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Context: Control of diabetes mellitus is a global challenge and nonadherence to diabetic medications is a public health concern. Factors related to patients, medications, and system can contribute to nonadherence. Aims: We aimed to determine self-reported adherence to oral hypoglycemics and to understand the determinants of medication adherence in a group of adult diabetics in South Kerala. Methods: A cross-sectional survey was conducted among 218 diabetic individuals. An eight-item questionnaire to assess the level of adherence and a structured interview schedule were administered to meet the objectives. Adherence was categorized as poor, moderate and high, based on k-means cluster analysis. Results: The proportion of good adherence was 60.09%. Higher age, male gender, nonalcoholic, higher family income, higher frequency of blood glucose monitoring, and controlled blood sugar level were independent predictors of good adherence. Conclusion: The proportion of individuals with poor medication adherence is low. Focus must be on determining factors influencing medication nonadherence.

Background Emergency department (ED) visits increase with age. However, knowledge about the frequency and drivers of ED visits among the oldest old (90 years and above) is scarce, and neither is it known whether patterns differ between those living at home and in round-the-clock care. As understanding of ED use and the factors influencing ED visits is crucial for the functioning of health care systems, this study examined the frequency and predictors of ED visits in a 90+ population living at home and in round-the-clock care. Methods Data from the Vitality 90+ survey, a population-based study with 1561 respondents in 2014 in Tampere, Finland, was combined with national register data on ED use and mortality until the end of 2017. Predictors of the first ED visit were examined using Cox regression models (4-year cumulative hazard) and the frequency and predictors of 1–3 and ≥ 4 ED visits in one year of follow-up with multinomial logistic regression models. Results Over the four-year study period, 79% of the participants had at least one ED visit. Those living at home had higher cumulative hazards of ED visits and were more often frequent ED users (≥ 4 ED visits) than those living in round-the-clock care. Not receiving home care, multimorbidity, poor subjective health and wellbeing, and limitations in functioning increased the risk of ED visits among home dwellers, while having dementia, limitations in functioning, impaired sensory functions, and less frequent social contacts decreased the risk among round-the-clock care residents. In both groups, the predictors of ED visits were similar in one- and four-year follow-ups. Conclusions The frequency and predictors of ED visits greatly differ between those living at home and in round-the-clock care. Since most ED visits occurred among those living at home and having poor health but not receiving formal home care, improving the continuity of care and the coverage of home care services could help to curb the increase in ED visits among the fast-growing oldest old population.

Background: The traditional teaching learning methods involve a one way process of transmission of knowledge leaving the students lacking behind in creative abilities. Medical schools need to change their teaching strategies to keep the interest of students and empower them for future self- learning and critical thinking. Objective: To assess the impact of mind mapping technique in information retrieval among medical college students in Puducherry. Methods: A pilot study was conducted using experimental study design among sixth semester MBBS students (n = 64) at a medical college in Puducherry, India. One group (n = 32) followed the text reading method and another group (n = 32) followed the mind mapping technique to learn the same passage given to them. The knowledge about the topic was assessed using a pre designed questionnaire at baseline, day 0 and day 7. The knowledge gain is the primary outcome variable and is compared between two groups. The feedback regarding the teaching methods was obtained from the participants. Results: Mean knowledge score in the text group was lesser than the mind map group at baseline (2.6 Vs 3.5; p = 0.08). On Day 0, the mean score in text group was slightly lesser than the mind map group (8.7 Vs 9.0; p = 0.26). On Day 7, the mean score in mind map group is significantly more than the text group (8.9 Vs 8.5; p = 0.03). Conclusion: The mind mapping technique is an innovative and effective method in remembering things better than the routine way of reading texts.

An indoor air quality monitoring system helps in the detection and improvement of indoor air quality. The monitoring systems presently available are very expensive. In this paper, we present a low-cost indoor air quality monitoring wireless sensor network system developed using Arduino, XBee modules, and micro gas sensors. The system is capable of collecting six air quality parameters from different locations simultaneously. We have also developed a linear least square estimation-based method for sensor calibration and measurement data conversion. In this paper, we present the detailed design of wireless air quality sensor node and the calibration method. The performance and usefulness of the system are demonstrated by comparing measurement results of our system with a professional-grade air quality measurement device.

Unplanned readmissions to the hospital are a problem faced by most health care organizations in the United States; hospitals are penalized for such readmissions. The project site identified high readmission rates for patients who were discharged after acute myocardial infarction (AMI), making careful transition home a necessity for post-AMI patients. The focus of this quality improvement (QI) project was implementation of an early follow-up appointment of AMI patients following discharge. The purpose of this project was to evaluate the effectiveness of changing follow-up appointments for patients with an AMI from 14-30 days to 7-14 days post discharge to reduce unplanned readmission rates. Bandura’s self- efficacy theory provided the theoretical framework for this project. An evaluation of the QI project was completed by comparing patient readmission rates 6 months before and 6 months after implementation of the early follow-up appointments. Data analysis demonstrated that the readmission rate was not improved in the first 6 months post QI project implementation. Using the plan-do-check-act process, a multifactorial approach was recommended to refine the QI project and address the system-wide readmission rates. The implications of this project for positive social change include providing early analysis of the readmission QI project, which allowed the hospital to restructure the QI approach and improve the plan for preventing readmission.

Poor air quality can greatly affect the public health. Research studies indicate that indoor air can be more polluted than the outdoor air. An indoor air quality monitoring system will help to create an awareness of the quality of air inside which will eventually help in improving it. The objective of this research is to develop a low cost wireless sensor system for indoor air quality monitoring. The major cost reduction of the system is achieved by using low priced sensors. Interface circuits had to be designed to make these sensors more accurate. The system is capable of measuring carbon dioxide, carbon monoxide, ozone, temperature, humidity and volatile organic compounds. The prototype sensor node modules were developed. The sensor nodes were the connected together by Zigbee network. The nodes were developed in such a way that it is compact in size and wireless connection of sensor nodes enable to collect air quality data from multiple locations simultaneously. The collected data was stored in a computer. We employed linear least-square approach for the calibration of each sensor to derive a conversion formula for converting the sensor readings to engineering units. The system was tested with different pollutants and data collected was compared with a professional grade monitoring system for analyzing its performance. The results indicated that the data from our system matched quite well with the professional grade monitoring system.

South-east Asia has one fifth of the world diabetic cases, with India alone contributing 61.3 million cases. Oral hypoglycemic agents substantially delay complications. Non adherence to medications decreases effectiveness of treatment leading to complications and increased cost of health care. Therefore, the objectives of this study are to measure the prevalence of patient’s adherence to anti-diabetic medications and to assess the factors associated with patient’s adherence. Cross-sectional study was conducted among 350 diabetic patients residing in the urban field practice area under Community Medicine Department of a medical college. Data were collected from May to August 2011 by house to house survey, using a pretested structured questionnaire. Patient’s adherence to diabetic medication was assessed using Morisky 4-Item Self-Report measure. Adherence to medication among the diabetics was 50.6 %. Adherence was 55.6 % among patients who were healthy subjectively (P = 0.000). Adherence was higher in non-alcoholics (53.8 %) and non smokers (52.1 %) as compared to alcoholics (23.7 %) and smokers (25.0 %). Adherence was higher among those who did not do physical exercises (56.7 %). Patients taking only one type of medication (67.7 %) were adhering better than those taking two or more type of medication (P = 0.000). Almost 50 % of diabetic patients were not adhering to the medications. Lifestyle factors were significantly associated with patient’s adherence. Hence, patients with poor lifestyle habits should be the primary target of effective intervention for enhancing patient’s adherence to anti-diabetic medications through Behaviour Change Communications.

The adoption of distributed energy resources such as photovoltaics (PVs) has increased dramatically during the previous decade. The increased penetration of PVs into distribution networks (DNs) can cause voltage fluctuations that have to be mitigated. One of the key utility assets employed to this end are step-voltage regulators (SVRs). It is desirable to include tap selection of SVRs in optimal power flow (OPF) routines, a task that turns out to be challenging because the resultant OPF problem is nonconvex with added complexities stemming from accurate SVR modeling. While several convex relaxations based on semi-definite programming (SDP) have been presented in the literature for optimal tap selection, SDP-based schemes do not scale well and are challenging to implement in large-scale planning or operational frameworks. This paper deals with the optimal tap selection (OPTS) problem for wye-connected SVRs using linear approximations of power flow equations. Specifically, the \\(LinDist3Flow\\) model is adopted and the effective SVR ratio is assumed to be continuous--enabling the formulation of a problem called \\(LinDist3Flow-OPTS\\), which amounts to a linear program. The scalability and optimality gap of \\(LinDist3Flow-OPTS\\) are evaluated with respect to existing SDP-based and nonlinear programming techniques for optimal tap selection in three standard feeders, namely, the IEEE 13-bus, 123-bus, and 8500-node DNs. For all DNs considered, \\(LinDist3Flow-OPTS\\) achieves an optimality gap of approximately \\(1\\%\\) or less while significantly lowering the computational burden.

Background Desmoplastic small round cell tumor (DSRCT) is a highly aggressive and uncommon sarcoma with a dismal clinical outcome. Western cohorts have reported clinical outcomes, but there is minimal evidence from the Indian context. This study examined the clinical features, management, and outcomes of DSRCT patients at a tertiary cancer center in India. Methods We retrospectively reviewed medical records of 25 patients with pathologically confirmed DSRCT treated between 2014 and 2023 at Regional Cancer Centre (RCC), Trivandrum. Survival outcomes were estimated using the Kaplan–Meier method and prognostic factors by Cox regression analysis. Results The median age at diagnosis was 29 years (range 14–53 years), with a male predominance ( N  = 24, 96%). Vincristine, doxorubicin, cyclophosphamide plus ifosfamide, and etoposide (VDC + IE) was the first-line regimen in 84% ( N  = 21) and was associated with the longest median overall survival (OS) of 25 months. Surgery was performed in 36% ( N  = 9) (all R2 resection) of patients and significantly improved OS (28.0 vs. 13.5 months; p  = 0.0093). Median OS for the cohort was 22.0 months, with 1-, 2-, and 3-year survival rates of 63.0%, 44.2%, and 14.7%, respectively. Median progression-free survival (PFS) was 16.0 months after first-line and 5.5 months after second-line therapy. Increasing age was independently associated with poorer survival (hazard ratio [HR] 1.09; p  = 0.0165). Conclusion Although DSRCT may initially respond to chemotherapy, the benefit diminishes with successive lines, and long-term outcomes remain poor. Surgical resection, when feasible, offers a survival advantage, but there is an urgent need for evidence-based novel therapeutic strategies. Trial registration Not applicable. This was a retrospective study of routinely collected clinical data.

Merkel cells (MCs) constitute a very unique population of postmitotic cells scattered along the dermo-epidermal junction. These cells that have synaptic contacts with somatosensory afferents are regarded to have a pivotal role in sensory discernment. Several concerns exist till date as to their origin, multiplication, and relevance in skin biology. The article, a collective review of literature extracted from PubMed search and dermatology books, provides novel insights into the physiology of MCs and their recent advances.