A multi-agent evolutionary robotics framework to train spiking neural networks

A novel multi-agent evolutionary robotics (ER) based framework, inspired by competitive evolutionary environments in nature, is demonstrated for training Spiking Neural Networks (SNN). The weights of a population of SNNs along with morphological parameters of bots they control in the ER environment are treated as phenotypes. Rules of the framework select certain bots and their SNNs for reproduction and others for elimination based on their efficacy in capturing food in a competitive environment. While the bots and their SNNs are given no explicit reward to survive or reproduce via any loss function, these drives emerge implicitly as they evolve to hunt food and survive within these rules. Their efficiency in capturing food as a function of generations exhibit the evolutionary signature of punctuated equilibria. Two evolutionary inheritance algorithms on the phenotypes, Mutation and Crossover with Mutation, are demonstrated. Performances of these algorithms are compared using ensembles of 100 experiments for each algorithm. We find that Crossover with Mutation promotes 40% faster learning in the SNN than mere Mutation with a statistically significant margin.Comment: 9 pages, 11 figure

Measurement of health system performance at district level: A study protocol

Background: Limited efforts have been observed in low and middle income countries to undertake health system performance assessment at district level. Absence of a comprehensive data collection tool and lack of a standardised single summary measure defining overall performance are some of the main problems. Present study has been undertaken to develop a summary composite health system performance index at district level. Methods: A broad range of indicators covering all six domains as per building block framework were finalized by an expert panel. The domains were classified into twenty sub-domains, with 70 input and process indicators to measure performance. Seven sub-domains for assessing health system outputs and outcomes were identified, with a total of 28 indicators. Districts in Haryana state from north India were selected for the study. Primary and secondary data will be collected from 378 health facilities, district and state health directorate headquarters. Indicators will be normalized, aggregated to generate composite performance index at district level. Domain specific scores will present the quality of individual building block domains in the public health system. Robustness of the results will be checked using sensitivity analysis. Expected impact for public health: The study presents a methodology for comprehensive assessment of all health system domains on basis of input, process, output and outcome indicators which has never been reported from India. Generation of this index will help identify policy and implementation areas of concern and point towards potential solutions. Results may also help understand relationships between individual building blocks and their sub-components

Database-centric Development of Menus andGraphic User Interfaces

The database-centric approach to graphic user interface (GUI) development, quickly andeasily manages standardisation and modification of labels and look and feel of controls bykeeping various control-creation data into the database. The runtime generation of controlsprovides the flexibility to control their creation and modification issues. This method freezes theapplication code once the development is over. The process of recompilation is eliminated whencreation or modification of controls is done. Dynamic controls such as menus, label, text box,button, combo box, list box, group box, check box, radio button, tab control, spin button, treecontrol can be easily formed and controlled using this approach

Effect of fungal biocontrol agents on enhancement of drought stress tolerance in rice (Oryza sativa L.)

Rice is the staple food crop for about half of the population of the world. Drought is a major stress limiting factor of this crop. In the recent years, biocontrol agents like Trichoderma spp. have become popular as plant growth promoter and shown to enhance drought tolerance in plants. Therefore, present investigation investigation was undertaken to evaluate the different biocontrol agents i.e. Trichoderma harzinum 1, Trichoderma harzianum 2, Chaetomium globosum and Talaromyces flavus against the drought in resistant (DRR 42 and Sahbhagi Dhan) and susceptible (IR 64) varieties of rice. Prior to sowing seeds were bioprimed separately with each isolates of Trichoderma harzianum @ 10g/kg and were sown in pots. Drought treatment of 4 days, 7 days, 10 days and 13 days were given as per the standard protocol. Biocontrol agent Trichoderma harzianum (T2) was observed most effective for drought tolerance followed by Chaetomium globosum. After 13 days of drought treatment minimum wilting (20%) was observed in Sahbhagi Dhan treated with Trichoderma harzianum 2. Four and 10 days drought stressed plants were subjected to different biochemical analysis. Significantly positive correlation (r = 0.91) was observed between wilting and Malondialdehyde (MDA) content. While negative correlation (r = −0.67) was observed between wilting and average plant weight. Study suggested that Trichoderma harzianum 2 treatment during drought stress in rice plants can delay the drought upto 3-5 days

Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment

Background: Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Methods: Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. Findings: The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. Interpretation: The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. Funding: This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India

Refining the provider payment system of India’s government-funded health insurance programme: an econometric analysis

Objectives: Reimbursement rates in national health insurance schemes are frequently weighted to account for differences in the costs of service provision. To determine weights for a differential case-based payment system under India’s publicly financed national health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), by exploring and quantifying the influence of supply-side factors on the costs of inpatient admissions and surgical procedures. Design: Exploratory analysis using regression-based cost function on data from a multisite health facility costing study—the Cost of Health Services in India (CHSI) Study. Setting: The CHSI Study sample included 11 public sector tertiary care hospitals, 27 public sector district hospitals providing secondary care and 16 private hospitals, from 11 Indian states. Participants: 521 sites from 57 healthcare facilities in 11 states of India. Interventions: Medical and surgical packages of PM-JAY. Primary and secondary outcome measures: The cost per bed-day and cost per surgical procedure were regressed against a range of factors to be considered as weights including hospital location, presence of a teaching function and ownership. In addition, capacity utilisation, number of beds, specialist mix, state gross domestic product, State Health Index ranking and volume of patients across the sample were included as variables in the models. Given the skewed data, cost variables were log-transformed for some models. Results: The estimated mean costs per inpatient bed-day and per procedure were 2307 and 10 686 Indian rupees, respectively. Teaching status, annual hospitalisation, bed size, location of hospital and average length of hospitalisation significantly determine the inpatient bed-day cost, while location of hospital and teaching status determine the procedure costs. Cost per bed-day of teaching hospitals was 38–143.4% higher than in non-teaching hospitals. Similarly, cost per bed-day was 1.3–89.7% higher in tier 1 cities, and 19.5–77.3% higher in tier 2 cities relative to tier 3 cities, respectively. Finally, cost per surgical procedure was higher by 10.6–144.6% in teaching hospitals than non-teaching hospitals; 12.9–171.7% higher in tier 1 cities; and 33.4–140.9% higher in tier 2 cities compared with tier 3 cities, respectively. Conclusion: Our study findings support and validate the recently introduced differential provider payment system under the PM-JAY. While our results are indicative of heterogeneity in hospital costs, other considerations of how these weights will affect coverage, quality, cost containment, as well as create incentives and disincentives for provider and consumer behaviour, and integrate with existing price mark-ups for other factors, should be considered to determine the future revisions in the differential pricing scheme

Local Bupivacaine Infiltration to Reduce Pain after Tonsillectomy: A Low Cost Approach

Introduction Tonsillectomy is one of the most commonly performed surgical procedures worldwide, with the major drawback of significant post operative pain.There is no consensus regarding topical application or local infiltration of anesthetics post operatively to reduce pain. The present study was performed to evaluate the effect of bupivacaine infiltration in the tonsillar fossae after tonsillectomy. Materials and Methods A double-blinded clinical trial was performed on 75 patients undergoing tonsillectomy between January 2019 and January 2020. All patients underwent tonsillectomy under general anesthesia and were then randomly divided into 3 groups of 25 patients each. For Group I, a swab soaked in normal saline was applied to the tonsillar fossae for 5 minutes just before extubation. In Group II, a swab soaked in 5 ml of 0.5% bupivacaine was placed for 5 minutes, while in Group III, 5ml of 0.5% bupivacaine was infiltrated in the tonsillar fossae. The intensity of pain for each group was measured in the immediate post op period, at6 hours, 24 hours and 1 week by Wong Baker Faces Pain Rating Scale. Results There was a significant difference in the mean level of pain between groups I and III in the immediate post op period, at 6 hours and 24 hours. Although the average pain scores of group III were better than those of group II, the results were significant only in the 6 hour post op period. Conclusion To reduce post-tonsillectomy pain,0.5% bupivacaine can be infiltrated into the tonsillar fossa

Impact of India's publicly financed health insurance scheme on public sector district hospitals: a health financing perspective

Background: Districts hospitals in India play a pivotal role in delivering health care services in the public sector and are empanelled under India's national health insurance scheme i.e. Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PMJAY). In this paper, we evaluate the extent to which the PMJAY impacts the district hospitals from a financing perspective. Methods: We used cost data from India's nationally representative costing study—‘Costing of Health Services in India’ (CHSI) to determine the incremental cost of treating PMJAY patients, after adjusting for resources that are paid through supply-side government financing route. Second, we used data on number and claim value paid to public district and sub-district hospitals during 2019, to determine the additional revenue generated through PMJAY. The annual net financial gain per district hospital was estimated as the difference between payments under PMJAY, and the incremental cost of delivering the services. Findings: At current levels of utilisation, the district hospitals in India gain a net annual financial benefit of $26.1 (₹ 1839.3) million, which can potentially increase up to$ 41.8 (₹ 2942.9) million with an increase in the share of patient volume. For an average district hospital, we estimate net annual financial gain of $169,607 (₹ 11.9 million), increasing up to$ 271,372 (₹ 19.1 million) per hospital with increased utilisation. Interpretation: Demand-side financing mechanisms can be used to strengthen the public sector. Increasing utilisation of district hospitals, by either gatekeeping or improving availability of services will enhance financial gains for district hospitals and strengthen public sector. Funding: Department of Health Research, Ministry of Health & Family Welfare, Government of India