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Abstract Introduction Primary health care has regained its importance in global policy making. In 2018, the Government of India initiated the Ayushman Bharat - Comprehensive Primary Health Care (AB-CPHC) programme. It was based on upgrading the existing primary health facilities into Health and Wellness Centers (HWCs). The current study aimed to assess the readiness and performance of HWCs in providing comprehensive primary health care services in India’s Chhattisgarh state. Methods We conducted a cross-sectional health facility assessment with a state-representative sample of 404 HWCs. A standardized health facility survey tool was used to collect information on essential inputs and service outputs of HWCs. The expected population healthcare needs were estimated using secondary sources. The performance of HWCs was assessed by comparing the volume of services provided against the expected population need for outpatient care. Results On an average, 358 outpatients including 128 non-communicable disease (NCD) patients were treated monthly at an HWC. HWCs were able to cover 31% of the total population’s health need for outpatient care, 26% for hypertension, and 21% for diabetes care. In addition to services for reproductive and child health, HWCs provided services for common acute ailments (cold, cough, fever, aches and pains); infections of skin, eye, ear, and reproductive tract, and minor injuries. HWCs were also contributing significantly to national disease control programmes. Acute ailments followed by NCDs and communicable diseases had the largest share among services provided. The key gaps were in coverage of mental illnesses and chronic respiratory diseases. Most of the HWCs showed adequate readiness for the availability of required human resources, supplies, and infrastructure. Conclusion HWCs were able to provide a comprehensive range of primary care services and able to cater to a sizable portion of the rural population’s acute and chronic health care needs. The performance was made possible by the adequate availability of medicines, staff, training programmes and tele-consultation linkages. If HWCs in other states are able to reach a similar level of performance, the initiative will prove to be a game changer for equitable primary care in India.

An analysis was conducted on both freshwater, coastal and marine fish species to evaluate the concentrations of heavy metals, with the aim of assessing their levels and examining the potential health risks for humans linked to the consumption of contaminated fish. This study estimate concentrations of Cr, Fe, Cu, As, Cd and Pb in 60 individuals belonging to 20 species (10 species for freshwater and another 10 for coastal and marine fishes) by using Atomic Absorption Spectrophotometer. Metal concentrations of Cr, Fe, and Pb in freshwater fishes and Cr, Fe, As, and Pb in marine fishes were exceeded the maximum allowable concentration (MAC). The Estimated Daily Intake (EDI), Average Pollution Load Index (APLI), Target Hazard Quotient (THQ), Hazard Index (HI) and Target Cancer Risk (TCR) of heavy metals were determined for the assessment of human health risk. Ranking order of the values of EDI for freshwater fishes, coastal and marine fishes were Cd > Fe > Pb > Cr > Cu > As and Cd > Fe > Pb > Cr > As > Cu. Highest APLI value of 8.14 (Puntius ticto) that is seriously polluted and 3.003 observed in Otolichthoides pama in freshwater and marine fishes, respectively. THQPb and THQAs for all the fish species were exceed the safe limit (THQ>1) suggesting potential health risk to consumers. The hazard index for both the fish samples were exceeded the USEPA (United States Environmental Protection Agency) permitted risk level (HI > 1). The target carcinogenic risk value for Cr and As were crossed the USEPA standard limit (TCR> 1E-04), which denotes that continuous consumption of studied fishes may cause health risk to the consumers. On the other hand, sensitivity analysis of freshwater, coastal and marine fishes indicates that all the metal concentrations were responsible factor for health risk.

Green Supply Chain Management (GSCM) has emerged as a paramount issue in modern business organizations striving to become environmentally sustainable. Suppliers are pivotal in building a green supply chain. Green supplier selection (GSS) is a complex task involving several steps, from evaluation to final selection. This research aims to select spare parts suppliers of an automotive company based on their GSCM practices. Fourteen critical criteria are extracted from extant literature and refined through a Delphi study. The data was collected through interviews with industry experts using structured questionnaires. This study proposes integrated multi-criteria decision-making (MCDM) and multivariate analysis method with internal consistency checks. The Principal Component Analysis (PCA) is used to calculate criteria weights. A Simple Additive Weighting (SAW) method ranks the suppliers based on weighted criteria. The result shows that “collaboration with suppliers for green purchasing” is the most influential parameter for GSS. The outcome of this research may aid managers in selecting the most suitable green suppliers in the automotive industry by attaining sustainability. The proposed framework can be replicated to select suppliers in other industries.

Background: Continuous blood pressure (BP) monitoring provides additional information about how changes in BP may correlate with daily activities and sleep patterns. Recommendations from the American Heart Association and American College of Cardiology strongly suggest confirming a diagnosis of hypertension with continuous BP monitoring. Non-invasive and non-intrusive detection of haemodynamic parameters is emerging as a norm, based on self-monitoring wearable medical devices. Researchers have carried out several studies using non-invasive and continuous BP measurements as an alternative to conventional cuff-based measurements. In this work, we proposed a novel method for cuffless estimation of BP using impedance cardiography (ICG). Methods: We conducted a single-centre, cross-sectional study of 104 subjects (of whom 30 were categorized as controls and the remaining 74 as the disease group) at the Medical College and Hospital, Kolkata. The disease group consisted of patients with confirmed coronary artery disease, while the individuals in the control group were deemed to be healthy. All subjects underwent electrocardiogram recording by on-duty doctors in order to determine their health status. A custom-made device based on the principle of impedance plethysmography was designed to record impedance changes due to subjects’ peripheral blood flow. The device was used to record ICG signals. In this study, we developed a novel auto-adaptive algorithm based on ICG signals for non-invasive, cuffless, continuous monitoring of BP and heart rate. Separate mathematical models were developed for all the estimated parameters (BP and heart rate) for both the study groups (control and disease). The developed models were auto-adaptive and did not require subject-specific calibration. Performance indicators including, r2, error percentage, standard deviation, and mean difference were used to quantify the performance of the models. Results: The ICG signal recorded by the device was used to extract features and compute the augmentation index. The calculated augmentation index values showed strong correlations with systolic BP (r=0.99, P

Abstract Haria, a fermented rice beverage, is commonly consumed as a traditional drink by the tribal people of rural West Bengal. This beverage is prepared by fermenting steamed rice with the starter culture tablets, known as Bakhar. It is known that some plant parts are added during Bakhar preparation that confer certain ethnomedicinal properties to the beverage as well as to Bakhar itself. An ethnobotanical survey was conducted that allowed documenting the traditional knowledge regarding this ethnic beverage preparation and it reveals that 10 plant species and one lichen species are used by the Santal tribe to prepare the Bakhar. Among them, roots of Kedar, Chaoli, rhizome of Bach, and bark of Lodh plants are essential, while other plant parts are used due to their specific taste, flavor, and therapeutic properties. But nowadays little or no plant additives are used during commercial Haria preparation for cost-effectiveness. Homemade and commercially produced Haria were investigated for their nutritional quality which revealed that homemade beverage contains more bioactive compounds, such as ascorbic acid (15.40 mg/100 ml) and flavonoids (36.67 mg/100 ml), which contribute toward the antioxidant property of the beverage. This current study documents the important medicinal plants used in the starter culture, the detailed process of Bakhar and Haria preparation, and the nutritional quality of Haria highlighting its ethnomedicinal properties.

Steady boundary layer mixed convection flow over a wedge moving parallel to a free stream in nanofluid having differently shaped nanoparticles is numerically investigated. The aspire of this article is to examine the combined influences of mixed convection, suction/blowing and variable shape of nanoparticles on motion of nanoliquid past a moving wedge moving faster/slower than the free stream. Nanofluid flow past a moving wedge is commendable of extraordinary concentration owing to its escalating applications in industrialized processes and technologies and so, the significance of this study is that the model is pertinent to a variety of manufacturing sectors for submissive control of nanoelements. The overriding equations under boundary layer approximations along with the matching conditions at the boundary are transformed to ordinary differential equations with the help of similarity alterations. Shooting technique is adapted to solve these equations numerically via Runge Kutta method using MATHEMATICA. Outcomes of the present study for a number of meticulous cases are assessed with the existing outcomes in open text and found a very well conventionality. The effects of various crucial parameters on velocity and temperature profiles of the fluid are accessible and analyzed graphically. The velocity of Cu-water nanofluid increases with the enhanced strengths of suction parameter, wedge angle parameter and also with the enhanced values of nanoparticle volume fraction. In comparison to spherical shaped nanoparticles, elevated temperature is experienced for nanoparticles of non-spherical shape. Also, the skin friction coefficient and surface heat transfer rates for some of the parameters are explored numerically. The outcomes of this learning depict numerous inspiring features that merit supplementary learning of the problem.

Background: Occupational health is a neglected public health issue among healthcare workers in developing countries. The quarrying sector poses large risks to occupational health and safety. Objectives: The objectives of this study are to investigate the impact of stone dust on cardiovascular and pulmonary health of stone quarry workers among an indigenous population of north-east India. Sample and Methods: This study was conducted in Wokha district of Nagaland, North-East India. A total number of 152 Lotha male stone quarry workers with age cohort 18-60 years and an ethnicity and age matching 152 adult males as the controls were selected for the present study. Blood pressures (both systolic and diastolic), oxygen saturation, pulse rate and forced vital capacity (FVC) were measured on each participant. Body Mass Index (BMI) was calculated following standard equation. Multivariate multiple regression (MMR) analysis was used to test the effect of stone dust on the workers. Results: Preliminary statistics showed significant difference between the exposed and control groups in body weight, BMI, oxygen saturation and pulse rate (p

Background: Obesity and hypertension and other non-communicable diseases (NCDs) continue to be a threat to the global health. Prevalence of NCDs has been observed to be rapidly increasing even among developing countries. Objective: The present study aims to assess the male-female differences in blood pressure and hypertension and the prevalence of overweight and obesity among the adult Angami Naga of Nagaland. Sample and methods: A cross-sectional sample of 194 (108 males and 86 females) adult Angami Naga from Kohima district, Nagaland were participated in the study. Anthropometric data on height vertex and body weight, whereas blood pressure data on both systolic and diastolic, were measured on each participant. Nutritional status was evaluated through body mass index (BMI). Results: Our results indicate high prevalence of hypertension among the Angami, for both SBP (50.0%Males vs 29.1%Females) and DBP (84.3%Males vs. 46.5%Females).A high prevalence of overweight and obesity (59.3%Males vs. 50.0%Females) was also found in the present population. Conclusion: The main findings in the present study show that irrespective of the age and sex, hypertension and obesity is observed to be on the rise.

The BCL2L1 gene expresses two isoforms of Bcl-x protein via the use of either of two alternative 5′ splice sites (5′ss) in exon 2. These proteins have antagonistic actions, Bcl-XL being anti-apoptotic and Bcl-XS pro-apoptotic. In a number of cancers the Bcl-XL isoform is over-expressed, resulting in cancer cell survival and growth, so switching splicing to the Xs isoform could have therapeutic benefits. We have previously proposed that a putative G-quadruplex (G4) exists downstream of the XS 5′ss and shown that the ellipticine derivative GQC-05, a previously identified DNA G4-specific ligand, induces an increase in the XS/XL ratio both in vitro and in cells. Here, we demonstrate that this G4 forms in vitro and that the structure is stabilised in the presence of GQC-05. We also show that GQC-05 binds RNA non-specifically in buffer conditions, but selectively to the Bcl-x G4 in the presence of nuclear extract, highlighting the limitations of biophysical measurements taken outside of a functional environment. We also demonstrate that GQC-05 is able to shift the equilibrium between competing G4 and duplex structures towards the G4 conformation, leading to an increase in accessibility of the XS 5′ss, supporting our previous model on the mechanism of action of GQC-05.

The implementation of green supply chain management (GSCM) practices is still in its rudimentary stage in small and medium-sized enterprises (SMEs) of emerging economies. So far, too little research has shown clear empirical evidence on the actual impact of various parameters on GSCM performance of SMEs. In order to fill this knowledge gap, this research attempts to identify the critical GSCM parameter and quantitively measure its influence on the GSCM performance of an India-based SME. To this end, twenty important GSCM parameters are identified from an extant literature and verified by the experts. Data is collected through questionnaire development, expert committee formation, and conducting interviews. This research employs an integrated multivariate analysis-robust design approach, in which item analysis is used to check the consistency of the data and principal component analysis (PCA) is used to determine the weights of the parameters. The Taguchi’s L9 orthogonal array analysis is used in which, qualitative data, quantitative data, and attitude of decision maker are taken as input parameters and a GSCM performance index is taken as a response parameter. The result reveals that, ‘Use of emission control system’ is the most critical GSCM parameter and the optimal combination of input parameters are: use of the emission control system (0.08); total carbon emission (0.37); attitude of decision maker (0.6), and the corresponding GSCM performance index is 0.196. The proposed framework may help decision makers identify and control a set of influential parameters for the best GSCM performance.

Background and Objective:: Predicting the treatment response of a patient undergoing treatment for NSCLC (non-small cell lung cancer) is useful in the estimation of effectiveness of the treatment protocol. To assess the prognostic value of radiomic features extracted from CBCT (cone-beam computed tomography) images of NSCLC patients, an efficient classification model is developed. The study aims to predict the early response (predicting the response at the third week of the radiation therapy) of the patients using the first-week and third-week data, of the acquired CBCT images. Methods:: This retrospective study includes 99 NSCLC patients having undergone conventionally fractionated radiation therapy (RT) over six weeks. The radiomic features are computed using the Python pyradiomics package. Initially 107 radiomic features were chosen. A triage-based learning paradigm is implemented, wherein the machine decides upon the difficulty of a sample. If the machine recognizes an instance to be hard to classify, then it is left for human expert assistance, otherwise, a feed-forward neural network is trained which classifies a patient’s response to treatment. Results:: The proposed model achieves accuracy 0.75±0.03, precision 0.79±0.03, sensitivity 0.82±0.05, f-score 0.80±0.03 and specificity 0.61±0.08 to predict the patient’s early response. Using, ensemble learning technique an accuracy of 0.79±0.03, precision 0.91±0.06, sensitivity 0.80±0.08, f-score 0.84±0.03 and specificity 0.82±0.13 is achieved. Conclusion:: The experimental results revealed that the accuracy of proposed model is better than the state-of-the-art technique. The results show that CBCT radiomic features can prognosticate the tumor response for NSCLC patients.

Surfactant free One-pot synthesis of Cu@CuFe2O4 nanocomposite was demonstrated via hydrothermal technique and its application in generation of oxygen in oxygen evolution reaction (OER). Various analytical techniques such as powder XRD, TEM, HRTEM, EDS, SEM/EDAX and XPS were used to characterize the synthesized nanocomposite. TEM and SEM image shows the morphology of Cu@CuFe2O4 nanocomposite which is spherical in shape and dimensions of diameter is in the range of 88 – 150 nm and 42–114.28 nm, respectively. The peaks corresponding to Cu, Fe and O in Cu@CuFe2O4 nanocomposite were observed in XPS data as well as in EDAX analysis. The electrochemical analysis was conducted for OER by cyclic voltammetry, linear sweep, electrochemical impedance spectroscopy (EIS). Current density as high as 16.5 mA.cm−2 at over-potential 1.4 V (vs Ag/AgCl) indicated excellent oxygen generation. The results revealed that the synthesized nanocomposite is an efficient catalyst for production of oxygen.

Steady boundary layer flow of nanofluid past an exponentially porous shrinking sheet in presence of heat and mass fluxes is presented. In this model the combined effects of Brownian motion and thermophoresis on heat transfer and nanoparticle volume fraction are considered. Similarity transformations are used to obtain the self-similar equations which are then solved numerically using shooting technique along with fourth order Runge-Kutta method. Similarity solution depends on the suction parameter. This investigation reveals that the variable heat flux and mass flux have major significant effects on temperature field and the nanoparticle volume fraction. The wall mass transfer through the porous sheet causes an increase of fluid velocity for the first branch of solution. Temperature as well as nanoparticle volume fraction decreases for both branches of solutions. For the Brownian motion, the temperature increases but the nanoparticle volume fraction decreases. Heat transfer rate becomes lower with the increase of Lewis number. Due to increase in thermophoresis parameter, both the temperature and nanoparticle volume fraction increase. Keywords: Nanofluid, Exponentially shrinking sheet, Suction, Heat flux, Mass flux

The aim of the paper is to investigate the flow of an incompressible viscous fluid past a nonlinearly shrinking permeable sheet. Partial slip condition is considered instead of no slip condition at the boundary. The self similar equations are obtained and then solved numerically by a shooting technique. Dual solutions are obtained for the flow past a nonlinearly shrinking sheet with slip condition in the presence of suction. It is found that for the first solution the momentum boundary layer thickness decreases with slip and suction parameters; but it increases with the power-law index of the shrinking velocity. The dual solutions for the velocity field are obtained for the positive values of power-law index n and for certain values of the other parameters in the study. Velocity slip controls the boundary layer separation. However, the power-law index acts to accelerate the boundary layer separation.

It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM) score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient′s livelihood, psychological aspects and chances of recurrence even after the procedure.

Background : Fentanyl-induced cough is not always benign and brief and can be remarkably troublesome, spasmodic, and explosive. Dextromethorphan, an opioid derivative with an antitussive action, may be effective in reducing the fentanyl-induced cough. Dextromethorphan, a N-methyl D aspartate receptor antagonist, may have some effect on diminishing the stress response to surgery. This study was undertaken to determine whether preoperative dextromethorphan could effectively attenuate its incidence, severity, and effect on postoperative stress hormone levels. Materials and Methods : Three hundred and twenty patients of American society of anesthesiologists I-II, aged 18-60 years, undergoing elective laparoscopic cholecystectomy or appendicectomy were randomly allocated into two groups (Group C, control; Group D, dextromethorphan) consisting of 160 patients each. Patients in Group D received dextromethorphan 40 mg orally and in Group C received placebo tablets 60 minutes before induction of anesthesia. The incidence of cough was recorded for 1 minute after fentanyl injection and graded as none (0), mild (1-2), moderate (3-5), and severe (>5 cough). Blood samples were collected for estimation of stress hormone levels before surgery and again at 1 hour and 24 hours postoperatively and compared. The appearance of adverse reactions was recorded. Results : The incidence of reflex fentanyl cough was lower in dextromethorphan group (3.9%) in comparison to placebo (59.8%). Five patients developed mild and one moderate cough in the dextromethorphan group. In the control group, 31 patients developed mild, 29 moderate, and 32 severe cough. The stress hormones were significantly higher at 1 hour and 24 hours postoperatively in both groups in comparison to its preoperative values. However, at 1 hour postoperatively, adrenocorticotropic hormone, epinephrine, and growth hormone values were significantly low in the dextromethorphan group (61.5 ± 21.1 pg/ ml, 142.1 ± 11.2 pg/ml, and 3.8 ± 0.7 ng/ml) relative to the control group (73.4 ± 21.9 pg/ml, 158.9 ± 17.9 pg/ml, and 4.2 ± 1.3 ng/ml), but changes became insignificant at 24 hours postoperatively. Conclusion : Preoperative oral dextromethorphan 40 mg decreased the incidence and severity of fentanyl induced cough and reduced the rise in stress hormones at 1 hour postoperatively.