A clean energy transition plan for India

Energy security warrants the uninterrupted supply of energy at affordable prices. India faces the twin challenges of meeting the aspirations of its 1.3 billion population even as it safeguards its energy security and contributes to global efforts to mitigate climate change. Thanks to the Electricity Act of 2003, the installed coal-fired thermal power plant (TPP) generation capacity in India more than doubled from 94 GW to 192 GW between March 2011 and 2017. This sharp increase in the installed capacity has enabled the government to increase per capita electricity consumption by 37% while reducing peak demand deficit from 9.8% (2010-11) to 1.6% (2016-17). However, India has a long way to go in providing electricity security to its people since its per capita electricity consumption is still only a third of the global average

Nerve excitability in the rat forelimb: a technique to improve translational utility

Background Nerve excitability testing by threshold-tracking is the only available method to study axonal ion channel function and membrane potential in the clinical setting. The measures are, however, indirect and the interpretation of neuropathic changes remains challenging. The same multiple measures of axonal excitability were adapted to further explore the pathophysiological changes in rodent disease models under pharmacologic and genetic manipulations. These studies are typically limited to the investigation of the “long nerves” such as the tail or the tibial nerves. New method We introduce a novel setup to explore the ulnar nerve excitability in rodents. We provide normative ulnar data in 11 adult female Long Evans rats under anaesthesia by comparison with tibial and caudal nerves. Additionally, these measures were repeated weekly on 3 occasions to determine the repeatability of these tests. Results Nerve excitability assessment of ulnar nerve proved to be a longitudinally repeatable measure of axonal function mature in rats, as were measures in tibial and caudal nerves. Comparison with existing method: Ulnar nerve motor excitability measures were different from the caudal and tibial excitability measures. Most notably, ulnar nerve showed the largest threshold changes during both depolarizing and hyperpolarizing threshold electrotonus. Conclusions Ulnar nerves demonstrate a distinct nerve excitability profile than the caudal and tibial nerves which could have functional and pathological implications

Peripheral nerve morphology and intraneural blood flow in chronic kidney disease with and without diabetes

Introduction/Aims: Sonographic alterations of peripheral nerves in pre-dialytic kidney disease are yet to be determined. We aimed to assess peripheral nerve cross-sectional area (CSA) and intraneural blood flow in patients with pre-dialytic chronic kidney disease (CKD) and diabetic kidney disease (DKD). Methods: Subjects with CKD (n = 20) or DKD (n = 20) underwent ultrasound to assess CSA of the median and tibial nerves as well as intraneural blood flow of the median nerve. Blood flow was quantified using maximum perfusion intensity. Neuropathy was assessed using the Total Neuropathy Score. A 6-m timed walk test was also performed. Healthy controls (n = 28) were recruited for comparison. Results: The DKD group had more severe neuropathy (p =.024), larger tibial nerve CSA (p =.002) and greater median nerve blood flow than the CKD group (p =.023). Blood flow correlated with serum potassium in disease groups (r = 0.652, p =.022). Disease groups had larger tibial nerve CSA than controls (p <.05). No blood flow was detected in controls. Tibial nerve enlargement was associated with slower maximal walking speeds in disease groups (r = −0.389, p =.021). Discussion: Subjects with DKD demonstrated enlarged tibial nerve CSA and increased median nerve blood flow compared to those with CKD. Elevations in serum potassium were associated with increased blood flow. Sonographic alterations were detectable in pre-dialytic kidney disease compared to controls, highlighting the utility of ultrasound in the assessment of nerve pathology in these patient groups

Evidence of Altered Peripheral Nerve Function in a Rodent Model of Diet-Induced Prediabetes.

Peripheral neuropathy (PN) is a debilitating complication of diabetes that affects >50% of patients. Recent evidence suggests that obesity and metabolic disease, which often precede diabetes diagnosis, may influence PN onset and severity. We examined this in a translationally relevant model of prediabetes induced by a cafeteria (CAF) diet in Sprague-Dawley rats (n = 15 CAF versus n = 15 control). Neuropathy phenotyping included nerve conduction, tactile sensitivity, intraepidermal nerve fiber density (IENFD) and nerve excitability testing, an in vivo measure of ion channel function and membrane potential. Metabolic phenotyping included body composition, blood glucose and lipids, plasma hormones and inflammatory cytokines. After 13 weeks diet, CAF-fed rats demonstrated prediabetes with significantly elevated fasting blood glucose, insulin and impaired glucose tolerance as well as obesity and dyslipidemia. Nerve conduction, tactile sensitivity and IENFD did not differ; however, superexcitability was significantly increased in CAF-fed rats. Mathematical modeling demonstrated this was consistent with a reduction in sodium-potassium pump current. Moreover, superexcitability correlated positively with insulin resistance and adiposity, and negatively with fasting high-density lipoprotein cholesterol. In conclusion, prediabetic rats over-consuming processed, palatable foods demonstrated altered nerve function that preceded overt PN. This work provides a relevant model for pathophysiological investigation of diabetic complications

Implementation of clean coal technologies to comply with "New Emission Norms" for thermal power plants - way forward for the Southern region. Summary Report of NITI Aayog-DST-NIAS Workshop, 17th September 2019

Coal based Thermal Power Plants (TPP) are the backbone of the power generation utilities in the country. Coal based TPPs constitute to around 56.1% of the total installed capacity and generates around 74.2% of the electricity generated in India. Considering the high pollution and resource impacts, of TPPs the Ministry of Environment, Forest and Climate Change (MoEF&CC) notified the Environment Protection (Amendment) Rules (EPAR) on December 5, 2015 with a two-year window for TPPs to meet these standards. When implemented, these norms are expected to have positive environmental and health benefits by leading to lower pollution levels from TPPs. However, compliance with the new emission norms would require retrofitting existing thermal power plants with various Pollution Control Technologies (PCT) in the form of auxiliary systems to control SO2, NOX and PM emissions. In order to ensure 24x7 supply of electricity, CPCB (in consultation with CEA) finalized the revised timelines for all TPPs to comply with the new emission norms by December 2022. The team at Energy and Environment Programme (EEP) in NIAS, Bangalore interacted with various Power Plant Generation companies (GENCOs) in Southern Region to understand their challenges and way forward with respect to the huge capital investment and schedules for implementation. This team developed and a “Concept Paper” for a workshop with the theme, “Strategies and Action Plans needed for transition to an environment friendly and sustainable Electricity Source mix for the Southern Region”. This Workshop was held at NIAS on 17th September 2019 to enable key stakeholders - Power Plant Owners (Central & Southern States), Pollution Control Equipment Suppliers, Regulators and Policymakers to share their experience and deliberate on the challenges to develop a road map for implementation. This report presents the gist of each talk by the invited participants, and also consolidates the key findings and recommendations of the Workshop. This summary report will form the basis for further research as well as for policy advocacy with GOI through NITI Aayog. A.V. Krishnan, Shyam Sundar R, Shilpa Srivastava and R. Srikant

Implementation of Clean Coal Technologies to comply with “New Emission Norms” for Thermal Power Plants - Way forward for Southern Region Summary Report of NITI Aayog-DST-NIAS Workshop 17th September 2019 (NIAS/NSE/EEP/U/WR/13/2019)

Coal based Thermal Power Plants (TPP) are the backbone of the power generation utilities in the country. Coal based TPPs constitute to around 56.1% of the total installed capacity and generates around 74.2% of the electricity generated in India. Considering the high pollution and resource impacts, of TPPs the Ministry of Environment, Forest and Climate Change (MoEF&amp;CC) notified the Environment Protection (Amendment) Rules (EPAR) on December 5, 2015 with a two-year window for TPPs to meet these standards.&nbsp; When implemented, these norms are expected to have positive environmental and health benefits by leading to lower pollution levels from TPPs. However, compliance with the new emission norms would require retrofitting existing thermal power plants with various Pollution Control Technologies (PCT) in the form of auxiliary systems to control SO2, NOX and PM emissions. In order to ensure 24x7 supply of electricity, CPCB (in consultation with CEA) finalized the revised timelines for all TPPs to comply with the new emission norms by December 2022. The team at Energy and Environment Programme (EEP) in NIAS, Bangalore interacted with various Power Plant Generation companies (GENCOs) in Southern Region to understand their challenges and way forward with respect to the huge capital investment and schedules for implementation. This team developed and a “Concept Paper” for a workshop with the theme, “Strategies and Action Plans needed for transition to an environment friendly and sustainable Electricity Source mix for the Southern Region”. This Workshop was held at NIAS on 17th September 2019 to enable key stakeholders - Power Plant Owners (Central &amp; Southern States), Pollution Control Equipment Suppliers, Regulators and Policymakers to share their experience and deliberate on the challenges to develop a road map for implementation.&nbsp; This report presents the gist of each talk by the invited participants, and also consolidates the key findings and recommendations of the Workshop.&nbsp; This summary report will form the basis for further research as well as for policy advocacy with GOI through NITI Aayog

Corneal dendritic cells and the subbasal nerve plexus following neurotoxic treatment with oxaliplatin or paclitaxel

Immune cell infiltration has been implicated in neurotoxic chemotherapy for cancer treatment. However, our understanding of immune processes is still incomplete and current methods of observing immune cells are time consuming or invasive. Corneal dendritic cells are potent antigen-presenting cells and can be imaged with in-vivo corneal confocal microscopy. Corneal dendritic cell densities and nerve parameters in patients treated with neurotoxic chemotherapy were investigated. Patients treated for cancer with oxaliplatin (n = 39) or paclitaxel (n = 48), 3 to 24 months prior to assessment were recruited along with 40 healthy controls. Immature (ImDC), mature (MDC) and total dendritic cell densities (TotalDC), and corneal nerve parameters were analyzed from in-vivo corneal confocal microscopy images. ImDC was increased in the oxaliplatin group (Median, Md = 22.7 cells/mm2) compared to healthy controls (Md = 10.1 cells/mm2, p = 0.001), but not in the paclitaxel group (Md = 10.6 cells/mm2). ImDC was also associated with higher oxaliplatin cumulative dose (r = 0.33, p = 0.04) and treatment cycles (r = 0.40, p = 0.01). There was no significant difference in MDC between the three groups (p > 0.05). Corneal nerve parameters were reduced in both oxaliplatin and paclitaxel groups compared to healthy controls (p < 0.05). There is evidence of elevation of corneal ImDC in oxaliplatin-treated patients. Further investigation is required to explore this potential link through longitudinal studies and animal or laboratory-based immunohistochemical research

Differentiating lower motor neuron syndromes

Lower motor neuron (LMN) syndromes typically present with muscle wasting and weakness and may arise from pathology affecting the distal motor nerve up to the level of the anterior horn cell. A variety of hereditary causes are recognised, including spinal muscular atrophy, distal hereditary motor neuropathy and LMN variants of familial motor neuron disease. Recent genetic advances have resulted in the identification of a variety of disease-causing mutations. Immune-mediated disorders, including multifocal motor neuropathy and variants of chronic inflammatory demyelinating polyneuropathy, account for a proportion of LMN presentations and are important to recognise, as effective treatments are available. The present review will outline the spectrum of LMN syndromes that may develop in adulthood and provide a framework for the clinician assessing a patient presenting with predominantly LMN features

Predictors of failed attendances in a multi-specialty outpatient centre using electronic databases.

BACKGROUND: Failure to keep outpatient medical appointments results in inefficiencies and costs. The objective of this study is to show the factors in an existing electronic database that affect failed appointments and to develop a predictive probability model to increase the effectiveness of interventions. METHODS: A retrospective study was conducted on outpatient clinic attendances at Tan Tock Seng Hospital, Singapore from 2000 to 2004. 22864 patients were randomly sampled for analysis. The outcome measure was failed outpatient appointments according to each patient's latest appointment. RESULTS: Failures comprised of 21% of all appointments and 39% when using the patients' latest appointment. Using odds ratios from the mutliple logistic regression analysis, age group (0.75 to 0.84 for groups above 40 years compared to below 20 years), race (1.48 for Malays, 1.61 for Indians compared to Chinese), days from scheduling to appointment (2.38 for more than 21 days compared to less than 7 days), previous failed appointments (1.79 for more than 60% failures and 4.38 for no previous appointments, compared with less than 20% failures), provision of cell phone number (0.10 for providing numbers compared to otherwise) and distance from hospital (1.14 for more than 14 km compared to less than 6 km) were significantly associated with failed appointments. The predicted probability model's diagnostic accuracy to predict failures is more than 80%. CONCLUSION: A few key variables have shown to adequately account for and predict failed appointments using existing electronic databases. These can be used to develop integrative technological solutions in the outpatient clinic