study. Research questions are usually generated by literature backed thorough analysis of the gaps in previous studies and funnelling it to a specific focussed issue. The research question should be framed using the PICO (Population, Intervention/Exposure, Comparator and Outcome) format and should fulfil the FINER (feasible, interesting, novel, ethically sound, and relevant) criteria for practical aspects. Objectives should always be framed in alignment of the research question using SMART (specific, measurable, achievable, realistic and time defined) approach. Outcomes are classified as primary and secondary. It is advisable to have only one primary objective while secondary objectives can be multiple (usually not exceeding five). This paper describes a cascade approach starting from framing the research question and then deciding on the outcomes and study objectives.

BACKGROUND Children 0-14 years constitute about 31.4% of Indian population, among whom the magnitude and risk factors of childhood injuries have not been adequately studied. OBJECTIVE To study the prevalence of and assess the factors associated with unintentional injuries among children aged 6 month - 18 years in various regions. METHODOLOGY This multi-centric, cross-sectional, community-based study was conducted at 11 sites across India. States included were Gujarat, Karnataka, Madhya Pradesh, Punjab, Sikkim, Tamil Nadu, Uttarakhand, and West Bengal between March, 2018 and September, 2020. A total of 2341 urban and rural households from each site were selected based on probability proportionate to size. The World Health Organization (WHO) child injury questionnaire adapted to the Indian settings was used after validation. Information on injuries was collected for previous 12 months. Definitions for types (road traffic accidents, falls, burns, poisoning, drowning, animal-related injuries) and severity of injuries was adapted from the WHO study. Information was elicited from parents/primary caregivers. Data were collected electronically, and handled with a management information system. RESULTS In the 25751 households studied, there were 31020 children aged 6 months-18 years. A total of 1452 children (66.1% males) had 1535 unintentional injuries (excluding minor injuries) had occurred in the preceding one year. The overall prevalence of unintentional injuries excluding minor injuries was 4.7% (95% CI: 4.4-4.9). The commonest type of injury was fall-related (842, 54.8%) and the least common was drowning (3, 0.2%). Injuries in the home environment accounted for more than 50% of cases. CONCLUSIONS The findings of the study provide inputs for developing a comprehensive child injury prevention policy in the country. Child safe school with age-appropriate measures, a safe home environment, and road safety measures for children should be a three-pronged approach in minimizing the number and the severity of child injuries both in urban and rural areas.

Lubricating additives play a pivotal role in automobiles and industrial machines. The present work describes the design and synthesis of three copolymeric lubricating additives using alkyl acrylates (Ac) and simulated feed containing 33% long-chain α-olefins (LCAO) in n-paraffins. The alkyl acrylates (C6, C10, and C16Ac) and α-olefins are taken in a 1:1 molar ratio, and the three different polymers P1, P2, and P3 are synthesized in a solvent-free medium by the free radical polymerization using benzoyl peroxide (BPO) as initiator. The polymeric additives (P1, P2, and P3) are blended with base oils, and their performances, such as density, pour point, viscosity index (VI), and corrosion properties were studied. The synthesized polymeric additives are miscible with base oils excellently, and they do not change the density of base oil and depress the pour point of the base oils. All the polymeric additives are successful in depressing the pour points of base oils. The pour point of BO-1 is −21, and the use of P1 depresses the pour point to ≤ 27 at 4000 ppm. However, P3 exhibits the best performance even at low concentration (2000 ppm) by depressing the pour point value to ca. 12 °C and 15 °C in case of BO-2, BO-3, respectively. In terms of viscosity index, P1 shows the better results at 6000 ppm concentration by increasing the VI by 13.9% compared to P2 and P3, which is a maximum increase in VI among different base oils used for study. Increasing the concentration of polymeric additives in base oils reduces the corrosion as per the standard corrosion test method ASTM D130-12. Synthesis of the copolymeric additives composed of alkyl acrylates and LCAO under solvent-free conditions by the free radical polymerization, which shows a potential eco-friendly additive for base oils, was demonstrated. The alkyl acrylate and LCAO appendage on polymeric additive enabled better miscibility and transparency with base oils and without modifying the nature of base oils. Polymeric additive blended base oils show superior properties in terms of increasing the viscosity index, depressing the pour point and anticorrosion. This has the potential of exploration in pour point depressants in petroleum industry.

Medical Council of India (MCI) implemented competency-based curriculum for undergraduate medical education nationwide in 2019, with assessment of competencies being its integral component. The curriculum has outlined some broad principles and components of assessment, but the process and schedule for formative and summative assessment is to be decided by the universities and institutions. In this document, we summarize the recommendations for the subject of Pediatrics, and propose an assessment model for summative assessment that can be adapted/adopted by universities and institutions. Few basic principles of formative assessment have been shared, the implementation of which may be the main challenge for the institutions. It is important to develop the capacity of the faculty for conducting the assessment under the ambit of principles of competency-based curriculum.

Justification The COVID-19 pandemic has affected schooling for more than 24 crores students, since March 2020. Students need a respite from the long standing social isolation so that they regain their chance to develop holistically, but after the devastating effects of the second wave, the administrators as well as parents are skeptical about the decision of school reopening. Process The Indian Academy of Pediatrics constituted a task force comprising of national and international experts in the field who deliberated on the issue. Objectives To bring out scientifically supported guidelines on the prerequisites of opening and attending the schools, in the current context of the COVID-19 pandemic. Recommendations The task force recommends i) Decentralization of the school reopening decision; ii) Three epidemiological parameters, case positivity rate (60% of the vaccine-eligible population) to be met at the local level, before the schools reopen; and iii) Criteria regarding health and vaccination to be met by the schoolattendees.

SARS-CoV-2, the virus that causes the COVID-19 infection, has been linked to all sorts of long-term health issues.Diabetes mellitus has a bidirectional relationship with COVID-19. Poorly controlled diabetes increases the severity of COVID-19 and is associated with increased morbidity and mortality. COVID-19 pandemic has also resulted in poor control of diabetes, progression of prediabetes to diabetes, increase in number of new onset diabetes.

Breast cancer causes the cells in the breast to grow in an uncontrolled manner. Countless research has been conducted to enhance the timely diagnose of breast cancer, which expands the likelihood of survival and hence the survival rates. Mammography photographs were the focus of the majority of the investigation. Early detection of cancer is frequently delayed because symptoms are frequently not visible during the early stages of cancer. Mammography scans, on the other hand, can sometimes produce false positives, putting the patient health in danger. Different techniques, which are simpler to implement and perform better with different data sets, are needed to develop more reliable and safer forecasts. Healthcare data is huge and unstructured. Machine learning has long been the methodology of choice in breast cancer pattern classification and forecast modelling because of its distinct benefits based on feature identification from a comprehensive breast cancer dataset. The study evaluates and compares the results of seven different ML algorithms based on different performance metrics.

Justification With the unprecedented COVID-19 pandemic and the resultant school closure, children all over the country are undergoing a lot of educational, psychosocial, and physical problems. There is an urgent and deep felt need to offer scientific and concrete guidance for these concerns and support children in their educational development during these testing times. Objectives To review the guidelines and recommendations given by various international agencies and formulate guidelines in the Indian context on (a) how and when to reopen the schools; (b) ways and means of remote learning; and (c) to identify the contents of curriculum that need restructuring in context of the current situation. Process Indian Academy of Pediatrics (IAP) formed a task force of pediatricians, educationists and technological experts who connected through various video and social platforms. They gathered and exchanged information and thoughts. The writing committee drafted the guidelines and got approval of all the members of the task force. Recommendations Schools can be reopened only when the local epidemiological parameters are favorable, the administration is equipped with adequate infrastructure and health care facilities, and the stakeholders (teachers, students, parents, and support staff) are prepared for the new normal. In the meanwhile, remote learning (media-based and /or otherwise) should reach to the last student to maintain uninterrupted education. The curriculum needs to be revised, with focus on revision and core contents. Informal learning of psychosocial empowerment and daily living skills should be encouraged rather than stressful formal learning.

Justification In view of new developments in vaccinology and the availability of new vaccines, there is a need to revise/review the existing immunization recommendations. Process Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP) had a physical meeting in March, 2020 followed by online meetings (September-October, 2020), to discuss the updates and new recommendations. Opinion of each member was sought on the various recommendations and updates, following which an evidence-based consensus was reached. Objectives To review and revise the IAP recommendations for 2020–21 and issue recommendations on existing and new vaccines. Recommendations The major changes include recommendation of a booster dose of injectable polio vaccine (IPV) at 4–6 years for children who have received the initial IPV doses as per the ACVIP/IAP schedule, re-emphasis on the importance of IPV in the primary immunization schedule, preferred timing of second dose of varicella vaccine at 3–6 months after the first dose, and uniform dosing recommendation of 0.5 mL (15 µg HA) for inactivated influenza vaccines.

PurposeConsiderable amount of purchases in business-to-business (B2B) markets make through the tendering process. As technology keeps driving B2B procurement, both the supplier/contractor and buyer firms have settled down in their respective roles in the electronic-tendering environment. Researchers have ignored the supplier-side e-tender-driven marketing process that might lead to substantively successful financial performance. The purpose of this study is to improve the performance of an e-tender-driven marketing process of an original equipment manufacturer (OEM) incorporating the stakeholder's inputs.Design/methodology/approachDiscrete event simulation modelling (DESM) has been used as a methodology to model, analyse and improve the process with the involvement of stakeholders at every stage of the study. Different scenarios are analysed to identify the near-optimal scenario based on agreed-upon key performance indicators.FindingsScenario that incorporated man-power sharing and eliminating avoidable activities gives the near-optimal solution for implementation.Research limitations/implicationsThis study highlights that better insights can be gained by adopting the process-oriented view of the marketing–operations interface. Embracing a stakeholder-based consultative approach gives research a more practical outlook and reduces the gap between theory and practice. Suggestions for further research are provided.Practical implicationsB2B organizations, where lines between marketing and operations are blurred, can improve their marketing processes by implementing operations research tools.Originality/valueThis study provides an attempt to improve the performance of a supplier-side e-tender-driven marketing process of an OEM using the DESM methodology incorporating stakeholder's inputs.

Biochar is a carbon-rich material obtained after thermochemical conversion of biomass under no oxygen environment. The effect of biochar amendment on soil properties, such as water retention, infiltration and desiccation crack potential was studied in the recent years. However, the effect of biochar or feedstock type on these properties is not explicit. This study investigates the effect of two different (in terms of feedstock) types of biochar on the water retention, infiltration and desiccation cracking behavior of compacted silty sand. Water retention characteristics, infiltration rate and the progression of desiccation cracks were measured after compacting soil amended with 5–10% (w/w) biochar produced from water hyacinth (WHB) and mesquite. Measurements were also taken for an unpyrolyzed material coir pith (CP, sourced from coconut husk)-amended soil for comparing the results of biochar-amended soil. The results show that the amendment of 5% to 10% biochar increased the maximum water holding capacity (θs), air entry value (AEV) and water content at 1500 kPa (θ1500) of the soil, whereas decreased the infiltration rate and peak crack intensity factor (CIF) of the soil. Moreover, the application of CP increased the infiltration rate. The amendment of WHB showed the highest increment in AEV and θ1500 and the highest decrement in infiltration rate and CIF compared to the other amendments. Based on the results, it is advisable to use the WHB-amended soil in bioengineered structures that could promote the growth of vegetation by higher water retention and could reduce the potential of leachate formation by decreasing water infiltration and desiccation crack potential.

The goal for making this paper on conglomerates is to introduce the rising trend of conglomerates in big companies. This paper shall introduce what might be the reasons for Conglomerates, and their increasing trends. What are the benefits that companies enjoy being a conglomerate and what might be the disadvantages for it too? Further, the conglomerates are classified in two types, which are also explained with examples. Then we have taken examples of many companies to explain details about conglomeration. At the end there is a case study on Facebook, about how it acquired some companies and what the effects on both companies actually were, in terms of growth and benefit. Keywords: Conglomerate, Market share, MNC, Facebook, Expansion, Diversification.

Objective To determine the prevalence and practices of exposure to screen-based media in children by 15-18 months of age. Methods This observational descriptive study was conducted from March to August, 2019. Mothers of 370 healthy developmentally normal children (15-18 months of age) were enrolled during their visit to immunization clinic of a medical college affiliated hospital. Parental response to a semi-structured questionnaire was recorded to assess the initiation, frequency and duration of screen exposure, and related parental perceptions. Results 369 (99.7%) children were exposed to screen-based media till 18 months of age, starting from median (IQR) age of 10 (8, 12) months. Smartphone and television were being viewed by 354 (96%) and 328 (89%) children, respectively. Screen time was >1 hour/day in 328 (88.7%) and >2 hours/day in 209 (56.5%) children (median (IQR): 120 (80, 180) minutes/d). Most (72%) parents were not concerned with their child's screen time. Conclusion Almost all young children seem to be exposed to screen-based media by 18 months of age in the urban setting. Extensive use of screen-based media by young children calls for formulation of guidelines on toddlers' screen use and their dissemination to parents.

Objective:To determine the prevalence and predictors of hypocalcaemia in under-five children (1–59 months) hospitalised with severe acute malnutrition (SAM).Design:A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) Setting:A tertiary care hospital in Delhi, between November 2017 and April 2019.Participants:One-hundred and fifty children (1–59 months) hospitalised with SAM were enrolled.Results:Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged P = 0·887). Vitamin D deficiency (serum 25-(OH)D P < 0·001), abdominal distension (OR 4·5, 95 % CI 1·39, 14·54, P = 0·012) and sepsis (OR 2·6, 95 % CI 1·00, 6·57, P = 0·050).Conclusion:Rickets and hypocalcaemia are common in children with SAM. Routine supplementation of vitamin D should be considered for severely malnourished children. Ca may be empirically prescribed to severely malnourished children with clinical rickets, abdominal distension and/or sepsis.

This paper presents a novel concept to enhance the reconfigurability issues (i.e. convertibility, flexibility, etc.) of a small-scale reconfigurable machine tool (RMT) by combining multiple modules (both basic and auxiliary parts) and manufacturing operations on a single workstation. The proposed reconfigurable machine will reduce the overall space, transport time, ramp up time, reconfiguration time and interim storage space. Further, various characteristics of reconfigurability (such as scalability; convertibility, flexibility, etc.) and enablers of the machine tool have been discussed. The proposed design is illustrated with a figure, which is designed on a 3D design tool (solid-works software platform).This machine tool will perform six major cutting and finishing operations, namely, hacksaw cutting, milling, drilling, grinding, buffing and lathe operations on a single work platform.

Background: Multiple-choice question (MCQ) is frequently used assessment tool in medical education, both for certification and competitive examinations. Ill-constructed MCQs impact the utility of the assessment and thus the fate of examinee. We conducted this study to ascertain whether a short training session for faculty on MCQ writing results in desired improvement in their item-writing skills. Methods: A 1-day workshop on constructing high-quality MCQs was conducted for the faculty as a before-after design, following training session of 3 h duration. 28 participants wrote preworkshop (n = 133) and postworkshop (n = 137) MCQs, which were analyzed and compared for 17 item-writing flaws. A mock test of 100 MCQs (selected by stratified random sampling from all the MCQs generated during the workshop) was conducted for MBBS-passed students for item analysis. Results: Item-writing flaws reduced following the training (15% vs. 27.7%, P < 0.05). Improvement mainly occurred in quality of options; heterogeneity dropped from 27.1% prior to the workshop to 5.8% postworkshop. The proportion of MCQs failing the cover test remained similarly high (68.4% vs. 60.6%), and there was no improvement in writing of the stem before and after the workshop. The item analysis did not reveal any significant improvement in facility value, discriminating index, and proportion of nonfunctioning distractors. Conclusion: A single, short-duration faculty training session is not good enough to correct flaws in writing of the MCQs. There is a need of focused training of the faculty in MCQ writing. Courses with a longer duration, supplemented by repeated or continuous faculty development programs, need to be explored.

PurposeE-government quality (e-GovQual) and e-government user value (e-GUV) are multidimensional concepts. While previous studies have identified apparent factors influencing e-government satisfaction (e-GovSat) and e-government adoption intention (e-GovAI), such as e-GovQual and e-GUV, but they have neglected to explain the influence of the dimensions of these two concepts. The purpose of this research is to study e-government service value chain (e-GSVC) one-GovQual dimensions, e-GUV dimensions, e-GovSat and e-GovAI.Design/methodology/approachThe study employs a quantitative method to test the hypotheses and validate the proposed model. Data are collected from 378 e-government users across different parts of India comprising of different demographic characteristics. The model is analyzed using structural equation modeling.FindingsThe findings highlight the impact of the dimensions of e-GovQual (efficiency, trust, reliability and citizen support) on the dimensions of e-GUV (functional, economic, social and emotional value) as e-GUV dimensions affect e-GovSat, which in turn influences e-GovAI. The results validate the e-GSVC and also stress the partial mediating role of the dimensions of e-GUV on the relationship between the dimensions of e-GovQual and e-GovSat.Research limitations/implicationsThe sample size of 378 may not be a proper representation of a country like India, which has huge diversity within its vast population.Practical implicationsThe study offers practitioners a clear picture and a useful guide to better understand the drivers of value, satisfaction and adoption in the case of e-government users.Originality/valueThis study is probably the first attempt toward demonstrating the process influencing e-GovSat via e-GUV dimensions originating from excellent e-GovQual dimensions to ultimately trigger e-GovAI.