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As the speech production mechanism is related to the breathing process, speech signals and breathing patterns impact each other. Breathing patterns are the physiological signals which help in understanding the psychological, physiological and cognitive states of an individual. Capturing such patterns relies on the availability of equipment such as respiratory belts, which are costly and uncomfortable to wear for long duration. In this paper, we attempt to extract the breathing patterns from speech signals, which are easily available and can be recorded using a smartphone's microphone. In the presented work, simultaneous speech and breath signals are captured from 100 Indians of the age group 20 to 25 years while they read a phonetically balanced passage in English language. We have identified five distinct breathing templates; following two broad speech-breath categories, exhibited by the speakers while they read the same passage. For one of the two categories, the time domain features with regression network can extract the breathing patterns from speech with a Pearson correlation coefficient of 0.70. By computational modelling, we distinguish these two breathing categories from speech with a classification accuracy of 79%.

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This paper presents the results of a scoping review that examines the extent to which legal empowerment has been used as a strategy in efforts to improve access to quality health services in low- and middle-income countries. The review identifies lessons learned regarding legal empowerment program strategy, as well as impact on health empowerment and health outcomes, research gaps, areas of consensus and tension in the field.The review included three main sources of data: 1) peer-reviewed literature, 2) grey literature, and 3) interviews with key legal empowerment stakeholders. Peer-reviewed and grey literature were identified via keyword searches, and interviewees were identified by searching an organizational database and snowball sampling.The key findings were: first, there is very limited documentation on the use of legal empowerment strategies for improving health services. Second, the legal empowerment approach tends to be focussed on issues that communities themselves prioritize, often narrowly defined local challenges. However, legal empowerment as a strategy that pursues collective and individual remedies has the potential to contribute to structural change. Third, for this potential to be realised, legal empowerment entails building capacity of service providers and other duty bearers on health and related rights. Finally, the review also highlights the importance of trust-trust in state institutions, trust in the paralegals who support the process and trust in the channels of engagement with public authorities for grievance redress.Several gaps also became evident through the review, including lack of work on private health providers, lack of discussion of the 'empowerment' effects of legal empowerment programs, and limited exploration of risk and sustainability. The paper concludes with a caution that practitioners need to start with the health challenges they are trying to address, and then assess whether legal empowerment is an appropriate approach, rather than seeing it as a silver bullet.

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Introduction Flipped classroom refers to a teaching model where the lecture and homework elements of the class are reversed. Students develop knowledge and understanding during the pre-class session, and use the in-class time for active learning such as small group discussions, wherein they are expected to develop the skills of problem-solving (application) and critical thinking (analysis). An educational psychologist, Benjamin Bloom, proposed Bloom's Taxonomy for the cognitive domain. According to this taxonomy, knowledge, and understanding have been considered to be lower-order cognitive skills (LOCS), while application (problem-solving), analysis (critical thinking), synthesis, and evaluation have been considered higher-order cognitive skills (HOCS). Only one study has reported that flipped classroom approach helps in the acquisition of HOCS such as application, analysis, synthesis, and evaluation. The present study aims to compare the flipped classroom model with the traditional lecture model and focuses particularly on the acquisition of HOCS such as application and analysis, by assessing the students using multiple-choice questions based on clinical vignettes. Methods The study was conducted in the Department of Physiology at Government Medical College, Bhavnagar. A total of 102 students in two groups, Group A (n=52) and Group B (n=50), participated in all the phases of the study. In the flipped classroom group, students watched the pre-recorded videos and studied standard textbooks, followed by a group discussion in the class. The traditional Lecture group attended the didactic lecture only. Topic I was taught to Group A using the flipped classroom model and to Group B using the traditional didactic lecture approach. Topic II was taught to Group B by using the flipped classroom method and to Group A using the traditional didactic lecture. Both groups of students were assessed after a gap of one week with multiple-choice questions based on clinical vignettes for checking the HOCS. These questions were designed based on Blooming Biology Tool (BBT). The feedback collected responses regarding the learning experience, perceived value of the flipped classroom, the course materials, the teaching process, and the evaluation system. Results The students, who participated in the flipped classrooms, performed statistically better than those in the traditional lecture model (5.36 ± 1.69 vs. 4.94 ± 1.34) (p<0.05). The students strongly agreed that the flipped classroom method was an enjoyable way of learning: it enhanced their problem solving and analytical ability as well as developed their ability to work as team members and plan their own work. Students in both the flipped classrooms gave a similar perception indicated by the small effect size (r <0.3). Conclusion The pre-class time of the flipped classroom model helps students remember the facts and understand the concepts (both lower-order cognitive skills), and uses the valuable in-class time to master the application of the concepts and critically analyze them (application and analysis being higher-order cognitive skills).

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This article was migrated. The article was marked as recommended. In today's era, medical teaching is becoming increasingly complex and challenging. Out of all subjects in the medical curriculum, Pharmacology is one of the major disciplines undergoing constant development and advancement. A strong foundation of pharmacological knowledge is needed to help students improve upon their understanding and thereby manage clinical conditions in a more effective manner. Unfortunately, Pharmacology is perceived as a dry and volatile subject by medical students. This calls for a need to explore various pedagogical tools at medical schools, so as to best identify methods effective for active learning. Efforts need to be directed towards the objective of making Pharmacology teaching interesting and learner-centered by formulating creative and innovative teaching-learning modules in and outside the classrooms. Learner-centered teaching can foster students' interest in the subject and contribute to knowledge acquisition as well as future application. In context to this, the current piece explores and addresses the application of "Autobiography of drugs" as one of the pedagogical tools in the subject of Pharmacology.

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BACKGROUND: The prescription error is a failure in the prescription writing process leading to wrong instructions about the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. This study is an effort directed to find errors in prescription writing and interventions to improve on such error-prone practices of prescription writing. METHODS: This was a cross-sectional, observational study conducted to analyze the prescription writing errors in the outpatient department in the rural area of Anand district of Central Gujarat. Prescriptions were collected from two nearby rural areas of Anand city-Petlad and Anklav. The prescription copies so-obtained were analyzed as per the WHO guidelines for "Prescription Writing Errors." RESULTS: Overall, 191 prescriptions were collected from both rural areas in the study. The highest number of prescriptions was collected from general practitioners, followed by surgeons and gynecologists. Name, qualification, and address of prescribers were mentioned in all the prescriptions while registration number was mentioned only in 14.10% of prescriptions. The esoteric symbol was mentioned in 63% of prescriptions. Prescribers signed their prescription only in 48% of prescriptions. A total of 420 drugs were prescribed to the patients in the study. All but one drug were prescribed by brand name. Dosage form and route of administration of drugs were mentioned in >60% of drugs. CONCLUSION: Most medical schools provide some training in prescribing to medical undergraduates; however, this training is perceived to be suboptimal by medical students and junior doctors. Such training programs are the need of the hour.

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INTRODUCTION: Rising concerns about antimicrobial resistance and inadequate development of effective new anti-infective drugs have stimulated universal efforts to strengthen infection-control interventions. Antimicrobial stewardship is a rational, systematic approach to promote the optimal selection, dosing, and duration of therapy for antimicrobial agents throughout the course of their use in order to improve the outcomes. AIM: Since in Shree Krishna Hospital (SKH), Antibiotic Stewardship Program (ASP) was first implemented in 2013, this study was planned to assess any change in antimicrobial use before and after implementation of ASP and to study the rate and pattern of antimicrobial use in medical ICU. MATERIALS AND METHODS: A cross-sectional study was conducted in 12 bedded medical intensive care unit, over a period of two years from October 2014 to October 2016 at SKH. Permission was taken from Institutional Human Research Ethics Committee. Total 150 case files i.e., 75 from year 2012 and 75 from year 2015 were retrieved from medical record section of the hospital. Appropriateness of prescriptions was decided on the basis of appropriateness of choice, dose, frequency and duration of antimicrobial agents. Data were analysed by using descriptive statistics. RESULTS: There were 68.67% males and the mean (±SD) age was 57.11 (±16.83) years. Majority of the patients were suffering from respiratory conditions. The most common group of drugs prescribed in MICU was ß-lactam antibiotics + ß-lactamase inhibitors during 2012 as well as 2015. Total 139 patients i.e., 69 (92%) patients in 2012 and 70 (93.33%) patients in 2015 were given antimicrobial for therapeutic purpose. During the year 2015, 67 (89.33%) antimicrobial prescriptions were adhering to antibiotic policy of SKH. Appropriateness of prescriptions had significantly improved in 2015 in MICU (p-value=0.031). CONCLUSION: In-depth analysis of the study revealed a positive impact of ASP and antibiotic policy. Implementation of ASP in year 2013, brought an effective increase in the appropriate use of antimicrobials.

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BACKGROUND: Globally, students with top academic performance and high intellectual capacity usually opt to study medicine. However, once students get enrolled, their academic performance varies widely. Such variations appear to be determined by various factors, one of them being types of learning strategies adopted by students. The learning strategies utilized by the students with better academic performance are likely to be more effective learning strategies. AIMS AND OBJECTIVES: The objective is to identify effective learning strategies used by medical students. METHODOLOGY: This study was carried out among the MBBS students of Final Professional Part I. Students were categorized into three groups namely: high, average, and low rankers based on overall academic performance in second Professional University examination. First, a questionnaire consisting of closed- and open-ended questions was administered to students, to find their learning strategies. Subsequently, focus group discussion and in-depth interviews were conducted for high- and low-rankers. Discussions were audio-recorded, transcribed, and analyzed. Key statements were highlighted, collated, and categorized into general themes and sub-themes. RESULTS: Evident themes which emerged as effective strategies were hard work in the form of regularity of studies, meticulous preparation of notes, constructive use of time, utilization of e-learning, learning styles and deep learning approach and regular ward visits. Intrinsic motivation, family support, balancing physical activities and studies, guidance by seniors, teachers, dealing with nonacademic issues such as language barriers and stress were also identified as important strategies. CONCLUSIONS: Disseminating effective learning strategies in a systematic manner may be helpful to students in achieving better academic outcomes. Furthermore, educationists need to modulate their teaching strategies based on students' feedback.

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INTRODUCTION: Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. AIM: To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. MATERIALS AND METHODS: A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. STATISTICAL ANALYSIS: Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. RESULTS: Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient's age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. CONCLUSION: As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

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INTRODUCTION: Various studies in medical education have shown that active learning strategies should be incorporated into the teaching-learning process to make learning more effective, efficient and meaningful. OBJECTIVES: The aim of this study was to evaluate student's perceptions on an innovative revision method conducted in Pharmacology i.e. in form of Autobiography of Drugs. The main objective of study was to help students revise the core topics in Pharmacology in an interesting way. SETTINGS AND DESIGN: Questionnaire based survey on a newer method of pharmacology revision in two batches of second year MBBS students of a tertiary care teaching medical college. MATERIALS AND METHODS: Various sessions on Autobiography of Drugs were conducted amongst two batches of second year MBBS students, during their Pharmacology revision classes. Student's perceptions were documented with the help of a five point likert scale through a questionnaire regarding quality, content and usefulness of this method. STATISTICAL ANALYSIS USED: Descriptive analysis. RESULTS: Students of both the batches appreciated the innovative method taken up for revision. The median scores in most of the domains in both batches were four out of five, indicative of good response. Feedback from open-ended questions also revealed that the innovative module on "Autobiography of Drugs" was taken as a positive learning experience by students. CONCLUSIONS: Autobiography of drugs has been used to help students recall topics that they have learnt through other teachings methods. Autobiography sessions in Pharmacology during revision slots, can be one of the interesting ways in helping students revise and recall topics which have already been taught in theory classes.

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INTRODUCTION: It has now been proven that tobacco abuse is the leading cause for various carcinomas such as oral, lung and oesophageal. It also leads to atherosclerosis of major vessels, development of hypertension, autoimmune disorders, COPD, bronchitis, asthma, bronchiectasis, etc. Most smokers are dependent on nicotine and abstinence from smoking results in tobacco withdrawal and craving. It also affects cognitive skills and reaction time. Many students in professional college have the habit of smoking. In spite of awareness programmes carried out in schools, colleges and having ban on smoking, prevalence of smoking is rising in India. AIM: To observe the effect of abstinence on audiovisual reaction time and to note the cause for reverting to smoking by the students pursing professional course. MATERIALS AND METHODS: Sixty male volunteers in the age group of 18-25 years participated in the study. The volunteers were divided in to two groups (control group and study group). Cigarette smokers consuming at least 10-19 cigarettes per day for more than 2-3 years were included as subjects in study group. The study was conducted using a audiovisual reaction time apparatus in a quiet and bright lit room. All volunteers were subjected to baseline readings after demonstrating working of the apparatus. Auditory (high pitched and low pitched sound) and visual (red light and green light) reaction time was recorded. Thirty students in study group were subjected to these tests immediately after smoking and after 12 hours of abstinence. After all the individuals were tested, the recorded values were compared by Student's t-test. RESULTS: Statistically significant difference was recorded in auditory and visual reaction time in study group subjects immediately after smoking and after 12 hours of abstinence as compared to base line readings. CONCLUSION: It was observed that auditory and visual reaction time was prolonged in chronic smokers after 12 hours of abstinence.

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Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal syndrome that results from inappropriate activation of the immune system. Many viral agents are known to trigger HLH but cytomegalovirus (CMV) associated HLH is rarely described. We report a case of CMV related HLH in a 3½ month old immunocompetent male infant who presented with fever, respiratory distress and hepatosplenomegaly. He had fulminant sepsis like course in the hospital as he continued to have hectic fever spikes, progressive pneumonia, increasing hepatosplenomegaly and multiple episodes of generalized convulsions. Investigations revealed bicytopenia, biochemical hepatitis, hyperferritinemia and hypofibrinogenemia. CMV IgM serology was reactive in both infant and mother. Diagnosis of CMV-HLH was made as per HLH 2004 diagnostic protocol. Infant was successfully treated with intravenous ganciclovir along with dexamethasone and etoposide.

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Background. Dementia is one of the most frequent disorders among elderly patients, reaching to epidemic proportions with an estimated 4.6 million new cases globally annually. Partially effective treatments are available for dementia. Aims & Objectives. We aim to study drugs used in dementia and find out frequency of types of Dementia. Method. This was an observational study conducted at rurally based tertiary care hospital. Prospective data was collected from outpatient department, while retrospective data was collected from medical records. Descriptive statistics were used to analyze data. Result. Total 125 prescriptions of patients diagnosed with dementia were analyzed. Alzheimer's dementia was most common (65.6%), followed by vascular dementia (21.6%), and frontotemporal dementia (10.4%), with the rarest being Lewy body dementia in (2.4%) cases. 60.57% of patients were males. Mini Mental Score Examination mean score was 15.93 ± 1.37. Frontal Battery Assessment mean score was 4.75 ± 1.01. Prescribed drugs were Donepezil (68.49%), Rivastigmine (13.63%), Donepezil + Memantine (6.43%) and Galantamine (12.83%), Quetiapine (38.46%), Lorazepam (23.07%), Clozapine (11.53%), Escitalopram (10.25%), Haloperidol (3.84%), Zolpidem, Sertraline, Olanzepine (2.56%), Nitrazepine, Lamotrigine, Fluoxetine, Tianeptine (1.28%), Folic acid, and Vitamin B12, respectively. Conclusion. Alzheimer's is the most common type of dementia while Donepezil was the most frequent drug.

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BACKGROUND: Stress indicates the response or reaction of an organism to the environmental circumstances and their outcomes. Acute stress is well known to trigger several hormonal alterations in animals. An increase in glucocorticoid concentration can represent intensity of discomfort or distress experienced by an animal. The study was undertaken to evaluate the effects of various physical stress models on serum cortisol level in Wistar male rats. METHODOLOGY: In this study six Wistar male rats weighing 150-200 gm were randomly selected. Animals were exposed to 'forced swim test' and 'restraint test'. Their serum cortisol level was measured by ELISA test using alpha prime ELISA system before and after the tests respectively. RESULTS: RESULTS were analyzed by students paired t-test. Serum cortisol level was significantly higher after forced swim test as well as after restraint test. When both the physical activities were compared, serum cortisol level was increased more after restraint stress than after forced swim test however, the difference was not significant statistically. INTERPRETATION AND CONCLUSION: The rise in serum cortisol level was observed in both the physical activity models . Rise in serum cortisol level was significantly higher after restraint test than exposing them to forced swim test. This indicates that restraining the rats produced more stress than making them forcefully swim.

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The present study was planned to assess the correlation of pulmonary functions with body fat percentage in young individuals. A total of 132 (males--68, females--64) young students (18 to 21 years) with moderately sedentary lifestyle were recruited in this study. Their height, weight, body mass index (BMI) and waist to hip ratio (WHR) were measured. Pulmonary function tests (static and dynamic) were recorded on a computerized portable Schiller lung function unit SP-1. The percentage of body fat was estimated by measuring skin fold thickness at four sites (4SFT-biceps, triceps, subscapular and suprailiac) with the help of Harpenden's caliper. In males body fat % showed negative correlation with expiratory reserve volume (ERV), forced vital capacity (FVC), maximum ventilatory volume (MVV), peak expiratory flow rate (PEFR) and forced expiratory volume at the end of first second (FEV1). It was observed that in females body fat % had negative correlation with ERV, FVC, and MVV. These results indicate that increase in percentage of body fat and central pattern of fat distribution may affect the pulmonary function tests.

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