99 research outputs found

    Household savings and residential mobility in informal settlements

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    Strategies to help the one billion people worldwide who live in informal settlements have mainly focused on slum upgrading, sites and services programs, and tenure security. In contrast, there has been less attention on what enables slum dwellers to transition into the formal housingsector, which has the dual benefits of improving service access and escaping social stigma. In this paper the authors investigate residential mobility among slum dwellers in Bhopal, India. Their analysis shows that one in five households succeeds in getting out of a slum settlement, and a major determinant is the household's ability to save on a regular basis. Due to limited outreach of institutional housing finance, most slum dwellers rely solely on household savings for purchasing a house. These findings underscore the urgent need to improve savings instruments for slum dwellers and to downmarket housing finance to reach the poorest residents of rapidly growing cities in developing countries.Housing&Human Habitats,Urban Housing,Banks&Banking Reform,Urban Services to the Poor,Urban Services to the Poor

    Information-based instruments for improved urban management

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    The task of urban managers is to ensure the provision of basic urban services, such as water, waste removal, security, transport, and an environment conducive to economic activity, while maintaining fiscal sustainability of city operations. City managers in developing countries face increasing pressure in achieving these goals because of rapid urbanization, the larger responsibilities following decentralization, and the economic challenges of globalization. Based on experience in Bangalore, India, the authors argue that effective, forward-looking urban management requires a much better information infrastructure than is currently available in most cities.Environmental Economics&Policies,Public Health Promotion,Public Sector Economics&Finance,Decentralization,ICT Policy and Strategies,Environmental Economics&Policies,ICT Policy and Strategies,Public Sector Economics&Finance,Municipal Financial Management,Banks&Banking Reform

    Factors Affecting The Cardioprotective Response To Remote Ischaemic Preconditioning In Patients Undergoing Cardiac Surgery

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    Death from ischaemic heart disease (IHD) remains the most common cause of death worldwide, and is also a significant cause of morbidity. Coronary artery bypass graft (CABG) surgery is performed in a significant number of IHD patients that meet certain clinical and angiographic criteria or are unsuitable for percutaneous coronary intervention. Increasingly higher risk surgeries are taking place, as the population survives to become more aged with well-managed co-morbidities. As such, the myocardium is at risk of peri-operative myocardial injury (PMI) during CABG surgery, the presence of which impacts on clinical outcomes. There are a number of strategies already in place to protect the myocardium during CABG surgery including therapeutic hypothermia, and the use of cardioplegic solutions, but there is a need to increase cardioprotection especially in higher-risk patients. In this regard, remote ischaemic conditioning (RIPC) is a promising, yet simple and cheap, non-invasive intervention, which shows huge promise in reducing PMI during CABG surgery. RIPC involves the serial inflations and deflations of a blood pressure cuff to the upper and/or lower limbs to induce brief cycles of ischaemia and reperfusion to the skeletal muscle. Despite the promise, clinical studies have produced variable results RIPC in the setting of CABG surgery, with confounding factors such as co-morbidities (age and diabetes) and comedications (propofol and glyceryl trinitrate) being proposed to interfere with the cardioprotective effect. In two separate clinical studies of adult patients undergoing CABG surgery, we investigated the effect of diabetes and glyceryl trinitrate (GTN) on the cardioprotective effect elicited by RIPC. We used an intensified RIPC protocol comprising 3 cycles of simultaneous inflation and deflation of two cuffs ‚Äď one placed on the upper arm and the other on the thigh. The primary outcome measures of both clinical studies, was the extent of peri-operative myocardial injury (PMI), as evidenced by the 72 hours serum Troponin T area-under-the-curve. Secondary outcomes measures included the incidence of post-operative atrial fibrillation, acute kidney injury, inotrope score and length of intensive care and hospital stay. In the diabetic study, we found that RIPC significantly reduced the extent of PMI, whereas in the GTN study, RIPC resulted in only a non-significant reduction in PMI, when compared to control. There were no differences in the secondary outcome measurements with RIPC versis control in either study. In conclusion, we have demonstrated that intensifying the RIPC stimulus can overcome the confounding effects of diabetes and GTN on RIPC cardioprotection in patients undergoing CABG surgery

    Thrombolysis in Myocardial Infarction

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    CT imaging features of carotid artery plaque vulnerability

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    Despite steady advances in medical care, cardiovascular disease remains one of the main causes of death and long-term morbidity worldwide. Up to 30% of strokes are associated with the presence of carotid atherosclerotic plaques. While the degree of stenosis has long been recognized as the main guiding factor in risk stratification and therapeutical decisions, recent evidence suggests that features of unstable, or 'vulnerable', plaques offer better prognostication capabilities. This paradigmatic shift has motivated researchers to explore the potentialities of non-invasive diagnostic tools to image not only the lumen, but also the vascular wall and the structural characteristics of the plaque. The present review will offer a panoramic on the imaging modalities currently available to characterize carotid atherosclerotic plaques and, in particular, it will focus on the increasingly important role covered by multidetector computed tomographic angiography

    Histological spectrum of ependymomas and correlation of p53 and Ki- 67 expression with ependymoma grade and subtype

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    BACKGROUND: Clinical and histological criteria for ependymoma prognosis are well recognized. Recently few studies have been done based on Immunohistochemistry for prognostication of these tumours. In this study we have correlated the histlogical spectrum with immmunoexpression of p53 and Ki67 in these tumors. AIMS: To know the incidence of ependymomas; study their morphological spectrum and to evaluate expression of P53 and Ki 67 in diffferent morphological subtypes. MATERIAL AND METHOD: A retrospective sudy was preformed on 70 ependymomas received in a period between 1994 and 2001. Entire tissue received was processed for routine paraffin embedded H&E stained sections. Immunocytochemistry was performed using antibodies to GFAP, EMA, Pancytokeratin and synaptophysin, to differentiate papillary ependymoma from choroid plexus papilloma; clear cell ependymoma from oligodendroglioma and central neurocytoma; ependymoblastoma from other embryonal tumours. p53 and Ki-67 immunohistochemistry was performed to correlate their expression with various tumour grades and subtypes. RESULTS: There were 3 cases (4.2%) of Grade I ependymoma (2 cases of myxopapillary ependymoma and 1 case of subependymoma); 57 cases (81.5%) of ependymoma grade II (43 of these were of classical variety, 11 of clear cell ependymoma, 2 of papillary and 1 case of cellular ependymoma). There were 9 cases (12.8%) of anaplastic ependymoma (one of these was a clear cell ependymoma and 1 case (1.5%) of ependymoblastoma CONCLUSION: p53 and Ki67 indices can be used in routine diagnostic laboratories to supplement the tumor grade on histology and more studies with follow up should be performed toanalyse the prognsis of different subtypes. The expression of Ki 67 and p53 was significantly higher in anaplastic ependymomas. 4 out of 11 cases of clear cell ependymomas showed higher Ki 67 indices as compared to classical grade II ependymomas, thus further highlighting the importance of differentiating the various subtypes

    Air Quality Prediction - A Study Using Neural Network Based Approach

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    India is the 7th largest country by area and 2nd most populated country in the world. The reports prepared by IQAir revels that India is 3rd most polluted country after Bangladesh and Pakistan, on the basis of fine particulates (PM2.5) concentration for the year 2020. In this article, the quality of air in six Indian cities is predicted using data-driven Artificial Neural Network. The data was taken from the 'Kaggle' online source. For six Indian cities, 6139 data sets for ten contaminants (PM2.5, PM10, NO, NO2, NH3, CO, SO2, O3, C6H6 and C7H8) were chosen. The datasets were collected throughout the last five years, from 2016 to 2020, and were used to develop the predictive model. Two machine learning model are proposing in this study namely Artificial Intelligence (AI) and Gaussian Process Regression (GPR) The R-value of ANN and GPR models are 0.9611 and 0.9843 sequentially. The other performance indices such as RMSE, MAPE, MAE of the GPR model are 21.4079, 7.8945% and 13.5884, respectively. The developed model is quite useful to update citizens about the predicted air quality of the urban spaces and protect them from getting affected by the poor ambient air quality. It can also be used to find the proper abatement strategies as well as operational measures

    A low-cost machine learning-based cardiovascular/stroke risk assessment system: integration of conventional factors with image phenotypes

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    Background: Most cardiovascular (CV)/stroke risk calculators using the integration of carotid ultrasound image-based phenotypes (CUSIP) with conventional risk factors (CRF) have shown improved risk stratification compared with either method. However such approaches have not yet leveraged the potential of machine learning (ML). Most intelligent ML strategies use follow-ups for the endpoints but are costly and time-intensive. We introduce an integrated ML system using stenosis as an endpoint for training and determine whether such a system can lead to superior performance compared with the conventional ML system.Methods: The ML-based algorithm consists of an offline and online system. The offline system extracts 47 features which comprised of 13 CRF and 34 CUSIP. Principal component analysis (PCA) was used to select the most significant features. These offline features were then trained using the event-equivalent gold standard (consisting of percentage stenosis) using a random forest (RF) classifier framework to generate training coefficients. The online system then transforms the PCA-based test features using offline trained coefficients to predict the risk labels on test subjects. The above ML system determines the area under the curve (AUC) using a 10-fold cross-validation paradigm. The above system so-called "AtheroRisk-Integrated" was compared against "AtheroRisk-Conventional", where only 13 CRF were considered in a feature set.Results: Left and right common carotid arteries of 202 Japanese patients (Toho University, Japan) were retrospectively examined to obtain 395 ultrasound scans. AtheroRisk-Integrated system [AUC=0.80, P<0.0001, 95% confidence interval (CI): 0.77 to 0.84] showed an improvement of similar to 18% against AtheroRisk-Conventional ML (AUC=0.68, P<0.0001, 95% CI: 0.64 to 0.72).Conclusions: ML-based integrated model with the event-equivalent gold standard as percentage stenosis is powerful and offers low cost and high performance CV/stroke risk assessment

    International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches

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    Cardiovascular disease (CVD) is the leading cause of mortality and disability in developed countries. According to WHO, an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to major adverse cardiac and cerebral events. Early detection and care for individuals at high risk could save lives, alleviate suffering, and diminish economic burden associated with these diseases. Carotid artery disease is not only a well-established risk factor for ischemic stroke, contributing to 10%‚Äď20% of strokes or transient ischemic attacks (TIAs), but it is also a surrogate marker of generalized atherosclerosis and a predictor of cardiovascular events. In addition to diligent history, physical examination, and laboratory detection of metabolic abnormalities leading to vascular changes, imaging of carotid arteries adds very important information in assessing stroke and overall cardiovascular risk. Spanning from carotid intima-media thickness (IMT) measurements in arteriopathy to plaque burden, morphology and biology in more advanced disease, imaging of carotid arteries could help not only in stroke prevention but also in ameliorating cardiovascular events in other territories (e.g. in the coronary arteries). While ultrasound is the most widely available and affordable imaging methods, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), their combination and other more sophisticated methods have introduced novel concepts in detection of carotid plaque characteristics and risk assessment of stroke and other cardiovascular events. However, in addition to robust progress in usage of these methods, all of them have limitations which should be taken into account. The main purpose of this consensus document is to discuss pros but also cons in clinical, epidemiological and research use of all these techniques

    Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An International, multispecialty, expert review and position statement

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    Objectives: The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispecialty position statement is to reconcile the conflicting views on the topic. Materials and methods: A literature review was performed with a focus on data from recent studies. Results: Several clinical and imaging high-risk features have been identified that are associated with an increased long-term ipsilateral ischemic stroke risk in patients with ACS. Such high-risk clinical/imaging features include intraplaque hemorrhage, impaired cerebrovascular reserve, carotid plaque echolucency/ulceration/ neovascularization, a lipid-rich necrotic core, a thin or ruptured fibrous cap, silent brain infarction, a contralateral transient ischemic attack/stroke episode, male patients <75 years and microembolic signals on transcranial Doppler. There is growing evidence that 80-99% ACS indicate a higher stroke risk than 50-79% stenoses. Conclusions: Although aggressive risk factor control and BMT should be implemented in all ACS patients, several high-risk features that may increase the risk of a future cerebrovascular event are now documented. Consequently, some guidelines recommend a prophylactic carotid intervention in high-risk patients to prevent future cerebrovascular events. Until the results of the much-anticipated randomized controlled trials emerge, the jury is still out regarding the optimal management of ACS patients
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