Post-birth exposure contrasts for children during the Household Air Pollution Intervention Network randomized controlled trial.

Exposure to household air pollution is a leading cause of ill-health globally. The Household Air Pollution Intervention Network (HAPIN) randomized controlled trial evaluated the impact of a free liquefied petroleum gas stove and fuel intervention on birth outcomes and maternal and child health. As part of HAPIN, an extensive exposure assessment was conducted. Here, we report on PM 2.5 and CO exposures of young children (≤ 15 months old) reconstructed using a Bluetooth-beacon based time-activity monitoring system coupled with microenvironmental pollutant monitors. Median (IQR) exposures to PM 2.5 were 65.1 (33 - 128.2) µg/m 3 in the control group and 22.9 (17.2 - 35.3) µg/m3 in the intervention group; for CO, median (IQR) exposures were 1.1 (0.3 - 2.9) ppm and 0.2 (0 - 0.7) ppm for control and intervention group, respectively. Exposure reductions were stable over time and consistent with previous findings for the children's mothers. In the intervention group, 75% of children's reconstructed exposures were below the WHO interim target guideline value of 35 µg/m 3 , while 26% were below the standard in the control group. Our findings suggest that an LPG fuel and stove intervention can substantially reduce children's exposure to household air pollution.

Laparoscopic versus Open Appendectomy: A Prospective Comparative Study and 4-Year Experience in a Tertiary Care Hospital.

Background The aim of this study was to validate the pros of laparoscopic appendectomy (LA) over open appendectomy (OA) and to compare various primary outcome measures in the management of acute and recurrent appendicitis. Study Design Prospective comparative study. Place and Duration Between June 2015 and October 2019 in JJ Hospital, Mumbai. Materials and Methods Total of 60 patients with acute and recurrent appendicitis were included in the study. Thirty patients underwent OA and 30 underwent LA. Both groups were comparable clinicopathologically and demographically. Various intraoperative and postoperative parameters were compared. Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. Mann-Whitney U test was used to compare continuous variables and chi-squared test was used to compare categorical variables. p -Value≤0.001 was considered to be statistically significant. Results The median age of patients undergoing OA and LA was 24.9 and 25.2 years ( p = 0.221), respectively. Female: male ratio in OA and LA was 1.30 and 1.14, respectively ( p = 0.795). Mean operative duration in LA and OA group was 47.17 ± 14.39 minutes and 36.9 ± 12.33 minutes ( p = 0.001), respectively. Mean length of postoperative stay in LA and OA group was 3.69 ± 0.71 days and 5.28 ± 0.63 days ( p = 0.000), respectively. Median visual analogue scale score in LA and OA group was 3.5 and 5 ( p = 0.001), respectively. Mean time to return to normal activity in LA and OA group was 8.13 ± 1.33 days and 10.10 ± 2.20 days ( p = 0.000), respectively. About 6.66% patients in LA group and 13.33% in OA group had postoperative wound infection ( p = 0.652). Mean scar scale scoring done on 30th postoperative day was 4.23 in LA and 8.23 in OA ( p = 0.000). Discussion and Conclusion LA is more promising than OA in the management of acute and recurrent appendicitis. LA offers lesser operative site pain in the postoperative period, shorter postoperative hospital stays, earlier recovery, and return to normal activities and cosmetically better scars on 30th day follow-up. No conversions or significant difference in wound related complications were seen in both groups. Prolonged intraoperative duration was the only drawback of LA.

Barriers to the Implementation of Electroconvulsive Therapy (ECT): Results From a Nationwide Survey of ECT Practitioners.

OBJECTIVE: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder; yet, its use is confined to <1% of individuals with this disorder. The authors aimed to examine barriers to ECT from the perspective of the provider. METHODS: Qualitative interviews were conducted with U.S.-based ECT providers to identify potential barriers. A quantitative survey was created asking providers to rank-order barriers to starting a new ECT service or expanding existing services. RESULTS: Survey responses were received from 192 physicians. Respondents were representative of all ECT providers found in the Medicare Provider Utilization and Payment Database with respect to gender and geographic distribution. Approximately one-third (N=58, 30%) of survey respondents graduated from one of 12 residency programs. Programs with dedicated hospital space were more likely to have larger services than those borrowing surgical recovery space (χ2=25.87, df=1, p<0.001). The most prominent provider-reported barriers to expanding an existing ECT service were lack of physical space, stigma on the part of patients, and transportation difficulties. The most prominent barriers to initiating a new service were lack of well-trained colleagues and ECT practitioners, lack of a champion within the institution, and lack of physical space. Wide geographic variation was found in the availability of ECT, with the highest concentration of ECT providers per 1 million individuals found in New England (6.4), and the lowest found in the West South Central (1.1). CONCLUSIONS: Coordinated efforts to overcome identified barriers may allow ECT to be more broadly implemented. Investments in education may increase the number of competent practitioners.

Estimation of Sex From Index and Ring Finger Lengths in An Indigenous Population of Eastern India.

INTRODUCTION: Forensic anthropology involves the identification of human remains for medico-legal purposes. Estimation of sex is an essential element of medico-legal investigations when identification of unknown dismembered remains is involved. AIM: The present study was conducted with an aim to estimate sex from index and ring finger lengths of adult individuals belonging to an indigenous population of eastern India. MATERIALS AND METHODS: A total of 500 unrelated adult individuals (18-60 years) from the Rajbanshi population (males: 250, females: 250) took part in the study. A total of 400 (males: 200, 200 female) participants were randomly used to develop sex estimation models using Binary Logistic Regression Analysis (BLR). A separate group of 200 adults (18-60 years) from the Karbi tribal population (males 100, females 100) were included to validate the results obtained on the Rajbanshi population. The univarate and bivariate models derived on the study group (n=400) were tested on hold-out sample of Rajbanshi participants (n=100) and the other test population of the Karbi (n=200) participants. RESULTS: The results indicate that Index Finger Length (IFL) and Ring Finger Length (RFL) of both hands were significantly longer in males as compared to females. The ring finger was longer than the index finger in both sexes. The study successfully highlights the existence of sex differences in IFL and RFL (p<0.05). No sex differences were however, observed for the index and ring finger ratio. The predictive accuracy of IFL and RFL in sex estimation ranged between 70%-75% (in the hold out sample from the Rajbanshi population) and 60-66% (in the test sample from the Karbi population). A Receiver Operating Curve (ROC) analysis was performed to test the predictive accuracy after predicting the probability of IFL and RFL in sex estimation. The predicted probabilities using ROC analysis were observed to be higher on the left side and in multivariate analysis. CONCLUSION: The study concludes that sex estimation from index and ring finger lengths could be of utility when more reliable means of sex estimation are not available during medico-legal investigations.

Estimation of stature from lengths of index and ring fingers in a North-eastern Indian population.

Forensic anthropology involves identification of human remains in a legal situation. Along with the other three parameters of forensic anthropology, i.e., age, sex and ethnicity, stature estimation is an essential element of medico-legal investigations when identifications of unknown dismembered remains are involved. The present study was conducted with an aim to find the correlation between stature and the lengths of the index and ring fingers and to derive linear and multiple regression models for estimation of adult stature from the index finger and ring finger measurements. The subjects chosen for the study were composed of adult individuals belonging to the "Rajbanshi", an ethnic community of North-eastern India. A total of 500 adults (250 males and 250 females) aged between 18 years and 60 years took part in the study. All the measurements were taken using standard techniques. Stature, index finger length and ring finger length were significantly longer in the males than the females. The correlation coefficient (r) between stature and finger lengths was observed to be positive and statistically significant. Linear and multiple regression models were derived for estimation of stature from a length of index and ring fingers. The predictive accuracy of stature estimation was higher for the females than the males. It was observed that the values of the correlation coefficient (r) and the coefficient of determination (R(2)) increased in multiple regression models when compared to the linear regression models. The study also focuses on the usability of sex-specific regression models in forensic casework. The study concludes that such regression models, as those derived in the present work, can be of significant utility in the estimation of stature.