INTER-ORGANIZATIONAL RELATIONS IN PUBLIC-PRIVATE PARTNERSHIPS: NATIONAL HEALTH INSURANCE IN INDIA

Ph.DDOCTOR OF PHILOSOPH

Impact of discrete source step size on the 3D dosimetry of interstitial implants with high dose rate brachytherapy

ABSTRACTBackground: High dose rate remote after loading brachytherapy machines have seen tremendous advancement both technologically and their clinical applications during the last 25 years. With the introduction of computerized remote after loading machines and computerized planning system, stepping source dosimetry system (SSDS) has become the system of choice making almost all traditional dosimetry systems obsolete. In this study we evaluated the impact of source step size on dosimetry of interstitial implant using parameters of ICRU-58 and various quality indices (QI).Material & Methods: For this study, 10 implant cases which have 3-D CT image based planning were selected. Contouring of clinical target volume and various organs were done following standard guidelines for the same. Plans were optimized to achieve the desired clinical outcome using different source step sizes of 2.5, 5 and 10 mm respectively. Cumulative DVH’s were calculated for the estimation of various ICRU-58 parameters and quality indices.Results and Conclusion: The mean values of the target volumes, minimum target doses, treated volumes, low dose volumes; high dose volumes, overdose volumes, reference volumes, coverage, external volume, relative dose homogeneity, overdose volume and COIN indices have been presented for the source step sizes of 2.5 mm, 5 mm and 10 mm respectively. Among source step sizes used in this study, most favorable clinically acceptable dose distributions & dose homogeneity occurs around step size of 5 mm as predicted by the various parameters of ICRU-58 and dose quality indices. Keywords: Brachytherapy, interstitial implant, source step-size, remote after loading, optimization, quality indices

Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India

Universal health coverage (UHC) has provided the impetus for the introduction of publicly funded health insurance (PFHI) schemes in the mixed health systems of India and many other low- and middle-income countries. There is a need for a holistic understanding of the pathways of impact of PFHI schemes, including their role in promoting equity of access. Methods: This paper applies an equity-oriented evaluation framework to assess the impacts of PFHI schemes in Chhattisgarh State by synthesising literature from various sources and highlighting knowledge gaps. Data were collected from an extensive review of publications on PFHI schemes in Chhattisgarh since 2009, including empirical studies from the first author's PhD and grey literature such as programme evaluation reports, media articles and civil society campaign documents. The framework was constructed using concepts and frameworks from the health policy and systems research literature on UHC, access and health system building blocks, and is underpinned by the values of equity, human rights and the right to health

Do policymakers use social media for policy design? A Twitter analytics approach

Social media has been used widely for communicating information, awareness, and promote public policies by government agencies. However, limited attention has been paid to the use of social media in improving the design of public policies. This paper explores to what extent citizens' responses/opinions expressed on social media platforms contribute to policy design.  The paper analyzes discussion about the 'Ayushman Bharat' scheme on Twitter through social media analytics techniques (e.g., content analytics) and then traces the change in policy design over two years.  To validate findings from Twitter data, and assess the evolution in policy design, we conducted in-depth interviews with experts and extensive document analysis. The paper reveals that consistently similar issues were raised by the experts in the past as well as by the citizens in the current scheme. However, over the period, the policy design has not changed significantly. Therefore, despite a strong social media presence, its optimum use to improve policy effectiveness is yet to be achieved. The paper contributes by exploring the role social media can play in the public policy process and policy design in developing countries' contexts and identifies gaps in existing social media strategies of public agencies

Impact of discrete source step size on the 3D dosimetry of interstitial implants with high dose rate brachytherapy

ABSTRACTBackground: High dose rate remote after loading brachytherapy machines have seen tremendous advancement both technologically and their clinical applications during the last 25 years. With the introduction of computerized remote after loading machines and computerized planning system, stepping source dosimetry system (SSDS) has become the system of choice making almost all traditional dosimetry systems obsolete. In this study we evaluated the impact of source step size on dosimetry of interstitial implant using parameters of ICRU-58 and various quality indices (QI).Material & Methods: For this study, 10 implant cases which have 3-D CT image based planning were selected. Contouring of clinical target volume and various organs were done following standard guidelines for the same. Plans were optimized to achieve the desired clinical outcome using different source step sizes of 2.5, 5 and 10 mm respectively. Cumulative DVH’s were calculated for the estimation of various ICRU-58 parameters and quality indices.Results and Conclusion: The mean values of the target volumes, minimum target doses, treated volumes, low dose volumes; high dose volumes, overdose volumes, reference volumes, coverage, external volume, relative dose homogeneity, overdose volume and COIN indices have been presented for the source step sizes of 2.5 mm, 5 mm and 10 mm respectively. Among source step sizes used in this study, most favorable clinically acceptable dose distributions & dose homogeneity occurs around step size of 5 mm as predicted by the various parameters of ICRU-58 and dose quality indices. Keywords: Brachytherapy, interstitial implant, source step-size, remote after loading, optimization, quality indices