Equitable Pricing of Episodes of Care in a Cluster-Based Bundled Payment System

Most of the individuals in the United States are concerned about healthcare affordability and rising healthcare costs. The prevalent healthcare cost reimbursement system, Fee-For-Service (FFS) has been deemed as a key driver for increasing healthcare costs. Bundle payments (BP) has been suggested as an alternative to replace FFS and has shown to reduce the rising healthcare costs. Under BP, the expected set of services involved in treating a diagnosis, or episode of care, is reimbursed by a single payment. We propose a systemic pricing of multiple diagnosis under a Cluster-Based Bundle Payment system (CBBP), where for a given diagnosis, groups of encounters with homogeneous service patterns are reimbursed by a single price. Through a two-stage multicriteria optimization model, we systemically price clusters of encounters to make highly critical episodes of care more affordable by collecting more revenue from less critical clusters across all episodes of care while mitigating the overall financial risks which can facilitate the implementation of BP and CBBP on a larger scale. The criticality of an episode of care and their clusters of encounters is obtained via Analytic Hierarchy Process (AHP) as a function of their average costs levels, average overpayments, and number of encounters. We compare the results of our proposed methodology with a benchmark model where pricing is done using the mean FFS cost for the 153 most expensive episodes of care in the Greater Rochester area for 2007. The proposed methodology offers a systematic approach for reimbursing episodes of care depending on their criticality, and improving the affordability and lowering of overpayment costs across any given range of episodes of care

Invasive genetic testing in pregnancy: experience from a tertiary care center

Background: Evaluation of outcome of pregnancies with high risk first trimester screening or abnormal ultrasonographic findings and complications of amniocentesis in second trimester and chorionic villous sampling in first trimester in a tertiary care hospital in India.Methods: This is a retrospective study in a tertiary care hospital from 2015 to 2017. All antenatal patients underwent combined nuchal translucency scan and dual screen ratio and who detected to have high risk for trisomy, they underwent amniocentesis/CVS. These procedures were done at minor OT in our hospital, taking aseptic precaution and under ultrasound guidance. First trimester combined screening included a detail nuchal translucency scan as per the international society of ultrasound in obstetrics and gynecology (ISUOG) guidelines and also biochemical screening done with serum beta human chorionic gonadotrophin (HCG) and pregnancy-associated plasma protein A (PAPP-A) in same genetic lab. Combined risk scoring done as high risk or low risk. Low risk patients without any genetic abnormality in previous obstetric history were followed as normal pregnancy. Results, complications and outcome of invasive genetic testing in pregnancy was observed. At our center CVS was done mostly for single gene disorder.Results: Out of 179 patients who underwent amniocentesis, total abnormal chromosomal were 14 (7.82%). The most common abnormality was trisomy 21 (4.46%). The other abnormalities were trisomy 18 (1.67%), trisomy 13 (1.11%) and triploidy XXY (0.55%). CVS was done for Nieman Pick disease, androgen insensitivity syndrome, both parents thalassemia minor and ultrasound abnormality detected early in pregnancy. For single gene disorder mutation identified in index case or in parents and same mutation looked in to fetus by chorionic villus sampling (CVS). For Nieman Pick disease, androgen insensitivity syndrome and both parent thalassemia minor, fetus detected to have heterozygous for same and nonpathogenic. Two patients underwent CVS for ultrasound abnormality out of which one detected to have trisomy 18 and other had loss of 2.1 Mb on Ch 22 in 22q11.21 region.Conclusions: Combined first trimester screening with nuchal translucency scan and dual screen ratio is an efficient method of screening with high sensitivity and low false positive rates. In our study prevalence of trisomy is slightly greater than other studies because number of patients were less and if we increase the number of patients probably we will have a prevalence data of trisomy similar to other studies which has been done for aneuploidy in fetus.

Cervical tuberculosis: a diagnostic dilemma in young mimicking cervical cancer

Genital tuberculosis (TB) is a disease that is still prevalent in third world countries but TB involving the cervix is a rare finding. It accounts for 0.1-0.65% of all cases of TB and nearly 5-10% cases of genital TB. Common presentation is persistent offensive vaginal discharge with either exophytic, ulcerative, interstitial or endo-cervical polypoidal growth over the cervix. We report here a rare presentation of cervical TB in young who presented with secondary amenorrhoea with ulcerative lesions over the cervix masquerading a cervical malignancy on local examination. Cervical biopsy revealed granulomatous cervicitis. The patient was managed with anti-TB treatment (ATT) for 6 months with resumption of menses and complete healing of the cervical lesion. Diagnosis of cervical TB is difficult clinically as it mimics an ulcerative variety of cancer cervix very closely. Confirmation is always by a cervical biopsy. This entity though rare can be entertained as a differential diagnosis in patients with cervical growth along with schistosomiasis, brucellosis and sarcoidosis

A SIMPLIFIED PROCESS FOR PURIFICATION OF KUTKIN FROM PICRORHIZA KURROA ROYALE EX BENTH

The present invention relates to development of a simplified process for purification of kutkin from Picrorhiza kurroa Royle ex Benth. Particularly, this invention relates to separation of kutkin (also known as picroliv R) from Picrorhiza kurroa underground parts by aqueous alcohol extraction, solvent - solvent partition, treatment with activated charcoal to remove colouring matters. The processing steps of the invention results into 2.0-3.0% yield. The process gave higher recovery of picroliv from the extract and 3.2% from plant powder (dry basis)

A PROCESS FOR OBTAINING b-AESCIN FROM INDIAN HORSE CHESTNUT (AESCULUS INDICA).

A process for obtaining p-aescin from Indian horse chestnut (Aesculus indica The present invention relates to development of a process for purification of (3-aescin from Indian horse chestnut (Aesculus indica). Aescin was obtained from Indian horse chestnut (Aesculus indica seeds) by drying, grinding and extracting with water and ethyl/methyl alcohol mixture followed by removal of organic solvent and fractionation of aqueous layer with butanol/ isopropanol saturated with water. Treating the organic layer i.e. Butanol/isopropanol fraction with base in a separating funnel with gentle shaking. Washing of base treated organic layer with water saturated with butanol followed by passing of organic layer through acidic alumina. Distilling the organic layer to yield aescin as white amorphous powder. The yield is 2.0-3.0% and purity is minimum 90%

Investigation of Ethyl Acetate Extract/Fractions of Acacia nilotica willd. Ex Del as Potent Antioxidant

This study was planned to evaluate the antioxidant activity of ethyl acetate extract/fractions of Acacia nilotica Willd. Ex. Del extracted with different solvents of increasing and decreasing order of solvent polarity. The antioxidative activities, including the 1’-1’ diphenylpicryl-hydrazyl (DPPH) radical-scavenging effects, hydroxyl radical scavenging potential, chelating ability, reducing power and lipid peroxidation inhibition in rat tissue homogenate were studied in vitro. It was found that the antioxidative effect provided by extract/fractions was strongly concentration dependent and increased on fractionating the extract into water and ethyl acetate fractions. In general, the antioxidative activity increased with increasing extract/fractions concentration to a certain extent, and then leveled off with further increase in antioxidant activity. From a comparison of the antioxidant potential and IC 50 values for different antioxidative reactions, it seemed that extract/fractions were more effective in scavenging DPPH and hydroxyl radicals than reducing, chelating heavy metals and lipid peroxidation inhibitory potential

Traditional practices of utilization and conservation of non-wood forest products by Adi tribes of Arunachal Pradesh

The survey was carried out during 2009-11 to collect the information of Non-Wood Forest Products (NWFPs) utilized by the Adi tribes of East Siang District of Arunachal Pradesh. It was observeds that Adi tribes used to collect different NWFPs such as wild fruits (Artocarpus heterophyllum Lam., Castanopsis indica (Roxb. ex Lindl.) A. DC., Canarium strictum Roxb. etc.), vegetables (Bauhinia variegata L., Clerodendrum colebrookianum Walp., Diplazium esculentum (Retz.) Sw., Moringa oleifera Lam. etc.), spices (Cinnamomum tamala Nees & Eber.,Cinnamomum zeylanicum Blume. and Piper longum L.), fibres (Calamus flagellum Griff. ex Mart., Dendrocalamus hemiltonii Nees et Arn. ex Munro, Pandanus nepaulensis H. St. John and Sterculia villosa Roxb.), floss (Bombax ceiba L.,), broom grass (Thysanolaena maxima (Roxb.) Ktze.), thatching material (Livistona jenkinsiana Griff.), various bamboo and cane species, and other miscellaneous products from the forests and community lands. NWFPs played a significant role in supporting the livelihood of Adi tribes as it has been observed that 32.50 %, 56.67 % and 10.83 % people were earning < Rs. 3000, Rs. 3000 - 6000 and > Rs. 6000, respectively from the sale of different NWFPs. Majority of respondents (80.83 %) were having the opinion that the availability of different NWFPs has declined considerably and maximum (85 %) respondents advocated that the availability of these products would further decrease in future also. Further, Adi tribal community is playing an important role in conservation of different NWFPs yielding species by domesticating them in their home gardens

E-Governance: An Approach towards Nation Development

ABSTRAC

A review of laser scanning for geological and geotechnical applications in underground mining

Laser scanning can provide timely assessments of mine sites despite adverse challenges in the operational environment. Although there are several published articles on laser scanning, there is a need to review them in the context of underground mining applications. To this end, a holistic review of laser scanning is presented including progress in 3D scanning systems, data capture/processing techniques and primary applications in underground mines. Laser scanning technology has advanced significantly in terms of mobility and mapping, but there are constraints in coherent and consistent data collection at certain mines due to feature deficiency, dynamics, and environmental influences such as dust and water. Studies suggest that laser scanning has matured over the years for change detection, clearance measurements and structure mapping applications. However, there is scope for improvements in lithology identification, surface parameter measurements, logistic tracking and autonomous navigation. Laser scanning has the potential to provide real-time solutions but the lack of infrastructure in underground mines for data transfer, geodetic networking and processing capacity remain limiting factors. Nevertheless, laser scanners are becoming an integral part of mine automation thanks to their affordability, accuracy and mobility, which should support their widespread usage in years to come