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HIV stigma is comprised of several beliefs, including transmission fears and moral judgments against affected communities. We examined the relationships among HIV-related stigma beliefs, endorsement of coercive measures for people living with HIV (PLWH), and intentions to discriminate. We sought to understand to what degree the different stigma beliefs shape support for restrictive policies and discriminatory intentions. Data were drawn from the baseline assessment of DriSti, a cluster randomized controlled trial of an HIV stigma reduction intervention in Indian healthcare settings (NCT02101697). Participants completed measures assessing transmission fears and moral judgments of HIV, endorsement of coercive measures against PLWH (public disclosure of HIV status, refusal of healthcare services, marriage and family restrictions, required testing, and sharing of HIV information in a clinic), and intentions to discriminate against PLWH in professional and personal settings. We utilized multivariate regression modeling with backward elimination to identify the coercive measures and behavioral intentions most strongly associated with moral judgments. 1540 ward staff members completed the assessment. Participants had relatively high perceptions of transmission fears (M = 1.92, SD = 0.79) and moral judgments (M = 1.69, SD = 0.83); endorsed more intentions to discriminate in professional (M = 6.54, SD = 2.28) than personal settings (M = 2.07, SD = 1.49), and endorsed approximately half of all coercive measures (M = 9.47, SD = 2.68). After controlling for transmission fears, perceptions of stronger moral judgments against PLWH were significantly associated with higher endorsement of coercive measures related to refusing services (β = 0.10, t = 4.14, p β = 0.07, t = 3.04, p = 0.002), as well as with stronger behavioral intentions to discriminate in professional settings (β = 0.05, t = 2.20, p = 0.022). HIV stigma interventions for hospital-based ward staff in India need to focus on both transmission fears and moral judgments that underlie prejudicial beliefs. While the moral judgments are not technically related to risk in a hospital setting, our findings suggest that personnel will continue to discriminate in their professional work so long as these beliefs bear on their decisions and actions.

This article explains a cascaded H-bridge without inductor for Electric operated and Hybrid Electric operated Vehicles applications. Power inverter systems, DC-DC converter [8] is now available for hybrid electric operated vehicles to improve conventional battery stored voltages. The existing inverters for HEV traction drives have High density of power, costly and poor performance, they need a bulky inductor. This paper proposes An H-bridge cascaded without inductor MLI for Electric operated and Hybrid Electric operated Vehicles applications. Any H-bridge historically requires a DC Electricity. In the proposed cascaded inductor less H-bridge, a regular 3-leg (one leg per phase) is used and a series H-Bridge using a DC power source condenser with each inverter leg. The PWM switching scheme is used to control [18] the modulation and create a five-stage phase voltage. Results indicate that the proposed circuit generates an improved AC voltage which can be the performance of a multilevel inductor less DC - AC H-Bridge cascaded inverter.

The industries in developing countries usually face the difficulty of the manual operations which will result in both accuracy and poor efficiency. This paper highlights the automation of a process Industry and at the same time monitoring operations are also done. In case of switching off of the single motor where the other motor runs at a specific load without any distraction can be done by using single circuitry of DC supply. The microcontroller and relays are being used for switching ON\OFF of all the DC motor. The main operation in this project is to sense the temperature of the DC motors which is done by temperature sensor. The scrutinized value of the DC motor’s temperature are being displayed in the LCD.

Renewable energy provisions must be extracted in a more resourceful way, with a power converter added to the mix. If the supply-demand curve rises with the seasons, it becomes clear that renewable energy sources are used to provide clean energy. This clean energy cannot be used on load directly due to fluctuating conditions, to solve this problem a modified DC to DC converter with a ripple-free output is introduced. The Vertical Axis Wind Turbine (VAWT) and Solar PV were combined to achieve a constant DC output in a hybrid renewable energy conversion system. For renewable energy applications, a redesigned converter with ripple-free output is used. The simulation is made under MATLAB/SIMULINK and experimental parameters were measured using a nominal prototype.

Among all other renewable energy conversion systems, solar energy conversion systems (SECS) are a trend. Energy conversion capability is one of the major shortcomings in SECS, which serves as an obstacle to its choice. The performance review of SECS with the integration of the advanced DC/DC converter super-lift Luo converter (SLLC) is discussed in this research paper. Traditionally, the fundamental converters are usually used for performance improvement in SECS. In this manuscript, the disadvantages of fundamental converters integrated SECS are specifically discussed by considering the consistency and efficiency of energy conversion. Unlike the fundamental converters, the proposed SLLC converts the geometric progression of the DC output voltage from the solar panel. Compared to fundamental converter integrated SECS, the ripple value in the output voltage is reduced greatly in SLLC integrated SECS. In this analysis, the SECS was designed to supply a classical induction motor (IM) drive. In addition, the DC/DC converter gate pulse in the formed IM drive is fixed. Using MATLAB/Simulink software, the built SECS fed IM drive is simulated. The results of the simulation, such as DC output voltage, ripple information, IM speed response and electromagnetic torque, validate the SLLC option over typical SECS converters.

BACKGROUND. Inflammation is a key component of immune response to infections and pathogenesis of metabolic and cardiovascular diseases. Inflammatory biomarkers, including alpha-1-acid glycoprotein (AGP), are considered prognostic tools for predicting risk, monitoring response to therapy, and adjusting nutritional biomarkers for accurate interpretation. Serum is considered a primary source of biomarkers; urine and saliva are increasingly being explored and utilized as rapidly accessible, noninvasive biofluids requiring minimal sample processing and posing fewer biohazard risks. METHODS. A lateral flow immunoassay was developed for an established mobile-based platform to quantify AGP in human serum, urine, and saliva. Assay performance was assessed with purified AGP in buffer, diluted human serum samples (n = 16) banked from a trial in people living with HIV, and saliva and urine (n = 15 each) from healthy participants. Reference methods were conventional clinical chemistry analyzer or commercial ELISA. Bootstrap analysis was used to train and validate sample calibration. FINDINGS. The correlation between the assay and reference method for serum was 0.97 (P < 0.001). Mean (95% CI) best fit line slope was 1.0 (0.88, 1.15) and intercept was −0.003 (−0.08, 0.09). The correlation for urine was 0.93, and for saliva was 0.97 (both P < 0.001). The median CV for the LFIA for AGP in buffer was 13.2% and for all samples was 28.7%. INTERPRETATION. The performance of the assay indicated potential use as a rapid, low sample volume input, and easy method to quantify AGP that can be licensed and adopted by commercial manufacturers for regulatory approvals and production. This has future applications for determining inflammatory status either alone or in conjunction with other inflammatory proteins such as C-reactive protein for prognostic, monitoring, or nutritional status applications, including large-scale country level surveys conducted by the DHS and those recommended by the WHO.

BACKGROUND: There is a need to identify and test low cost approaches for cardiovascular disease (CVD) risk reduction that can enable health systems to achieve such a strategy. OBJECTIVE: Community health workers (CHWs) are an integral part of health-care delivery system in lower income countries. Our aim was to assess impact of CHW based interventions in reducing CVD risk factors in rural households in India. METHODS: We performed an open-label cluster-randomized trial in 28 villages in 3 states of India with the household as a unit of randomization. Households with individuals at intermediate to high CVD risk were randomized to intervention and control groups. In the intervention group, trained CHWs delivered risk-reduction advice and monitored risk factors during 6 household visits over 12 months. Households in the non-intervention group received usual care. Primary outcomes were a reduction in systolic BP (SBP) and adherence to prescribed BP lowering drugs. RESULTS: We randomized 2312 households (3261 participants at intermediate or high risk) to intervention (1172 households) and control (1140 households). At baseline prevalence of tobacco use (48.5%) and hypertension (34.7%) were high. At 12 months, there was significant decline in SBP (mmHg) from baseline in both groups-controls 130.3±21 to 128.3±15; intervention 130.3±21 to 127.6±15 (p

INTRODUCTION: Dermatophytic infections, also known as ringworm, is one of the most common fungal infections of the skin around the world. The most common symptom seen with dermatophyte infection is pruritis. The varied presentation of tinea is often confusing with other skin diseases. It may be due to the irrational application of broad-spectrum steroid ointments and creams, leading to misdiagnosis and mismanagement. This study was begun to know the prevalence, clinical, and mycological prole of various dermatophytes OBJECTIVES OFTHE STUDY: 1.To study the prevalence of tinea infections. 2.To study the clinical presentation of patients with tinea infections. 3.To study the mycological prole of various tinea infections. METHODS: Clinical assessment was done, which include a detailed history, general physical examination, and examination of the lesion. After a complete review, the evaluation took place. Direct Microscopic Examination. Culture helps in the identication of species. CONCLUSION: To conclude, dermatophytosis is very common in India. It has been registered all over the world but with a different distribution, incidence, and epidemiology from location to location. Geographic location, climate, overcrowding, health care, immigration, personal and environmental hygiene, culture, and socioeconomic status have been attributed as major risk factors for these variations

Health facility stigma impedes HIV care and treatment. Worry of contracting HIV while caring for people living with HIV is a key driver of health facility stigma, however evidence for this relationship is largely cross-sectional. This study evaluates this relationship longitudinally amongst nursing students and ward staff in India. Worry of contracting HIV and other known predictors of intent to discriminate were collected at baseline and 6 months in 916 nursing students and 747 ward staff. Using fixed effects regression models, we assessed the effect of key predictors on intent to discriminate over a 6-month period. Worry of contracting HIV predicted intent to discriminate for nursing students and ward staff in care situations with low and high-risk for bodily fluid exposure, confirming prior cross-sectional study results and underscoring the importance of addressing worry of contracting HIV as part of health facility HIV stigma-reduction interventions.

BACKGROUND: HIV stigma in health care settings acts as a significant barrier to health care. Stigma drivers among health professionals include transmission fears and misconceptions and pre-existing negative attitudes towards marginalized groups vulnerable to HIV. The DriSti intervention, consisted of two sessions with videos and interactive exercises on a computer tablet and one interactive skills-based face-to-face group session, mostly tablet administered, was designed to target key stigma drivers that included instrumental stigma, symbolic stigma, transmission misconceptions and blame to reduce HIV stigma and discrimination among nursing students and ward staff and tested in a cluster randomized trial. SETTING: This report focuses on second and third year nursing students (NS) recruited from a range of nursing schools that included private, non-profit, and government- run nursing schools from south India. RESULTS: Six hundred seventy nine NS received intervention and 813 NS were in the wait-list control group. Twelve months outcome analyses showed significant reduction among intervention participants in endorsement of coercive policies (p

Antimicrobial resistance (AMR) is a fundamental global concern analogous to climate change threatening both public health and global development progress. Infections caused by antimicrobial-resistant pathogens pose serious threats to healthcare and human capital. If the increasing rate of AMR is left uncontrolled, it is estimated that it will lead to 10 million deaths annually by 2050. This global epidemic of AMR necessitates radical interdisciplinary solutions to better detect antimicrobial susceptibility and manage infections. Rapid diagnostics that can identify antimicrobial-resistant pathogens to assist clinicians and health workers in initiating appropriate treatment are critical for antimicrobial stewardship. In this review, we summarize different technologies applied for the development of rapid diagnostics for AMR and antimicrobial susceptibility testing (AST). We briefly describe the single-cell technologies that were developed to hasten the AST of infectious pathogens. Then, the different types of genotypic and phenotypic techniques and the commercially available rapid diagnostics for AMR are discussed in detail. We conclude by addressing the potential of current rapid diagnostic systems being developed as point-of-care (POC) diagnostic tools and the challenges to adapt them at the POC level. Overall, this review provides an insight into the current status of rapid and POC diagnostic systems for AMR.

HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV & AIDS. Across cultures, including in India, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with stigma drivers that include fears and misconceptions regarding transmission during casual social contact and pre-existing negative attitudes towards marginalized groups vulnerable to HIV. In order to increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention that was delivered to ward staff (n=1,557) and nursing students (n=1,625) in 62 Indian institutions, using a cRCT design, comparing intervention participants to wait-list controls. Outcome analyses conducted at 6-month follow-up, showed significant reductions in misconceptions (p

A growing number of low- and middle-income country (LMIC) institutions have developed and implemented formal programs to support mentorship. Although the individual-level benefits of mentorship are well established, such activities can also sustainably build institutional capacity, bridge inequities in health care, and catalyze scientific advancement. To date, however, evaluation of these programs remains limited, representing an important gap in our understanding about the impact of mentoring. Without rigorous and ongoing evaluation, there may be missed opportunities for identifying best practices, iteratively improving program activities, and demonstrating the returns on investment in mentorship. In this report, we propose a framework for evaluating mentorship programs in LMIC settings where resources may be constrained. We identify six domains: 1) mentor–mentee relationship, 2) career guidance, 3) academic productivity, 4) networking, 5) wellness, and 6) organizational capacity. Within each, we describe specific metrics and how they may be considered as part of evaluation plans. We emphasize the role of measurement and evaluation at the institutional level, so that programs may enhance their mentoring capacity and optimize the management of their resources. Although we advocate for a comprehensive approach to evaluation, we recognize that—depending on stage and relative maturity—some domains may be prioritized to address short- and medium-term program goals. Fil: Chi, Benjamin H.. University of North Carolina; Estados Unidos Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Blas, Magaly M.. Universidad Peruana Cayetano Heredia; Perú Fil: Chuang, Alice. University of North Carolina; Estados Unidos Fil: Wilson, Michael D.. University Of Ghana; Ghana Fil: Chibwesha, Carla J.. University of North Carolina; Estados Unidos Fil: Farquhar, Carey. University of Washington; Estados Unidos Fil: Cohen, Craig R.. University of California; Estados Unidos Fil: Raj, Tony. St. John’s Research Institut; India

A growing body of evidence highlights the importance of competent mentoring in academic research. We describe the development, implementation, and evaluation of four regional 2-day intensive workshops to train mid- and senior-level investigators conducting public health, clinical, and basic science research across multiple academic institutions in low- and middle-income countries (LMICs) on tools and techniques of effective mentoring. Sponsored by the Fogarty International Center, workshops included didactic presentations, interactive discussions, and small-group problem-based learning and were conducted in Lima, Peru; Mombasa, Kenya; Bangalore, India; and Johannesburg, South Africa, from 2013 to 2016. Mid- or senior-level faculty from multiple academic institutions within each region applied and were selected. Thirty faculty from 12 South America–based institutions, 29 faculty from eight East Africa–based institutions, 37 faculty from 14 South Asia–based institutions, and 36 faculty from 13 Africa-based institutions participated, with diverse representation across disciplines, gender, and academic rank. Discussions and evaluations revealed important comparisons and contrasts in the practice of mentoring, and specific barriers and facilitators to mentoring within each cultural and regional context. Specific regional issues related to hierarchy, the post-colonial legacy, and diversity arose as challenges to mentoring in different parts of the world. Common barriers included a lack of a culture of mentoring, time constraints, lack of formal training, and a lack of recognition for mentoring. These workshops provided valuable training, were among the first of their kind, were well-attended, rated highly, and provided concepts and a structure for the development and strengthening of formal mentoring programs across LMIC institutions.

Following the Fogarty International Center-supported “Mentoring the Mentors” workshops in South America, Africa, and Asia, approaches and guidelines for mentorship at institutions within these low- and middle-income country (LMIC) contexts, appropriate for the respective regional resources and culture, were implemented. Through the presentation of case studies from these three geographic regions, this article illustrates the institutional mentorship infrastructure before the workshop and the identified gaps used to implement strategies to build mentorship capacity at the Universidad Peruana Cayetano Heredia (Peru), Kenya Medical Research Institute (Kenya), Saint John’s Research Institute (India), and Eduardo Mondlane University (Mozambique). These case studies illustrate three findings: first, that mentorship programs in LMICs have made uneven progress, and institutions with existing programs have exhibited greater advancement to their mentoring capacity than institutions without formal programs before the workshops. Second, mentoring needs assessments help garner the support of institutional leadership and create local ownership. Third, developing a culture of mentorship that includes group mentoring activities at LMIC institutions can help overcome the shortage of trained mentors. Regardless of the stage of mentoring programs, LMIC institutions can work toward developing sustainable, culturally effective mentorship models that further the partnership of early career scientists and global health.

Mentoring is a proven path to scientific progress, but it is not a common practice in low- and middle-income countries (LMICs). Existing mentoring approaches and guidelines are geared toward high-income country settings, without considering in detail the differences in resources, culture, and structure of research systems of LMICs. To address this gap, we conducted five Mentoring-the-Mentor workshops in Africa, South America, and Asia, which aimed at strengthening the capacity for evidence-based, LMIC-specific institutional mentoring programs globally. The outcomes of the workshops and two follow-up working meetings are presented in this special edition of the American Journal of Tropical Medicine and Hygiene. Seven articles offer recommendations on how to tailor mentoring to the context and culture of LMICs, and provide guidance on how to implement mentoring programs. This introductory article provides both a prelude and executive summary to the seven articles, describing the motivation, cultural context and relevant background, and presenting key findings, conclusions, and recommendations.

The cutting tool process became one of the uncommon thermal energy-based manufacturing methods used in aerospace and different electronics industries to create complex shapes on different metals and their alloys. This paper presents a genetic algorithm for optimizing wear rate and kerf width mostly during cutting tools of aluminum 6351 CO2. The experiments were based on the design of Box Behnken, which took into account three laser specifications for cutting process. Control of laser beams, cutting speeds and gas pressure. By reducing the surface roughness and kerf width, the optimum parameters for the laser cutting were determined. Our test results reveal that in solving optimization problems, the suggested genetic algorithm is efficient and efficient and can be incorporated into the intelligent production environment.

Worldwide force age is estimate to increment by some 60% somewhere in the range of 2017 and 2040 to cover a fourth of essential vitality request, the IEA said in its World Energy Outlook 2018. “Power markets are experiencing a special change with more popularity brought by the advanced economy, electric vehicles” however numerous components are impacting the agreeableness of vitality innovation. The change of the vitality area is searching for clean vitality innovation that is additionally appropriate for base burden power generation. The sun based vitality is most utilized clean vitality today, but Terrestrial sun oriented vitality has several obstructions, Putting colossal sun based power satellite systems for arena addresses a lot of creative mechanical benefits than may give gigantic degree, normally clean base weight power into natural markets and it is one of the way in which satisfied essentialist demand in best in class days. Later, a symmetric concentrated with a high sun-based arrangement competence has been proposed.

We describe a new wearable device that has been developed to monitor the effectiveness of Kangaroo Mother Care (KMC) treatment administered to premature neonates. We identify the sensors needed to monitor KMC treatment. Our device measures the neonate's and caregiver's skin temperature and the neonate's relative position during KMC. The device incorporates skin touch sensors to qualify the temperature readings, thus preventing false alarms. Design constraints related to form factor, placement and battery life and few measurement results from pre-clinical trials are provided.

A modified single-phase hybrid cascaded H bridge multilevel inverter with a minimum number of power electronic devices and isolated DC sources is presented in this study. It consists of two inverters (upper and lower) coupled in cascade. The lower inverter is capable of developing a multilevel output and switches at low frequency and another inverter develops two-level output and switches at high frequency. In the proposed inverter, every additional power electronic switch in the lower inverter increases the level by four. This study also introduces a generalised hybrid modulation switching strategy, which gives arithmetical and logical expressions for switching the additional device for any required increase in levels. The voltage rating of the devices, conduction and switching loss of the proposed inverter are compared with the similarly setup topologies. The generalised hybrid modulation algorithm is simulated in MATLAB/Simulink and implemented in a SPATRAN 3A DSP board. Simulation and experimental results are presented for different loading conditions.

This paper presents a new cascaded asymmetrical single phase multilevel converter with a lower number of power semiconductor switches and isolated DC sources. Therefore, the number of power electronic devices, converter losses, size, and cost are reduced. The proposed multilevel converter topology consists of two H-bridges connected in cascaded configuration. One H-bridge operates at a high frequency (high frequency inverter) and is capable of developing a two level output while the other H-bridge operates at the fundamental frequency (low frequency inverter) and is capable of developing a multilevel output. The addition of each power electronic switch to the low frequency inverter increases the number of levels by four. This paper also introduces a hybrid switching algorithm which uses very simple arithmetic and logical operations. The simplified hybrid switching algorithm is generalized for any number of levels. The proposed simplified switching algorithm is developed using a TMS320F2812 DSP board. The operation and performance of the proposed multilevel converter are verified by simulations using MATLAB/SIMULINK and experimental results.

Summary Background & aims The 2007 FAO/WHO/UNU lysine requirement is 30 mg kg−1 d−1. Developing country populations may be at risk of lysine deficiency, with effects on muscle and its function. The effect of an 8 wk lysine supplementation diet on muscle mass and function was assessed. Methods Healthy, under and well-nourished men were studied before and after 8 wk, during which low (n = 20) and high (n = 20) lysine diets were consumed. The low lysine diets (∼25 and ∼40 mg kg−1 d−1 for under and well-nourished respectively) were based on the subjects’ habitual lysine intake, while the high lysine diet supplied 80 mg kg−1 d−1. Anthropometry, muscle function, insulin sensitivity (IS) and leucine kinetics were measured before and after the experimental period. Results The high lysine diet had a small positive effect (about +7.5%) on muscle strength, but no effect on other parameters. Over the 8 wk period in the whole group, the change in muscle strength correlated with the change in muscle mass (r = 0.5, P = 0.001), while the change in muscle mass correlated with the change in IS (r = 0.3, P = 0.04), but there were no intake specific differences. Conclusion Over an 8 wk controlled feeding period, an intake of 80 mg lysine kg−1 d−1 had a small positive effect on muscle strength, but no other effects.

Integration of mobile phone technology into HIV care holds potential, particularly in resource-constrained settings. Clinic attendees in urban and rural South India were surveyed to ascertain usage of mobile phones and perceptions of their use as an adherence aid. Mobile phone ownership was high at 73%; 26% reported shared ownership. A high proportion (66%) reported using phones to call their healthcare provider. There was interest in weekly telephonic automated voice reminders to facilitate adherence. Loss of privacy was not considered a deterrent. The study presents important considerations in the design of a mobile phone-based adherence intervention in India.

Hyperinsulinemia related to obesity may result in activation of the sympathetic nervous system (SNS). Acute autonomic responsiveness to insulin is influenced by body composition, particularly obesity. However, it is unclear whether skeletal muscle mass or function determines autonomic responsiveness to insulin. While muscle function is associated with insulin sensitivity, there are no studies that have assessed if skeletal muscle function modulates autonomic responses to hyperinsulinemia. Fifty healthy men (aged 18-35years) were evaluated for skeletal muscle function (hand grip strength and static and dynamic endurance) and then divided into low and high endurance (LE and HE) groups. Heart rate variability (HRV) in the frequency domain was measured during a hyperinsulinemic euglycemic clamp (HEC). With hyperinsulinemia, the HE group had a higher increment in total power of HRV (1615+/-2536 vs. 97+/-1943, P=0.08) and normalized low frequency (LF) HRV (16.2+/-17.9 vs. -1.3+/-14.8, P=0.008) as compared to the LE group. A significant reduction in the normalized high frequency (HF) HRV was seen in the HE group but not in the LE group (-12.3+/-12.9 vs. 1.7+/-13.9, P=0.009); this translated into an increase in LF/HF ratio for the HE group and but not the LE group (1.21+/-1.8 vs. -0.08+/-0.65, P=0.016). The present study indicates that there are differential cardiac autonomic responses to hyperinsulinemia in healthy human subjects with variable skeletal muscle function.

BACKGROUND/OBJECTIVES There is a high prevalence of diabetes mellitus associated with insulin resistance in Indian adults, probably due to an inappropriately high accumulation of body fat at lower body mass indices (BMIs, kg/m(2)), as well as to a lower skeletal muscle mass. Although skeletal muscle is an important site of glucose disposal, the strength of its association with insulin sensitivity (IS) is unknown in the Indian population. SUBJECTS/METHODS This was a cross-sectional study performed to assess the association of body fat, muscle and muscle function with IS in 51 young, healthy, nonobese Indian men with BMI ranging from 15 to 25 kg/m(2), using hyperinsulinemic euglycemic clamp method. RESULTS The median IS was 5.32 (mg/(kg min))/(microU/ml), lower, upper quartile, 4.03, 6.56); (SI units: 4.25, lower, upper quartile, 3.22, 5.24 (micromol/(kg min))/(pmol/l)). A multiple linear regression of the natural log transformed value of IS on BMI and body muscle mass measured as the appendicular lean soft tissue (expressed as a percentage of body weight) explained 49% of the variance in IS. Independently, body fat percent and muscle (handgrip) strength showed significant bivariate correlations with IS (rho=-0.61, P

The aim of this study is to increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). A wireless, RFID based system was developed and implemented in the ICU. The ICU beds were divded into an intervention arm (n?=?10) and a control arm (n?=?14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout.

Background The daily requirement for phenylalanine is not known with certainty. Earlier 24-h tracer studies have suggested that the requirement is between 30 and 40 mg . kg(-1) . d(-1). Objective The objective was to assess the phenylalanine requirement in healthy well-nourished Indians with the use of 8 test phenylalanine intakes (19, 23, 27, 31, 35, 38, 43, and 47 mg . kg(-1) . d(-1)) and the 24-h indicator amino acid oxidation (24-h IAAO) and 24-h indicator amino acid balance (24-h IAAB) methods. Design Thirty-two healthy, well-nourished Indian men were studied during each of 2 randomly assigned 6-d diet periods in which phenylalanine intakes of 19, 23, 27, 31, 35, 38, 43, and 47 mg . kg(-1) . d(-1) were supplied; the diet was devoid of tyrosine. A 24-h [13C]leucine tracer infusion was used to measure 24-h IAAO and 24-h IAAB on day 7. The breakpoint in the relation between these values and the phenylalanine intake was determined. Results Two-phase linear regression of daily leucine oxidation and balance against phenylalanine intake estimated a breakpoint in the response curve at phenylalanine intakes of 37 and 38 mg . kg(-1) . d(-1) (95% CI for both: 31, >47 mg . kg(-1) . d(-1)), respectively. Conclusion On the basis of the 24-h IAAO and 24-h IAAB methods, a mean phenylalanine requirement of 38 mg . kg(-1) . d(-1) is proposed for healthy well-nourished Indian adults in the absence of tyrosine intake. This finding is similar to that in Western adults.

Low-cost generic antiretroviral drugs are available in resource-limited settings for treatment of HIV infections. However, few bioequivalence data in specific populations in which these generics are likely to be used are available. We conducted a randomized crossover bioequivalence study of generic and brand name formulations of nevirapine, zidovudine, and lamivudine in HIV-negative Indian women using US Food and Drug Administration (FDA) criteria. Subjects took single doses of all formulations separated by a 14-day washout period. Plasma concentrations were measured over 96 hours during each study period. Average bioequivalence was determined using natural log-transformed maximum concentration (C(max)) and area-under-the-concentration-time curve (AUC) mean ratio data. Fifteen Indian women were enrolled. The 90% confidence intervals for nevirapine (14 subjects) and lamivudine (15 subjects) C(max), AUC from 0 to the last measurable time point (AUC(0-t)), and AUC from 0 to infinity (AUC(0-infinity)) mean ratios and zidovudine (15 subjects) AUC(0-t) and AUC(0-infinity) mean ratios were all within 0.80 to 1.25. However, the 90% confidence interval for zidovudine C(max) mean ratio was 0.70 to 1.46. Generic and brand name nevirapine and lamivudine met FDA average bioequivalence criteria. Lack of average bioequivalence for zidovudine was found for C(max) but is not expected to be clinically significant, because the total AUC values were similar between formulations.

There is now an expanding body of evidence to recommend, in the case of adult humans, the use of revised indispensable amino acid requirement values; these are approximately 2 to 3 times higher than the current international recommendations. The earlier methodologies for determining amino acid requirements, based on nitrogen balance, were criticized because of their design and the associated high energy intakes. The 1985 World Health Organization/Food & Agriculture Organization/United Nations University requirement for leucine has been demonstrated to be too low by short- and long-term (24-h) tracer-derived estimates of leucine oxidation and balance. The best values for leucine requirements come from 24-h direct amino acid oxidation (DAAO) and direct amino acid balance (DAAB) studies. Finally, we also collated all available data from studies on fed-state leucine oxidation with an adequate dietary adaptation period to assess the inflection on the leucine oxidation-leucine intake curve. The mean requirements for leucine, valine, and isoleucine are likely to be 40, 17-25, and 19 mg . kg(-1) . d(-1), respectively. This adds up to a total of approximately 84 mg . kg(-1) . d(-1), which is much lower than the lowest estimate of the total BCAA requirement of approximately 110 mg . kg(-1) . d(-1) made by the short-term indicator amino acid oxidation (IAAO) method, which determined the BCAA requirement from the pattern of oxidation of an indicator amino acid (phenylyalanine) at different levels of BCAA intake. An additional estimate of the leucine requirement was also made by a meta-analysis of all available 24-h DAAO/DAAB data from different studies. This resulted in a higher value for the leucine requirement than that obtained by the specific studies that utilized the 24-h DAAO/DAAB approach; however, even adding this value to the total BCAA requirement does not account for the difference in the total BCAA requirement estimates and the summed individual BCAA estimates.

BACKGROUND The mean lysine requirement of healthy Indian subjects was estimated from short-term experimental diet periods to be 29 mg x kg(-1) x d(-1), which is higher than the 1985 FAO/WHO/UNU upper requirement of 12 mg x kg(-1) x d(-1). OBJECTIVE Our objective was to confirm our proposed requirement of 29 mg x kg(-1) x d(-1) by extending the diet period to 21 d and by using 4 test lysine intakes (12, 20, 28, and 36 mg x kg(-1) x d(-1)) and a 24-h indicator amino acid oxidation and balance approach. DESIGN During two 21-d diet periods, 18 healthy Indian men were randomly assigned to receive 12 and 28 or 20 and 36 mg lysine x kg(-1) x d(-1) as part of an L-amino acid diet. At 1800 on days 6 and 20, [(13)C]leucine was infused over 24 h to assess leucine oxidation and daily leucine balance at each test intake. RESULTS Leucine oxidation, balance, and flux did not differ significantly between days 7 and 21. Twenty-four-hour leucine oxidation was lower at lysine intakes of 28 and 36 mg than at 12 and 20 mg. Leucine balances at lysine intakes of 12 and 20 mg were negative and significantly less than equilibrium (P < 0.01) and lower (P < 0.02) than balances at 28 and 36 mg lysine. Two-phase regression analysis indicated a breakpoint at 31 mg lysine x kg(-1) x d(-1) in the relation between lysine intake and 24-h leucine oxidation and balance. CONCLUSIONS Full adaptation to a low lysine intake occurs within 7 d. The previously proposed tentative mean lysine requirement for Western subjects of 30 mg x kg(-1) x d(-1) is confirmed for healthy Indian adults.

Clinical documentation and health information portability pose unique challenges in urban and rural areas of India. This article presents findings of a pilot study conducted in a primary health center in rural India. In this article, we focus on primary care in rural India and how a portable health record system could facilitate the availability of medical information at the point of care. We followed a geriatric cohort and a maternal cohort of 308 participants over a nine-month period. Physician encounters were entered into a web-based electronic health record. This information was made available to all study participants through a short messaging service (SMS). Additionally, 135 randomly selected participants from the cohort were issued a USB-based memory card that contained their detailed health records and could be viewed on most computers. The dual portability model implemented in the pilot study demonstrates the utility of the concept.

Background The 1985 FAO/WHO/UNU requirement for leucine is too low according to tracer-derived estimates of leucine oxidation and balance in adults from developed regions. Objective The leucine requirement in populations in developing countries was assessed with use of the 24-h tracer balance method and on the basis of nitrogen balances. Design Twenty healthy Indian men were studied during their consumption for 6 d of 2 L-amino acid diets that supplied either 14 and 30 (n = 10) or 22 and 40 (n = 10) mg leucine x kg(-1) x d(-1) in random order. At 1800 on day 7, a 24-h constant intravenous [13C]leucine tracer-infusion protocol was conducted to determine leucine oxidation and daily leucine balance. During the intake of 40 mg leucine/d, [2H3]leucine was given orally to assess the splanchnic uptake of leucine. Results Mean 24-h leucine oxidation rates were 29.8, 30.6, 33.6, and 39.3 mg x kg(-1) x d(-1) at leucine intakes of 14, 22, 30, and 40 mg x kg(-1) x d(-1), respectively; daily leucine balances were -16.5, -9.0, -3.3, and 0.5 mg x kg(-1) x d(-1), respectively. Mixed-models linear regression of balance against leucine intake resulted in a zero balance at a leucine intake of 37.3 mg x kg(-1) x d(-1). Nitrogen balances were -12.7, -17.9, -3.9, and 1.0 mg x kg(-1) x d(-1) at leucine intakes of 14, 22, 30, and 40 mg x kg(-1) x d(-1). Regression of nitrogen balance against intake resulted in a zero balance at a leucine intake of 37.6 mg x kg(-1) x d(-1). The first-pass splanchnic uptake of leucine was 45.7% and 33.9% in the fasted and fed periods, respectively. Conclusion A tentative mean leucine requirement of 40 mg x kg(-1) x d(-1) is proposed for healthy Indian adults, as it is for Western subjects.

The international 1985 FAO/WHO/UNU upper dietary requirement for lysine of 12 mg.kg-1.d-1 may be inadequate for healthy Indian adults. To test this, we used a modified indicator amino acid oxidation technique to assess the adequacy of lysine intake of 12 and 28 mg.kg-1.d-1. Seven healthy, male, Indian subjects were studied during each of two randomly assigned 6-d periods while receiving an otherwise adequate diet based on an L-amino acid mixture. Beginning at 1800 on day 6 of the diet, a 24-h infusion protocol in which a [13C]leucine tracer was administered intravenously was used to assess leucine oxidation and daily leucine balance at each test lysine intake. Mean 24-h leucine oxidation was 54.7 compared with 46.9 mg.kg-1.d-1 (P0.05) and mean 24-h leucine balances were -4.1 and 3.5 mg.kg-1.d-1 (P0.05) for lysine intakes of 12 and 28 mg, respectively. Leucine balances were significantly negative (0.025P0.05) with the 12-mg lysine intake and not significantly different (P0.10) from zero or equilibrium with the 28-mg intake. These findings indicate that the international requirement for lysine appears to be inadequate to maintain body amino acid homeostasis and function in apparently healthy subjects characteristic of the south Asia region. They further indicate that our previously proposed, tentative lysine requirement of 30 mg.kg-1.d-1 is probably adequate for this population.