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Abstract The snowline exhibits significant seasonal shifts upward and downward, reflecting the ever-changing dynamics of the seasons and being influenced by climate variations, which can vary annually. These fluctuations profoundly impact the cryosphere, biota, and ecosystem processes in high mountain regions. Despite the critical role of snowline variations, comprehensive information on how actual climate variability affects snow cover trends in the central mountain range of the western Himalayas is scarce. In the 'Pindari' region of the Uttarakhand district, India, which is part of the Himalayas, these challenges are exacerbated by the unchecked growth of anthropogenic activities and the broader impacts of climate change. This study analyses snowline variations in the Pindari glacial region from 1972 to 2018. The findings revealed that the snowline elevation significantly shifted upward between 1972 and 2018. Notably, this research revealed a decrease in snow-covered areas of approximately 5.01 km2 over the course of 46 years. This decrease is attributed to a direct response to the increasing number of high-temperature events that occurred during this extended period. This study emphasizes the urgent need for conservation measures in the study region and similar high mountains to combat global warming and safeguard the snowline, which serves as a visible proxy indicator to safeguard high-altitude Himalayan glaciers.

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives' competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts.

Negligible quantitative research evidence exists on standardisation and psychometric validation of questionnaires that measure midwifery educators' confidence in their competence. This study developed a self-assessment of confidence in competence questionnaire in India based on the WHO Midwifery Educator Core Competencies (2014) with an aim to develop and validate a self-assessment tool measuring midwifery tutors' confidence in competence in imparting quality midwifery education. The questionnaire was developed as part of a multi-centre study to identify confident midwifery tutors for further training as educators, supporting India's rollout of professional midwives. The questionnaire underwent rigorous psychometric testing among 2016 midwifery tutors in India. Following exploratory Principal Component Analyses (PCA), the nine core competencies outlined in the WHO document were analysed separately. The results indicate that the questionnaire is psychometrically valid, with an internal consistency range of 0.81-0.93 for the nine domains. This robust testing process ensures the reliability and validity of the questionnaire. The self-assessment questionnaire can potentially be a valuable tool in India and other high-, middle-, and low-income countries. From a programmatic perspective, it can help identify key gaps and prioritise training needs, particularly in low-resource settings, so that limited resources are best utilised to fill the most prominent gaps. Furthermore, it can provide a universal platform for comparing data from different settings, facilitating global collaboration and learning in midwifery education.

AbstractLandslide susceptibility mapping plays an imperative role in mitigating hazards and determining the future direction of developmental activities in mountainous regions. Here, we used 518 landslide occurrences and nine landslide-conditioning parameters to build landslide vulnerability models in the Kailash Sacred Landscape (KSL), India. Four multivariate statistical models were applied, namely the generalized linear model (GLM), maximum entropy (MaxEnt), Mahalanobis D2 (MD), and support vector machine (SVM), to calibrate and compare four maps of landslide susceptibility. The results demonstrated the outperformance of Mahalanobis D2 for predictability compared to other models obtained from the area under the receiver operating characteristic curve (ROC). The ensemble model data shows that 10.5% of the landscape has susceptible conditions for future landslides, whereas 89.50% of the landscape falls under the safe zone. The occurrence of landslides in the KSL is linked to the middle elevations, vicinity to water bodies, and the motorable roads. Furthermore, the observed patterns and the resulting models exhibit the major variables that cause landslides and their respective significance. The current modelling approach could provide baseline data at the regional scale to improve the developmental planning in the KSL.

Abstract Objective To explore the differentials of postpartum contraceptive adoption between rural and urban poor after adjusting for utilization of MCH services and other selected socioeconomic and demographic covariates. Methods The data for this study is taken from the 4th round of NFHS survey conducted in India during 2015–16. The analysis is limited to 125,340 currently married women whose menses had returned at the time of survey. Discrete time complementary log–log multilevel model was applied. Results The results clearly indicate that women from rural areas had a lower chance of early initiation of modern spacing methods after having recent birth as compare to that of Urban Poor and Urban non-poor areas. The contributions of several socioeconomic and demographic characteristics that were important for family planning practice were also highlighted in this study. Conclusion There is an urgent need of designing an intervention that will result in effective delivery of services to achieve the greatest impact. Policy planners must focus on targeted interventions for family planning use in the postpartum period than simply focusing on family planning.

In this paper, a new bivariate XGamma (BXG) distribution is presented using Farlie-Gumbel-Morgenstern (FGM) copula. We derive the expressions for conditional distribution, regression function and product moments for the BXG distribution. Concept of reliability and various measures of local dependence are also studied for the proposed model. Furthermore, estimation of the parameters of the BXG distribution is obtained through maximum likelihood estimation and inference function of margin estimation procedures. Finally, an application of the same is also demonstrated to a real data set.

Background: This mixed-methods study was undertaken to ascertain undergraduate medical students’ perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study. Methods: Data was collected using a validated questionnaire and four focus group discussions. Results: Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures. Conclusions: Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback.

Background: This mixed-methods study was undertaken to ascertain undergraduate medical students’ perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study. Methods: Data was collected using a validated questionnaire and four focus group discussions. Results: Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures. Conclusions: Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback.

Background The stability of biological samples is vital for reliable measurements of biomarkers in large-scale survey settings, which may be affected by freeze-thaw procedures. We examined the effect of a single freeze-thaw cycle on 13 nutritional, noncommunicable diseases (NCD), and inflammatory bioanalytes in serum samples. Method Blood samples were collected from 70 subjects centrifuged after 30 minutes and aliquoted immediately. After a baseline analysis of the analytes, the samples were stored at − 70°C for 1 month and reanalyzed for all the parameters. Mean percentage differences between baseline (fresh blood) and freeze-thaw concentrations were calculated using paired sample t-tests and evaluated according to total allowable error (TEa) limits (desirable bias). Results Freeze-thaw concentrations differed significantly (p < 0.05) from baseline concentrations for soluble transferrin receptor (sTfR) (− 5.49%), vitamin D (− 12.51%), vitamin B12 (− 3.74%), plasma glucose (1.93%), C-reactive protein (CRP) (3.45%), high-density lipoprotein (HDL) (7.98%), and cholesterol (9.76%), but they were within respective TEa limits. Low-density lipoprotein (LDL) (− 0.67%), creatinine (0.94%), albumin (0.87%), total protein (1.00%), ferritin (− 0.58%), and triglycerides (TAG) (2.82%) concentrations remained stable following the freeze-thaw cycle. In conclusion, single freeze-thaw cycle of the biomarkers in serum/plasma samples after storage at − 70°C for 1 month had minimal effect on stability of the studied analytes, and the changes in concentration were within acceptable limit for all analytes.

Introduction: Hemophilia is a hereditary bleeding disorder with significant consequences involving the joints, leading to debilitating functions. Prophylactic replacement therapy is limited in lower-middle-income countries, and often it is the episodic or intermittent factor replacement which is feasible. Although many tools are available to evaluate the assessment of joints at the time of initial contact, its utility in response evaluation to intervention is limited. Materials and Methods: In this quasi-experimental study, we compared the Hemophilia Joint Health Score (HJHS) and Functional Independence Score in Hemophilia (FISH) scores pre and postphysiotherapy with intermittent factor support. Results: Forty-eight patients with hemophilia (PwH) were screened, and 18 PwH consented and completed the treatment protocol. The mean duration of physiotherapy was 11 days, with an average total factor consumption of 120 U/Kg. The pre and postphysiotherapy HJHS was 40 ± 18.8 and 19.5 ± 11.9 with a standardized response mean (SRM) of −2.41 (95% confidence interval [CI] −3.25–−1.53) and FISH, 16.89 ± 3.44 and 22.33 ± 3.36 with SRM of 1.78 (195% CI.29–2.23). Both the SRMs were statistically significant (both the P values were 0.000). Conclusion: This study highlights the utility of HJHS and FISH in assessing responsiveness to intermittent prophylaxis and physiotherapy.

Abstract Background India has launched the malaria elimination initiative in February 2016. Studies suggest that estimates of malaria are useful to rationalize interventions and track their impact. Hence, a national study was launched to estimate burden of malaria in India in 2015. Methods For sampling, all 624 districts of India were grouped in three Annual Parasite Incidence (cases per thousand population) categories, five (high) API. Using probability proportional to size (PPS) method, two districts from each stratum were selected covering randomly 200,000 persons per district. Active surveillance was strengthened with 40 trained workers per study district. Data on malaria cases and deaths was collated from all health care providers i.e. pathological laboratories, private practitioners and hospitals in private and public health sectors and was used for analysis and burden estimation. Results Out of 1215,114 population under surveillance, 198,612 (16.3%) tests were performed and 19,386 (9.7%) malaria cases were detected. The malaria cases estimated in India were 3875,078 (95% confidence interval 3792,018–3958,137) with API of 3.05 (2.99–3.12) including 2789,483 (2740,577–2838,389) Plasmodium falciparum with Annual Falciparum Incidence of 2.2 (2.16–2.24). Out of 8025 deaths investigated, 102 (1.27%) were attributed to malaria. The estimated deaths in India were 29,341 (23,354–35,327) including 19,067 (13,665–24,470) confirmed and 10,274 (7694–12,853) suspected deaths in 2015–2016. Conclusions Estimated malaria incidence was about four folds greater than one million reported by the national programme, but three folds lesser than thirteen million estimated by the World Health Organization (WHO). However, the estimated deaths were 93 folds more than average 313 deaths reported by the national malaria programme in 2015–2016. The 29,341 deaths were comparable with 24,000 deaths in 2015 and 22,786 deaths in 2016 estimated by the WHO for India. These malaria estimates can serve as a benchmark for tracking the success of malaria elimination campaign in India.

Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS’s recommended metrices. Method The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030.

BackgroundEstimating the clinical demand for blood and components arising in a health facility is crucial to ensure timely availability of blood. This study aims to estimate disease-specific clinical demand, supply and utilization of whole blood and components in India.MethodsWe conducted a national level cross-sectional study in five randomly selected states from five regions of the country. We included 251 public and private facilities representing primary, secondary and tertiary care facilities. We collected annual disease-specific demand, supply and utilization of blood and components using a structured tool. We estimated the national demand by extrapolating the study data (demand and beds) to the total number of estimated beds in the country.FindingsAccording to the study, the total clinical demand of 251 health facilities with 51,562 beds was 474,627 whole blood units. Based on this, the clinical demand for India was estimated at 14·6 million whole blood units (95 CI: 14·59-14·62), an equivalent of 36·3 donations per 1,000 eligible populations, which will address whole blood and component requirement. The medicine specialty accounted for 6·0 million units (41·2%), followed by surgery 4·1 million (27·9%), obstetrics and gynecology 3·3 million (22·4%) and pediatrics 1·2 million (8·5%) units. The supply was 93% which is equivalent to 33·8 donations against the demand.ConclusionThe study indicated a demand and supply gap of 2.5 donations per 1,000 eligible persons which is around one million units. The gap emphasises the need for sustained and concerted efforts from all stakeholders and for increasing the awareness about repeat voluntary non-remunerated blood donation (VNRBD); optimizing the availability of blood components through efficient blood component separation units; promoting modern principles of patient blood management and strengthening capacities of human resources in the blood transfusion system in India.

Introduction: Equinovarus foot deformity is a significant problem in adolescents and its treatment remains challenging. Triple arthrodesis, even though an effective palliative tool in management of complex foot deformity, has its own limitations if it is done for acute deformity correction. Ilizarov technique offers gradual deformity correction, fusion and takes care of many known complications of acute correction. However, there are very few studies about effectiveness and functional outcome of triple arthrodesis for equinovarus deformity when done gradually with an Ilizarov fixator. Aim: To study the effectiveness of triple arthrodesis, performed with Ilizarov technique for equinovarus foot deformity in adolescents and adults and to evaluate the early functional outcome and patient satisfaction rate for this procedure. Materials and Methods: A retrospective analysis of 22 feet in 20 patients with equinovarus foot deformity between January 2015 and December 2018 was done. Patients underwent gradual deformity correction and triple fusion with Ilizarov fixator. Foot was assessed for any residual deformity and shortening. Functional outcome and patient satisfaction were assessed by Ankle Hind Foot Scale (AHFS) and Likert scale, respectively using paired t-test. Final analysis was done with Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Twelve males and eight females with mean age of 15.9±3.4 years fulfilled the inclusion criteria and were included for final analysis of results. Fusion rate was 86.1% with mean union time of 12.5 weeks. Mean AHFS improved from 61.27 before surgery to 76.9 which was statistically significant (p

Abstract The doubly-doped bismuth vanadate with Al and Ti having formula unit, Bi2V1−x Al x/2Titx/2O5.5-δ (0.10 ⩽ x ⩽ 0.25) was synthesized. The specimens were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared (FT-IR), differential scanning calorimetric (DSC), UV-Vis, and electrochemical impedance spectroscopy (EIS) for their structural, thermal, optical, and electrical studies. Influence of both dopant cations (Al and Ti) was observed in the gradual stabilization of the tetragonal phase of Bi2VO5.5-δ with dopant amount. A non-uniform grain growth phenomenon was observed up to x = 0.175, with dopant addition. UV-Vis study revealed the comparatively higher order of oxide ion vacancies for the composition x = 0.175. Impedance spectroscopy measurements indicate a significant decrease of both the grain (R g) and grain boundary resistances (R gb) with the rise in temperature and the overall resistance is found to be dominated by the grain interior contribution. Enhancement of ionic conductivity was found in all the compositions in the intermediate temperature range as compared to the parent compound, and the single Al-doped system and the highest value were obtained for x = 0.175.

The Polycrystalline ceramic samples with formula unit Bi2V1-xTix/2Alx/2O5.5-δ (x = 0.1 and 0.175) were synthesized. The specimens were characterized by AC Impedance Spectroscopy for dielectric studies. The variation of dielectric parameters: dielectric constant ( ), dielectric loss (tan ), complex electric modulus and AC conductivity, as a function of frequency and temperature, have been analyzed. The dielectric loss peaks and AC conductivity plots revealed different relaxation mechanisms i.e. electrode-electrolyte, conduction and dipolar occurring at low, intermediate and high-frequency regimes respectively. The shifting of the dielectric relaxation peaks and hopping frequency in AC conductivity plots towards higher frequency sides with an increase in temperature imply these materials are ionic conductor.

Effects of sintering temperature on structural and electrical properties of La2Mo2O9 synthesized via solution combustion method are addressed in this work. Single phase of La2Mo2O9 was obtained at relatively lower calcination temperature ( about 700 oC) than the conventional route. The synthesized specimen was sintered at three different temperatures 800 oC, 900 oC and 1000 oC for 12 hours and was subjected to structural & electrical characterizations. X-Ray diffraction pattern confirms the formation of monoclinic phase with space group P213 for all three sintering temperatures. Lattice parameters were calculated using Reitveld technique and found to be increased with the sintering temperature. α to β phase transition is prominent in the Arrhenius plot of all the sintered samples but the transition temperature is lower than the powders obtained by the solid state technique. Conductivity was found to be increased slightly at lower and intermediate temperatures for 900 oC and 1000 oC as compared to specimen sintered at 800 oC. In the intermediate temperatures, grain boundary contribution to the total resistance is more distinguished in the Nyquist plot of the sample sintered at 800 oC which causes the decrement in the conductivity. Activation energy in the temperature range 600 oC - 750 oC for the sample sintered at 800 oC, 900 oC and 1000 oC are 0.5298 eV, 0.35896 eV and 0.35805 eV respectively. The sample sintered at 1000 oC exhibited highest ionic conductivity 0.0391 S.cm-1 at 750 oC.

La2Mo2O9 based Tb-doped compound, La2-xTbxMo2O9 (x=0.1, 0.2, 0.5), was synthesized and characterised by EIS studies. The frequency and temperature dependent dielectric, electric modulus and ac conductivity studies have been done. Different formalisms have been used to understand relaxation mechanism in our compound. The conductivity in these specimens appears to be due to mobility of oxygen ions.

Background Home-based newborn care has been found to reduce neonatal mortality in rural areas. Study evaluated effectiveness of home-based care delivered by specially recruited newborn care workers- Shishu Rakshak (SR) and existing workers- anganwadi workers (AWW) in reducing neonatal and infant mortality rates.Methods This three-arm, community-based, cluster randomised trial was conducted in five districts in India. Intervention package consisted of pregnancy surveillance, health education, care at birth, care of normal/low birthweight neonates, identification and treatment of sick neonates and young infants using oral and injectable antibiotics and community mobilisation. The package was similar in both intervention arms—SR and AWW; difference being healthcare provider. The control arm received routine health services from the existing health system. Primary outcomes were neonatal and young infant mortality rates at ‘endline’ period (2008–2009) assessed by an independent team from January to April 2010 in the study clusters.Findings A total of 6623, 6852 and 5898 births occurred in the SR, AWW and control arms, respectively, during the endline period; the proportion of facility births were 69.0%, 64.4% and 70.6% in the three arms. Baseline mortality rates were comparable in three arms. During the endline period, the risk of neonatal mortality was 25% lower in the SR arm (adjusted OR 0.75, 95% CI 0.57 to 0.99); the risks of early neonatal mortality, young infant mortality and infant mortality were also lower by 32%, 27%, and 33%, respectively. The risks of neonatal, early neonatal, young infant, infant mortality in the AWW arm were not different from that of the control arm.Interpretation Home-based care is effective in reducing neonatal and infant mortality rates, when delivered by a dedicated worker, even in settings with high rates of facility births.Trial registration number The study was registered with Clinical Trial Registry of India (CTRI/2011/12/002181).

Frailty models are used in the survival analysis to account for the unobserved heterogeneity in individual risks to disease and death. To analyze the bivariate data on related survival times (e.g. matched pairs experiments, twin or family data), the shared frailty models were suggested. In this manuscript, we propose a new mixture shared inverse Gaussian frailty model based on modified Weibull as baseline distribution. The Bayesian approach of Markov Chain Monte Carlo technique is employed to estimate the parameters involved in the models. In addition, a simulation study is performed to compare the true values of the parameters with the estimated values. A comparison with the existing model was done by using Bayesian comparison techniques. A better model for infectious disease data related to kidney infection is suggested.

Abstract L-Cysteine functionalized magnetite nanoparticles (L-Cyst-Fe3O4 NPs) were synthesized by chemical co-precipitation using Fe2+ and Fe3+ as iron precursors, sodium hydroxide as a base and L-Cysteine as functionalized agent. The structural and morphological studies were carried out using X-ray powder diffraction, transmission electron microscopy, dynamic light scattering, scanning electron microscopy and energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, and UV-Vis spectrophotometric techniques. The zeta potential of bare Fe3O4 and functionalized L-Cyst-Fe3O4 NPs were +28 mV and −30.2 mV (pH 7.0), respectively. The positive surface charge changes to negative imply the presence of L-Cyst monolayer at particle interface. Band gap energy of 2.12 eV [bare Fe3O4NPs] and 1.4 eV [L-Cyst-Fe3O4 NPs] were obtained. Lead and chromium removal were investigated at different initial pHs, contact time, temperatures and adsorbate-adsorbent concentrations. Maximum Cr6+ and Pb2+ removal occurred at pH 2.0 and 6.0, respectively. Sorption dynamics data were best described by pseudo-second order rate equation. Pb2+ and Cr6+ sorption equilibrium data were best fitted to Langmuir equation. Langmuir adsorption capacities of 18.8 mg/g (Pb2+) and 34.5 mg/g (Cr6+) at 45 °C were obtained. Regeneration of exhausted L-Cyst-Fe3O4 NPs and recovery of Pb2+/Cr6+ were demonstrated using 0.01 M HNO3 and NaOH. L-Cyst-Fe3O4 NPs stability and reusability were also demonstrated.

Summary: Background: India had the largest number of under-5 deaths of all countries in 2015, with substantial subnational disparities. We estimated national and subnational all-cause and cause-specific mortality among children younger than 5 years annually in 2000–15 in India to understand progress made and to consider implications for achieving the Sustainable Development Goal (SDG) child survival targets. Methods: We used a multicause model to estimate cause-specific mortality proportions in neonates and children aged 1–59 months at the state level, with causes of death grouped into pneumonia, diarrhoea, meningitis, injury, measles, congenital abnormalities, preterm birth complications, intrapartum-related events, and other causes. AIDS and malaria were estimated separately. The model was based on verbal autopsy studies representing more than 100 000 neonatal deaths globally and 16 962 deaths among children aged 1–59 months at the subnational level in India. By applying these proportions to all-cause deaths by state, we estimated cause-specific numbers of deaths and mortality rates at the state, regional, and national levels. Findings: In 2015, there were 25·121 million livebirths in India and 1·201 million under-5 deaths (under-5 mortality rate 47·81 per 1000 livebirths). 0·696 million (57·9%) of these deaths occurred in neonates. There were disparities in child mortality across states (from 9·7 deaths [Goa] to 73·1 deaths [Assam] per 1000 livebirths) and regions (from 29·7 deaths [the south] to 63·8 deaths [the northeast] per 1000 livebirths). Overall, the leading causes of under-5 deaths were preterm birth complications (0·330 million [95% uncertainty range 0·279–0·367]; 27·5% of under-5 deaths), pneumonia (0·191 million [0·168–0·219]; 15·9%), and intrapartum-related events (0·139 million [0·116–0·165]; 11·6%), with cause-of-death distributions varying across states and regions. In states with very high under-5 mortality, infectious-disease-related causes (pneumonia and diarrhoea) were among the three leading causes, whereas the three leading causes were all non-communicable in states with very low mortality. Most states had a slower decline in neonatal mortality than in mortality among children aged 1–59 months. Ten major states must accelerate progress to achieve the SDG under-5 mortality target, while 17 are not on track to meet the neonatal mortality target. Interpretation: Efforts to reduce vaccine-preventable deaths and to reduce geographical disparities should continue to maintain progress achieved in 2000–15. Enhanced policies and programmes are needed to accelerate mortality reduction in high-burden states and among neonates to achieve the SDG child survival targets in India by 2030. Funding: Bill & Melinda Gates Foundation.

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole.

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole.

Objectives: This cross-sectional community based study was conducted to estimate the prevalence of consumption habits for non tobacco pan masala (ASU) and the risk of developing oral precancer in North India. Methods: This study was conducted in the old town of Lucknow city in the state of Uttar Pradesh in India. Subjects residing for more than 6 months and aged 15 years or above, were enrolled in the study after their informed consent. A two page survey tool was used to collect the data. A three times more matched sample of non users was randomly obtained from this data to analyze and compare the final results. Results: 0.45 million subjects were surveyed. Majority of tobacco users were in the age group of 20–35 years among males and 35–39 years among females. Consumption of non tobacco pan masala among males as well as females was most common in 15–19 years of age group. Prevalence of oral precancer (leukoplakia, submucous fibrosis, erythroplakia, lichen planus, smokers palate and verrucous hyperplasia) was 3.17% in non tobacco pan masala users and 12.22% in tobacco users. The odds of developing oral precancer in non tobacco pan masala users was 20.71 (18.79–22.82) and in tobacco users was 88.07 (84.02–92.31) at 95% confidence interval against non users of both. Conclusion: The odds of developing oral precancer even with consumption of pan masala is high, even when it is consumed without tobacco. It is hence recommended to discourage this habit.

Trauma is the cause of over 45% of deaths in children aged 1 to 14 years. Children are susceptible to polytrauma, as the body of a child has higher elasticity and adverse body size-weight ratio, which allows for a greater distribution of traumatic injuries. The emergency physician or pediatrician manages a polytrauma child by an initial primary survey with an objective to identify and address immediate life-threatening injuries and a secondary survey to provide definitive treatment. Emergency radiology plays a crucial role in the management of a polytrauma child. Several imaging techniques are available, each one with its own advantages and limits and the radiologist should promptly decide which modality to use as to obtain maximum useful information to develop an appropriate treatment and/or surgical plan. The sensitivity of a radiological investigation for polytrauma is more important than its specificity with the primary aim of not missing any critical finding which is life-threatening. X-ray is the first important modality in primary survey, Focused assessment with sonography in trauma (FAST) and extended FAST (e-FAST) have crucial role in hemodynamically unstable patients, whole-body computerized tomography (CT) is a diagnostic aid of the secondary survey and Magnetic resonance imaging ( MRI) plays a pivotal role in patients with diffuse axonal injury and spinal trauma.

Objectives The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. Methods The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. Results The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for 350 cells/mm3), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for 60 kg) were strongly associated with the survival of HIV patients. Conclusions The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.

It has been suggested that particle size plays an important role in determining the genotoxicity of gold nanoparticles (GNPs). The purpose of this study was to compare the potential radio-sensitization effects of two different sized GNPs (3.9 and 37.4 nm) fabricated and examined in vitro in Lewis lung carcinoma (LLC) as a model of non-small cell lung cancer through use of comet and clonogenic assays. After treatment with 2Gy X-ray irradiation, both particle sizes demonstrated increased DNA damage when compared to treatment with particles only and radiation alone. This radio-sensitization was further translated into a reduction in cell survival demonstrated by clonogenicity. This work indicates that GNPs of both sizes induce DNA damage in LLC cells at the tested concentrations, whereas the 37.4 nm particle size treatment group demonstrated greater significance in vitro. The presented data aids in the evaluation of the radiobiological response of Lewis lung carcinoma cells treated with gold nanoparticles.

The COVID-19 pandemic is rising at an unprecedented rate. The surging number of deaths every day, global lockdown and travel restrictions have resulted in huge losses to society. The impact is massive and will leave a historical footprint. The Spanish Flu of 1918, which was the last pandemic that had a similar impact, was shadowed under the consequences of World War I. All the brilliance, strength and economies of countries worldwide are aimed at fighting the COVID-19 pandemic. The knowledge about coronavirus dynamics, its nature and epidemiology are expanding every day. The present review aims to summarize the structure, epidemiology, symptoms, statistical status of the disease status, intervention strategies and deliberates the lessons learnt during the pandemic. The intervention approaches, antiviral drug repurposing and vaccine trials are intensified now. Statistical interpretations of disease dynamics and their projections may help the decision-makers.

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole.