Operations management

1st edition, 201

Is 'mainstreaming AYUSH' the right policy for Meghalaya, northeast India?

BACKGROUND: National policy on medical pluralism in India encourages the mainstreaming of AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) systems and the revitalization of local health traditions (LHT). In Meghalaya state in the northeast, the main LHT is its indigenous tribal traditional medicine. This paper presents the perceptions of tribal medicine and of AYUSH systems among various policy actors and locates the tribal medicine of Meghalaya within the policy on medical pluralism currently being implemented in the state, a region that is ethnically and culturally different and predominantly inhabited by indigenous peoples. METHODS: A stakeholder mapping exercise identified appropriate policy actors and 46 in-depth interviews were conducted with policy makers, doctors, academics, members of healer associations and elders of the community. A further 44 interviews were conducted with 24 Khasi and 20 Garo traditional healers. Interview data were supplemented with document analysis and observations. Qualitative data were analyzed using thematic content analysis that incorporated elements of grounded theory. RESULTS: In Meghalaya there is high awareness and utilization of tribal medicine, but no visible efforts by the public sector to support or engage with healers. The AYUSH systems in contrast had little local acceptance but promotion of these systems has led to a substantial increase in AYUSH doctors, particularly homeopaths, in rural areas. Policy actors outside the health department saw an important role for tribal medicine due to its popularity, local belief in its efficacy and its cultural resonance. The need to engage with healers to enhance referral, training, documentation and research of tribal medicine was made. CONCLUSIONS: The wide acceptance of tribal medicine suggests that tribal medicine needs to be supported. The results of the study question the process of the implementation of the 'mainstreaming AYUSH' policy for Meghalaya and highlight the importance of contextualizing health policy within the local culture. A potential role for Health Policy and Systems Research (HPSR) at sub-national levels is also highlighted

An Experiment on Friction

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https://digitalcommons.library.umaine.edu/mmb-vp/4265/thumbnail.jp

Doktor Kot, Doktor Sla - book doctors, plant doctors and the segmentation of the medical market place in Meghalaya, northeast India.

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism

Structure of Triadic Relations in Multiplex Networks

Recent advances in the study of networked systems have highlighted that our interconnected world is composed of networks that are coupled to each other through different "layers" that each represent one of many possible subsystems or types of interactions. Nevertheless, it is traditional to aggregate multilayer networks into a single weighted network in order to take advantage of existing tools. This is admittedly convenient, but it is also extremely problematic, as important information can be lost as a result. It is therefore important to develop multilayer generalizations of network concepts. In this paper, we analyze triadic relations and generalize the idea of transitivity to multiplex networks. By focusing on triadic relations, which yield the simplest type of transitivity, we generalize the concept and computation of clustering coefficients to multiplex networks. We show how the layered structure of such networks introduces a new degree of freedom that has a fundamental effect on transitivity. We compute multiplex clustering coefficients for several real multiplex networks and illustrate why one must take great care when generalizing standard network concepts to multiplex networks. We also derive analytical expressions for our clustering coefficients for ensemble averages of networks in a family of random multiplex networks. Our analysis illustrates that social networks have a strong tendency to promote redundancy by closing triads at every layer and that they thereby have a different type of multiplex transitivity from transportation networks, which do not exhibit such a tendency. These insights are invisible if one only studies aggregated networks.Comment: Main text + Supplementary Material included in a single file. Published in New Journal of Physic

Mathematical Formulation of Multi-Layer Networks

A network representation is useful for describing the structure of a large variety of complex systems. However, most real and engineered systems have multiple subsystems and layers of connectivity, and the data produced by such systems is very rich. Achieving a deep understanding of such systems necessitates generalizing "traditional" network theory, and the newfound deluge of data now makes it possible to test increasingly general frameworks for the study of networks. In particular, although adjacency matrices are useful to describe traditional single-layer networks, such a representation is insufficient for the analysis and description of multiplex and time-dependent networks. One must therefore develop a more general mathematical framework to cope with the challenges posed by multi-layer complex systems. In this paper, we introduce a tensorial framework to study multi-layer networks, and we discuss the generalization of several important network descriptors and dynamical processes --including degree centrality, clustering coefficients, eigenvector centrality, modularity, Von Neumann entropy, and diffusion-- for this framework. We examine the impact of different choices in constructing these generalizations, and we illustrate how to obtain known results for the special cases of single-layer and multiplex networks. Our tensorial approach will be helpful for tackling pressing problems in multi-layer complex systems, such as inferring who is influencing whom (and by which media) in multichannel social networks and developing routing techniques for multimodal transportation systems.Comment: 15 pages, 5 figure

One optometrist’s personal experience with age-related macular degeneration (AMD) and nutritional supplementation

Background: Age-related macular degeneration (AMD) is the leading cause of blindness in ageing western societies and accounts for greater than 50% of all US visual disability. This report describes the 25-year history of a 66-year-old optometrist who has successfully endured AMD.  Case Report: Visual acuity and serial retinal photographs from 1983 to 2009 as various nutritional modalities and non-dietary lifestyle changes were introduced. After starting lutein-based nutritional supplements beginning at approximately 15 years from diagnosis, the optometrist’s Snellen visual acuity improved in his right eye from 20/40 to 20/25 with a subjective improvement in distortion, but eventually regressed to 20/70-20/80 with some increase in metamorphopsia. The left eye, initially 20/30, improved to 20/15 and has remained stable at 20/20 with complete resolution of metamorphopsia and near complete resolution of a parafoveal scotoma. Fundus photographs demonstrate a reduction in soft and hard drusen count over time in each retina and possible parafoveal repigmentation of atrophic areas with later addition of higher dose zeaxanthin. Conclusions: AMD is a nutritionresponsive disease. The carotenoids, lutein and zeaxanthin appear to be particularly robust therapeutic components of nutritional supplement formulations

A STUDY OF TISSUE CULTURE CELLS BY ELECTRON MICROSCOPY : METHODS AND PRELIMINARY OBSERVATIONS

By means of a tissue culture technique, cells from chick embryos were procured in a state which proved to be suitable for electron microscopy. The electron micrographs disclosed details of cell structure not revealed by other methods of examination

Measurement of branching fractions and CP-violating charge asymmetries for B-meson decays to D^(*)D^(*), and implications for the Cabibbo-Kobayashi-Maskawa angle γ

We present measurements of the branching fractions and charge asymmetries of B decays to all D^(*)D^(*) modes. Using 232×10^6 BB pairs recorded on the Υ(4S) resonance by the BABAR detector at the e^+e^- asymmetric B factory PEP-II at the Stanford Linear Accelerator Center, we measure the branching fractions B(B^0→D^(*+)D^(*-))=(8.1±0.6±1.0)×10^(-4), B(B^0→D^(*±)D^∓)=(5.7±0.7±0.7)×10^(-4), B(B^0→D^+D^-)=(2.8±0.4±0.5)×10^(-4), B(B^+→D^(*+)D^(*0))=(8.1±1.2±1.2)×10^(-4), B(B^+→D^*+D^0)=(3.6±0.5±0.4)×10^(-4), B(B^+→D^+D^(*0))=(6.3±1.4±1.0)×10^(-4), and B(B^+→D^+D^(0))=(3.8±0.6±0.5)×10^(-4), where in each case the first uncertainty is statistical and the second systematic. We also determine the limits B(B^0→D^(*0)D^(*0))<0.9×10^(-4), B(B^0→D^(*0)D^0)<2.9×10^(-4), and B(B^0→D^0D^0)<0.6×10^(-4), each at 90% confidence level. All decays above denote either member of a charge-conjugate pair. We also determine the CP-violating charge asymmetries A(B^0→D^(*±)D^∓)=0.03±0.10±0.02, A(B^+→D^(*+)D^(*0))=-0.15±0.11±0.02, A(B^+→D^(*+)D^0)=-0.06±0.13±0.02, A(B^+→D^+D^(*0))=0.13±0.18±0.04, and A(B^+→D^+D^0)=-0.13±0.14±0.02. Additionally, when we combine these results with information from time-dependent CP asymmetries in B^0→D^((*)+)D^((*)-) decays and world-averaged branching fractions of B decays to D_s^(*)D^(*) modes, we find the Cabibbo-Kobayashi-Maskawa phase γ is favored to lie in the range (0.07–2.77) radians (with a +0 or +π radians ambiguity) at 68% confidence level