The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India.

The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

The 2017 Academic College of Emergency Experts and Academy of Family Physicians of India position statement on preventing violence against health-care workers and vandalization of health-care facilities in India.

There have been multiple incidents where doctors have been assaulted by patient relatives and hospital facilities have been vandalized. This has led to mass agitations by Physicians across India. Violence and vandalism against health-care workers (HCWs) is one of the biggest public health and patient care challenge in India. The sheer intensity of emotional hijack and the stress levels in both practicing HCWs and patient relative's needs immediate and detail attention. The suffering of HCWs who are hurt, the damage to hospital facilities and the reactionary agitation which affects patients who need care are all together doing everything to damage the delivery of health care and relationship between a doctor and a patient. This is detrimental to India where illnesses and Injuries continue to be the biggest challenge to its growth curve. The expert group set by The Academic College of Emergency Experts and The Academy of Family Physicians of India makes an effort to study this Public Health and Patient Care Challenge and provide recommendations to solve it.

A method of increasing the film intrinsic robustness of radiochromic film dosimetry.

The radiochromic film, which is used, in combination with a flatbed scanner has become a widely used tool for a quantitative evaluation of radiation dose in radiation therapy. One aspect of uncertainty using the radiochromic film is the magnitude of orientation effects when the orientation of the film is not kept constant during the digitization process. The aim of this note was to investigate the impact of using a combination of two crossed sheets of EBT2 film on various aspects of radiochromic film dosimetry. First the impact on the film sensitivity was studied. We also investigated the influence on orientation effects during scanning. The results show that the double crossed film combination increases the sensitivity with a factor 1.7-2.1 and practically eliminates the effects of film orientation on the optical density read-out and the lateral correction profiles.

The effects of incidence angle on film dosimetry and their consequences in IMRT dose verification.

PURPOSE: The dosimetric accuracy of EDR2 radiographic film has been rigorously assessed in regular and intensity modulated beams for various incidence angles, including the parallel and perpendicular orientation. There clearly exists confusion in literature regarding the effect of film orientation. The primary aim is to clarify potential sources of the confusion and to gain physical insight into the film orientation effect with a link to radiochromic film as well. METHODS: An inverse pyramid IMRT field, consisting of six regular and elongated 3 × 20 cm(2) field segments, was studied in perpendicular and parallel orientation. Assessment of film self-perturbation and intrinsic directional sensitivity were also included in the experiments. Finally, the authors investigated the orientational effect in composite beams in the two extreme orientations, i.e., perpendicular and parallel. RESULTS: The study of an inverse pyramid dose profile revealed good agreement between the perpendicular film and the diamond detector within 0.5% in the low-scatter regions for both 6 and 18 MV. The parallel oriented film demonstrated a 3% under-response at 5-cm (6 MV) depth against the perpendicular orientation, but both orientations over responded equally in the central region, which received only scattered dose, at both 5- and 20-cm depths. In a regular 6-MV 5 × 5 cm(2) field, a 4.1% lower film response was observed in the parallel orientation compared to perpendicular orientation. The under response gradually increased to 6% when reducing the field size to 0.5 × 5 cm(2). On the other hand, the film showed a 1.7% lower response in parallel orientation for the large field size of 20 × 20 cm(2) at 5-cm depth but the difference disappeared at 10 cm. At 18 MV, similar but somewhat lower differences were found between the two orientations. The directional sensitivity of the film diminishes with increasing field size and depth. Surprisingly a composite IMRT beam consisting of 20 adjacent strip segments also produced a significant orientational dependence of film response, notwithstanding the large total field size of 20 × 20 cm(2). CONCLUSIONS: This analysis allowed the development of a hypothesis about the physics behind the orientational dependence of film response in general and to formulate precautions when using film dosimetry in the dosimetric verification of multibeam treatments.

Evaluation of a glassless photographic film scanner for high-gradient radiochromic film dosimetry.

This study evaluates the performance of the Nikon Coolscan 9000 ED film scanner for high-gradient radiochromic film dosimetry. As a reference for comparison, analogue experiments were performed on the Epson Expression 10000XL flatbed scanner. Based on these results, a dosimetric protocol was established for the Nikon scanner and its overall performance for high-gradient dosimetry was evaluated. The Nikon scanner demonstrated a high sensitivity for radiochromic film dosimetry, resulting in more contrast in the digitized image. The scanner's optics also demonstrated excellent stability and did not necessitate warm-up scans prior to data acquisition. Moreover, negative effects of temperature changes of the film inside the scanner were shown to be limited. None of the digitized images showed significant disturbances by moiré-patterns, by virtue of the absence of a glass plate for film positioning. However, scanner response was found to vary considerably across the reading area, requiring an optical density-dependent correction procedure to be incorporated into the scanning protocol. The main limitation of the Nikon Coolscan 9000 ED transmission scanner remains its film size restriction to 6.2 × 20 cm2. Nevertheless, its excellent characteristics render it the preferential tool for high-gradient radiochromic film dosimetry in applications limited to small film sizes, such as dosimetry in the build-up region.

The value of EDR2 film dosimetry in compensator-based intensity modulated radiation therapy.

Radiographic or silver halide film is a well-established 2D dosimeter with an unquestioned spatial resolution. But its higher sensitivity to low-energy photons has to be taken into consideration. Metal compensators or physical modulators to deliver intensity modulated radiation therapy (IMRT) are known to change the beam energy spectrum and to produce scattered photons and contaminating electrons. Therefore the reliability of film dosimetry in compensator-based IMRT might be questioned. Conflicting data have been reported in the literature. This uncertainty about the validity of film dosimetry in compensator-based IMRT triggered us to conduct this study. First, the effect of MCP-96 compensators of varying thickness on the depth dose characteristics was investigated using a diamond detector which has a uniform energy response. A beam hardening effect was observed at 6 MV that resulted in a depth dose increase that remained below 2% at 20 cm depth. At 25 MV, in contrast, beam softening produced a dose decrease of up to 5% at the same depth. Second, dose was measured at depth using EDR2 film in perpendicular orientation to both 6 MV and 25 MV beams for different compensator thicknesses. A film dose underresponse of 1.1% was found for a 30 mm thick block in a 25 MV beam, which realized a transmission factor of 0.243. The effect induced by the compensators is higher than the experimental error but still within the accepted overall uncertainty of film dosimetry in clinical IMRT QA. With radiographic film as an affordable QA tool, the physical compensator remains a low threshold technique to deliver IMRT.

Mulberry (Morus alba) leaves as human food: a new dimension of sericulture.

Mulberry leaf is commonly used for sericulture in almost every part of the world but its potential to be utilized for human consumption is not well recognized. This paper deals with development of mulberry leaf powder and its use with wheat flour to develop paratha, the most common food item of breakfast and dinner in the Indian diet. The optimum ratio of the mulberry leaf powder and wheat flour (MLP-WF) mix for preparation of paratha on the basis of sensory quality was found to be 1:4. The protein quality of the MLP-WF mix was estimated by measuring the Protein Efficiency Ratio, and was found to be 1.82 against a casein diet for which a value of 2.44 was observed. The in vivo toxic effect of mix was studied and no adverse effect on the growth of internal organs of rats (heart, liver, kidney and testes) was found. The storage stability of the mix was estimated for a period of 2 months in polyethylene bags at room temperature. A non-significant difference was observed between paratha prepared from fresh and stored mix. This indicated that mix can be stored for a period of 2 months at room temperature without loss of quality.

Effect of Japanese mint (Mentha arvensis) oil as fumigant on stored sorghum: physical characteristics, sensory quality and germination.

The Japanese mint (Mentha arvensis) oil (JMO) was effective as fumigant against Sitophilus oryzae in sorghum (Sorghum bicolor). The observations on the effect of JMO treatment at a dose of 166.6 microliters/l of space to grains stored for 3 months in desiccators at 28 +/- 5 degrees C showed non significant (P approximately 0.05) effect on grain hardness, grain density and per cent water absorption. The cooking quality evaluated in terms of cooking time required for boiling of grains was also not significantly affected. The JMO treated samples of boiled sorghum scored significantly lower values for sensory quality characteristics viz. taste, aroma and overall acceptability compared to untreated samples. No effect of JMO on seed germination was observed. As sensory quality is lowered by use of JMO, the technique can only be recommended for seed sorghum preservation, not food.

Design, synthesis, and evaluation of A/C/D-ring analogs of the fungal metabolite K-76 as potential complement inhibitors.

The terpenoid 6,7-diformyl-3',4',4a',5',6',7',8',8a'-octahydro-4,6',7'-trihydrox y-2',5',5', 8a'-tetramethylspiro[1'(2'H)-naphthalene-2(3H)-benzofuran] (1a; K-76), a natural product of fungal origin, and its monocarboxylate sodium salt 1c (R = COONa; K-76COONa) inhibit the classical and alternative pathways of complement, and 1c was shown to inhibit the classical pathway at the C5 activation step. In an attempt to elucidate the essential pharmacophore of 1a,c, the natural product was used as a "topographical model" for the design of partial analogs retaining the desired complement inhibiting potency. Therefore, A/C/D-ring analogs have been synthesized, as shown in Scheme 1 using 3-methoxyphenol (3) and limonene chloride (5) as starting materials, which contain functional groups similar to those found on the natural product. The use of (4R)-(+)- and (4S)(-)-limonene chloride (5a,b, respectively) provided two series of compounds differing in the stereochemistry of the C-4 chiral center (limonene moiety numbering). The in vitro assay results of the inhibition of anaphylatoxin production and classical complement-mediated hemolysis revealed that 7-carboxy-2-(R,S)-methyl-2-(1'-methylcyclohexen-(4'R)-yl)-4-met hoxybenzofuran (13a) and 7-carboxy-2-(R,S)-methyl-2-(1'-methylcyclohexen-(4'S)-yl)-4-met hoxybenzofuran (13b) were active in the same range of concentrations as the natural product.

Effect of Japanese mint (Mentha arvensis) oil as fumigant on nutritional quality of stored sorghum.

Japanese mint (Mentha arvensis) oil (JMO) can be used effectively as fumigant against Sitophilus oryzae in stored sorghum. The effect of JMO at a dose of 166 microliter/l of space on nutrient composition and protein quality was studied in infested and uninfested sorghum grains stored for 3 months. The results revealed non significant effect of JMO on gran moisture, total ash, crude fibre, crude fat, crude protein and fat acidity in infested and uninfested grains at the end of 3 months storage. The JMO treatment had small but significant effect on reducing and non-reducing sugars. The values of Protein Efficiency Ratio (PER) for uninfested JMO treated grains, infested JMO treated grains and for untreated control stored for 3 months were 1.11, 1.07 and 1.09, respectively against control casein diet for which it was 2.15.

Naloxone-induced withdrawal in patients with buprenorphine dependence.

Naloxone-induced withdrawal was studied in seven patients currently dependent only on injecting buprenorphine, within 3 to 6 hours of their last dose. Withdrawal severity began to rise from 5 minutes and reached a peak at 60 minutes after 1.2 mg naloxone given intravenously. The mean withdrawal severity score was significantly higher at 30, 60 and 90 minutes compared to the baseline. The most frequent withdrawal signs and symptoms were mydriasis, systolic hypertension, tachypnoea, muscle pains, yawning, anxiety, restlessness and craving.

Abuse of boot polish by ingestion: a case report.

This case report describes the abuse of boot polish by inhalation and ingestion in a 32 year old patient who also had alcohol dependence. Pleasurable psychological effects, craving, active search for the substance and tolerance were present but withdrawal symptoms could not be demonstrated because of simultaneous alcohol dependence.

Pregnancy interceptive efficacy and biological profile of 3-amino-6,7-dimethoxy-1H-pyrazolo [3,4-b] quinoline (compound 85/83) in rodents.

Administration of compound 85/83 during the peri- and post-implantation period intercepted pregnancy in hamster and guinea pig by parenteral route and in hamster by oral route also. The m.e.d. for hamster and guinea pig was 10 and 20 mg/kg, respectively; lower doses were less effective. Restricting the administration to early post-implantation schedule interrupted pregnancy partially in both species. The compound was, however, ineffective in rat and in the pre-implantation schedule (days 1-4 post-coitum) in hamster. When tested in vitro on growing trophoblasts at 13.8 x 10(-5) M concentration, it prevented growth and caused degeneration of the cells within 24 h; lower concentration (9.2 x 10(-5) M) was less effective. The compound was found to be devoid of estrogenic, antiestrogenic, progestational and antiprogestational properties in conventional bioassays. In hormone competition assays, its relative binding affinity (RBA) to estrogen receptor was negligible (0.002% of estradiol-17 beta), while for uterine cytosol progesterone receptors in rabbit and hamster was 0.06 and 0.08% of progesterone, respectively. The compound 85/83 appears to intercept pregnancy by interfering with development of trophoblast cells.

Synthesis of 2,5-disubstituted benzimidazoles, 1,3,4-thiadiazoles and 3,5-diiodosalicylanilides as structural congeners of rafoxanide and closantel.

The synthesis of a series of 2,5-disubstituted benzimidazoles (8-10, 13), substituted 3,5-diodosalicylanilides (6, 7, 11, 12, 16-29), 2-(4-substituted phenyl)-4-aroylamino-1,3,4-thiadiazoles (33-38) and benzoxazines (14, 30, 31) has been carried out as the structural congeners of rafoxanide and closantel. All the compounds have been tested for their anthelmintic activity against Ancylostoma ceylanicum, Nippostrongylus brasiliensis, Hymenolepis nana and Cysticecus fasciolaris in rodents. Compounds 8, 22 and 23 exhibited 90-100% elimination of the hookworms A. ceylanicum and tapeworms H. nana from hamsters and rats, respectively, at an oral dose 50-250 mg/kg body mass.

Emerging concepts towards the development of contraceptive agents.

PIP: The theoretical background for development of steroid contraceptive agents, LH-RH agonists and antagonists, heterocyclic abortifacients, male contraceptive agents, and contraceptive vaccines are reviewed, with emphasis on basic steroid receptor research. Recent findings confirming the steroid receptor interaction theory proposed in 1960 are described. This model suggests that the steroid enters target cells by diffusion and binds to specific protein receptors in the cytoplasm. The steroid- receptor complex moves to the nucleus by concentration gradient and binds to chromatin or DNA, altering gene expression. both estrogen and progesterone receptors are asymmetric peptides with rigid hydrophobic domains that bind specific steroids, doisynolic acids, stilbenes, gem- diarylethylenes, triarylpropiones, all of which have a set distance between a phenolic hydroxyl and another hydroxyl analogous to the steroid C17-beta-hydroxyl groups. Antiprogestins without glucocorticoid activity are being sought. LH-RH antagonists are being developed by substituting amino acids in the peptide. A large variety of heterocyclic compounds, 26 types, with abortifacient activity, acting by interfering with blastocyst binding to the deciduum is described, such as a series of quinine derivatives. Male antifertility agents must block spermatogenesis without affecting libido or sperm maturation. Combined steroid pills with cyproterone acetate and an androgen are in clinical trials. The most hopeful immunologic contraceptives are vaccines based on part of the beta subunit of hCG, sperm antigens and zona pellucida antigens.^ieng

Dark-field microscopy of subgingival plaque microflora in Indian and English subjects.

This present investigation reports on the microbial pattern of subgingival plaque from English and Indian subjects living in the West Midlands of England. Subgingival plaque from healthy and diseased sites was studied using darkfield microscopy. The results indicate that significant differences exist in microbial flora of clinically normal and diseased sites of English as well as Indian subjects. Coccoid cells predominated in healthy sites, with an increase of 21% in the spirochaetes in diseased sites. The ratio of non-motiles to motiles was 1:0.6 in healthy sites, whereas in diseased sites the ratio observed was 1:1.8 in English subjects and 1:3.6 in Indian subjects. Comparison of healthy sites in Indians with healthy sites in English subjects revealed significant differences between numbers of rods (p less than 0.05). Comparing diseased sites of Indians with diseased sites in English subjects revealed significant difference between both cocci (p less than 0.05) and motile rods (p less than 0.01). A positive correlation between chronic inflammatory periodontal disease and spirochaete burden, and a negative one between the disease and coccal burden, was found.

Contraceptive and hormonal properties of a new 1,4-dihydro-2-oxoquinoline derivative (compound 84-182) in rodents and rhesus monkeys.

Compound 84-182 prevented pregnancy when administered subcutaneously at 10 mg/kg dose on days 3-8 post-coitum in hamsters and on days 6-10 post-coitum in guinea pigs. At lower doses, while in hamsters there was a marked reduction in implantation number, majority of implantations in guinea pigs showed signs of resorption. The compound was ineffective when administered at 10 mg/kg dose on days 1-3 or 6-7 post-coitum in hamsters and on days 1-5 or 4-8 post-coitum in rats. In rhesus monkeys, treatment with the compound at 5 and 10 mg/kg doses on days 16-21 of the menstrual cycle induced frank vaginal bleeding between days 21 and 24. Treatment on days 21-30 or after confirmation of pregnancy on days 32-36 was ineffective. In conventional bioassays, the compound was devoid of any estrogenic, antiestrogenic, progestational, antiprogestational, androgenic or antiandrogenic properties at the contraceptive dose. In competitive protein binding assay, the compound showed relative binding affinity (RBA) of less than 0.1% and 0.28% of progesterone, respectively, for rabbit and hamster uterine cytosol progesterone receptors. Its RBA for rat uterine cytosol estrogen receptors was less than 0.1% of estradiol-17 beta.