Bridging the Gap of Skilled Surgeons in Low and Middle Income Countries Using ICT Based Tools : A Case Study in Super-Speciality Training

Introduction: Over the last two decades, advancement of super specialised surgical disciplines has shown improved health outcome, in particular quality and safety. Although medical technology has developed to meet diagnostics and therapeutic needs, there is a scarcity of trained human resources in advanced specialities in low and middle income countries (LMICs). Innovative methods are needed to educate and train people at their workplaces using collaborative technologies and networks. Methods: Over the last 15 years, two general surgeons in Cuttack have been telementored from Lucknow 1,163 km away, using collaborative technologies to develop Endocrine Surgery. This study reviews the last 11 years of the service which includes a clinical decision support system and treatment planning advice using real time videoconferencing. Results: Over the last 11 years, 199 endocrine surgeries per annum were performed with most being thyroid cases as compared with 119 surgeries per annum during the previous five years. Parathyroid and adrenal cases increased significantly during this period (p <0.001). Rates of temporary and permanent vocal cord palsy (1.7% and 0%), hypocalcaemia (5.9% and 1.1%) were comparable with high volume centres. Based on the quantum, safety and quality outcome of endocrine surgery the provincial government has approved creation of a super-speciality department of endocrine surgery in Cuttack. Conclusion: Sustained engagement using telementoring can transfer surgical skills to needy surgeons and enable them to match the expertise of mentors. This model can be replicated in other specialities in a cost effective way to develop specialised human resources for healthcare, in particular in LMICs

Role of Remittances on Households’ Expenditure Pattern in India

Using the unit data from the National Sample Survey (64th round, 2007-08), this paper examine the effect of remittances on the marginal spending behavior of households in India. Majority of the households reported that they spent remittances on food items, clothing bedding and foot wears, healthcare and educating the household members and on durable goods etc. The share of expenditure on difference heads with respect to receipts of remittance, however, suggests that households receiving remittances spend 2 per cent less at the margin on food articles compared to households those who do not receive remittances. Further, households receiving remittances spend more at the margin on education (12 per cent), clothing and bedding & foot wears (1.5 per cent) and durable consumer goods (6 per cent), compared to those who do not receive any remittance. These findings support the theoretical argument that remittances help to increase the level of investment in human and physical capital and play an important role in raising the standard of living of the households

Two Distributed Algorithms for E-ticket Validation Protocols for Mobile Clients

The e-ticket (electronic ticket) validation problem has relevance in mobile computing environment because of the multiple submission of a ticket that is possible due to intermittent disconnections and mobility of hosts. Here, we propose protocols that are not only sensitive to disconnection but also to location. One of the proposed protocols is the variant of the distributed protocol proposed by Pedone (2000) for Internet users. This shows that a distributed protocol for static network can be restructured for distributed computation in a mobile computing environment. We have also proposed another protocol that uses a hierarchical location database of mobile hosts (Pitoura and Samaras, 2001)

Public health insurance coverage in India before and after PM-JAY:Repeated cross-sectional analysis of nationally representative survey data

Introduction:The provision of non-contributory public health insurance (NPHI) to marginalised populations is a critical step along the path to universal health coverage. We aimed to assess the extent to which Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) - potentially, the world's largest NPHI programme - has succeeded in raising health insurance coverage of the poorest two-fifths of the population of India. Methods:We used nationally representative data from the National Family Health Survey on 633 699 and 601 509 households in 2015-2016 (pre-PM-JAY) and 2019-2021 (mostly, post PM-JAY), respectively. We stratified by urban/rural and estimated NPHI coverage nationally, and by state, district and socioeconomic categories. We decomposed coverage variance between states, districts, and households and measured socioeconomic inequality in coverage. For Uttar Pradesh, we tested whether coverage increased most in districts where PM-JAY had been implemented before the second survey and whether coverage increased most for targeted poorer households in these districts. Results:We estimated that NPHI coverage increased by 11.7 percentage points (pp) (95% CI 11.0% to 12.4%) and 8.0 pp (95% CI 7.3% to 8.7%) in rural and urban India, respectively. In rural areas, coverage increased most for targeted households and pro-rich inequality decreased. Geographical inequalities in coverage narrowed. Coverage did not increase more in states that implemented PM-JAY. In Uttar Pradesh, the coverage increase was larger by 3.4 pp (95% CI 0.9% to 6.0%) and 4.2 pp (95% CI 1.2% to 7.1%) in rural and urban areas, respectively, in districts exposed to PM-JAY and the increase was 3.5 pp (95% CI 0.9% to 6.1%) larger for targeted households in these districts. Conclusion:The introduction of PM-JAY coincided with increased public health insurance coverage and decreased inequality in coverage. But the gains cannot all be plausibly attributed to PM-JAY, and they are insufficient to reach the goal of universal coverage of the poor.</p

Engineering Solutions to Improve the Removal of Fecal Indicator Bacteria by Bioinfiltration Systems during Intermittent Flow of Stormwater

Bioinfiltration systems facilitate the infiltration of urban stormwater into soil and reduce high flow events and flooding. Stormwater carries a myriad of pollutants including fecal indicator bacteria (FIB). Significant knowledge gaps exist about the ability of bioinfiltration systems to remove and retain FIB. The present study investigates the ability of model, simplified bioinfiltration systems containing quartz sand and iron oxide-coated quartz sand (IOCS) to remove two FIB (Enterococcus faecalis and Escherichia coli) suspended in synthetic stormwater with and without natural organic matter (NOM) as well as the potential for accumulated FIB to be remobilized during intermittent flow. The experiments were conducted in two phases: (1) the saturated columns packed with either sand or IOCS were contaminated by injecting stormwater with bacteria followed by injection of sterile stormwater and (2) the contaminated columns were subjected to intermittent infiltration of sterile stormwater preceded by a pause during which columns were either kept saturated or drained by gravity. During intermittent flow, fewer bacteria were released from the saturated column compared to the column drained by gravity: 12% of attached E. coli and 3% of attached Ent. faecalis were mobilized from the drained sand column compared to 3% of attached E. coli and 2% attached Ent. faecalis mobilized from the saturated sand column. Dry and wet cycles introduce moving air–water interfaces that can scour bacteria from grain surfaces. During intermittent flows, less than 0.2% of attached bacteria were mobilized from IOCS, which bound both bacteria irreversibly in the absence of NOM. Addition of NOM, however, increased bacterial mobilization from IOCS: 50% of attached E. coli and 8% of attached Ent. faecalis were released from IOCS columns during draining and rewetting. Results indicate that using geomedia such as IOCS that promote irreversible attachment of bacteria, and maintaining saturated condition, could minimize the mobilization of previous attached bacteria from bioinfiltration systems, although NOM may significantly decrease these benefits

Heavy lepton pair production in nucleus-nucleus collisions at LHC energy - a case study

We present a study of $\tau^{+}\tau^{-}$ lepton pair production in Pb+Pb collisions at $\sqrt{s_{NN}}$ = 5.5 TeV. The larger $\tau^{\pm}$ mass ($\sim$ 1.77 GeV) compared to $e^{\pm}$ and $\mu^{\pm}$ leads to considerably small hadronic contribution to the $\tau^{+}\tau^{-}$ pair invariant mass ($M$) distribution relative to the production from thermal partonic sources. The quark-anti-quark annihilation processes via intermediary virtual photon, Z and Higgs bosons have been considered for the production of $\tau^{+}\tau^{-}$. We observe that the contribution from Drell-Yan process dominates over thermal yield for $\tau^{+}\tau^{-}$ pair mass from 4 to 20 GeV at the LHC energy. We also present the ratio of $\tau$ lepton pair yields for nucleus-nucleus collisions relative to yields from p+p collisions scaled by number of binary collisions at LHC energies as a function $\tau$ pair mass. The ratio is found to be significantly above unity for the mass range 4 to 6 GeV. This indicates the possibility of detecting $\tau^{+}\tau^{-}$ pair from quark gluon plasma (QGP) in the mass window $4\leq M$(GeV)$\leq 6$.Comment: Five pages with one LaTeX file and three eps files for figure

Correlatiing Growth, Yield and Adoption of Urdbean Technologies

ABSTRACT in farmers&apos; practices during 2008. The result revealed that even in case of lowest yield under FLD, the increase was recorded to be 43 per cent over the farmers&apos; practice in the year 2005. The economic viability and profitability showed that the benefit cost ratio (B: C) was higher in the case of improved agro-technologies (FLD) with 2.60 as against 1.94 in farmers&apos; practice (FP). The net return from improved agro-technologies (FLD) wa

Multidimensional Poverty and Child Survival in India

Background: Though the concept of multidimensional poverty has been acknowledged cutting across the disciplines (among economists, public health professionals, development thinkers, social scientists, policy makers and international organizations) and included in the development agenda, its measurement and application are still limited. Objectives and Methodology: Using unit data from the National Family and Health Survey 3, India, this paper measures poverty in multidimensional space and examine the linkages of multidimensional poverty with child survival. The multidimensional poverty is measured in the dimension of knowledge, health and wealth and the child survival is measured with respect to infant mortality and under-five mortality. Descriptive statistics, principal component analyses and the life table methods are used in the analyses. Results: The estimates of multidimensional poverty are robust and the inter-state differentials are large. While infant mortality rate and under-five mortality rate are disproportionately higher among the abject poor compared to the nonpoor, there are no significant differences in child survival among educationally, economically and health poor at the national level. State pattern in child survival among the education, economical and health poor are mixed. Conclusion: Use of multidimensional poverty measures help to identify abject poor who are unlikely to come out of poverty trap. The child survival is significantly lower among abject poor compared to moderate poor and non-poor. We urge t

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions