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This paper reports the results of a pilot study aimed at evaluating the performance of the ICDS programme. The study is based on a field survey conducted in 1996 in ten selected blocks in five states comprising 1362 anganwadi centres, 2700 beneficiary households, 10 CDPOs and 40 circle supervisors. The analysis employs a set of indicators classified under five major heads viz. Infrastructure at the anganwadi centres, profile of the anganwadi functionaries, functioning of anganwadi centres, utilisation of ICDS services, and community participation. According to the survey results, low levels of anganwadi infi-astructure, inadequate training of workers, poor maintenance of growth monitoring charts, inadequate availability of equipment and medical kits, irregular food supplies, and health check-ups, limited immunisation coverage, and poor community response are found to be responsible for poor utilisation and delivery of services. However, both literacy levels and training of anganwadi workers are seen to contribute to better delivery of ICDS services. The study also indicates that for better community participation the awareness levels in the community needs to be further improved. While the component of nutrition &health education seems to be working well, it seems to have had little impact in translating knowledge into action. The policy implications of this study, therefore, are quite clear. With a view to achieving a steady decline in the incidence of malnutrition among children, particularly among certain socially and economically disadvantaged groups, basic infrastrucure at anganwadi centres and training of functionaries must be strengthened, besides ensuring regular supplies of food and other inputs and eliciting active participation of the community. The above conclusions are based on a rather small sample and can at best be treated as tentative.

There have been two major kinds of reforms affecting the rural health services. One is the introduction or expansion of user fees and the other is the devolution of central responsibilities to lower levels of government. This paper reviews the various initiatives towards decentralisation in the formulation of the several World Bank assisted projects in population, health and nutrition with a focus on the problems which may arise in the effective implementation of the policy.

Sickle cell-beta thalassemia is a double heterozygous state. Red cell exchange (RCE) transfusion reduces the concentration of sickle cells without increasing the hematocrit or whole-blood viscosity. It can be performed manually or by erythrocytapheresis. RCE transfusion is an effective tool for both acute and chronic complications of sickle cell disease. In patients unaffording erythrocytapheresis, even manual RCE can give favorable results. A 37-year-old male, a known case of sickle cell-beta+ thalassemia (βsβ+), presented with avascular necrosis of right femur and humeral head. He was posted for the right hip arthroplasty and shoulder hemiarthroplasty. Successful manual RCE transfusions were done. The hemoglobin S levels decreased postmanual RCE procedures, and the patient was operated successfully.

DNA-based vaccines, while highly immunogenic in mice, generate significantly weaker responses in primates. Therefore, current efforts are aimed at increasing their immunogenicity, which include optimizing the plasmid/gene, the vaccine formulation and method of delivery. For example, co-immunization with molecular adjuvants encoding an immunomodulatory protein has been shown to improve the antigen (Ag)-specific immune response. Thus, the incorporation of enhancing elements, such as these, may be particularly important in the influenza model in which high titered antibody (Ab) responses are critical for protection. In this regard, we compared the ability of plasmid-encoded high-mobility group box 1 protein (HMGB1), a novel cytokine in which we have previously mutated in order to increase DNA vaccine immunogenicity, with boost Ag-specific immune responses during DNA vaccination with influenza A/PR/8/34 nucleoprotein or the hemagglutinin of A novel H1N1/09. We show that the HMGB1 adjuvant is capable of enhancing adaptive effector and memory immune responses. Although Ag-specific antibodies were detected in all vaccinated animals, a greater neutralizing Ab response was associated with the HMGB1 adjuvant. Furthermore, these responses improved CD8 T + -cell effector and memory responses and provided protection against a lethal mucosal influenza A/PR/8/34 challenge. Thus, co-immunization with HMGB1 has strong in vivo adjuvant activity during the development of immunity against plasmid-encoded Ag.

Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. The present report describes the initial experience of transplantation of organs from DCD donors in a tertiary care center in India. Between 2011 and 2015, five donors had kidneys retrieved after cardiac arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following cardiopulmonary resuscitation (CPR), which was restarted in three patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 9/10 kidneys were utilized. Mean donor age was 29.6 ± 16.3 years, M:F 4:1 and mean age of recipients was 38.7 ± 10.8 years, M:F 7:2. Seven patients required dialysis in postoperative period. Mean postoperative day 0 urine output was 1.9 ± 2.6 L. Baseline creatinine achieved was 1.38 ± 0.35 mg/dl after a mean duration of 26.12 ± 15.4 days. Kidneys from donors where CPR was continued after the declaration of death ( = 3) had better recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days, baseline creatinine 1.36 ± 0.25 vs. 1.52 ± 0.45 mg%). In donors without CPR, one kidney never functioned and others had patchy cortical necrosis on protocol biopsy, which was not seen in the kidneys from donors with CPR. Kidneys from DCD donors can serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death seems to help in improving outcomes.

While the practice of reporting multi-model ensemble climate projections is well established, there is much debate regarding the most appropriate methods of evaluating model performance, for the purpose of eliminating and/or weighting models based on skill. The CMIP3 model evaluation undertaken by the Pacific Climate Change Science Program (PCCSP) is presented here. This includes a quantitative assessment of the ability of the models to simulate 3 climate variables: (1) surface air temperature, (2) precipitation and (3) surface wind); 3 climate features: (4) the South Pacific Convergence Zone, (5) the Intertropical Convergence Zone and (6) the West Pacific Monsoon; as well as (7) the El Niño Southern Oscillation, (8) spurious model drift and (9) the long term warming signal. For each of 1 to 9, it is difficult to identify a clearly superior subset of models, but it is generally possible to isolate particularly poor performing models. Based on this analysis, we recommend that the following models be eliminated from the multi-model ensemble, for the purposes of calculating PCCSP climate projections: INM-CM3.0, PCM and GISS-EH (consistently poor performance on 1 to 9); INGV-SXG (strong model drift); GISS-AOM and GISS-ER (poor ENSO simulation, which was considered a critical aspect of the tropical Pacific climate). Since there are relatively few studies in the peer reviewed literature that have attempted to combine metrics of model performance pertaining to such a wide variety of climate processes and phenomena, we propose that the approach of the PCCSP could be adapted to any region and set of climate model simulations.

We recently reported on the physical characteristics of photo-triggerable liposomes containing dipalmitoylphosphatidylcholine (DPPC), and 1,2-bis (tricosa-10,12-diynoyl)-sn-glycero-3-phosphocholine (DC(8,9)PC) carrying a photo agent as their payload. When exposed to a low-intensity 514 nm wavelength (continuous-wave) laser light, these liposomes were observed to release entrapped calcein green (Cal-G; Ex/Em 490/517 nm) but not calcein blue (Cal-B; Ex/Em 360/460 nm). In this study, we have investigated the mechanism for the 514 nm laser-triggered release of the Cal-G payload using several scavengers that are known specifically to inhibit either type I or type II photoreaction pathways. Liposomes containing DPPC:DC(8,9)PC: distearoylphosphatidylethanolamine (DSPE)-polyethylene glycol (PEG)-2000 (86:10:04 mole ratio) were loaded either with fluorescent (calcein) or nonfluorescent ((3)H-inulin) aqueous markers. In addition, a non-photo-triggerable formulation (1-palmitoyl-2-oleoyl phosphatidylcholine [POPC]:DC(8,9)PC:DSPE-PEG2000) was also studied with the same payloads. The 514 nm wavelength laser exposure on photo-triggerable liposomes resulted in the release of Cal-G but not that of Cal-B or (3)H-inulin, suggesting an involvement of a photoactivated state of Cal-G due to the 514 nm laser exposure. Upon 514 nm laser exposures, substantial hydrogen peroxide (H2O2, ≈100 μM) levels were detected from only the Cal-G loaded photo-triggerable liposomes but not from Cal-B-loaded liposomes (≤10 μM H2O2). The Cal-G release from photo-triggerable liposomes was found to be significantly inhibited by ascorbic acid (AA), resulting in a 70%-80% reduction in Cal-G release. The extent of AA-mediated inhibition of Cal-G release from the liposomes also correlated with the consumption of AA. No AA consumption was detected in the 514 nm laser-exposed Cal B-loaded liposomes, thus confirming a role of photoactivation of Cal-G in liposome destabilization. Inclusion of 100 mM K3Fe(CN)6 (a blocker of electron transfer) in the liposomes substantially inhibited Cal-G release, whereas inclusion of 10 mM sodium azide (a blocker of singlet oxygen of type II photoreaction) in the liposomes failed to block 514 nm laser-triggered Cal-G release. Taken together, we conclude that low-intensity 514 nm laser-triggered release of Cal-G from photo-triggerable liposomes involves the type I photoreaction pathway.