"Whenever I tell her to wear slippers, she turns a deaf ear. She never listens": a qualitative descriptive research on the barriers to basic lymphedema management and quality of life in lymphatic filariasis patients in a rural block of eastern India.

BACKGROUND: Chronic lymphatic filariasis patients in Bihar, India, need management of lymphedema to live a disability-free life. For patients who have recurrent attacks of acute dermato-lymphangio-adenitis (ADLA), World Health Organization (WHO) has recommended simple home-based measures that include maintaining hygiene, skin care, and limb movement. However, patients in rural areas are unable to adopt them, resulting in a vicious cycle of ADLA attacks. There might be multiple realities from patients' and healthcare workers' perspectives that were unexplored. Qualitative research was deemed best suitable to identify the barriers to carrying out home-based lymphedema practices that adversely affected quality of life. METHODS: The qualitative descriptive study was conducted in two villages in the rural field practice area under a tertiary care hospital in Bihar. Researchers purposively selected ten participants, including patients affected by lymphedema, their caregivers, the grassroots healthcare workers, and the block health manager. In-depth interviews were conducted using a semi-structured interview guide. Data were entered into QDA Miner Lite, where researchers did attribute, in-vivo, process, descriptive, emotion, and holistic coding, followed by content analysis, where categories and themes emerged from the codes. RESULTS: Three themes emerged: the inherent nature of disease, patient-related factors, and healthcare system-related factors. The fifteen identified barriers were low awareness, low adherence, low health-seeking behavior, poor personal hygiene, and categories like signs and symptoms, seasonal factors, hampered activities of daily living, hopelessness from not getting cured, psychosocial difficulty, lack of capacity building and receipt of incentives by healthcare workers, unavailability of laboratory diagnosis and management of complications at the facility, inconsistent drug supply, and no financial assistance. CONCLUSIONS: Accessibility to WaSH, regular training of home-based care, increasing the capacity and motivation of grassroots workers, and the generation of in-depth awareness among the patients are required to achieve the elimination of filariasis, with MMDP as a key component of that strategy for endemic districts across the whole country.

Tobacco Usage and Its Association With Mental Health Status of School-Going Adolescents Near Patna, Bihar: A Community-Based Cross-Sectional Study in Eastern India.

Background Of all the adolescents in India, 7.3% are suffering from some form of mental disorder. They frequently use tobacco to cope with these problems, but get stuck in a vicious cycle of deteriorating mental health. Our study aimed to determine the effect of tobacco on the mental health status of adolescents studying in the 9th to 12th standards in 10 high schools in urban and rural areas near Patna, Bihar. Methodology An analytical cross-sectional study was conducted among 360 school-going adolescents recruited using stratified random sampling. Selected adolescents were given the Indian Adolescent Health Questionnaire. The mental health status was calculated from the Strengths and Difficulties Questionnaire (SDQ) score. Information on sociodemographic characteristics and tobacco use was also obtained. Independent t-test, analysis of variance, and multiple linear regression analysis were used for predicting the significant factors. Significance was set at p-values <0.05. Results In this study, 40 (11.1%) adolescents had abnormal whereas 55 (15.3%) had borderline overall SDQ scores. The majority of those affected had peer problems (40%) and conduct problems (24.7%). All SDQ components of conduct (F = 2.94, p = 0.013), hyperactivity (F = 2.90, p = 0.014), emotional problems (F = 1.14, p = 0.001), and peer pressure (F = 3.06, p = 0.010), as well as the overall SDQ score (F = 5.74, p < 0.001), were significantly associated with increasing age. The adolescents attending rural schools (13.28 ± 5.22, p = 0.047) had significantly higher SDQ scores than those attending urban schools (12.08 ± 5.60). Hyperactivity scores were significantly higher in those studying in class 10 compared to other classes and in those attending rural rather than urban schools. Emotional problems score was significantly higher in 16-17-year-old students than in 14-15-year-old students, in females than in males, and in class 10 than in class 9 students. Only 24 (6.7%) adolescents had a history of tobacco consumption at least once which was significantly associated with the SDQ score (17.71 ± 5.69; t = 4.95, df = 358, p < 0.001). Around 79.4% of adolescents were exposed to passive smoking from close friends which deteriorated their overall mental health status (14.50 ± 5.99; F = 6.29, df = 2,357, p = 0.002). Those who had smoked for more than 10 days had significantly greater conduct problems and lesser pro-social behavior. Overall, 96.1% agreed that tobacco is harmful to health, and 76.1% had seen anti-smoking messages in the media. Female gender, increasing class and age, and history of smoking or chewing tobacco at least once also led to a significant increase in emotional problems. Age, area of the school, history of tobacco consumption, and exposure to cigarette smoke by either a close friend or male guardian had a significant impact on the conduct, hyperactivity, peer problems, and overall mental health status of school-going adolescents. Conclusions Predicting risk factors such as age, area of the school, and the history of tobacco consumption by self or by close friends is important for decision-making by school administration regarding counseling for mental health and preventing tobacco use.

Quantitative sonoelastography of the uterine cervix in predicting successful outcome of induction of labour.

Objectives: The aim of the study was to evaluate the stiffness of cervix and determine its significance in predicting successful outcome of induction of labour. The primary objective was to determine the differences in elastography indices of different areas of cervix between the outcome groups of successful and failed induction of labour. A secondary objective was to find out the correlation of these elastography indices with Bishop's score and cervical length. Methods: This was a prospective, observational study conducted over a period of 6 months on pregnant women admitted in the labour room for induction of labour. Establishment of adequate regular uterine contractions - at least three contractions lasting 40-45 s in a 10-min period - was taken as end point for successful outcome of induction of labour. Even after 24 h of initiation of induction of labour, regular, adequate and painful uterine contractions were not established, then induction of labour was described as having failed. Prior to induction, cervical length measurement, Bishop's scoring and elastographic evaluation of the cervix were done by stress-strain elastography. A colour map was produced from purple to red and a five-step scale - the elastography index - was used to describe the various parts of the cervix. The differences between elastography indices of different parts of cervix were estimated using Mann-Whitney U test. Correlation of the indices with cervical length and Bishop's score was determined by Spearman's correlation coefficient. Results: A total of 64 women were included in the study. A significant difference (p < 0.001) was found in the elastography index of internal os between the two outcome groups of success (1.76 ± 0.64) and failure (0.54 ± 0.18). However, the elastography index of central cervical canal, external os, anterior lip and posterior lips did not differ significantly across the outcome groups. A significant positive correlation was found between elastography index of internal os and cervical length (Spearman's correlation coefficient, r = 0.441, p < 0.001) and between elastography index of external os and cervical length (r = 0.347, p = 0.005), whereas a negative correlation was seen between elastography index of external os and Bishop's score (r = -0.270, p = 0.031). Conclusion: Elastography index of internal os can be used to predict outcome of induction of labour. Cervical elastography is a promising new technique for cervical consistency assessment. Further larger studies are required to determine some cut-off point for elastography index of internal os in prediction of outcome of induction of labour and to strongly establish the usefulness of cervical elastography for pregnancy management, preventing preterm delivery and establishment of cut-off points to determine successful induction.

Unveiling the theoretical aspects of superelectrophilic activation in an inverse demand Diels-Alder reaction.

The present computational study using B3LYP functional and 6-31+G(d) basis set has been accomplished to investigate the mechanism of the inverse demand Diels-Alder reaction between pyridyl imine and propene. The highly charged dicationic superelectrophilic diene with exceptionally low-lying LUMO makes the cycloaddition reaction with propene more favorable by significantly lowering the activation energy. The Wiberg bond indices are calculated in accordance with the formation and breaking processes of bonds. The synchronicity concept is also utilized to explain the global nature of the reaction. A potential outcome of this investigation is the utilization of propene as a C2 building block in the industry.

New kind of electride sandwich complexes based on the cyclooctatetraene ligand M12(η8-C8H8)2M22 (M1 = Na, K and M2 = Ca, Mg): a theoretical study.

In the present study, the electronic structures of a series of binuclear sandwich complexes based on the cyclooctatetraene ligand M12(η8-C8H8)2M22 (M1 = Na, K and M2 = Ca, Mg) are studied theoretically. Each cyclooctatetraene ligand binds with the metal in the η8 binding mode. The M2-M2 bond length agrees well with the reported bimetallic covalent Ca2 and Mg2 bond lengths. The Wiberg bond index (WBI) also indicates the presence of covalent M2-M2 bonds, which gives additional stability to the complex. A non-nuclear attractor (NNA) is found in-between the M2-M2 bond and the negative Laplacian of the electron density is found at the NNA. Noncovalent interaction (NCI) plot shows that electron density is localized at the M2-M2 bond. Based on the performed analysis, we have concluded that the designed sandwich complexes are electrides. We herein report, for the first time, the electride sandwich complexes of the cyclooctatetraene ligand. Due to the presence of a diffuse electron system, the electride complexes exhibit higher values of the static second hyperpolarizability within the range of 2.6 × 105 to 1.4 × 106 a.u. Among the studied complexes, M12(η8-C8H8)2Ca2 exhibit a higher value of static second hyperpolarizability.

Development and validation of sonological classification and scoring system for uterine adenomyosis: A pilot study.

Background: Adenomyosis is a common disorder in women of reproductive age. The gold standard for diagnosis is histopathological examination of hysterectomy specimen. However, only a small percentage of women undergo surgery as treatment is primarily hormonal. Non-invasive methods of diagnosis include transvaginal sonography and magnetic resonance imaging. Patient management in adenomyosis is often based on ultrasonographic diagnosis alone, highlighting the importance of a uniform, reproducible, clinically relevant and validated sonological classification and scoring system. Although a few investigators have proposed classification and scoring system for diagnosis of adenomyosis, none of those have been validated yet. This study aimed to propose and validate a new sonological classification and scoring system for adenomyosis. Methods: This was a prospective observational pilot study. A new sonological classification and scoring system of adenomyosis was proposed based on topography, type, size and extent, which was validated by comparing the sonological reporting with histopathological reporting. The main outcome measures that were measured were rate of agreement (Cohen's kappa) between the findings of sonologist and pathologist; and diagnostic accuracy of the sonological classification of adenomyosis. Results: This pilot study included 30 women who underwent hysterectomy over a time period of one year with ultrasonographic diagnosis of adenomyosis. The rate of agreement (Cohen's kappa) between the findings of sonologist and pathologist showed substantial agreement (0.703) for topography and almost perfect agreement for type (0.896), extent (0.892) and size (0.898). Conclusions: Our newly proposed sonological classification and scoring system for adenomyosis is valid and can be used for clinical application in interpersonal communication between clinicians, to prognosticate patients about the disease severity, to assess the candidates for surgical management and in further studies to correlate with symptoms severity and effectiveness of medical therapies.

Effect of physical health, dietary behaviour and personal hygiene on body mass index of school-going adolescents near Patna, Bihar: A cross-sectional study.

Background: Body mass index (BMI) is the most frequently used method to determine the nutritional status in adolescents. School-going population in developing countries like India are susceptible to undernutrition due to several socioeconomic, demographic, and nutritional factors. Poor dietary habits, sedentary lifestyles and improper hygiene can have a deleterious effect on their BMI. Methods: The aim of the study was to determine any association of BMI with physical health, nutrition, and personal hygiene among the school-going adolescents near Patna, Bihar. Analytical cross-sectional study was conducted among 160 school-going adolescents, chosen by stratified random sampling. They were given Indian Adolescent Health Questionnaire which had close-ended questions about physical activity, nutritional, and hygienic practices. BMI was calculated from self-reported height and weight. Pearson's correlation, independent t test, ANOVA, and Chi-Square test of proportions were done. Significance level was set at P < 0.05. Results: Only 39.4% adolescents had normal BMI, and almost half were underweight. Pearson's correlation of BMI with age showed a weak positive correlation (r = 0.124, P = 0.118). Participants perceiving themselves overweight, did physical exercise to lose weight (P < 0.001), whereas who stated that they rarely consumed cooked vegetables, had the self-perception of being underweight (P = 0.009). This self-perception of their weight, physical activity, handwashing after using toilet/latrine and weekly frequency of brushing teeth significantly predicted the BMI in these adolescents (F = 10.895, df (4,155), P < 0.001, R2 = 21.9%, Adj. R2 = 19.9%). Conclusion: Malnutrition can lead to infection, impaired reproductive health, anaemia and other long-term morbidities into adulthood. Hence there is need of more objective nutritional assessment in adolescence for prevention of disease burden in the community.

Prevalence and knowledge of hepatitis B infection in pregnant women in a primary health center of Patna district, Bihar.

INTRODUCTION: There is a risk of chronic hepatitis B virus (HBV)infection to the newborn through perinatal transmission from a hepatitis B surface antigen (HBsAg) positive mother that can later cause liver cirrhosis or hepatocellular carcinoma. This study was undertaken in a primary health center (PHC)in the Patna district to determine the prevalence of HBV among pregnant women and assess their knowledge across different characteristics. METHODOLOGY: A cross-sectional study was done among 275 pregnant women attending the PHC for the first time, using consecutive sampling. The study duration was 12 months. Socioeconomic, obstetric, risk history, and levels of knowledge about hepatitis B were collected followed by rapid diagnostic test (RDT)for serum HBsAg. Univariate analysis was used to compare the knowledge levels across different background characteristics. The significance was set at P < 0.05. RESULTS: Hepatitis B-positive pregnant women were 0.4%. Out of the 275 participants, only 43 had heard about hepatitis B. The mean knowledge score was 0.65 (±1.73) with 1.45% having adequate knowledge. The knowledge score was significant across education (P 0.040), category (P 0.022), hepatitis B immunization status (P 0.003), and risk factor (P 0.039). CONCLUSION: Knowledge was higher in the literate women belonging to the general category and higher social class, who received hepatitis B vaccination. However, the overall level of knowledge among the pregnant women was very poor, so they should be targeted for quality health education. Additionally, identifying the afflicted pregnant women through point-of-contact diagnosis will aid in community prevention of chronic hepatitis B.

Superalkali-doped borazine and lithiated borazine complexes: diffuse excess electron and large first-hyperpolarizability.

A number of superalkali (M3O / M3S; M = Li, Na, K)-doped borazine and hexalithio borazine complexes are considered for the theoretical study of their electronic structure and quadratic polarizability. Electron-rich O/S atom of superalkali species remains very close to one boron atom of the ring through non-covalent interaction. The first-hyperpolarizability increases rather significantly upon superalkali doping. The chosen complexes possess diffuse excess electron which is located on the superpalkali moiety of borazine complexes and at the ring site of lithiated borazines. First-hyperpolarizability of M3O(S)@B3N3Li6 complexes are significantly larger than that of the corresponding M3O(S)@B3N3H6 complexes. The magnitude of first-hyperpolarizability of Li3S@B3N3Li6 is larger than that of Li3S@B3N3H6 by about three orders of magnitude.

Using Ancestry Informative Markers (AIMs) to Detect Fine Structures Within Gorilla Populations.

The knowledge of ancestral origin is monumental in conservation of endangered animals since it can aid in preservation of population level genetic integrity and prevent inbreeding among related individuals. Despite maintenance of studbook, the biogeographical affiliation of most captive gorillas is largely unknown, which has constrained management of captive gorillas aiming at maximizing genetic diversity at the population level. In recent years, ancestry informative markers (AIMs) has been successfully employed for the inference of genomic ancestry in a wide range of studies in evolutionary genetics, biomedical research, genetic stock identification, and introgression analysis and forensic analyses. In this study, we sought to derive the AIMs yielding the most cohesive and faithful understanding of biogeographical affiliation of query gorillas. To this end, we compared three commonly used AIMs-determining methods namely, Infocalc, F ST , and Smart Principal Component Analysis (SmartPCA) with ADMIXTURE, using gorilla genome data available through Great Ape Genome Project database. Our findings suggest that the SNPs that were detected by at least three of the four AIMs-determining approaches (N = 1,531), is likely most suitable for delineation of gorilla AIMs. It recapitulated the finer structure within western lowland gorilla genomes with high degree of precision. We further have validated the robustness of our results using a randomized negative control containing the same number of SNPs. To the best of our knowledge, this is the first report of an AIMs panel for gorillas that may aid in developing cost-effective resources for large-scale demographic analyses, and greatly help in conservation of this charismatic mega-fauna.

Electronic structure and large second-order non-linear optical property of COT derivatives - a theoretical exploration.

A new strategy to design new molecules based on a fused hydrocarbon ring system comprising a COT ring and two 5-membered rings has been proposed for the study of second order NLO properties. The four charge transferring groups -NR2 (R = H, Li, Na and K) in conjunction with a sufficient number of electron withdrawing groups lead to significant variation of structural parameters and polarity. The charge transfer characteristics can be strongly modulated by introducing calcium metal atoms at suitable sites. Ca metal atoms end-capping the nitrogen ends of two adjacent -CN groups lead to electride character while a Ca metal atom bonded directly to the COT ring leads to greater charge transfer. The size of the alkali metal atom has been found to have a dramatic effect on the enhancement of first hyperpolarizability. The most significant electronic asymmetry induced by the larger potassium metal atom strongly enhances the magnitude of first hyperpolarizability. The variation of first hyperpolarizability has been satisfactorily explained in terms of TD-CAMB3LYP calculated spectroscopic parameters in light of the two-state model.

Erratum to: First hyperpolarizability of cyclooctatetraene modulated by alkali and alkaline earth metals.

The original version of this article unfortunately contained a mistake. Schemes I and II were missing. These important components are given below.

First hyperpolarizability of cyclooctatetraene modulated by alkali and alkaline earth metals.

In the present investigation, the first hyperpolarizability of alkali and alkaline earth metal derivatives of cyclooctatetraene (COT) has been calculated using BHHLYP and CAM-B3LYP functional for 6-311++G(d,p), 6-311++G(3df,3pd), and aug-pc 2 basis sets. Introduction of Na/K atoms at the axial position of COT and Li, Na, K/Be, Mg, Ca metal atoms and cyanide groups at the equatorial sites leads to lager enhancement of first hyperpolarizability. The ring charge density can account for the variation of first hyperpolarizability. The two state model has been invoked to explain the variation of first hyperpolarizability.

Successive lithiation of acetylene, ethylene and benzene: a comprehensive computational study of large static second hyperpolarizability.

This work is a revisit of the study of the electron correlation effect of lithium substitution on the second hyperpolarizability (106 a.u.) of acetylene, ethylene and benzene. The large quenching of mean second hyperpolarizability has been addressed by CCSD calculations. The inclusion of triple excitation in the MP4 method generally overestimates second hyperpolarizability in comparison to the MP4SDQ method. The present CCSD γav value of C6Li6: 405 × 104 a.u. obtained with a relatively larger basis set established the earlier prediction of Sadlej et al. [Phys. Chem. Phys. Chem., 2000, 2, 3393-3399] where degenerate non-dipolar transitions in low lying excited states play the crucial role. The successive lithiation results in gradual red shifting of transition energy leading to significant enhancement of second hyperpolarizability. Most of the chosen DFT functionals predict the correct qualitative trend of second hyperpolarizability. The quantitatively different results may be attributed to the case when the ground state wave function cannot be approximated by a single SD.