Promoting Socio-Economic Equity in South Asia: Challenges and Prospects

For the past decade or so, questions related to equity have been front loaded on the global agenda of economic growth and development. Equity has an umbilical but extremely uneasy relationship with growth. It is almost meaningless to talk of equity if there is no growth, and growth, in the long run, may be seriously imperilled and jeopardised if it thwarts equity. The vision of “Growth with Equity”, so assiduously projected during the Sixties and the Seventies sadly stands shaken if not shattered. The illusion of “trickle-down” mythology has been exposed. Pope Francis, in a paper written in November 2013, described the “trickle-down theories” as “never being confirmed by facts”, adding that these theories express “a crude and naïve trust in the goodness of those wielding economic power and in the sacralised workings of the prevailing economic system.” A few months later, in April 2014, the Pontiff again twitted: “Inequality is the root of social evils.” Reading this tweet, my memory was thrown back to the early seventies when Indira Gandhi of India called poverty the greatest polluter of human society. DOI: 10.5281/zenodo.336690

Arms build-up and development: linkages in the Third World

In this monograph Dr S.D. Muni examines the linkages between arms build-up and development in the Third World. The linkages are very complex and the field of study is both vast and new. These linkages have, therefore, been viewed in this monograph from a broad perspective. The question of the interrelationship between development and armaments is vitally important for peace and security in the world. Though attention has been paid to this factor in the last few years, systematic and rigorous studies have yet to emerge

Hyperv Alent Iodine Mediated Oxidative Annulations and cross Dehydrogenative Couplings

Iodine is a special element. Its speciality lies in the fact that it is the heaviest non radioactive element in the periodic table and it is the most polarizable of the halogens. Amongst many iodine compounds that we have observed hypervalent(polyvalent )iodine compounds are the best. The time from 1990 onwards has seen a streak advancement of the applications of Hypervalent Iodine in organic synthesis. Hypervalent iodine compounds have received considerable attention these years because of their non toxic ,recyclable, oxidizing, electrophilic characteristics. Hypervalent Iodine compounds are not only used as SET reagents but also they are used in delivery of many functional groups. They are also used in Azidation ,Aminations, Radical fragmentations ,Oxidative Coupling of aromatic substrates, Oxidation of alkenes and alkynes, Thiocyanations, Arylselenations. Poly Iodide compounds are also used for facile and efficient oxidation of primary alcohols to aldehydes and secondary alcohols to ketones. PhIO2 can generate the alkoxy radicals from alcohols in certain photochemical reactions. Hypervalent iodine reagents are also used as polymerization initiators(ex Diaryl iodonium salts). There are many hypervalent iodine reagents. To name a few we have PIDA, PIFA ,IBX,DMP etc. Chemists have successfully conducted the reactions of hypervalent iodine in water,recyclable organic solvents, and also in solvent free conditions. Several reviews and books have been published regarding hypervalent iodine which have described its chararcteristics .We have compiled authentic information from 2009-2016 regarding application of hypervalent iodine

Assessment of Environmental Knowledge and Attitudes of Undergraduate Students at Malla Reddy University: A Study on Environmental Ethics

Educating University students at the initial levels can improve their knowledge of environmental issues. A relevant study was conducted at the School of Allied Healthcare Sciences, Malla Reddy University, Hyderabad, India, based on a cross-sectional design. A self-administered questionnaire focused on the socio-demographics, knowledge, and attitudes of 380 students toward environmental ethics was used to collect the data and analyzed by SPSS. The findings include about 50% (N=200) of the students were found to have low knowledge scores; on the other hand, 49.2% (N = 187) of students showed a pro attitude towards environmental issues. Chi2 analysis showed that place of birth and courses undergoing (clinical/nonclinical) resulted in a notable relationship with knowledge scores. Pearson's correlation analysis showed that the place of birth (POB) (r=0.143; p=0.05) and clinical/nonclinical courses (r=0.206; p=0.05) had weak relation to knowledge score; a negative, weak correlation was found between attitude score and education levels (r= -0.105; p=0.01) of the students. The present study showed that University students had a moderate level of knowledge of the environment, and about 20% showed a negative attitude toward environmental practices. The present study suggests the need to include environmental awareness programs in corresponding curricula to improve awareness of the environment

Hospitalization rates from radiotherapy complications in the United States

Hospitalizations due to radiotherapy (RT) complications result in significant healthcare expenditures and adversely affect the quality of life of cancer patients. Using a nationally representative dataset, the objective of this study is to identify trends in the incidence of these hospitalizations, their causes, and the resulting financial burden. Data from the National Inpatient Sample was retrospectively analyzed from 2005 to 2016. RT complications were identified using ICD-9 and ICD-10 external cause-of-injury codes. The hospitalization rate was the primary endpoint, with cost and in-hospital death as secondary outcomes. 443,222,223 weighted hospitalizations occurred during the study period, of which 482,525 (0.11%) were attributed to RT. The 3 most common reasons for RT-related hospitalization were cystitis (4.8%, standard error [SE] = 0.09), gastroenteritis/colitis (3.7%, SE = 0.07), and esophagitis (3.5%, SE = 0.07). Aspiration pneumonitis (1.4-fold) and mucositis (1.3-fold) had the highest relative increases among these hospitalizations from 2005 to 2016, while esophagitis (0.58-fold) and disorders of the rectum and anus were the lowest (0.67-fold). The median length of stay of patient for hospitalization for RT complications was 4.1 (IQR, 2.2–7.5) days and the median charge per patient was $10,097 (IQR, 5755–18,891) and the total cost during the study period was$4.9 billion. Hospitalization for RT-related complications is relatively rare, but those that are admitted incur a substantial cost. Use of advanced RT techniques should be employed whenever possible to mitigate the risk of severe toxicity and therefore reduce the need to admit patients

Systematic review and meta-analysis of lung cancer brain metastasis and primary tumor receptor expression discordance

Background: Treatment paradigms for metastatic non-small cell lung cancer are increasingly based on biomarker-driven therapies, with the most common alteration being mutation in the epidermal growth factor receptor (EGFR). Change in expression of such biomarkers could have a profound impact on the choice and efficacy of a selected targeted therapeutic, and hence the objective of this study was to analyze discordance in EGFR status in patients with lung cancer brain metastasis (LCBM). Methods: Using PRISMA guidelines, a systematic review was performed of series in the Medline database of biopsied or resected LCBM published before May, 2020. Key words included “lung cancer” and “brain metastasis” combined with “epidermal growth factor receptor/EGFR,” and “receptor conversion/discordance or concordance.” Weighted random effects models were used to calculate pooled estimates. Results: We identified 501 patients from 19 full-text articles for inclusion in this study. All patients underwent biopsy or resection of at least one intracranial lesion to compare to the primary tumor. On primary/LCBM comparison, the weighted pooled estimate for overall EGFR receptor discordance was 10% (95% CI 5–17%). The weighted effects model estimated a gain of an EGFR mutation in a brain metastases in patients with negative primary tumors was 7% (95% CI 4–12%). Alternatively, the weighted effects model estimate of loss of an EGFR mutation in patients with detected mutations in the primary tumor was also 7% (95% CI 4–10%). KRAS testing was also performed on both primary tumors and LCBM in a subset of 148 patients. The weighted effects estimate of KRAS-mutation discordance among LCBM compared to primary tumors was 13% (95% CI 5–27%). The weighted effects estimated of KRAS gain and loss in LCBM was 10% (95% CI 6–18%) and 8% (95% CI 4–15%), respectively. Meta-regression analysis did not find any association with any factors that could be associated with discordances. Conclusions: EGFR and KRAS mutation status discordance between primary tumor and LCBM occurs in approximately 10% and 13% of patients, respectively. Evaluation of LCBM receptor status is key to biomarker-driven targeted therapy for intracranial disease and awareness of subtype switching is critical for those patients treated with systemic therapy alone for intracranial disease

Factors associated with unplanned readmissions and costs following resection of brain metastases in the United States

The purpose of this study was to critically analyze the risk of unplanned readmission following resection of brain metastasis and to identify key risk factors to allow for early intervention strategies in high-risk patients. We analyzed data from the Nationwide Readmissions Database (NRD) from 2010–2014, and included patients who underwent craniotomy for brain metastasis, identified using ICD-9-CM diagnosis (198.3) and procedure (01.59) codes. The primary outcome of the study was unplanned 30-day all-cause readmission rate. Secondary outcomes included reasons and costs of readmissions. Hierarchical logistic regression model was used to identify the factors associated with 30-day readmission following craniotomy for brain metastasis. During the study period, 44,846 index hospitalizations occurred for patients who underwent resection of brain metastasis. In this cohort, 17.8% (n = 7,965) had unplanned readmissions within the first 30 days after discharge from the index hospitalization. The readmission rate did not change significantly during the five-year study period (p-trend = 0.286). The median per-patient cost for 30-day unplanned readmission was $11,109 and this amounted to a total of$26.4 million per year, which extrapolates to a national expenditure of $269.6 million. Increasing age, male sex, insurance status, Elixhauser comorbidity index, length of stay, teaching status of the hospital, neurological complications and infectious complications were associated with 30-day readmission following discharge after an index admission for craniotomy for brain metastasis. Unplanned readmission rates after resection of brain metastasis remain high and involve substantial healthcare expenditures. Developing tools and interventions to prevent avoidable readmissions could focus on the high-risk patients as a future strategy to decrease substantial healthcare expense

Adult North Star Network (ANSN): Consensus Document for Therapists Working with Adults with Duchenne Muscular Dystrophy (DMD) - Therapy Guidelines

BACKGROUND The survival of people with Duchenne Muscular Dystrophy (DMD) significantly increased due to improvements in standards of care (SOC) [1]. Consequently, DMD has evolved from a paediatric disease to a severe, chronic, multisystem, adult condition. The published international standards of care advocate specialist multidisciplinary health monitoring through proactive, anticipatory approaches to slow down the effects of the disease and allow advanced, informed decision-making [1–3]. Therapy starts as soon as the diagnosis is made and plays a vital role in symptom management in individuals to improve function, participation and effective quality of life. Therapy interventions for management, differ depending on the setting in which the care is being provided, specifically in terms of the expertise within the teams and resources available within these settings. People with DMD find that when they transition to adult services there is a dearth of expertise and limited access to therapy services. The survey conducted in the UK highlighted substantial differences between the care received by adults and children with the condition [2]. A large proportion of adults with DMD reported increased difficulties with access to professional physiotherapy, particularly at transition from childhood to adulthood. Additionally, having their functional abilities assessed regularly or receiving professional physiotherapy in general were both significantly more difficult to achieve within adult services in the UK. Furthermore, some of the major problems expressed by adults with DMD were mobility and transportation as well as, getting involved in leisure activities and work [3]. Therefore, while pediatric services are predominantly family-centred, after transition the paradigm of patient care changes towards individual-centred with focus on different therapy goals. Those become more tailored to the individuals’ needs, balancing quality of life and management options.This document is aimed at providing guidelines for physiotherapy, occupational therapy and speech and language considerations. The ‘Adult North Star Network’ (ANSN) was founded in 2015 to advance care of adults with DMD living in the UK and to develop a prospective natural history database. There are currently 28 adult centres within the network, caring for at least 700 DMD patients. Transition age is varied depending on services and is generally between the ages of 16 to 18. There is a wide range of severity affecting people with DMD transitioned to adult services, those who are steroid naive will have been permanent wheelchair users for many years and have profound muscle weakness. On the other hand, steroid treated patients will most commonly have good upper limb function, and some maybe ambulant at the time of transition. Additionally the specific type of genetic mutation, compliance to therapy and environmental factors may play a role in disease progression and presentation at transition. The aim of these guidelines is to support therapists working with adults with DMD with little or no experience to assist their clinical practice. Whilst the recommendations can be adopted by other health care systems in the world, we appreciate it will depend on resource availability