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Objectives: To assess the feasibility, spectrum, outcomes, and challenges of delivering super-specialty consultations through telemedicine to remote areas of the Union Territory (UT) of Ladakh. Methodology: The authors report on a prospective, observational (descriptive), pilot study. Super-specialty medical teleconsultations were provided to healthcare providers in UT Ladakh by specialists in the Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, from October 2021 to May 2022, employing the Hub-and-Spoke model of the Ayushman Bharat Digital Mission. Doctorto-doctor teleconsultations were initiated by treating doctors at healthcare facilities in UT Ladakh on the eSanjeevani™ platform. An audio-video model was used for teleconsultation, and digitally signed prescriptions were shared. The outcome measures included demand and spectrum of super-specialty teleconsultations, the outcome of consults (whether managed successfully at the teleconsultation level or required referral for in-person visits), and technical challenges faced. Results: A total of 26 super-specialty teleconsultations were provided: 14 (54%) were for women. Patient distribution was uniform across all age groups. The super-specialty-wise distribution of consultations was nine from endocrinology, nine from neurology, three from hepatology, two from cardiology, and three from neonatology. Reasons for seeking consultation were assistance in diagnosis (3, 12%), optimization of therapy (10, 38%), or both diagnostic evaluation and treatment optimization (13, 50%). Five cases (19%) were referred for physical visits to a higher center for advanced diagnostic testing like liver biopsy, brain biopsy, upper GI endoscopy, etc.; other cases were managed remotely. Problems with audio-visual connectivity were encountered in three patients. Conclusion: This pilot study demonstrates that telemedicine can effectively deliver complex, super-specialty medical consultations to remote areas. Future research should focus on assessing long-term outcomes, patient satisfaction, and cost-effectiveness to evaluate this model's impact better. [ABSTRACT FROM AUTHOR]

The current research proposed the work on the consumption of waste cooking oil (WCO) as a valuable resource for the production of biodiesel. This study focuses on maximizing output yield by employing composite heterogeneous catalysts, namely calcinated calcium oxide with aluminum oxide (CaO/Al2O3) and calcium oxide with titanium oxide (CaO/TiO2). The calcination process was adopted for the catalysts at 600°C for 5 h to improve catalytic activities and to increase surface area. XRD and TGA were implemented to analyze the crystal structure and thermal stability of these heterogeneous catalysts. Experimentation was planned by implementing the response surface methodology (RSM) approach in combination with the BoxBehnken design. The optimum yield of fatty acid methyl esters (FAMEs) was experimentally observed at 96.56%, using CaO/Al2O3 at methanol to oil (m/o) molar ratio of 11.9:1, 3.19% catalyst loading, 53.79°C and 76.86 minutes (min). The maximum experimental yield with CaO/TiO2 was observed at 98.15% with the optimized operating conditions of independent process variables viz. m/o molar ratio 11:99, 2.53 wt.% catalyst loading and 68.14 min at 59.79°C. The research recommends the potential use of WCO and both the heterogeneous catalysts for optimal biodiesel yield; however, CaO/TiO2 exhibits superior performance over CaO/Al2O3, which is also confirmed by the XRD and TGA results. [ABSTRACT FROM AUTHOR]