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BackgroundKangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies from a baseline of 1.5 hours/baby/day to above 4 hours/baby/day through a series of plan-do-study-act (PDSA) cycles over a period of 53 weeks.MethodsAll babies with birth weight <2000 g not on any respiratory support or phototherapy and or umbilical lines were eligible. The key quantitative outcome was KMC hours/baby/day. A QI collaborative was formed between six centres of Karnataka mentored by a team with a previous QI experience on KMC. The potential barriers for extended KMC were evaluated using fishbone analysis. Baseline data were collected over 3 weeks. A bundled approach consisting of a variety of parent centric measures (such as staff awareness, making KMC an integral part of treatment order, foster KMC, awareness sessions to parents weekly, recognising KMC champions) was employed in multiple PDSA cycles. The data were aggregated biweekly and the teams shared their implementation experiences monthly.ResultsA total of 1443 parent–baby dyads were enrolled. The majority barriers were similar across the centres. Bundled approach incorporating foster KMC helped in the quick implementation of KMC even in outborns. Parental involvement and empowering nurses helped in sustaining KMC. Two centres had KMC rates above 10 hours/baby/day, while remaining four centres had KMC rates sustained above 6 hours/baby/day. Cross-learnings from team meetings helped to sustain efforts. Extended KMC could be implemented and sustained by low intensity training and QI collaboration.ConclusionsFormation of a QI collaborative with mentoring helped in scaling implementation of extended KMC. Extended KMC could be implemented by parent centric best practices in all the centres without any additional need of resources.

We report a case which aims to highlight how multiple problems may exist in a single patient, yet can be managed with a favourable outcome. This patient of ours had infertility, RPL, genital TB. After successful treatment of infertility and TB, she had intrauterine demise of 1 baby of twin, thereby presenting multiple challenges, yet had a good outcome.

An unresolved issue in the vegetation ecology of the Indian subcontinent is whether its savannas, characterized by relatively open formations of deciduous trees in C 4 -grass dominated understories, are natural or anthropogenic. Historically, these ecosystems have widely been regarded as anthropogenic-derived, degraded descendants of deciduous forests. Despite recent work showing that modern savannas in the subcontinent fall within established bioclimatic envelopes of extant savannas elsewhere, the debate persists, at least in part because the regions where savannas occur also have a long history of human presence and habitat modification. Here we show for the first time, using multiple proxies for vegetation, climate and disturbances from high-resolution, well-dated lake sediments from Lonar Crater in peninsular India, that neither anthropogenic impact nor fire regime shifts, but monsoon weakening during the past ~ 6.0 kyr cal. BP, drove the expansion of savanna at the expense of forests in peninsular India. Our results provide unambiguous evidence for a climate-induced origin and spread of the modern savannas of peninsular India at around the mid-Holocene. We further propose that this savannization preceded and drove the introduction of agriculture and development of sedentism in this region, rather than vice-versa as has often been assumed.

The shift toward electric mobility is becoming an essential component of sustainable urban transport in India, yet the pace of adoption of electric autorickshaws (e-autos) varies considerably across cities. This study examines the key behavioural factors shaping the uptake of e-autos in Bangalore, a leading hub of mobility innovation. The analysis is guided by the Grounded theory,  while also incorporating locally relevant aspects like charging infrastructure, financial barriers, and regulatory incentives. Data were gathered through surveys and interviews with drivers of autorickshaws (both e-autos and ICE autos), complemented by secondary evidence. Microsoft 365 supported conversion of audio file to transcripts, while qualitative insights were developed through thematic coding in Taguette. The study extends the application of grounded theory approach within the Indian e-mobility context and offers practical recommendations for stakeholders. Strengthening infrastructure, providing targeted financial support, and enhancing awareness campaigns emerge as critical measures for accelerating e-auto adoption and advancing Bangalore’s sustainable transport agenda.

Introduction:Indian railway systems are fourth largest in the world, and cause on average 15 deaths daily due to various intentional and unintentional reasons. This study presents a 5-year retrospective data analysis of polytrauma patients with train-related injuries.Aim:To highlight key lessons learned from data analysis to inform better safety measures and laws.Methods:Trauma registry data between 2012 and 2016 were analyzed for patients with train-related injuries. Data from 726 patients were analyzed for demographics, event, injuries, management, and final outcome. ISS was used to quantify the extent of injury.Results:Mean patient age was 33 years with an 86% to 14% male to female ratio. 62% of patients were in the 20- to 40-year age group. Average time of arrival at health facility post-injury was 3.3 hours. Half of the patients were trespassers. Mean ISS was 11.65. Chest injuries were present in 24.6% of patients, with half requiring interventions like ICD insertion or surgery. 20% of patients underwent amputations of extremities. 40% of patients needed admission to the ICU. 3.5% died in the Emergency Department (ED). Mean hospital stay was 17 days with an in-hospital mortality of 17.4%.Discussion:This analysis is the largest to date showing comprehensive injury patterns and outcomes of train-related injuries from a developing country. Patients injured on the platform and off the platform had the same severity of injuries. This analysis shows the need for safety measures and strict law enforcement both at the station and at the track.

Patients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation. This retrospective observational study of US healthcare claims included patients ≥40 years old with COPD who initiated triple therapy (1/1/2011-3/31/2020) after ≥2 moderate or ≥1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤30 days post-index), delayed (31-180 days), very delayed (181-365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics. A total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10-1.13] and 1.07 [1.05-1.08]), a 4.3% (95% CI: 3.9-4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3-2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6-2.6%) increase in COPD-related costs during follow-up. Promptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.

Triple therapy to prevent exacerbations from chronic obstructive pulmonary disease (COPD) is associated with improved health compared to single and dual-agent therapy in some populations. This study assessed the benefits of prompt administration of budesonide/glycopyrrolate/formoterol fumarate (BGF) following a COPD exacerbation. EROS was a retrospective analysis of people with COPD using the MORE Registry . Inclusion required ≥1 severe, ≥2 moderate, or ≥1 moderate exacerbation while on other maintenance treatment. Within 12 months following the index exacerbation, ≥1 pharmacy claim for BGF was required. Primary outcomes were the rate of COPD exacerbations and healthcare costs for those that received BGF promptly (within 30 days of index exacerbation) versus delayed (31-180 days) and very delayed (181-365 days). The effect of each 30-day delay in initiation of BGF was estimated using a multivariable negative binomial regression model. 2409 patients were identified: 434 prompt, 1187 delayed, and 788 very delayed. The rate (95% CI) of total exacerbations post-index increased as time to BGF initiation increased: prompt 1.52 (1.39-1.66); delayed 2.00 (1.92-2.09); and very delayed 2.30 (2.20-2.40). Adjusting for patient characteristics, each 30-day delay in receiving BGF was associated with a 5% increase in the average number of subsequent exacerbations (rate ratio, 95% CI: 1.05, 1.01-1.08; <0.05). Prompt initiation of BGF was also associated with lower post-index annualized COPD-related costs ($5002 for prompt vs $7639 and $8724 for the delayed and very delayed groups, respectively). Following a COPD exacerbation, promptly initiating BGF was associated with a reduction in subsequent exacerbations and reduced healthcare utilization and costs.

Strange C, Tkacz J, Schinkel J, et al. Int J Chron Obstruct Pulmon Dis. 2023;18:2245-2256. The authors have advised that there are errors in the 95% CI interval values on page 2248. Results, Baseline and Follow-Up Exacerbation Rates, sentence 3, the text \"Relative rates of total exacerbations for prompt were 0.76, 95% CI: (0.72 - 0.79) and 0.66, 95% CI: (0.63 - 0.69) versus delayed and very delayed\" should read \"Relative rates of total exacerbations for prompt were 0.76, 95% CI: (0.69 - 0.83) and 0.66, 95% CI: (0.60 - 0.72) versus delayed and very delayed\". Results, Baseline and Follow-Up Exacerbation Rates, sentence 5, the text \"Relative rates of severe exacerbations for prompt were 0.75 (95% CI: 0.67-0.90) and 0.38 (95% CI: 0.29-0.47) versus delayed and very delayed\" should read \"Relative rates of severe exacerbations for prompt were 0.75 (95% CI: 0.45-1.15) and 0.38 (95% CI: 0.22-0.55) versus delayed and very delayed\". The authors apologize for these errors and confirm that the overarching interpretation of the results and conclusions of the study remain consistent with the originally published article and no other text or figures are affected.

Langerhans cell histiocytosis (LCH) is a group of rare disorders histologically characterized by the proliferation of Langerhans cells. Multiple organs and systems may be involved by the disease. Typically, there is bone involvement and, less frequently, lesions may be found in the lungs, liver, lymph nodes, skin, and mucosa. Oral soft tissue lesions without bone involvement are rare. We present a case of oral lesions associated with LCH in a young woman.

Microstomia is defined as an abnormally small oral orifice which can be due to various factors. Microstomia is a definite prosthodontic hindrance to carry out the different treatment successfully. To rehabilitate a patient with microstomia, successfully, the methods and designs incorporated in the prosthesis have to be modified. In the past, various techniques have been tried, incorporating certain biological and scientific methods to rehabilitate patients with microstomia. This article reviews the previously described treatment modalities in case of patients with microstomia.