Air pollution in Delhi: A review of past and current policy approaches

Delhi National Capital Region (Delhi NCR) is facing serious challenges linked to worrying levels of air pollution (mainly NO2, PM10 and PM2.5). The CADTIME prject (Clean Air in Delhi through Implementation, Mitigation and Engagement) aims to understand what is required to deliver significant reductions in levels of air pollution. This paper presents the results of the first stage of the project: it firstly contextualises the challenges of air quality management in Delhi within the broader evolution of environmental policies and governance in India, with particular consideration to the tensions between environmental protection and the country's development objectives. Secondly, it sets out how CADTIME will combine multiple source qualitative and quantitative data to develop an air quality action plan and an implementation strategy. In particular, through two workshops with local and national experts and stakeholders, and two rounds of focus groups with citizens of Delhi we will contrast stakeholders' priorities and preferences for existing and potential solutions to air pollution with citizens' lived experiences, thus assessing the political/technical feasibility and public acceptability of current and proposed measures. Furthermore, we will complement the primary qualitative data with a critical review examining the successes and failures of UK and European policies to draw lessons that can be relevant for Delhi and to avoid ineffective policies and achieve cost-effective solutions for the city in the shortest possible time

Air Pollution in Delhi: A Review of Past and Current Policy Approches

Delhi National Capital Region (Delhi NCR) is facing serious challenges linked to worrying levels of air pollution (mainly NO2, PM10 and PM2.5). The CADTIME prject (Clean Air in Delhi through Implementation, Mitigation and Engagement) aims to understand what is required to deliver significant reductions in levels of air pollution. This paper presents the results of the first stage of the project: it firstly contextualises the challenges of air quality management in Delhi within the broader evolution of environmental policies and governance in India, with particular consideration to the tensions between environmental protection and the country’s development objectives. Secondly, it sets out how CADTIME will combine multiple source qualitative and quantitative data to develop an air quality action plan and an implementation strategy. In particular, through two workshops with local and national experts and stakeholders, and two rounds of focus groups with citizens of Delhi we will contrast stakeholders’ priorities and preferences for existing and potential solutions to air pollution with citizens’ lived experiences, thus assessing the political/technical feasibility and public acceptability of current and proposed measures. Furthermore, we will complement the primary qualitative data with a critical review examining the successes and failures of UK and European policies to draw lessons that can be relevant for Delhi and to avoid ineffective policies and achieve cost-effective solutions for the city in the shortest possible time

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Cost estimation models for drinking water treatment unit processes

223-235<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "times="" new="" roman";mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:="" minor-latin;mso-bidi-font-family:"times="" roman";mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">Cost models for unit processes typically utilized in a conventional water treatment plant and in package treatment plant technology are compiled in this paper. The cost curves are represented as a function of specified design parameters and are categorized into four major categories: construction, maintenance materials, energy and labour. The cost curves are developed so that cost indices may be used to update cost estimates from the base year. These models can be used to assist in making decisions related to construction of new water treatment facilities or modification of existing water treatment processes to meet drinking water standards or provide improved water quality. They can also be used as a part of sophisticated economic evaluation such as the calculation of cost to benefit ratios.</span

One-step synthesis of noble metal–titanium dioxide nanocomposites in a flame aerosol reactor

Noble metal–titanium dioxide nanocomposites (Pt/TiO2, Pd/TiO2 and bimetallic Pt-Pd/TiO2) were synthesized in one step using a flame aerosol reactor (FLAR). The specific surface area, crystal phase and morphology of the nanocomposites were controlled by adjusting the reactant concentration and the temperature–time history in the reactor. The synthesized nanomaterials were characterized using transmission electron microscopy (TEM), electron diffraction, X-ray diffraction (XRD) and nitrogen adsorption (BET). Nanocomposites with 0.5–3.0% (wt%) noble metal loading were synthesized. Nanosized noble metal particles (2–4 nm) were dispersed on the 30–40 nm TiO2 surface with an overall specific surface area in the range of 40–60 m2/g. The specific surface area increased with increasing noble metal loading. For the chosen flame conditions, a mixture of anatase and rutile phase was obtained without noble metal addition. On incorporation of the noble metal, the formation of the rutile phase of titanium dioxide was suppressed. The synthesized nanocomposites were tested for the photocatalytic oxidation of methyl orange dye in an aqueous phase. Platinum particles dispersed on the TiO2 surface enhanced the photocatalytic activity compared to pristine TiO2. The existence of an optimum platinum loading for the highest photocatalytic activity was confirmed, and was approximately 0.5–1.0% Pt. Palladium addition had a detrimental effect on the photocatalytic activity of titanium dioxide. Bimetallic noble metal catalysts (Pt-Pd/TiO2) showed enhanced photocatalytic activity compared to pristine titanium dioxide, but lower than platinum (only)–titanium dioxide nanocomposites.© Elsevie

A Comparative Pilot Study to Evaluate the Adjunctive Role of Levosulpride with Trigger Point Injection Therapy in the Management of Myofascial Pain Syndrome of Orofacial Region

Uvod: Dojenje je vještina koju uče i majka i dijete, a pogreške znače da im treba malo vremena za uskladiti se. Uz dobru potporu, savjete i upornost, trud se isplati jer majka i dijete imaju priliku iskusiti jedan od najljepših osjećaja na svijetu, a za dijete i najzdraviji. Cilj: Utvrditi stupanj zadovoljstva majki edukacijom o dojenju, duljinu dojenja, razloge prestanka dojenja te izvor najbolje edukacije. Metode i obrada: Istraživanje je provedeno online anketom. Sudjelovanje je bilo dobrovoljno i anonimno. Ispitanici su bile majke – doilje, članice društvene mreže Facebook.com i to grupa Roda – Roditelji u akciji, posjetiteljice Facebook stranica Hrvatske komore primalja te Sveučilišnog odjela zdravstvenih studija Sveučilišta u Splitu. Istraživanje je provedeno u veljači i ožujku 2017. godine online anketom koja se sastojala od 12 pitanja. Za obradu je korištena deskriptivna statistika. Za određivanje srednje vrijednosti korišten je medijan. Rezultati: U istraživanju je sudjelovalo 1064 ispitanica. Ukupno 58 % ispitanica imalo je uspješan podoj u prvih sat vremena po porodu, 60 % ispitanica poticano je na dojenje od stane zdravstvenog osoblja rodilišta. Ukupno 66 % ispitanica još uvijek doji dijete, dok 34 % ispitanica ne doji više. Samo 4 % ispitanica navelo je da je odustalo od dojenja jer nije znalo kako dojiti dijete. Prosječna duljina dojenja je kod ispitanica je 13 mjeseci (0-48). Najučestaliji razlog prestanka dojenja su: zdravstveni razlozi - 27 %, nedostatak mlijeka - 21 %, dijete nije željelo više - 19 %. Najveći broj ispitanica (31 %) najzadovoljniji je informacijama dobivenima od grupa za potporu dojenja, zatim informacijama s interneta (26 %), patronažnim sestrama (12 %), majkama, bakama, prijateljicama (10 %), osobljem rodilišta (10 %), dok su najmanje zadovoljne informacijama, odnosno dobivene informacije su im najmanje pomogle iz ordinacije izabranog ginekologa. Zaključak: Unatoč impozantnom uzorku, kada je riječ o dojenju, istraživanje bi trebalo proširiti i napraviti na nacionalnoj razini. Budući je dojenje, možemo slobodno reći, od državnog interesa, potrebno je uključiti sve razine društva te uz donošenje strategija iznalaziti i načine kako da se poveća stopa dojene djece. Edukacija je polazište i osnovna intervencija kojom se osigurava dojenje te bi formalni načini edukacije trebali biti dostupniji trudnicama i majkama. Posjeti patronažnih sestara koje su prošle tečaj za savjetnicu dojenja, jačanje preventivne uloge djelovanja primarne zdravstvne zaštite te pružanje provjerenih i pravovremenih informacija ključ je uspjeha stvaranja zdravih temelja za početak novog života. Korištenje interneta i društvenih mreža bitno olakšava situaciju i komunikaciju s majkama što izravno doprinosi uspostavi i uspjehu dojenja.Introduction: Breastfeeding is a skill which both mother and child learn, and the errors mean they need more time to comply. With good support, advices and persistence, the effort is worth it because both mother and child have the opportunity to experience one of the most beautiful feelings in the world, and for the child the healthiest. Aim: To determine the degree of satisfaction of mothers with breastfeeding education, duration of breastfeeding, reasons for discontinuance of breastfeeding and source of the best education. Methods and processing: The study was conducted with an online questionnaire. Participation was voluntary and anonymous. The participants were mothers - breastfeeding mothers, members of the social network Facebook.com, group Roda- Roditelji u akciji and visitors of Facebook pages: Croatian chamber of midwives and University Department for Health Studies University of Split. The study was conducted in February and March 2017 with an online questionnaire consisting of 12 questions. Processing was done using descriptive statistics. Median was used for determination of average value. Results: The study included 1064 women. 58% of participants had successful breastfeeding in the first hour after birth, 60% of participants received encouragement from the medical staff of hospital to breastfeed. 66% of participants are still breastfeeding, while 34% of participants don’t breastfeed anymore. Only 4% of participants indicated they gave up breastfeeding because they did not know how to do it. The average length of lactation in the participants was 13 months (0-48). The most common reason for discontinuance are health reasons (27%), lack of milk (21%), the child’s refusal (19%). Most participants (31%) were satisfied with the information obtained from a breastfeeding support group, then the information from the Internet (26%), district nurses (12%), mothers, grandmothers, friends (10%), hospital employees (10%), while they are the least satisfied with the information they got from their chosen gynaecologist i.e. these information were least helpful. Conclusion: Despite impressive sample size, research should be expanded and raised to the national level. Breastfeeding is, we can say, of national interest, it is necessary to involve all levels of society in making strategies to find the ways to increase the rate of breastfed infants. Education is the starting point and basic intervention to ensure breastfeeding, and formal methods of education should be accessible to pregnant women and mothers. District nurses who have undergone a course of breastfeeding counselling, strengthening of preventive action roles of primary health care as well as providing trustworthy and timely information are the key to the success of creating a healthy foundation to start a new life. The use of the Internet and social networks makes situation and communication between mothers much easier, which contributes directly to the establishment and success of breastfeeding

Numerična analiza sistema dvostopenjskega ejektorja-difuzorja na osnovi konstantne hitrosti sprememb kinetične energije

Supersonic ejector energy flow devices are extensively used in various applications, such as pumping, mixing, compression, etc. The conventional single-stage ejector (SSE) design approaches are inefficient for modelling an efficient ejector because of their inefficiency in minimizing mixing losses in the mixing chamber, thermodynamic shock in constant area diffuser, and utilization of redundant discharged momentum at the exit of the first stage. The physics-based single-stage ejector design has better solutions because it minimizes irreversibility due to thermodynamic shocks. The present study utilizes the constant rate of a kinetic energy change physics-based approach to design a two-stage ejector (TSE) for water vapour. The computational fluid dynamics (CFD) tool ANSYS-Fluent has been utilized to predict flow characteristics. The performance of the ejector-diffuser system has also been compared with a single-stage ejector. It is found that the performance of TSE is 70 % higher than that of the performance of SSE