Blended Tele-mentoring Support for Strengthening Antenatal Care by Private Health care Facilities: FOGSI VISTRIT INITIATIVE.

Introduction: The objective of the present initiative was to build capacity of health care providers in private sector along with standardisation of care during antenatal period for common antenatal problems of GDM and iron deficiency anaemia in private sector. Methods: A pilot project for all levels of health care providers including doctors, nurses, counsellors and laboratory technicians of 34 private facilities in six districts of Jharkhand was planned. Training modules for GDM and anaemia based on government of India guidelines were developed. End line evaluation included data collection and descriptive analysis of quantitative data quality scores from assessment standards on GDM and anaemia in pregnancy. Results: Knowledge assessment of health care providers and doctors through baseline and end line knowledge assessment survey questionnaire showed that 100% health care providers who were trained scored 85% or more in knowledge assessment questionnaires as seen by baseline and end line questionnaire results. All project hospitals (n = 34) in Jharkhand achieved quality standards of care in intervention period for gestational diabetes mellitus and anaemia in pregnancy. They achieved total score more than 80% and exceeded target of 80% of the quality standards. Conclusion: A systematic strengthening of private health care facilities through a blended tele-mentoring and onsite support is possible. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-023-01866-5.

Machine learning analysis of thermophysical and thermohydraulic properties in ethylene glycol- and glycerol-based SiO2 nanofluids.

The study investigates the heat transfer and friction factor properties of ethylene glycol and glycerol-based silicon dioxide nanofluids flowing in a circular tube under continuous heat flux circumstances. This study tackles the important requirement for effective thermal management in areas such as electronics cooling, the automobile industry, and renewable energy systems. Previous research has encountered difficulties in enhancing thermal performance while handling the increased friction factor associated with nanofluids. This study conducted experiments in the Reynolds number range of 1300 to 21,000 with particle volume concentrations of up to 1.0%. Nanofluids exhibited superior heat transfer coefficients and friction factor values than the base liquid values. The highest enhancement in heat transfer was 5.4% and 8.3% for glycerol and ethylene glycol -based silicon dioxide Nanofluid with a relative friction factor penalty of ∼30% and 75%, respectively. To model and predict the complicated, nonlinear experimental data, five machine learning approaches were used: linear regression, random forest, extreme gradient boosting, adaptive boosting, and decision tree. Among them, the decision tree-based model performed well with few errors, while the random forest and extreme gradient boosting models were also highly accurate. The findings indicate that these advanced machine learning models can accurately anticipate the thermal performance of nanofluids, providing a dependable tool for improving their use in a variety of thermal systems. This study's findings help to design more effective cooling solutions and improve the sustainability of energy systems.

Medical, Administrative, Financial, and Social Challenges in the Management of a Case of Hemolytic Disease of the Fetus Caused by a Rare Alloantibody in a Low-Resource Setting.

Antibodies to high-frequency antigens are rarely implicated in cases of hemolytic disease of the fetus and newborn (HDFN), yet they pose a challenge to both clinical staff and transfusion medicine, especially with the identification of the implicating antibody and the arrangement of compatible blood for intrauterine transfusion. Here we report one such interesting case of HDFN caused by an alloantibody to a high-frequency antigen belonging to the Rhesus (Rh) blood group system. The patient presented at the 19th week with Rh-isoimmunized pregnancy. She received six intrauterine transfusions (IUTs) at different intervals during the antenatal period. Arranging the blood of this rare blood group required great efforts from hospital administration, clinicians, and social workers. At 31 weeks, the fetus developed a non-reassuring non-stress test (NST). Hence, the baby was delivered by cesarean section. The baby fared well in the neonatal period. With great efforts and support from social health workers, the Japanese Red Cross society, the administration, and non-government organizations, the impossible became possible.

Landscape assessment of the availability of medical abortion medicines in India.

BACKGROUND: Medical abortion with mifepristone and misoprostol can be provided up to 63 days' gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India. METHODS: We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021. RESULTS: Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment. CONCLUSION: Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed.

Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions.

Improved Tensor Current Limit from

A precision measurement of the ß^{+} decay of ^{8}B was performed using the Beta-decay Paul Trap to determine the ß-ν angular correlation coefficient a_{ßν}. The experimental results were combined with new ab initio symmetry-adapted no-core shell-model calculations to yield the second-most precise measurement from Gamow-Teller decays, a_{ßν}=-0.3345±0.0019_{stat}±0.0021_{syst}. This value agrees with the standard model value of -1/3 and improves uncertainties in ^{8}B by nearly a factor of 2. By combining results from ^{8}B and ^{8}Li, a tight limit on tensor current coupling to right-handed neutrinos was obtained. A recent global evaluation of all other precision ß decay studies suggested a nonzero value for right-handed neutrino coupling in contradiction with the standard model at just above 3σ. The present results are of comparable sensitivity and do not support this finding.

Sulfonated nitrogen and added-sulfur sources influence productivity, quality, and nutrient acquisition of soybean-wheat cropping system.

Soybean-wheat is the predominant cropping system covering >2.5 Mha area in India. The lower productivity of soybean-wheat cropping system (SWCS), remains a serious concern primarily due to inadequate nutrient management. Increasing sulfur (S) deficiency is widespread, especially under oilseed-based cropping system. Hence, to standardize the S requirement through customized fertilization, an experiment was conducted in completely randomized block design (RBD) comprised of 12 nutrient sources, replicated thrice. The study aims to evaluate the agronomic performance of sulfonated nitrogen (SN) in comparison to conventional S nutrient sources in SWCS. The maximum soybean productivity was recorded under NPK + S through 40-0-0-13 (SN1), although NPK + 50% S (15 kg/ha) as basal and 50% (15 kg/ha) as top dressing through SN2 10-0-0-75 produced maximum wheat grain yield. When compared with no nitrogen (control), the application of 30 kg S ha-1 to both crops increased the productivity of the soybean-wheat cropping system up to 39%. The maximum system (SWCS) productivity (8.45 tha-1) was obtained with the application of 50% S as basal and 50% as top dressing (SN2-based), remaining N through urea. The highest sustainable yield index of soybean (SYIS), i.e. 0.90 was under SN1+ remaining N through urea and likewise highest sustainable yield index of wheat (SYIW) was under S splitting. The application of SN also improved the nutrient acquisition and grain quality of soybean and wheat with a positive nutrient balance in the soil. The protein content and yield of soybean and wheat grains also improved. The higher gluten content in wheat grain was produced with 60 kg S ha-1 applied. The agronomic efficiency of N and S (AEN and AEs) were highest under SN1 and SN2, respectively (32.8 kg grain/kg N applied; 15 kg grain/kg S applied) in soybean, however in wheat, S splitting and urea application resulted in highest agronomic efficiency (AEN and AES) of N and S (17.1 kg grain/kg N applied; 22.3 kg grain/kg S applied respectively). Hence splitting of S doses of SN along with urea and recommend P, K was found efficient for the soybean-wheat cropping system.

Neuronal Population Encoding of Identity in Primate Prefrontal Cortex.

The ventrolateral prefrontal cortex (VLPFC) shows robust activation during the perception of faces and voices. However, little is known about what categorical features of social stimuli drive neural activity in this region. Since perception of identity and expression are critical social functions, we examined whether neural responses to naturalistic stimuli were driven by these two categorical features in the prefrontal cortex. We recorded single neurons in the VLPFC, while two male rhesus macaques (Macaca mulatta) viewed short audiovisual videos of unfamiliar conspecifics making expressions of aggressive, affiliative, and neutral valence. Of the 285 neurons responsive to the audiovisual stimuli, 111 neurons had a main effect (two-way ANOVA) of identity, expression, or their interaction in their stimulus-related firing rates; however, decoding of expression and identity using single-unit firing rates rendered poor accuracy. Interestingly, when decoding from pseudo-populations of recorded neurons, the accuracy for both expression and identity increased with population size, suggesting that the population transmitted information relevant to both variables. Principal components analysis of mean population activity across time revealed that population responses to the same identity followed similar trajectories in the response space, facilitating segregation from other identities. Our results suggest that identity is a critical feature of social stimuli that dictates the structure of population activity in the VLPFC, during the perception of vocalizations and their corresponding facial expressions. These findings enhance our understanding of the role of the VLPFC in social behavior.

Evaluation of microplastic pollution and risk assessment in a tropical monsoonal estuary, with special emphasis on contamination in jellyfish.

Estuaries, which serve as vital links between land and coastal ecosystems, play a significant part in facilitating the transfer of plastic waste from the land to the ocean. In this research, we examined the prevalence, characteristics, and ecological risks of microplastics (MPs) in the extensively urbanized Cochin Estuarine System (CES), India. Additionally, it represents one of the initial evidence-based examinations of MPs ingestion by jellyfish in Indian waters, focusing on Acromitus flagellatus, Blackfordia virginica, and Pleurobrachia pileus species. The abundance of MPs found in the surface water of the Cochin Estuarine System (CES) varied between 14.44 ± 9 to 30 ± 15.94 MP/m3, with an average of 21.6 ± 11 MP/m3. In both surface waters and jellyfish from the Cochin Estuarine System (CES), fibers were the most prevalent type of MPs, with polyethylene (PE), polypropylene (PP), and polyamide (PA) being the most common polymer varieties. To evaluate the current levels of MPs and their effect on the CES, the Pollution Load Index (PLI), Potential Ecological Risk Index (PERI), and Polymeric Risk Index (H) were utilized. The high PLIestuary values (20.33), high Hestuary values (234.02), and extreme PERIestuary value (1646.06) indicate that the CES is facing an extreme ecological risk. Among the 280 jellyfish individuals examined, 118 (42.14%) were recognized to contain MPs with an average of 1.54 ± 2.68 MPs/individual. Pearson bivariate analysis revealed a significant correlation between the jellyfish bell size and number of plastics per individual. Comparison between jellyfish species revealed, the majority (66%) of the MPs identified in jellyfish were from A. flagellatus and 44 among the 50 jellyfish examined (88%) had MPs. These findings suggest that A. flagellatus may be a potential sink for MPs and may be utilized to be a bioindicator for monitoring MPs contamination in estuarine systems, aiding in future plastic pollution mitigation efforts.

Bridging gaps in antenatal care: Implementation of the WHO ANC model using a web-based mobile application at different levels of the healthcare system.

INTRODUCTION: Antenatal care (ANC) is crucial for ensuring positive maternal and perinatal outcomes. The World Health Organization (WHO) has released comprehensive guidelines on ANC with the aim of providing a "positive pregnancy experience". While mobile health (mHealth) technology shows immense potential in improving healthcare services, evidence of its effectiveness remains limited. OBJECTIVES: This study aimed to develop a mobile application aligned with the WHO antenatal care model and follow a group of antenatal women using that and compare it to the conventional care provided. METHODS: A prospective open-label study was carried out at three health centers, where patients with singleton/twin pregnancies and access to smartphones were recruited after obtaining informed consent. The study group was followed using the mobile application, while the control group received conventional care. A recall-based questionnaire was used to assess the content of care, including comprehensive history, examination, and patient counselling. Patient satisfaction and the feasibility of using the application were also evaluated. RESULTS: A total of 85 patients in the study group and 73 controls were followed until delivery. Baseline demographic details were comparable, while the number of antenatal visits were higher in the intervention group. Patients in the study group had significantly higher mean scores compared to the controls in terms of comprehensive history (8.26 ± 2.26 vs 3.58 ± 2.30; p < 0.001), physical examination (4.26 ± 1.03 vs 3.66 ± 1.09; p = 0.001) and patient counselling (6.09 ± 1.65 vs 4.33 ± 1.69; p < 0.001). Among the recommended investigations, a hemogram (100 % vs 93.2 %; p = 0.02) and ultrasound prior to 24 weeks (89.4 % vs 56.2 %; p < 0.001) were carried out in a larger number of patients in the study group. Patient satisfaction scores, calculated using the PreMAPeQ questionnaire, were higher in the intervention group. CONCLUSION: This study highlights the effectiveness of an m-health application in enhancing the quality of antenatal care and facilitating standardized ANC visits. Further research is necessary to establish mHealth technology as a cost-effective intervention in this area.

Perinatal Outcome in Congenital Diaphragmatic Hernia (CDH): A Single-Center Experience.

Objective: To study the perinatal outcome in fetuses diagnosed with congenital diaphragmatic hernia (CDH). Methods: Thirty-two pregnant women with antenatal diagnosis of CDH in fetus, who delivered between 2018 and 2021, were included in the study. Postnatally eventration of diaphragm was diagnosed in 3 neonates and were excluded. Results: The median gestational age at diagnosis was 23 weeks (IQR: 216-261 weeks). The mean O/E LHR was 34.88 ± 9.03%, and the O/E LHR was significantly lower in fetuses who did not survive (40.81 ± 4.25 vs 31.26 ± 9.33; p = 0.0037). On ROC analysis, at a cutoff of ≤ 32.93, O/E LHR had a specificity of 100% with a sensitivity of 72.22% in predicting mortality. Cases with liver herniation were not significantly different between survivors versus non-survivors. The overall survival rate was 37.93%, and the leading cause of death was severe persistent pulmonary hypertension. Conclusion: O/E LHR can predict mortality in neonates with antenatal diagnosis of CDH. The presence of pulmonary hypertension was the leading cause of death in these neonates.

Genetic and molecular analysis of leaf blast resistance in Tetep derived line RIL4 and its relationship to genes at Pita/Pita2 locus.

The Vietnamese indica landrace 'Tetep' is known worldwide for its durable and broad spectrum-resistance to blast. We performed genetic and molecular analyses of leaf blast resistance in a Tetep derived recombinant inbred line 'RIL4' which is resistant to both leaf and neck blast. Phenotypic analysis of segregating F2 progenies suggested that leaf blast resistance in RIL4 was controlled by a dominant gene tentatively designated as Pi-l(t). The gene was mapped to a 2.4 cm region close to the centromere of chromosome 12. The search for the gene content in the equivalent genomic region of reference cv. Nipponbare revealed the presence of five NBS-LRR genes, two of which corresponded to the alleles of Pita and Pi67 genes previously identified from Tetep. The two other genes, LOC_Os12g17090, and LOC_Os12g17490 represented the homologs of stripe rust resistance gene Yr10. The allelic tests with Pita2 and Pi67 lines suggested that the leaf blast resistance gene in RIL4 is either allelic or tightly linked to these genes. The genomic position of the leaf blast resistance gene in RIL4 perfectly coincided with the genomic position of a neck blast resistance gene Pb2 previously identified from this line suggesting that the same gene confers resistance to leaf and neck blast. The present results were discussed in juxtaposition with past studies on the genes of Pita/Pita2 resistance gene complex.

NEUROPLASTICITY AND BRAIN STIMULATION: DEVELOPING INTERVENTIONS TO PROMOTE RECOVERY FROM STROKE AND TRAUMATIC BRAIN INJURY.

This article's purpose is to explore how "non-invasive brain stimulation" (NBS) can be used to treat "traumatic brain injury" (TBI) and promote neuroplasticity. Along with the pathophysiological processes that occur after a TBI, "transcranial direct current stimulation" (tDCS) and "transcranial magnetic stimulation" (TMS) are described. These processes are based on a study of the relevant literature. Individualized treatment plans are required because the pathophysiological processes that result from TBI change over time. Given their neurophysiological effects, TMS and tDCS may be used to (a) significant suppression of post-traumatic cerebral hyper excitability; (b) control synaptic plasticity over the long run to prevent unfavorable outcomes; and (c) in addition to other forms of treatment such as physical and behavioral, assist some neural networks to reorganize and consolidate their learning. These treatments have the potential to reduce the disabling symptoms of brain injury.Animal and human research show that NBS may help reduce the severity of injuries and increase plastic changes in lesioned brain tissue, both of which are necessary for the successful acquisition of new knowledge and the restoration of lost functions. However, at present, this evidence is mostly speculative. The relevance of NBS in TBI, further elucidating its therapeutic benefits, and defining appropriate stimulation levels all need investigations in TBI patients due to safety concerns.

THE MICROBIOME AND METABOLIC DISORDERS: THE LINK BETWEEN THE GUT MICROBIOTA AND METABOLIC SYNDROME.

The diverse population of microbes that live in our digestive system, known as the gut microbiota, remains essential for many physiological processes. It plays a role in obtaining energy from food and controls both regional and overall immunity. In addition, changes in the microbiota of the digestive tract are connected to the emergence of an extensive variety of illnesses, such as cancer, gastrointestinal problems, and metabolic disorders. From a metabolic perspective, the gut microbiota can affect processes like lipid accumulation, lipopolysaccharide satisfied, and short-chain fatty acid synthesis, all of which have an effect on food intake, inflammatory reactions, and insulin signaling. Prebiotics, probiotics, specialized anti-diabetic medications, and faecalmicrobiota implantation are a few of the ways that have been discovered to alter the gut microbiota; each has a different influence the human body's metabolism and the emergence of metabolic disorders. These therapies have been reported to be therapeutic strategies for enhancing general wellness and reestablishing a balanced gut flora.

Spatial distribution of total petroleum hydrocarbons in the seawater and sediment of Southeast coast of India.

The spatial distribution of total petroleum hydrocarbons (TPH) were analysed in the seawater and sediment samples collected from 27 locations along the Southeast coast of India. A first-time assessment was carried out on the distribution of TPH in both water and sediments for the entire coastline of Tamil Nadu. The concentration of TPH in seawater showed large spatial variation ranging from below detection level (BDL) to 47.5 µg/L and 0.01 to 53.12 µg/L in the surface and bottom waters, respectively. TPH levels exceeded the regulatory limits specified by FAO, China's Marine Monitoring Standards and the European Community in the seawater samples of Thoothukudi harbour (S2 station). The results showed that seawaters of southern stations were comparatively more polluted with TPH. TPH values in sediment were between 2.33 and 30.07 µg/g, and their levels remained below the Marine Sediment Quality Standard (500 µg/g). The spatial profile of TPH in sediments were contrasting to that observed for seawater. Higher TPH values were observed in sediments of the northern region than southern. TPH contents are strongly correlated with clay (R2 = 0.776; P < 0.001) and silt (R2 = 0.648; P < 0.001); conversely, there is a significant negative correlation between TPH and sand (R2 = 0.753; P < 0.001). ANOVA analysis demonstrated a significant difference (F = 11.75; p < 0.01) between the TPH concentrations of water and sediments. Non-metric multidimensional scaling (nMDS) was performed to determine the similarity among sampling stations that formed five crusted groups. Sediment along the southeast coast can be categorised as slightly polluted with respect to TPH as per the ATSDR standards.

Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy.

AIMS: Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS: A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS: Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS: Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION: Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022.  https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .

Cardio-oncology in China.

OPINION STATEMENT: Cardio-oncology is going under rapid development in various areas across an increasing number of provinces in China. However there are still a myriad of challenges that need to be overcome in order to ensure its gradual and consistent expansion. The Cardio-Oncology Knowledge Transfer Model (KTM) forms the basis to allow exponential development of effective cardio-oncology services. This would ensure the implementation of precision-based practice while dynamically evolving cardio-oncology to integrate both Western and Chinese medical practices to become an official clinical sub-speciality in its own right in China, for the ultimate benefit of the patient.

Blended Teaching Methodology of E-learning and Simulation Training in Obstetrics and Gynecology for Undergraduate Medical and Nursing Trainees.

Context The concept of simulation-based teaching has become a standard practice for health education in the present era. However, there is a paucity of literature on integrating simulation-based teaching in the conventional training of undergraduate medical and nursing students. Aim To explore the effectiveness and benefits of e-learning along with low-fidelity simulation in obstetrics and gynecology among undergraduate medical and nursing students at a tertiary care center in India. Methodology It was a prospective study conducted on 53 final-year undergraduate medical students and 61 final-year undergraduate nursing students. All students underwent a knowledge-based pre-test followed by exposure to an e-learning module on four selected obstetrics and gynecology skills, namely, conducting normal delivery, episiotomy suturing, pelvic examination, and insertion of intrauterine device. Students practiced these four skills on low-fidelity simulators. After this, they underwent a post-test assessment and gave feedback. A focused group discussion was conducted to explore their experiences. Results There was a statistically significant difference between the pre-test and post-test knowledge scores of all the students (p =< 0.001). Students found this teaching strategy useful and reported an increase in self-assessed confidence. Focused group discussion revealed various themes like improved satisfaction and ability to practice repeatedly without fear of harming patients. Conclusions Based on the results, this teaching methodology should be integrated as an adjunct method of teaching in the undergraduate curriculum from the first year itself, which will motivate students to participate in clinical care and will result in quality improvement of health care.

Meta-analysis comparing diabetes in pregnancy study group India (DIPSI) vs the international association of the diabetes and pregnancy study groups (IADPSG) criteria for diagnosis of gestational diabetes among Indian population.

Despite consensus on universal screening of women at 24-28 weeks for a diagnosis of gestational diabetes, controversy remains on an appropriate criterion. The study is aimed to find out the sensitivity and specificity of Diabetes in Pregnancy Study Group India (DIPSI) criteria compared to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosis of Gestational Diabetes Mellitus (GDM). A meta-analysis of studies comparing DIPSI as an index test to IADPSG as the reference test for diagnosing GDM was carried out. A total of 8 comparative studies were included. Pooled analysis showed a sensitivity of 0.44 [0.29 to 0.60] and specificity of 0.97 [0.94 to 0.98], which means the index test DIPSI will correctly identify only 44% of the subjects who have the disease (GDM positive) but it will also fail to identify 56% of the GDM positive subjects. Derek's funnel graph revealed fewerchances of publication bias. Though convenient, DIPSI criteria was not found to be sensitive enough for a diagnosis of GDM and missed an opportunity to improve pregnancy and subsequent long-term outcomes for a substantial number of women. Further studies should focus on comparing pregnancy outcomes for the two criteria, so that decision to adopt any criteria is more evidence-based.