Cities Of Northern India Research Articles

Our Experiences and Learnings in Diagnosing MODY from Non-Institutional-Based Diabetes Care Clinics

Abstract Introduction: Maturity-onset diabetes of the young (MODY) is a rare group of disorders characterised by impaired functions or development of pancreatic islets and monogenic diabetes at a young age. Diagnosing MODY can be rewarding for both clinicians and patients as it can change the management from generic to targeted therapy. Methods: This study reports the retrospective analysis of data collected from four clinics between March 2016 and February 2023 from Lucknow, a city in northern India. Fifty-three individuals are suspected to be affected by MODY based on ISPAD guidelines. Following a detailed clinical evaluation, they were referred for genetic diagnostic testing. Results: The cohort consists of 19 females and 34 males with a mean age of diagnosis of 25.3 years and a body mass index of 22.3 Kg/m2. Genetic testing detected variants in 13/53 (~24.5%) individuals. Five cases had significant pathogenic/likely pathogenic variants, HNF1A gene in two [(p.Phe268LeufsTer74) (p.Arg200Gln)], one each in HNF4A (Arg311His), PDX1(p.Ala228GlyfsTer33), and a case with suggestive digenic variants in HNF1A gene (p.Arg200Gln) and HNF1B [(p.Leu13Met)]. Variants of uncertain significance (VUSs) with inconclusive evidence of pathogenicity were reported in eight patients, and five were considered to be clinically significant as they are lean young onset, sulfonylurea-responsive, and presented with diabetes without acanthosis nigricans and with high pretest probability. These individuals harboured variants in HNF1A (p.Thr425_Thr429delinsPro), HNF1B (p.Ser19Phe), CEL (p.Val681ArgfsTer6), ABCC8 (p.Ile872Met), and KCNJ11 (p.Arg221Cys) genes. Conclusion: We found a diagnostic yield of around 10% of pathogenic or likely pathogenic variants in individuals who were suspected to have MODY. As it is a field that is still evolving, we might consider starting with oral agents under close supervision in those individuals who have VUS; there are some proportions of individuals who might not have classical sulfonylurea-responsive genetic variants, but they might respond to it.

A prevalence study of functional gastrointestinal disorders among the school-going adolescent population in an urban city in northern India

BackgroundFunctional Gastrointestinal disorders (FGIDs) are highly prevalent in the adolescent population leading to morbidity. However, their exact prevalence is not clearly known. The present study attempts to assess their prevalence in adolescent children. Material & methodsA total of 757 school/college-going adolescents aged 10–19 years attending four different schools covered in a field study were assessed for the prevalence of FGIDs using a questionnaire based on ROME-IV criteria. Socio-demographic data of the participants were also noted. Prevalence and type of FGIDs were determined. The chi-square test and Independent samples ‘t’-test were used to compare the data. ResultsThe prevalence of FGIDs was 15.85 % (n = 120) in the adolescent population in our study. Functional abdominal pain disorders (n = 65; 54.2 %) were the most common type followed by functional defecation disorders (n = 49; 40.8 %) and functional nausea and vomiting disorders (n = 6; 5 %) respectively. Adolescents with FGIDs had significantly lower mean age (12.98 ± 2.30 years) and mean BMI (16.9 ± 3.2 kg/m2) as compared to those without FGIDs (p < 0.001). However, no significant association of sex was seen with FGID prevalence (p = 0.755). ConclusionsFGIDs were found to be prevalent in school/college-going adolescents in our setting with functional abdominal pain disorders contributing to the majority of FGIDs. The Rome-IV criteria-based questionnaire is a useful tool in diagnosing FGIDs among adolescents.

Agriculture mechanization in Siddhartha Nagar: block-wise comparative study

Siddhartha Nagar, a city in northern India, has witnessed a remarkable journey of agricultural development over the years. The agricultural sector in this region has evolved significantly, driven by changes in technology, government policies, and the ingenuity of the local farming community. This transformation, which spans several decades, has not only improved the farmers' livelihoods but also contributed to the region's overall economic growth.

The Ittar Industry of Kannauj: A Saga of Commodification of Olfactory Aesthetics

Kannauj is an historic city in northern India, which is known since antiquity for producing high quality natural ittar (natural perfume). This study explores the notion that perfume is a product of science and standardised production and marketing practices, whereas ittar is a natural product derived from traditional knowledge and craft production processes passed on through generations. The study highlights the ‘deg-bhapka’ technique of ittar production, explores the lifeworlds of the artisans, their perception of the art, discusses the main ittar varieties, and explores the role of social and cultural capital in preserving the legacy over generations. Semi-structured, open-ended interviews were used for data collection. Finally, the study examines the contemporary challenges and bottlenecks in this heritage industry and the incongruency of the art of ittar-making to the nuances of the capitalist economy. The possibilities for evolving and marketing ittar as a ‘green’, ‘organic’ and ‘indigenous’ product of traditional art and contemporary aesthetic standards are explored.

Risk and the everyday: potentialities, gendered mobilities and women’s worlds in Banaras

This ethnographic study is an exploration of risk as an everyday practice that women undertake to actualize their mobilities and social worlds in the city of Banaras, renowned as a sacred urban city in Northern India. The scholarship about this site has typically not centered on women’s experiences, knowledge, and lives, in narrating the overwhelming sacred rhetoric of the city. This paper contributes to the extant scholarship on gender, risk, corporeality, and urbanity by establishing a dialogue between risk theories embedded in institutional management discourse, emerging from Western contexts, and the lived and embodied risk practices of women in the global South. Risk, as conceptualized in this paper, presents a grounded discussion of women’s active and conscious modes of being emplaced in myriad sites in urban cities through their mobilities. In essence, the paper draws links between the potentiality of everyday risk-taking and women’s mobilities. This is achieved through interrogating the embedded notions of ‘respectable’ femininity, honor, fear, and violence, through ethnographic accounts of having observed, interacted with, and interviewed women from diverse socio-economic backgrounds in the city. In doing so, the paper argues that women attempt to enable themselves and recreate their worlds in a patriarchal urban setting through various intersectional forms of risk-taking, namely, what I denote ‘imposed’ and ‘chosen’ varieties, which intersect in complex ways. Therefore, the paper highlights women’s risk-taking as potentializing the everyday but also views this as a practice that sustains them as inhabitants of Banaras.

Antibiotic Prescription Audits Among Pediatric Outpatients With Acute Ailments in a Secondary Care Hospital During the COVID-19 Omicron Wave in Northern India.

Background Antibiotics, as defined by the World Health Organization (WHO), are pharmaceuticals used to treat bacterial infections. There is growing recognition that inappropriate antibiotic prescription in children is linked to increasing rates of severe adverse drug events and higher medical expenditures. There are a few prescriptions audit studies from smaller cities in Northern India, especially those conducted during the COVID-19 pandemic whenthe unregulated private sector accounted for 90% of antibiotic sales and 75% of healthcare requirements. Thestudy objectiveswere to determine the rate of outpatient antibiotic prescription and adherence to WHO drug indicators in prescriptions to pediatric outpatients in private healthcare facilities in India. Methodology This cross-sectional survey was conducted over three months (January to March 2022) in the outpatient setting of a private pediatric hospital in Kanpur, a city having a population of nearly three million population located in the state of Uttar Pradesh in India. Prescriptions of children aged <10 years with a history of onset of complaint <14 days were included in this audit. Prescriptions were numbered;data were collected using a specially designed semistructured, pretested prescription audit checklist; and the recommended WHO indicators were also calculated. Data were entered using CSPro (U.S. Census Bureau, Washington, DC, USA) and analyzed using STATA 15 (StataCorp LLC, College Station, TX, USA). Results This study observed an antibiotic prescription rate of 65.75%, which was higher than the WHO-recommended value, which might indicate indiscriminate usage of antibiotics in the setting. Out of the 144 antibiotic medications prescribed, none were generic and all the antibiotics were prescribed presumptively. The most commonly prescribed medicines were cefpodoxime, azithromycin, and ofloxacin, which were primarily used to treat cough and stomach infections. Conclusions This antibiotic audit conducted in a private hospital outpatient setting in a city in Northern India during the Omicron wave of the COVID-19 pandemic found nongeneric, predominantly oral, presumptive antibiotic prescriptions in nearly two out of three young pediatric patients. Improvement in prescribing practices through regulation, monitoring, and antibiotic stewardship in low-resource settings is urgently warranted to curb the impending global pandemic of antimicrobial resistance.

Health implications, distribution and source apportionment of heavy metals in road deposited dust of Jammu City in northern India

Road deposited dust (RDD) is an important indicators of heavy metal contamination in urban areas. In this study, we measured eight heavy metals (V, Cr, Mn, Fe, Ni, Cu, Zn, and Pb) in RDD collected from 34 different locations in Jammu city represented by different land uses such as industrial, urban-residential, high-density traffic, and sub-urban locations, and evaluated their ecological and health risks. The ratio of metal concentrations in RDD to their respective background levels varied as: Cu (3.94) > Pb (3.75) > Zn (3.01) > Cr (1.75) > Ni (1.51) > Mn (1.40) > V (1.35) > Fe (1.1) suggesting Cr, Ni, Cu, Zn and Pb were enriched anthropogenically. Geospatial maps revealed a heterogeneous distribution of metals in Jammu city with metal(s) specific hotspots primarily localized around high traffic density locations and industrial clusters. The index of geoaccumulation indicated 32%, 26%, 20%, 9%, and 8%, of samples belonged to “moderately polluted” category for Zn, Cu, Pb, Cr, and Ni respectively. Health index (HI) showed low non-carcinogenic hazards of metal contamination to adults but a high hazard to children. Though the values of total carcinogenic risks (TCR) (6.53E-05 to 3.71E−04) considerably exceeded the USEPA acceptable levels (1 × 10−6 ≤ TCR <1 × 10−4) suggesting high carcinogenic risks of metal contamination to both adults and children. Besides potential ecological risk index (PERI) revealed that 56% of samples had PERI >40 suggesting “moderate to high ecological risk” of metal contamination in the Jammu city RDD.

Evidences of microplastics in aerosols and street dust: a case study of Varanasi City, India.

Microplastics (MPs) are ubiquitous in our environment. Its presence in air, water, and soil makes it a serious threat to living organisms and has become a critical challenge across ecosystems. Present study aimed to assess the abundance of MPs in aerosols and street dust in Varanasi, a typical urban city in Northern India. Airborne particulates and street dust samples were collected from various sampling sites around Varanasi City. The physical identification of MPs was conducted by binocular microscopy, fluorescence microscopy, and scanning electron microscopy (SEM), while elemental analysis was made by energy-dispersive X-ray (EDX). Finally, Fourier-transform infrared spectroscopy (FTIR) was used for chemical characterization of MPs. Presence of MPs in both aerosols and street dust from all selected sampling sites was confirmed, however with varying magnitude. MPs of different colors having the shape of fragments, films, spherules, and fibers were recorded in the study while fragments (42%) in street dust and fibers (44%) dominated in aerosols. Majority of the MPs were < 1mm in size and were primarily polypropylene, polystyrene, polyethylene, polyethylene terephthalate, polyester, and polyvinyl chloride types. The EDX spectra showed the presence of toxic inorganic contaminants like metallic elements on MPs, especially elements like aluminum, cadmium, magnesium, sodium, and silicon found to adsorb on the MPs. Presence of MPs in the airborne particulates and street dust in Varanasi is reported for the first time, thus initiating further research and call for a source-specific management plan to reduce its impact on human health and environment.

Clinico-epidemiological study of an outbreak of typhoid in North India.

Typhoid fever is endemic in India. There have been various outbreaks of typhoid fever reported from different parts of India. Considering the outbreak potential of typhoid, the present study was undertaken wherein an outbreak of typhoid occurred in a city in northern India. The study design used was a cross-sectional descriptive study. Detailed information was obtained from each reported case. Active case finding surveys were conducted. Case definitions for suspect, probable, and confirmed case taken for our study, have already been validated by the World health organisation (WHO). All patients were subjected to requisite investigations. A sanitary survey was carried out to locate defects in water supply and sewage disposal. Record of bacteriological survey of water samples from the area was scrutinized. Descriptive epidemiology of cases was carried out. Attack rate was 16.1% and 17.4% among men and women, respectively. Fever was present in 52 (69.3%) cases. The epidemic curve displayed a sudden peak and an abrupt fall of cases. This is suggestive of a common point source outbreak. There were no fatalities. Sanitary survey teams found a sewage leak in the locality where maximum cases were reported. Lab reports tested positive for salmonella species in water. The outbreak was promptly controlled after repair of the leaking sewage pipeline; and provision of alternative source of water supply. This study reemphasises the requirement of a basic public health measure and infrastructure, that is, water quality monitoring by concerned authorities to break the chain of transmission of typhoid fever.

GIS Mapping of Short-Term Noisy Event of Diwali Night in Lucknow City

Noise is a universal problem that is particularly prominent in developing nations like India. Short-term noise-sensitive events like New Year’s Eve, derby matches, DJ night, Diwali night (celebration with firecracker) in India, etc. create lots of noise in a short period. There is a need to come up with a system that can predict the noise level for an area for a short period indicating its detailed variations. GIS (Geographic Information System)-based google maps for terrain data and crowd-sourced or indirect collection of noise data can overcome this challenge to a great extent. Authors have tried to map the highly noisy Diwali night for Lucknow, a northern city of India. The mapping was done by collecting the data from 100 points using the noise capture app (30% were close to the source and 70% were away from the source (receiver). Noise data were predicted for 750 data points using the modeling interpolation technique. A noise map is generated for this Diwali night using the crowd-sourcing technique for Diwali night. The results were also varied with 50 test points and are found to be within ±4.4 dB. Further, a noise map is also developed for the same site using indirect data of noise produced from the air pollution open-sourced data. The produced noise map is also verified with 50 test points and found to be ±6.2 dB. The results are also corroborated with the health assessment survey report of the residents of nearby areas.

Psychiatric morbidity and substance use in migrant workers: A population based study.

The prevalence of mental health problems and substance abuse in the migrant population is higher than the general population. To assess the prevalence and pattern of mental health issues and substance use in the migrant population and highlight the association with the reverse migration of migrant workers. The field staff visited the shelter homes for migrant population in four cities of Northern India (Chandigarh (UT), Bhatinda (Punjab), Panchkula (Haryana) and Jaipur (Rajasthan). After maintaining the social distance and wearing masks by the staff and migrants, written informed consent was taken for participation in the study. The socio-demographic details of reverse migrants were noted down and Hindi version of Patient Health Questionnaire (PHQ-9) for mental health problems and screening tool for pattern of substance abuse was administered. Geographically matched undisplaced were also administered these tools. A total of 275 reverse migrants and 276 undisplaced were included in the study. The prevalence of ever use for all the substances among reverse migrants was 44.4% (122/275) and among undisplaced, it was 45.3%. The prevalence of alcohol, tobacco and cannabis was higher than the general population. The prevalence of at least one diagnosis on PHQ-9 is 13.45% (reverse migrants 19.3% and undisplaced 7.6) and the prevalence of other depressive disorder is significantly higher in reverse migrants (17.1%) than undisplaced (4.0%). The study concludes that prevalence of mental health issues and substance abuse in migrant population is significantly higher than the general population and the prevalence of at least one diagnosis and other depressive disorder is significantly higher in reverse migrants than undisplaced.

Atmospheric polychlorinated biphenyls in a non-metropolitan city in northern India: Levels, seasonality and sources

Recent studies from India reported polychlorinated biphenyls (PCBs) associated with incomplete combustion processes. In this study we have monitored atmospheric PCBs in Agra, a non-metropolitan city of northern India. During first month of summer and winter of 2017, polyurethane foam based passive air sampler (PUF-PAS) was deployed at each of 14 locations across urban, suburban and rural transects and one background site. Range of Σ25PCBs varied between 25 and 1433 pg/m3 (Avg ± Stdev: 460 ± 461) in summer and 26–205 pg/m3 (Avg ± Stdev: 106 ± 59) in winter. Mean Σ25PCBs concentration, showed an urban > suburban > rural trend in summer while, in winter a rural > urban > suburban trend was observed. PCB-52 was the dominant congener and after excluding this congener no significant difference was observed between summer and winter PCB concentrations. Using a combination of K-means cluster and principal component analysis (PCA) four major source types were identified. Open burning source accorded 80% of atmospheric PCBs, majorly indicator PCBs while the remaining 20% was contributed by atmospheric transport, petrogenic combustion and biomass burning. From the ten days back trajectory of the air mass it can be suggested that atmospheric transport from the hotspots resulted in a minor percentage of dioxin like PCBs in Agra. Maximum TEQs was accorded by PCB-77 (30%) and it is consistent with previous observations from Agra. Levels observed in the current study are well within the public health guideline based on inhalation unit risk (10 ng/m3) and United States Environmental Protection Agency’s regional screening level high risk tier (4.9 ng/m3) for ambient air.

Occurrence of Cryptosporidium and Giardia in potable water sources in Chandigarh, Northern India

AbstractContamination with Cryptosporidium and Giardia from drinking water sources in a city in Northern India was assessed. A protocol modified from a standard ISO protocol, which includes filtration, concentration, separation and detection steps, was tested and showed comparable recovery efficiencies (Giardia mean = 77.4%, Cryptosporidium mean = 61.8% from the modified protocol, compared with Giardia mean = 61.6%, Cryptosporidium mean = 69% from the ISO protocol) at a substantial cost reduction. This protocol was used for analysing 71 samples of potable water from different areas of Chandigarh, where sampling locations were divided into groups according to the population density, which also partially equates with the level of infrastructure. Samples were collected during (n = 29) and outside the monsoon season (n = 42). Of all samples analysed, 16 (22.5%) were Cryptosporidium- and/or Giardia-positive. Parasites per sample were low (1–10 (oo)cysts per 10 L), although one sample contained large numbers of Giardia cysts (&gt;1,000). Polymerase chain reaction analyses on the small subunit ribosomal ribonucleic acid (SSU rRNA), triose-phosphate isomerase (tpi), glutamate dehydrogenase (gdh) and beta-giardin (bg) gene sequences on Giardia-positive samples and SSU rRNA on Cryptosporidium-positive samples tended to be unsuccessful, although Giardia cysts of Assemblages B and C were identified. No association with the season was detected, but an association with the location of water supply was identified. Samples from areas with the lowest infrastructure were not associated with higher levels of contamination, but samples from the middle level were significantly more likely to be contaminated than those from the highest level of infrastructure. Results indicate that even in a city with a well-developed infrastructure, the contamination of potable water with protozoan parasites remains a public health risk.

Domestic Accidents in the Suburbs of a Metropolitan City in Northern India

Domestic Accidents in the Suburbs of a Metropolitan City in Northern India

Branding effectiveness measurement in non-profit environment

Purpose Literature suggests that branding effectiveness measures are present in for-profit sectors but lacks such comprehensive measures for the non-profit sector. Moreover, most of the branding effectiveness measures are either based on brand image approach or on brand identity approach. The purpose of this paper is, therefore, to propose an integrated branding effectiveness measurement metrics for non-profit organizations (NPOs). Design/methodology/approach Judgmental and simple random sampling techniques are used for data collection. The final sample comprises 150 respondents including donors, volunteers, beneficiaries and media who were administered interview schedules. Based on the ratings given by the respondents regarding branding effectiveness parameters of the five NPOs of a major city in Northern India, branding effectiveness score of each NPO is computed. The branding measures adopted by NPOs rated high are selected in the proposed brand effectiveness metrics. Findings The proposed metrics encapsulates brand identity parameters such as management profile, vision, culture, as well as brand image parameters such as brand awareness, brand understanding, brand association of the stakeholders, etc. The metrics also link the two through brand performance parameters. Research limitations/implications Multiple hierarchical structures of government infested with bureaucracy and lack of specialized staff with focused approach have reduced the effectiveness of their socio-development programs in emerging economies. This has led to an increase in number, diversity and impact of NPOs that compete for resource generation. Branding is a powerful tool for NPOs not only for resource generation but also for driving the social goals. The branding effectiveness metrics would help NPO managers reinforce the internal identity by increasing the cohesion and the capacity of the organization as well as create a strong brand image by garnering the support of multiple stakeholders through mutual trust thereby creating a greater social impact. Originality/value The uniqueness of the study stems from the fact that the proposed branding effectiveness measurement metrics in non-profit environment encapsulates brand image, brand identity and brand performance parameters.

Morbidity Profile of Workers in Scissors Manufacturing Industries in a City in Northern India

Morbidity Profile of Workers in Scissors Manufacturing Industries in a City in Northern India

Prevalence and zoonotic potential of intestinal protozoans in bovines in Northern India.

Bovines, and especially cattle, have a dual position of appreciation in India, being both important in the food industry as providers of dairy products, and, culturally, being considered as holy creatures that must not be harmed, killed or eaten. This status means that cattle have a paradoxical existence in India; as they are worshipped and protected, they are able to roam freely among humans, but they are also often left to fend for themselves. The water buffalo represents a significant contributor to the Indian agricultural economy as well as general social development, and are in this way somehow replacing the indigenous cattle. The vast numbers of roaming cattle without clear owners are difficult to look after in terms of veterinary healthcare and appropriate interventions when necessary, and have no regular supply of food. This article describes an investigation of the occurrence of Cryptosporidium spp. and Giardia duodenalis in bovines either roaming the streets or being kept in animal holdings in and around Chandigarh, a city in Northern India, and addresses the zoonotic potential of these protozoan parasites shed from bovines living in close contact with humans. 294 animals of all ages were sampled, and the majority of the positive samples were found from calves. The overall prevalence of Giardia was 8.2% and Cryptosporidium was 2.4%. Non-zoonotic assemblages were predominantly found in the case of the Giardia - positive samples, and in the case of Cryptosporidium, as well as non-zoonotic genotypes, zoonotic subgroups previously described from infected human infections in this area, were identified, indicating that there may be sharing of intestinal parasites in these settings, where cattle live in close contact with humans.

Checking the detail in retail: Occurrence of Cryptosporidium and Giardia on vegetables sold across different counters in Chandigarh, India

Fresh produce has been recognized as a vehicle of infection for protozoan parasites, particularly Cryptosporidium, and, to a lesser extent, Giardia. For both parasites, outbreaks associated with fresh produce have been documented. Although documented outbreaks tend to be from industrialized countries, contamination of fresh produce with these parasites is a global issue. In developing countries, infections with these parasites are often endemic in the community, and basic infrastructure and hygiene measures may be inadequate, thus the likelihood of contamination of fresh produce with these parasites may be higher. Realization of the importance of this transmission route comes against a backdrop of raw salads and more Western culinary habits gaining a foothold, and fresh produce being encouraged as part of the diet due to their associated health benefits. However, if consumption of uncooked fresh produce is going to increase its market sector in India, it is important that it is safe. In this study, various types of fresh produce obtained from three types of vendors in Chandigarh, a major city in Northern India, were analyzed for contamination with Cryptosporidium oocysts and Giardia cysts using a method that has been previously validated in inter-laboratory spiking experiments. A total of 284 samples of different fresh produce items were analyzed, obtained from the different retailers situated in different societal layers of the city. The overall prevalence of contamination of fresh produce with these parasites was just under 11%, with 6% of the vegetables contaminated with Cryptosporidium oocysts, and 5% with Giardia cysts. Contaminated vegetables included turnip, cabbage, carrot, chili, coriander, cucumber, radishes, and tomatoes. Molecular analyses identified contamination with Cryptosporidium parvum and Giardia duodenalis of Assemblage A and Assemblage D, indicating that contamination from animals may be of relevance. Although the prevalence of contamination is similar to those reported in previous studies, the levels of contamination on some items of fresh produce were relatively high. Although the different socioeconomic areas of Chandigarh from which the samples were obtained was not associated with likelihood of contamination, fresh produce from supermarkets had heavier contamination with Cryptosporidium oocysts than fresh produce purchased through other sales outlets. The results are discussed in relation to the fresh produce chain and sales models in Chandigarh, both in terms of where contamination may occur and the potential importance of fresh produce as a transmission vehicle.

A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India.

Introduction:Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers.Materials and Methods:A cross-sectional quantitative study was conducted from January to June 2015 among health care workers (n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction.Results:Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level.Conclusion:Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services.

Managing Customers Brand Experience for Creating Brand Resonance in Smartphones

The present study is aimed at analyzing the relationship between three constructs, i.e. brand experience, customer experiential value, and brand resonance. The study was undertaken in two stages, in the first stage a qualitative study was conducted to identify the smart phone brands which offered rich brand experience. Further in the quantitative study, the data were obtained from 188 smart phone customers from Jammu and Dehradun cities of Northern India using a structured questionnaire. The data analysis results have indicated that brand experience has significant positive effect on customer experiential value and brand resonance. And also the customer experiential value has been found to have partial mediation effect on the relationship between brand experience and brand resonance.