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Objectives This study aimed to evaluate the performance of vaccine logistics management information systems at public health facilities in Amhara Region, Ethiopia. Methods An institution-based concurrent explanatory mixed design was used at public health facilities in Amhara Region, Ethiopia. In total, 102 health facilities were selected using the multi-stage, stratified, random-sampling proportionate-to-size method. Data were collected using a structured data abstraction checklist from vaccine logistics management information system records. Additionally, experiences of Expanded Program for Immunization focal persons were gathered through interviewer-administered questionnaires. Results Among the 102 health facilities surveyed, 99 (97.1%) provided vaccination services during the study period. On the day of the visit, the average availability and utilization rates of 15 vaccine logistics management information system forms were 44.1% and 40.5%, respectively. The mean inventory accuracy for tracer vaccines stood at 58.3% ± 45.1%. The overall average accuracy percentages for urban and rural vaccine request form reports were 73.4% and 69.6%, respectively. Conclusions The performance of vaccine logistics management information systems in these public health facilities was suboptimal. Key issues identified include inconsistent use of recording forms, shortages of reporting forms, lack of digitalization, poor data quality, and a shortage of qualified staff. These findings underscore the urgent need for standardization of the vaccine logistics management information system and enhancement of data quality.

Abstract Background Breast cancer represents a significant public health concern in India, accounting for 28% of all cancer diagnoses and imposing a substantial economic burden. This study introduces a novel approach to forecasting the number of breast cancer cases (based on prevalence rates) and estimating the associated economic impact in India using the autoregressive integrated moving average (ARIMA) model. Methods Data on the prevalence of breast cancer in India from 2000 to 2021 were obtained from the Global Burden of Disease (GBD) database. This dataset provided annual estimates of the number of patients with breast cancer, serving as the basis for modeling future prevalence and estimating the economic burden. The ARIMA (Auto-Regressive Integrated Moving Average) model was employed to analyze and predict breast cancer prevalence in India up to the year 2030 (time-series forecasting). Data were visualized and checked for stationarity using the Augmented Dickey-Fuller (ADF) test. Using the autocorrelation function (ACF) and partial autocorrelation function (PACF) plots, the appropriate parameters (p, d, q) were determined. Several ARIMA configurations were tested to identify the model with the best fit. The goodness-of-fit of the model was assessed using standard metrics such as the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). The residuals were tested using the Box-Ljung test to confirm the absence of autocorrelation and verify that they followed a white noise distribution. Using the fitted ARIMA model, prevalence rates were forecasted from 2022 to 2030, with 95% confidence intervals to capture prediction uncertainty. Direct costs were calculated based on medical expenses for breast cancer patients, such as hospital visits, diagnostic tests, treatment costs, and follow-up care. A bottom-up approach was applied, which involves aggregating individual cost components from each stage of care to estimate the total direct burden of disease. A bottom-up approach was applied, which involves aggregating individual cost components from each stage of care to estimate the total direct burden of disease. Indirect costs were estimated using the human capital approach, which assesses productivity losses due to morbidity and premature mortality. The Disability-Adjusted Life Years (DALY) associated with breast cancer were also predicted using the ARIMA model. Results The results of coefficient of determination (0.99), mean absolute percentage error (69%), mean absolute error (5229), and root mean squared error (6451.2) showed that the ARIMA (0,2,0) model fitted well. Coefficient of determination (0.99) indicated that 99% of the variance in the data was explained by the model. Akaike information criterion (411.54) and Bayesian information criterion (412.53) indicated the ARIMA (0,2,0) model was reliable when analysing our data. The result of the relative error of prediction (2.76%) also suggested that the model predicted well. The number of patients with breast cancer from 2021 to 2030 was predicted to be about 1.25 million, 1.1.29 million,, 1.34 million, 1.39 million, 1.44 million, 1.48 million, 1.53 million, 1.58 million, 1.63 million, 1.68 million, and respectively. The total economic burden of breast cancer from 2021 to 2030 was estimated to be $8 billion, $8.72 billion, $9.05 billion, $9.84 billion, $10.20 billion, $11.07 billion, $11.49 billion, $12.44 billion, $12.91 billion, $13.95 billion, respectively is estimated to rise significantly. Conclusion Breast cancer prevalence and its economic impact are projected to grow substantially in India. Between 2021 and 2030, the number of breast cancer patients is expected to increase by approximately 0.05 million annually, with an annual increase rate of about 5.6%. The associated economic burden will also rise, averaging an additional $19.55 billion per year, underscoring the need for intensified healthcare and economic strategies to manage this growing challenge.

Cardiovascular diseases (CVDs) are the leading cause of death globally and the prevention and control of these diseases tend to entail longer and larger social and economic commitments on the part of governments. This systematic review (SR) aims to understand the quantum, diversity, and quality of implementation research (IR) done in the field of CVDs in India with a view to maximizing the utility of the efforts made by the government. The evidence was collated on IR on CVDs in India conducted in the past 20 years (2001–2021) using a SR approach. The SR was drafted using Preferred Reporting Items for SRs and Meta-analyses guidelines. Academic databases (PubMed, Embase, and Science Direct) and nonacademic databases (Google Scholar and ProQuest) were chosen, along with repositories of gray literature. Retrieved articles were screened for titles and abstracts and assessed by two independent reviewers. The articles also underwent a concomitant risk of bias assessment utilizing checklists (STARI, STROBE, CONSORT, etc.,) and a narrative summary was drafted using SwiM guidelines. In the final analysis, 10 articles that fitted the inclusion criteria of IR for CVD in India were included, of which seven were directed at IR on hypertension, and three were related to coronary artery disease, myocardial infarction, and stroke. Acceptability, adoption, and feasibility were the only attributes of IR that were explored in these studies.

Abstract Background Health guideline developers engage with interested people and groups to ensure that guidelines and their recommendations are relevant and useful to those who will be affected by them. These ‘interest‐holders’ include patients, payers/purchasers of health services, payers of health research, peer review editors, product makers, programme managers, policymakers, providers, principal investigators, and the public. The Guidelines International Network (GIN) and McMaster University Guideline Development Checklist describes 146 steps of the guideline process organized into 18 topics. While one topic focuses on engagement, it does not describe how to engage with interest‐holders. In addition, interest‐holder input could be sought throughout the guideline development process. This scoping review is part of a series of four related reviews. The three other reviews address barriers and facilitators to engagement in guideline development, managing conflicts of interest in guideline development, and assessing the impact of interest‐holder engagement on guideline development. The four reviews will inform the development of guidance for multi‐interest‐holder engagement in guideline development; the GIN‐McMaster Guideline Development Checklist Extension for Engagement. Objectives The objective of this scoping review is to identify, describe, and summarise existing guidance and methods for multi‐interest‐holder engagement throughout the health guideline development process. Search Methods We conducted one comprehensive search for studies of engagement in guidelines to meet the inclusion criteria of one or more of the four systematic reviews in this series. We searched MEDLINE (OVID), CINAHL (EBSCO), EMBASE (OVID), PsycInfo (OVID) and SCOPUS databases up to September 2022. We did not include limits for date, study design, or language. We searched websites of agencies and organizations that engage interest‐holder groups, such as the Agency for Healthcare Research and Quality (AHRQ), CIHR Strategy for Patient‐Oriented Research (SPOR), National Institute for Health and Care Research (NIHR) Be Part of Research, Guidelines International Network (G‐I‐N), the National Institute for Health and Care Excellence, and the PatientCentred Outcomes Research Institute (PCORI). We handsearched the websites of guideline producing agencies. We solicited additional grey literature from the members of the MuSE Consortium. Selection Criteria Studies were included in this review if they reported on engagement of any of our identified groups, patients, payers/funders of research, payers/purchasers of health services, policymakers, programme managers, providers, principal investigators/researchers, peer review editors, product makers in the development of a health guideline. Titles and abstracts of identified citations were screened independently, in duplicate. The full text of potentially relevant papers were screened for eligibility into one or more of the four reviews in the series. Screening was done independently, by two reviewers. The team held weekly meetings with all reviewers involved in screening to discuss and resolve conflicts. Data Collection and Analysis Two reviewers extracted relevant data into a pilot‐tested data extraction form using Excel. We used the GIN‐McMaster guideline development checklist as a framework for extracting the available guidance for each of our identified interest‐holder groups throughout the development process. We presented descriptive statistics of the number of papers reporting guidance for each groups across the steps of the guideline process. We synthesized the relevant text using a qualitative meta‐summary approach. Main Results We included 16 papers (from 17 reports). These papers were from Australia, Denmark, the Netherlands, the UK, and the USA, and eight papers were international (countries not specified). The papers provided guidance for at least one of our interest‐holder groups for at least one stage of guideline development. We mapped this guidance to the GIN‐McMaster Guideline Development Checklist to identify the available guidance for each of our interest‐holder groups across all stages of the guideline development process. Guidance was available for patient engagement in 15 of the 16 papers. At least two papers provided guidance for each of the 18 topics of the GIN‐McMaster Guideline Development Checklist. For healthcare providers, 9 papers provided guidance for their engagement across 10 of the 18 guideline development topics. Guidance for engaging with the public was provided for 14 of the 18 topics and reported in 4 of our included papers. For payers/purchasers of health services, policymakers, product makers, programme managers, and principal investigators, 2–3 papers provided guidance for these groups across 4–7 topics of the GIN‐McMaster checklist. We did not identify any specific guidance for payers of health research or for editors of peer‐reviewed journals. Authors' Conclusions Guidance for interst‐holder engagement in guidelines is available but has focused primarily on patients. We will utilize the guidance identified in this scoping review to inform the GIN‐McMaster Guideline Development Checklist Extension for engagement. Combined with the information obtained from the other systematic reviews in this series, we will address the gaps in guidance for the other identified interest‐holder groups.

Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.

Lung ischemia-reperfusion injury (IRI), a common complication after lung transplantation (LTx), plays a crucial role in both primary graft dysfunction (PGD) and chronic lung allograft dysfunction (CLAD) thereby adversely impacting the clinical outcomes in these patient cohorts. Lung IRI is characterized by several molecular events including immune cell infiltration, reactive oxygen species (ROS) generation, calcium overload, inflammation and various forms of cell death pathways. Currently, no therapeutic agents are available to clinically prevent lung IRI. While animal and cell culture models are highly valuable in understanding the pathophysiology of lung IRI, they may not completely recapitulate the complexity of human lung tissue pathology. This limitation necessitates the requirement for developing innovative preclinical human research tools that can supplement available scientific modalities. Emerging evidence suggests that precision-cut lung slices (PCLS) have become an indispensable tool in scientific research to study lung biology in an ex vivo tissue system. Recent studies using PCLS have investigated lung diseases including asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. Although PCLS can be successfully employed to determine the deleterious events in the pathogenesis of lung IRI, including cell-cell interactions as well as hallmarks of inflammation and oxidative stress-dependent pathways, detailed studies employing PCLS to decipher these molecular events in post-LTx injury are currently limited. This review focuses on the applicability and unexplored potential of PCLS as a powerful tool in lung IRI research for understanding the pathophysiology and consequent development of new therapeutic modalities.

Aluminum alloys (Al) produced by fusion-based additive manufacturing techniques exhibit limited strength due to undesirable grain growth, porosity, and thermal gradient. To address these limitations, Scalmalloy (Al–Mg4.6-Sc0.72-Zr0.3 wt%) deposits of 5 mm thickness using helium and nitrogen gases were manufactured using a solid-state cold spray (CS) deposition. The microstructure of these deposits revealed a bimodal distribution of coarse and fine grains in the splat interior and jetting region, respectively, characterized by a higher degree of plastic deformation in the He-deposit. These bimodal grains resulted in a nanohardness of 1.2 GPa in the jetting region, 20% higher than that in the interior. The cumulative effect of these microstructural features resulted in a microhardness of 149 HV in the He-deposit, 1.1 times compared to that in the N2-deposit. The increased hardness is translated to a yield strength of 383 MPa and ultimate strength of 487 MPa in the He-deposit, 1.17 and 1.08 times of N2-deposit, respectively, estimated by Profilometry-based indentation plastometry (PIP). Across the hierarchical layers, profilometry-based indentation plastometry captured a consistent pile-up difference of ∼2 μm in the He-deposit and ∼3 μm in the N2-deposit on the plane perpendicular to build plane, a manifestation of in-plane anisotropy. This study advances the microstructural understanding and its relationship with observed mechanical properties, deformation behavior, and anisotropic response in high-strength Scalmalloy CS deposits.

Background: Human rights provide a universal foundation for pursuing justice in public health in order to achieve the dignity of all individuals. In spite of international attempts to promote human rights in the context of health, a significant portion of India’s indigenous population continues to have a limited understanding of these rights. Objective: This study aims to analyze tribal people’s attitudes towards human rights in health care. The population consists of tribal residents from Manbazar – I and Puncha Blocks in the Puruliya district of West Bengal, India. Tribal young adults between the ages of 18 and 35 were the subject of a cross-sectional study. Methods: A pretested questionnaire was used to collect data. MS Excel and SPSS 27 were used for analysis. A descriptive analysis was carried out. Results: The participants’ mean scores for awareness, accessibility and communication, autonomy and sexual and reproductive health and sexual and reproductive health rights (SRHR) were 8.06, 15.76, 7.35 and 32.52 revealing a moderate perception level among the young adult tribal population in the selected blocks. Conclusion: A holistic focus of the governmental and other non-governmental organizations towards the tribals is required. Introducing various aspects of human rights in healthcare in the education curriculum along with community outreach would by all likelihood improve the perception of ‘Human Rights’ and thus help in better utilization of various services including health among tribal populations in India.

This research aims to reveal the crucial role of subcontractor selection in irrigation projects, which require water resource management to increase agricultural productivity and ensure adequate water availability. The projects are complex, involving designing efficient water distribution systems, constructing structures such as dams, and tight coordination between various stakeholders. The selection of subcontractors significantly impacts the project's success, affecting critical aspects such as time, quality, and cost. This research applies the Weight Product method as a multi-criteria decision-making approach to prioritize these aspects. The advantage of this method lies in its ability to handle multi-criteria decisions systematically. By modeling this method, this research aims to improve the effectiveness and efficiency of subcontractor selection in irrigation projects. The results are expected to provide directional guidance for the dev developing tractor selection applications to improve the quality of project implementation and r quality due to associated risks

Objective: Tribal population in India (8.6% of the total population) have a greater prevalence of tuberculosis compared to the national average. The article aims to study out-of-pocket expenditure (OOPE), hardship financing, and impoverishment effects of TB hospitalisation treatment among tribal populations in India. Methods: Data of three rounds of National Sample Surveys (NSS) 60th (2004–05), 71st (2013–14) and 75th (2017–18) rounds were analyzed. Descriptive statistics, bivariate estimates and multivariate models were performed to calculate the OOPE, healthcare burden (HCB), catastrophic health expenditure (CHE), hardship financing and impoverishment effects using standard definitions at February 2023 price values. Propensity score matching (PSM) was used to examine the effect of health insurance coverage on catastrophic health expenditure, and impoverishment. Results: Over two-thirds of the TB cases are seen in the economically productive age group (14–59 years). Substantial OOPE and its impact on HCB, CHE, and poverty impact observed among 15–35 age group across all three rounds. Illiterate patients and those availing private hospitals for TB treatment had higher OOPE, HCB, hardship financing, CHE, and poverty impact. 38.5% (2014) and 33.2% (2018) are covered with any kind of public healthcare coverage, PSM analysis shows households with health insurance have lower incidence of CHE and impoverishment effects due to TB hospitalisation expenditure. Conclusions: The current study aids in comprehending the patterns in the financial burden of TB on tribal households during the previous 15 years and gives policy makers information for efficient resource allocation management for TB among Indian tribal communities.

Abstract Background Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal‐child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle‐income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle‐income countries (LMICs). Objectives The main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs. Search Methods The systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022. Selection Criteria The PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi‐experimental, factorial designs, and quantitative components (experimental, quasi‐experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single‐group study designs and qualitative studies were excluded from the review. Data Collection and Analysis Two reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies. Main Results A total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta‐analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] −0.62, 95% confidence interval [CI] (−1.01, −0.23), Z = 3.13 (p = 0.002), χ2 = 49.49; df = 2; p

Background: Tribes are the most socially excluded group in the nation due to their restricted access to healthcare. There are little data on the real burden and distribution of illnesses among tribes. The present study determines the types and patterns of sickness among tribal populations in West Bengal. Methods: Five blocks from five districts in West Bengal were used for this cross-sectional study. Between the years 2018 and 2019, 52,189 patients visited these mobile medical clinics (MMCs), but only 36,128 were included in our study. Data were analyzed using the SPSS software (ver. 27.0). Results: Younger age groups (1-25 years) show higher primary registration compared to other age categories; older age groups (>60 years) show higher repeat registration. High prevalence in infectious diseases (44.5% of the total primary registration) and high repeated cases in NCDs (11.5% to 33.2%), which are nearly three times higher than primary cases (Cramer's V test = 0.29; P = .001) are observed. Among the studied MMCs, Binpur II and Matiali MMC have more than two times the risk of gastrointestinal problems, while Madarihat MMC has more than one time the risk. Garbeta II MMC shows more than three times the risk of NCDs (adjusted odds ratio = 3.97; 95% confidence interval: 3.05-5.17) than the other diseases. Conclusion: The present study shows high prevalence of infectious diseases, injury and pain, NCDs, gastrointestinal problems, and vertigo in tribal populations of West Bengal.

This research presents a novel game theory based model for femtocell power management, engineered to significantly enhance the Signal-to-Interference-plus-Noise Ratio (SINR) while optimizing energy consumption across wireless communication networks. Femtocells, as a solution to the increasing demand for high-quality indoor network coverage, face challenges in power management and interference mitigation. Our proposed model addresses these issues, providing a sophisticated algorithmic approach that ensures high SINR levels without a proportional increase in power usage. Through a series of simulations, the model’s performance was evaluated against existing power management techniques. The results, delineated across several tables, revealed that the proposed model consistently achieved and often surpassed targeted SINR levels with modest power consumption increments, even at high targets. Notably, at a SINR target of 20, the model sustained a high SINR of 23.62 while maintaining a reasonable energy profile. Additionally, the model exhibited exceptional operational efficiency, characterized by low execution times and rapid convergence rates, across varying network conditions. This responsiveness is essential for adapting to user mobility and varying traffic patterns, particularly in dense urban settings and during peak usage periods.

As a dynamic and complex sector, the construction industry is often faced with challenges in managing projects and determining their priorities. In the context of intense business competition and changes in the external environment, this research highlights the importance of developing efficient methods for prioritizing construction projects. The focus is on applying the Weight Product (WP) method, a decision-making framework, to score projects based on cost, time, quality, and risk criteria. The method integrates data collection, analysis, modeling, and ranking. The results identify projects that align with the company's priority objectives, while the systematic steps can provide practical guidance for construction companies in optimizing resource allocation. This research also has the potential to contribute to the literature and practice of the construction industry, as well as be the basis for developing more advanced applications and decision-making methods and priority project selection applications

Latar belakang : Elektrolit memiliki peranan krusial pada tubuh manusia yang bisa memberi pengaruh pada metabolisme sehingga perlu dijaga keseimbangannya. Ketidakseimbangan kadar elektrolit-elektrolit di dalam tubuh perlu diantisipasi dengan mengukur atau memeriksa kadar elektrolit tersebut sehingga dapat mendeteksi penyakit, menetapkan diagnosis, menentukan prognosis, menjadi pedoman di dalam penatalaksanaan penderita, dan pemantauan pengobatan. Kesalahan pada pemeriksaan dapat memberikan konsekuensi serius yang dapat menyebabkan kekeliruan dalam pengobatan karena didasarkan oleh hasil yang tidak akurat. Penanganan sampel merupakan salah satu penyebab ketidakakuratannya hasil dari pemeriksaan. Sampel darah pada pemeriksaan kadar elektrolit tidak diperkenanankan dibiarkan terlalu lama. Oleh karena itu, diperlukan penelitian mengenai pengaruh penundaan pemeriksaan elektrolit darah terutama Kalium terhadap hasil pemeriksaan. Tujuan Penelitian: Untuk mengetahui pengaruh lama penundaan pemeriksaan terhadap kadar elektrolit Kalium pada sampel pemeriksaan segera, penundaan 12 jam, dan penundaan 24 jam. Metode Penelitian : Penelitian ini menggunakan metode eksperimental dengan menggunakan 30 sampel darah dari pasien rumah sakit AR Bunda Prabumulih pada bulan Januari. Hasil: Rata-rata nilai kadar elektrolit pada pemeriksaan segera, yaitu 4,11. Sedangkan, pada pemerisaan dengan penundaan 12 jam, kadar elektrolit Kalium rata-rata sebesar 4,10, dan untuk hasil pemeriksaan dari penundaan 24 jam, kadar elektrolit Kalium sebesar 4,12. Untuk membuktikan ada tidaknya pengaruh dari penundaan pemeriksaan Kalium terhadap hasil pemeriksaan maka dilakukan uji statistik dengan aplikasi SPSS. Kesimpulan : Dari hasil penelitian tersebut, diperoleh pernyataan bahwa tidak ada pengaruh lama penundaan terhadap pemeriksaan elektrolit Kalium dan sampel darah dengan penundaan pemeriksaan sampai 24 jam masih bisa digunakan untuk pemeriksaan kadar elektrolit darah.

Objectives: Ever since the emergence of COVID-19, health and the economy worldwide have witnessed a severe disruption, with infection spreading rapidly, covering 231 countries as of May 07, 2023. Policymakers and Governments have been working to offer tailored interventions to the most vulnerable cohorts. Given this background, the paper involves description towards developing a Web-based Calculator to compute various estimates that quantify health economic impacts as these are much helpful than just mortality and simpler measures. Methods: The computations required to determine the estimates and the variables involved have been picked based on the observations and literature. The manuscript presents the significance of the estimates, a description of the Calculator developed, followed by validation. The values estimated using Calculator were validated against those computed using formulas for the state of West Bengal, India. Results: The results indicated that the Calculator is able to produce near accurate results with the highest error percentage witnessed for Cost of Productivity Lost due to Absenteeism as 0.946%. Error percentages for Disability-Adjusted Life Years was 0.175, and less than 0.1 for all other estimates. Conclusions: This could prove to be an effective tool for the policymakers and practitioners to identify the long-term impacts and the most vulnerable cohorts and devise targeted interventions. Additionally, these tools will allow the policymakers and governments to save time in compute these estimates in the future.

Abstract Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low‐ and middle‐income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high‐income countries have successfully reduced RTI by using a public health approach and implementing evidence‐based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high‐income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post‐crash pre‐hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non‐fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case‐control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post‐crash pre‐hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non‐fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety‐six percent of the studies were reported from high‐income countries (HIC), 4.5% from upper‐middle‐income countries, and only 1.4% from lower‐middle and low‐income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence‐synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Abstract Background Involving collaborators and partners in research may increase relevance and uptake, while reducing health and social inequities. Collaborators and partners include people and groups interested in health research: health care providers, patients and caregivers, payers of health research, payers of health services, publishers, policymakers, researchers, product makers, program managers, and the public. Evidence syntheses inform decisions about health care services, treatments, and practice, which ultimately affect health outcomes. Our objectives are to: A. Identify, map, and synthesize qualitative and quantitative findings related to engagement in evidence syntheses B. Explore how engagement in evidence synthesis promotes health equity C. Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement in evidence syntheses Methods Our diverse, international team will develop guidance for engagement with collaborators and partners throughout multiple sequential steps using an integrated knowledge translation approach: 1. Reviews. We will co-produce 1 scoping review, 3 systematic reviews and 1 evidence map focusing on (a) methods, (b) barriers and facilitators, (c) conflict of interest considerations, (d) impacts, and (e) equity considerations of engagement in evidence synthesis. 2. Methods study, interviews, and survey. We will contextualise the findings of step 1 by assessing a sample of evidence syntheses reporting on engagement with collaborators and partners and through conducting interviews with collaborators and partners who have been involved in producing evidence syntheses. We will use these findings to develop draft guidance checklists and will assess agreement with each item through an international survey. 3. Consensus. The guidance checklists will be co-produced and finalised at a consensus meeting with collaborators and partners. 4. Dissemination. We will develop a dissemination plan with our collaborators and partners and work collaboratively to improve adoption of our guidance by key organizations. Conclusion Our international team will develop guidance for collaborator and partner engagement in health care evidence syntheses. Incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.

Integrating and dispersing one-dimensional (1D) nano reinforcements in metal matrix composites (MMC) is challenging due to their higher specific surface area, strong van der Waals forces within the nano reinforcement, and poor wettability with the matrix. In the present study, ultrasonic cavitation-assisted casting was employed to fabricate boron nitride nanotubes (BNNT)-reinforced aluminum matrix composites. The ultrasonic treatment (UST) demonstrated excellent deagglomeration, and dispersion of BNNTs in molten aluminum along with enhanced grain refinement potency. A remarkable ∼62% grain refinement efficiency in Al-BNNT composite compared to pure Al was achieved owing to the combined effect of UST, BNNT reinforcement and cold rolling. The increase in low-angle grain boundaries (LAGBs) by ∼58% in Al-BNNT composite, as revealed by electron backscatter diffraction (EBSD) maps, demonstrates the pileup of dislocations resulting in strength improvement. The yield strength exhibited a 97% improvement in the BNNT-reinforced composite compared to pure Al. The strengthening is attributed to UST, enhanced dislocation density and efficient bridging effect between BNNTs and the matrix. Thus, the present study constitutes the first successful report on the role of UST in the mechanism of BNNT dispersion, grain morphology and enhanced mechanical properties, including cold rolling of BNNT-reinforced MMC. Successful dispersion of BNNTs by ultrasonic cavitation confirms that UST technology is a promising method for manufacturing high-strength nanoparticle-reinforced lightweight metal matrix composites.

[This corrects the article DOI: 10.1371/journal.pone.0264956.].

Introduction The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced. Intended Outcomes The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.

Malignant melanoma is considered the most aggressive among all cutaneous cancer. Malignant melanoma commonly causes cerebral metastasis. The survival rate of melanoma with cerebral metastases is considerably poor. Surgical resection, radiotherapy, and chemotherapy are often used to increase overall survival. In this case report we present a fifty-four-year-old female with recurrent leptomeningeal metastatic malignant melanoma after gross total resection, with an additional literature review of the management. We describe how gross tumor resection results in an immediate clinical improvement in symptomatology in this patient who has previously undergone tumor resection.

BackgroundGlobally, among all the vector-borne diseases, mosquito-borne diseases are responsible for a substantial number of cases and deaths and amount to an economic cost of US $12 billion per year. However, there is a dearth of systematic research conducted on the economic burden of mosquito-borne diseases. To address the lack of comprehensive information on this topic, a systematic review will be conducted to synthesize evidence for informing targeted policies and strategies addressing this growing burden and for better financial protection of households. ObjectiveThe systematic review aims to review the economic burden of mosquito-borne diseases in low- and middle-income countries (LMICs). The review estimates the total cost, which is the compilation of both the direct costs and indirect costs. Additionally, it reports cost estimates per disease, country, and patient. The review outcome will also discuss the impact of the economic burden in terms of out-of-pocket expenditure, catastrophic health expenditure, impoverishment, and gross domestic product impact due to mosquito-borne diseases in LMICs. MethodsSystematic searches will be conducted in PubMed (MEDLINE), Ovid Embase, Scopus, the cumulative index of nursing and allied health literacy, and Cochrane CENTRAL. Additionally, websites of the World Bank, World Health Organization, and Asian Development Bank as well as grey literature (eg, Malaria No More and the Ministry of Health websites) will be searched to gather comprehensive information on the topic and identify studies published in the English language. The titles and abstracts will be independently screened by 2 reviewers, followed by a full-text review against the inclusion criteria. Disagreements will be resolved through discussion with a third author. The methodological reporting quality of the studies will be evaluated using the Larg and Moss checklist, Cochrane risk-of-bias tool for randomized trials, and the Consensus on Health Economic Criteria. Data will be extracted using a standardized data extraction form. ResultsThe protocol was registered in PROSPERO (CRD42023427111) prior to the initiation of the search strategy. The review is currently ongoing and will synthesize information from the identified studies through a process involving structured screening, data extraction, and critical appraisal in the form of tables and a narrative summary of studies reporting the economic burden incurred due to mosquito-borne diseases in LMICs. ConclusionsThis review seeks to report the economic burden of mosquito-borne diseases. It will act as evidence for policymakers to prioritize their decisions regarding containing the prevalence of mosquito-borne diseases and the means to lowering the incidence of diseases spread by mosquitoes. Trial RegistrationPROSPERO CRD42023427111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427111 International Registered Report Identifier (IRRID)PRR1-10.2196/50985

I denna artikel undersöks hur ungdomar på två olika yrkesförberedande gymnasieprogram på en gymnasieskola talar om och talar på dialekt i ett geografiskt område där dialekten länge har haft hög kulturell och social status. Två fokusgruppssamtal analyseras för att undersöka både vilka uppfattningar om – och attityder till – dialekter och dialektalt språkbruk som uttrycks samt vilka dialektala varianter som deltagarna själva använder när de samtalar med varandra. Med utgångspunkt i en innehållsanalys och en dialektal språklig analys visar resultaten att deltagarna uttrycker tämligen bestämda uppfattningar om och attityder till dialektalt språkbruk, att en majoritet av dem betraktar dialekten som sin egen och att de även är stolta över den. Resultaten visar även att ungdomarna tenderar att positionera sig själva genom att hänvisa till den egna dialekten och uppfattningar om vem som är typisk dialekttalare. Den språkliga analysen visar hur ungdomarna även använder ett stort antal dialektala varianter när de diskuterar dialekter med andra ungdomar.

The current era is marked by rapid technological advancements, with e-commerce being one of the most prominent innovations that caters to people's needs and saves time. In this study, we examine the factors that significantly influence user satisfaction in Shopee, a popular e-commerce platform, using the End User Computing Satisfaction (EUCS) method. Data was collected through the distribution of questionnaires to students in the DKI Jakarta area. Our analysis revealed that Content, Accuracy, Format, Ease of Use, Timeliness, and Fulfillment are all significant factors that affect user satisfaction. Together, these factors explain 78.7% of user satisfaction. Additionally, through T-tests, we found that only three variables have a significant and positive impact on user satisfaction: Ease of Use, Timeliness, and Fulfillment. These findings indicate that e-commerce platforms should prioritize these factors to enhance user satisfaction.

PT Rapier Technology International applies scrum in developing the BBLobster Content Management System (CMS). Scrum is a framework for developing an iterative, flexible, and effective BBLobster CMS designed to deliver significant value quickly. This study aims to identify the problems encountered in scrum implementation and validate the factors that influence the interaction with Scrum adoption during the BBLobster CMS development process using variable measurements. The measurement variables are the team factor variable, individual factor variable, technology factor variable, organizational factor variable, and scrum adoption variable. They analyzed the measurement of the data model (outer model) and structural model (inner model) using SmartPLS 3.0 after data collection using a questionnaire via google forms. The results of this study show that the analysis of the structural model test conducted by knowing the value of R-Square (R2) is a team factor variable, individual factor, technological factor, and organizational factor that has an influence of 67.4% on scrum adoption.

Data and information are essential in various fields today, as well as in the field of education, especially in universities. Some universities already have information systems that support data and information needs. However, the system has not been integrated, so it cannot provide data and information needs quickly and in an integrated manner. Information systems in universities are still primarily departmental because each was built at a different time and uses another platform. The departmental nature of this information system causes inaccuracies and inconsistencies of data that drive the information produced in reports and data reused in transactions to be invalid. Invalid data, in the end, also impacts decision-making taken by management. This study aims to develop a data warehouse at a university to integrate academic data using a star schema. The method used is the Nine Step Methodology. The result of this research is data warehouse architecture used in the academic field; fact tables and ERDs have been designed at the current stage of designing a Prototype of the Study Program Performance Sheet (LKPS).

Objectives The state of West Bengal witnessed a significant surge of COVID-19 in all three waves. However, there is a gap in understanding the economic loss associated with COVID-19. This study estimates future non-health gross domestic product (NHGDP) losses associated with COVID-19 deaths in West Bengal, India.Setting Various open domains were used to gather data on COVID-19 deaths in West Bengal and the aforementioned estimates.Primary and secondary outcome measures The NHGDP losses were evaluated using the cost-of-illness approach. Future NHGDP losses were discounted at 3%. Excess death estimates by the WHO and Global Burden of Disease (GBD) were used. Sensitivity analysis was carried out by varying discount rates and average age of death (AAD).Results 21 532 deaths in West Bengal from 17 March 2020 to 31 December 2022 decreased the future NHGDP by $0.92 billion. Nearly 90% of loss was due to deaths occurring in the age group of 30 years and above. Majority of the NHGDP loss was borne by the 46–60 years age group. NHGDP loss/death was $55,171; however, the average loss/death declined with rise in age. Based on the GBD and WHO excess death estimates, the NHGDP loss increased to $9.38 billion and $9.42 billion, respectively. When the lower age interval is considered as AAD, the NHGDP loss increased to $1.3 billion. At 5% and 10% discount rates, the losses reduced to $0.767 billion and $0.549 billion, respectively.Conclusions Results from the study suggest that COVID-19 contributed to a major economic loss in West Bengal. The mortality and morbidity caused by COVID-19, the substantial economic costs at individual and population levels in West Bengal, and probably across India and other countries, is another economic argument for better infection control strategies across the globe to minimise the impact of COVID-19.

Background: SARS-CoV-2 has resulted in widespread awareness of health workers’ work realities and their mental health impacts, and corresponding unprecedented research effort. Reviews of the quantitative literature on mental health of clinical skilled healthcare personnel in low- and lower-middle income countries (LLMIC), however, point at quality issues in the pre-pandemic literature. We used the evidence generated in the context of one pre-pandemic review to understand methodological strengths and weaknesses in detail, with the aim of distilling recommendations for future research. Methods: Our study used the literature identified in a systematic search from inception to the end of 2020, in English or French language, in MEDLINE, EMBASE, PsychINFO, Global Health, and CAIRN. Following a scoping review approach, we extracted and charted data on key study characteristics as well as on study quality. In regard to the latter, we developed nine quality criteria on the basis of existing quality checklists, but expanding on issues of particular relevance to the measurement and interpretation of levels of mental health or illness. We collated the charted data in descriptive fashion. Results: We included data from 152 studies, which assessed a range of mental health outcomes, although most burnout. Most studies were conducted in India, Nigeria, Pakistan, or Egypt, in urban secondary- and tertiary-care settings. We judged only 20% of studies as of high quality due to shortcomings particularly regarding sample representativeness, context-specific measurement tool validity, and reporting of methodological detail. Conclusion: We conclude that despite its impressive size, we can learn comparatively little from the body of literature up to the end of 2020 due to narrow study focus on specific settings and strong limitations in quality. Based on our findings, we outline areas for expansion, methodological improvement, and standardization of reporting in future research. PROSPERO Registration: CRD42019140036.

Plain English Summary All major problems, including complex global problems such as air pollution and pandemics, require reliable data sharing between disciplines in order to respond effectively. Such problems require evidence-informed collaborative methods, multidisciplinary research and interventions in which the people who are affected are involved in every stage. However, there is currently no standardised way to share information about initiatives and problem-solving across and between fields such as health, environment, basic science, manufacturing, education, media and international development. A multi-disciplinary international team of over 100 citizens, experts and data-users has been involved in co-creating STARDIT to help everyone in the world share, find and understand information about collective human actions, which are referred to as ‘initiatives’. STARDIT is an open access data-sharing system to standardise the way that information about initiatives is reported, including information about which tasks were done by different people. Reports can be updated at all stages, from planning to evaluation, and can report impacts in many languages, using Wikidata. STARDIT is free to use, and data can be submitted by anyone. Report authors can be verified to improve trust and transparency, and data checked for quality. STARDIT can help create high-quality standardised information on initiatives trying to solve complex multidisciplinary global problems. Among its main benefits, STARDIT offers those carrying out research and interventions access to standardised information which enables well-founded comparisons of the effectiveness of different methods. This article outlines progress to date; current usage; information about submitting reports; planned next steps and how anyone can become involved.

This work explored the possibility of producing a compositional functionally graded material (FGM) between mild steel and Inconel 625. An in-house fabricated, dual filler wire tungsten inert gas welding set up was used to deposit weld beads on a mild steel substrate. Filler wire feed rates were controlled independently and the combinations of filler material volumes, i.e., mild steel–Inconel 625 of (100:0), (75:25), (50:50), (25:75), and (0:100) were fed into the arc simultaneously and individual weld beads deposited. Preliminary studies revealed that defect free completely fused new alloys were formed and intermetallic phases rich in Nb observed. Compositional analysis showed that the content of each element changed from one alloy to the other gradually, smoothly indicating the feasibility of a mild steel–Inconel 625 functionally graded material.

Background: Rabies is an endemic and major public health problem in India. This paper reports cost of implementation of various Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) strategies at programmatic level to avert rabies deaths in children in India. Methods: The cost of implementation of various PrEP + PEP and PEP only regimens recommended by WHO and national guidelines was calculated separately for the first year of implementation for children in the age group of 0–5 years (U-5) and 5–15 years (U-15). The cost was calculated at the level of health facility from government's perspective considering the implementation of the strategies under National Rabies Control Program. All costs were converted into 2020 Indian National Rupee and International Dollars' value using implicit price deflators for Purchasing Power Parities. Base case, scenario and one-way sensitivity analyses were conducted. Results: The cost of implementation of PrEP regimen is several times higher than all other PEP regimens in children in the age groups of 0–5 years and 5–15 years for the first year of implementation. However, the study also reported use of intradermal route of vaccination and local infiltration of ERIG in wounds only as a cost-saving approach to prevent rabies deaths in children in situations where PEP only strategies are implemented. Conclusions: There is a need to conduct primary studies in order to obtain data for cost of implementation of shorter regimens in real-time settings.

Introduction Children’s learning abilities suffer when their oral health is compromised. Inadequate oral health can harm children’s quality of life, academic performance, and future success and achievements. Oral health problems may result in appetite loss, depression, increased inattentiveness, and distractibility from play and schoolwork, all of which can lower self-esteem and contribute to academic failure. An oral health curriculum, in addition to the standard school curriculum, may instil preventive oral hygiene behaviour in school students, enabling them to retain good oral health for the rest of their lives. Because most children attend school, the school setting is the most effective for promoting behavioural change in children. A ‘health-promoting school’ actively promotes health by enhancing its ability to serve as a healthy place to live, learn and work, bringing health and education together. Making every school a health-promoting school is one of the joint objectives of the WHO and UNICEF. The primary objective of this proposed study is to assess the effectiveness of an oral health curriculum intervention in reducing dental caries incidence and improving oral hygiene behaviour among high school children in grades 8–10 of the Ernakulam district in Kerala, India. If found to be effective in changing children’s behaviour in a positive way, an oral health curriculum may eventually be incorporated into the school health curriculum in the future. Classroom interventions can serve as a cost-effective tool to increase children’s oral health awareness.Methods and analysis This protocol presents a cluster randomised trial design. It is a parallel-group comparative trial with two arms having a 1:1 distribution—groups A and B with oral health curriculum intervention from a dental professional and a schoolteacher, respectively. High schools (grades 8–10) will be selected as clusters for the trial. The minimum cluster size is 20 students per school. The total sample size is 2000 high school children. Data will be collected at three time points, including baseline, after 1 year (mid-term) and 2 years (final), respectively. The outcome measures are Decayed, Missing and Filled Teeth Index; Oral Hygiene Index-Simplified; and knowledge, attitude and behaviour. Data collection will be done by clinical oral examination and questionnaire involving oral health-related knowledge, attitude and behaviour items.Ethics and dissemination Ethical approval was obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences and Research Centre (dated 19 July 2022, no: IEC-AIMS-2022-ASD-179).Trial registration number Clinical Trial Registry of India (CTRI/2022/09/045410).

Objectives The COVID-19 pandemic has posed unprecedented challenges to health systems and populations, particularly in India. Comprehensive, population-level studies of the burden of disease could inform planning, preparedness and policy, but are lacking in India. In West Bengal, India, we conducted a detailed analysis of the burden caused by COVID-19 from its onset to 7 January 2022.Setting Open-access, population-level and administrative data sets for West Bengal were used.Primary and secondary outcome measures Disability-adjusted life years (DALYs), years of potential productive life lost (YPPLL), cost of productivity lost (CPL: premature mortality and absenteeism), years of potential life lost (YPLL), premature years of potential life lost, working years of potential life lost (WYPLL) and value of statistical life (VSL) were estimated across scenarios (21 for DALY and 3 each for YPLL and VSL) to evaluate the effects of different factors.Results COVID-19 had a higher impact on the elderly population with 90.2% of deaths arising from people aged above 45. In males and females, respectively, DALYs were 190 568.1 and 117 310.0 years, YPPLL of the productive population was 28 714.7 and 16 355.4 years, CPL due to premature mortality was INR3 198 259 615.6 and INR583 397 335.1 and CPL due to morbidity was INR2 505 568 048.4 and INR763 720 886.1. For males and females, YPLL ranged from 189 103.2 to 272 787.5 years and 117 925.5 to 169 712.0 years for lower to higher age limits, and WYPLL was 54 333.9 and 30 942.2 years. VSL (INR million) for the lower, midpoint and upper life expectancies was 883 330.8; 882 936.4; and 880 631.3, respectively. Vaccination was associated with reduced mortality.Conclusions The losses incurred due to COVID-19 in terms of the computed estimates in West Bengal revealed a disproportionately higher impact on the elderly and males. Analysis of various age-gender subgroups enhances localised and targeted policymaking to minimise the losses for future pandemics.

Healthcare personnel who deal with COVID-19 experience stigma. There is a lack of national-level representative qualitative data to study COVID-19-related stigma among healthcare workers in India. The present study explores factors associated with stigma and manifestations experienced by Indian healthcare workers involved in COVID-19 management. We conducted in-depth interviews across 10 centres in India, which were analysed using NVivo software version 12. Thematic and sentiment analysis was performed to gain deep insights into the complex phenomenon by categorising the qualitative data into meaningful and related categories. Healthcare workers (HCW) usually addressed the stigma they encountered when doing their COVID duties under the superordinate theme of stigma. Among them, 77.42% said they had been stigmatised in some way. Analyses revealed seven interrelated themes surrounding stigma among healthcare workers. It can be seen that the majority of the stigma and coping sentiments fall into the mixed category, followed by the negative sentiment category. This study contributes to our understanding of stigma and discrimination in low- and middle-income settings. Our data show that the emergence of fear of the virus has quickly turned into a stigma against healthcare workers.

Introduction: Since 2011, sale of commercially available smokeless tobacco products for chewing such as gutkha has been prohibited in many states in India. The current study attempts to understand the effectiveness and perception towards ban on gutkha sales in West Bengal and Kerala. Methods: Total six districts from both the states (three districts from each state). From each district, 1 Municipality and 2 Community Development Blocks were selected randomly, representing each cluster. From each cluster, line transect survey was used to identify Point of Sale (POS) of tobacco products. Tobacco consumers and vendors were interviewed from POS. Results: 865 tobacco users (West Bengal = 450, Kerala = 415) and 173 vendors (West Bengal = 90, Kerala = 83) were interviewed for the study. 16.1% of the total users from Kerala were using gutkha alone or in combination with other tobacco chewing products while in West Bengal the corresponding figure was 17.3%. Knowledge on ban was high among the consumers (95.7%) and vendors (100%) in Kerala while in West Bengal it was 64% and 62.2% respectively. Gutkha was available in 68% of the shops in West Bengal, while in Kerala no sale was reported in shops, though half of the vendors interviewed, admitted its sales in black market. Conclusion: The ban had little impact in West Bengal in the open market, while it had moderate impact in Kerala. However, the black market sales in Kerala are a matter of concern. Strict legislative measures are essential to cut the supply route for effective implementation of the ban.

This study is intended to answer the question of how political polarization is related to social media users’ posts about Covid-19. The researchers chose health cases related to Covid-19 instead of political issues (e.g. elections) to prove that this political polarization has spread to many areas. The research also wants to see the relationship between this political polarization and selective exposure. Theories applied in this study are polarization, filter bubble, and selective exposure. The study applied two methods: social media network analysis and content analysis. The network analysis included 82,156 posts, while the content analysis was carried out on 4,050 social media accounts. The research outcome proves the occurrence of political polarization. Social media users were divided into two major groups, namely pro-Jokowi and anti-Jokowi. Each group interacted with fellow users who had the same political choices and shared the same message content. Users with certain political choices tend to receive the same information as their political choices, and ignore information from other political parties. Another interesting finding from this study is how this polarization was sharpened by the use of hashtags. Each party (supporters and oppositions of Jokowi) uses hashtags to create solidarity and mobilization from each supporter. Research also proves the validity of the selective exposure and filter bubble hypothesis in the Indonesian context.

The quantification of spatially variable mechanical response in structural materials remains a challenge. Additive manufacturing methods result in increased spatial property variations—the effect of which on component performance is of key interest. To assist iterative design of additively manufactured prototypes, lower-cost benchtop test methods with high precision and accuracy will be necessary. Profilometry-based indentation plastometry (PIP) promises to improve upon the instrumented indentation test in terms of the measurement uncertainty. PIP uses an isotropic Voce hardening model and inverse numerical methods to identify plasticity parameters. The determination of the baseline uncertainty of PIP test is fundamental to its use in characterizing spatial material property variability in advanced manufacturing. To quantify the uncertainty of the PIP test, ninety-nine PIP tests are performed on prepared portions of a traditionally manufactured Al 7075 plate sample. The profilometry data and the Voce parameter predictions are examined to distinguish contributions of noise, individual measurement uncertainty, and additional set-wide variations. Individual measurement uncertainty is estimated using paired profilometry measurements that are taken from each indentation. Principal component analysis is used to analyze and model the measurement uncertainty. The fitting procedure used within the testing device software is employed to examine the effect of profile variations on plasticity predictions. The expected value of the error in the plasticity parameters is given as a function of the number of tests taken, to support rigorous use of the PIP method. The modeling of variability in the presence of measurement uncertainty is discussed.

Abstract This is the protocol for a Campbell systematic review. The objectives are as follows: to identify, describe, and summarize existing guidance and methods for multistakeholder engagement throughout the health guideline development process.

Purpose: Visual evoked potentials (VEP) are used to determine the function of visual pathway from the optic nerve to visual cortex. Various factors may affect VEP response, viz., technical and environmental. The aim of this study is to obtain the normative value of VEP latency and amplitude parameters in adulthood in Indonesia, as well as the relationship of height, weight, body mass index (BMI), head circumference, and visual acuity with the variety of latency and amplitude values of VEP parameters. Methods: It is a cross-sectional study on 120 healthy subjects consisting of 60 males and 60 females between 18 and 65 years old. Height, weight, BMI, head circumference, and visual acuity were measured and continued with VEP examination using a 26′ checkerboard pattern on the left and right eyes alternately. All data were collected and analyzed with the Shapiro–Wilk test using statistical software R version 3.5.2. Results: Mean value of P100 latency (interocular latency) of left and right eye were 104.6 ± 3.4 ms and 104.1 ± 3.4 ms, respectively, as well as 9.8 ± 4.7 μV and 10.3 ± 5.4 μV for the amplitude. There was no significant difference between the male and female group, as well as on the age group. Female significantly exhibited a higher P100 amplitude than male. The greater the age, the lower amplitude of P100 significantly. Conclusion: Gender and age do not affect the P100 latency value but only affect P100 amplitude. Height, weight, BMI, head circumference, and visual acuity also do not affect the P100 latency and amplitude.

Investigación cuyo objetivo fue determinar las causas más relevantes para el incremento de los casos de feminicidio íntimo en la ciudad de El Alto, Bolivia. El estudio se abordó desde un enfoque cualitativo, de tipo descriptivo, bajo el diseño de investigación no experimental. Los resultados de la investigación arrojaron que los factores sociales, culturales, económicos y educativos influyen para que la pareja esté en situación de violencia, debido al “aprendizaje violento” dado desde la historia familiar de ambos, como también al aprendizaje que se produce en el ciclo violento por la incapacidad de resolución de conflictos, partiendo que los agresores minimizan los hechos. Se creó un programa educativo de prevención de “feminicidio íntimo”, violencia en parejas denominado “Formemos juntos y juntas una familia sin violencia” para coadyuvar en la necesaria sensibilización acerca de la problemática.

Background Fiscal policy targeting tobacco control is identified as the most effective strategy for rapid control of tobacco use. An optimum fiscal policy to estimate the percentage taxation that will maximise the government tax revenue, social savings and the net monetary benefit has not been empirically designed before in Sri Lanka. Methods A model was developed using Microsoft Excel 2016, utilizing up-to-date published evidence on the cigarette sales, current fiscal policy, social cost of tobacco use, consumer response and the price elasticity of cigarettes. Univariate estimates on the expected revenue from tobacco tax, average annual social savings and the net monetary benefit were predicted for different levels of tobacco taxation. A deterministic sensitivity analysis was performed covering all possibilities. The percentage taxation maximizing the government tax revenue and the net monetary benefit were identified. Results It was estimated that a further 30% tax increase from the 2019 baseline will generate approximately LKR 3544 million per year of additional tax revenue for the government while saving LKR 28 069 million per annum as social savings. A fiscal elevation of 50% will produce identical annual tax revenue to that of 2018, while securing a social saving of more than LKR 47 600 million per annum. The maximum net monetary benefit is achievable at an overnight tax increase of 90% from the baseline, however with a short-term compromise in tax revenue. Conclusion The well-defined thresholds take tobacco taxation advocacy in Sri Lanka a step forward and will assist the government in taking an informed decision on its fiscal policy for cigarettes.

Thank you so much for forwarding the critical analysis the author (VK) conducted on our recently published modelling study ‘A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India’ in your reputed journal [...]

Background: Non communicable diseases (NCD) are a rising problem worldwide and is a cause of public health concern in India too. These diseases result in high health care demand and are expensive especially in low resource settings. We studied the NCD burden estimates for India and its major states and the associated cost in 2017. Methods: The disease burden was estimated using DALYs (Disability Adjusted life years), the Years of Life lost (YLL) and Years lived in disability (YLD). Health expenditure data from National Sample Survey was used to calculate out of pocket expenditure (OOPE) and catastrophic health expenditure (CHE). Results: NCDs account for 16939 DALYs per 100 000 in India. About 50–70% of patients took treatment in private facilities. There is huge variation in the utilization of health facilities, disease burden and cost of treatment across the states. Karnataka had highest DALY rate of 25790 DALYs per 100 000 but Chandigarh showed highest mean OOPE of INR 63952 and Arunachal Pradesh showed the highest CHE of 47.7 percent. Conclusions: The economic burden of NCDs is notably high both in terms of OOPE and CHE and indicate variation across states in both disease burden and economic burden. The findings highlight the need for improvement of NCD management programmes in socioeconomically lower states of India.

Introduction Coronary artery disease (CAD), the leading cause of mortality worldwide, is characterised by an earlier onset and more severe disease in South Asians as compared to Western populations. Methods This is an observational study on 928 individuals who attended three tertiary care centres in Kerala, India from 2014-to 2017. The demographic, anthropometric, behavioural factors and the lipoprotein (Lp(a)) and cholesterol values were compared between the two groups and across disease severity. The Chi-square test was used to compare the categorical variables and independent sample t-test for the continuous variables. Multivariable logistic regression was performed to investigate the association of demographic, clinical and behavioural factors with the disease. Odds ratios are presented with a 95% confidence interval. In individuals below 50 years, two logistic regression models were compared to investigate the improvement in modelling the association of the independent factors and Lp(a) with the occurrence of the disease. Results We included 682 patients in the diseased group and 246 patients treated for non-coronary conditions in the control group. Those in the control group were significantly younger than in the diseased group(pConclusion Age, diabetes, hypertension and tobacco use appear to be associated more with the occurrence of coronary artery disease in adults of all ages. Lipoprotein(a), cholesterol and BMI categories do not seem to be related to disease status in all ages. However, in individuals below 50 years, diabetes, tobacco use and lipoprotein (a) are significantly associated with the occurrence of the disease.

Background COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. Methods A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. Results Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66–3.41), income≥20000(AOR = 1.74, 95% CI, (1.16–2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09–2.46), contact tracing (AOR = 2.05, 95% CI (1.1–3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14–6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28–2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). Conclusion The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

IntroductionCoronary artery disease (CAD), the leading cause of mortality worldwide, is characterised by an earlier onset and more severe disease in South Asians as compared to Western populations.MethodsThis is an observational study on 928 individuals who attended three tertiary care centres in Kerala, India from 2014-to 2017. The demographic, anthropometric, behavioural factors and the lipoprotein (Lp(a)) and cholesterol values were compared between the two groups and across disease severity. The Chi-square test was used to compare the categorical variables and independent sample t-test for the continuous variables. Multivariable logistic regression was performed to investigate the association of demographic, clinical and behavioural factors with the disease. Odds ratios are presented with a 95% confidence interval. In individuals below 50 years, two logistic regression models were compared to investigate the improvement in modelling the association of the independent factors and Lp(a) with the occurrence of the disease.ResultsWe included 682 patients in the diseased group and 246 patients treated for non-coronary conditions in the control group. Those in the control group were significantly younger than in the diseased group(pConclusionAge, diabetes, hypertension and tobacco use appear to be associated more with the occurrence of coronary artery disease in adults of all ages. Lipoprotein(a), cholesterol and BMI categories do not seem to be related to disease status in all ages. However, in individuals below 50 years, diabetes, tobacco use and lipoprotein (a) are significantly associated with the occurrence of the disease.

Background Snakebite is possibly the most neglected of the NTDs (Neglected Tropical Diseases). Half of the global deaths due to venomous snakebites, estimated at 100,000 per year, occur in India. The only representative data on snakebite available from India is the mortality data from the RGI-MDS study (Registrar General of India- 1 Million Death Study) and another study on mortality from the state of Bihar. Incidence data on snakebite is available for 2 districts of the state of West Bengal only. Hospital-based data on snakebite admissions and use of ASV are gross underestimates as most snakebite victims in rural India depend more on alternate treatment methods which do not get represented in National registries. The proposed study is a multi-centric study to determine the incidence, morbidity, mortality and economic burden of snakebites in India covering all 5 geographical zones of the country. Protocol A community level surveillance for snakebite covering 31 districts in 13 states of India in order to obtain annual incidence of snakebites from the community. Frontline health workers will be trained to gather information on new cases of snakebite over the study period of 1-year, from “wards “(smallest administrative subunit of a village or town) that they represent in the study districts. Dedicated field officers would collect data on snakebites, victim characteristics, outcomes, utilization of health facilities on a questionnaire sheet designed for this purpose. The study duration is for 18 months from April 2022 to October 2023. Discussion The study would be the first of its kind in India looking prospectively at the incidence of snakebite covering 13 states in 5 zones of India and a population of 84 million. Our study covers 6.12% of the total population of the country as compared to the incidence study conducted in Sri Lanka which covered 1% of the total population.