Out-of-Pocket Health Care Expenditure and Poverty Impact in a Fragile Indian State of Assam

Out-of-Pocket (OOP) expenditure on health care is one of the debilitating factors in pushing households into poverty. Households, especially the lower income groups and which do not have security measures like medical insurance, are the worst sufferers when faced with health shocks. Conventional methods of poverty estimation do not take into account health care consumption expenditure, which might understate the poverty headcount. In this study, poverty headcount and impoverishing effects of OOP health care expenditure have been analysed. The data have been collected from Chirang district of Indian state of Assam. The state is a fragile state due to ethnic violence, militancy and natural calamities like flood that the region has been experiencing for decades. The recall period for the inpatient care is 365 days, and six months for outpatient care. The poverty headcount is the difference between post Hp and pre Hp. The pre-payment (i.e. pre-OOP) ‘poverty headcount’ is calculated by comparing household’s consumption expenditure gross of payments for health care with the poverty line defined by the planning commission of India (2001). The post-OOP payment ‘poverty headcount’ is computed by netting out health care payments from a household’s consumption expenditure and then comparing with the poverty line. The intensity of poverty has been estimated with the help of the methods introduced by Wagstaff and Doorslaer (2003). The higher income households make higher OOP expenditure than the lower income households. The burden of OOP is higher on the lower income households because the proportion of OOP expenditure to total income of households is higher amongst the poor households compared to higher income households. OOP expenditure pushed households into poverty. This is more serious with the inpatient care compared to the OOP expenditure on outpatient care. The poverty gap or the intensity of poverty of the overall OOP expenditure is Rs. 279.28, which varies between outpatient and inpatient OOP expenditure

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

The synergistic effects of cavitation erosion-corrosion in ship propeller materials

Synergy tests were performed for two most common propeller materials, duplex stainless steel (DSS) and nickel aluminium bronze (NAB), by means of an indirect ultrasonic vibratory system. Tests were conducted for pure cavitation erosion in distilled water, pure corrosion using in situ electrochemistry under 3.5 % NaCl solution and a combination of cavitation erosion–corrosion to understand the overall synergism existing between the two. The results were analysed using gravimetric as well as volumetric analysis. Alicona and Talysurf were employed for the surface topography, and scanning electron microscope was used to see the microstructural morphologies of the samples under different conditions. As a result, the electrochemical tests held at open circuit potential showed that, although DSS exhibited higher resistance to corrosion under seawater alone, NAB exhibited much higher resistance to corrosion when subjected to cavitation. From the experiments conducted, it was concluded that synergy had measurable impact on the cavitation erosion–corrosion of both NAB and DSS. NAB was found to be more susceptible to erosion under both the conditions as compared to DSS with prominent selective cavitation erosion of alpha phase in the microstructure. The overall synergism of NAB was found to be higher than that of DSS

Energy-related tribo-corrosion research at the National Centre for Advanced Tribology at Southampton

This paper is based on a keynote lecture given at the Third International Conference on Tribo-Corrosion, sponsored by ASTM International and held at the Georgia Institute of Technology, Atlanta, GA, April 19–20, 2012. It summarises the tribo-corrosion-related research relevant to the energy sector that has taken place over the past 30 years at the National Centre for Advanced Tribology at Southampton at the University of Southampton in the United Kingdom. Research is presented that relates to multiple components in energy generation/conversion systems and involves a wide range of tribo-corrosion mechanisms. These include cavitation erosion–corrosion of turbomachinery, abrasion–corrosion of downhole drilling equipment, erosion–corrosion of nuclear slurry handling components, bearing degradation of renewable energy systems (wind turbines), erosion–corrosion in nuclear power plants (Berg, H.-P., “Corrosion Mechanisms and Their Consequences for Nuclear Power Plants with Light Water Reactors,” Reliability and Risk Analysis: Theory and Applications, Vol. 2, 2009,pp. 57–68), erosion–corrosion in non-renewable energy systems (oil and gas), and tribochemical processes in internal combustion engines. Work from other research groups is also used to show the importance of understanding tribo-corrosion in energy generation/conversion systems

Clinical and Radiological Features of Seizures in Children Admitted in the PICU at a Tertiary Care Hospital in North-eastern India: A Retrospective Study

Introduction: A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behaviour, or movement, which affect persons of all ages, but are particularly common in childhood. Seizure is a serious neurological symptom in the Paediatric Intensive Care Unit (PICU), yet data on the clinical spectrum of seizures occurring in the PICU setting in India are scarce. Aim: To determine the aetiology, clinical and radiological features of seizures in critically ill children admitted to PICU at a tertiary care hospital. Materials and Methods: This retrospective study was conducted at Gauhati Medical College and Hospital, Guwahati, Assam, India, from April 2017 to September 2018. A total of 253 children aged between 29 days to 12 years, admitted to PICU with seizures were enrolled in the study. Data regarding demographics, diagnosis, clinical seizures, associated diagnosis, Electroencephalogram (EEG) features, imaging, length of stay in PICU, and in-hospital mortality were collected. Data was presented in frequencies, mean, standard deviation. Results: In present study, male to female ratio was 1.5:1 with mean age of 48.9±44.5 months. The most common causes of seizures in PICU setting were acute symptomatic in 185 (73.1%) and epileptic in 68 (26.9%) patients. Central Nervous System (CNS) infections constituted 15.8% of the PICU admissions following seizures. Most frequent co-existent diagnosis at admission was infectious diseases in 96 (38%) patients, followed by pulmonary diseases in 28 (11%) and cardiologic diseases in 14 (5.5%). Conclusion: CNS infections are the most common cause of acute symptomatic seizure, while non infectious diseases such as metabolic disorders, epilepsy and immune disorders also contribute to seizure occurrence in PICU. Identification of common seizure aetiologies in PICU is important step for a prompt and effective treatment