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According to the World Health Organization, in 2015, raised BP was responsible for 7.5 million deaths, about 12.8 per cent of the total of all deaths globally[1]. According to data from the GBD study of 2016, hypertension led to 1.63 million deaths in India in the year 2016 alone[2]. According to the report, the initiative is being carried out through 10,512 health and wellness centres (HWCs), over half of which are located in five States - Andhra Pradesh, Tamil Nadu, Uttar Pradesh, Karnataka and Kerala[10]. According to the National Health Mission document, the programme also aims to improve overall awareness regarding non-communicable diseases and risk factors through increased information, education and communication activities[9].

Purpose The purpose of this paper is to investigate the significant supply chain issues in the small and medium-sized enterprise (SME) food industry. The objectives are to identify the major themes and the dynamic evolution of SME food supply chain (FSC) issues, the current research trends, the different modelling approaches used in SME FSC, and the most addressed SME food sector. Design/methodology/approach In all, 3,733 published articles from 2002 to 2018 in the Clarivate Analytics Web of Science database were collected, from which 1,091 articles were shortlisted for the review. The authors used bibliographic coupling combined with co-word analysis to identify the historical relations of the research themes that emerged during the periods 2002–2014 and 2002–2018. Findings This research identified five major research themes such as production and distribution in alternative food networks, relationship, safety and standards in the FSC, greenhouse gas (GHG) emission impact of the farm food system, traceability and product quality in FSC and asymmetric price transmission in the FSC. Among the identified themes, GHG emission impact of the farm food system and traceability and product quality in the FSC have received increasing attention in recent years. The dairy sector is the most addressed sector (36 per cent), followed by fruits and vegetables (27 per cent), meat and poultry (18 per cent), seafood (10 per cent) and grains and oilseed (8 per cent). It is also identified that the dairy sector has received significant attention in the “GHG Emission impact of farm food system” theme. Similarly, meat and poultry sectors have received much attention in the “Traceability and product quality in the food supply chain” theme. Also, the authors identified that the empirical modelling approaches are the most commonly used solution methodology, followed by the conceptual/qualitative methods in the SME FSC. Originality/value This study maps and summarizes the existing knowledge base of supply chain issues in the SME food sector. The results of this review provide the major research areas, most commonly used approaches and food sectors addressed. This study also highlights the research gaps and potential future research direction.

Human bocaviruses (HBoVs) can cause respiratory illness in young children. Although the first HBoV infection in India was reported in 2010, very little information is available about its prevalence, clinical features, or geographic distribution in this country. This study was conducted using 136 respiratory samples from paediatric patients in a tertiary care hospital in Kerala, 21 of which tested positive for HBoV1 and were further characterized through VP1/VP2 gene sequencing. We found that different strains of HBoV1 are co-circulating in the region and that HBoV1 can be detected in children with severe acute respiratory infections, either alone or coinfections with other pathogens, without any significant differences in their clinical characteristics.

IntroductionWe aimed to compare the predictive accuracy of surrogate indices namely the lipid accumulation product (LAP) index, homeostatic model of assessment of insulin resistance (HOMA-IR), fasting glucose-insulin ratio (FG-IR) and the quantitative-insulin sensitivity check index (QUICKI), against the M value of hyperinsulinemic-euglycemic clamp (HEC), and to determine a cut-off value for the LAP index to predict risk of insulin resistance in non-obese (body mass index <21 kg/m2), normoglycemic, Asian Indian males from Southern India.Research design and methodsData of HEC studies performed in 108 non-obese, normoglycemic, Asian Indian males was obtained retrospectively and the M value (a measure of whole-body insulin sensitivity) was calculated. The M value is the rate of whole-body glucose metabolism at the hyperinsulinemic plateau (a measure of insulin sensitivity) and is calculated between 60 and 120 min after the start of the insulin infusion in the HEC procedure. The LAP index, the HOMA-IR, FG-IR and QUICKI were calculated. Spearman’s correlation and logistic regression analysis were performed. Cut-off value for the LAP index was obtained using receiver operating characteristics with area under curve (AUC) analysis at 95% CI. P value <0.05 was considered to be statistically significant.ResultsSignificant negative correlation was observed for the M value with LAP index (r=−0.39, p<0.001) while significant positive correlation was noted with FG-IR (r=0.25; p<0.01) and QUICKI (r=0.22; p<0.01). The LAP index cut-off value ≥33.4 showed 75% sensitivity and 75% specificity with AUC (0.72) to predict risk of insulin resistance in this cohort.ConclusionThe LAP index showed higher predictive accuracy for the risk of insulin resistance as compared with HOMA-IR, QUICKI and FG-IR in non-obese, normoglycemic Asian Indian males from Southern India.

Background Hypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians’ perceptions and implementation of hypertension guidelines exists, mostly focussed on higher income settings. This study aims to explore how hypertension guidelines are used by clinicians across different resource settings, and the factors influencing their use. Methods A qualitative approach was employed using convenience sampling and in-depth semi-structured interviews. Seventeen medical doctors were interviewed over video or telephone call from March to August 2020. Two clinicians worked in low-income countries, ten in middle-income countries, and five in high-income countries. Interviews were recorded, transcribed, and coded inductively. Reflexive thematic analysis was used. Results Themes were generated at three levels at which clinicians perceived influencing factors to be operating: healthcare worker, healthcare worker interactions with patients, and the wider health system. Within each level, influencing factors were described as barriers to and facilitators of guideline use. Variation in factors occurred across income settings. At the healthcare worker level, usability of guidelines, trust in guidelines, attitudes and views about guidelines’ purpose, and relevance to patient populations were identified as themes. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare settings. Influences at the patient level were clinician perceived patient motivation and health literacy, and access to, and cost of treatment, although these represented doctors’ perceptions rather than patient perceived factors. Conclusions This study adds a high level global view to previous studies investigating clinician perspectives on hypertension guideline use. Guidelines should be evidence-based, regularly updated and attention should be given to increasing applicability to LMICs and a range of healthcare professionals.

Often a single blood pressure (BP) measurement is used to diagnose and manage hypertension in busy clinics. However, repeated BP measurements have been shown to be more representative of the true BP status of the individual. Improper measurement of office BP can lead to inaccurate classification, overestimation of a patient’s true BP, unnecessary treatment, and misinterpretation of the true prevalence of hypertension. There is no consensus among major guidelines on the number of recommended measurements at a single visit or the method of arriving at final clinic BP reading. The participants of the National Family Health Survey (NFHS-4), a nationwide survey conducted in India from 2015 to 2016, were used for the analysis. The prevalence and median difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) for single as well as combinations of two or more readings were calculated. Cross-tabulation was used to assess classification of individuals based on first BP reading compared with the mean of two or more BP measurements. There was a 63% higher prevalence of hypertension when only the first reading was considered for diagnosis in comparison to the mean of the second and third readings. A decrease of 3.6 mmHg and 2.4 mm Hg in mean SBP and DBP, respectively, was observed when the mean of the second and third readings was compared to the first reading. In those who are identified to have grade 1 or higher categories of hypertension, we recommend three BP measurements, with the mean of the second and third measurements being the clinic BP.

IntroductionThere is dearth of data on prevalent vertebral fractures in perimenopausal women in India and limited literature on the utility of FSH, AMH and estradiol in evaluating bone health them. The objective was to study the prevalence of vertebral fractures (VF) and to assess the utility of FSH, estradiol and AMH in predicting them in Indian perimenopausal womenMaterials and methodsIt was a cross-sectional study. Perimenopausal women aged 40–49 years underwent assessment for prevalent vertebral fractures, bone mineral density (BMD) and trabecular bone score (TBS). Utility of serum FSH, estradiol and AMH in predicting prevalent vertebral fractures was also assessed.ResultsA total of 300 perimenopausal women with mean (SD) age of 43.2 (2.8) years was recruited and 18% had moderate–severe VF. Mean (SD) serum AMH was lower in perimenopausal women with VF as compared to those without fractures [0.752 (0.594) vs 1.023 (0.704) P = 0.006]. AMH showed significant positive correlation with TBS (r = 0.3; P < 0.001) and BMD at the femoral neck (r = 0.2; P < 0.001) and lumbar spine (r = 0.3; P < 0.001).On ROC analysis, AMH demonstrated good performance in predicting prevalent VF with an AUC of 0.800 (95% CI 0.705–0.880) and a sensitivity of 85% and specificity of 60% at a cut-off of 1.12 ng/mL. On an exploratory multivariate logistic regression analysis, AMH significantly predicted prevalent fractures with an adjusted OR (OR) of 1.85 (95% CI: 1.03–3.00; P = 0.04). The performance of FSH and estradiol in predicting prevalent fractures was sub-optimal.ConclusionAbout one-fifth of the study subjects had prevalent vertebral fractures. AMH may be a menstrual cycle independent biomarker and may reflect bone loss in perimenopausal women. Further prospective studies are needed to validate these findings.

The cause of infertility in women with endometriosis remains unclear. Elevated levels of iron in the follicular fluid (FF), potentially leading to oxidative stress, have been reported in endometriosis. In this study, we aimed to compare markers of iron status, oxidative stress, and inflammation in the FF of infertile women with and without endometriosis. Infertile women undergoing assisted reproductive technology (ART) were the subjects of the study. Endometriosis ( n  = 21) was diagnosed laparoscopically, and the control arm ( n  = 14) comprised women with tubal factor, male factor, or unexplained infertility. FF collected during oocyte retrieval was used to estimate iron levels, transferrin, interleukin-6 (IL-6), and malondialdehyde (MDA). MDA levels were significantly higher in FF of women with endometriosis compared to controls. Interestingly, the MDA levels did not differ between affected and unaffected ovaries in women with unilateral endometrioma. In fact, MDA levels were significantly higher in the non-ovarian endometriosis compared to those with ovarian endometrioma. Iron, transferrin, and interleukin-6 (IL-6) were not significantly different between controls and those with endometriosis, and there were no correlations between MDA and iron or IL-6. In conclusion, our findings indicate that the presence of endometriomas does not worsen oxidative stress or elevate iron levels in the FF. These results suggest that the decision to surgically remove an endometrioma before ART should be taken based on clinical considerations such as accessibility issues during oocyte retrieval.

This work investigates the flexural and vibration characteristics of several PLA-ABS composites. Modal analysis was used to determine the intrinsic frequencies and mode forms of different composite constructions, providing information about their dynamic performance. According to the current vibration research, PLA40/ABS60 displayed the highest mode 1 and mode 2 frequencies, indicating higher resistance to secondary vibrations, while PLA60/ABS40 produced an extraordinarily high mode 3 frequency of 928.75 Hz, showing enhanced rigidity. The results show that the resonance peaks shift to higher frequencies when ABS is added, indicating improved damping and stiffness properties. PLA100 and ABS/PLA/ABS composites had the highest maximum stress, indicating greater strength, according to tests of flexural modulus and impact strength. The greatest deflection was displayed by PLA40/ABS60, indicating increased flexibility but decreased strength. In impact tests, PLA50/ABS50 had the best energy absorption and durability with the maximum impact strength of 9757.47 J/m, closely followed by PLA100. Therefore, sandwich configurations like ABS/PLA/ABS enhance vibrational behavior and dynamic performance, whereas PLA/ABS composites with ideal blending ratios strike a balance between strength and flexibility.

In the current phase of world economy, the utilization of the petroleum-based fossil fuels has drastically surpassed the supply. This scenario supplements to the fact that there is an ever increasing necessity for industrialization, specifically in the transportation sector. This requirement and supply of the petroleum and diesel fuels have an astounding impact over the market economy and related commodities. Low viscous and low cetane number biofuels are getting more attention for their usage in engine applications without any further processing. In the present work, lemon peel oil is being fuelled in diesel engine at different timing of injection and exhaust gas recirculation rates. Operation of lemon peel oil (LPO) at standard operating conditions results in increased brake thermal efficiency by consuming less fuel when compared with diesel fuel. The LPO biofuel properties such as boiling point and viscosity being lower leads to better evaporation capacity and thereby results in complete combustion. The advancement in injection timing of 25° bTDC and 27° bTDC resulted in the efficiency increment of 2.17% and 6.19% respectively. Furthermore, the smoke, carbon monoxide and hydrocarbon emissions are decreased in consequence on increased nitrogen oxide (NOx) emissions. Hence, in order to decrease the content of nitrogen oxide emissions in the exhaust, exhaust gas recirculation (EGR) has been implemented in the present work. For EGR rate of 10% and 20%, the NOx emissions is reduced by 43% and 46% respectively for 27° bTDC injection timing. Thus, the advancement of injection timing with optimum EGR is a viable option for the lemon peel oil biofuel in diesel engine with superior performance and emission output.