Oxime-functionalized anti-insecticide fabric reduces insecticide exposure through dermal and nasal routes, and prevents insecticide-induced neuromuscular-dysfunction and mortality.

Farmers from South Asian countries spray insecticides without protective gear, which leads to insecticide exposure through dermal and nasal routes. Acetylcholinesterase plays a crucial role in controlling neuromuscular function. Organophosphate and carbamate insecticides inhibit acetylcholinesterase, which leads to severe neuronal/cognitive dysfunction, breathing disorders, loss of endurance, and death. To address this issue, an Oxime-fabric is developed by covalently attaching silyl-pralidoxime to the cellulose of the fabric. The Oxime-fabric, when stitched as a bodysuit and facemask, efficiently deactivates insecticides (organophosphates and carbamates) upon contact, preventing exposure. The Oxime-fabric prevents insecticide-induced neuronal damage, neuro-muscular dysfunction, and loss of endurance. Furthermore, we observe a 100% survival rate in rats when repeatedly exposed to organophosphate-insecticide through the Oxime-fabric, while no survival is seen when organophosphate-insecticide applied directly or through normal fabric. The Oxime-fabric is washable and reusable for at least 50 cycles, providing an affordable solution to prevent insecticide-induced toxicity and lethality among farmers.

Assessing the accuracy of pleural puncture sites in patients with pleural effusion as determined by clinical examination versus ultrasound-A single-centre prospective study.

INTRODUCTION: This study aimed to ascertain the accuracy of clinical examination for the determination of pleural puncture sites as compared to the use of ultrasonography in patients with pleural effusion. MATERIAL AND METHODS: A single-centre, prospective, observational study was carried out amongst 115 patients with pleural effusion in a tertiary care hospital in western India. Patients were subjected to clinical assessment for determination of pleural puncture sites and the same were confirmed with ultrasonography. All physicians were blinded to the marking of the previous physician to prevent any influence on their assessment. RESULTS: The study had 345 physician observations. The overall accuracy of the clinical examination was 94.8%. Multivariate logistic regression of the factors responsible for the accuracy of clinical examination demonstrated a significant role of higher body mass index (BMI) (OR-1.19) and lower zone pleural effusions (OR-4.99) when adjusted for age, gender, side of effusion, and experience of examining doctors. When the effusions were classified according to their location, lower zone pleural effusions and loculated pleural effusions had an error rate of 15.9% and 8.33%, respectively. CONCLUSION: An ultrasound is the standard of care to assess all pleural effusions and guide the best point for aspiration.

A Case Report of Caudal Migration of a Lumbar Epidural Catheter Confirmed by Doppler Ultrasound: Ultrasound to the Rescue!

Combined spinal-epidural anaesthesia is an excellent technique for providing intraoperative and postoperative analgesia in patients undergoing total knee arthroplasty. Epidural catheters threaded through a Tuohy needle with a cephalad needle bevel orientation follow a winding pattern within the epidural space. Caudal or downward migration of an epidural catheter may lead to unsatisfactory anaesthesia and epidural failure. Colour flow Doppler sonography is emerging as an effective technique to determine the epidural catheter tip position. We report an interesting case of caudal migration of a lumbar epidural catheter confirmed by colour flow Doppler ultrasound.

Chloromethylation of Lignin as a Route to Functional Material with Catalytic Properties in Cross-Coupling and Click Reactions.

Invited for this issue's cover are researchers from Tallinn University of Technology (TalTech). The image depicts the lignin chemical evolution route from raw biomass through a greener chloromethylation procedure developed by the research team. It showcases the transformation into lignin-supported metal nanoparticles, serving as a catalyst for various chemical reactions in both batch and continuous flow conditions. The Research Article itself is available at 10.1002/cssc.202301588.

Recent progress in molecular transition metal catalysts for hydrogen production from methanol and formaldehyde.

Hydrogen is considered as a potential alternative and sustainable energy carrier, but its safe storage and transportation are still challenging due to its low volumetric energy density. Notably, C1-based substrates, methanol and formaldehyde, containing high hydrogen contents of 12.5 wt% and 6.7 wt%, respectively, can release hydrogen on demand in the presence of a suitable catalyst. Advantageously, both methanol and aqueous formaldehyde are liquid at room temperature, and hence can be stored and transported considerably more safely than hydrogen gas. Moreover, these C1-based substrates can be produced from biomass waste and can also be regenerated from CO2, a greenhouse gas. In this review, the recent progress in hydrogen production from methanol and formaldehyde over noble to non-noble metal complex-based molecular transition metal catalysts is extensively reviewed. This review also focuses on the critical role of the structure-activity relationship of the catalyst in the dehydrogenation pathway.

Methyl jasmonate improves resistance in scab-susceptible Red Delicious apple by altering ROS homeostasis and enhancing phenylpropanoid biosynthesis.

Apple (Malus domestica) is an economically important rosaceous fruit crop grown at temperate climate zones. Nevertheless, its production is severely affected by scab disease caused by the ascomycetous fungus Venturia inaequalis (VI). Methyl jasmonate (MeJA) is a stress induced plant hormone, shown to induce resistance against wide range of pathogens. The current study investigated the role of MeJA in promoting scab tolerance in susceptible apple varieties through exogenous application of optimized (100 µM) MeJA concentration, followed by VI infection. According to our analysis, applying MeJA exogenously onto leaf surfaces resulted in increased membrane stability and decreased malondialdehyde levels in Red Delicious, suggesting that MeJA is capable of protecting tissues against oxidative damage through its role in restoring membrane stability. In addition, the changes in the levels of key antioxidative enzymes and reactive oxygen species (ROS) showed that exogenous MeJA maintains ROS homeostasis as well. Higher phenylalanine ammonia-lyase activity and increased accumulation of phenylpropanoids in MeJA-treated VI-infected plants indicated the MeJA reprogrammed phenylpropanoid biosynthesis pathway for scab tolerance. Our study of scab tolerance in apples induced by MeJA provides new insights into its physiological and biochemical mechanisms.

Gallaphosphene L(Cl)GaPGaL: A novel phosphinidene transfer reagent.

Gallaphosphene L(Cl)GaPGaL 1 (L=HC[C(Me)N(Ar)]2; Ar=2,6-iPr2C6H3) reacts with N-heterocyclic carbenes RNHC (RNHC=[CMeN(R)]2C; R=Me, iPr) to RNHC-coordinated phosphinidenes RNHC→PGa(Cl)L (R=Me 2 a, iPr 2 b) and with isonitriles RNC (R=iPr, Cy) to 1,3-phosphaazaallenes L(Cl)GaP=C=N-R (R=iPr 3 a, Cy 3 b), respectively. Quantum chemical calculations reveal that 2 a/2 b possess two localized lone pair of electrons, whereas 3 a/3 b only show one localized lone pair as was reported for gallaphosphene 1. 2 b reacts with 2.5 equivalents of a borane (THF ⋅ BH3) to the NHC-stabilized phosphinidene-borane complex [iPrNHC→P(BH2)]2(BH3)3 4 with concomitant formation of LGa(H)Cl 5. 2-5 are characterized by heteronuclear (1H, 13C{1H}, 31P{1H}) NMR and IR spectroscopy, elemental analysis, and single crystal X-ray diffraction (sc-XRD).

Chloromethylation of Lignin as a Route to Functional Material with Catalytic Properties in Cross-Coupling and Click Reactions.

We present a novel, greener chloromethylation procedure for organosolv aspen lignin under mild reaction conditions without Lewis acid as a catalyst and in acetic acid as a solvent. This synthetic protocol provides a reliable approach to chloromethylated lignin (CML) and means to obtain valuable lignin derivatives. The resulted CML was subsequently transformed into 1-methylimidazolium lignin (ImL), which effectively serves as a stabilizing agent for Pd/CuO nanoparticles (Pd/CuO-NPs). To evaluate the versatility of developed lignin-based catalyst, we investigate its performance in a series of carbon-carbon bond formation reactions, including Suzuki-Miyaura, Sonogashira, Heck reactions, and azide-alkyne cycloaddition (click) reaction. Remarkably, this catalyst exhibited a high degree of catalytic efficiency, resulting in reactions with yields ranging from average to excellent. The heterogeneous catalyst demonstrated outstanding recyclability, enabling its reuse for at least 10 consecutive reaction cycles, with yields consistently falling within the range of 42 % to 84 %. A continuous flow reactor cartridge prototype employing Lignin@Pd/CuO-NPs was developed, yielding results comparable to those achieved in batch reactions. The utilization of Lignin@Pd/CuO-NPs as a catalyst showcases its potential to facilitate diverse carbon-carbon bond formation reactions and underscores its promising recyclability, aligning with the green chemistry metrics and principles of sustainability in chemical processes.

Comparative Evaluation of the Antimicrobial Efficacy of Chemical and Phytomedicinal Agents When Used As Intracanal Irrigants: An In Vitro Study.

AIM: This study aimed to compare and evaluate the antimicrobial efficacy of chemical and phytomedicinal agents when used as intracanal irrigants against Candida albican (C. albican) and Enterococcus faecalis (E. faecalis). Materials and methods: This study was conducted at Kothiwal Dental College and Research Centre, Moradabad, India. One-hundred human tooth roots with a standardized length of 12±0.5 mm were divided into two groups (A and B, 50 each) inoculated with C. albican and E. faecalis, respectively. The groups were further divided according to the irrigants: A1 (11% ethanolic extract of propolis), A2 (2% chlorhexidine gluconate (CHX)), A3 (0.5% metronidazole), A4 (10% babool), and A5 (sterile saline (control) for the C. albican group and E. faecalis group (B1 to B5, respectively). The samples of different specimens were taken at subsequent intervals. The first collection was taken two days and 21 days after inoculation in group A and group B, respectively. The second collection was taken post irrigation, and the third collection seven days after different irrigants were used in both the groups. Microbiological samples were grown in a culture medium and incubated at 37°C for 24 hours for C. albican and 48 hours for E. faecalis (Sabouraud dextrose agar for C. albican and brain heart fusion for E. faecalis). The results were submitted for analysis of variance (ANOVA) and post-hoc test for statistical analysis. RESULTS: In group A, 2% chlorhexidine gluconate showed a highly significant percentage reduction of colony-forming unit (CFU) count (p≤0.001) with respect to the time interval against C. albican, followed by metronidazole, babool, propolis, and saline, whereas in group B, propolis showed a significant percentage reduction of CFU count (p<0.001) with respect to time interval against E. faecalis, followed by 2% CHX, metronidazole, babool, and saline. CONCLUSION: Two percent chlorhexidine gluconate showed the highest antimicrobial efficacy against C. albican, whereas propolis showed the highest antimicrobial efficacy against E. faecalis. Chemical irrigants proved effective over herbal irrigants against C. albican, whereas herbal irrigants showed better antimicrobial efficacy over chemical irrigants against E. faecalis.

Pyrus pashia fruit extract and its major phytometabolite chrysin prevent hippocampal apoptosis and memory impairment in PTZ-kindled mice.

OBJECTIVES: Epilepsy is a chronic neurological condition with recurrent seizures. One-third of epilepsy patients experience unacceptable side effects from antiepileptic drugs. Pyrus pashia is a deciduous tree from southern Asia. Ethnomedicinally, Malakand tribes use its fruits for epilepsy treatment. Our prior research demonstrated the anticonvulsive properties of ethanolic extract of Pyrus pashia (EPP) and its bioactive compound chrysin in acute seizure tests. This study aims to investigate the impact of EPP and chrysin on cognitive impairment in a PTZ-induced kindling mice model of epilepsy. METHODS: Swiss albino male mice were equally divided into four groups. The first group received 0.5% carboxy methyl cellulose dissolved in normal saline while the other three groups were pre-treated with Diazepam (DZP) (1 mg/kg, i.p.), EPP (200 mg/kg, p.o.) and chrysin (5 mg/kg, p.o.). After 30 min, all groups were administered PTZ (35 mg/kg, i.p.) and evaluated for seizure severity, cognitive function, and neuronal apoptosis. Western blot analysis was conducted to analyze the expressions of apoptosis biomarkers and memory-related genes, including cAMP response element-binding protein (CREB) and Brain Derived Neurotrophic Factor (BDNF). RESULTS: The therapeutic effects of EPP and Chrysin were comparable to DZP in terms of reducing seizure severity, but unlike DZP, they prevented PTZ-induced memory impairment in experimental animals. Additionally, they increased the levels of BDNF and CREB while reducing apoptotic biomarkers in the hippocampus of experimental animals. CONCLUSIONS: Based on the leads offered by this study EPP and its major bioactive constituent, could be developed as the treatment option for epilepsy.

Scorpion Sting Envenomation, a Neglected Tropical Disease: A Nationwide Survey Exploring Perspectives and Attitudes of Resident Doctors from India.

Scorpion sting envenomation (SSE) is a commonly encountered and a significant problem in the tropics, affecting rural and marginalized communities. However, it is not formally listed as a neglected tropical disease (NTD) by the WHO. We designed this cross-sectional study to explore medical graduates' and resident doctors' perspectives on SSE as an NTD and to assess their experiences, knowledge, and confidence in managing these patients. An online questionnaire was developed, validated, and administered to interns and resident doctors across India. Adjusted odds ratios were calculated for factors predicting high self-reported confidence scores for managing scorpion stings using multivariable logistic regression. The final questionnaire contained 26 items including participant background, perspectives about SSE being an NTD, experiences, knowledge, and skills needed to manage, and prevent stings effectively. Of 454 participants, 69% opined that SSE was an NTD, and > 60% felt that SSE was inadequately addressed within undergraduate training. Predictors of high self-reported confidence scores in management competencies were residency in a clinical branch that commonly encountered SSE (internal/emergency medicine or pediatrics, P < 0.0001), having ever managed an SSE patient alone or as a part of a team (P < 0.0001), and attending a class or teaching session on SSE during undergraduate training (P = 0.048). Our results suggest that residents across India believe that there is an urgent need to declare SSE an NTD to increase its visibility, further paving the way for innovative multilevel cross-cutting solutions for mitigation. Designing authentic learning experiences can help produce competent and empathetic physicians in managing and preventing SSE.

Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients.

Aim: To evaluate the effectiveness of the audiovisual distraction (AVD) technique and filmed modeling (FM) on anxiety and fear in pediatric dental patients. Materials and methods: This experimental in vivo study was conducted on 80 subjects of age-groups 5-8 years coming to the Department of Pediatric and Preventive Dentistry for their first dental visit. Study subjects were subjected to noninvasive restorative treatment under AVD in group I, FM in group II, and a combination of AVD and FM in groups III and IV (control 0). To assess the level of pre and postoperative anxiety and fear, various biological parameters like pulse rate, oxygen saturation, body temperature, respiratory rate, and salivary cortisol estimation along with facial image scale (FIS), and fear assessment picture scale (FAPS) were used. Results: Group III (a combination of AVD and FM) came out to be better than other experimental groups and control groups in reducing dental anxiety and fear in pediatric dental patients. Conclusion: A combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique. Clinical significance: A child's disruptive behavior due to dental anxiety causes difficulty in delivering effective dental treatment. Thus, a child's behavior management is of paramount importance in the pediatric dental setup. Nonpharmacological behavior management techniques, that is, a combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique to reduce dental anxiety and fear in pediatric dental patients. How to cite this article: Jamil F, Khan SY, Jindal MK. Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. Int J Clin Pediatr Dent 2023;16(4):598-602.

Syntheses and Structures of 5-Membered Heterocycles Featuring 1,2-Diphospha-1,3-Butadiene and Its Radical Anion.

LGa(P2 OC)cAAC 2 features a 1,2-diphospha-1,3-butadiene unit with a delocalized π-type HOMO and a π*-type LUMO according to DFT calculations. [LGa(P2 OC)cAAC][K(DB-18-c-6)] 3[K(DB-18-c-6] containing the 1,2-diphospha-1,3-butadiene radical anion 3⋅- was isolated from the reaction of 2 with KC8 and dibenzo-18-crown-6. 3 reacted with [Fc][B(C6 F5 )4 ] (Fc=ferrocenium) to 2 and with TEMPO to [L-H Ga(P2 OC)cAAC][K(DB-18-c-6)] 4[K(DB-18-c-6] containing the 1,2-diphospha-1,3-butadiene anion 4- . The solid state structures of 2, 3K(DB-18-c-6], and 4[K(DB-18-c-6] were determined by single crystal X-ray diffraction (sc-XRD).

Triamcinolone Acetonide Produced by Bacillus velezensis YEBBR6 Exerts Antagonistic Activity Against Fusarium oxysporum f. sp. Cubense: A Computational Analysis.

Fusarium oxysporum f. sp. cubense is one of the most severe and threatening pathogens of bananas, causing "Panama wilt" worldwide. Confrontation assay of Foc antagonistic bacterial endophyte, Bacillus velezensis YEBBR6, with the Foc and GC-MS profiling of excised agar from the zone of inhibition, led to the unveiling of secondary metabolites produced by the endophyte. To refine the probable antifungal compounds among the numerous biomolecules formed during their di-trophic interaction with the pathogen, fungal protein targets were modeled, and docking studies (AutoDock Vina module of the PyRx 0.8 server) were done with all the compounds. Triamcinolone acetonide exhibited the most excellent affinity for the protein targets among the compounds studied. It had a maximum binding affinity of 11.2 kcal/mol for XRN2 (5' → 3'). Further, the protein-ligand complex formation kinetics was done through Molecular Dynamic Simulation studies. Graphs for the RMSD, RMSF, Rg, potential energy, and SASA were generated, and the values during the simulation period suggested the stability of the biomolecule as a complex with the protein. This indicated Triamcinolone acetonide's potential ability to act as a functional disrupter of the target protein and likely an antifungal molecule. Further, the biomolecule was tested for its activity against Foc by screening in the wet lab through the poisoned plate technique, and it was found to be fully inhibitory to the growth of the pathogen at 1000 ppm.

Overview on century progress in research on mosaic disease of apple (Malus domestica Borkh) incited by apple mosaic virus/apple necrotic mosaic virus.

Apple mosaic is widely distributed disease throughout the apple growing regions leading to the major adverse effects both qualitatively and quantitatively. Earlier the apple mosaic virus-ApMV was regarded as the only causal agent of the disease, but recently a novel virus apple necrotic mosaic virus-ApNMV have been reported as the causal pathogen from various apple growing countries. Accurate diagnosis of disease and detection of ApMV and ApNMV are of utmost importance, because without this ability we can neither understand nor control this disease. Both the viruses are mostly controlled through quarantine, isolation, sanitation and certification programs depending on sensitive and specific detection methods available. Here we review the 100-year progress in research on apple mosaic disease, which includes history, yield losses, causal agents, their genome organization, replication, traditional to recent detection methods, transmission, distribution and host range of associated viruses and management of the disease.

ortho-[1-(p-MeOPhenyl)vinyl]benzoate PMPVB as a recyclable auxiliary for C-O and C-S bond formation reactions under Brønsted acid catalysis.

A practically simple and useful method is reported for the synthesis of ethers and thioethers via Brønsted acid-catalyzed activation of ortho-[1-(p-MeOphenyl)vinyl]benzoate (PMPVB) donors derived from alcohols. The mechanism of action is based on the remote activation of an active alkene followed by intramolecular 5-exo-trig cyclization leading to a reactive intermediate that can react via a substrate dependent SN1 or SN2 mechanism with alcohols and thiol nucleophiles providing facile access to ether and thioether functionalities, respectively.

Protective antigen of Bacillus anthracis in combination with TLR4 or TLR5 agonist confers superior protection against lethal challenge in mouse model.

The immunogenicity and protective ability of recombinant PA (rPA) with two innate immune system modulators, i.e., monophosphoryl lipid A (MPLA), a TLR4 agonist, and recombinant flagellin C (FliC), a TLR5 agonist, were studied in the mouse model. BALB/c mice were inoculated with three doses of rPA + alum (Alum group), rPA + FliC + alum (FliC group), rPA + MPLA + alum (MPLA group), or only alum adjuvant (Alum alone group). Significant increases in anti-PA IgG titers were observed in the Alum, FliC and MPLA groups when compared to control Alum alone group. Similarly, a significant enhancement of proinflammatory (TNF-α, IL-1ß), Th1 (IFN-γ, IL-12(p70), IL-2) and Th2 (IL-10, IL-4) cytokines were also noticed in Alum, FliC and MPLA groups compared to Alum alone group. The rPA-specific IgG and cytokine responses in MPLA and FliC groups were significantly higher than the Alum group, suggesting enhancement of immune response by these TLR agonists. MPLA was also found to skew the IgG1:IgG2a ratio towards IgG2a. At a challenge dose of 25 LD50, complete protection was observed in mice of MPLA group whereas lesser protection was observed in FliC (87%) and Alum (50%) groups. Therefore, we suggest the use of MPLA in further development of rPA based anthrax vaccines.

Renormalization of the shell model of turbulence.

Renormalization enables a systematic scale-by-scale analysis of multiscale systems. In this paper, we employ renormalization group (RG) to the shell model of turbulence and show that the RG equation is satisfied by |u_{n}|^{2}=K_{Ko}ε^{2/3}k_{n}^{-2/3}, where Ko is the Kolmogorov constant and ν_{n}=ν_{*}sqrt[K_{Ko}]ε^{1/3}k_{n}^{-4/3}, where k_{n}andu_{n} are the wave number and velocity of shell n; ν_{*}andK_{Ko} are RG and Kolmogorov's constants; and ε is the energy dissipation rate. We find that ν_{*}≈0.5 and K_{Ko}≈1.7, consistent with earlier RG works on the Navier-Stokes equation. We verify the theoretical predictions using numerical simulations.

Bolgiano-Obukhov spectrum and mixing efficiency in stably stratified turbulence.

In this paper, using a shell model, we simulate highly turbulent stably stratified flow for weak to moderate stratification at unitary Prandtl number. We investigate the energy spectra and fluxes of velocity and density fields. We observe that for moderate stratification, in the inertial range, the kinetic energy spectrum E_{u}(k) and the potential energy spectrum E_{b}(k) show dual scaling-Bolgiano-Obukhov scaling [E_{u}(k)∼k^{-11/5} and E_{b}(k)∼k^{-7/5}] for kk_{B}. In addition, we find that the mixing efficiency η_{mix} varies as η_{mix}∼Ri for weak stratification, whereas η_{mix}∼Ri^{1/3} for moderate stratification, where Ri is the Richardson number.

Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study.

Introduction Kangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methods  We conducted a before-and-after intervention hospital-based, single-center study in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time period of five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant.  Results  One hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day. According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22% long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles. The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. Conclusion Sets of intervention packages based on needs analysis using the PDSA cycle were able to improve the rate and duration of KMC in the hospital and at home.