Search results for: Nitish Kumar Singh

Authors: Manisha Singh, Padam Simkhada

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Background: Although mental health policy has been adapted in Nepal since 1997, the implementation of the policy framework is yet to happen. The fact that mental health services are largely concentrated in urban areas more specific to treatment only provides a clear picture of the scarcity of mental health services in the country. The shreds of evidence from around the world, along with WHO’s (World Health Organization) Mental Health Gap Action Program (mhGAP) suggest that effective mental health services can be provided from Primary Health Care (PHC) centers through community-based programs without having to place a specialized health worker. However, the country is still facing the same challenges to date with very few psychiatrists and psychologists, but they are largely based in cities. Objectives: The main objectives of this study are; (a) to understand the perception of health workers at PHC on maternal mental health, and (b) to assess the availability of the mental health services at PHC to address maternal mental health. Methods: This study used a qualitative approach where an in-depth interview was conducted with the health workers at the primary level. “Mayadevi” rural municipality in Rupendehi District that comprised of 13 small villages, was chosen as the study site. A total 8 health institutions which covered all 13 sites were included where either the health post in- charge or health worker working in maternal and child health care was interviewed for the study. All the health posts in the study area were included in the study. The interviews were conducted in Nepali; later, they were translated in English, transcribed, and triangulated. NViVO was used for the analysis. Results: The findings show that most of the health workers understood what maternal mental health was and deemed it as a public health issue. They could explain the symptoms and knew what medication to prescribe if need be. However, the majority of them failed to name the screening tools in place for maternal mental health. Moreover, they hadn’t even seen one. None of the health care centers had any provision for screening mental health status. However, one of the centers prescribed medication when the patients displayed symptoms of depression. But they believed there were a significant number of hidden cases in the community due to the stigma around mental health and being a woman with mental health problem makes the situation even difficult. Nonetheless, the health workers understood the importance of having screening tools and acknowledged the need of training and support in order to provide the services from PHC. Conclusion: Community health workers can identify cases with mental health problems and prevent them from deteriorating further. But there is a need for robust training and support to build the capacity of the health workers. The screening tools on mental health needs to be encouraged to be used in the PHC levels. Furthermore, community-based culture-sensitive programs need to be initiated and implemented to mitigate the stigma related issues around mental health.

Keywords: maternal mental health, health care providers, screening, Nepal

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Authors: Nalla Somaiah, Praveen Kumar

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Scaling of transistors and, hence, interconnects is very important for the enhanced performance of microelectronic devices. Scaling of devices creates significant complexity, especially in the multilevel interconnect architectures, wherein current crowding occurs at the corners of interconnects. Such a current crowding creates hot-spots at the respective corners, resulting in non-uniform temperature distribution in the interconnect as well. This non-uniform temperature distribution, which is exuberated with continued scaling of devices, creates a temperature gradient in the interconnect. In particular, the increased current density at corners and the associated temperature rise due to Joule heating accelerate the electromigration induced failures in interconnects, especially at corners. This has been the classic reliability issue associated with metallic interconnects. Herein, it is generally understood that electromigration induced damages can be avoided if the length of interconnect is smaller than a critical length, often termed as Blech length. Interestingly, the effect of non-negligible temperature gradients generated at these corners in terms of thermomigration and electromigration-thermomigration coupling has not attracted enough attention. Accordingly, in this work, the interplay between the electromigration and temperature gradient induced mass transport was studied using standard Blech structure. In this particular sample structure, the majority of the current is forcefully directed into the low resistivity metallic film from a high resistivity underlayer film, resulting in current crowding at the edges of the metallic film. In this study, 150 nm thick Cu metallic film was deposited on 30 nm thick W underlayer film in the configuration of Blech structure. Series of Cu thin strips, with lengths of 10, 20, 50, 100, 150 and 200 μm, were fabricated. Current density of ≈ 4 × 1010 A/m² was passed through Cu and W films at a temperature of 250ºC. Herein, along with expected forward migration of Cu atoms from the cathode to the anode at the cathode end of the Cu film, backward migration from the anode towards the center of Cu film was also observed. Interestingly, smaller length samples consistently showed enhanced migration at the cathode end, thus indicating the existence of inverse Blech length effect in presence of temperature gradient. A finite element based model showing the interplay between electromigration and thermomigration driving forces has been developed to explain this observation.

Keywords: Blech structure, electromigration, temperature gradient, thin films

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Authors: Manoj Kumar Reddy Pulim, Lakshmi Muthukrishnan, Geetha Jayapathy, Radhika Raman

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Introduction: In the past two decades, noninvasive positive pressure ventilation (NIPPV) emerged as one of the most important advances in the management of both acute and chronic respiratory failure in children. In the acute setting, it is an alternative to intubation with a goal to preserve normal physiologic functions, decrease airway injury, and prevent respiratory tract infections. There is a need to determine the clinical profile and parameters which point towards the need for NIV in the pediatric emergency setting. Objectives: i) To study the clinical profile of children who required non invasive ventilation and invasive ventilation, ii) To study the clinical parameters common to children who required non invasive ventilation. Methods: All children between one month to 18 years, who were intubated in the pediatric emergency department and those for whom decision to commence Non Invasive Ventilation was made in Emergency Room were included in the study. Children were transferred to the Paediatric Intensive Care Unit and started on Non Invasive Ventilation as per our hospital policy and followed up in the Paediatric Intensive Care Unit. Clinical profile of all children which included age, gender, diagnosis and indication for intubation were documented. Clinical parameters such as respiratory rate, heart rate, saturation, grunting were documented. Parameters obtained were subject to statistical analysis. Observations: Airway disease (Bronchiolitis 25%, Viral induced wheeze 22%) was a common diagnosis in 32 children who required Non Invasive Ventilation. Neuromuscular disorder was the common diagnosis in 27 children (78%) who were Intubated. 17 children commenced on Non Invasive Ventilation who later needed invasive ventilation had Neuromuscular disease. High frequency nasal cannula was used in 32, and mask ventilation in 17 children. Clinical parameters common to the Non Invasive Ventilation group were age < 1 year (17), tachycardia n = 7 (22%), tachypnea n = 23 (72%) and severe respiratory distress n = 9 (28%), grunt n = 7 (22%), SPO2 (80% to 90%) n = 16. Children in the Non Invasive Ventilation + INTUBATION group were > 3 years (9), had tachycardia 7 (41%), tachypnea 9(53%) with a male predominance n = 9. In statistical comparison among 3 groups,'p' value was significant for pH, saturation, and use of Ionotrope. Conclusion: Invasive ventilation can be avoided in the paediatric Emergency Department in children with airway disease, by commencing Non Invasive Ventilation early. Intubation in the pediatric emergency department has a higher association with neuromuscular disorders.

Keywords: clinical parameters, indications, non invasive ventilation, paediatric emergency room

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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Introduction: An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavored to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learners. Aim: Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Methods: Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Results: Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. Discussion: After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Conclusion: Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: ethics, medical student, doubt, medical education, faith

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Authors: Ravi Prakash Maurya, Munaswamyreddygari Sreedhar

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The present studies on ecological engineering through soil amendments in cabbage crops for insect pests regulation were conducted at G. B. Pant University of Agriculture and Technology, Pantnagar, Udham Singh Nagar, Uttarakhand, India. Ten treatments viz., Farm Yard Manure (FYM), Neem cake (NC), Vermicompost (VC), Poultry manure (PM), PM+FYM, NC+VC, NC+PM, VC+FYM, Urea+ SSP+MOP (Standard Check) and Untreated Check were evaluated to study the effect of these amendments on the population of insect pests, natural enemies and the microbial community of the rhizosphere in the cabbage crop ecosystem. The results revealed that most of the cabbage pests, viz., aphids, head borer, gram pod borer, and armyworm, were more prevalent in FYM, followed by PM and NC-treated plots. The best cost-benefit ratio was found in PM + FYM treatment, which was 1: 3.62, while the lowest, 1: 0.97, was found in the VC plot. The population of natural enemies like spiders, coccinellids, syrphids, and other hymenopterans and dipterans was also found to be prominent in organic plots, namely FYM, followed by VC and PM plots. Diversity studies on organic manure-treated plots were also carried out, which revealed a total of nine insect orders (Hymenoptera, Hemiptera, Lepidoptera, Coleoptera, Neuroptera, Diptera, Orthoptera, Dermaptera, Thysanoptera, and one arthropodan class, Arachnida) in different treatments. The Simpson Diversity Index was also studied and found to be maximum in FYM plots. The metagenomic analysis of the rhizosphere microbial community revealed that the highest bacterial count was found in NC+PM plot as compared to standard check and untreated check. The diverse microbial population contributes to soil aggregation and stability. Healthier soil structures can improve water retention, aeration, and root penetration, which are all crucial for crop health. The further analysis also identified a total of 39 bacterial phyla, among which the most abundant were Actinobacteria, Firmicutes, and the SAR324 clade. Actinobacteria and Firmicutes are known for their roles in decomposing organic matter and mineralizing nutrients. Their highest abundance suggests improved nutrient cycling and availability, which can directly enhance plant growth. Hence, organic amendments in cabbage farming can transform the rhizosphere microbiome, reduce pest pressure, and foster populations of beneficial insects, leading to healthier crops and a more sustainable agricultural ecosystem.

Keywords: cabbage ecosystem, organic amendments, rhizosphere microbiome, pest and natural enemy diversity

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Authors: Sunil Kumar Ghosh

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Som plant (Machilus bombycina King) is an important plant in agroforestry system. It is cultivated in north -east part of India. It is cultivated in agricultural land by the marginal farmers for multi-storeyed cultivation with intercropping. Localized cottage industries are involved with this plant like sericulture industry (muga silk worm cultivation). Clothes are produced from this sericulture industry. Leaves of som plants are major food of muga silk worm ( Antherea assama ). Nutritional value of leaves plays an important role in the larval growth and silk productivity. The plant also has timber value. The plant is susceptible to mite pest (Tetranychus sp.) causes heavy damage to tender leaves. Lower population was recorded during 7th to 38th standard week, during 3rd week of February to 4th week of September and higher population was during 46th to 51st standard week, during 3rd week of November to 3rd week of December and peak population (6.06/3 leaves) was recorded on 46th standard week that is on 3rd week of November. Correlation studies revealed that mite population had a significant negative correlation with temperature and non-significant positive correlation with relative humidity. This indicates that activity of mites population increase with the rise of relative humidity and decrease with the rise of temperature. Tobacco leaf extracts was found most effective against mite providing 40.51% suppression, closely followed by extracts of Spilanthes (39.06% suppression). Extracts of Garlic and extracts of Polygonum plant gave moderate results, recording about 38.10% and 37.78% mite suppression respectively. The polygonum (Polygonum hydropiper) plant (floral parts), pongamia (Pongamia pinnata) leaves, garlic (Allium sativum), spilanthes (Spilanthes paniculata) (floral parts) were extracted in methanol. Synthetic insecticides contaminate plant leaves with the toxic chemicals. Plant extracts are of biological origin having low or no hazardous effect on health and environment and so can be incorporated in organic cultivation.

Keywords: Abiotic factors, incidence, botanical extracts, organic cultivation, silk industry

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Authors: Sanjay Kumar Srivastava, Anu Rani Sharma, Kamna Sachdeva

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Every year, fog formation over the Indo-Gangetic Plains (IGPs) of Indian region during the winter months of December and January is believed to create numerous hazards, inconvenience, and economic loss to the inhabitants of this densely populated region of Indian subcontinent. The aim of the paper is to analyze the spatial and temporal variability of winter fog over IGPs. Long term ground observations of visibility and other meteorological parameters (1971-2010) have been analyzed to understand the formation of fog phenomena and its relevance during the peak winter months of January and December over IGP of India. In order to examine the temporal variability, time series and trend analysis were carried out by using the Mann-Kendall Statistical test. Trend analysis performed by using the Mann-Kendall test, accepts the alternate hypothesis with 95% confidence level indicating that there exists a trend. Kendall tau’s statistics showed that there exists a positive correlation between time series and fog frequency. Further, the Theil and Sen’s median slope estimate showed that the magnitude of trend is positive. Magnitude is higher during January compared to December for the entire IGP except in December when it is high over the western IGP. Decade wise time series analysis revealed that there has been continuous increase in fog days. The net overall increase of 99 % was observed over IGP in last four decades. Diurnal variability and average daily persistence were computed by using descriptive statistical techniques. Geo-statistical analysis of fog was carried out to understand the spatial variability of fog. Geo-statistical analysis of fog revealed that IGP is a high fog prone zone with fog occurrence frequency of more than 66% days during the study period. Diurnal variability indicates the peak occurrence of fog is between 06:00 and 10:00 local time and average daily fog persistence extends to 5 to 7 hours during the peak winter season. The results would offer a new perspective to take proactive measures in reducing the irreparable damage that could be caused due to changing trends of fog.

Keywords: fog, climatology, Mann-Kendall test, trend analysis, spatial variability, temporal variability, visibility

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Authors: Anand Kumar Yadav

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Purpose – The purpose of this paper is to investigate the fluctuation of amplitude ratios of various transmitted and reflected waves. Design/methodology/approach – The reflection and transmission of plane waves on the interface between an orthotropic hygro-thermo-elastic half-space (OHTHS) and a viscous-fluid half-space (VFHS) were investigated in this study with reference to coupled hygro-thermo-elasticity. Findings – The interface, where y = 0, is struck by the principal (P) plane waves as they travel through the VFHS. Two waves are reflected in VFHS, and four waves are transmitted in OHTHS as a result namely longitudinal displacement, Pwave − , thermal diffusion TDwave − and moisture diffusion mDwave − and shear vertical SV wave. Expressions for the reflection and transmitted coefficient are developed for the incidence of a hygrothermal plane wave. It is noted that these ratios are graphically displayed and are observed under the influence of coupled hygro-thermo-elasticity. Research limitations/implications – There isn't much study on the model under consideration, which combines OHTHS and VFHS with coupled hygro-thermo-elasticity, according to the existing literature Practical implications – The current model can be applied in many different areas, such as soil dynamics, nuclear reactors, high particle accelerators, earthquake engineering, and other areas where linked hygrothermo-elasticity is important. In a range of technical and geophysical settings, wave propagation in a viscous fluid-thermoelastic medium with various characteristics, such as initial stress, magnetic field, porosity, temperature, etc., gives essential information regarding the presence of new and modified waves. This model may prove useful in modifying earthquake estimates for experimental seismologists, new material designers, and researchers. Social implications – Researchers may use coupled hygro-thermo-elasticity to categories the material, where the parameter is a new indication of its ability to conduct heat in interaction with diverse materials. Originality/value – The submitted text is the sole creation of the team of writers, and all authors equally contributed to its creation.

Keywords: hygro-thermo-elasticity, viscous fluid, reflection coefficient, transmission coefficient, moisture concentration

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Authors: Vikas Kumar

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Portable batteries are reliable source of mobile energy to power smart wearable electronics, medical devices, communications, and others internet of thing (IoT) devices. There is a continuous increase in demand for thinner, more flexible battery with high energy density and reliability to meet the requirement. For a flexible battery, factors that affect these properties are the stability of current collectors, electrode materials and their interfaces with the corrosive electrolytes. State-of-the-art conventional and flexible batteries utilise carbon as an electrode and current collectors which cause high internal resistance (~100 ohms) and limit the peak current to ~1mA. This makes them unsuitable for a wide range of applications. Replacing the carbon parts with metallic components would reduce the internal resistance (and hence reduce parasitic loss), but significantly increases the risk of corrosion due to galvanic interactions within the battery. To overcome these challenges, low cost electroplated nickel (Ni) on copper (Cu) was studied as a potential anode current collector for a zinc-manganese oxide primary battery with different concentration of NH4Cl/ZnCl2 electrolyte. Using electrical impedance spectroscopy (EIS), we monitored the open circuit potential (OCP) of electroplated nickel (different thicknesses) in different concentration of electrolytes to optimise the thickness of Ni coating. Our results show that electroless Ni coating suffer excessive corrosion in these electrolytes. Corrosion rates of Ni coatings for different concentrations of electrolytes have been calculated with Tafel analysis. These results suggest that for electroplated Ni, channelling and/or open porosity is a major issue, which was confirmed by morphological analysis. These channels are an easy pathway for electrolyte to penetrate thorough Ni to corrode the Ni/Cu interface completely. We further investigated the incorporation of a special printed graphene layer on Ni to provide corrosion protection in this corrosive electrolyte medium. We find that the incorporation of printed graphene layer provides the corrosion protection to the Ni and enhances the chemical bonding between the active materials and current collector and also decreases the overall internal resistance of the battery system.

Keywords: corrosion, electrical impedance spectroscopy, flexible battery, graphene, metal current collector

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Authors: Amlan Kumar Das, Avinash Marwal, Vikram Pareek

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Liposome plays an important role in medical and pharmaceutical science as e.g. nano scale drug carriers. Liposomes are vesicles of varying size consisting of a spherical lipid bilayer and an aqueous inner compartment. Magnet-driven liposome used for the targeted delivery of drugs to organs and tissues1. These liposome preparations contain encapsulated drug components and finely dispersed magnetic particles. Liposomes are vesicles of varying size consisting of a spherical lipid bilayer and an aqueous inner compartment that are generated in vitro. These are useful in terms of biocompatibility, biodegradability, and low toxicity, and can control biodistribution by changing the size, lipid composition, and physical characteristics2. Furthermore, liposomes can entrap both hydrophobic and hydrophilic drugs and are able to continuously release the entrapped substrate, thus being useful drug carriers. Magnetic liposomes (MLs) are phospholipid vesicles that encapsulate magneticor paramagnetic nanoparticles. They are applied as contrast agents for magnetic resonance imaging (MRI)3. The biological synthesis of nanoparticles using plant extracts plays an important role in the field of nanotechnology4. Green-synthesized magnetite nanoparticles-protein hybrid has been produced by treating Iron (III)/Iron(II) chloride with the leaf extract of Dhatura Inoxia. The phytochemicals present in the leaf extracts act as a reducing as well stabilizing agents preventing agglomeration, which include flavonoids, phenolic compounds, cardiac glycosides, proteins and sugars. The magnetite nanoparticles-protein hybrid has been trapped inside the aqueous core of the liposome prepared by reversed phase evaporation (REV) method using oleic and linoleic acid which has been shown to be driven under magnetic field confirming the formation magnetic liposome (ML). Chemical characterization of stealth magnetic liposome has been performed by breaking the liposome and release of magnetic nanoparticles. The presence iron has been confirmed by colour complex formation with KSCN and UV-Vis study using spectrophotometer Cary 60, Agilent. This magnet driven liposome using nanoparticles-protein hybrid can be a smart vesicles for the targeted drug delivery.

Keywords: nanoparticles-protein hybrid, magnetic liposome, medical, pharmaceutical science

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Authors: Palash Soni, Vivek Kumar Gaba, Shubhankar Bhowmick, Bidyut Mazumdar

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Refrigeration technology is a fast developing field at the present era since it has very wide application in both domestic and industrial areas. It started from the usage of simple ice coolers to store food stuffs to the present sophisticated cold storages along with other air conditioning system. A variety of techniques are used to bring down the temperature below the ambient. Adsorption refrigeration technology is a novel, advanced and promising technique developed in the past few decades. It gained attention due to its attractive property of exploiting unlimited natural sources like solar energy, geothermal energy or even waste heat recovery from plants or from the exhaust of locomotives to fulfill its energy need. This will reduce the exploitation of non-renewable resources and hence reduce pollution too. This work is aimed to develop a model for a solar adsorption refrigeration system and to simulate the same for different operating conditions. In this system, the mechanical compressor is replaced by a thermal compressor. The thermal compressor uses renewable energy such as solar energy and geothermal energy which makes it useful for those areas where electricity is not available. Refrigerants normally in use like chlorofluorocarbon/perfluorocarbon have harmful effects like ozone depletion and greenhouse warming. It is another advantage of adsorption systems that it can replace these refrigerants with less harmful natural refrigerants like water, methanol, ammonia, etc. Thus the double benefit of reduction in energy consumption and pollution can be achieved. A thermodynamic model was developed for the proposed adsorber, and a universal MATLAB code was used to simulate the model. Simulations were carried out for a different operating condition for the silicagel-methanol working pair. Various graphs are plotted between regeneration temperature, adsorption capacities, the coefficient of performance, desorption rate, specific cooling power, adsorption/desorption times and mass. The results proved that adsorption system could be installed successfully for refrigeration purpose as it has saving in terms of power and reduction in carbon emission even though the efficiency is comparatively less as compared to conventional systems. The model was tested for its compliance in a cold storage refrigeration with a cooling load of 12 TR.

Keywords: adsorption, refrigeration, renewable energy, silicagel-methanol

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Authors: Lok Raj Joshi, Naveen Prakash Shah, Sharad Kumar Sharma, I. Ratna Bhattarai, Rajendra Basnet, Deepak Dahal, Bahagwan Maharjan, Seraphine Kaminsa

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Context: Tuberculosis (TB) is a significant health issue in Nepal, a country with a high burden of the disease. Despite efforts to control TB, there is still a gap in the notification of TB cases, which hinders effective control and treatment. This paper aims to address this notification gap and proposes strategies to improve TB control in Nepal. Research Aim: The aim of this research is to understand and address the tuberculosis notification gap in Nepal. The focus is on enhancing the healthcare system, involving the private sector and communities, raising awareness, and addressing social determinants to achieve sustainable TB control. Methodology: The research methodology involved a review of existing epidemiological data and research studies related to TB in Nepal. Additionally, consultation with an expert group from the TB control program in Nepal provided insights into the current state of TB control and challenges in addressing the notification gap. Findings: The findings reveal that only 55% of TB cases were reported in 2022, indicating a significant notification gap. Of the reported cases, only 32% and 19% were referred by the private sector and community, respectively. Furthermore, 20% of diagnosed cases were not treated in the initial phase. The estimated number of cases of multidrug-resistant TB (MDR TB) was 2,800, suggesting a low diagnosis rate. Among the diagnosed MDR TB cases, only 60% were receiving treatment. Additionally, it was observed that 20% of diagnosed MDR TB cases were from India and not enrolling in TB treatment in Nepal, indicating a high rate of defaulters. Theoretical Importance: The study highlights the importance of adopting a holistic strategy to address the notification gap in TB cases in Nepal. It emphasizes the need to enhance healthcare infrastructure, raise awareness, involve the private sector and local communities, establish effective methods to trace initial defaulters, implement TB interventions in border regions, and mitigate the social stigma associated with the disease. Data Collection and Analysis Procedures: Data for this study was collected through a review of existing epidemiological data and research studies. The data were then analyzed to identify patterns, trends, and gaps in TB case notification in Nepal.

Keywords: TB, tuberculosis, private sector, community, migrants, nepal

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Authors: Devendra Gupta, Vikash Arya, Prabhat K. Singh

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Background: Ultrasound guidance could be beneficial in placing central venous catheters by improving the success rate, reducing the number of needle passes, and decreasing complications. Central venous cannulation set has a single puncture needle of a fixed length of 6.4 cm. However, the average distance of midpoint of IJV to the skin is around 1 cm to 2 cm. The long length needle has tendency to go in depth more than required and this is very common during learning period of any individual. Therefore, we devised a long needle with a guard which can be adjusted according to the required length. Methods: After approval from the institute ethics committee and patient’s written informed consent, a prospective, randomized, single-blinded controlled study was conducted. Adult patient aged of both sexes with ASA grade 1-2 undergoing surgery requiring internal jugular venous (IJV) access was included. After intubation, the head was rotated to the contralateral side at 30 degree head rotation on the position of the right IJV. The transducer probe a 6.5 to 13-MHz linear transducer (Sonosite, USA) had been placed at the apex of triangle with minimal pressure to avoid IJV compression. The distance from skin to midpoint of the right IJV and skin to anterior wall of Common Carotid Artery (CCA) had been done using B-mode duplex sonography with a 6.5 to 13-MHz linear transducer. Depending upon the results of randomization 420 patients had been divided into two groups of equal numbers (n=210). Group 1. USG guided right sided IJV cannulation was done with conventional (6.4 cm) needle; and Group 2. USG guided right sided IJV cannulation was done with conventional (6.4 cm) needle with guard fixed to a required length (length between skin and midpoint of IJV) by an experienced anesthesiologist. Independent observer has noted the number of attempts and occurrence of complications (CCA puncture, pneumothorax or adjacent tissue damage). Results: Demographic data were similar in both the group. The groups were comparable when considered for relationship of IJV to CCA. There was no significant difference between groups as regard to distance of midpoint of IJV to the skin (p<0.05). IJV cannulation was successfully done in single attempts in 180 (85.7%), in two attempts in 27 (12.9%) and three attempts in 3 (1.4%) in group I, whereas in single attempt in 207 (98.6%) and second attempts in 3 (1.4%) in group II (p <0.000). Incidence of carotid artery puncture was significantly more in group I (7.1%) compared to group II (0%) (p<0.000). Incidence of adjacent tissue puncture was significantly more in group I (8.6%) compared to group II (0%) (p<0.000). Conclusion: Therefore IJV catheterization using guard over the needle at predefined length with the help of real-time ultrasound results in better success rates and lower immediate complications.

Keywords: ultrasound guided, internal jugular vein cannulation, measured guided needle, common carotid artery puncture

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Authors: Sadaf H. Khan, Jyoti Kumar

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Sick Building Syndrome (SBS) is a situation in which inhabitants of a building develop illness symptoms or get infected with a chronic disease as a result of the building in which they reside or work. Certain symptoms tend to get more severe as an individual spends more time in the building; however, they generally improve with time or even disappear when they leave that space. Though ‘Design of Built-Spaces’ is a crucial factor in regulating these symptoms but it still needs to be identified further as to what specific design features of a ‘Built-Space’ trigger sick building syndrome (SBS). Much of the research work present to date is focused on the physiological or physical sickness caused due to inappropriate built-space design. In this paper, the psychological aspects of sick building syndrome (SBS) will be investigated across the adult population, more specifically graduate students in India trying to settle in back to their previous physical work environments, i.e., campus, classrooms, hostels, after a very long hold which lasted more than a year due to lockdowns during Covid-19 crisis all over the world. The study will follow an analytical approach and the data will be collected through self-reported online surveys. The purpose of this study is to enquire causal agents, diagnosable symptoms and remedial design of built spaces which can enhance the productive level of built environments and better facilitate the inhabitants by improving their psychological wellbeing, which is the most uprising concern. The fact that SBS symptoms can be studied only within the initial few weeks as an occupant starts interacting with a built-environment and leaves as the occupant leaves that space or zone, the post-lockdown incoming of students back to their respective campuses provides an opportunity to clearly draw multiple conclusions of the relationship that exist between the Design of Built-Spaces and Psychological Sickness Syndrome associated with it. The study will be one of a kind approach for understanding and formulating methods to improve psychological wellbeing within a built-setting by better identifying factors associated with these psychological symptoms, including anxiety, mental fatigue, reduced attention span and reduced memory span as refined symptoms of SBS discussed in 1987 by Molhave within his study.

Keywords: built-environment psychology, built-space design, healthcare architecture, psychological wellbeing

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Authors: Pronob Kumar Mozumder M. Nazrul Islam, M. Abdur Rob Mollah

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This study was conducted in Cox’s Bazar-Teknaf Peninsula and Sonadia Island Ecologically Critical Areas during the period of October, 2011 to June, 2013. Six species of marine turtle are found in the Indian Ocean. Among them, olive ridley (Lepidochelys olivacea) listed as endangered in the IUCN Red List of Threatened Species. Marine turtle populations in the Indian Ocean have been depleted through long-term exploitation of eggs and adults, incidental capture (fisheries bycatch) and many other sources of mortality. The specific objective of the study was to conserve the sea turtles specially the olive ridley (Lepidochelys olivacea) with a view to contribute towards protection of the turtle species from extinction and to facilitate hatching of eggs through providing protection to turtle eggs or nest through ex-situ conservation efforts. In order to achieve the desired outputs and success, a total of five turtle hatcheries were established at Pechardwip, Khurermukh, Hazompara, Bodormokam, and Sonadia Eastpara sites. In total, 31,853 eggs were collected from 260 nests and were transferred to five hatcheries. The number of eggs/nest varied from 38 to 190 with an average clutch size of 122 eggs/ nest. Hatching of eggs took place during January to June with a peak in April. Sea turtle eggs were incubated by metabolic heat and the heat of the sun. The incubation period of turtle eggs in Cox’s Bazar-Teknaf Peninsula and Sonadia Island ECAs extended from 54 to 75 days depending on the month with an average of 66 days. During study period the temperature in the ECAs varied between 10.5-34.5°C. A total of 27,937 hatchlings of turtle were produced from the five hatcheries and all the hatchlings produced were released into the sea. Hatching rates varied from 74-98 % depending on the location and months with an average of 88 %. Sea turtles spend the majority of their lives in the sea, only emerging on beaches to nest. Despite the intense conservation efforts on the beaches, some populations have still declined to the edge of extinction. So proper conservation and awareness measure should be taken for prevention of turtle extinction.

Keywords: conservation of sea turtle, Bangladesh, ecologically critical area, ECA, Lepidochelys olivacea

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Authors: Sabyasachi Behera, Shiv Kumar, Pramod Gautam, Anisur Rahman, Pawan Pathak, Rahul Bhadouria

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Background: The increasing proportion of population especially urban poor and vulnerable groups or groups with specific needs, with health indicators worse than their rural counterparts in India face various issues related with availability and quality of health care. The reasons are myriad, starting from information and awareness of the community, especially, in a scenario wherein the needs and challenges of floating and migrant urban populations remain poorly understood. Weak linkages between health care facilities and slum dwellers and vulnerable populations hinder the improvement of health services for urban poor. Method: To address this issue, TCIHC program is helping health department of Indore city of Madhya Pradesh to establish a referral mechanism with a dual approach: at both community and facility level. The former is based on the premise of ‘building social capital’, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services at appropriate levels of care (Minus 2: Accredited Social Health Activist and Community Health Groups; Minus 1: Urban Health Nutrition Days; Zero: Urban Primary Health Center; Plus 1: secondary facility with BEmONC services; Plus 2: secondary facilities with CEmONC services; Plus 3: tertiary level facility) for the urban poor. The latter focuses on encouraging the provision of all services at various levels of service delivery points and stakeholders to function in a coordinated manner to ensure better health service availability and coverage in underserved slum areas. Results: This initiative has enhanced the utilization of community based, primary and secondary level services through defined referral pathways that are clearly known to a community dweller. Conclusion: An ideal referral mechanism should begin with referral at the community level wherein services of a frontline health care provider are accessed by them at their door-step, causing no delay in both understanding and decision on the health issues faced by them.

Keywords: levels of care, linkages, referral mechanism, service delivery

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Authors: Swati Tomar, Sunil Kumar Gupta

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Anammox is a promising and cost effective alternative to conventional treatment systems that facilitates direct oxidation of ammonium nitrogen under anaerobic conditions with nitrite as an electron acceptor without addition of any external carbon sources. The present study investigates the process kinetics of laboratory scale anammox hybrid reactor (AHR) which combines the dual advantages of attached and suspended growth. The performance & behaviour of AHR was studied under varying hydraulic retention time (HRTs) and nitrogen loading rate (NLRs). The experimental unit consisted of 4 numbers of 5L capacity anammox hybrid reactor inoculated with mixed seed culture containing anoxic and activated sludge. Pseudo steady state (PSS) ammonium and nitrite removal efficiencies of 90.6% and 95.6%, respectively, were achieved during acclimation phase. After establishment of PSS, the performance of AHR was monitored at seven different HRTs of 3.0, 2.5, 2.0, 1.5, 1.0, 0.5 and 0.25 d with increasing NLR from 0.4 to 4.8 kg N/m3d. The results showed that with increase in NLR and decrease in HRT (3.0 to 0.25 d), AHR registered appreciable decline in nitrogen removal efficiency from 92.9% to 67.4 %, respectively. The HRT of 2.0 d was considered optimal to achieve substantial nitrogen removal of 89%, because on further decrease in HRT below 1.5 days, remarkable decline in the values of nitrogen removal efficiency were observed. Analysis of data indicated that attached growth system contributes an additional 15.4 % ammonium removal and reduced the sludge washout rate (additional 29% reduction). This enhanced performance may be attributed to 25% increase in sludge retention time due to the attached growth media. Three kinetic models, namely, first order, Monod and Modified Stover-Kincannon model were applied to assess the substrate removal kinetics of nitrogen removal in AHR. Validation of the models were carried out by comparing experimental set of data with the predicted values obtained from the respective models. For substrate removal kinetics, model validation revealed that Modified Stover-Kincannon is most precise (R2=0.943) and can be suitably applied to predict the kinetics of nitrogen removal in AHR. Lawrence and McCarty model described the kinetics of bacterial growth. The predicted value of yield coefficient and decay constant were in line with the experimentally observed values.

Keywords: anammox, kinetics, modelling, nitrogen removal, sludge wash out rate, AHR

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Authors: Govind Kumar

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The concept of ‘e-governance’ that was brought about by the new wave of reforms, namely ‘LPG’ in the early 1990s, has been enabling governments across the globe to digitally transform themselves. Digital transformation is leading the governments with qualitative decisions, optimization in rational use of resources, facilitation of cost-benefit analyses, and elimination of redundancy and corruption with the help of ICT-based applications interface. ICT-based applications/technologies have enormous potential for impacting positive change in the social lives of the global citizenry. Supercomputers test and analyze millions of drug molecules for developing candidate vaccines to combat the global pandemic. Further, e-commerce portals help distribute and supply household items and medicines, while videoconferencing tools provide a visual interface between the clients and hosts. Besides, crop yields are being maximized with the help of drones and machine learning, whereas satellite data, artificial intelligence, and cloud computing help governments with the detection of illegal mining, tackling deforestation, and managing freshwater resources. Such e-applications have the potential to take governance an extra mile by achieving 5 Es (effective, efficient, easy, empower, and equity) of e-governance and six Rs (reduce, reuse, recycle, recover, redesign and remanufacture) of sustainable development. If such digital transformation gains traction within the government framework, it will replace the traditional administration with the digitalization of public administration. On the other hand, it has brought in a new set of challenges, like the digital divide, e-illiteracy, technological divide, etc., and problems like handling e-waste, technological obsolescence, cyber terrorism, e-fraud, hacking, phishing, etc. before the governments. Therefore, it would be essential to bring in a rightful mixture of technological and humanistic interventions for addressing the above issues. This is on account of the reason that technology lacks an emotional quotient, and the administration does not work like technology. Both are self-effacing unless a blend of technology and a humane face are brought in into the administration. The paper will empirically analyze the significance of the technological framework of digital transformation within the government set up for the digitalization of public administration on the basis of the synthesis of two case studies undertaken from two diverse fields of administration and present a future framework of the study.

Keywords: digital transformation, electronic governance, public administration, knowledge framework

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Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

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Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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Authors: L. V. Lokesha, Jagadeesh S. Sanganal, Yogesh S. Gowda, Shekhar, N. B. Shridhar, N. Prakash, Prashantkumar Waghe, H. D. Narayanaswamy, Girish V. Kumar

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Organochlorine (OC) insecticides are among the most important organotoxins and make a large group of pesticides. Physicochemical properties of these toxins, especially their lipophilicity, facilitate the absorption and storage of these toxins in the meat thus possess public health threat to humans. The presence of these toxins in broiler meat can be a quantitative and qualitative index for the presence of these toxins in animal bodies, which is attributed to Waste water of irrigation after spraying the crops, contaminated animal feeds with pesticides, polluted air are the potential sources of residues in animal products. Fifty broiler meat samples were collected from different retail outlets of Bengaluru city, Karnataka state, in ice cold conditions and later stored under -20°C until analysis. All the samples were subjected to Gas Chromatograph attached to Electron Capture Detector(GC-ECD, VARIAN make) screening and quantification of OC pesticides viz; Alachlor, Aldrin, Alpha-BHC, Beta-BHC, Dieldrin, Delta-BHC, o,p-DDE, p,p-DDE, o,p-DDD, p,p-DDD, o,p-DDT, p,p-DDT, Endosulfan-I, Endosulfan-II, Endosulfan Sulphate and Lindane(all the standards were procured from Merck). Extraction was undertaken by blending fifty grams (g) of meat sample with 50g Sodium Sulphate anahydrous, 120 ml of n-hexane, 120 ml acetone for 15 mins, extract is washed with distilled water and sample moisture is dried by sodium sulphate anahydrous, partitioning is done with 25 ml petroleum ether, 10 ml acetonitrile and 15 ml n-hexane shake vigorously for two minutes, sample clean up was done with florosil column. The reconstituted samples (using n-hexane) (Merck chem) were injected to Gas Chromatograph–Electron Capture Detector(GC-ECD). The present study reveals that, among the fifty chicken samples subjected for analysis, 60% (15/50), 32% (8/50), 28% (7/50), 20% (5/50) and 16% (4/50) of samples contaminated with DDTs, Delta-BHC, Dieldrin, Aldrin and Alachlor respectively. DDT metabolites, Delta-BHC were the most frequently detected OC pesticides. The detected levels of the pesticides were below the levels of MRL(according to Export Council of India notification for fresh poultry meat).

Keywords: accuracy, gas chromatography, meat, pesticide, petroleum ether

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Authors: S. Vijay Kumar, Kishore K. Jena, Saeed M. Alhassan

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Elemental sulfur is currently produced on the level of 70 million tons annually by petroleum refining, majority of which is used in the production of sulfuric acid, fertilizer and other chemicals. Still, over 6 million tons of elemental sulfur is generated in excess, which creates exciting opportunities to develop new chemistry to utilize sulfur as a feedstock for polymers. Development of new polymer composite materials using sulfur is not widely explored and remains an important challenge in the field. Polymer nanocomposites prepared by carbon nanotube, graphene, silica and other nanomaterials were well established. However, utilization of sulfur as filler in the polymer matrix could be an interesting study. This work is to presents the possibility of utilizing elemental sulfur as reinforcing fillers in the polymer matrix. In this study we attempted to prepare polypropylene/sulfur nanocomposite. The physical, mechanical and morphological properties of the newly developed composites were studied according to the sulfur loading. In the sample preparation, four levels of elemental sulfur loading (5, 10, 20 and 30 wt. %) were designed. Composites were prepared by the melt mixing process by using laboratory scale mini twin screw extruder at 180°C for 15 min. The reaction time and temperature were maintained constant for all prepared composites. The structure and crystallization behavior of composites was investigated by Raman, FTIR, XRD and DSC analysis. It was observed that sulfur interfere with the crystalline arrangement of polypropylene and depresses the crystallization, which affects the melting point, mechanical and thermal stability. In the tensile test, one level of test temperature (room temperature) and crosshead speed (10 mm/min) was designed. Tensile strengths and tensile modulus of the composites were slightly decreased with increasing in filler loading, however, percentage of elongation improved by more than 350% compared to neat polypropylene. The effect of sulfur on the morphology of polypropylene was studied with TEM and SEM techniques. Microscope analysis revels that sulfur is homogeneously dispersed in polymer matrix and behaves as single phase arrangement in the polymer. The maximum elongation for the polypropylene can be achieved by adjusting the sulfur loading in the polymer. This study reviles the possibility of using elemental sulfur as a solid plasticizer in the polypropylene matrix.

Keywords: crystallization, elemental sulfur, morphology, thermo-mechanical properties, polypropylene, polymer nanocomposites

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Authors: S. H. Gasa, L. Singh, B. Pillay, A. O. Olaniran

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Wastewater treatment plants (WWTPs) have been implicated as the leading reservoir for antibiotic resistant bacteria (ARB), including Enterococci spp. and antibiotic resistance genes (ARGs), worldwide. Enterococci are a group of clinically significant bacteria that have gained much attention as a result of their antibiotic resistance. They play a significant role as the principal cause of nosocomial infections and dissemination of antimicrobial resistance genes in the environment. The main objective of this study was to ascertain the role of WWTPs in Durban, South Africa as potential reservoirs for antibiotic resistant Enterococci (ARE) and their related ARGs. Furthermore, the antibiogram and resistance gene profile of Enterococci species recovered from treated wastewater effluent and receiving surface water in Durban were also investigated. Using membrane filtration technique, Enterococcus selective agar and selected antibiotics, ARE were enumerated in samples (influent, activated sludge, before chlorination and final effluent) collected from two WWTPs, as well as from upstream and downstream of the receiving surface water. Two hundred Enterococcus isolates recovered from the treated effluent and receiving surface water were identified by biochemical and PCR-based methods, and their antibiotic resistance profiles determined by the Kirby-Bauer disc diffusion assay, while PCR-based assays were used to detect the presence of resistance and virulence genes. High prevalence of ARE was obtained at both WWTPs, with values reaching a maximum of 40%. The influent and activated sludge samples contained the greatest prevalence of ARE with lower values observed in the before and after chlorination samples. Of the 44 vancomycin and high-level gentamicin-resistant isolates, 11 were identified as E. faecium, 18 as E. faecalis, 4 as E. hirae while 11 are classified as “other” Enterococci species. High-level aminoglycoside resistance for gentamicin (39%) and vancomycin (61%) was recorded in species tested. The most commonly detected virulence gene was the gelE (44%), followed by asa1 (40%), while cylA and esp were detected in only 2% of the isolates. The most prevalent aminoglycoside resistance genes were aac(6')-Ie-aph(2''), aph(3')-IIIa, and ant(6')-Ia detected in 43%, 45% and 41% of the isolates, respectively. Positive correlation was observed between resistant phenotypes to high levels of aminoglycosides and presence of all aminoglycoside resistance genes. Resistance genes for glycopeptide: vanB (37%) and vanC-1 (25%), and macrolide: ermB (11%) and ermC (54%) were detected in the isolates. These results show the need for more efficient wastewater treatment and disposal in order to prevent the release of virulent and antibiotic resistant Enterococci species and safeguard public health.

Keywords: antibiogram, enterococci, gentamicin, vancomycin, virulence signatures

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Authors: Rakesh Mishra, Rajni Singh, Mukunda Upadhyay

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Since the last few decades, the prima facie of development has shifted towards the working population in India. There has been a paradigm shift in the development approach with the realization that the present demographic dividend has to be harnessed for sustainable development. Rapid urbanization and improved socioeconomic characteristics experienced within its territory has catalyzed various forms of migration into it, resulting in massive transference of workforce between its states. Workforce in any country plays a very crucial role in deciding development of both the places, from where they have out-migrated and the place they are residing currently. In India, people are found to be migrating from relatively less developed states to a well urbanized and developed state for satisfying their neediness. Linking migration to HDI at place of destination, the regression coefficient (β ̂) shows affirmative association between them, because higher the HDI of the place would be, higher would be chance of earning and hence likeliness of the migrants would be more to choose that place as a new destination and vice versa. So the push factor is compromised by the cost of rearing and provides negative impulse on the in migrants letting down their numbers to metro cities or megacities of the states but increasing their mobility to the suburban areas and vice versa. The main objective of the study is to check the role of migration in deciding the dividend of the place of destination as well as people at the place of their usual residence with special focus to highly urban states in India. Idealized scenario of Indian migrants refers to some new theories in making. On analyzing the demographic dividend of the places we got to know that Uttar Pradesh provides maximum dividend to Maharashtra, West Bengal and Delhi, and the demographic divided of migrants are quite comparable to the native’s shares in the demographic dividend in these places. On analyzing the data from National Sample Survey 64th round and Census of India-2001, we have observed that for males in rural areas, the share of unemployed person declined by 9 percentage points (from 45% before migration to 36 % after migration) and for females in rural areas the decline was nearly 12 percentage points (from 79% before migration to 67% after migration. It has been observed that the shares of unemployed males in both rural and urban areas, which were significant before migration, got reduced after migration while the share of unemployed females in the rural as well as in the urban areas remained almost negligible both for before and after migration. So increase in the number of employed after migration provides an indication of changes in the associated cofactors like health and education of the place of destination and arithmetically to the place from where they have migrated out. This paper presents the evidence on the patterns of prevailing migration dynamics and corresponding demographic benefits in India and its states, examines trends and effects, and discusses plausible explanations.

Keywords: migration, demographic shift, human development index, multilevel analysis

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Authors: Shamie Kumar

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Background: Radiologists and radiographers (RR) need to educate themselves and their colleagues to ensure that AI is integrated safely, useful, and in a meaningful way with the direction it always benefits the patients. AI education and training are fundamental to the way RR work and interact with it, such that they feel confident using it as part of their clinical practice in a way they understand it. Methodology: This exploratory research will outline the current educational and training gaps for radiographers and radiologists in AI radiology diagnostics. It will review the status, skills, challenges of educating and teaching. Understanding the use of artificial intelligence within daily clinical practice, why it is fundamental, and justification on why learning about AI is essential for wider adoption. Results: The current knowledge among RR is very sparse, country dependent, and with radiologists being the majority of the end-users for AI, their targeted training and learning AI opportunities surpass the ones available to radiographers. There are many papers that suggest there is a lack of knowledge, understanding, and training of AI in radiology amongst RR, and because of this, they are unable to comprehend exactly how AI works, integrates, benefits of using it, and its limitations. There is an indication they wish to receive specific training; however, both professions need to actively engage in learning about it and develop the skills that enable them to effectively use it. There is expected variability amongst the profession on their degree of commitment to AI as most don’t understand its value; this only adds to the need to train and educate RR. Currently, there is little AI teaching in either undergraduate or postgraduate study programs, and it is not readily available. In addition to this, there are other training programs, courses, workshops, and seminars available; most of these are short and one session rather than a continuation of learning which cover a basic understanding of AI and peripheral topics such as ethics, legal, and potential of AI. There appears to be an obvious gap between the content of what the training program offers and what the RR needs and wants to learn. Due to this, there is a risk of ineffective learning outcomes and attendees feeling a lack of clarity and depth of understanding of the practicality of using AI in a clinical environment. Conclusion: Education, training, and courses need to have defined learning outcomes with relevant concepts, ensuring theory and practice are taught as a continuation of the learning process based on use cases specific to a clinical working environment. Undergraduate and postgraduate courses should be developed robustly, ensuring the delivery of it is with expertise within that field; in addition, training and other programs should be delivered as a way of continued professional development and aligned with accredited institutions for a degree of quality assurance.

Keywords: artificial intelligence, training, radiology, education, learning

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Authors: Ilham Zaidi, P. Sankara Sarma, Quazi Taufique Ahmed, V. Raman Kutty, Khalid Umer Khayyam, Gurpreet Singh, Abhishek Royal

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Introduction: Tuberculosis is a global public health emergency, but it is particularly acute in India, which has the world's highest tuberculosis burden. Due to overpopulation, lack of sanitation, malnutrition, low living standards, and poor socioeconomic status, among other factors, it is India's most common infectious disease. The long period of treatment is one of the main reasons for considering it as a public health emergency. Consequently, there is an increase in patient noncompliance, which leads to treatment failure, adverse treatment outcomes, and deaths. This could lead to the growth of anti-TB drug resistance. According to the WHO, approximately 558 thousand new cases of Multi-Drug Resistance Tuberculosis were diagnosed worldwide, with 8.5 percent developed Extensively Drug Resistance Tuberculosis. Methodology: This study is a program-based cross-sectional descriptive survey of adult tuberculosis patients enrolled in the Delhi-based Revised National Tuberculosis Program. The study setting was 27 NTEP districts of Delhi. (N=65,893) and Sample size- was 200; the sampling method which is used in the study was the systemic random sampling method. Results: Most of the demographic factors (age, gender, residence, and family type) were not significantly associated with adherence; marital status was found statistically significant with the treatment compliance. Hesitation while telling people about the disease and motivation to strictly follow drug schedule by healthcare workers were other factors where a significant association with drug adherence was observed. The study findings also suggest that provision of food, minimal financial and other moral support from family, counseling, discussion and politeness by healthcare providers might also facilitate adherence. Discussion and Conclusions: For TB treatment, adherence, age, sex, socioeconomic status, types of accommodations, malnutrition, and personal hygiene should all be considered; similar results were observed in previous studies. In the care of TB patients, DOTS services, health workers, and family support play a significant role. According to the country's National Strategic Plan, the Indian government has set a goal of eliminating tuberculosis by 2025 and patients' compliance with TB care and treatment adherence is very crucial to achieve this aim. A cohort study will be able to give a better understanding of factors associated with adherence since this study may have missed some defaulters who were absconding and could not be reached. Important Terms: RNTCP, NTEP, DOTS, DS-TB, DR-TB, RR-TB, MDR-TB, XDR-TB, Treatment failure, Treatment relapse, Treatment adherence.

Keywords: treatment adherence, treatment relapse, treatment failure, drug resistance tuberculosis

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Authors: Balwinder Singh, Veerpaul Kaur Mann

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A composite material is formed by the combination of two or more phases or materials. Natural minerals-derived Basalt fiber is a kind of fiber being introduced in the polymer composite industry due to its good mechanical properties similar to synthetic fibers and low cost, environment friendly. Also, there is a rising trend towards the use of industrial wastes as fillers in polymer composites with the aim of improving the properties of the composites. The mechanical properties of the fiber-reinforced polymer composites are influenced by various factors like fiber length, fiber weight %, filler weight %, filler size, etc. Thus, a detailed study has been done on the characterization of short-chopped Basalt fiber-reinforced polymer matrix composites using fly ash as filler. Taguchi’s L9 orthogonal array has been used to develop the composites by considering fiber length (6, 9 and 12 mm), fiber weight % (25, 30 and 35 %) and filler weight % (0, 5 and 10%) as input parameters with their respective levels and a thorough analysis on the mechanical characteristics (tensile strength and impact strength) has been done using ANOVA analysis with the help of MINITAB14 software. The investigation revealed that fiber weight is the most significant parameter affecting tensile strength, followed by fiber length and fiber weight %, respectively, while impact characterization showed that fiber length is the most significant factor, followed by fly ash weight, respectively. Introduction of fly ash proved to be beneficial in both the characterization with enhanced values upto 5% fly ash weight. The present study on the natural fibres reinforced epoxy composites using fly ash as filler material to study the effect of input parameters on the tensile strength in order to maximize tensile strength of the composites. Fabrication of composites based on Taguchi L9 orthogonal array design of experiments by using three factors fibre type, fibre weight % and fly ash % with three levels of each factor. The Optimization of composition of natural fibre reinforces composites using ANOVA for obtaining maximum tensile strength on fabricated composites revealed that the natural fibres along with fly ash can be successfully used with epoxy resin to prepare polymer matrix composites with good mechanical properties. Paddy- Paddy fibre gives high elasticity to the fibre composite due to presence of approximately hexagonal structure of cellulose present in paddy fibre. Coir- Coir fibre gives less tensile strength than paddy fibre as Coir fibre is brittle in nature when it pulls breakage occurs showing less tensile strength. Banana- Banana fibre has the least tensile strength in comparison to the paddy & coir fibre due to less cellulose content. Higher fibre weight leads to reduction in tensile strength due to increased nuclei of air pockets. Increasing fly ash content reduces tensile strength due to nonbonding of fly ash particles with natural fibre. Fly ash is also not very strong as compared to the epoxy resin leading to reduction in tensile strength.

Keywords: tensile strength and epoxy resin. basalt Fiber, taguchi, polymer matrix, natural fiber

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Authors: Pragati Sirohi, Vivek Singh Rana

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Brand is a name, term, sign, symbol or design or a combination of all these which is intended to identify the goods or services of one seller or a group of sellers and to differentiate them from those of the competitors and perception influences purchase decisions here and so building that perception is critical. The FMCG industry is a low margin business. Volumes hold the key to success in this industry. Therefore, the industry has a strong emphasis on marketing. Creating strong brands is important for FMCG companies and they devote considerable money and effort in developing brands. Brand loyalty is fickle. Companies know this and that is why they relentlessly work towards brand building. The purpose of the study is a comparison between Indian and Multinational companies with regard to FMCG sector in India. It has been hypothesized that after liberalization the Indian companies has taken up the challenge of globalization and some of these are giving a stiff competition to MNCs. There is an existence of strong brand image of MNCs compared to Indian companies. Advertisement expenditures of MNCs are proportionately higher compared to Indian counterparts. The operational area of the study is the country as a whole. Continuous time series data is available from 1996-2014 for the selected 8 companies. The selection of these companies is done on the basis of their large market share, brand equity and prominence in the market. Research methodology focuses on finding trend growth rates of market capitalization, net worth, and brand values through regression analysis by the usage of secondary data from prowess database developed by CMIE (Centre for monitoring Indian Economy). Estimation of brand values of selected FMCG companies is being attempted, which can be taken to be the excess of market capitalization over the net worth of a company. Brand value indices are calculated. Correlation between brand values and advertising expenditure is also measured to assess the effect of advertising on branding. Major results indicate that although MNCs enjoy stronger brand image but few Indian companies like ITC is the outstanding leader in terms of its market capitalization and brand values. Dabur and Tata Global Beverages Ltd are competing equally well on these values. Advertisement expenditures are the highest for HUL followed by ITC, Colgate and Dabur which shows that Indian companies are not behind in the race. Although advertisement expenditures are playing a role in brand building process there are many other factors which affect the process. Also, brand values are decreasing over the years for FMCG companies in India which show that competition is intense with aggressive price wars and brand clutter. Implications for Indian companies are that they have to consistently put in proactive and relentless efforts in their brand building process. Brands need focus and consistency. Brand longevity without innovation leads to brand respect but does not create brand value.

Keywords: brand value, FMCG, market capitalization, net worth

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Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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Authors: Senthil Kumar Anantharaman

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Providing telecommunications based network services in developing countries like India which has a population of 1.5 billion people, so that these services reach every individual, is one of the greatest challenges the country has been facing in its journey towards economic growth and development. With growing number of telecommunications service providers in the country, a constant challenge that has been faced by these providers is in providing not only quality but also delightful customer experience while simultaneously generating enhanced revenues and profits. Thus, the role played by process improvement methodologies like Six Sigma cannot be undermined and specifically in telecom service provider based operations, it has provided substantial benefits. Therefore, it advantages are quite comparable to its applications and advantages in other sectors like manufacturing, financial services, information technology-based services and Healthcare services. One of the key reasons that this methodology has been able to reap great benefits in telecommunications sector is that this methodology has been combined with many of its competing process improvement techniques like Theory of Constraints, Lean and Kaizen to give the maximum benefit to the service providers thereby creating a winning combination of organized process improvement methods for operational excellence thereby leading to business excellence. This paper discusses about some of the key projects and areas in the end to end ‘Quote to Cash’ process at big three Indian telecommunication companies that have been highly assisted by applying Six Sigma along with other process improvement techniques. While the telecommunication companies which we have considered, is primarily in India and run by both private operators and government based setups, the methodology can be applied equally well in any other part of developing countries around the world having similar context. This study also compares the enhanced revenues that can arise out of appropriate opportunities in emerging market scenarios, that Six Sigma as a philosophy and methodology can provide if applied with vigour and robustness. Finally, the paper also comes out with a winning framework in combining Six Sigma methodology with Kaizen, Lean and Theory of Constraints that will enhance both the top-line as well as the bottom-line while providing the customers a delightful experience.

Keywords: emerging markets, lean, process improvement, six sigma, telecommunications, theory of constraints

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Authors: Kamal Kumar Gupta

Abstract:

The present research work was carried out on Dysdercus koenigii to understand various aspects of reproductive behavior such as mate finding and recognition, mate selection and mating preference, mating receptivity, and prolonged copulation. The studies carried out on mate searching and courtship behaviour of Dysdercus reflected the courtship behaviour in Dysdercus was brief. The opposite sexes are brought together by the pheromone. The males responded to female sex pheromones by showing directional movements toward the sex partners. Change in mating receptivity pattern of female Dysdercus was ascertained using three parameters of mating behaviour i.e. numbers of male’s encounter, the time taken to mate successfully and per cent females responding to mating. It was seen that a receptive female responded positively to the courting males and a high percentage of females mate usually in a very short time span. The females of Dysdercus showed continued mating receptivity throughout their life. The studies pertaining to mate selection by females showed that females generally do not discriminate among males and usually mate with any male they encountered first. The adults of Dysdercus remain in continuous copula up to 72hr. and mate 5-7 time in their life span. Studies pertaining to significance of prolonged mating in the life time reproductive success of the female Dysdercus indicated that fecundity and fertility and oviposition behavior of the female Dysdercus was related to duration of mating. In order to understand sperm precedence, the sterilized males were produced by exposing them to Gamma radiation. Our studies indicated that a dose of 50 Gy of Gamma radiations induced 95% sterility but does not impair the mating behaviour drastically. To understand role of sperms which were transfer during second mating in fertilizing the subsequent egg batches the sperm utilization pattern of doubly mated female was assessed. The females were mated with normal male or sterilized male in a combination. The sperm utilization pattern was determined by P2 value, our studies indicated a very high P2 value of 0.966, and indicated that sperms of last mating were utilized by the female for fertilization. In light of some of the unique reproductive behaviour of Dysdercus koenigii, such as brief courtship behavior, generalized mate selection by the female, continued mating receptivity and a prolonged pre oviposition period, the present studies on sperm precedence provides an explanation to an unusually prolonged copulation in Dysdercus.

Keywords: dysdercus koenigii, mating behaviour, reproductive performance, entomology

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