How might India's public health systems be strengthened ?

The central government’s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry’s capacity for stewardship of the nation’s public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship, and re-vitalizing the states’ public health managerial cadres as well as the grassroots public health workers. The central government could consider linking its fiscal support to states with phased progress in four areas: (1) the enactment of state Public Health Acts; (2) the establishment by states of separate public health directorates; (3) the re-vitalization of grassroots public health workers; and (4) health department engagement in ensuring municipal public health. The central focal point could provide the needed support, oversight, incentives, and sanctions to ensure that states build robust public health systems. These measures can do much to help governments use public funds more effectively for protecting people’s health.Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Disease Control&Prevention,Health Economics&Finance

Nonlinear thermo-elastic buckling characteristics of cross-ply laminated joined conical–cylindrical shells

AbstractHere, the nonlinear thermo-elastic buckling/post-buckling characteristics of laminated circular conical–cylindrical/conical–cylindrical–conical joined shells subjected to uniform temperature rise are studied employing semi-analytical finite element approach. The nonlinear governing equations, considering geometric nonlinearity based on von Karman’s assumption for moderately large deformation, are solved using Newton–Raphson iteration procedure coupled with displacement control method to trace the pre-buckling/post-buckling equilibrium path. The presence of asymmetric perturbation in the form of small magnitude load spatially proportional to the linear buckling mode shape is assumed to initiate the bifurcation of the shell deformation. The study is carried out to highlight the influences of semi-cone angle, material properties and number of circumferential waves on the nonlinear thermo-elastic response of the different joined shell systems

Associations of autozygosity with a broad range of human phenotypes

In many species, the offspring of related parents suffer reduced reproductive success, a phenomenon known as inbreeding depression. In humans, the importance of this effect has remained unclear, partly because reproduction between close relatives is both rare and frequently associated with confounding social factors. Here, using genomic inbreeding coefficients (FROH) for >1.4 million individuals, we show that FROH is significantly associated (p < 0.0005) with apparently deleterious changes in 32 out of 100 traits analysed. These changes are associated with runs of homozygosity (ROH), but not with common variant homozygosity, suggesting that genetic variants associated with inbreeding depression are predominantly rare. The effect on fertility is striking: FROH equivalent to the offspring of first cousins is associated with a 55% decrease [95% CI 44–66%] in the odds of having children. Finally, the effects of FROH are confirmed within full-sibling pairs, where the variation in FROH is independent of all environmental confounding

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Development of stress field equations and determination of stress intensity factor during dynamic fracture of orthotropic composite materials

Equations have been developed to determine the dynamic stress field and strain field around a crack moving at a constant velocity in a finite size orthotropic composite material. A simple experimental technique using strain gages has been used to determine the dynamic stress intensity factor for cracks propagating in a unidirectional glass-epoxy composite laminate. Evaluation of the optimum size, orientation and location of the strain gage to minimize errors has been discussed. © 1994

PEDOT–PSSA as an alternative support for Pt electrodes in PEFCs

Poly (3,4-ethylenedioxythiophene) (PEDOT) and poly (styrene sulphonic acid) (PSSA) supported platinum (Pt) electrodes for application in polymer electrolyte fuel cells (PEFCs) are reported. PEDOT–PSSA support helps Pt particles to be uniformly distributed on to the electrodes, and facilitates mixed electronic and ionic (H+-ion) conduction within the catalyst, ameliorating Pt utilization. The inherent proton conductivity of PEDOT–PSSA composite also helps reducing Nafion content in PEFC electrodes. During prolonged operation of PEFCs, Pt electrodes supported onto PEDOT–PSSA composite exhibit lower corrosion in relation to Pt electrodes supported onto commercially available Vulcan XC-72R carbon. Physical properties of PEDOT– PSSA composite have been characterized by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy and transmission electron microscopy. PEFCs with PEDOT–PSSA-supported Pt catalyst electrodes offer a peak power-density of 810 mW cm–2 at a load current-density of 1800 mA cm–2 with Nafion content as low as 5 wt.% in the catalyst layer. Accordingly, the present study provides a novel alternative support for platinized PEFC electrodes