Tectonic interleaving along the Main Central Thrust, Sikkim Himalaya

Geochemical and geochronological analyses provide quantitative evidence about the origin, development and motion along ductile faults, where kinematic structures have been overprinted. The Main Central Thrust is a key structure in the Himalaya that accommodated substantial amounts of the India–Asia convergence. This structure juxtaposes two isotopically distinct rock packages across a zone of ductile deformation. Structural analysis, whole-rock Nd isotopes, and U–Pb zircon geochronology reveal that the hanging wall is characterized by detrital zircon peaks at c. 800–1000 Ma, 1500–1700 Ma and 2300–2500 Ma and an εNd(0) signature of –18.3 to –12.1, and is intruded by c. 800 Ma and c. 500–600 Ma granites. In contrast, the footwall has a prominent detrital zircon peak at c. 1800–1900 Ma, with older populations spanning 1900–3600 Ma, and an εNd(0) signature of –27.7 to –23.4, intruded by c. 1830 Ma granites. The data reveal a c. 5 km thick zone of tectonic imbrication, where isotopically out-of-sequence packages are interleaved. The rocks became imbricated as the once proximal and distal rocks of the Indian margin were juxtaposed by Cenozoic movement along the Main Central Thrust. Geochronological and isotopic characterization allows for correlation along the Himalayan orogen and could be applied to other cryptic ductile shear zones

Modelling malaria treatment practices in Bangladesh using spatial statistics

<p>Abstract</p> <p>Background</p> <p>Malaria treatment-seeking practices vary worldwide and Bangladesh is no exception. Individuals from 88 villages in Rajasthali were asked about their treatment-seeking practices. A portion of these households preferred malaria treatment from the National Control Programme, but still a large number of households continued to use drug vendors and approximately one fourth of the individuals surveyed relied exclusively on non-control programme treatments. The risks of low-control programme usage include incomplete malaria treatment, possible misuse of anti-malarial drugs, and an increased potential for drug resistance.</p> <p>Methods</p> <p>The spatial patterns of treatment-seeking practices were first examined using hot-spot analysis (Local Getis-Ord Gi statistic) and then modelled using regression. Ordinary least squares (OLS) regression identified key factors explaining more than 80% of the variation in control programme and vendor treatment preferences. Geographically weighted regression (GWR) was then used to assess where each factor was a strong predictor of treatment-seeking preferences.</p> <p>Results</p> <p>Several factors including tribal affiliation, housing materials, household densities, education levels, and proximity to the regional urban centre, were found to be effective predictors of malaria treatment-seeking preferences. The predictive strength of each of these factors, however, varied across the study area. While education, for example, was a strong predictor in some villages, it was less important for predicting treatment-seeking outcomes in other villages.</p> <p>Conclusion</p> <p>Understanding where each factor is a strong predictor of treatment-seeking outcomes may help in planning targeted interventions aimed at increasing control programme usage. Suggested strategies include providing additional training for the Building Resources across Communities (BRAC) health workers, implementing educational programmes, and addressing economic factors.</p

What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India

BACKGROUND: India's Revised National Tuberculosis Control Programme (RNTCP) is deemed highly successful in terms of detection and cure rates. However, some patients experience delays in accessing diagnosis and treatment. Patients falling between the 96th and 100th percentiles for these access indicators are often ignored as atypical 'outliers' when assessing programme performance. They may, however, provide clues to understanding why some patients never reach the programme. This paper examines the underlying vulnerabilities of patients with extreme values for delays in accessing the RNTCP in Mumbai city, India. METHODS: We conducted a cross-sectional study with 266 new sputum positive patients registered with the RNTCP in Mumbai. Patients were classified as 'outliers' if patient, provider and system delays were beyond the 95th percentile for the respective variable. Case profiles of 'outliers' for patient, provider and system delays were examined and compared with the rest of the sample to identify key factors responsible for delays. RESULTS: Forty-two patients were 'outliers' on one or more of the delay variables. All 'outliers' had a significantly lower per capita income than the remaining sample. The lack of economic resources was compounded by social, structural and environmental vulnerabilities. Longer patient delays were related to patients' perception of symptoms as non-serious. Provider delays were incurred as a result of private providers' failure to respond to tuberculosis in a timely manner. Diagnostic and treatment delays were minimal, however, analysis of the 'outliers' revealed the importance of social support in enabling access to the programme. CONCLUSION: A proxy for those who fail to reach the programme, these case profiles highlight unique vulnerabilities that need innovative approaches by the RNTCP. The focus on 'outliers' provides a less resource- and time-intensive alternative to community-based studies for understanding the barriers to reaching public health programmes

Health and Gross National Happiness: review of current status in Bhutan

Tashi Tobgay1, Ugen Dophu1, Cristina E Torres2, Kesara Na-Bangchang31Department of Public Health, Ministry of Health, Kawajangsa, Bhutan; 2Forum for Ethical Review Committees in Asian and Western Pacific Region, Clinical Coordination and Training Center, 3Thailand Center of Excellence on Drug Discovery and Development (TCEDDD), Thammasat University, Rangsit Campus, ThailandAbstract: Worldwide, contemporary measures of the success of health development programs have been mostly in terms of the reduction of mortality and morbidity as well as increasing longevity. While these goals have yielded much-needed health improvements, the subjective outcomes of these improvements, as experienced by individuals and the communities, have not been considered. Bhutan, under the overarching policy of Gross National Happiness, has provided due consideration to these subjective indicators. Here, we report on the current status of health and happiness in Bhutan as revealed by conventional objective indicators and subjective Gross National Happiness indicators. The current literature on health in Bhutan in relation to the Gross National Happiness Survey conducted by the Centre of Bhutan Studies has been reviewed. Bhutan has made great strides within a short period of modernization, as shown by both objective and subjective indicators. Tremendous challenges lie ahead to achieve the ultimate goal of health and happiness, and how Bhutan articulates its path to modernization may be a lesson for the rest of the world.Keywords: Bhutan, happiness, health, indicator

Managing Wildlife Damage to Agriculture in Bhutan: Conflicts, Costs and Compromise

Conflicts between wildlife and agricultural producers are a dominant problem in Bhutan, with policy debates focusing increasingly on whether most of the conservation costs are borne directly by the small producers and rural poor through crop losses and labor time diverted to guarding crops and livestock. This chapter attempts to quantify the extent of wildlife damage to crops and to livestock in Bhutan. While several important studies document in detail wildlife damage to agriculture in and near protected areas in Bhutan, this chapter aims to provide a more comprehensive assessment of the extent of the problem around the country, presenting the results of a survey of 526 households and outlining the extent of wildlife damage to their crops during a 12-month perio