Mapping of variations in child stunting, wasting and underweight within the states of India: the Global Burden of Disease Study 2000–2017

Background To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states. Methods We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 × 5 km grid estimates, using all accessible data from various surveys with subnational geographical information. The states were categorised into three groups using their Socio-demographic Index (SDI) levels calculated as part of the Global Burden of Disease Study based on per capita income, mean education and fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using coefficient of variation (CV). We projected the prevalence of CGF indicators for the districts up to 2030 based on the trends from 2000 to 2017 to compare with the NNM 2022 targets for stunting and underweight, and the WHO/UNICEF 2030 targets for stunting and wasting. We assessed Pearson correlation coefficient between two major national surveys for district-level estimates of CGF indicators in the states. Findings The prevalence of stunting ranged 3.8-fold from 16.4% (95% UI 15.2–17.8) to 62.8% (95% UI 61.5–64.0) among the 723 districts of India in 2017, wasting ranged 5.4-fold from 5.5% (95% UI 5.1–6.1) to 30.0% (95% UI 28.2–31.8), and underweight ranged 4.6-fold from 11.0% (95% UI 10.5–11.9) to 51.0% (95% UI 49.9–52.1). 36.1% of the districts in India had stunting prevalence 40% or more, with 67.0% districts in the low SDI states group and only 1.1% districts in the high SDI states with this level of stunting. The prevalence of stunting declined significantly from 2010 to 2017 in 98.5% of the districts with a maximum decline of 41.2% (95% UI 40.3–42.5), wasting in 61.3% with a maximum decline of 44.0% (95% UI 42.3–46.7), and underweight in 95.0% with a maximum decline of 53.9% (95% UI 52.8–55.4). The CV varied 7.4-fold for stunting, 12.2-fold for wasting, and 8.6-fold for underweight between the states in 2017; the CV increased for stunting in 28 out of 31 states, for wasting in 16 states, and for underweight in 20 states from 2000 to 2017. In order to reach the NNM 2022 targets for stunting and underweight individually, 82.6% and 98.5% of the districts in India would need a rate of improvement higher than they had up to 2017, respectively. To achieve the WHO/UNICEF 2030 target for wasting, all districts in India would need a rate of improvement higher than they had up to 2017. The correlation between the two national surveys for district-level estimates was poor, with Pearson correlation coefficient of 0.7 only in Odisha and four small north-eastern states out of the 27 states covered by these surveys. Interpretation CGF indicators have improved in India, but there are substantial variations between the districts in their magnitude and rate of decline, and the inequality between districts has increased in a large proportion of the states. The poor correlation between the national surveys for CGF estimates highlights the need to standardise collection of anthropometric data in India. The district-level trends in this report provide a useful reference for targeting the efforts under NNM to reduce CGF across India and meet the Indian and global targets. Keywords Child growth failureDistrict-levelGeospatial mappingInequalityNational Nutrition MissionPrevalenceStuntingTime trendsUnder-fiveUndernutritionUnderweightWastingWHO/UNICEF target

Stress analysis of cement mills

A method of computing stresses on a grinding mill due to freely falling balls has been presented using finite element analysis and a semi-analytical approach. The reliability of the results obtained has been demonstrated by comparing it with experimental data available on an industrial mill of 3.8 m diameter. It is concluded that this approach can be satisfactorily used for designing grinding mills taking into account the role of liners and diaphragms

Solar Photovoltaic Water Pumping System Utilizing An BLDC Motor Drive

This research describes a cost-effective BLDC motor-driven solar photovoltaic (PV) water pumping system. We're working with a dual stage power conversion here with this solar PV water pump setup. To get the most power out of a solar PV array, the duty ratio of a DC-DC boost converter is adjusted at the first stage. By adjusting the motor speed, the DC bus voltage is kept at a constant level. This regulation reduces motor losses due to the drop in motor currents at a higher voltage for the same power injection as a result of this regulation. Using an INC-based maximum power point tracking (MPPT) control method, the duty ratio can be controlled. Models and simulations of the proposed system's performance have been done in great detail. The speed sensor/encoder is no longer necessary with scalar control. Motor current sensors are also no longer required. An additional speed feed forward term in the control scheme enhances the dynamics even further. The pump's constant variation is not a problem for the proposed control method. BLDC motors, which are more efficient and quieter than DC motors, are used in our suggested system. Maximum PV generator power loss is well matched to the BLDC motor's load characteristics. Analyzed are the MATLAB/SIMULINK results for several DC-DC converter topologies

An expert review of the scientific literature on independent wheelchair transfers

Purpose. The purpose of this study was to perform a literature review and seek expert opinion on the relevance and strength of the evidence concerning setup and transfer performance. Methods. Scientific literature databases were searched until June 2009 using 43 keywords resulting in 339 articles. These were internally reviewed and narrowed to 41 articles which were formally assessed by 13 external experts. Articles that 80% or more of the reviewers scored as moderately or highly relevant were included in the final results. Results. Nineteen articles met the relevancy criteria. The aspects of setup that experts felt were addressed to some degree included vertical transfer distance, transferring across a gap and position of the mobility device relative to target destination. None of the 19 articles were scored as having strong to very strong resulting evidence. Conclusions. There is a consensus among studies that transferring to a higher surface implies greater exertion of the upper limb. However, there is no evidence concerning how high or low, how close, and how much space is needed next to the target surface so it can be accessible by a majority of wheelchair users. © 2012 Informa UK, Ltd

Development of custom measurement system for biomechanical evaluation of independent wheelchair transfers

This study describes a new custom measurement system designed to investigate the biomechanics of sitting-pivot wheelchair transfers and assesses the reliability of selected biomechanical variables. Variables assessed include horizontal and vertical reaction forces underneath both hands and three-dimensional trunk, shoulder, and elbow range of motion. We examined the reliability of these measures between 5 consecutivetransfer trials for 5 subjects with spinal cord injury and 12 nondisabled subjects while they performed a self-selected sitting pivot transfer from a wheelchair to a level bench. A majority of the biomechanical variables demonstrated moderate to excellentreliability (r > 0.6). The transfer measurement system recorded reliable and valid biomechanical data for future studies of sitting-pivot wheelchair transfers.We recommend a minimum of five transfer trials to obtain a reliable measure of transfer technique for future studies

The relationship between quality of life and change in mobility 1 year postinjury in individuals with spinal cord injury

Riggins MS, Kankipati P, Oyster ML, Cooper RA, Boninger ML. The relationship between quality of life and change in mobility 1 year postinjury in individuals with spinal cord injury. Objective: To examine quality-of-life (QOL) factors and change in mobility in individuals with traumatic spinal cord injury (SCI) 1 year after injury. Design: Retrospective case study of National SCI Database data. Setting: SCI Model Systems (SCIMS) sites (N=18). Participants: Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility data for both assessments. Interventions: Not applicable. Main Outcome Measures: Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire, Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores. Results: Of the sample, 55 individuals transitioned from walking to wheelchair use within 1 year of discharge. This group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001). Conclusions: Individuals with SCI who transitioned from walking at discharge to wheelchair use within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair, rather than primary ambulation during acute inpatient rehabilitation. © 2011 American Congress of Rehabilitation Medicine

Design Features That Affect the Maneuverability of Wheelchairs and Scooters

Koontz AM, Brindle ED, Kankipati P, Feathers D, Cooper RA. Design features that affect the maneuverability of wheelchairs and scooters. Objective: To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space. Design: Case series. Setting: University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event. Participants: The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14). Intervention: A mock environment was constructed to create passageways to form an L-turn, 360°-turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests. Main Outcome Measure: Minimum passageway widths for the 4 maneuverability tasks. Results: Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs (P<.05). Mid-wheel-drive PWCs required the least space for the 360°-turn in place compared with front-wheel-drive and rear-wheel-drive PWCs (P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks. Conclusions: Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas. © 2010 American Congress of Rehabilitation Medicine

Upper limb kinetic analysis of three sitting pivot wheelchair transfer techniques

Background: The objective of this study was to investigate differences in shoulder, elbow and hand kinetics while performing three different SPTs that varied in terms of hand and trunk positioning. Methods: Fourteen unimpaired individuals (8 male and 6 female) performed three variations of sitting pivot transfers in a random order from a wheelchair to a level tub bench. Two transfers involved a forward flexed trunk (head-hips technique) and the third with the trunk remaining upright. The two transfers involving a head hips technique were performed with two different leading hand initial positions. Motion analysis equipment recorded upper body movements and force sensors recorded hand reaction forces. Shoulder and elbow joint and hand kinetics were computed for the lift phase of the transfer. Findings: Transferring using either of the head hips techniques compared to the trunk upright style of transferring resulted in reduced superior forces at the shoulder (P < 0.002), elbow (P < 0.004) and hand (P < 0.013). There was a significant increase in the medial forces in the leading elbow (P = 0.049) for both head hip transfers and the trailing hand for the head hip technique with the arm further away from the body (P < 0.028). The head hip techniques resulted in higher shoulder external rotation, flexion and extension moments compared to the trunk upright technique (P < 0.021). Interpretation: Varying the hand placement and trunk positioning during transfers changes the load distribution across all upper limb joints. The results of this study may be useful for determining a technique that helps preserve upper limb function overtime. © 2011 Elsevier Ltd