Growth and infrastructure investment in India: Achievements, challenges, and opportunities

The paper analyses the recent scenario of infrastructure investment in India, with the recognition that inadequate infrastructure is one of the major constraints on India’s ability to sustain high GDP growth. It conducts an overview of the trends in infrastructure investment from the 10th Five Year Plan onwards, and tries to examine the linkage between infrastructure and economic growth. The results exhibit a very high rate of return and also highlight that, since resource constraints will continue to limit public investment in infrastructure in other areas, Public Private Partnership (PPP) project-based development needs to be encouraged wherever feasible

A Real Man!

Arjun* is a community health worker who has been working in a remote, hilly region in the state of Odisha, India, for the past 10 years. This region is primarily inhabited by indigenous communities, known as Adivasis, and has had relatively poorer health outcomes until the past decade, when the Government of India introduced several health system reforms to strengthen public health service deliver

Clinical Computing in Dentistry

Machines can seldom replace dentists in rightly handling the patients with optimistic human insight, considerations, creative planning and the monitoring of psychological acceptance and comfort experienced by any patient with the rehabilitation done. Intelligent computer related armamentarium with software can still help dental practitioners detect typical medical and dental signs and classify them according to certain rules more effectively. Based on image analysis algorithms, CAD systems can be used to look for signs of any tooth pathology that can be spotted in dental X-ray or cone beam computed tomography (CBCT) images. Applying computer vision algorithms to high-resolution CBCT slices helps to a great extent in diagnosing periapical lesions like granulomas, cysts, etc., and can help creating 3-D model of a root canal that reflects its shape with sufficient precision facilitating an optimum endodontic treatment planning. Hence, computer vision systems are already able to speed up the diagnostic process and provide a valuable second opinion in doubtful cases. This can lead a dentist and the patient thoroughly experience an optimistic acceptance and satisfaction of the treatment done

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Horizontal Equity and the Thirteenth Finance Commission: Issues and Ponderables

An attempt has been made in this paper to critically analyse the parameters/ criteria on which basis awards are finalized. With special reference to poorer states, the following aspects have been discussed: i) Basic parameters of the 13th FC; ii) Distribution neutral factors; iii) Redistributive factors; iv) Fiscal incentive factors; and v) Grants-in-aid. Scope for possible improvement in the working of fiscal federalism and policy implications thence have also been deliberated upon.13th Finance Commission, Horizontal equity, Fiscal federalism, grants-in-aid, fiscal federalism, policy, states, incentive, Tax Efforts, GDP,

Market Connectedness and Volatility Spillovers: A Meta-Literature Review

Evaluation of market connectedness and asymmetric volatility spillover has recently seen a surge in financial risk analytics and portfolio diversification. We carried out a meta-literature review on connectedness and spillovers, providing solid insight into the research field and robust guidelines for future investigation. The review consists of a quantitative bibliometric analysis of 594 papers and a qualitative content analysis of 77 papers covering 1991 to 2021. The results of the meta-citation analysis show that Diebold’s Spillover index (2007) is the predominant method in most works as far as market connectedness and spillover are concerned. With an extensive review, we achieved the following objectives: (1) Analyze the most influential authors, journals, and publications. (2) Understand the research streams and most studied streams. (3) Understand the theme’s structure, thematic evolution, and keyword trends. (4) Examine the pattern of collaboration and most productive affiliations. (5) Explore future research directions and untapped areas. The content analysis revealed the following important research streams in the current literature: (1) Asymmetries in market connectedness. (2) Influence of macro factors in market connectedness and spillover. (3) The role of oil in market spillovers and hedging portfolios. (4) Dynamic cross-market connectedness and spillovers. Our study is the first to employ a meta-review to assess the domain of market connectedness; thus, our work will significantly contribute to macroeconomic policymakers, researchers and hedging investors

Return and volatility spillover between India and leading Asian and global equity markets: an empirical analysis

Purpose: The study uses the multivariate GARCH-BEKK model (which was first proposed by Baba et al. (1990) and then further developed by Engle and Kroner (1995)) to examine the return and volatility spillover between India and four leading Asian (namely, China, Japan, Singapore and Hong Kong) and two global (namely, the United Kingdom and the United States) equity markets. Design/methodology/approach: The study employs a multivariate GARCH-BEKK model to quantify return correlation and volatility transmission across the pre- and post-2008 global financial crisis periods (apart from other conventional time series modelling like cointegration, Granger causality using vector error correction model (VECM)). Findings: The results show a tendency of the Indian stock market index to move along with the US and Hong Kong market indices. The decrease in the value of the co-integration coefficient during the recession was explained by reduced investor confidence in developing countries. The result further shows a clear distinction in terms of volatility spillover between the Asian market vis-a-vis US and UK markets. Volatility transmission from India to Asian markets was found to be significantly higher as compared to the US and UK. So also, the study’s results show a puzzling result giving us comparable co-integration ranks for phase 2 (expansion) and phase 3 (slow-down) of the business cycle in most cases. Research limitations/implications: In Granger causality testing, the results were unable to ascertain the difference between phase 2 (expansion) and phase 3 (slowdown). However, the multivariate GARCH (MGARCH)-BEKK model showed a clear reduction in volatility transmission to NIFTY50 (is the flagship index on the National Stock Exchange of India Ltd. (NSE)) as India entered slow-down. This shows that the Indian economy does go through different business cycles, and the changes in parameters hence prove hypothesis 3 to be true with respect to volatility transmission to India from International markets. Originality/value: The results show that for all countries, the volatility transmitted to India increases significantly going from phase 1 (recession) to phase 2 (expansion) and reduces again once the countries enter slow-down in phase 3 (slowdown). This shows that during expansion shocks and impulses in international markets affect the Indian markets significantly, supporting the increase in co-integration in phase 2 (expansion). During expansion, developing markets like India become profitable for investors, due to the high growth rate when compared to developed countries. This implies that a significant amount of capital enters Indian markets, which is susceptible to the volatility of international markets. The volatility transmission from India to the US and UK was insignificant in phase 1 (recession and recovery) and phase 3 (slow-down) showing a weak linkage between the markets during volatile time periods

Comparison of retrograde transillumination and conventional technique for flexible videoscopy by novice anaesthesia residents: A randomised controlled trial

Background and Aims: Retrograde transillumination technique has been found helpful for performing direct and video laryngoscopy by better identification of glottis. The usefulness of this technique during flexible videoscopy by novices has not been evaluated. So, we aimed to compare the retrograde transillumination and conventional technique of flexible videoscopy by novices. The primary outcomes were the time required to visualise the glottis from the point of insertion of the scope into the nostril (T1) and the time needed to see tracheal rings after glottis visualisation (T2). The secondary outcomes were incidence of desaturation with peripheral oxygen saturation (SpO2) <92% and the ease of performance of flexible videoscopy using retrograde transillumination. Methods: A total of 92 surgical patients who are undergoing general anaesthesia with normal airway parameters were randomised into two groups, Group C (Conventional flexible videoscopy- Ambu® aScopeTM 3 Broncho Slim) and Group R (Flexible videoscopy aided by retrograde transillumination through the cricothyroid space using an OTICA LED vein finder). Results: The time to visualise glottis from scope insertion into the nose (T1) (median [interquartile range]) in group C and group R was (19.23 [13.6-30.5] versus 22.50 [17.8-25.5] seconds; P value = 0.417) and time to visualise the tracheal rings (T2) was (13.07 [9.1-20.00] versus 12.13 [9.0-19.1] seconds; P value = 0.714) were comparable in both the groups. 61% of residents found the retrograde transillumination to be very helpful. No incidence of desaturation was noted in either group. Conclusion: Retrograde transillumination-aided flexible videoscopy does not shorten the time but facilitates glottis and tracheal rings visualisation among novice anaesthesia residents