IDENTIFICATION OF CRITICAL FACTORS FOR DELAY IN METRO RAIL PROJECTS IN INDIA

Purpose of the study:World over, transportation infrastructure projects face delays in commissioning and India is no exception. This study is carried out with an objective to specifically identify the critical delay factors in the commissioning of metro rail projects in India. Methodology: A questionnaire survey was conducted to identify the major causes of delay from the opinion of clients, contractors and consultants. Calculation of Relative Importance Index (RII) for the shortlisted factors yielded the ranking. The ranking by various categories of respondents was analysed using Spearman’s rank coefficient. Main Findings:The study concluded in identification of 10 most critical delay-factors from a list of 49 shortlisted factors spread across 7 categories. The identified factors included: (1) Delay in land acquisition and site handover to contractor, (2) Shifting of utilities and contingency works, (3) Scope change, (4)Delay in payments, (5) Effects of unforeseen subsurface and changing ground condition, (6) Shortage of construction materials in the market, (7) Delays in design approvals and decision making, (8) Shortage of labour, (9) Lack of data collection and survey before design, and (10) Delay in obtaining permits from local body. Implications: Project management interventions based on the identified critical factors of delay can improve the delivery of upcoming metro rail projects in terms of schedule compliance. Applications of this study:The Application of suitable course correction measures targeting the critical factors can result in mitigation of delays. Novelty/Originality of this study:The study is one of its kind attempt to investigate all the commissioned metro rail projects in India for analyzing delays in the Indian urban rail sector

Maternal and fetal outcomes in HIV positive pregnant female

Background: Vertical Transmission is still not an uncommon mode of HIV transmission. HIV and its treatment can also affect maternal and fetal outcomes. We aimed to study incidence and factors of MTCT and maternal and fetal outcomes with the current standard of care.Methods: It was an observational study, at BRD medical college Gorakhpur. Pregnant, HIV positive females consenting for the study were enrolled. Follow up was up to 6 months post-delivery. Infant testing for transmission was done at 6 months.Results: A total 35 HIV positive pregnant female were studied. Follow up could be completed in only 29 patients. Four (13.79%) infants had HIV DNA detectable in whole blood at 6 months. Transmission was 16.6% in group taking ART for 3 months, 25% in mixed feeding group vs. 12% in exclusive breast feeding and 16.6% in NVD group vs. 9% in LSCS. Incidence of Preterm delivery was higher in group who took ART for longer duration. IUGR was present in 10/29 (27%) and growth failure in 12/29 (41%) infants.Conclusions: Longer ART duration and cesarean section delivery were more effective in preventing MTCT. Even exclusive breast feeding could result in MTCT. HIV exposure in utero may lead to IUGR. ART has no deleterious or positive effect on fetal growth but may be associated with preterm delivery. Better patient education will probably lead to earlier diagnosis and initiation of therapy to prevent transmission, and also to better fetal and infant outcomes

The stress polarity signaling (SPS) pathway serves as a marker and a target in the leaky gut barrier: implications in aging and cancer.

The gut barrier separates trillions of microbes from the largest immune system in the body; when compromised, a "leaky" gut barrier fuels systemic inflammation, which hastens the progression of chronic diseases. Strategies to detect and repair the leaky gut barrier remain urgent and unmet needs. Recently, a stress-polarity signaling (SPS) pathway has been described in which the metabolic sensor, AMP-kinase acts via its effector, GIV (also known as Girdin) to augment epithelial polarity exclusively under energetic stress and suppresses tumor formation. Using murine and human colon-derived organoids, and enteroid-derived monolayers (EDMs) that are exposed to stressors, we reveal that the SPS-pathway is active in the intestinal epithelium and requires a catalytically active AMP-kinase. Its pharmacologic augmentation resists stress-induced collapse of the epithelium when challenged with microbes or microbial products. In addition, the SPS-pathway is suppressed in the aging gut, and its reactivation in enteroid-derived monolayers reverses aging-associated inflammation and loss of barrier function. It is also silenced during progression of colorectal cancers. These findings reveal the importance of the SPS-pathway in the gut and highlights its therapeutic potential for treating gut barrier dysfunction in aging, cancer, and dysbiosis

GIV/Girdin is a central hub for profibrogenic signalling networks during liver fibrosis.

Progressive liver fibrosis is characterized by the deposition of collagen by activated hepatic stellate cells (HSCs). Activation of HSCs is a multiple receptor-driven process in which profibrotic signals are enhanced and antifibrotic pathways are suppressed. Here we report the discovery of a signalling platform comprising G protein subunit, Gαi and GIV, its guanine exchange factor (GEF), which serves as a central hub within the fibrogenic signalling network initiated by diverse classes of receptors. GIV is expressed in the liver after fibrogenic injury and is required for HSC activation. Once expressed, GIV enhances the profibrotic (PI3K-Akt-FoxO1 and TGFβ-SMAD) and inhibits the antifibrotic (cAMP-PKA-pCREB) pathways to skew the signalling network in favour of fibrosis, all via activation of Gαi. We also provide evidence that GIV may serve as a biomarker for progression of fibrosis after liver injury and a therapeutic target for arresting and/or reversing HSC activation during liver fibrosis

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Air Quality in Delhi

Air pollution in Delhi, India, is one of the most hazardous issues that the developing nation is facing in the current day. Through our gigamap, we encompassed research and intervention and recommendations and developed an understanding of the numerous relationships between the individual elements in this system. Designed for our “Systems” class, the gigamap shows our process of researching, mess mapping, and three horizons (short term and long term effects of the potential solutions). The layout of the gigamap was informed by identifying patterns and categorizing problems, allowing us to define the broader problem and tackle it effectively. The map outlines how to affect positive change in the different categories within this system through various interventions. Through a STEEP analysis, we found that this is a wicked problem because there is no definable solution and it must be approached from a variety of leverage points. Through this process, we learned how strategic solutions and design thinking play a role in intervening in a wicked problem such as air pollution in Delhi and how designers can use these tools to help bring about a positive change to an increasingly complex world. Reading Air Quality in Delhi Our gigamap organizes the information into six sections: introduction, feedback loops, mess map, three horizons, interventions, and the impact of globalization. The viewer should approach our map by first reading the introduction and feedback loops to gain a general understanding and breakdown of the wicked problem. Then examine our mess map, three horizons, and interventions recognizing the problem on a more complex level to grasp our approach to intervene over time. Finally, the viewer should read how the wicked problem ties to economic globalization. (Viewers should refer to the key to understand the relationship between various factors in the map)

Maternal and fetal outcomes in HIV positive pregnant female

Background: Vertical Transmission is still not an uncommon mode of HIV transmission. HIV and its treatment can also affect maternal and fetal outcomes. We aimed to study incidence and factors of MTCT and maternal and fetal outcomes with the current standard of care.Methods: It was an observational study, at BRD medical college Gorakhpur. Pregnant, HIV positive females consenting for the study were enrolled. Follow up was up to 6 months post-delivery. Infant testing for transmission was done at 6 months.Results: A total 35 HIV positive pregnant female were studied. Follow up could be completed in only 29 patients. Four (13.79%) infants had HIV DNA detectable in whole blood at 6 months. Transmission was 16.6% in group taking ART for <3 month as compared to 11.7% in group taking ART for >3 months, 25% in mixed feeding group vs. 12% in exclusive breast feeding and 16.6% in NVD group vs. 9% in LSCS. Incidence of Preterm delivery was higher in group who took ART for longer duration. IUGR was present in 10/29 (27%) and growth failure in 12/29 (41%) infants.Conclusions: Longer ART duration and cesarean section delivery were more effective in preventing MTCT. Even exclusive breast feeding could result in MTCT. HIV exposure in utero may lead to IUGR. ART has no deleterious or positive effect on fetal growth but may be associated with preterm delivery. Better patient education will probably lead to earlier diagnosis and initiation of therapy to prevent transmission, and also to better fetal and infant outcomes