(Im)mobility at the margins : low-income households’ experiences of peripheral resettlement in India and South Africa

Expanded state-subsidised housing programmes in middle-income countries raise questions about the displacement and socio-spatial marginalisation of poor households. Examining these questions through people’s experiences of resettlement indicates the importance of mobility to their lives. Drawing on a mixed-method comparative study of Ahmedabad, Chennai and Johannesburg, we ask: How does the relocation of low-income households to urban peripheries reshape the links between their physical and socio-economic mobility, and how does this impact on their ability to build secure urban futures? Experiences of families moving to five peripheral settlements indicate two linked challenges to the social and economic mobility of the peripheralised urban poor: first, their immediate and individual ability to be mobile within the city and second, the longer-term social mobility of their households. While trajectories towards secure urban citizenship for all remain a policy aspiration, housing policies and practices are placing this on hold or even reversing this, with mobility constraints locking many low-income groups into marginality

Epidemiological and clinical burden of EGFR Exon 20 insertion in advanced non-small cell lung cancer: A systematic literature review

Objectives The burden of epidermal growth factor receptor (EGFR) exon 20 insertion mutation (Exon 20ins) in non-small cell lung cancer is not well understood. A systematic review was conducted to identify evidence on mutation frequency, prognostic impact, clinical, patient-reported, and economic outcomes associated with Exon 20ins. Materials and methods Searches were conducted in Embase and Medline and supplemented with recent conference proceedings. Included studies were not limited by intervention, geography, or publication year. Results Seventy-eight unique studies were included; 53 reporting mutation frequency, 13 prognostic impact, 36 clinical outcomes, and one humanistic burden. No economic burden data were identified. The frequency of Exon 20ins mutation ranged from 0.1% to 4% of all NSCLC cases and 1% to 12% of all EGFR mutations. Data on the prognostic impact of Exon 20ins were heterogeneous but highlighted poorer outcomes in patients with Exon 20ins mutation compared with patients with other EGFR mutations and EGFR wildtype across a wide range of therapies and treatment lines. Comparative evidence on the clinical efficacy and safety of currently available therapies were limited, as were sample sizes of studies reporting on real-world effectiveness. Nine single-arm trials and 27 observational studies reported clinical outcomes for patients with Exon 20ins. Trends towards better survival and response were observed for chemotherapy compared with TKIs as first-line treatments. For subsequent treatment lines, novel targeted therapies provided encouraging preliminary responses while results for chemotherapy were less favorable. Limited safety data were reported. One conference abstract described the symptom burden for Exon 20ins patients with fatigue and pain being most common. Conclusion Findings of the systematic review show a high unmet need for safe and efficacious treatments for patients with Exon 20ins as well and need for further evidence generation to better understand the patient-level and economic impact for these patients

Planning a 'slum free' Trivandrum: housing upgrade and the rescaling of urban governance in India

This paper examines how India’s national urban development agenda is reshaping relationships between national, State and city-level governments. JNNURM, the flagship programme that heralded a new era of urban investment in India, contained a range of key governance aspirations: linking the analysis of urban poverty to city-level planning, developing holistic housing solutions for the urban poor, and above all empowering Urban Local Bodies to re-balance relationships between State and city-level governments in favour of the latter. Here, we trace JNNURM’s implementation in Kerala’s capital city, Trivandrum (Thiruvananthapuram), where the city’s decentralised urban governance structure and use of ‘pro-poor’ institutions to implement housing upgrade programmes could have made it an exemplar of success. In practice, Trivandrum’s ‘city visioning’ exercises and the housing projects it has undertaken have fallen short of JNNURM’s lofty goals. The contradictions between empowering cities and retaining centralised control embedded within this national programme, and the unintended city-level consequences of striving for JNNURM funding success, have reshaped urban governance in ways not envisaged within policy. As a result, JNNURM has been important in rescaling governance relationships through three interlinked dynamics of problem framing, technologies of governance and the scalar strategy of driving reform ‘from above’ that together have ensured the national state’s continued influence over the practices of urban governance in India

Patients’ preferences for osteoporosis drug treatment: a discrete choice experiment

Summary: Active case finding for osteoporosis is used to identify patients at high fracture risk who may benefit from preventive drug treatment. We investigated the relative weight that women place on various aspects of preventive drugs in a discrete choice experiment. Our patients said they were prepared to take preventive drugs even if side effects were expected. Int

Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five