CRO in chennai
It’s entirely human to struggle with letting go of the past, but when this behaviour begins to infect society as a whole, it can create a mob mentality that’s difficult to break.
Now mathematicians from Dartmouth college have shown how this powerful social phenomenon, known as ‘hysteresis’, can explain the dynamics of the anti-vaccination movement.
“Given all the benefits of vaccination, it’s been a struggle to understand why vaccination rates can remain stubbornly low,” says lead author Feng Fu, a mathematical biologist at Dartmouth.
“History matters, and we now know that hysteresis is part of the answer.”
Hysteresis, which roughly translates to “remaining” in Greek, is essentially what happens when the past comes back to haunt the present.
The term was first applied in 1881 to describe the physics of magnetism, but since then this puzzling phenomenon has been applied to several other fields, including economics, marketing and human behaviour.
In physics, when a magnetic field is increased and then turned off, it is impossible for a magnet’s flux to return to its exact original state, and this is exactly what is meant by the term hysteresis.
It’s the same thing that occurs when unemployment rates remain high, even in the face of a recovering economy.
And now, strangely enough, mathematicians think it can also help explain social resistance to vaccinations.
Here’s the thing: even though there is overwhelming evidence that vaccines are both safe and effective, in recent years vaccination rates have begun to plateau and the anti-vax movement has continued to grow.
It seems that no matter how many pro-vaccine campaigns are started, the world just cannot meet appropriate levels of herd immunity (the percentage of a population that needs to be vaccinated to develop sufficient disease resistance), and this puts all of society at risk.
The new research suggests that at least part of this resistance may be due to a lingering sense of unease, brought about by negative past events like the MMR-autism debacle.
It’s memories like these, no matter how scientifically inaccurate, that create a negative history, trapping society in a hysteresis loop and stiffening public resolve against vaccines.
The root of the problem essentially stems from the nature of vaccines themselves. Since vaccines can sometimes produce unwanted side effects and can never confer full disease protection, the authors think it is especially easy for society to grow skeptical of their necessity.
“Once people question the safety or effectiveness of a vaccine, it can be very difficult to get them to move beyond those negative associations,” explains Fu.
In other words, when society gets stuck in one of these loops, it can create a sort of friction, slowing the recovery of vaccination rates and leaving us all vulnerable to disease outbreaks.
The authors point out, for instance, that in England and Wales it took fifteen years to build vaccination rates from 30 percent to 91 percent – a feat that should have taken just a year under ideal circumstances.
What’s more, in countries such as France, measles has been making a comeback, despite the availability of an effective vaccine.
“Vaccination levels in a population can drop quickly, but, because of hysteresis, the recovery in that same population can take many years,” explains co-author Xingru Chen, a mathematician at Dartmouth.
The study represents the very first time that hysteresis has been found useful to analyse a public health issue, and the authors hope that if we can find a way around this roadblock, it could pull us out of our current vaccination rut.
“This study shows why it is so hard to reverse low or declining vaccine levels,” says co-author Xingru Chen, a mathematician at Dartmouth.
“The sheer force of factual, logical arguments around public health issues is just not enough to overcome hysteresis and human behaviour.”
Instead, the mathematical models suggest that vaccines need to reach a certain level of efficacy before the public is fully willing to accept them.
As such, the mathematicians are urging officials to focus on developing more efficient vaccines, and then afterwards making the public as aware of this efficiency as possible.
“Aside from the public health prevention perspective, vaccination campaign should promote vaccination as an altruistic behaviour that is desired for societal benefit,” Fu told Newsweek.
You’re not getting that jab just for yourself or your own kid – you’re helping others, too.
This study has been published in the Proceedings of the Royal Society B.
The Central government is planning to offer incentives to attract private investments in hospitals in tier 2 and tier 3 cities to support its Pradhan Mantri Jan Arogya Yojana (PMJAY) or Ayushman Bharat initiative. As per the guidelines issued by the health ministry, the government will allocate land on lease, facilitate various permissions and clearances through a special window with timelines.
“The objective of the broad guidelines is to improve the supply of healthcare services in the underserved areas to ensure maximum utilisation of the benefits under PMJAY and to improve the demand for quality healthcare services at affordable prices to the general public,” the statement issued by the ministry says.
The private sector will have to build, design, finance, manage, operate and maintain quality standards, take the market risk and provide services at PMJAY rates. In addition, the government guarantees compulsory empanelment of the hospitals for PMJAY and other government schemes, timely payments for services, viability gap funding up to 40 per cent of the total cost of the project and gap funding up to 50 per cent of tax on capital cost.
Ayushman Bharat provides insurance cover of up to Rs.5 lakh per family per year to over 10 crore poor families in the empanelled hospitals. So far 33 states and Union territories have come on board.
Last week, West Bengal Chief Minister Mamata Banerjee said her government would pull out of the Ayushman Bharat scheme, stating that the Central government has been taking credit for the scheme, which is funded by state governments.
“Today we are withdrawing from the Ayushman Bharat scheme. Now, the Centre will have to bear the entire cost of the scheme as we will no longer pay our share of the money. Why should we pay if it (Centre) takes all the credit?” Banerjee said at a rally at Krishnanagar in Nadia district. Her government has already sent a letter to the Centre on its intent to pull out of the scheme.
Our bodies are pretty good at telling us when we need to drink water.
It’s a message that’s been drummed into us since childhood. Drink water, especially when it’s hot, otherwise you’ll get dehydrated.
But how do you know if you’re dehydrated? Who’s more at risk? And what can you do about it?
What’s dehydration and why does it matter?
When people use the term dehydration, they usually refer to what doctors call “volume depletion” or hypovolaemia.
Volume depletion is a reduction in the volume of water in the blood vessels. But dehydration is quite different and is less common. It’s the loss of water from both blood vessels and the body’s cells.
Doctors are concerned about volume depletion and dehydration because adequate hydration is required for the body to function normally. Water maintains our body temperature and lubricates our joints.
Our body’s cells rely on water as does our circulatory, respiratory, gastrointestinal and neurological systems.
Severe cases of volume depletion can lead to shock and collapse. Without resuscitation with fluid, the consequences may be devastating.
Water, water everywhere
A 70 kilogram (154 pound) person is made up of 40 litres (10 gallons, 40 kilograms) of water. Two-thirds of that water is in the cells (intracellular), one-third outside the cells (extracellular).
Outside the cells, 20 percent of body water is in plasma (around 3 litres or quarts), which together with red bloods cells (2 litres) gives a total 5 litres of blood. It’s the movement of water between compartments that maintains each one’s biochemical composition, allowing your cells and body to work normally.
The total body water volume (water in both the blood vessels and the body’s cells) is remarkably constant given the large variation in how much an individual might take in and lose each day.
Water intake is accounted for mostly by how much and what you drink and eat, and the daily variation is regulated by the kidney, which alters your urine output.
The main function of the kidney is to regulate the volume and composition of body fluids within narrow limits by altering output.
When you drink large volumes of fluid, your body can afford to get rid of increased amounts of dilute urine. But when you drink a minimal amount of fluid, your urine is concentrated and you pass only a small volume.
If you’re urinating less often than normal, or urinating small volumes of darker coloured urine, it may be time to drink more water.
Other small losses of water include through stool, sweat and lungs.
So if you have diarrhoea or are exercising in the heat, for instance, you will need to drink more fluids.
As fluid is lost from the extracellular compartment such as in cases of diarrhoea and vomiting or bleeding, you can develop symptoms of volume depletion including:
- thirst, including a dry mouth
- dizziness, particularly when standing due to the low blood pressure (a consequence of volume loss)
- and when very severe, confusion (a consequence of inadequate oxygenation of the brain).
Doctors might also note:
- that it takes longer for your skin to bounce back when pinched (known as reduced skin turgor)
- low blood pressure as a reduction in volume directly affects blood pressure
- an increased heart rate, in an attempt by the body to maintain blood pressure
- reduced weight as fluid makes up two-thirds of body weight. A loss of 1 litre (1 quart) of fluid will read as a drop in 1 kilogram (2.2 pounds) on the scales.
Blood testing will often reveal a degree of kidney impairment. That’s because the kidneys require a large blood flow to work normally.
In cases of volume depletion and reduction in blood pressure, blood flow to the kidneys is compromised and they go into a state of “shock”. Mostly this is reversible when volume and blood pressure is restored.
As there’s no single test for volume depletion, doctors will make a diagnosis after taking a note of your history, examining you and a combination of blood and urine tests.
Here’s what happened to Tom
I was on call at the hospital recently when, at 9:45 pm on a Sunday, I received a call from the emergency department.
Tom, a 78 year old man, had come in by ambulance after neighbours had found him on his bedroom floor. Tom’s cognition was not great at the best of times, and that night he couldn’t tell us how long he had been on the floor.
There were no obvious injuries, his blood pressure was low (100/60mmHg), pulse rate high (98 beats per minute) and his temperature was normal. Blood tests showed he had low sodium salt levels and kidney impairment.
Tom had been in the emergency department for six hours by the time the call came to me; in that time he had not passed urine. It all pointed to volume depletion.
We treated Tom with intravenous fluid. He needed 5 litres over 48 hours, after which he was passing urine again. His blood pressure was back to normal 140/70mmHg, his kidney function had normalised and his weight was up from 46 kilograms (101 pounds) on admission to 50 kilograms (110 pounds).
Tom told us he had fallen while getting up at night. He had been on the floor for most of the next day and had not eaten or drunk anything for hours.
Who’s most at risk and why?
Some groups are more susceptible to volume depletion, including:
- elderly people like Tom, as our total body water reduces with age and the elderly often have a reduced sensation of thirst. Many older people also have other health problems including chronic kidney disease, which may impact the ability to concentrate urine when the volume is depleted
- babies, because they aren’t able to articulate when they’re thirsty. They have a higher metabolic rate than adults meaning they require more fluid
- people with impaired thirst mechanisms such as the elderly or people with certain brain injuries
- people losing large volumes of fluid via the bowel (from diarrhoea or through a colostomy)
- people taking medications that promote water loss, in particular diuretics, often referred to as water tablets.
These vulnerable groups need to be aware of the increased risk of volume depletion, minimise their risk by maintaining fluid levels, recognise the symptoms of volume depletion early, and seek prompt treatment, including going to hospital if necessary.
If you experience the symptoms of volume depletion it’s important to take heed. At home, start with water if you’re thirsty. Once dizziness is present, significant volume loss has ensued and a trip to the doctor is in order. Confusion mandates emergency treatment.
How about physiological dehydration?
Physiological dehydration, which occurs when water is lost from both the blood vessels and from the body’s cells compartment, is distinct from volume depletion. But there are many overlapping symptoms, such as thirst, a drop in blood pressure and when severe, confusion.
Dehydration can happen with prolonged and sustained high blood sugar levels as can occur in someone with diabetes. This is because the high sugar levels in the blood pull water out of the cells in an attempt to lower the levels.
High sugar levels also make you pass more urine. So in this instance there is loss of fluid from both the intracellular and extracellular compartments.
So for those with diabetes, monitoring blood sugar levels is important. If the blood sugar is persistently high it’s important to seek medical advice to reduce the level safely and prevent dehydration.
In a nutshell
Water is vitally important to the normal function of the body. Volume depletion can occur during anytime of the year, but people are particularly prone over the summer months.
The key is prevention and knowing what the signs and symptoms are. So in summer keep your fluids up; talk to your doctor about any medications that may need adjusting (such as diuretics) and keep an eye out for friends, family and neighbours.
India part of four clinical trials on newer surgical techniques in digestive diseases to support faster access to treatment
India is conducting five major clinical trials for newer surgical techniques in digestive diseases. This is even as 50% of the cases in India in the 50 years age-group manifests the condition. The locations are Smiles International Institute of Colo-Proctology (SIICP) in Bengaluru for laser hemorrhoidoplasty and Garg Fistula Research Institute, Haryana performing the clinical study with PERFACT. The distal laser and proximal ligation study is being conducted at the Healing Hands Clinic, Pune. The surgical technique clinical evaluation conducted for LIFT is performed at the Gem Hospital, Coimbatore.
Some factors attributed to digestive diseases are unhealthy diets and lack of exercise. The country also lags behind most advanced countries in the diagnosis and treatment of digestive diseases.
Two reasons for this are paucity of specialists and the role played by quacks harming patients. Moreover, digestive diseases also carry a stigma which prevents those suffering to seek treatment from a qualified specialist. Therefore, a more enlightened view needs to be adopted in India to combat digestive diseases, Dr. Parameshwar CM, chief colorectal surgeon, Smiles International Institute of Colo-Proctology (SIICP) told Pharmabiz in an email.
There are several drugs to treat the condition, there are also clinical trials going on in our country for various aspects of digestive diseases. These studies are being done in teaching institutes and corporate hospitals. There are new techniques for the treatment of colorectal disorders, for haemorrhoids/piles we have laser hemorrhoidoplasty, DG HAL RAR and for fistula the new techniques are LIFT (ligation of intersphincteric fistula tract), TROPIS (transanal opening of intersphincteric space), these are all minimal invasive technique with minimal blood loss and minimal postoperative pain, after these procedures, patients can be discharged within 24 hours, he added.
In India many patients with colorectal disease consult quacks and are undertreated without complete evaluation of the disease which very uncommon in the other parts of world. Therefore a big challenge for doctors to diagnose and treat digestive diseases is that many patients come in the advanced stage. Since patients suffer for a long time they will end up with the complications like anaemia, depression and loss of quality life, said Dr. Parameshwar.
SIICP is a pioneer in innovation in the field of colorectal treatment and surgery. Dr. Parameshwar claimed that is the only specialist hospital that treats digestive diseases in India. The facility has successfully performed 14,000 surgeries. Most of the colorectal disorders are treated with minimal invasive procedure using advanced instruments like laser, DGHAL RAR, radiofrequency and laparoscopic techniques. Here the operative procedure and postoperative pain is very less hence recovery period fast compared to other conventional techniques. Also around 85,000 of its patients were successfully treated without surgery. Our specialists know that nearly 90% suffering from digestive diseases can be cured if they adopt a healthier lifestyle, he said.
Leading pediatricians said there is little evidence that shows screen time is “toxic” for children, even after other research suggested that just a few hours a day could damage developing brains.
New guidance for under-18-year-olds from the Royal College of Paediatrics and Child Health in the UK said the evidence that time in front of a screen has a negative effect on children is “contested” and that the “evidence of harm is often overstated”.
The evidence is so weak, the group said, that it could not offer parents a guide for how much they should be limiting their children’s screen time.
“Because the effect of screen time depends so much on context, and the uncertain nature of the evidence, it is impossible to give comprehensive national guidance or limits,” it said.
“Evidence is weak for a threshold to guide children and parents to the appropriate level of screen time, and we are unable to recommend a cut-off for children’s screen time overall.”
But it recommended that children did not use screens for the hour before their bedtime.
Max Davie, the officer for health promotion for the Royal College of Paediatrics and Child Health, said that parents should “stop worrying” as much about screen time.
“We want to cut through that and say ‘actually if you’re doing OK and you’ve answered these questions of yourselves and you’re happy, get on and live your life and stop worrying,'” he said.
“But if there are problems and you’re having difficulties, screen time can be a contributing factor.”
While there is little evidence that screen time itself has a negative effect on children, the group did acknowledge that screens can have a negative effect by taking time away from more positive activities like socialising, exercise, and sleep.
The group also acknowledges other risks, like children being victims of cyberbullying.
The group recommended that “families should negotiate screen time limits with their children based upon the needs of an individual child” and that families should ask four questions to examine the time it is spending in front of screens:
- Is screen time in your household controlled?
- Does screen use interfere with what your family want to do?
- Does screen use interfere with sleep?
- Are you able to control snacking during screen time?
Other studies suggested that young children should be kept away from screens as much as possible
Meanwhile, the initial findings from an ongoing first-of-its-kind study by the National Institutes of Health on how screen time affects students’ brains found that as little as two hours of screen time daily could negatively affect children.
The study found that children who have more than two hours of screen time a day got lower scores on tests focused on thinking and language skills.
The study will follow more than 11,000 children, who are currently nine to 10 years old, over the next decade as they grow up around screens.
Screen-time guidelines from the American Academy of Pediatrics state that parents should accompany young children whenever they use screens and say parents should avoid screen time for toddlers between the ages of 18 and 24 months, with the exception of video calling.
This article was originally published by Business Insider