Intra-household evaluations of alcohol abuse in men with depression and suicide in women: A cross-sectional community-based study in Chennai, India.

BACKGROUND: Harmful effects of alcohol abuse are well documented for drinkers, and adverse effects are also reported for the physical and emotional well-being of family members, with evidence often originating from either drinkers or their families in clinic-based settings. This study evaluates intra-household associations between alcohol abuse in men, and depression and suicidal attempts in women, in community-based settings of Chennai, India. METHODS: This community-based cross-sectional study of chronic disease risk factors and outcomes was conducted in n = 259 households and n = 1053 adults (aged 15 years and above) in rural and urban Chennai. The Alcohol Use Disorder Identification Test (AUDIT) score was used to classify alcohol consumption into 'low-risk', 'harmful', 'hazardous' and 'alcohol dependence' drinking and the Patient Health Questionnaire (PHQ-9) score to classify depression as 'mild', 'moderate', 'moderate-severe' and 'severe'. Multivariate logistic regression models estimated the association of depression in women with men's drinking patterns in the same household. RESULTS: A significant 2.5-fold increase in any depression (PHQ-9 ≥ 5) was observed in men who were 'alcohol-dependent' compared to non-drinkers (OR = 2.53; 95% CI: 1.26, 5.09). However, there was no association between men's drinking behavior and depression in women of the same household, although suicidal attempts approached a significant dose-response relationship with increasing hazard-level of men's drinking (p = 0.08). CONCLUSION: No significant intra-household association was observed between men's alcohol consumption and women's depression, though an increasing (non-significant) trend was associated with suicidal attempts. Complex relationships between suicidal attempts and depression in women and male abusive drinking require further exploration, with an emphasis on intra-household mechanisms and pathways

Performance Analysis of MC-CDMA for Rayleigh fading Channel

For wireless communication system multipath fading is a common problem specially in urban areas where a large number of buildings reflects the radio signals which results in interference amongst the reflected signals which causes the multipath fading effect since its selective by nature some spectrum at some specific location cancels out hence the receive signal losses some part of their information this abruptly increases the BER of communication system in slight movement of receiver, this paper specially analyzes the BER performance under Rayleigh fading channel conditions of MC-CDMA (Multicarrier Code Division Multiple Access) in presence of AWGN (Additive White Gaussian Noise) for different number of subcarrier, different number of users, and different path gains system analysis is performed by simulating the MC-CDMA using MATLAB program, and finally the paper also presents a comparison between simulated results. Keywords: MC-CDMA (Multicarrier Code Division Multiple Access), AWGN (Additive White Gaussian Noise), Rayleigh fading

Socio-economic patterning of cardiometabolic risk factors in rural and peri-urban India: Andhra Pradesh children and parents study (APCAPS).

AIM: To assess the prevalence of cardiometabolic risk factors by socio-economic position (SEP) in rural and peri-urban Indian population. SUBJECTS AND METHODS: Cross-sectional survey of 3,948 adults (1,154 households) from Telangana (2010-2012) was conducted to collect questionnaire-based data, physical measurements and fasting blood samples. We compared the prevalence of risk factors and their clustering by SEP adjusting for age using the Mantel Hansel test. RESULTS: Men and women with no education had higher prevalence of increased waist circumference (men: 8 vs. 6.4 %, P < 0.001; women: 20.9 vs. 12.0 %, P = 0.01), waist-hip ratio (men: 46.5 vs. 25.8 %, P = 0.003; women: 58.8 vs. 29.2 %, P = 0.04) and regular alcohol intake (61.7 vs. 32.5 %, P < 0.001; women: 25.7 vs. 3.8 %, P < 0.001) than educated participants. Unskilled participants had higher prevalence of regular alcohol intake (men: 57.7 vs. 38.7 %, P = 0.001; women: 28.3 vs. 7.3 %, P < 0.001). In contrast, participants with a higher standard of living index had higher prevalence of diabetes (top third vs. bottom third: men 5.2 vs. 3.5 %, P = 0.004; women 5.5 vs. 2.4 %, P = 0.003), hyperinsulinemia (men 29.5 vs. 16.3 %, P = 0.002; women 31.1 vs. 14.3 %, P < 0.001), obesity (men 23.3 vs. 10.6 %, P < 0.001; women 25.9 vs. 12.8 %, P < 0.001), and raised LDL (men 16.8 vs. 11.4 %, P = 0.001; women 21.3 vs. 14.0 %, P < 0.001). CONCLUSIONS: Cardiometabolic risk factors are common in rural India but do not show a consistent association with SEP except for higher prevalence of smoking and regular alcohol intake in lower SEP group. Strategies to address the growing burden of cardiometabolic diseases in urbanizing rural India should be assessed for their potential impact on social inequalities in health

Anthropology in and of MOOCs

The suddenness with which Massive Open Online Courses, or MOOCs, sprang upon us left many within the academy grasping for interpretations. Early proponents touted them as revolutionary tools that could enhance on-campus learning while also making high-quality education accessible to a vast global population, reforming a malfunctioning university system, and producing new kinds of data on how people learn. Critics countered that behind this latest techno-utopian fad lurked an all-too-familiar conservative agenda to downsize the university; the global ambitions of a few elite, resource-rich schools; Silicon Valley corporate interests; and the disciplinary priorities of science, technology, engineering, and mathematics (the STEM fields). With some critical distance, the eight scholars in this Vital Topics Forum draw upon their experiences as anthropologists involved in MOOCs and anthropologists doing studies of MOOCs to propel us beyond such facile responses. Doing what anthropologists do best, they employ contextually rich analysis to upend received wisdom about what MOOCs mean, provide processual accounts of how they are made, and offer first-hand observations of how students are using them on the ground

Association between empirically derived dietary patterns with blood lipids, fasting blood glucose and blood pressure in adults - the India migration study.

BACKGROUND: Dietary patterns (DPs) in India are heterogenous. To date, data on association of indigenous DPs in India with risk factors of nutrition-related noncommunicable diseases (cardiovascular disease and diabetes), leading causes of premature death and disability, are limited. We aimed to evaluate the associations of empirically-derived DPs with blood lipids, fasting glucose and blood pressure levels in an adult Indian population recruited across four geographical regions of India. METHODS: We used cross-sectional data from the Indian Migration Study (2005-2007). Study participants included urban migrants, their rural siblings and urban residents and their urban siblings from Lucknow, Nagpur, Hyderabad and Bangalore (n = 7067, mean age 40.8 yrs). Information on diet (validated interviewer-administered, 184-item semi-quantitative food frequency questionnaire), tobacco consumption, alcohol intake, physical activity, medical history, as well as anthropometric measurements were collected. Fasting-blood samples were collected for estimation of blood lipids and glucose. Principal component analysis (PCA) was used to identify major DPs based on eigenvalue> 1 and component interpretability. Robust standard error multivariable linear regression models were used to investigate the association of DPs (tertiles) with total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides, fasting-blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP) levels. RESULTS: Three major DPs were identified: 'cereal-savoury' (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), 'fruit-vegetable-sweets-snacks' (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and 'animal food' (red meat, poultry, fish/seafood, eggs) patterns. High intake of the 'animal food' pattern was positively associated with levels of TC (β = 0.10 mmol/L; 95% CI: 0.02, 0.17 mmol/L; p-trend = 0.013); LDL-C (β = 0.07 mmol/L; 95% CI: 0.004, 0.14 mmol/L; p-trend = 0.041); HDL-C (β = 0.02 mmol/L; 95% CI: 0.004, 0.04 mmol/L; p-trend = 0.016), FBG: (β = 0.09 mmol/L; 95% CI: 0.01, 0.16 mmol/L; p-trend = 0.021) SBP (β = 1.2 mm/Hg; 95% CI: 0.1, 2.3 mm/Hg; p-trend = 0.032); DBP: (β = 0.9 mm/Hg; 95% CI: 0.2, 1.5 mm/Hg; p-trend = 0.013). The 'cereal-savoury' and 'fruit-vegetable-sweets-snacks' patterns showed no association with any parameter except for a positive association with diastolic blood pressure for high intake of 'fruits-vegetables-sweets-snacks' pattern. CONCLUSION: Our results indicate positive associations of the 'animal food' pattern with cardio-metabolic risk factors in India. Further longitudinal assessments of dietary patterns in India are required to validate the findings

Cohort profile: Andhra Pradesh Children and Parents Study (APCAPS).

The Andhra Pradesh Children and Parents Study (APCAPS) was originally established to study the long-term effects of early-life undernutrition on risk of cardiovascular disease. Its aims were subsequently expanded to include trans-generational influences of other environmental and genetic factors on chronic diseases in rural India. It builds on the Hyderabad Nutrition Trial (HNT) conducted in 1987-90 to compare the effects on birthweight of a protein-calorie supplement for pregnant women and children. The index children of HNT and their mothers were retraced and examined in 2003-05, and the children re-examined as young adults aged 18-21 years in 2009-10. The cohort was expanded to include both parents and siblings of the index children in a recently completed follow-up conducted in 2010-12 (N=∼6225 out of 10,213 participants). Recruitment of the remaining residents of these 29 villages (N=∼55,000) in Ranga Reddy district of Andhra Pradesh is now under way. Extensive data on socio-demographic, lifestyle, medical, anthropometric, physiological, vascular and body composition measures, DNA, stored plasma, and assays of lipids and inflammatory markers on APCAPS participants are available. Details of how to access these data are available from the corresponding author

Using Interprofessional Collaboration to Reduce CLABSI Rates in an Intensive Care Setting

Background: Central line associated bloodstream infections (CLABSI) are preventable hospital-acquired infections associated with increased morbidity and mortality, and cost. CLABSIs are the most expensive healthcare associated infection (HAI) with a cost upwards of $90,000 per infection. This cost does not account for increased length of stay or future readmissions. The criteria used to define CLABSIs in an acute care setting is based on the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) definitions. An infection window period (IWP) is used to review infection criteria to meet the surveillance definition. This is defined as a 7 day period, which includes the 3 calendar days before and after the first positive diagnostic test (Table 1). If no secondary sources are identifiable as a cause of the bloodstream infection (BSI) within the IWP, it will qualify as a CLABSI based on the NHSN definition. Healthcare organizations are encouraged to adhere to evidence based central line (CL) insertion and maintenance practices to reduce infection, which include: Adherence to hand hygiene practices Insertion bundles Maintenance bundles Removal of CL when they are no longer indicated Despite improved compliance with these infection prevention interventions, the surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) continued to experience high CLABSI rates in 2019 and 2020. Aims: Using an interprofessional proactive approach, this project\u27s goal was to reduce the number of NHSN reportable CLABSIs by identifying at risk patients and clinically assessing for alternative infection sources. Methods: An interprofessional team formed to better understand the occurrence of CLABSI on the surgical intensive care unit (SICU). The team included: Unit Medical Director Infection Prevention Specialist Clinical Nurse Specialist Multiple opportunities were identified when reviewing root cause analysis data: Care team documentation Assessments for alternative infection. Verification of blood culture indication following HFH Blood Culture Stewardship Guidelines IRB approval and a waiver of informed consent were obtained. The interprofessional team (Figure 1): Completed daily chart audits on patients with central access Screened patients for blood culture collection and result status Verified blood culture indication using the HFH Blood Culture Stewardship Guidelines Established an IWP and reviewed medical record for infection source once blood cultures were collected Shared findings with interprofessional team via secure messaging Communicated potential gaps with the patient care teams, which included collaborative efforts regarding the treatment plan and proper documentation of clinical findings This proactive approach ensured supporting evidence was present to meet NHSN definitions for secondary BSI to avoid CLABSIs This quasi experimental retrospective study compared data from the pre intervention period (January 2019 to January 2021) to the intervention period (March 2021 to December 2022): CLABSI rate per 1,000 CL days Blood culture order rate per 1,000 CL days CL utilization ratio per 1,000 patient days Standardized infection ratio The t test was used to compare the continuous variables and was determined statistically significant if P \u3c 0.05. All analyses were performed using IBM SPSS Statistics (Version 29; Armonk, NY). Results: After implementation, the interprofessional team identified alternative sources of bloodstream infection in 37 patients (17 in 2021 and 20 in 2022) with qualifying central access and positive blood culture. When comparing pre and post intervention periods, significant reductions were made (see Table 2). This included an 82$1.6 million difference in healthcare costs. Discussion: This project demonstrates that an interpersonal team reviewing potential CLABSIs and identifying alternative sources of BSI can decrease CLABSI rates, improve patient management and lead to better outcomes. In addition to being a safe and effective approach, this intervention had the additional benefit of cost savings for the health system. Healthcare institutions should consider implementing this intervention to reduce unnecessary CLABSI rates, as well as cost.https://scholarlycommons.henryford.com/nursresconf2023/1001/thumbnail.jp

Aggressive angiomyxoma of vagina: a rare entity

Aggressive angiomyxoma a soft tissue tumor arising in the pelvis and perineal regions of women in reproductive age group is a rare entity. It is slow growing locally aggressive myxoid mesenchymal tumor, with a marked tendency to local recurrence. Preoperative clinical diagnosis is usually difficult due to absence of diagnostic features as well as rarity of the disease. We describe a case of aggressive angiomyxoma of vagina in a 47-year-old para 4 woman with multiple fibromyoma (upto 22-week size of pregnant uterus) with 10*10 cms posterior vaginal cyst. Total abdominal hystrectomy with surgical excision of vaginal wall cyst done. A retrospective diagnosis-Aggressive Angiomyxoma of the vagina was made after histological confirmation. Surgical excision with wide margins and long term follow up remains treatment of choice