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Background: Multi-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women. Methods: This community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed. Results: The study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues. Conclusion: The findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy. [ABSTRACT FROM AUTHOR]

This paper presents evidence of gender peer effects in high schools in India using new administrative data. Identification of gender peer effects is achieved by exploiting variation induced by idiosyncratic changes in gender composition across cohorts within schools, in addition to controlling for past scores. The proportion of female classmates in a student's cohort has a sizeable positive effect on the test scores of both male and female students. We find that peer effects vary non-linearly with the proportion of female students. Finally, we provide suggestive evidence on plausible mechanisms. We show that achievement spillovers are not the main driver of positive gender peer effects. Using a supplemental dataset, we show that a greater proportion of female students leads to an improved classroom environment in the context of Indian schools. [ABSTRACT FROM AUTHOR]

Copyright of Indian Journal of Palliative Care is the property of Scientific Scholar LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cancer affects mental health in older adults with cancer (OAC), affecting almost 50% of the patients. There are only a few studies on psychiatric disorders in OAC, especially in low resource settings. We report on our real-world experience of prevalence of and factors associated with psychiatric disorders in OAC referred to a psycho-oncology service in an Indian tertiary care cancer institute. Methods: We retrospectively analysed medical and psycho-oncology records of patients aged 60 + on cancer-directed treatment or follow-up for < 2 years after treatment completion, referred to psycho-oncology services in a tertiary care cancer centre in Mumbai, India, from Jan 2011-Dec 2017. We recorded sociodemographic, clinical, and treatment-related variables, as well as past psychiatric disorders. The ICD-10 was used to record current psychiatric disorder type and presence. IBM SPSS version 24 (Armonk, NY, USA) was used for descriptive measures, tests of association, and logistic regression analysis. The study protocol was approved by Institutional Ethics Committee and registered with the Clinical Trials Registry-India (CTRI/2020/06/026095). Results: Of 763 patients included in the study, 475 (62.3%) were males and 436 (57.1%) were inpatients, with a median age of 65 years. 93% of the patients had a solid tumour and 207 (27.1%) had a history of psychiatric disorder. A current psychiatric diagnosis was noted in 556 patients (72.9%) on initial presentation, of which adjustment disorders, delirium and depression and anxiety disorders were most frequently seen in 25.2%, 21% and 11.1%, respectively. On univariate analysis, a past history of psychiatric disorders (χ2 = 34.6, p < 0.001), lower performance status (χ2 = 9.9, p = 0.002) and haematolymphoid malignancy (χ2 = 4.08, p = 0.04) significantly increased the risk of current psychiatric diagnosis. Logistic regression confirmed these variables as significant. Conclusion: Older adults with cancer referred to psycho-oncology services have high rates of psychiatric disorders at their initial presentation, mainly adjustment disorders, delirium and depression and anxiety. A past history of psychiatric disorders, lower performance status and haematolymphoid cancers significantly increased the risk of psychiatric disorders. Multidisciplinary psycho-oncology teams including a psychiatrist should be integrated in comprehensive care of this group of patients. Further research outcomes and effect of psycho-oncological interventions is required in older adults with cancer in LMIC settings. [ABSTRACT FROM AUTHOR]

This research work focuses on the Internet of Things (IoT) idea utilizing an intelligent (or smart or innovative) city model with the support of Raspberry Pi. Using Raspberry Pi, this model examined the strategy and execution of a smart city established on the Internet of Things. This study attempts to create an urban IoT system utilizing Raspberry Pi to help smart cities solve domestic difficulties. The Internet of Things idea assists in analyzing the functions used to define the functions of the Raspberry Pi. The IoT is critical to creating a smart city concept in a developing nation like India. The various low-cost operations help analyze Raspberry Pi functionalities in the smart city model. A better Smart city development strategy has been presented when comparing the existing system, Raspberry Pi-based techniques. [ABSTRACT FROM AUTHOR]

The demand for transit is linked to a country's economic and population growth. As per the Ministry of Road Transport and Highways (MORTH), from 2009 to 2019, India witnessed an average growth rate of 9.9% per annum in registered vehicles. Even though the vehicle ownership is often viewed as a symbol of economic prosperity, the associated negative externalities (congestion, air pollution, road crashes, noise pollution, etc.) are substantial. To counter this, carpooling has been proposed as a solution globally. However, there is a paucity of literature for analysing the difference in travel characteristics of car-poolers among other private vehicle users. The present study aims to bridge this gap by comparing the demographic and travel characteristics of existing car-poolers with two-wheelers and single-occupant car users in Gurugram in the national capital region of India. Using an unsupervised machine learning clustering method (two-step cluster), the findings of the present study indicate that the profile of single-occupant car (SOC) users and car-poolers are highly distinguished from two-wheeler users. However, car-poolers have similar characteristics to single-occupant car users, except for travel cost, income level, and gender, suggesting that SOC users are potential car-poolers. A comparative study of this kind would help city planners and policymakers identify prospective car-poolers, and formulate policies to encourage SOC users to adopt carpooling and promote urban transportation sustainability. • The present study intends to compare the demographic profile and travel characteristics of carpoolers with other private vehicle users. • Using a Compared to two-wheeler users, single occupancy car (SOC) users are more likely to switch to carpooling. • Carpoolers have almost the same characteristics as single-occupant car users, except for travel costs, income levels. [ABSTRACT FROM AUTHOR]

The objective of the present study was to evaluate the Drug utilisation pattern in patients of diabetic nephropathy (stage 1–4) in a tertiary care hospital in South-Asia. A cross-sectional observational study was conducted in the nephrology out-patient-department of a tertiary care hospital in South-Asia. WHO core prescribing, dispensing, and patient care indicators were evaluated, and adverse drug reactions (ADRs) encountered by the patients were analysed for causality, severity, preventability, and outcome. The most commonly prescribed antidiabetics in diabetic nephropathy patients were insulin (17.42%), followed by metformin (4.66%). Current drugs of choice SGLT-2 inhibitors were prescribed in a lesser frequency than expected. Loop diuretics and calcium channel blockers (CCBs) were the preferred antihypertensives. The use of ACE inhibitors (1.26%) and ARBs (3.45%) for hypertension was restricted to Stage 1 and 2 nephropathy. The patients were on 6.47 drugs on average. 30.70% of drugs were prescribed by generic names, 59.07% of the drugs were prescribed from the national essential drugs list and 34.03% of the prescribed drugs were supplied by the hospital. CTCAE grade 1 (68.60%) and grade 2 (22.09%) ADR severity was the highest. Prescribing patterns in patients of diabetic nephropathy were adapted from relevant medical evidence, affordability and availability of the drugs. Generic prescribing, availability of drugs and ADR preventability in the hospital have a broad scope for improvement. [ABSTRACT FROM AUTHOR]

Background: Antifungal stewardship is a less explored component of antimicrobial stewardship programmes, especially in developing countries. Objective: We aimed to determine antifungal prescription practices in a tertiary centre of a developing country to identify the challenges for antifungal stewardship programmes. Methods: Four single‐day point prevalent surveys were performed in inpatient units and data were collected from medical records. Antifungal use was recorded in terms of consumption, therapeutic strategies and appropriateness. Results: We found a 2.42%‐point prevalence of antifungal prescriptions. Antifungal use was higher in children than adults (4.1% vs. 2.03%), medical than surgical units (3.7% vs. 1.24%) and ICUs than general wards (5.8% vs. 1.9%). The highest antifungal use was observed in the haematology‐oncology units (29.3%) followed by emergency (16.2%) and gastroenterology units (11.6%). Among 215 prescriptions, amphotericin B was the most commonly prescribed (50.2%) followed by fluconazole (31.6%). The targeted antifungal therapy was practised more commonly (31.5%) than empiric (29.1%), pre‐emptive (22.6%) and prophylactic (16.8%) therapy. Amphotericin B was commonly used for pre‐emptive (p =.001) and targeted (p =.049) therapy, while fluconazole (p =.001) and voriconazole (p =.011) for prophylaxis. The prescriptions were inappropriate in 25.1% due to the wrong choice of antifungal (44.4%), indication (27.7%) and dosage (24%). The overall mean antifungal consumption was 2.71 DDD/1000 PD and 8.96 DOT/1000 PD. Conclusions: We report here the low prevalence of antifungal use at a tertiary care centre in a developing country. Though training for antifungal use would be important for antifungal stewardship, the challenge would remain with the affordability of antifungals. [ABSTRACT FROM AUTHOR]

Children with underlying cancer are often immunocompromised. Data on severity of coronavirus disease 2019 (COVID-19) in children with cancer and its outcomes is emerging. Treatment protocols of specific cancers are decided based on the infrastructure, availability of supportive-care, and logistic issues of the locality. The purpose of the study was clinical analysis of COVID-19 in children and adolescents with cancer. The retrospective observational study was conducted at a tertiary healthcare-center in East India. Children and adolescents (aged 0–19 years) with cancer and under treatment with reverse-transcriptase-polymerase-chain-reaction (RT-PCR) confirmed COVID-19 between 5-July-2020 and 5-December-2020 were studied. Median age of the 68 identified patients was six years. Acute leukemia was the most common (66%) diagnosis. COVID-19 was asymptomatic/mildly symptomatic in 91% and moderate to severe in only 9% of patients. Fever (87%) was the commonest symptom, followed-by cough/coryza (75%). Three patients with acute myeloid leukemia (AML) and severe/critical COVID-19 and associated neutropenic sepsis were required transfer to the intensive-care-unit (ICU) for management. Three (4.4%) patients succumbed with COVID-19. Delay in treatment was observed in 63.2% of patients, and the median duration of delay was 28 days after acquiring COVID-19. Median time to attain negative COVID-19 RT-PCR was 16 days, and eight patients were repeat positives. While pediatric and adolescent cancer patients on active treatment may have a higher risk of mortality from severe COVID-19 than their healthy counterparts, the risk may be much lower than deemed. It is essential to continue cancer therapy in these children. Delay in treatment remains a concern. [ABSTRACT FROM AUTHOR]

Despite high level vaccination and the availability of two different types of vaccines, whole cell (wP) and acellular vaccines (aP), the resurgence of pertussis has been reported in many countries. Antigenic variation within circulating and vaccine strains is the most documented reason reported for the resurgence of pertussis. Research on genetic divergence among circulating and vaccine strains has largely been reported in countries using aP vaccines. There are inadequate data available for antigenic variation in B. pertussis from wP-using countries. India has used wP for more than 40 years in their primary immunization program. The present study reports five clinical isolates of B. pertussis from samples of pediatric patients with pertussis symptoms observed in India. Genotypic and phenotypic characterization of clinical isolates were performed by serotyping, genotyping, whole genome analyses and comparative genomics. All clinical isolates showed serotype 1, 2 and 3 based on the presence of fimbriae 2 and 3. Genotyping showed genetic similarities in allele types for five aP genes within vaccine strains and clinical isolates reported from India. The presence of the ptxP3 genotype was observed in two out of five clinical isolates. Whole-genome sequencing was performed for clinical isolates using the hybrid strategy of combining Illumina (short reads) and oxford nanopore (long reads) sequencing strategies. Clinical isolates (n = 5) and vaccine strains (n = 7) genomes of B. pertussis from India were compared with 744 B. pertussis closed genomes available in the public databases. The phylogenomic comparison of B. pertussis genomes reported from India will be advantageous in better understanding pertussis resurgence reported globally with respect to pathogen adaptation. [ABSTRACT FROM AUTHOR]

Background: Noncommunicable diseases (NCD) are the leading cause of death in India, with cardiovascular diseases (CVD) in particular accounting for nearly 1 in 3 deaths. The prevention of key CVD risk factors – namely, diabetes and hypertension – is a public health priority. Objectives: The objective is to describe the results of large-scale, community-based NCD screening using the Government of India's Community Based Assessment Checklist (CBAC) scoring system. Materials and Methods: Trained enumerators visited each household in 10 villages in Punjab, India, between September 2019 and March 2020. Standardized methods were used to measure blood pressure, blood glucose, waist circumference, family medical history, and lifestyle behaviors. Results: A total of 11,322 adults (52.1% women; mean age 48.3 years) completed the assessment and 14.4% were classified as high-risk (CBAC >4). Those classified as high-risk were significantly more likely to have hypertension (46.0% vs. 20.6% among low-risk, P < 0.0001) and diabetes (12.0% vs. 7.7%, P < 0.0001). Only 26.8% of those with hypertension were diagnosed and only 14.9% treated. Proportions among those with diabetes were similarly low: 29.2% diagnosed and 16.0% treated. Conclusions: To the best of our knowledge, this is the first study to estimate the prevalence of high-risk CBAC scores in a population-based sample. Given that the Government of India aims to undertake population-based screening of all adults >30 years for NCDs, the results of this study are directly translatable. [ABSTRACT FROM AUTHOR]

The present study focused on the Business Process Outsourcing (BPO) industry in India. The BPO is a service industry. It is contributing to a great extent to the Indian economy, as per the Indian Brand and Equity Foundation. The major research question is how and why the BPO industry has emerged in India, a developing country. A descriptive research analysis has been conducted in this research paper. It is found that the Indian workforce is laborious, efficient, and proficient in speaking English to manage businesses around the world. So it is easier to attract the BPO industry to India. It is also observed that the workforce in India is available at a cheaper cost in comparison to other developed countries in the world. So it provides cost advantages to those companies who want to outsource them. The other reason may be the liberalisation of government policies in India for investment by companies around the world. [ABSTRACT FROM AUTHOR]

This article discusses the challenges of assessing health-related quality of life (HRQoL) in children who have undergone surgery for transposition of the great arteries in a developing country. The study focuses on a single center in Kerala, India, and evaluates HRQoL outcomes of children who underwent an arterial switch operation (ASO) between 2012 and 2018. The results show that overall HRQoL scores were high, indicating good quality of life for these children. However, the study also highlights limitations in the measurement of HRQoL, such as cultural appropriateness of the measures and reliance on proxy reporting. The article concludes by emphasizing the need for further research to understand the long-term outcomes of these children as they grow up. [Extracted from the article]

• Trading regulations are important to control biological invasions. • Evaluated biosecurity framework related to invasive plant species trading in India. • Legal framework exclusively to deal with these species is absent in the country. • Proposed a set of policy interventions considering stakeholders' varied interests. • Outlined a standard operating procedure for effective execution of the policies. Biological invasions are a major global challenge for the conservation of biodiversity, maintenance of ecosystem health and sustainable livelihoods. As the number of novel introductions of invasive species is predicted to increase due to rising trade volumes in the emerging economies, regulatory policies to prevent the introduction and spread of invasive species are of paramount importance. However, poor response capacities, lack of coordination between stakeholders, heavy dependence on biological resources and little public awareness are some of the formidable barriers in framing and implementing such policies in developing countries. This study was conceptualized to establish common ground by considering the diverse interests of different actors and design a policy framework to control invasive alien plant species (IAPS) in the lower-middle income economies considering India as a case study. To achieve this objective, we evaluated the introduction pathways and current economic uses of IAPS in India and critically reviewed the infrastructure and current response capacity of the country for regulating pre- and post-border trading of these problematic species. We found that the majority of IAPS were introduced for ornamental purposes and some of them are still actively traded and used for several economic purposes. Despite having a rich legacy of environmental policies, a legal framework exclusively to deal with invasive species is non-existent in India. Here, we propose a set of policy interventions, for international and domestic trading, by integrating trade regulations based on a risk assessment framework with interests of both consumers and traders to ensure effective compliance from all stakeholders. Further, we identify potential hurdles for policy implementation in India and therefore, based on the existing biosecurity infrastructure, we outline an operable and dynamic decentralized system having a standard operating procedure to ensure coordination between different stakeholders, increase public awareness and guide further research direction. [ABSTRACT FROM AUTHOR]

The sustainable development goals (SDGs) were result of extensive stakeholder participation and global consensus. Despite large promises, there is an increasing concern among the member states whether SDGs address real problems of nations, particularly the developing world. This study discusses key issues raised by developing countries with respect to the SDGs. Using opinion of experts on SDGs regarding its implications and future, a case study for India is presented. The study with its findings and policy recommendations intend to benefit SDG implementation efforts and planning at the national and sub-national level in India and other developing countries, helping them redesign and investigate their national SDG implementation strategies on similar lines as India to improve its reach and effectiveness. [ABSTRACT FROM AUTHOR]

Aim: To estimate the comprehensive healthcare costs of heart failure (HF) and determine the utilization of healthcare resources (HRU) for 2 years following index hospitalization. Subjects and methods: The Manipal Heart Failure Registry (MHFR) is a prospective registry analyzing the financial burden and HRU in 610 patients with HF. Costs incurred by patients during 2 years following index hospitalization were estimated, and their association with socio-demographic and clinical factors were calculated. After 54 (8.8%) in-hospital mortalities, 556 patients were followed up for 2 years. Results: The mean age of the study cohort was 65.08 ± 13.6 years, and 245 (40.2%) were females. Based on the ejection fraction (EF), 506 (82.9%) patients were diagnosed as having HF with reduced EF. Average hospital stay during index admission was 5.3 ± 2.9 days. Total expenditure during index hospitalization was INR 36.3 million and during 2-year follow-up was INR 45.2 million. Average total expenditure per patient was INR 133,663. The average out-of-pocket expense was INR 82,766 and average health insurance coverage was INR 50,896. Difference in expenditure was significant (P < 0.05) between specific groups, i.e., etiologies, genders, HF phenotypes, age groups, and healthcare insurance types. Conclusion: Healthcare expenditure of patients with HF in India is much lower than for the western counterparts. Higher utilization of healthcare resources in HF patients with ischemic etiology, non-compliant to medications, and elderly (age > 60 years) was associated with increased expenses. Interventional procedures and implantations account for the bulk of the expenses in ischemic HF patients. Trial registration number: Clinical Trial Registry of India: CTRI/2017/11/010395; National Institute of Health (NIH) clinical trial no.: NCT03157219. [ABSTRACT FROM AUTHOR]

Purpose: Using survey data of a developing country city, this study aims to examine the impact of different socio-demographic factors on the choice of less-polluting modes of transport for purposes other than work. Design/methodology/approach: Stratified random sampling technique is employed and data on socio-demographic characteristics and mode of transport used is collected. Descriptive statistics complemented with a logit model of choice probabilities is implemented on the data obtained. Findings: Majority of the population in the city uses motorized means of transportation irrespective of the socio-demographic changes existing among them. Women, the individuals belonging to the youngest age group, the least economically well-off group of people, the least educated and the non-working are the individuals more likely to use more of less-polluting modes and less of more-polluting modes for non-work purposes as compared to their counterparts. Research limitations/implications: The study also calls for the development of an efficient and secured system of public transportation and non-motorized transportation in the city in such a way so as to neither hamper the goal of sustainability nor the goal of empowerment. Originality/value: To the best of the authors' knowledge, this is the first time a comprehensive analysis of the influence of socio-demographic factors on choice of type of mode of transport is carried out in this region of the developing world. This analysis will facilitate the policy makers in catering to the transportation needs of different segments of the society. [ABSTRACT FROM AUTHOR]

Background: The COVID19 lockdown has altered the dynamics of living. Its collateral fallout on head injury care has not been studied in detail, especially from low- and middle-income countries, possibly overwhelmed more than developed nations. Here, we analyze the effects of COVID19 restrictions on head injury patients in a high-volume Indian referral trauma center. Methods: From the prospective trauma registry, clinico-epidemiological and radiological parameters of patients managed during 190 days before and 190 days during COVID19 phases were studied. As an indicator of care, the inpatient mortality of patients with severe HI was also compared with appropriate statistical analyses. Results: Of the total 3372 patients, there were 83 head injury admissions per week before COVID19 restrictions, which decreased to 33 every week (60% drop) during the lock phases and stabilized at 46 per week during the unlock phases. COVID19 restrictions caused a significant increase in the proportion of patients arriving directly without resuscitation at peripheral centers and later than 6 h of injury. Though the most common mechanism was vehicular, a relative increase in the proportion of assaults was noted during COVID19. There was no change in the distribution of mild, moderate, and severe injuries. Despite a decrease in the percentage of patients with systemic illnesses, severe head injury mortality was significantly more during the lock phases than before COVID19 (59% vs. 47%, p = 0.02). Conclusions: COVID19 restrictions have amplified the already delayed admission among patients of head injury from north-west India. The severe head injury mortality was significantly greater during lock phases than before COVID19, highlighting the collateral fallout of lockdown. Pandemic control measures in the future should not ignore the concerns of trauma emergency care. [ABSTRACT FROM AUTHOR]

Background: Lacunar stroke accounts for a quarter of all acute ischemic infarction. Insufficient information is available with respect to the pattern and risk factor profiles of patients with lacunar stroke from developing countries. We undertook this study to define the clinical features, imaging characteristics, and risk factors in a group of patients with image proven lacunar stroke from southern India, and contrast them with those described from developed countries. Methods: We retrospectively reviewed the demographic, risk factor profiles (presence of hypertension, diabetes mellitus, dyslipidemia, smoking) and CT/MRI brain findings (microbleeds, small vessel ischemic changes, old infarcts) and CV Doppler/CT or MR angiography of brain and neck vessels of 132 consecutive patients diagnosed with image proven acute infarct measuring 2-20mm in subcortical white matter, basal ganglia, thalamus or pons, presumed to result from the occlusion of a single small perforating artery(lacunar infarct), in Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India. Results: Males comprised 63.6%, with 56% between the ages of 55-75 years. Hypertension was present in 98 (74.2%) and 50 (37.8%) had diabetes mellitus. Pure motor hemiparesis was the most common clinical syndrome 79 (59.8%), followed by ataxic hemiparesis in 32 (24.2%). Chronic lacunar infarct was detected in 68 (51.5%) patients MRI; however, past history of stroke was present only in 10 (7.6%). Small vessel ischemic changes were present in 100 (75.8%), and cerebral micro-bleeds in 10 (7.6%) patients. Angiography showed symptomatic side carotid stenosis of over 50% in 6 (4.5%), intracranial major vessel stenosis in 12.61% of patients. Conclusion: Lacunar stroke, although less dramatic in its clinical presentation, is frequently associated with modifiable risk factors like hypertension and diabetes. It should be regarded as a warning sign of underlying diffuse small vessel disease; hence, portends recurrent stroke and vascular dementia. Our findings are in accordance with most studies from developed countries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess awareness about online classes and to assess if they can aid learning in the field of medicine amid lockdown.Methods: Online survey comprising a questionnaire related to the aspects of online teaching was undertaken. There were 16 questions, and responses were collected from undergraduates, postgraduates, and the teaching faculties.Results: Online classes were viewed favorably by the vast majority of respondents. Out of 412 respondents 79.9% actively attended the classes. While 42% felt the timings were inappropriate as they clashed with duty hours, a set of 35% had difficulty understanding the content and most of them were undergraduates. Poor internet connection was a main hindrance identified. In total, 69.2% respondents were happy with the feasibility of the classes and believed these classes had the advantage of being economical as they offered exposure to national and international faculty from the comfort of their homes.Conclusion: Conducting online classes on a national scale is a herculean task for a developing country because of poor internet connectivity and deficient access to high-speed broadband services. Nevertheless, their popularity among students during the current crisis shows that it is a very pragmatic and feasible teaching option and can definitely supplement traditional classroom teaching. [ABSTRACT FROM AUTHOR]

Study on transformative adaptation to climate change is scarce despite its tremendous importance. This study assesses the transformative adaptation of fishery-based livelihoods of the Jamuna River in Bangladesh (a trans-boundary river called the Brahmaputra in India). Using interviews, focus group discussions and matrices data from two Jamuna River dependent fishing communities (Kalitola Ghat and Debdanga), this study found 80-91% fishers in both communities have been exposed to floods, storms and riverbank erosion affecting their livelihood capitals, activities, strategies and outcomes. This study identifies five transformative adaptations: migration, building concrete house, livelihood diversification, changes in fishing gear and techniques and tree plantation. In Kalitola Ghat, 57.3% and in Debdanga, 78% of fishers have migrated to safer places to minimise the adverse impacts of climatic hazards. To withstand the impacts of storms and floods, in Kalitola Ghat, 5% and in Debdanga, 6% of fishers have built concrete houses. More fishers of Kalitola Ghat (56%) have diversified their livelihoods than Debdanga counterparts (5%). Around 78% and 100% of fishers in Kalitola Ghat and Debdanga have changed their traditional fishing gear and techniques to overcome the impacts of climatic hazards. Traditionally, the fishing communities have coped with or adapted to the impacts of climate change which are not sufficient to maintain their sustainable livelihoods. The findings of this study allow identification of the measures that could help address the impacts of current and future climate change for the fishing communities. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Internationale Bildungsforschung und Entwicklungspädagogik is the property of Waxmann Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Persistent pulmonary hypertension of newborn (PPHN) is a common neonatal morbidity. There is a scarcity of data about PPHN from developing countries and the profile of babies with PPHN is different from those reported from developed countries. Aims: The aim is to study the incidence, maternal and infant risk factors, etiologies, treatment modalities, and outcome in babies with PPHN. Setting and Design: This retrospective study was conducted in the Level III neonatal unit of a referral center of Kolkata, India. Methods: This study was conducted by retrospective review of the departmental electronic database and nursing charts of the babies admitted with the diagnosis of PPHN from January 2013 to March 2019. Statistical Analysis: Chi-square test was used for categorical variable and Student's t-test was used for continuous variables to determine statistical significance. P < 0.05 was considered statistically significant. Results: A total of 86 neonates with PPHN were identified during the period, with the incidence of 3.38/1000 live births. Meconium aspiration syndrome (MAS) and transient tachypnea of newborn (TTNB) were the most common etiologies (17.44% each), followed by pneumonia, asphyxia, and congenital diaphragmatic hernia. Overall mortality rate was 29.06%. Survival in surgical cases was poor compared to medical cases (P = 0.0002). Pulmonary hypoplasia was associated with significant mortality. On the other hand, TTNB and idiopathic variety were associated with better prognosis. Use of high-frequency oscillatory ventilation without inhaled nitric oxide (iNO), milrinone, and combined use of pulmonary vasodilators and inotropes were associatedwith increased mortality, whereas use of surfactant was associated with increased survival. Conclusion: PPHN has been associated with significant mortality. In the absence of iNO, use of other drugs has not been associated with reduction of mortality. [ABSTRACT FROM AUTHOR]

Background: Trauma is a major cause of morbidity and mortality in India. A trauma-related death occurs every 1.9 min, and the mortality in serious injuries is six times worse compared to a developed country. Methods: The postgraduates were given a questionnaire with three sections. The first and second sections had questions pertaining to the participants' demographic data, their training, and their perceptions on training in trauma care. The third section contained ten multiple-choice questions designed to check their factual knowledge on basic trauma care. Their scores were rated as follows: poor (0-6), satisfactory (7-8), and excellent (9-10). Results: All 146 participants were postgraduates. Fifty-five (37.7%) of them claimed to have undergone a formal training in the initial trauma management. The scores obtained by both trained and untrained respondents were very low. Only 30.9% of the trained postgraduates managed a score of ≥7. 87%, whereas the untrained ones had a score of <7. While nearly 19% of the specifically trained postgraduates scored 9--10, only 2.63% of the untrained ones did so. Two trained students and no untrained student got a score of 10. Conclusion: The knowledge of trauma care among postgraduates is grossly inadequate to provide trauma care in acute trauma scenarios. Since training has shown to have better outcomes, such programs need to be incorporated in the postgraduate curriculum. [ABSTRACT FROM AUTHOR]

Efficient transportation system management is possible only through managing travel needs of commuters, using travel demand models. The extend by which a commuter need to travel for accomplishing his/her daily needs is here represented by the total travel time. Total travel time is one of the activity-travel behaviour which is least considered by transportation researchers. Travel demand studies often focus the workers, but give little attention to the students. In a developing country like India, students also contribute a major share in morning and evening peak hour traffic. This study presents the analysis of total travel time for the student community incorporating the socio-demographic features using activity based modelling approach. Preliminary analysis gives details on daily activity-travel pattern, mode choice preferences and other particulars of students in the study area. Statistical models are developed and simulation of choice probabilites is also done for understanding the factors affecting total travel time behaviour, for students in a usual working day. [ABSTRACT FROM AUTHOR]

Chronic myeloid leukemia (CML) is a myeloproliferative disorder with clonal expansion of transformed primitive hematopoietic progenitor cells without loss of their capacity to differentiate. Annual incidence of CML in females ranges from 0.6 to 1.6 per 100,000 populations. In developing countries like India where onset of hematological malignancy occurs in early age, thereby increases chances of concomitant occurrence of CML and pregnancy together. Although the incidence is rare, anesthesia management of pregnant female presenting more so for an emergency cesarean section (C/S) is challenging because of the physiological changes during pregnancy, presence of anemia, coagulopathy, immunosuppressant drugs, leukocytosis, and rarely blast cells in circulation. We report the successful management of a 19-year-old primigravida, recently diagnosed with CML, planned for emergency C/S under general anesthesia in view of meconium-stained liquor with fetal distress. [ABSTRACT FROM AUTHOR]

There exists a vast literature inquiring and modelling the nexus between politics and macroeconomic policy making. Most of the empirical studies based on data of OECD countries have found that electoral and partisan motives have a greater short term impact on inflation than on real variables like output growth or rate of unemployment. Recent studies based panel data on OECD countries have reinforced these findings. The present study is an empirical attempt to explore the nature of this nexus in case of independent India using 62 years of monthly data on inflation supplemented with data on election and ideological stand of political parties in power. The empirical exercise is based two statistical procedures. These are regression based procedures and Anova based procedures. As regards Anova based exercises, the GLM procedure is to take into account the unbalanced nature of the implied factorial design of the exercise. [ABSTRACT FROM AUTHOR]

Purpose: To determine the efficacy of the online monitoring tool, WINROP (https://winrop.com/) in detecting sight-threatening type 1 retinopathy of prematurity (ROP) in Indian preterm infants.Methods: Birth weight, gestational age, and weekly weight measurements of seventy preterm infants (<32 weeks gestation) born between June 2014 and August 2016 were entered into WINROP algorithm. Based on weekly weight gain, WINROP algorithm signaled an alarm to indicate that the infant is at risk for sight-threatening Type 1 ROP. ROP screening was done according to standard guidelines. The negative and positive predictive values were calculated using the sensitivity, specificity, and prevalence of ROP type 1 for the study group. 95% confidence interval (CI) was calculated.Results: Of the seventy infants enrolled in the study, 31 (44.28%) developed Type 1 ROP. WINROP alarm was signaled in 74.28% (52/70) of all infants and 90.32% (28/31) of infants treated for Type 1 ROP. The specificity was 38.46% (15/39). The positive predictive value was 53.84% (95% CI: 39.59-67.53) and negative predictive value was 83.3% (95% CI: 57.73-95.59).Conclusion: This is the first study from India using a weight gain-based algorithm for prediction of ROP. Overall sensitivity of WINROP algorithm in detecting Type 1 ROP was 90.32%. The overall specificity was 38.46%. Population-specific tweaking of algorithm may improve the result and practical utility for ophthalmologists and neonatologists. [ABSTRACT FROM AUTHOR]

Background. To ascertain the validity of kidney paired donations (KPDs) as an alternative strategy for increasing living donor kidney transplantations (LDKTs) in an LDKT-dominated transplant programme since directed kidney transplantation, ABO-incompatible or crossmatch-positive pairs are not feasible due to costs and infectious complications. Methods. This was a prospective single-centre study of 77 KPD transplantations (25 two-way, 7 three-way and 1 six-way exchange) from 1 January 2015 to 1 January 2016 of 158 registered donor recipient pairs. During this period, a total of 380 kidney transplantations [71 deceased donor kidney transplantations (DDKTs), 309 LDKTs] were performed. The reasons for opting for KPD were ABO incompatibility (n=45), sensitization (n=26) and better matching (n=6). Results. KPD matching was facilitated in 62% (n=98) of transplants. In all, 48.7% (n=77) of the transplants were completed in 2015, whereas 13.3% (n=21) of the matched patients were to undergo transplant surgery in early 2016 after getting legal permission. The waiting time for KPD was shorter compared with DDKT. The death-censored graft survival and patient survival were 98.7% (n=76) and 93.5% (n=72), respectively. In all, 14.2% (n=11) of patients had acute rejection. Match rates among sensitized (n=60) and O group patients (n=62) were 58.3% (n=35) and 41.9% (n=26), respectively. Of these, 43.3% (n=26) and 29% (n=18) of transplants were completed and 15% (n=9) and 12.9% (n=8), respectively, are waiting for legal permission. Conclusions. LDKT increased by 25% in 1 year in our single-centre KPD programme. Our key to success was the formation of a KPD registry, awareness and active counselling programs and developing a dedicated team. [ABSTRACT FROM AUTHOR]

This paper presents an empirical analysis of non-workers' activity-travel behaviour from Bangalore city, India. The paper builds a causal model-to describe the relationships among socio-demographics, activity-participation, and travel behaviour of non-workers-following structural equation modelling methodology. The results indicate that in-home maintenance activity-duration drives the time allocation decisions of non-workers. The model also shows the presence of 'time-budget' effects i.e., excess travel time cuts into in-hhome discretionary activity duration, implying the trade-off between daily travel time and in-home discretionary activity duration. The out-of-home activity durations of non-workers are found to be insensitive to travel time-an important finding of this research. The model also suggests that mixed residential development reduce travel distance and indirectly contribute to more trips. An indirect effect of mixed residential development on daily travel distance offsets the direct effect, which leads to a limited total effect of this variable on travel distance. The basic model was expanded further by separating the time spent on others' activity (children and elders) from in-home maintenance activity duration. The stable model reveals that the time spent on others' activity also influences in-home and out-of-home activities, and travel behaviour. This indicates that the time spent on others' activity is an important time allocation of its own. [ABSTRACT FROM AUTHOR]

Sustainable tourism in Kerala is on the rise. Therefore, this South Indian state is assessed according to the sustainable tourism criteria of the Strasdas et al. (2007) framework. Kerala as a state does not qualify as a sustainable tourism destination, although individual success stories at the NGO and government level exist. This conceptual paper delivers a detailed analysis of the three dimensions of sustainability, i.e. ecology, economy and socio-cultural aspects, of the 'Kerala tourism model' and discusses the question of whether this model can be transferred to other developing countries. Copyright © 2016 John Wiley & Sons, Ltd and ERP Environment [ABSTRACT FROM AUTHOR]

The purpose of this research is to examine the challenges and opportunities behind developing a collaborative food supply chain (FSC) in the context of Punjab, India. To achieve the purpose, we use relational exchange theory (RET). We adopted a mixed-methods approach, including focus groups and observations. We analyzed the data to identify themes and in particular, the RET norms that inductively emerged. We found several challenges to building collaborative FSC partnerships. The challenges were especially the domination of FSCs by limited information exchange and power imbalances, characterized by limited role integrity and large transaction commitment effects. Guided by the RET, our findings demonstrate a need to prioritize partnership solidarity, information exchange, reciprocal benefits within deep collaborative FSC partnerships, and at the same time, restrain power advantages. Using RET, we contribute to understanding FSCs in developing countries by demonstrating that there is a staged norm demonstration to initiate and build collaborative exchange partnerships; a small set of specific norms need to be established to initiate collaborative FSC partnerships. We also see that intermediaries have a debilitating effect on initiating collaborative FSC partnerships, and as such should be removed to facilitate direct relationships between supply chain partners. Relational norms to craft collaborative food supply chain partnerships. [Display omitted] [ABSTRACT FROM AUTHOR]

Arterial injuries present the most challenging conditions in surgical practice. Many fail to reach the specialist in time and end up losing limbs or lives. Though well addressed elsewhere, it has received less attention in developing countries like India. There is a need to study these injuries from the perspective of countries like India. The aims of the study are to (1) analyze the epidemiology, presentation, and outcomes of arterial injuries operated by the author in Indian settings; (2) identify factors associated with adverse outcomes; and (3) discuss the critical issues with relevance to our country. Retrospective analysis of arterial injuries operated by the author between July 2010 and February 2014 at our institution was performed. Patients with feasibility of revascularization were included and nonviable limbs requiring primary amputations were excluded. Sixty-one patients fulfilled the criteria of which 55 (90.1 %) were males and 6 (9.8 %) females aged between 5 and 70 years. The mean duration of presentation was 21 h. Majority were resultant of road traffic accidents (62.7 %). Among 49 (80.3 %) noniatrogenic injuries, the mechanism was blunt in 46 (93.8 %, n = 49) and penetrating in 3 (6.1 %) cases. Iatrogenic injuries were seen in 12 (19.6 %) cases. Lower limbs accounted for 37 (60.6 %) cases, popliteal segment being common, 22 (36 %) cases. Bony injuries were associated in 39 (63.9 %) cases. The most common procedure was interposition graft (49.1 %). Six (9.8 %) patients required an amputation resulting in 55 (90.1 %) salvaged limbs. Reaching a specialist center in appropriate time can result in good limb salvage rates and functional outcomes. Creating awareness and training the personnel are the critical issues in the management of arterial injuries in India. [ABSTRACT FROM AUTHOR]

Background: Quality of care provided during childbirth is a critical determinant of preventing maternal mortality and morbidity. In the studies available, quality has been assessed either from the users' perspective or the providers'. The current study tries to bring both perspectives together to identify common key focus areas for quality improvement. This study aims to assess the users' (recently delivered women) and care providers' perceptions of care to understand the common challenges affecting provision of quality maternity care in public health facilities in India.Methods: A qualitative design comprising of in-depth interviews of 24 recently delivered women from secondary care facilities and 16 health care providers in Uttar Pradesh, India. The data were analysed thematically to assess users' and providers' perspectives on the common themes.Results: The common challenges experienced regarding provision of care were inadequate physical infrastructure, irregular supply of water, electricity, shortage of medicines, supplies, and gynaecologist and anaesthetist to manage complications, difficulty in maintaining privacy and lack of skill for post-delivery counselling. However, physical access, cleanliness, interpersonal behaviour, information sharing and out-of-pocket expenditure were concerns for only users. Similarly, providers raised poor management of referral cases, shortage of staff, non-functioning of blood bank, lack of incentives for work as their concerns.Discussion: The study identified the common themes of care from both the perspectives, which have been foundrelevant in terms of challenges identified in many developing countries including India. The study framework identified new themes like management of emergencies in complicated cases, privacy and cost of care which both the group felt is relevant in the context of providing quality care during childbirth in low resource setting. The key challenges identified by both the groups can be prioritized, when developing quality improvement program in the health facilities. The identified components of care can match the supply with the demand for care and make the services truly responsive to user needs.Conclusion: The study highlights infrastructure, human resources, supplies and medicine as priority areas of quality improvement in the facility as perceived by both users and providers, nevertheless the interpersonal aspect of care primarily reported by the users must also not be ignored. [ABSTRACT FROM AUTHOR]

Research on the social determinants of health in developing countries is increasingly focusing on the importance of gender. Cardiovascular conditions such as hypertension are a growing concern in developing countries, where they are now the leading cause of death. Researchers have documented differences in hypertension between men and women, but the importance of gendered practices in shaping these differences has been left unexamined. Using national data from the India Human Development Survey 2005 ( N = 101,593), this study assesses the moderating role of two salient and widespread gendered practices—women’s seclusion and decision-making power—on hypertension disparities between women and men. Both seclusion and low decision-making power are associated with increased odds of hypertension for women, but in the case of seclusion reduced hypertension for men. Results also show the gender gap in hypertension is exacerbated with women’s seclusion and low decision-making power. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the impact of traumatic lumbar puncture (TLP) at diagnosis of relapse in childhood acute lymphoblastic leukemia (ALL). Risk factors associated with TLP were assessed.Materials and Methods: A retrospective analysis was performed from the records of children with ALL who were treated from January 2010 to December 2012.Results: A total of 311 patients with median age of 5 years (range: 1-13) were treated for ALL. The cerebrospinal fluid analysis obtained from first LP revealed 275: Central nervous system 1 (CNS 1) (no blasts); 8: CNS 3 (blasts positive); and 28: TLP. Twenty-eight (9%) patients relapsed. Twelve (3.9%) had a CNS relapse. A TLP at diagnosis was not associated with an increased risk of systemic or CNS relapse (P = 0.298, 0.295). Three years event-free survival of patients with TLP and without atraumatic LP (ATLP) at diagnosis was 56 ± 5.2% and 51.8 ± 12.4%, (P = 0.520). Three years overall survival with TLP and ATLP was 73.3 ± 3.5% and 70.4 ± 12.5%, respectively, (P = 0.963). Median platelet count in patients with TLP was significantly lower than those without TLP (10,000/μL and 28,000/μL, P < 0.001). A receiver operating characteristic curve was constructed for predicting the risk of TLP based on platelet count. Area under the curve was 0.74 ± 0.05 (95% confidence interval 0.64-0.84). Platelet count < 23.5 × 109/L at the time of LP had 75% sensitivity and 64.4% specificity in predicting a TLP.Conclusions: Low platelet counts are significantly associated with risk of TLP. Traumatic LP at diagnosis was not associated with an increased risk of relapse. [ABSTRACT FROM AUTHOR]

Management of municipal solid waste is a global problem and is faced by all developing countries. The rapid pace of increase in population, economic growth, urbanization and industrialization is coupled with accelerated solid waste generation. In most of the developing countries wastes are either scattered in urban centers or disposed off unplanned in low lying areas or open dumps. The lack of infrastructure for collection, transportation, treatment and disposal of solid waste, proper solid waste management planning, insufficient financial resources, technical expertise and public attitude have made the situation exasperating due to which several environmental and health related problems are increasing. Though, there are many negative issues related to solid waste, it also provides many opportunities that not only mitigates its negative impact but also helps in meeting the demand for energy and employment generation as well as in soil health improvement. Keeping in mind the present situation the current review was planned with the objective to overlook the challenges and opportunities faced during urban solid waste management in developing countries like India. [ABSTRACT FROM AUTHOR]

Across the globe, catch-and-release (C&R) angling represents a leisure activity indulged by millions. The practice of C&R is commonly advocated by conservation managers because of its potential to protect local fish populations from a range of anthropogenic threats, including over-fishing. In India, C&R angling in fresh waters has a history dating back to colonial times. Despite this, little is known about the current state of the sector. To address this, an online web-based survey was conducted to target C&R anglers who fish in Indian rivers to assess their knowledge, attitudes and perceptions relating to the status of India's freshwater C&R fisheries. From a total of 148 responses, factors such as angling quality (score of 4.6/5.0); aesthetics of surroundings (4.6/5.0), presence of other wildlife (4.4/5.0), fishery management practices (4.6/5.0) and socioeconomic benefits (4.4/5.0) were evaluated. Over 65% ( n = 148) of the anglers reported an observed decrease in the quality of fishing (e.g. a reduction in the size and/or numbers of fish available for capture). Respondents also considered deforestation (score of 4.2/5.0), water abstraction (4.4/5.0), pollution (4.4/5.0), hydropower projects (4.2/5.0) and destructive fishing techniques (4.7/5.0) as factors which threaten both the habitat and species they target. C&R practitioners were largely united regarding the benefits and willingness to contribute both their time and financial input to support conservation initiatives (score of 4.7/5.0). The current study provides the first overview of the status of C&R angling in India and explores challenges, opportunities, and priorities for future resource management. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to demonstrate how lean tools were applied to some unique issues of providing healthcare in a developing country where many patients face challenges not found in developed countries. The challenges provide insight into how lean tools can be utilized to provide similar results across the world. Design/methodology/approach -- This paper is based on a qualitative case study carried out by a master's student implementing lean at a hospital in India. Findings -- This paper finds that lean tools such as value-stream mapping and root cause analysis can lead to dramatic reductions in waste and improvements in productivity. The problems of the majority of patients paying for their own healthcare and lacking transportation created scheduling problems that required patients to receive their diagnosis and pay for treatment within a single day. Many additional wastes were identified that were significantly impacting the hospital's ability to provide care. As a result of this project, average outpatient wait times were reduced from 1 hour to 15 minutes along with a significant increase in labor productivity. Practical implications -- The results demonstrate how lean tools can increase value to the patients. It also provides are framework that can be utilized for healthcare providers in developed and developing countries to analyze their value streams to reduce waste. Originality/value -- This paper is one of the first to address the unique issues of implementing lean to a healthcare setting in a developing country. [ABSTRACT FROM AUTHOR]

There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world's elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries. [ABSTRACT FROM AUTHOR]

India has no equivalent of a social security number and more than 400 millions of poor suffer in the hands of the existing corrupt system because they are unable to participate in the formal economy. In a nation that is struggling to meet basic challenges of poverty, hunger, poor infrastructure and corruption, the government of India's Unique Identification (UID) project appears to be a striking outlier as it is building the world's biggest and advanced biometric based database of identities for 1.2 billion people at a remarkable pace. Using the theoretical lens of institutional voids, this paper describes the case of UID project and explores its potential in terms of filling institutional voids and enabling inclusive innovation in India. [ABSTRACT FROM AUTHOR]

A riverbank filtration (RBF) system was installed in a rural village near the Kali River in southwestern India to evaluate its performance in attenuating total coliform bacteria and Escherichia coli loads in a monsoon-dominated climate in a developing country. A statistical analysis showed that RBF water was of higher microbial quality than other water sources in the study area. Based on the geometric mean of the data from the primary RBF well (MW3), the percent removal compared to the Kali River was 95.1% for total coliforms and 99.2% for £. coli. The maximum percent removals were 99.8% for total coliforms and 99.96% for E. coli. Bacteria concentrations were lower during the dry season than during the monsoon season when contaminants apparently infiltrated into the subsurface. The geometric mean of the annual removal efficiency translates to an approximately 1-log unit removal of E. coli per 26 m (≈75 ft) setback distance from the river. During the 1-year monitoring period, Indian water quality standards for total coliform bacteria were regularly exceeded, whereas £ coli standards were met for 29% of the dry season but only 7% of the monsoon season. The consistent problem of attaining local regulatory limits for bacteria show that, at this study site, (1) RBF needs to be considered a pre-treatment method and, (2) should be combined with conventional disinfection technology. Finally, although the bacteria data confirms that the setback distance of a RBF well from a river is an important factor determining the water quality, local conditions, such as influence of flood-irrigation of nearby rice paddies, presence of freely-roaming cattle and latrines, and outside defecation by residents, must be considered when establishing a RBF system in a monsoon climate in a developing country. [ABSTRACT FROM AUTHOR]

The article presents a five-year review regarding the use of intensive care unit (ICU) by critically ill obstetric patients. It says that the study was performed on obstetric patients at the ICU of medical college hospital in northern India during 1999-2004 on 49 patients. Results showed that the main cause of ICU admission was haemorrhage, followed by sepsis and hypertensive disorders of pregnancy.

Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50 000 for a life-year. [ABSTRACT FROM PUBLISHER]

Purpose To test the applicability of the new International League Against Epilepsy ( ILAE) 2010 classification for epilepsies and to compare it with the ILAE 1989 classification and the ILAE 2001 diagnostic scheme in developing countries with limited resources such as India. Methods Prospective data of 500 consecutive patients with epilepsy, presenting in neurology department of All India Institute of Medical Sciences, was collected from January 2011 to June 2012 and analyzed according to the three systems proposed by ILAE in 1989, 2001, and 2010. Key Findings All 500 patients could be classified in the ILAE 1989 classification system, but only 413 in the ILAE 2001 diagnostic scheme (in axes 3 and 4) and 420 in the ILAE 2010 classification system. Leading categories were localization-related epilepsies, symptomatic focal epilepsies, perinatal insult, and epilepsies attributed to structural and metabolic cause in ILAE 1989, 2001 axis 3, 2001 axis 4, and 2010 systems, respectively. The ILAE 1989 classification system could categorize significantly greater numbers of patients compared to the 2001 and 2010 systems, whereas the latter two remained similar. Significance A large group of patients remained unclassified in the new classification system despite our tremendous gain in knowledge through improved imaging, genomics, and molecular biology, and so on, which could be attributed to lack of availability of facilities in developing countries. Dichotomy of localization-related and generalized epilepsy still makes for a fundamental and pragmatic working diagnosis and guides the physician about the extent of investigations and treatment especially in 'epilepsies of unknown cause.' [ABSTRACT FROM AUTHOR]

Many developing countries are very vulnerable to flood risk since they are located in climatic zones characterised by extreme precipitation events, such as cyclones and heavy monsoon rainfall. Adequate flood mitigation requires a routing mechanism that can predict the dynamics of flood waves as they travel from source to flood-prone areas, and thus allow for early warning and adequate flood defences. A number of cutting edge hydrodynamic models have been developed in industrialised countries that can predict the advance of flood waves efficiently. These models are not readily applicable to flood prediction in developing countries in Asia, Africa and Latin America, however, due to lack of data, particularly terrain and hydrological data. This paper explores the adaptations and adjustments that are essential to employ hydrodynamic models like LISFLOOD-FP to route very high-magnitude floods by utilising freely available Shuttle Radar Topographic Mission digital elevation model, available topographical maps and sparse network of river gauging stations. A 110 km reach of the lower Damodar River in eastern India was taken as the study area since it suffers from chronic floods caused by water release from upstream dams during intense monsoon storm events. The uncertainty in model outputs, which is likely to increase with coarse data inputs, was quantified in a generalised likelihood uncertainty estimation framework to demonstrate the level of confidence that one can have on such flood routing approaches. Validation results with an extreme flood event of 2009 reveal an encouraging index of agreement of 0.77 with observed records, while most of the observed time series records of a 2007 major flood were found to be within 95 % upper and lower uncertainty bounds of the modelled outcomes. [ABSTRACT FROM AUTHOR]

Anemia during pregnancy remains an important public health problem in developing countries like India. Anemia is the direct cause of 12-15% of maternal deaths. Iron deficiency is the commonest cause for anemia in the Indian subcontinent. Several preventive and therapeutic approaches are in practice. The available routes of iron supplementation are oral and intravenous. In spite of oral iron being least invasive, cheap and safe, the ineffectiveness of oral iron due to dietary inhibitors and poor compliance are well known. Intravenous iron sucrose can be a promising therapy for moderate to severely anemic pregnant women and has been in practice for quite some time in private and public health practices. In this article, we report the current evidence on the safety and efficacy of intravenous iron sucrose in anemic pregnant women on hematological and clinical outcomes. Though the evidence on its efficacy in improving hemoglobin and serum ferritin is convincing, its effect on maternal and fetal outcomes are unclear. This is primarily due to lack of well-designed and larger studies powered to detect difference in clinical outcomes. Hence, there is a need to gather evidence from a well-designed large randomized clinical trial conducted in a developing country. The results of such a study would feed into the national policy and would form the basis to frame guidelines for management of anemia in developing countries. [ABSTRACT FROM AUTHOR]

In developing nations, road traffic crashes involving pedestrians have become a foremost worry. Presently, most of the road safety assessment projects and selection of interventions are still restricted to traditional methods that depend on historical crash data. However, in low and middle-income countries such as India, the availability, reliability, and accuracy of crash data are uncertain. Alternatively, Post Encroachment Time (PET) has added attention as a proximal indicator to examine pedestrian-vehicular potential crashes and address pedestrian risk under mixed traffic conditions. Hence, it will be meaningful to examine if the PET is a good substitute for pedestrian-vehicular crashes and if so, what built environment and pedestrian-level factors influence PET. In this background, the present study establishes a mathematical association between the average PET value of the urban road network level and actual crashes. Afterward, multiple linear regression models are developed to study the impact of the built environment, traffic parameters, and pedestrian-level attributes on PET. The outcomes indicate that vehicle speed, lack of enforcement, absence of traffic signal (for traffic as well as pedestrians), land use type, slum population, inadequate sight distance, pedestrian's state of crossing, and pedestrian's risky crossing behaviour substantially affect the average PET at road network-level.