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Introduction: There is dearth of information regarding the status of patient safety culture in Bhutanese healthcare system. The aim of the study was to assess the baseline patient safety culture among the healthcare professionals working in different levels of hospitals in Bhutan. Methods: A cross-sectional study was conducted using the Hospital Survey on Patient Safety, version 2 (HSOPS2) questionnaire in 2021 in six District Hospitals (DHs), two Regional Referral Hospitals (RRHs), and one National Referral Hospital (NRH) in Bhutan. A total of 782 healthcare professionals were recruited into the study. EpiData version 3.0 and Statistical Package for Social Science (SPSS) version 28.0 were used to process data and conduct the statistical analysis on survey data including descriptive statistics and validity and reliability of survey. The internal consistency reliability of each composite measure was assessed by calculating Cronbach’s alpha score. Results: The overall level of patient safety culture was 61.28% (95% CI: 113.26, 115.27) and the percentage scores for the ten patient safety dimensions ranged from 45.13% to 82.65%. The dimension, “Teamwork within the hospital units” had the highest positive score while the dimensions, “Staffing and work pace” and “Reporting patient safety events” had the lowest positive scores. Conclusions: The healthcare professionals working in hospitals in Bhutan had average patient safety culture. To improve patient safety culture, more emphasis should be given on human resource management, patient safety event reporting system, hospital management support for patient safety and quality improvement initiatives and creating an environment that promote just and learning culture.

The functional Scale for the Assessment and Rating of Ataxia (f-SARA) assesses Gait, Stance, Sitting, and Speech. It was developed as a potentially clinically meaningful measure of spinocerebellar ataxia (SCA) progression for clinical trial use. Here, we evaluated content validity of the f-SARA. Qualitative interviews were conducted among individuals with SCA1 (n = 1) and SCA3 (n = 6) and healthcare professionals (HCPs) with SCA expertise (USA, n = 5; Europe, n = 3). Interviews evaluated symptoms and signs of SCA and relevance of f-SARA concepts for SCA. HCP cognitive debriefing was conducted. Interviews were recorded, transcribed, coded, and analyzed by ATLAS.TI software. Individuals with SCA1 and 3 reported 85 symptoms, signs, and impacts of SCA. All indicated difficulties with walking, stance, balance, speech, fatigue, emotions, and work. All individuals with SCA1 and 3 considered Gait, Stance, and Speech relevant f-SARA concepts; 3 considered Sitting relevant (42.9%). All HCPs considered Gait and Speech relevant; 5 (62.5%) indicated Stance was relevant. Sitting was considered a late-stage disease indicator. Most HCPs suggested inclusion of appendicular items would enhance clinical relevance. Cognitive debriefing supported clarity and comprehension of f-SARA. Maintaining current abilities on f-SARA items for 1 year was considered meaningful for most individuals with SCA1 and 3. All HCPs considered meaningful changes as stability in f-SARA score over 1-2 years, 1-2-point change in total f-SARA score, and deviation from natural history. These results support content validity of f-SARA for assessing SCA disease progression in clinical trials.

Abstract Identifying the drivers of population declines in migratory species requires an understanding of how individuals are distributed between periods of the annual cycle. We built post- (fall) and pre-breeding (spring) migratory networks for the blackpoll warbler (Setophaga striata), a Neotropical-Nearctic songbird, using tracking data from 47 light-level geolocators deployed at 11 sites across its breeding range. During pre-breeding migration, two stopover nodes (regions) on the U.S. eastern seaboard received high scores in our network metrics (betweenness centrality and time-adjusted node weight), likely acting as key refuelling areas for most of the global blackpoll warbler population before their multi-day flights over the Atlantic Ocean. During post-breeding migration, highly ranked stopover nodes in the southeastern U.S. acted as a geographical bottleneck before birds dispersed to their boreal breeding destinations. Nodes located in northern Colombia and Venezuela were also ranked highly during both migrations and were likely used to prepare for (pre-breeding) and recover from (post-breeding) Atlantic flights. Blackpoll warblers showed a crosswise migration pattern, whereby individuals from western breeding populations tended to spend the nonbreeding season in the eastern part of the nonbreeding range and vice-versa. Despite this, the strength of migratory connectivity between the breeding and nonbreeding grounds ranged from moderate to low, largely because many individuals used more than one node during the ‘stationary’ nonbreeding period. Our results suggest that the number of breeding populations affected by a threat in the blackpoll warbler’s range will strongly depend on where and when this threat occurs. Consequently, our migratory network should be key to inform future conservation planning and population monitoring efforts.

Abstract This research takes on a crucial task- exploring the optimal placement of Renewable Distributed Generators such as Solar Photovoltaic, wind turbines and Electric Vehicles into the Radial Distribution System (RDS). This is a strategic move aimed at minimising power loss (PLoss) and improving the voltage profile and stability index. The RDGs are integrated into RDS with and without considering the uncertainty of the different load demands for 24 h. The probability function of Beta and Weibull distribution functions are employed to attain the solar irradiance and wind speed in a particular region. In addition, EVs are also integrated into RDS, employing meta-heuristic algorithms intended to reduce power loss (PLoss) and improve the voltage profile. The study uses an Indian 28-bus test system mimicking a balanced radial distribution network to integrate distributed generators (DGs) and EV charging stations. The simulated results demonstrate that integrating DGs into power systems has offered considerable benefits, including reduced PLoss, heightened efficiency, decreased dependency on centralised generation, and improved environmental sustainability. It is discovered that the Multi-population Evolution Whale Optimization Algorithm (MEWOA) produces better results than other methods in the literature and is valuable and practical for handling these nonlinear optimisation situations.

An online questionnaire investigating the attitudes of Bhutanese school leaders towards inclusive education was conducted in 2016. The respondents were 20 school leaders, 16 males and 4 females, with an average age of 41 years, and teaching experience ranging from 8 to 32 years. Responses revealed that this group of school leaders had generally positive attitudes towards inclusive education; however, they were uncertain about including children with high support needs resulting from socio-emotional, cognitive and behavioural difficulties. Results confirmed that the school leaders' religious beliefs did not negatively influence their perceptions of disability and inclusive education. The findings from this exploratory study highlight the need for a legal and educational framework to underpin inclusive education in Bhutan. Such a framework will guide the provision of adequate professional learning for school leaders, appropriate resourcing, and the implementation of further systemic support.

This article contributes to the growing body of literature on the methods and techniques that might be used to help ensure the cultural integrity and rigor of research that has a cross-cultural dimension. Drawing upon our experiences while conducting a study investigating patient safety concerns in Bhutan, we will reflect on how the study was conceptualized and framed around the elements of the Bhutanese traditional cultural values; how the researchers were positioned; and how the intercultural perceptions, representations, languages, and attitudes influenced the fieldwork processes. It is anticipated that the approach described in this article will help qualitative researchers to understand how important it is to recognize and be responsive to the cultural and linguistic nuances of given research settings to achieve cultural integrity.

The construction industry in developing countries faces significant challenges, including limited resources, infrastructure constraints, and varying levels of technological readiness, which hinder the adoption of Building Information Modelling. Despite the recognized benefits in enhancing project efficiency, reducing costs, and improving collaboration, there is a lack of comprehensive understanding and tailored strategies for Building Information Modelling implementation in these contexts. This study aims to address these gaps by systematically reviewing Building Information Modelling adoption literature from 2013 to 2023 and developing a model specifically designed to guide its integration in developing nations. It categorizes nations by demographic and economic parameters and employs thematic analysis to explore benefits, challenges, and strategies. The study develops a tailored Building Information Modelling adoption model, by highlighting the dynamic interplay between adoption, contextual and strategic factors, technological advancement and socio-economic development and synthesizing key insights from academic literature and empirical findings. It offers strategic recommendations for nations at different Building Information Modelling integration stages, addressing their unique socio-economic and environmental contexts. The study identifies trends in utilization and highlights significant gaps, particularly in empirical, educational and strategic initiatives on digital construction transformation.

Students preferentially absorb and process information in diverse ways. Pedagogy should vary accordingly. The knowledge of teachers on the learners' preferred learning styles plays a pivotal role in better teaching and learning processes, contributing to a better-quality education. Still, little is known about the preferred learning style of learners. In the present study, the VARK (visual, aural, read or write, kinaesthetic) model version 8.01 survey questionnaire was adapted and given to 215 middle and higher secondary students. Using descriptive analysis of correlation, frequency and percentage, the study revealed that the preferred learning styles of students are aural (A) and kinaesthetic (K) with the smallest preference given to visual (V). The findings showed that male and female participants' preferences were the same, and that high-achiever learners prefer K. Recommendations from the findings apply to both the classroom and teacher training opportunities.

The study explored the use of Flipped Classroom (FC) approach in learning Economics by grade X students at Gaselo Higher Secondary School, Wangduephodrang, Bhutan employing a quasi-experimental design. The study found a significant mean difference between control (M = 9.5200, SD = 2.21491) and experiment group (M = 14.2273, SD = 3.48252) and the independent sample t-test indicated that this mean difference was significantly greater than zero [t(78) = 1.994, p = 0.000 < 0.05]. Further, the Wilcoxon Signed Rank Test (Z = - 3.933, p < 0.001) and the one-way ANOVA (p < 0.05 [F(1, 78) = 38.447, p = 0.000]) revealed that there was a statistical significant difference in mean scores of the experiment and control groups. Thus, FC approach was effective in learning economic subjects and was also more effective than traditional face-to-face teacher centered learning. It is recommended that FC approach should be used as one of the most effective approaches to teach and learn economics. However, the present study focused on only grade X students, so a study may be carried out across the school to have a broader understanding of the subject.

This research study surveyed 100 undergraduate teacher education students in a regional university in Australia, explored self-reported perceptions of their knowledge about students with exceptional needs, and their competence to be effective educators of these students in an inclusive classroom. Additionally, we included a measure of general attitude toward teaching in an inclusive classroom. What made this exploratory study atypical was broadening the concept of 'exceptionality' to the inclusion of items related to students with physical and cognitive challenges, superior academic gifts and those deemed to be twice exceptional. The results were unexpected in that teachers' age, parental status and exposure to units of study in special and inclusive education did not differentiate their knowledge, perceived competence, or general attitude.

Presenting Natovenator polydontus, a non-avian dinosaur from the Upper Cretaceous of Mongolia displaying morphology indicative of swimming behaviour.

Abstract Dichloroacetic acid (DCA), an organohalide that present in environmental sample and biological systems, got high attention for its therapeutic potential as the inhibitor of pyruvate dehydrogenase kinase (PDK), elevated in obesity, diabetes, heart disease and cancer. Herein, we developed a Cobalt conjugated carbon quantum dots (N-CQDs/Co) that selectively detect DCA by fluorescence “turn-on” mechanism. Utilizing TEM, DLS, UV–vis and fluorescence spectroscopy, the mechanism has been thoroughly elucidated and is attributed to disaggregation induced enhancement (DIE). The limit of detection of the N-CQDs/Co complex is 8.7 µM. The structural characteristics and size of the N-CQDs and N-CQDS/Co complex have been verified using FT-IR, XPS, HRTEM, DLS, EDX have been performed. Additionally, the complex is used to specifically find DCA in the human cell line and in zebrafish.Journal instruction requires a city for affiliations; however, these are missing in affiliation [4]. Please verify if the provided city is correct and amend if necessary.Kharagpur is the city. The address is okay.

Inclusive education is a relatively new educational concept in Bhutan. Teachers play a critical role in the successful implementation of educational change. Investigating teachers' attitudes towards inclusion was conducted through an online survey. Respondents included 145 teachers (70 male and 75 female) from eight schools from across eight different districts in Bhutan, representing a return rate of 57%. Data were analysed using Rasch latent trait scaling techniques ("Proquest") to determine the face validity of the survey. Case estimates from Rasch were incorporated into further analysis adopting the R statistical environment. Significant differences of attitude were detected based on gender (Pr(Chi) = 0.031); teacher qualifications (Pr(Chi) = 0.005); and experience of teaching children with special education needs (SEN) (Pr(Chi) = 0.018). The slightly positive attitude towards inclusion, measured by a 38-item questionnaire on a six-point scale, showed a mean average score of 3.965. Teachers' satisfaction of teaching children with SEN was positive (73%). The study also revealed the need for safer playgrounds, accessible toilets, less crowded classrooms, and greater education for teachers and support staff. These findings inform future policies and advancement of inclusive education in Bhutanese schools.

The Kingdom of Bhutan is endowed with abundant water resources. However, owing to rugged topography and associated climatic variations, accessibility remains a major challenge with communities facing seasonal and local scarcity of water. Generally, freshwater appears in the form of glaciers, lakes, wetlands, marshes, springs, and streams which support diverse life and livelihood. However, comprehensive inventories of water resources seem lacking in a water-rich country like Bhutan. Thus, water sources inventory was carried out using Focus Group Discussion and semi-structured questionnaires survey with 81 households (27 villages) from three highly populated gewog under Sarpang district in 2016 and collected the geo-coordinates (location) of each water source using Garmin GPS. The survey recorded a total of 104 perennial water sources from three gewogs under the district. Among the three gewogs, Samtenling and Dekiling have the highest water sources (n = 40) and Gelephu has the lowest (n = 24). While, in the case of source types, Samtenling gewog has the highest (n = 29), followed by Gelephu (n = 18) and Dekiling has the lowest (n = 14). Likewise, Dekiling has the highest number of streams (n = 24), followed by Samtenling (n = 9) and the lowest was Gelephu (n = 6). Therefore, periodic monitor of existing water sources, strengthening water governance, and adaptation of an integrated watershed management plan backed with detailed hydro-geological assessment covering entire watersheds are suggested for ensuring sustainable management of water sources, but also mitigates the climate change effects of these regions in the future.

Objectives: Compare pain intensity at entry into the cervical os, during uterine distension and 15 min after the procedure, in patients undergoing diagnostic hysteroscopy with room temperature normal saline versus that with saline warmed to 38–40°C, using visual analog scale (VAS) score. Furthermore, compare the time taken and failed procedures between them. Materials and Methods: This was a randomized controlled, prospective study conducted at a Tertiary Care Center on 100 patients planned for diagnostic hysteroscopy with a 4 mm 30° hysteroscope using vaginoscopy technique. They were divided into two groups of 50 each, with control undergoing the procedure using normal saline at room temperature and the test with saline warmed to 38–40°C as distension medium. Primary outcomes were VAS at the point of entry into the internal os (T0), 1 min later (T1), and 15 min after the procedure (T15). Secondary outcomes were procedural acceptance, time taken, and failed procedures. Results: The mean VAS in the control group at T0, T1, T15 was 3.31 (1.461;‒0.870–0.245), 2.46 (1.398;‒0.539–0.498), 0.75 (0.911;‒0.379–0.338), respectively, as compared to the test group of 3.62 (1.282;‒0.870–0.245), 2.48 (1.148;‒0.540–0.498), 0.77 (0.911;‒0.379–0.379), respectively. About 73.5% of controls and 68.8% in the test group were willing to undergo the procedure again. About 93.9% of controls would recommend it further as against 93.8% among the test controls. The time taken and number of failed procedures showed no statistical difference. Conclusion: No significant difference was noted in terms of outcomes measured by warming the distension medium.

Abstract A new ankylosaurid dinosaur, Tarchia tumanovae sp. nov., has been recovered from the Upper Cretaceous Nemegt Formation of Mongolia. It includes a well-preserved skull, dorsal, sacral, caudal vertebrae, sixteen dorsal ribs, ilia, a partial ischium, free osteoderms, and a tail club. The squamosal horns of T. tumanovae are divided into two layers, the external dermal layer and the underlying squamosal horn proper. The irregular ventral margin of the base of the upper dermal layer may represent a resorption surface, suggesting that the squamosal horns of some ankylosaurids underwent extreme ontogenetic remodeling. Localized pathologies on the dorsosacral ribs and the tail provide evidence of agonistic behaviour. The tail club knob asymmetry of T. tumanovae resulted from restricted bone growth due to tail club strikes. Furthermore, T. tumanovae had an anteriorly protruded shovel-shaped beak, which is a morphological character of selective feeders. Ankylosaurid diets shifted from low-level bulk feeding to selective feeding during the Baruungoyot and the Nemegt “age” (middle Campanian-lower Maastrichtian). This ankylosaurid niche shifting might have been a response to habitat change and competition with other bulk-feeding herbivores.

Abstract Implementing different tools and injury mechanisms in multiple animal models of retina regeneration, researchers have discovered the existence of retinal stem/progenitor cells. Although they appear to be distributed uniformly across the vertebrate lineage, the reparative potential of the retina is mainly restricted to lower vertebrates. Regenerative repair post‐injury requires the creation of a proliferative niche, vital for proper stem cell activation, propagation, and lineage differentiation. This seems to be lacking in mammals. Hence, in this review, we first discuss the many forms of retinal injuries that have been generated using animal models. Next, we discuss how they are utilized to stimulate regeneration and mimic eye disease pathologies. The key to driving stem cell activation in mammals relies on the information we can gather from these models. Lastly, we present a brief update about the genes, growth factors, and signaling pathways that have been brought to light using these models.

Objective The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. Methods We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. Results We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. Conclusion In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Objective Laparoscopy has now become a state-of-the-art technique for many diagnostic and therapeutic procedures with known advantages over laparotomy. There is scarce literature from India regarding minilaparoscopy, as per our literature review. Therefore, we performed this study with a 2.9-mm laparoscope to determine its feasibility and efficacy for diagnostic purposes and level II surgeries with the aim of reducing postoperative pain and better cosmesis. Methods This was a prospective study conducted from June 2019 to March 2020. Diagnostic modern minilaparoscopy with a 2.9-mm telescope was performed under general anesthesia by a single surgeon. Operative intervention was performed depending on the intraoperative findings. Results The mean age was 29.3 years. The most common indication for laparoscopy was infertility (98%). Only diagnostic laparoscopy was performed in 76% of patients, while 24% underwent operative laparoscopy. The various operative procedures performed were cystectomy, salpingectomy, ovarian drilling, and adhesiolysis. The mean visual analog scale scores at 1 hour and 2 hours postoperatively and discharge were 1.57±0.59, 1.41±0.51, and 1.29±0.47, respectively. Mild pain was present in 70 (72.2%) patients at the time of discharge, and only one patient had severe pain. Five or more analgesic tablets were required in only 16.5% of patients in the postoperative period. There was no wound infection or port-site hernia at follow-up. Conclusion Modern minilaparoscopy with a 2.9-mm laparoscope is a feasible and safe option for diagnostic laparoscopy and level II gynecological procedures with minimal postoperative morbidity, such as pain and wound infection, and provides good cosmetic outcomes.

Abstract The furcula is a distinctive element of the pectoral skeleton in birds, which strengthens the shoulder region to withstand the rigor of flight. Although its origin among theropod dinosaurs is now well-supported, the homology of the furcula relative to the elements of the tetrapod pectoral girdle (i.e., interclavicle vs clavicles) remains controversial. Here, we report the identification of the furcula in the birdlike theropod Halszkaraptor escuilliei. The bone is unique among furculae in non-avian dinosaurs in bearing a visceral articular facet in the hypocleideal end firmly joined to and overlapped by the sternal plates, a topographical pattern that supports the primary homology of the furcula with the interclavicle. The transformation of the interclavicle into the furcula in early theropods is correlated to the loss of the clavicles, and reinforced the interconnection between the contralateral scapulocoracoids, while relaxing the bridge between the scapulocoracoids with the sternum. The function of the forelimbs in theropod ancestors shifted from being a component of the locomotory quadrupedal module to an independent module specialized to grasping. The later evolution of novel locomotory modules among maniraptoran theropods, involving the forelimbs, drove the re-acquisition of a tighter connection between the scapulocoracoids and the interclavicle with the sternal complex.

The coronavirus disease (COVID-19) pandemic is a global health crisis that negatively impacts the health infrastructure by diverting resources to manage this infection. The long-term impact on the health of patients due to a lack of appropriate medical care to avoid COVID-19 infection is already visible in the mortality rates of the general population. The presence of the severe acute respiratory syndrome coronavirus 2 in the female genital tract is not clear. Bubbles produced during hysteroscopy tend to cool down to the temperature of the distension medium and then dissolve. Hence, aerosols are not produced during hysteroscopy, which is usually performed in an office setting. If anesthesia is required, conscious sedation or regional anesthesia should preferably be used to reduce aerosol production. Hence, hysteroscopy is not an aerosol-generating procedure and the risk of COVID-19 infection is low; therefore, hysteroscopy should not be ruled out in emergencies.

Falls are common and preventable adverse events that occur in a hospital setting. Falls can cause pain, damage, increase cost and mistrust in the health system. Inpatient fall is a multifactorial event which can be reduced with multistrategic interventions.In this project, we aimed to reduce the fall rate in paediatric ward of Jigme Dorji Wangchuck National Referral Hospital, Bhutan by 25% from the baseline over a period of 6 months by focusing on fall risk assessment, staff education on fall prevention measures and devoting more attention to patients at high risk of fall.We tested three sets of interventions using the Plan–Do–Study–Act approach. For the first cycle, emphasis was on staff education in terms of proper use of fall risk assessment form, risk categorisation and fall prevention advice. In the second cycle, in addition to the first we introduced the ‘high risk of fall package’ and the third cycle focused on early and easy identification of high-risk patients by continuous fall risk assessment and use of high risk of fall sticker.We observed that at the start of the quality improvement project despite our intervention the fall rate of our ward went up but as we continued adding more ideas focusing on high risk patients, we could achieve a fall reduction of 49.3% from the base line by end of third cycle. Our ward saw fall free days of almost 90 days at the end of project.We conclude that inpatient falls occur due to multiple factors therefore a multi-pronged strategy is needed to prevent it. One of the prime preventive strategy is identifying patients who are at high risk of fall and concentrating attention to those patients.

The major concern that has confronted surgeons during the COVID-19 pandemic is the risk of infection during surgery. So far, no studies have found SARS-CoV-2 in surgical smoke, and if it was found, whether it was infectious or not is unknown. To date, no evidence shows that respiratory viruses can be transmitted through a surgical plume or an aerosolized gas. There are various advantages of laparoscopy over laparotomy that must be kept in mind in the COVID-19 era, such as early recovery and shorter hospital stay, which can greatly help to conserve valuable hospital resources, and reduced risk of spillage of blood and body fluids, which can help to reduce transmission risk; most importantly, the distance between surgeons and between surgeons and patient is greater. Certain precautionary measures can be taken to reduce SARS-CoV-2 transmission during laparoscopy. Whenever possible, it should be the surgical option of choice.

Abstract A new articulated postcranial specimen of an indeterminate ankylosaurid dinosaur from the Upper Cretaceous (middle-upper Campanian) Baruungoyot Formation from Hermiin Tsav, southern Gobi Desert, Mongolia includes twelve dorsal vertebrae, ribs, pectoral girdles, forelimbs, pelvic girdles, hind limbs, and free osteoderms. The new specimen shows that Asian ankylosaurids evolved rigid bodies with a decreased number of pedal phalanges. It also implies that there were at least two forms of flank armor within Ankylosauridae, one with spine-like osteoderms and the other with keeled rhomboidal osteoderms. Unique anatomical features related to digging are present in Ankylosauridae, such as dorsoventrally flattened and fusiform body shapes, extensively fused series of vertebrae, anteroposteriorly broadened dorsal ribs, a robust humerus with a well-developed deltopectoral crest, a short robust ulna with a well-developed olecranon process, a trowel-like manus, and decreased numbers of pedal phalanges. Although not fossorial, ankylosaurids were likely able to dig the substrate, taking advantage of it for self-defence and survival.

Objective To study the efficacy and safety of 0.5% bupivacaine in paracervical block to reduce immediate postoperative pain after total laparoscopic hysterectomy. Methods A prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary referral center involving thirty women each in the treatment and placebo groups. Paracervical block with 10 mL of 0.5% bupivacaine (treatment group) or 0.9% saline (placebo group) was administered following general anesthesia and prior to proceeding with total laparoscopic hysterectomy. Visual analogue scale (VAS) scores at 30 and 60 minutes post extubation and mean VAS score (average VAS score at 30 and 60 minutes) were compared. Adequate pain control was defined as mean VAS score ≤5. Additional postoperative opioid requirement, hospital stay, and readmissions were also compared. Results Baseline variables such as age, previous history of cesarean section, operating time, and weight of the specimen were comparable in both groups. VAS scores at 30 (5.0±2.8 vs. 7.0±1.4) and 60 minutes (5.2±2.8 vs. 7.0±0.8) and the mean VAS score (5.1±2.7 vs. 6.8±0.9) were significantly lower in the treatment group. Adequate pain control (mean VAS score ≤5) was 57% higher and additional opioid consumption was 47% lower in the treatment group. No significant difference was found in the duration of hospital stay and readmission rate. Conclusion Paracervical block with bupivacaine was useful in reducing immediate postoperative pain with a 25% reduction in mean VAS score and a 47% reduction in opioid consumption in the first hour after total laparoscopic hysterectomy.

Background: Early pregnancy losses can be a distressing experience both for the parents and the treating clinician. We aim to explore the role of chemokine receptor 4 (CXCR4) in early pregnancy losses by comparing its expression among patients with spontaneous miscarriages and patients undergoing termination of viable pregnancies for unwanted pregnancies. Aim: The aim of the study was to investigate the expression of CXCR4 in early pregnancy losses and correlate the various clinical parameters with differential expression of the above receptor in the chorionic villi and maternal decidua. Study and Setting: The present study is a case-“control study done in a tertiary care center. Methodology: Fifty patients attending outdoor and antenatal clinic of the hospital aged 18-“40 years with spontaneous miscarriage under 20 weeks of gestational age were included as cases and compared with fifty females of comparable age group (18-“40 years) seeking medical termination of pregnancy as controls. Chorionic villi and decidua obtained from the cases and controls were analyzed for CXCR4 expression. Statistical Analysis: The results were analyzed using mean ± standard deviation, percentiles values, Chi-square test, and P value to determine the association of CXCR4 expression in decidua and chorionic villi of cases versus controls. Results: CXCR4 expression was significantly downregulated in cases as compared to the controls with P < 0.001. The mean normalized ratio of CXCR4 expression to housekeeping gene (β Actin) expression in the case group was 1.607 ± 1.108 and in the control group, it was 2.506 ± 1.457. There was a strong correlation between the expression of CXCR4 and maternal age. With increasing age, the expression of CXCR4 was more downregulated in both the cases and control groups (P < 0.001). The expression of CXCR4 was elevated in controls as compared to cases in

Context: Hysteroscopic metroplasty (HM) is the gold standard treatment for women with septate uterus with recurrent pregnancy loss. Miniresectoscope requires less cervical dilatation as compared to conventional resectoscope. Very few studies are available in the literature on use of miniresectoscope for operative purpose. Aim of the Study: This study aimed to compare operative and postoperative outcome parameters using conventional versus mini resectoscope (MR) for hysteroscopic septal resection (HSR). Study Settings and Design: This was a prospective randomized controlled trial conducted in the Department of Obstetrics and Gynaecology from July 2017 to May 2019. Materials and Methods: Forty patients fulfilling the inclusion criteria were recruited and randomized into two groups. In Group A (20 patients), HSR was done using conventional resectoscope (CR) and in Group B (20 patients), MR was used. The various parameters recorded were cervical dilatation time, operating time, intraoperative complications, postoperative pain, and hospital stay and reproductive outcome post surgery in both groups. Results: Data analysis was carried out using SPSS IBM software version 20.0. The mean operating time was comparable but cervical dilatation time was significantly more in Group A. The duration of hospital stay was significantly less in Group B. There were no differences in adequacy of vision in both the groups but area of field was less in MR group. Four out of nine patients with infertility conceived after surgery. 65% in Group A and 70% in Group B conceived during follow up. Conclusion: Our study showed that hysteroscopic metroplasty with MR, has comparable efficacy to CR in terms of good vision and septal resectability with added advantages of shorter cervical dilatation time, ease of entry of resectoscope, shorter operative time and significantly reduced postoperative morbidity in terms of less pain. However, the field of vision is less and resection time is more, hence more expertise is required. Further larger randomized trials are required.

Objectives: Tubal factor is the leading cause of female infertility. Diagnostic hysterolaparoscopy with chromopertubation plays a pivotal role in its evaluation. Office hysteroscopy (OH) has gained popularity as the outpatient procedure for diagnostic purposes. OH being a less invasive approach, the current study was undertaken to compare the accuracy of assessment of tubal patency with chromopertubation at OH with modified minilaparoscopy in infertile patients. Materials and Methods: The present study was a pilot study conducted from March 2017 to August 2018. Eighty patients were recruited. OH was done without anesthesia. Diluted methylene blue dye was injected. The eddy current of blue dye, “Visualizable flow” at ostium, and disappearance of blue dye from the uterine cavity through ostium was documented as evidence of patent tubal ostium. In case of tubal occlusion, uterine cavity became blue due to backflow of dye. After OH, minilaparoscopy with chromopertubation was performed under general anesthesia. Both tubes were assessed separately for tubal patency. Results: All patients underwent OH followed by minilaparoscopy in the same sitting. OH was 87.5% sensitive with positive predictive value of 95.2%. Compared to minilaparoscopy, OH is 85.6% accurate in predicting tubal patency. The area under receiver operating curve was 0.96 (SE is 0.15 with 95% confidence interval of 0.93–0.99, P < 0.001). It implies that, OH should correctly identify all laparoscopic cases with probability of 0.96. Conclusion: OH chromopertubation can be used as an alternative to laparoscopy for assessing tubal patency with added advantages of lack of requirement of anesthesia, minimal cost, and better patient acceptance. Moreover, the procedure is less time-consuming and less invasive with high sensitivity and moderate specificity.

Introduction: Osteoporosis could be viewed as a metabolic disease. The WHO guidelines for diagnosing osteoporosis reflect structural damage only and not the metabolic imbalance that leads to it. Biochemical markers of bone turnover have been shown to provide valuable information for diagnosing and monitoring metabolic bone disease. The present study analyzed bone-specific alkaline phosphatase (BALP) and urinary hydroxyproline in pre- and postmenopausal women and correlated them with changes in bone mineral density (BMD) in the state of Sikkim. The study also intended to know the ethnicity-based disease burden in Sikkim. Materials and Methods: A hospital-based cross-sectional study was done at a tertiary hospital in Sikkim. Blood and 24-h urine samples from 50 premenopausal and 50 postmenopausal women were analyzed for total alkaline phosphatase (ALP), BALP, and Urine Hydroxyproline. BMD was measured using the quantitative ultrasound technique by Achilles densitometer. Results: There was a statistically significant increase in serum calcium (P = 0.01), ALP (P = 0.01), and urine hydroxyproline (P = 0.03) levels in postmenopausal women as compared to premenopausal women. Although ALP was higher in postmenopausal women, BALP isoform was more elevated in premenopausal women (P = 0.001). BMD was significantly lower in postmenopausal women (P < 0.001). It was also noted that there was a significant difference in BMD between tribal and nontribal populations (P = 0.003). Total ALP and BALP as the bone formation marker and urine hydroxyproline as a bone resorption marker added statistically significant r to BMD prediction (P < 0.05). Conclusion: In this study, BALP combined with Urine Hydroxyproline was helpful as a screening biomarker to predict osteoporosis in postmenopausal women.

The aim of this study was to compare meditators and non-meditators in terms of their tendency to have peak experiences and their dream lucidity, while examining the associations between these outcomes and some related variables such as non-dual awareness, mindfulness facets and absorption. In this cross-sectional study, 237 participants from general Spanish population completed an online survey that included ad hoc questions related to the study aim, along with the Five Facet Mindfulness Questionnaire (FFMQ), the Non-dual Embodiment Thematic Inventory (NETI), the Tellegen Absorption Scale (TAS) and the Lucidity and Consciousness in Dreams Scale (LUCID). Of the total, 110 participants were identified as meditators and 127 as non-meditators. More than half of the sample (58.2%) reported having experienced at least one peak experience in their life; these showed no differences in the number, intensity, or self-inducing ability of these experiences between both groups but were significantly more common among meditators (71.8% vs. 46.8%; p < 0.001), who also presented higher scores in most of the questionnaires, except for some LUCID subscales. Regression models demonstrated that being a meditator was a significant predictor of having had a peak experience, but not of LUCID scores. These results, which need to be interpreted considering the study limitations, support the potential of meditation to facilitate having peak experiences, while its impact on lucid dreams remains unclear.

Study Objective: The objective of this was to evaluate the effectiveness of misoprostol in premenopausal nulliparous women with 200-mcg single vaginal dose 4 h before the procedure. Design: This was a prospective randomized double-blind placebo-controlled trial. Setting: This study was conducted in a tertiary care and academic research center. Patients: One hundred patients were included in the study: 50 in misoprostol group and 50 in placebo. Interventions: Patients underwent office hysteroscopy 4 h after vaginal application of misoprostol or placebo. Measurements and Main Results: Ease of doing hysteroscopy was significantly better in the misoprostol group (difficulty score: 2.74 ± 1.20) as compared to placebo (difficulty score: 4.20 ± 1.10), P = 0.001. The time taken for negotiating the internal os (cervical passage time) was found to be significantly shorter in the misoprostol group (6.20 ± 5.21 s) as compared to placebo (14.78 ± 11.84 s), P = 0.001. The overall Visual Analog Scale (VAS) score was significantly lower in the intervention group (2.64 ± 1.62) as compared to placebo (4.90 ± 1.90), P = 0.001. Moreover, the VAS score at the point of passing internal os was significantly lower in the misoprostol group (2.82 ± 1.39) as compared to placebo (4.94 ± 1.96), P = 0.001. Misoprostol had a significant positive effect on satisfaction level of patients; 76% (n = 38) of women in the misoprostol group expressed their willingness to undergo the procedure again if required versus 18% (n = 9) in placebo, P = 0.001. Furthermore, 78% (n = 39) of women in the misoprostol group would recommend the procedure to their friends and relatives versus 36% (n = 18) in placebo, P = 0.001. Conclusion: Preoperative cervical preparation with 200 mcg of misoprostol vaginal application 4 h before office hysteroscopy in premenopausal nulliparous women significantly reduces the difficulty encountered in negotiating the cervical canal. Further, it significantly reduces the pain experienced by the patient at the point of passage through internal os as well as throughout the entire procedure.

Led by His Holiness the Dalai Lama, the initiative taken by the Tibetan Buddhist monastic community to connect with western science and scientists presents a unique opportunity to understand the motivations and engagement behaviors that contribute to monastic science learning. In this study, we draw on quantitative data from two distinct surveys that track motivations and engagement behaviors related to science education among monastic students. The first survey was administered at one monastic university in 2018, and the second follow-up survey was completed by students at two monastic universities in 2019. These surveys assessed the reception of science education related to motivations among monastics and their demonstration of engagement-with-science behaviors. We also tested for variation over time by surveying students in all years of the science curriculum. We identified that monastic students are motivated by their perception that studying science has an overall positive effect and benefits their Buddhist studies, rather than negatively affecting their personal or collective Buddhist goals. In accordance with this finding, monastics behave in ways that encourage fellow scholars to engage with science concepts. Survey responses were disaggregated by years of science study and indicated changes in motivation and engagement during the six-year science curriculum. These insights support the relevance of considering motivation and engagement in a novel educational setting and inform ongoing work to expand the inclusiveness of science education. Our findings provide direction for future avenues of enhancing exchange of knowledge and practice between Buddhism and science.