A Study of Alienation in the Novels of Bapsi Sidhwa and Rohinton Mistry

Bapsi Sidhwa and Rohinton Mistry are diasporic award winning Pakistani and Indian novelists respectively. Both of the writers have migrated to foreign countries; Bapsi Sidhwa to America and Rohinton Mistry to Canada. Bapsi Sidhwa was born in Karachi in 1939 which was then in undivided India while Rohinton Mistry was born in Bombay on July 3, 1952 after Independence of India. Both the writers mentioned here, are Parsis and their community made India its home some centuries ago after the Arab invasion on Persia (Iran). According to Jagdish Batra, “Their exodus to India started after a century or so. The documentary evidence speaks of a stream of migrants from 785 to 1021 A.D. However, trade and cultural relations between India and Persian Empire existed since, at least, the third century A.D. According to Kissa-I Sanjan written in Persian by Dastur Sanjana, the migrating Parsis were received by the king of a coastal region in Gujarat- Jadhav Rana, who gave them permission to settle down on certain conditions.” (Rohinton Mistry: Identities, Values and Other Sociological Concerns 34) They can be said to lead a life of up rootedness from their original roots. But the migration of Bapsi Sidhwa and Rohinton Mistry to foreign lands is tantamount to their ‘doubly displaced’ status. As the Parsis were forced into exile by the Islamic conquest of Persia, both-Bapsi Sidhwa and Rohinton Mistry’s are in Diaspora even in India as their ancestors were also included the lot of the exiled Parsis. It is for this reason that their writings are replete with the experience of double displacement. The present paper intends to find out the phenomenon of this feeling of search for their lost home and also tries to find out to which extent these elements of alienation and marginality are present in their novels with special reference to The Bride, An American Brat and The Crow Eaters of Bapsi Sidhwa and A Fine Balance,, Family Matters and Such a Long Journey of Rohinton Mistry

Portryal of Socio-Political Conditions of the Period in the Novels of Bapsi Sidhwa and Rohinton Mistry

The present paper tries to find out the various accounts of socio-political conditions of the period that have been infused in the novels of Bapsi Sidhwa and Rohinton Mistry. As it is known that both these novelists are in Diaspora—Bapsi Sidhwa presently living in America and Rohinton Mistry in Canada, they have huge knowledge and experience of societies and cultures they have come across since their birth. They have thus gathered the experiences of not only the country of their birth but also the knowledge and experiences of culture, civilization and heritage of the country of their adoption. It is therefore expected that they will by and large, cast the instances of such happenings in their works too. However the paper has picked up An American Brat, Ice-Candy-Man, and The Crow Eaters of Bapsi Sidhwa and Rohinton Mistry’s A Fine Balance for the purpose

Cross Layer Aware Adaptive MAC based on Knowledge Based Reasoning for Cognitive Radio Computer Networks

In this paper we are proposing a new concept in MAC layer protocol design for Cognitive radio by combining information held by physical layer and MAC layer with analytical engine based on knowledge based reasoning approach. In the proposed system a cross layer information regarding signal to interference and noise ratio (SINR) and received power are analyzed with help of knowledge based reasoning system to determine minimum power to transmit and size of contention window, to minimize backoff, collision, save power and drop packets. The performance analysis of the proposed protocol indicates improvement in power saving, lowering backoff and significant decrease in number of drop packets. The simulation environment was implement using OMNET++ discrete simulation tool with Mobilty framework and MiXiM simulation library.Comment: 8 page

A COMPARATIVE STUDY OF PRE AND POST-OPERATIVE REFRACTIVE ERRORS IN CATARACT SURGERY – PHACO & SICS.

Background:  The method of phacoemulsification for cataract surgery is preferred by surgeons, but it is not an affordable method. On the other hand, small-incision cataract surgery performed manually is economically affordable. This is a comparative study conducted prospectively to analyze the visual ability of the patients who had cataract extraction surgery by either of the methods. Methods:  50 patients had cataract extraction by phacoemulsification and another 50 patients who underwent manual incision cataract surgery were included in the prospective comparative study. The refractive errors and the visual acuity of the subjects were evaluated in the follow-ups conducted after a day, three days, a week, three weeks, for weeks, six weeks, and 12 weeks after the surgery. The results obtained were statistically compared. Results:  The observations of the refractive errors after the surgery were comparable in both methods. The difference in the refractive errors was significant with phacoemulsification and manual small-incision cataract surgery. However, the visual acuity was better than the preoperative baseline visual acuity. Conclusion:  Phacoemulsification is a superior method for cataract surgery when compared to the manual incision method in terms of the occurrence of refractive errors after the surgery. Recommendation: The history of any ocular surgery or contact lens use must be documented. Accurate preoperative measurements should be verified and repeated if they do not make sense

AN OBSERVATIONAL STUDY ON THE EFFICACY AND SAFETY FOR THE COMBINATION OF LUTEIN, VITAMIN C, ZEAXANTHIN, ZINC, COPPER, AND VITAMIN E IN INDIAN PATIENTS OF AGE-RELATED MACULAR DEGENERATION (AMD).

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the elderly population, particularly those over the age of 65. The progressive decline in visual function experienced by individuals with AMD significantly impacts their daily lives and incurs their social activities and independence. This study aims to conduct a post-marketing investigation of a fixed-dose combination created for patients in India affected with AMD, evaluating its safety and efficiency. Material and Methods: In this research, a total of 450 participants were registered in the span of 10 months. The study was conducted at Anugrah Narayan Magadh Medical College, Gaya, Bihar. During the research, efficacy and safety assessments were conducted on every visit conducted after 3 months. The efficacy assessment involved the use of two parameters, namely vision-related quality of life (VRQOL) and vision impairment score, which were obtained by the administration of a Vision Impairment Questionnaire. Results: Assessing the patients with the help of vision impairment and VRQOL test, the following were the observations- For the VRQOL test, on the 2nd and the 3rd visit, the VRQOL increased by 19% and 33% that compared to the first assessment, this indicates a positive impact of the dosage administered. For the Vision impairment test, on visit 1 the percentage was 23% which further reduced to 15% by the second visit and 11% approx.  Conclusion: After the successful investigation, the combination of Vit C (250 mg), Cu (1 mg), Zn (40 mg), Lutein (5 mg), Vit E (200 IU), and Zeaxanthin (1 mg) per capsule was determined to be both effective and safe in treating age-related macular degeneration (AMD) in Indian patients. Recommendation: It is to consult an eye-care professional as soon as possible if vision changes and also continue to attend routine sight tests with an optometrist

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.