Scheduling process operations under uncertainty and integration with long term planning

This thesis centers upon the application of mathematical modelling, optimization theory and uncertainty analysis to the problem of scheduling batch operations for large scale industries. Over the years, decision making strategies such as scheduling, that deals with allocation of plant resources, has been widely adopted by industries to efficiently carry out their operations and achieve the desired targets. In this thesis, the focus is on planning and scheduling under endogenous uncertainty in the context of multijob, multitasking batch plants. This class of scheduling problems are of practical importance, specially in the analytical services sector, where effective scheduling models could increase the efficiency in carrying out the plant operations and may lead to increased throughput, or reduced makespan, resulting in greater profits or customer satisfaction

Impact of nutrition interventions for reduction of anemia in women of reproductive age in low- and middle-income countries: a meta-review

The UN Sustainable Development Goal aims at a 50% reduction of anemia in women of reproductive age (WRA) by 2030. Several nutrition-specific and sensitive interventions are targeted across low- and middle-income countries (LMICs) to reduce anemia. In this meta-review we comprehensively assessed the effectiveness of nutrition-specific and -sensitive interventions on hemoglobin (Hb) and serum ferritin (SF) concentrations and the prevalence of iron deficiency and anemia among WRA, pregnant women, and lactating women from LMICs. The preparation of the present meta-review followed a double-blinded synthesis process with 3 stages: screening, quality appraisal, and data extraction in Eppi Reviewer. A comprehensive search was performed for systematic reviews (SRs) published between January 2000 and May 2022 using 21 international, national, and regional databases. The methodological quality appraisal of included studies was conducted using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. A total of 23 SRs evaluated the effects of various nutrition-specific interventions included in the final synthesis. The included SRs included analyses of nutrition-specific interventions such as supplementation of the nutrients iron (n = 7), iron and folic acid (n = 4), vitamin A (n = 3), calcium (n = 2), multiple micronutrients (n = 7), and intravenous iron sucrose (n = 2). Also, SRs on fortification of nutrients included multiple micronutrients (n = 6), iron and folic acid (n = 4), and iron (n = 4). Of the 23 SRs, 22 were of high quality. Iron with or without folic acid supplementation and fortification and vitamin A supplementation consistently showed positive effects on either reduction in the prevalence of anemia or iron deficiency and improving the Hb or SF concentrations in WRA and pregnant women from LMICs. The comprehensive meta-review reported the beneficial effects of iron with or without folic acid, multiple micronutrient supplementation/fortification, and vitamin A supplementation in reducing the prevalence of anemia or iron deficiency and increasing Hb or SF concentrations in WRA from LMICs.The evidence summary was supported by the UK Department for International Development (DFID), by the Systematic Review Program for South Asia (SARH) grant, hosted by the Indian Institute of Public Health–Gandhinagar in collaboration with the University of Bedfordshire, UK, Bangladesh, and BRAC. The funding was solely for research assistance and the report generated during the grant tenure.gold o

Effectiveness of nutrition interventions in low-and middle-income countries: a meta-review

Background: Undernutrition remains an unfinished agenda for a majority of low- and middle-income countries (LMICs). Numerous nutrition interventions have been implemented in LMICs and various indicators have been used to measure the impact of these interventions. The aim of this meta-review was to summarise the findings on the effectiveness of various nutrition interventions that have been implemented in LMICs on the WHO global nutrition targets-related outcomes. The six outcomes are- reducing stunting, wasting, anemia among women of reproductive age, low birthweight, childhood overweight, and improving exclusive breastfeeding. This study presents the results for one of the outcomes (stunting). Methods: We conducted a comprehensive search on 21 electronic databases, including six regional and four systematic reviews (SRs) specific databases. Two researchers independently screened identified records against the inclusion criteria. Quality of included SRs were assessed using the AMSTAR tool. Extracted data were narratively synthesised examining the direction of impact. The review protocol was registered with the EPPI-Centre. Results: Of 6,597 SRs initially identified, 28 SRs that assessed outcomes of WHO global nutrition targets-related outcomes were eligible for inclusion. We found 12 SRs that assessed stunting outcomes, these SRs synthesised 68 quantitative primary studies, from 29 LMICs. All included SRs were of high quality. Eight nutrition interventions were reported in the included SRs- five nutrition-specific (n=9) and three nutrition-sensitive (n=3). Among all interventions, two nutrition-specific (complementary feeding: n=1; dietary supplementation: n=2) interventions showed a positive effect. Conclusion: This meta-review identified, two interventions, complementary feeding and dietary supplementation, with most frequently reported evidence of positive impact on stunting. In LMICs, public health policymakers should consider these two interventions for scaling-up.UK Department for International Development (DFID)https://worldnutritionjournal.org/index.php/wn/about "World Nutrition is an open access journal, with no publication charges to contributors, and all content available to readers at no cost. Authors retain all copyrights to their materials

The hidden crisis: double burden of malnutrition among refugee children in South Asia – a systematic review and meta-analysis from observational studies

BackgroundChildren living in refugee camps in South Asian countries suffer from undernutrition. However, the emerging prevalence of double burden of malnutrition could potentially cause a crisis in the healthcare of the refugee population. Double burden increases the risk for co-morbidities, poor functional health, and increased risk for premature death among these children. The study aims to assess the prevalence of malnutrition among refugee children in South Asia.MethodsThis systematic review and meta-analysis followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using CoCoPop mnemonic approach. We searched JSTOR, Scopus, PubMed, Web of Science, and MEDLINE databases for studies on the prevalence of malnutrition in refugee children from 1984 to August 2024 with restricted English language. The screening of research articles was undertaken using COVIDENCE 2.0 software. The JBI checklist was used to assess the methodological quality of the included articles. The meta analysis was carried out using MedCalc 22.018 software. The gray literature was manually searched from the reputed organizations focusing on refugee children and was narratively analyzed for malnutrition statistics. Furthermore, the corroboration of primary research articles and gray literature was conducted for comprehensive understanding.ResultsThe review included 10 full-text research articles, all with cross-sectional study design and 11 gray literatures. The 10 studies covered a total of 4,274 participants with 3,536 urban and 738 rural refugee children aged between 0 and 19 years [refugee children (n = 8) and refugee adolescents (n = 2)]. The sample size of the included studies varied between 58 and 1,087 and mostly from Bangladesh. The prevalence of stunting ranged from 3.9–75.4% in the included studies [pooled prevalence: 31.8% (95% CI: 18.6–46.6%)]; wasting between 0.3–24.3% [pooled prevalence:10.1% (95% CI: 4.6–17.3)]; underweight between 4.4–65% [pooled prevalence: 19.1% (95% CI: 10.8–29.2%)]; and overweight between 3 and 24% [pooled prevalence: 6.5% (95% CI: 2.6–12.1%)]. Time trend analysis of the prevalence of malnutrition showed a decreasing trend in underweight, an increasing trend for stunting and wasting, and overweight including a rising prevalence of dual burden of under-and overnutrition.DiscussionThe study indicates a high prevalence of undernutrition and a rising prevalence of overnutrition -the Asian paradox of the double burden of malnutrition in refugee children living in South Asia. The coexisting double burden of malnutrition among refugee children calls for comprehensive programs and policies for the prevention and management of the double burden of malnutrition

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570