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BackgroundThe medical tourism industry is currently popular in India, but there is no confirmation of the common perspectives among the country’s medical travelers. ObjectiveThis qualitative research study analyzed web-based narratives from health travelers visiting India and described the themes of their experiences. This study aimed to answer the following primary question: What can we learn about health travelers’ experiences in India from an analysis of their web-based narratives? The secondary questions were as follows: (1) What are the primary health care reasons for which patients in the examined narratives traveled to India? (2) What can be derived from the narratives regarding medical tourists’ satisfaction with the outcome and result of the treatment they received in India? (3) What are some positive and negative factors influencing medical tourists’ perceptions and overall experiences about their health travel to India? (4) What are the characteristics of medical tourists who write web-based narratives regarding their health experiences in India? MethodsPublicly available narratives written by medical tourists who visited India were obtained from a Google search. The narratives included blog posts and discussion board posts by medical tourists. The analysis process consisted of initial open coding being conducted on the narratives to create initial codes and identify common themes with a focus on the primary research question and subquestions. ResultsAlthough Mumbai, Chennai, and New Delhi were not the only destination cities mentioned, these were the most popular cities patients visited for care. The medical tourists, who stated their origin country, came from one of the following continents: Africa, Europe, North America, and Oceania. Dental care, Ayurveda treatment, and eye care were the most popular types of care that medical tourists sought. The results showed that most of the medical tourists were happy with the overall experience of receiving care in India. The most popular themes with regard to the patients’ satisfaction were low costs, good customer service, and services being offered that were unavailable in their home country. When negative feedback was provided, it was mainly concentrated on the overall environment of India being unorganized and unsanitary. ConclusionsPrimarily, the study’s findings can benefit health care providers and patients. Providers hosting medical tourists in India can use negative feedback to improve their services; similarly, providers who are losing patients to medical tourism can identify opportunities for improvement (ie, why are we losing patients). Indian providers hosting medical tourists should keep their prices competitive and continue to provide exceptional service; however, they should do their best to lessen the crowdedness of their facilities while making sure they are esthetically pleasing. Providers losing patients to medical tourism need to identify ways to ensure their services match the benefits that their international counterparts are providing, such as competitive pricing and expansion on the services provided.

Introduction: Pain scales are often used in peripheral nerve block studies but are problematic due to their subjective nature. Ultrasound-measured diaphragmatic excursion is an easily learned technique that could provide a much-needed objective measure of pain control over time with serial measurements.Case Series: We describe three cases where diaphragmatic excursion was used as an objective measure of decreased pain and improved respiratory function after serratus anterior plane block in emergency department patients with anterior or lateral rib fractures.Conclusion: Diaphragmatic excursion may be an ideal alternative to pain scores to evaluate serratus anterior plane block efficacy. More data will be needed to determine whether this technique can be applied to other ultrasound-guided nerve blocks.

Each human genome includes de novo mutations that arose during gametogenesis. While these germline mutations represent a fundamental source of new genetic diversity, they can also create deleterious alleles that impact fitness. Whereas the rate and patterns of point mutations in the human germline are now well understood, far less is known about the frequency and features that impact de novo structural variants (dnSVs). We report a family-based study of germline mutations among 9,599 human genomes from 33 multigenerational CEPH-Utah families and 2,384 families from the Simons Foundation Autism Research Initiative. We find that de novo structural mutations detected by alignment-based, short-read WGS occur at an overall rate of at least 0.160 events per genome in unaffected individuals, and we observe a significantly higher rate (0.206 per genome) in ASD-affected individuals. In both probands and unaffected samples, nearly 73% of de novo structural mutations arose in paternal gametes, and we predict most de novo structural mutations to be caused by mutational mechanisms that do not require sequence homology. After multiple testing correction, we did not observe a statistically significant correlation between parental age and the rate of de novo structural variation in offspring. These results highlight that a spectrum of mutational mechanisms contribute to germline structural mutations and that these mechanisms most likely have markedly different rates and selective pressures than those leading to point mutations.

Body composition (BC) is a valuable indicator of health and performance. Air-displacement plethysmography (ADP) is a popular, efficient, and reliable method for assessing BC. A-mode ultrasonography (AUS) is another method, and its affordability, mobility, and practicality make it a plausible device for industry and health professionals. This study assessed the cross-sectional and change relationships and agreements between AUS and ADP from a 12-week resistance exercise intervention designed to increase fat-free mass (FFM). BC was measured by both modalities pre/post-intervention. Twenty-nine normal weight males (age: 20.6 ± 2.2 years) participated. Both modalities tracked changes in FFM and % body fat (%BF) ([delta] ADP = 1.7 ± 1.5 kg, -0.4 ± 2.5%; [delta] AUS = 2.4 ± 1.9 kg, -1.4 ± 2.1%; main effects for time p < 0.005, respectively), with no differences between modalities (interactions p > 0.05), and were moderately significantly correlated (r = 0.58 and r = 0.60, p < 0.01). Bland-Altman plots revealed no proportional biases. These devices tracked changes in FFM and %BF similarly over time. Future research should assess AUS at different levels of adiposity.