Search results for: Ashish Bhatnagar

Authors: Ashish Jaiswal, Ashwin Ramesh Babu, Mohammad Zaki Zadeh, Fillia Makedon, Glenn Wylie

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Functional magnetic resonance imaging (fMRI) is a neuroimaging technique that records neural activations in the brain by capturing the blood oxygen level in different regions based on the task performed by a subject. Given fMRI data, the problem of predicting the state of cognitive fatigue in a person has not been investigated to its full extent. This paper proposes tackling this issue as a multi-class classification problem by dividing the state of cognitive fatigue into six different levels, ranging from no-fatigue to extreme fatigue conditions. We built a spatio-temporal model that uses convolutional neural networks (CNN) for spatial feature extraction and a long short-term memory (LSTM) network for temporal modeling of 4D fMRI scans. We also applied a self-supervised method called MoCo (Momentum Contrast) to pre-train our model on a public dataset BOLD5000 and fine-tuned it on our labeled dataset to predict cognitive fatigue. Our novel dataset contains fMRI scans from Traumatic Brain Injury (TBI) patients and healthy controls (HCs) while performing a series of N-back cognitive tasks. This method establishes a state-of-the-art technique to analyze cognitive fatigue from fMRI data and beats previous approaches to solve this problem.

Keywords: fMRI, brain imaging, deep learning, self-supervised learning, contrastive learning, cognitive fatigue

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Authors: Ashish Kumar, T. Venkatappa Rao, Subhendu Ray Chowdhury, S. V. S. Ramana Reddy

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The main objective of this work is to determine the influence of electron beam irradiation on thermal and mechanical properties of Poly (lactic acid) (PLA)/Poly (ethylene-co-glycidyle methacrylate) (PEGM)/Hexagonal boron nitride (HBN) blend-composites. To reduce the brittleness and improve the toughness of PLA, the PLA/PEGM blend is prepared by using twin-screw Micro compounder. However, the heat deflection temperature (HDT) and other tensile properties were reduced. The HBN has been incorporated into the PLA/PEGM blend as part per hundred i.e. 5 phr and 10phr to improve the HDT. The prepared specimens of blend and blend-composites were irradiated to high energy (4.5 MeV) electron beam (E-beam) at different radiation doses to introduce the cross linking among the polymer chains and uniform dispersion of HBN particles in the PLA/PEGM/HBN blend-composites. The further improvement in the notched impact strength and HDT have been achieved in the case of PLA/PEGM/HBN blend-composites. The irradiated PLA/PEGM/HBN 5phr blend composite shows high notched impact strength and HDT as compared to other unirradiated and E-beam irradiated blend and blend-composites. The improvements in the yield strength and tensile modulus have also been noticed in the case of E-beam irradiated PLA/PEGM/HBN blend-composites as compared to unirradiated blend-composites.

Keywords: blend-composite, e-beam, HDT, PEGM, PLA

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Authors: Shivani Verma, Amit Agrawal, Pankaj Kumar Meena, Ashish B. Deoghare

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Over the decade robotics has been a major area of interest among the researchers and scientists in reducing human efforts. The need for robots to replace human work in different dangerous fields such as underground mining, nuclear power station and war against terrorist attack has gained huge attention. Most of the robot design is based on human structure popularly known as humanoid robots. However, the problems encountered in humanoid robots includes low speed of movement, misbalancing in structure, poor load carrying capacity, etc. The simplification and adaptation of the fundamental design principles seen in animals have led to the creation of bio-inspired robots. But the major challenges observed in naturally inspired robot include complexity in structure, several degrees of freedom and energy storage problem. The present work focuses on design and fabrication of a bionic quadruped walking robot which is based on different joint of quadruped mammals like a dog, cheetah, etc. The design focuses on the structure of the robot body which consists of four legs having three degrees of freedom per leg and the electronics system involved in it. The robot is built using readily available plastics and metals. The proposed robot is simple in construction and is able to move through uneven terrain, detect and locate obstacles and take images while carrying additional loads which may include hardware and sensors. The robot will find possible application in the artificial intelligence sector.

Keywords: artificial intelligence, bionic, quadruped robot, degree of freedom

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Authors: Swati Srivastava, Ashish Kumar Upadhyay

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Haemophilus influenzae Type B (Hib) cause infections of pneumonia, meningitis, epiglottises and other invasive disease exclusively among children under age five. Occurrence of these infections may impair child growth by causing micronutrient deficiency. Using longitudinal data from first and second waves of Young Lives Study conducted in India during 2002 and 2006-07 respectively and multivariable logistic regression models (using generalised estimation equation to take into account the cluster nature of sample), this study aims to examine the impact of Hib vaccination on child anthropometric outcomes (stunting, underweight and wasting) in India. Bivariate result shows that, a higher percent of children were stunted and underweight among those who were not vaccinated against Hib (39% & 48% respectively) as compare to those who were vaccinated (31% and 39% respectively).The risk of childhood stunting and underweight was significantly lower among children who were vaccinated against Hib (odds ratio: 0.77, 95% CI: 0.62-0.96 and odds ratio: 0.79, 95% C.I: 0.64-0.98 respectively) as compare to the unvaccinated children. No significant association was found between vaccination status against Hib and childhood wasting. Moreover, in the statistical models, about 13% of stunting and 12% of underweight could be attributable to lack of vaccination against Hib in India. Study concludes that vaccination against Hib- in addition to being a major intervention for reducing childhood infectious disease and mortality- can be consider as a potential tool for reducing the burden of undernutrition in India. Therefore, the Government of India must include the vaccine against Hib into the Universal Immunization Programme in India.

Keywords: Haemophilus influenzae Type-B, Stunting, Underweight, Wasting, Young Lives Study (YLS), India

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Authors: Richa Soni, Vibha Bhatnagar, N. K. Jain

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This study was conducted to develop a computer mediated programme for weight management and physical fitness and examining its efficacy in reducing weight and improving physical fitness in obese adults. A user friendly, computer based programme was developed to provide a simple, quick, easy and user-friendly method of assessing energy balance at individual level. The programme had four main sections viz. personal Profile, know about your weight, fitness and food exchange list. The computer programme was developed to provide facilities of creating individual profile, tracking meal and physical activities, suggesting nutritional and exercise requirements, planning calorie specific menus, keeping food diaries and revising the diet and exercise plans if needed. The programme was also providing information on obesity, underweight, physical fitness. An exhaustive food exchange list was also given in the programme to assist user to make right food choice decisions. The developed programme was evaluated by a panel of 15 experts comprising endocrinologists, nutritionists and diet counselors. Suggestions given by the experts were paned down and the entire programme was modified in light of suggestions given by the panel members and was reevaluated by the same panel of experts. For assessing the impact of the programme 22 obese subjects were selected purposively and randomly assigned to intervention group (n=12) and no information control group. (n=10). The programme group was asked to strictly follow the programme for one month. Significant reduction in the intake of energy, fat and carbohydrates was observed while intake of fruits, green leafy vegetables was increased. The programme was also found to be effective in reducing body weight, body fat percent and body fat mass whereas total body water and physical fitness scores improved significantly. There was no significant alteration observed in any parameters in the control group.

Keywords: body composition, body weight, computer programme, physical fitness

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Authors: Prajwal Eachempati, Laurent Muzellec, Ashish Kumar Jha

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We use Facebook as a case study to investigate the complex relationship between the firm’s public discourse (and actions) surrounding data privacy and the performance of a business model based on monetizing user’s data. We do so by looking at the evolution of public discourse over time (2004–2021) and relate topics to revenue and stock market evolution Drawing from archival sources like Zuckerberg We use LDA topic modelling algorithm to reveal 19 topics regrouped in 6 major themes. We first show how, by using persuasive and convincing language that promises better protection of consumer data usage, but also emphasizes greater user control over their own data, the privacy issue is being reframed as one of greater user control and responsibility. Second, we aim to understand and put a value on the extent to which privacy disclosures have a potential impact on the financial performance of social media firms. There we found significant relationship between the topics pertaining to privacy and social media/technology, sentiment score and stock market prices. Revenue is found to be impacted by topics pertaining to politics and new product and service innovations while number of active users is not impacted by the topics unless moderated by external control variables like Return on Assets and Brand Equity.

Keywords: public discourses, data protection, social media, privacy, topic modeling, business models, financial performance

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Authors: Mia I. Allen, Bernard N. Johnson, Gagan Deep, Yixin Su, Sangeeta Singth, Ashish Kumar, , Michael A. Nader

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With no FDA-approved treatments for cocaine use disorders (CUD), research has focused on the behavioral and neuropharmacological effects of cocaine in animal models, with the goal of identifying novel interventions. While the majority of people with CUD also use tobacco/nicotine, the majority of preclinical cocaine research does not include the co-use of nicotine. The present study examined nicotine and cocaine co-use under several conditions of intravenous drug self-administration in monkeys. In Experiment 1, male rhesus monkeys (N=3) self-administered cocaine (0.001-0.1 mg/kg/injection) alone and cocaine+nicotine (0.01-0.03 mg/kg/injection) under a progressive-ratio schedule of reinforcement. When nicotine was added to cocaine, there was a significant leftward shift and significant increase in peak break point. In Experiment 2, socially housed female and male cynomolgus monkeys (N=14) self-administered cocaine under a concurrent drug-vs-food choice schedule. Combining nicotine significantly decreased cocaine choice ED50 values (i.e., shifted the cocaine dose-response curve to the left) in females but not in males. There was no evidence of social rank differences. In delay discounting studies, the co-use of nicotine and cocaine required significantly larger delays to the preferred drug reinforcer to reallocate choice compared with cocaine alone. Overall, these results suggest drug interactions of nicotine and cocaine co-use is not simply a function of potency but rather a fundamentally distinctive condition that should be utilized to better understand the neuropharmacology of CUD and the evaluation of potential treatments.

Keywords: polydrug use, animal models, nonhuman primates, behavioral pharmacology, drug self-administration

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Authors: Poonam A. Trambadia, Ashish V. Trambadia

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The architecture of sultanate period of Ahmedabad had evolved just before the establishment of Mughal rule in North India. After shifting the capital of the kingdom from Patan to Ahmedabad, when the buildings and structures were being built, an interesting cultural blend happened in architecture. Many sultanate buildings in Ahmedabad historic city have resemblance with Patan including the names. Outer fortification walls and Gates were built during the rule of the third ruler in the late 15th century. All the gates had sandstone slabs supported by three arched entrance in sandstone with wooden shutter. A restoration project of Khanpur Gate was initiated in 2016. The paper identifies some evidences and some hidden layers of structures as important elements of cultural interchange while some were just forgotten in the process. The recycling of pre-existing elements of structures are examined and compared. There were layers uncovered that were hidden behind later repairs using traditional brick arch, which was taken out in the process. As the gate had partially collapsed, the restoration included piece by piece dismantling and restoring in the same sequence wherever required. The recycled materials found in the process were recorded and provided the basis for this study. The gate after this discovery sets a new example of fortification Gate built in Sultanate era. The comparison excludes Maratha and British Period Gates to avoid further confusion and focuses on 15th – 16th century sultanate architecture of Ahmedabad.

Keywords: Ahmedabad World Heritage, fortification, Indo-Islamic style, Sultanate architecture, cultural interchange

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Authors: Ashish Bohre, Blaž Likozar, Saikat Dutta, Dionisios G. Vlachos, Basudeb Saha

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Graphene oxide, decorated with surface oxygen functionalities, has emerged as a sustainable alternative to precious metal catalysts for many reactions. Herein, we report for the first time that graphene oxide becomes super active for C-C coupling upon incorporation of multilayer crystalline features, highly oxidized surface, Brønsted acidic functionalities and defect sites on the surface and edges via modified oxidation. The resulting improved graphene oxide (IGO) demonstrates superior activity to commonly used framework zeolites for upgrading of low carbon biomass furanics to long carbon chain aviation fuel precursors. A maximum 95% yield of C15 fuel precursor with high selectivity is obtained at low temperature (60 C) and neat conditions via hydroxyalkylation/alkylation (HAA) of 2-methylfuran (2-MF) and furfural. The coupling of 2-MF with carbonyl molecules ranging from C3 to C6 produced the precursors of carbon numbers 12 to 21. The catalyst becomes inactive in the 4th cycle due to the loss of oxygen functionalities, defect sites and multilayer features; however, regains comparable activity upon regeneration. Extensive microscopic and spectroscopic characterization of the fresh and reused IGO is presented to elucidate high activity of IGO and to establish a correlation between activity and surface and structural properties. Kinetic Monte Carlo (KMC) and density functional theory (DFT) calculations are presented to further illustrate the surface features and the reaction mechanism.

Keywords: methacrylic acid, itaconic acid, biomass, monomer, solid base catalyst

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Authors: Deependra Prasad Sarraf, Gajendra Prasad Rauniar, Robin Maskey, Rajiv Maharjan, Ashish Shrestha, Ramayan Prasad Kushwaha

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Objectives: To assess the perception of faculties towards online teaching-learning activities conducted during the COVID-19 pandemic and to identify barriers and facilitators to conducting online teaching-learning activities in our context. Methods: A cross-sectional study was conducted among faculties at B. P. Koirala Institute of Health Sciences using a 26-item semi-structured questionnaire. A Google Form was prepared, and its link was sent to the faculties via email. Descriptive statistics were calculated, and findings were presented as tables and graphs. Results: Out of 158 faculties, the majority were male (66.46%), medical faculties (85.44%), and assistant professors (46.84%). Only 16 (10.13%) faculties had received formal training regarding preparing and/or delivering online teaching learning activities. Out of 158, 133 (84.18%) faculties faced technical and internet issues. The most common advantage and disadvantage of online teaching learning activities perceived by the faculties were ‘not limited to time or place’ (94.30%) and ‘lack of interaction with the students’ (82.28%), respectively. Majority (94.3%) of them had a positive perception towards online teaching-learning activities conducted during COVID-19 pandemic. Slow internet connection (91.77%) and frequent electricity interruption (82.91%) were the most common perceived barriers to online teaching-learning. Conclusions: Most of the faculties had a positive perception towards online teaching-learning activities. Academic leaders and stakeholders should provide uninterrupted internet and electricity connectivity, training on online teaching-learning platform, and timely technical support.

Keywords: COVID-19 pandemic, faculties, medical education, perception

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Authors: Anish Desai, Reshmi Pillai, Nilesh Mahajan, Hitesh Chopra, Vishal Mahajan, Ajay Grover, Ashish Kohli

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Surgical Site Infection (SSI) is hospital acquired infection of growing concern. This study presents the efficacy and cost-effectiveness of triclosan-coated suture, in reducing the burden of SSI in India. Methodology: A systematic literature search was conducted for economic burden (1998-2018) of SSI and efficacy of triclosan-coated sutures (TCS) vs. non-coated sutures (NCS) (2000-2018). PubMed Medline and EMBASE indexed articles were searched using Mesh terms or Emtree. Decision tree analysis was used to calculate, the cost difference between TCS and NCS at private and public hospitals, respectively for 7 surgical procedures. Results: The SSI range from low to high for Caesarean section (C-section), Laparoscopic hysterectomy (L-hysterectomy), Open Hernia (O-Hernia), Laparoscopic Cholecystectomy (L-Cholecystectomy), Coronary artery bypass graft (CABG), Total knee replacement (TKR), and Mastectomy were (3.77 to 24.2%), (2.28 to 11.7%), (1.75 to 60%), (1.71 to 25.58%), (1.6 to 18.86%), (1.74 to 12.5%), and (5.56 to 25%), respectively. The incremental cost (%) of TCS ranged 0.1%-0.01% in private and from 0.9%-0.09% at public hospitals across all surgical procedures. Cost savings at median efficacy & SSI risk was 6.52%, 5.07 %, 11.39%, 9.63%, 3.62%, 2.71%, 9.41% for C-section, L-hysterectomy, O-Hernia, L-Cholecystectomy, CABG, TKR, and Mastectomy in private and 8.79%, 4.99%, 12.67%, 10.58%, 3.32%, 2.35%, 11.83% in public hospital, respectively. Efficacy of TCS and SSI incidence in a particular surgical procedure were important determinants of cost savings using one-way sensitivity analysis. Conclusion: TCS suture led to cost savings across all 7 surgeries in both private and public hospitals in India.

Keywords: cost Savings, non-coated sutures, surgical site infection, triclosan-coated sutures

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Authors: Jean Yves Trepanier, Sami Ammar, Sagnik Banik

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Lattice Boltzmann Method has been advantageous in simulating complex boundary conditions and solving for fluid flow parameters by streaming and collision processes. This paper includes the study of three different test cases in a confined domain using the method of the Lattice Boltzmann model. 1. An SRT (Single Relaxation Time) approach in the Lattice Boltzmann model is used to simulate Lid Driven Cavity flow for different Reynolds Number (100, 400 and 1000) with a domain aspect ratio of 1, i.e., square cavity. A moment-based boundary condition is used for more accurate results. 2. A Thermal Lattice BGK (Bhatnagar-Gross-Krook) Model is developed for the Rayleigh Benard convection for both test cases - Horizontal and Vertical Temperature difference, considered separately for a Boussinesq incompressible fluid. The Rayleigh number is varied for both the test cases (10^3 ≤ Ra ≤ 10^6) keeping the Prandtl number at 0.71. A stability criteria with a precise forcing scheme is used for a greater level of accuracy. 3. The phase change problem governed by the heat-conduction equation is studied using the enthalpy based Lattice Boltzmann Model with a single iteration for each time step, thus reducing the computational time. A double distribution function approach with D2Q9 (density) model and D2Q5 (temperature) model are used for two different test cases-the conduction dominated melting and the convection dominated melting. The solidification process is also simulated using the enthalpy based method with a single distribution function using the D2Q5 model to provide a better understanding of the heat transport phenomenon. The domain for the test cases has an aspect ratio of 2 with some exceptions for a square cavity. An approximate velocity scale is chosen to ensure that the simulations are within the incompressible regime. Different parameters like velocities, temperature, Nusselt number, etc. are calculated for a comparative study with the existing works of literature. The simulated results demonstrate excellent agreement with the existing benchmark solution within an error limit of ± 0.05 implicates the viability of this method for complex fluid flow problems.

Keywords: BGK, Nusselt, Prandtl, Rayleigh, SRT

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Authors: Shabnam Monadizadeh, Charles Kibert, Jiaxuan Li, Janghoon Woo, Ashish Asutosh, Samira Roostaei, Maryam Kouhirostami

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A significant share of the technology that has emerged over the past several decades produces electromagnetic field (EMF) radiation. Communications devices, household appliances, industrial equipment, and medical devices all produce EMF radiation with a variety of frequencies, strengths, and ranges. Some EMF radiation, such as Extremely Low Frequency (ELF), Radio Frequency (RF), and the ionizing range have been shown to have harmful effects on human health. Depending on the frequency and strength of the radiation, EMF radiation can have health effects at the cellular level as well as at brain, nervous, and cardiovascular levels. Health authorities have enacted regulations locally and globally to set critical values to limit the adverse effects of EMF radiation. By introducing a more comprehensive field of EMF radiation study and practice, architects and designers can design for a safer electromagnetic (EM) indoor environment, and, as building and construction specialists, will be able to monitor and reduce EM radiation. This paper identifies the nature of EMF radiation in the built environment, the various EMF radiation sources, and its human health effects. It addresses European and US regulations for EMF radiation in buildings and provides a preliminary action plan. The challenges of developing measurement protocols for the various EMF radiation frequency ranges and determining the effects of EMF radiation on building occupants are discussed. This paper argues that a mature method for measuring EMF radiation in building environments and linking these measurements to human health impacts occupant health should be developed to provide adequate safeguards for human occupants of buildings for future research.

Keywords: biological affection, electromagnetic field, building regulation, human health, healthy building, clean construction

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Authors: Ragi Poyyara, V. Vivek, Ashish Khaparde

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The Product Development Process (PDP) in the technology group plays a very important role in the launch of any product. While a manufacturing process encourages the use of certain measures to reduce Health, Safety and Environmental (HSE) risks on the shop floor, the PDP concentrates on the use of Geometric Dimensioning and Tolerancing (GD&T) to develop a flawless design. Furthermore, PDP distributes and coordinates activities between different departments such as marketing, purchasing, and manufacturing. However, it is seldom realized that PDP makes a significant contribution to developing a product that reduces HSE risks by encouraging the Technology group to use effective GD&T. The GD&T is a precise communication tool that uses a set of symbols, rules, and definitions to mathematically define parts to be manufactured. It is a quality assurance method widely used in the oil and gas sector. Traditionally it is used to ensure the interchangeability of a part without affecting its form, fit, and function. Parts that do not meet these requirements are rejected during quality audits. This paper discusses how the Technology group integrates this quality assurance tool into the PDP and how the tool plays a major role in helping the HSE department in its goal towards eliminating HSE incidents. The PDP involves a thorough risk assessment and establishes a method to address those risks during the design stage. An illustration shows how GD&T helped reduce safety risks by ergonomically improving assembling operations. A brief discussion explains how tolerances provided on a part help prevent finger injury. This tool has equipped Technology to produce fixtures, which are used daily in operations as well as manufacturing. By applying GD&T to create good fits, HSE risks are mitigated for operating personnel. Both customers and service providers benefit from reduced safety risks.

Keywords: HSE risks, product development process, geometric dimensioning and tolerances, mechanical engineering

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Authors: Deependra Prasad Sarraf, Ashish Shrestha, Mehul Rajesh Jaisani, Gajendra Prasad Rauniar

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Background: Honey is the worlds’ oldest known wound dressing. Its wound healing properties are not fully established till today. Concerns about antibiotic resistance, and a renewed interest in natural remedies have prompted the resurgence in the antimicrobial and wound healing properties of Honey. Evidence from animal studies and some trials has suggested that honey may accelerate wound healing in burns, infected wounds and open wounds. None of these reports have documented the effect of honey on the healing of socket after tooth extraction. Therefore, the present experimental study was planned to evaluate the efficacy of honey on the healing of socket after tooth extraction in rabbits. Materials and Methods: An experimental study was conducted in six New Zealand White rabbits. Extraction of first premolar tooth on both sides of the lower jaw was done under anesthesia produced by Ketamine and Xylazine followed by application of honey on one socket (test group) and normal saline (control group) in the opposite socket. The intervention was continued for two more days. On the 7th day, the biopsy was taken from the extraction site, and histopathological examination was done. Student’s t-test was used for comparison between the groups and differences were considered to be statistically significant at p-value less than 0.05. Results: There was a significant difference between control group and test group in terms of fibroblast proliferation (p = 0.0019) and bony trabeculae formation (p=0.0003). Inflammatory cells were also observed in both groups, and it was not significant (p=1.0). Overlying epithelium was hyperplastic in both the groups. Conclusion: The study showed that local application of honey promoted the rapid healing process particularly by increasing fibroblast proliferation and bony trabeculae.

Keywords: honey, extraction wound, Nepal, healing

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Authors: Ashish Agarwal, Vaibhav Singh

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Harmful emissions from oil and gas processing facilities have long remained a matter of concern for governments and environmentalists throughout the world. This paper analyses Oil and Natural Gas Corporation (ONGC) gas processing plant in Hazira, Gujarat, India. It is the largest gas-processing complex in the country designed to process 41MMSCMD sour natural gas & associated sour condensate. The complex, sprawling over an area of approximate 705 hectares is the mother plant for almost all industries at Hazira and enroute Hazira Bijapur Jagdishpur pipeline. Various sources of pollution from each unit starting from Gas Terminal to Dew Point Depression unit and Caustic Wash unit along the processing chain were examined with the help of different emission data obtained from ONGC. Pollution discharged to the environment was classified into Water, Air, Hazardous Waste and Solid (Non-Hazardous) Waste so as to analyze each one of them efficiently. To protect air environment, Sulphur recovery unit along with automatic ambient air quality monitoring stations, automatic stack monitoring stations among numerous practices were adopted. To protect water environment different effluent treatment plants were used with due emphasis on aquaculture of the nearby area. Hazira plant has obtained the authorization for handling and disposal of five types of hazardous waste. Most of the hazardous waste were sold to authorized recyclers and the rest was given to Gujarat Pollution Control Board authorized vendors. Non-Hazardous waste was also handled with an overall objective of zero negative impact on the environment. The effect of methods adopted is evident from emission data of the plant which was found to be well under Gujarat Pollution Control Board limits.

Keywords: sulphur recovery unit, effluent treatment plant, hazardous waste, sour gas

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Authors: Ashish Bhattarai, Bishnu Bhatta, Hem Raj Joshi, Nabin Neupane, Pankaj Yadav

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This report concerns the design, development, and analysis of the combined Darrieus and Savonius wind turbine. Vertical Axis Wind Turbines (VAWT's) are of two type's viz. Darrieus (lift type) and Savonius (drag type). The problem associated with Darrieus is the lack of self-starting while Savonius has low efficiency. There are 3 straight Darrieus blades having the cross-section of NACA(National Advisory Committee of Aeronautics) 0018 placed circumferentially and a helically twisted Savonius blade to get even torque distribution. This unique design allows the use of Savonius as a method of self-starting the wind turbine, which the Darrieus cannot achieve on its own. All the parts of the wind turbine are designed in CAD software, and simulation data were obtained via CFD(Computational Fluid Dynamics) approach. Also, the design was imported to FlashForge Finder to 3D print the wind turbine profile and finally, testing was carried out. The plastic material used for Savonius was ABS(Acrylonitrile Butadiene Styrene) and that for Darrieus was PLA(Polylactic Acid). From the data obtained experimentally, the hybrid VAWT so fabricated has been found to operate at the low cut-in speed of 3 m/s and maximum power output has been found to be 7.5537 watts at the wind speed of 6 m/s. The maximum rpm of the rotor blade is recorded to be 431 rpm(rotation per minute) at the wind velocity of 6 m/s, signifying its potentiality of wind power production. Besides, the data so obtained from both the process when analyzed through graph plots has shown the similar nature slope wise. Also, the difference between the experimental and theoretical data obtained has shown mechanical losses. The objective is to eliminate the need for external motors for self-starting purposes and study the performance of the model. The testing of the model was carried out for different wind velocities.

Keywords: VAWT, Darrieus, Savonius, helical blades, CFD, flash forge finder, ABS, PLA

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Authors: Apostolos Kalatzis, Ashish Teotia, Vishnunarayan Girishan Prabhu, Laura Stanley

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Emotions are functional behaviors influenced by thoughts, stimuli, and other factors that induce neurophysiological changes in the human body. Understanding and classifying emotions are challenging as individuals have varying perceptions of their environments. Therefore, it is crucial that there are publicly available databases and virtual reality (VR) based environments that have been scientifically validated for assessing emotional classification. This study utilized two commercially available VR applications (Guided Meditation VR™ and Richie’s Plank Experience™) to induce acute stress and calm state among participants. Subjective and objective measures were collected to create a validated multimodal dataset and classification scheme for affective state classification. Participants’ subjective measures included the use of the Self-Assessment Manikin, emotional cards and 9 point Visual Analogue Scale for perceived stress, collected using a Virtual Reality Assessment Tool developed by our team. Participants’ objective measures included Electrocardiogram and Respiration data that were collected from 25 participants (15 M, 10 F, Mean = 22.28  4.92). The features extracted from these data included heart rate variability components and respiration rate, both of which were used to train two machine learning models. Subjective responses validated the efficacy of the VR applications in eliciting the two desired affective states; for classifying the affective states, a logistic regression (LR) and a support vector machine (SVM) with a linear kernel algorithm were developed. The LR outperformed the SVM and achieved 93.8%, 96.2%, 93.8% leave one subject out cross-validation accuracy, precision and recall, respectively. The VR assessment tool and data collected in this study are publicly available for other researchers.

Keywords: affective computing, biosignals, machine learning, stress database

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Authors: Satpal Yadav, Ashish Phulkar, Krishna K. Sahu

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Aim: The research aims at doing a 3 Dimension biomechanical analysis in the shot put techniques of International throwers to evaluate the performance. Research Method: The researcher adopted the descriptive method and the data was subjected to calculate by using Pearson’s product moment correlation for the correlation of the biomechanical parameters with the performance of shot put throw. In all the analyses, the 5% critical level (p ≤ 0.05) was considered to indicate statistical significance. Research Sample: Eight (N=08) international shot putters using rotational/glide technique in male category was selected as subjects for the study. The researcher used the following methods and tools to obtain reliable measurements the instrument which was used for the purpose of present study namely the tesscorn slow-motion camera, specialized motion analyzer software, 7.260 kg Shot Put (for a male shot-putter) and steel tape. All measurement pertaining to the biomechanical variables was taken by the principal investigator so that data collected for the present study was considered reliable. Results: The finding of the study showed that negative significant relationship between the angular velocity right shoulder, acceleration distance at pre flight (-0.70), (-0.72) respectively were obtained, the angular displacement of knee, angular velocity right shoulder and acceleration distance at flight (0.81), (0.75) and (0.71) respectively were obtained, the angular velocity right shoulder and acceleration distance at transition phase (0.77), (0.79) respectively were obtained and angular displacement of knee, angular velocity right shoulder, release velocity shot, angle of release, height of release, projected distance and measured distance as the values (0.76), (0.77), (-0.83), (-0.79), (-0.77), (0.99) and (1.00) were found higher than the tabulated value at 0.05 level of significance. On the other hand, there exists an insignificant relationship between the performance of shot put and acceleration distance [m], angular displacement shot, C.G at release and horizontal release distance on the technique of shot put.

Keywords: biomechanics, analysis, shot put, international throwers

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Authors: Vikash Yadav, Ashish Arora

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Microorganisms have self-defense mechanisms to protect themselves from toxic environments. Phenolic acid decarboxylase(pad) is responsible for the defense against toxicity caused by phenolic acids, converting them into less toxic vinyl derivatives. The transcription of the pad gene is regulated by a negative transcription factor, phenolic acid decarboxylase regulators (PadR), in a substrate-inducible manner. The PadR family members share the conserved DNA-binding features and interact with the operator DNA using a winged helix-turn-helix (wHTH) motif, which contains a three-helix motif and a β-stranded wing. The members of this family function as transcriptional regulators that are involved in various cellular survival processes, such as toxin production, detoxification, multidrug resistance, antibiotic biosynthesis, and carbon catabolism. Rv1176 of Mycobacterium tuberculosis H37Rv has been assigned to the PadR family protein that remains to be structurally and functionally uncharacterized. To reveal the structural mechanism by which Rv1176 could regulates effector-responsive transcription, several experiments were performed, including Electrophoretic Mobility Shift Assay (EMSA) for DNA protein interaction, differential scanning calorimetry (DSC) and Differential Scanning Fluorimetry (DSF) for temperature and ligand-dependent protein stability, Circular Dichroism (CD) spectroscopy for secondary structure analysis. Further, to evaluate the functional role of Rv1176, the intracellular survival of recombinant M. smegmatis was examined in murine macrophage cell line J774A.1 and different stressed conditions like oxidative, pH, and nutritive stress. All these studies demonstrated that Rv1176 could behave as a transcription regulator and its expression in recombinant M. smegmatis increases intracellular survival.

Keywords: EMSA, Mycobacterium tuberculosis, PadR family protein, transcriptional regulator

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Authors: Suresh Hettiarachchi, Conrad Wasko, Ashish Sharma

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The ever changing and expanding urban landscape increases the stress on urban systems to support and maintain safe and functional living spaces. Flooding presents one of the more serious threats to this safety, putting a larger number of people in harm’s way in congested urban settings. Climate change is adding to this stress by creating a dichotomy in the urban flood response. On the one hand, climate change is causing storms to intensify, resulting in more destructive, rarer floods, while on the other hand, longer dry periods are decreasing the severity of more frequent, less intense floods. This variability is creating a need to be more agile and innovative in how we design for and manage urban flooding. Here, we argue that to cope with this challenge climate change brings, we need to move towards urban flood management through resilience rather than flood prevention. We also argue that dealing with the larger variation in flood response to climate change means that we need to look at flooding from all aspects rather than the single-dimensional focus of flood depths and extents. In essence, we need to rethink how we manage flooding in the urban space. This change in our thought process and approach to flood management requires a practical way to assess and quantify resilience that is built into the urban landscape so that informed decision-making can support the required changes in planning and infrastructure design. Towards that end, we propose a Simple Urban Flood Resilience Index (SUFRI) based on a robust definition of resilience as a tool to assess flood resilience. The application of a simple resilience index such as the SUFRI can provide a practical tool that considers urban flood management in a multi-dimensional way and can present solutions that were not previously considered. When such an index is grounded on a clear and relevant definition of resilience, it can be a reliable and defensible way to assess and assist the process of adapting to the increasing challenges in urban flood management with climate change.

Keywords: urban flood resilience, climate change, flood management, flood modelling

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Authors: Bipul Krishna Saha, Basab Chakraborty, Ashish Alex Sam, Parthasarathi Ghosh

Abstract:

The demand for energy is cumulatively increasing with time.  Since the availability of conventional energy resources is dying out gradually, significant interest is being laid on searching for alternate energy resources and minimizing the wastage of energy in various fields.  In such perspective, low-grade waste heat from several industrial sources can be reused to generate electricity. The present work is to further the adoption of the Organic Rankine Cycle (ORC) technology in Indian industrial sector.  The present paper focuses on extending the previously reported idea to the next level through a comparative review with three different working fluids using practical data from an Indian industrial plant. For comprehensive study in the simulation platform of Aspen Hysys^®, v8.6, the waste heat data has been collected from a current coke oven gas plant in India.  A parametric analysis of non-regenerative ORC and regenerative ORC is executed using the working fluids R-123, R-11 and R-21 for subcritical ORC system.  The primary goal is to determine the optimal working fluid considering various system parameters like turbine work output, obtained system efficiency, irreversibility rate and second law efficiency under applied multiple heat source temperature (160 °C- 180 °C).  Selection of the turbo-expanders is one of the most crucial tasks for low-temperature applications in ORC system. The present work is an attempt to make suitable recommendation for the appropriate configuration of the turbine. In a nutshell, this study justifies the proficiency of integrating the ORC technology in Indian perspective and also finds the appropriate parameter of all components integrated in ORC system for building up an ORC prototype.

Keywords: organic Rankine cycle, regenerative organic Rankine cycle, waste heat recovery, Indian industry

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Authors: Shiwani Bhatnagar, K. K. Srivastava, Sangeeta Singh, Ameen Ullah Khan, Bundesh Kumar, Lokendra Singh Rathore

Abstract:

From the instigation of the world medicinal plants are treated as part and parcel of human society to fight against diseases. Azadirachta indica (Neem) a herbal plant has been used as an Indian traditional medicine since ages and its products are acknowledged to solve agricultural, forestry and public health related problems, owing to its beneficial medicinal properties. Each part of the neem tree is known for its medicinal property. Bark & leaf extracts of neem have been used to control leprosy, respiratory disorders, constipation and also as blood purifier and a general health tonic. Neem is still regarded as ' rural community dispensary' in India or a tree for solving medical problems. Use of Neem as pesticides for the management of insect pest of agriculture crops and forestry has been seen as a shift in the use of synthetic pesticides to ecofriendly botanicals. Neem oil and seed extracts possess germicidal and anti-bacterial properties which when sprayed on the plant helps in protecting them from foliage pests. Azadirachtin, the main active ingredient found in neem tree, acts as an insect repellent and antifeedant. However the young plants are susceptible to many insect pest and foliar diseases. Recently, in the avenue plantation, planted by Arid Forest Research Institute, Jodhpur, around the premises of IIT Jodhpur, two years old neem plants were found to be severely infested with tip borer Laspeyresia koenigana (Family: Eucosmidae). The adult moth of L. koenigana lays eggs on the tender shoots and the young larvae tunnel into the shoot and feed inside. A small pinhole can be seen at the entrance point, from where the larva enters in to the stem. The severely attached apical shoots exhibit profuse gum exudation resulting in development of a callus structure. The internal feeding causes the stem to wilt and the leaves to dry up from the tips resulting in growth retardation. Alternaria Leaf spot and blight symptoms were also recorded on these neem plants. For the management of tip borer and Alternaria Leaf spot, foliar spray of monocrotophos @0.05% and Dithane M-45 @ 0.15% and powermin @ 2ml/lit were found efficient in managing the insect pest and foliar disease problem. No Further incidence of pest/diseases was noticed.

Keywords: azadirachta indica, alternaria leaf spot, laspeyresia koenigana, management

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Authors: Mahendran Ganesan, Sanjeet Kumar Verma, Zafar Iqbal, Ashish Chandran, Zakir Husain, Shama Afroz, Sana Shahid, Laiq Ur Rahman

Abstract:

Highly efficient in vitro regeneration system has been developed for Swertia chirayita (Roxb. ex Fleming) H. Karst, a high prized traditional medicinal plant to treat numerous ailments such as liver disorders, malaria and diabetes and are reported to have a wide spectrum of pharmacological properties. Its medicinal usage is well-documented in Indian pharmaceutical codex, the British and the American pharmacopeias, and in different traditional medicine such as the Ayurveda, Unani and Siddha medical systems. Nodal explants were cultured on MS medium supplemented with various phytohormones for multiple shoot induction. The nodal segments failed to respond in growth regulator free medium. All the concentrations of BAP, Kin and TDZ facilitated shoot bud break and multiple shoot induction. Among the various cytokinins tested, BAP was found to be more effective with respect to initiation and subsequent development of shoots. Of the various concentrations BAP tested, BAP at 4.0 mg/L showed the higher average number of shoot regeneration (10.80 shoots per explant). Kin at 4 mg/L and TDZ at 4 mg/L induced 5.70 and 04.5+0 shoots per explant, respectively. Further increase in concentration did not favour an increase in the number of shoots. However, these shoots failed to elongate further. Hence, addition of GA₃ (1 mg/L) was added to the above medium. This treatment resulted in the elongation of shoots (2.50 cm) and a further increase in the number of microshoots (34.20 shoots/explant). Roots were also induced in the same medium containing BAP (4 mg/L) + GA₃ (1 mg/L) + NAA (0.5 mg/L). In vitro derived plantlets with well-developed roots were transferred to the potting media containing garden soil: sand: vermicompost (2:1:1). Plantlets were covered with a polyethylene bag and irrigated with water. The pots were maintained at 25 ± 2ºC, and then the polyethylene cover was gradually loosened, thus dropping the humidity (65–70%). This procedure subsequently resulted in in vitro hardening of the plantlet.

Keywords: micropropagation, nodal explant, plant growth regulators, Swertia chirayita

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Authors: Ujala, Diksha Sharma, Mahinder Partap, Ashish R. Warghat, Bhavya Bhargava

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In soil-less agriculture, hydroponic is considered a potential farming system for the production of uniform quality plant material in significantly less time. Therefore, for the first time, the current investigation corroborates the effect of different cultivation conditions (open-field, poly-house, and hydroponic) on morpho-physiological traits, phenolic content, and essential oil components analysis in three flower color variants (yellow, scarlet red, and orange) of Tagetes patula. The results revealed that the maximum plant height, number of secondary branches, number of flowers, photosynthesis, stomatal conductance, and transpiration rate were observed under the hydroponic system as compared to other conditions. However, the maximum content of gallic acid (0.82 mg/g DW), syringic acid (3.98 mg/g DW), epicatechin (0.48 mg/g DW), p-coumaric acid (7.28 mg/g DW), protocatechuic acid (0.59 mg/g DW), ferulic acid (2.58 mg/g DW), and luteolin (8.24 mg/g DW) were quantified maximally under open-field conditions. However, under hydroponic conditions, the higher content of vanillic acid (0.43 mg/g DW), caffeic acid (0.49 mg/g DW), and quercetin (0.92 mg/g DW) were quantified. Moreover, a total of nineteen volatile components were identified in the essential oil of different flower color variants of T. patula cultivated under different conditions. The major reported volatile components in essential oil were (-)-caryophyllene oxide, trans-β-caryophyllene, trans-geraniol, 3 methyl-benzyl alcohol, and 2,2’:5’,2”-terthiophene. It has also been observed that the volatile component percentage range in all variants was observed in open-field (70.85 % to 90.54 %), poly-house (59.03 % to 77.93 %), and hydroponic (68.78 % to 89.41 %). In conclusion, the research highlighted that morpho-physiological performance with flower production was enhanced in the hydroponic system. However, phenolic content and volatile components were maximally observed in open-field conditions. However, significant results have been reported under hydroponic conditions in all studied parameters, so it could be a potential strategy for quality biomass production in T. patula.

Keywords: Tagetes patula, cultivation conditions, hydroponic, morpho-physiology

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Authors: Swati Srivastava, Ashish Kumar Upadhyay

Abstract:

Background: According to United Nation Children’s Fund, it has been estimated that worldwide about 165 million children were stunted in 2012 and India alone accounts for 38% of global burden of stunting. In terms of incidence, India is home of more than 60 million stunted children worldwide. Our study aims to examine the effect of pregnancy intention and maternal postnatal depressive symptoms on early childhood stunting in India. We hypothesized that effect of pregnancy intention and postnatal maternal depressive symptoms were mediated by social support. Methods: We used data from first wave of Young Lives Study India. Out of 2011 children recruited in original cohort, 1833 children had complete information on pregnancy intention, maternal depression and other variables. A series of multivariate logistic regression model were used to examine the effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting. Results: Bivariate result indicates that a higher percent of children born after unintended pregnancy (40%) were stunted than children of intended pregnancy (26%). Likewise, proportion of stunted children was also higher among women of high postnatal depressive symptoms (35%) than low level of depression (24%). Results of multivariate logistic regression model indicate that children born after unintended pregnancy were significantly more likely to be stunted than children born after intended pregnancy (Coefficient: 1.70, CI: 1.17, 2.48). Likewise, early childhood stunting was also associated with maternal postnatal depressive symptoms among women (Coefficient: 1.48, CI: 1.16, 1.88). The effect of pregnancy intention and postnatal depressive symptoms on early childhood stunting remains unchanged after controlling for social support and other variables. Conclusions: The findings of this study provide conclusive evidence regarding consequences of pregnancy intention and postnatal depressive symptoms on early childhood stunting in India. Therefore, there is need to identify the women with unintended pregnancy and incorporate the promotion of mental health into their national reproductive and child health programme.

Keywords: pregnancy intention, postnatal depressive symptoms, social support, childhood stunting, young lives study, India

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Authors: Akanksha Bhatnagar, Sandhya Kortegare, Felice Elefant

Abstract:

Context: Alzheimer's disease (AD) is a neurodegenerative disorder that is characterized by progressive cognitive decline and memory loss. The cause of AD is not fully understood, but it is thought to be caused by a combination of genetic, environmental, and lifestyle factors. One of the hallmarks of AD is the loss of neurons in the hippocampus, a brain region that is important for memory and learning. This loss of neurons is thought to be caused by a decrease in histone acetylation, which is a process that regulates gene expression. Research Aim: The research aim of the study was to develop mall molecule compounds that can enhance the activity of Tip60, a histone acetyltransferase that is important for memory and learning. Methodology/Analysis: The researchers used in silico structural modeling and a pharmacophore-based virtual screening approach to design and synthesize small molecule compounds strongly predicted to target and enhance Tip60’s HAT activity. The compounds were then tested in vitro and in vivo to assess their ability to enhance Tip60 activity and rescue cognitive deficits in AD models. Findings: The researchers found that several of the compounds were able to enhance Tip60 activity and rescue cognitive deficits in AD models. The compounds were also developed to cross the blood-brain barrier, which is an important factor for the development of potential AD therapeutics. Theoretical Importance: The findings of this study suggest that Tip60 HAT activators have the potential to be developed as therapeutic agents for AD. The compounds are specific to Tip60, which suggests that they may have fewer side effects than other HDAC inhibitors. Additionally, the compounds are able to cross the blood-brain barrier, which is a major hurdle for the development of AD therapeutics. Data Collection: The study collected data from a variety of sources, including in vitro assays and animal models. The in vitro assays assessed the ability of compounds to enhance Tip60 activity using histone acetyltransferase (HAT) enzyme assays and chromatin immunoprecipitation assays. Animal models were used to assess the ability of the compounds to rescue cognitive deficits in AD models using a variety of behavioral tests, including locomotor ability, sensory learning, and recognition tasks. The human clinical trials will be used to assess the safety and efficacy of the compounds in humans. Questions: The question addressed by this study was whether Tip60 HAT activators could be developed as therapeutic agents for AD. Conclusions: The findings of this study suggest that Tip60 HAT activators have the potential to be developed as therapeutic agents for AD. The compounds are specific to Tip60, which suggests that they may have fewer side effects than other HDAC inhibitors. Additionally, the compounds are able to cross the blood-brain barrier, which is a major hurdle for the development of AD therapeutics. Further research is needed to confirm the safety and efficacy of these compounds in humans.

Keywords: Alzheimer's disease, cognition, neuroepigenetics, drug discovery

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Authors: Parul Kulshreshtha, Subrata Sinha, Rakesh Bhatnagar

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This study was conducted by taking B. anthracis as a model pathogen. On infecting a host, B. anthracis secretes three proteins, namely, protective antigen (PA, 83kDa), edema factor (EF, 89 kDa) and lethal factor (LF, 90 kDa). These three proteins are the components of two anthrax toxins. PA binds to the cell surface receptors, namely, tumor endothelial marker (TEM) 8 and capillary morphogenesis protein (CMG) 2. TEM8 and CMG2 interact with LDL-receptor related protein (LRP) 6 for endocytosis of EF and LF. On entering the cell, EF acts as a calmodulin-dependent adenylate cyclase that causes a prolonged increase of cytosolic cyclic adenosine monophosphate (cAMP). LF is a metalloprotease that cleaves most isoforms of mitogen-activated protein kinase kinases (MAPKK/MEK) close to their N-terminus. By secreting these two toxins, B.anthracis ascertains death of the host. Once the systemic levels of the toxins rise, antibiotics alone cannot save the host. Therefore, toxin-specific inhibitors have to be developed. In this wake, monoclonal antibodies have been developed for the neutralization of toxic effects of anthrax toxins. We created hybridomas by using spleen of mice that were actively immunized with rLFn (recombinant N-terminal domain of lethal factor of B. anthracis) to obtain anti-toxin antibodies. Later on, separate group of mice were immunized with rLFn to obtain a polyclonal control for passive immunization studies of monoclonal antibodies. This led to the identification of one cohort of rLFn-immunized mice that harboured disease-enhancing polyclonal antibodies. At the same time, the monoclonal antibodies from all the hybridomas were being tested. Two hybridomas secreted monoclonal antibodies (H8 and H10) that were cross-reactive with EF (edema factor) and LF (lethal factor), while the other two hybridomas secreted LF-specific antibodies (H7 and H11). The protective efficacy of H7, H8, H10 and H11 was investigated. H7, H8 and H10 were found to be protective. H11 was found to have disease enhancing characteristics in-vitro and in mouse model of challenge with B. anthracis. In this study the disease enhancing character of H11 monoclonal antibody and anti-rLFn polyclonal sera was investigated. Combination of H11 with protective monoclonal antibodies (H8 and H10) reduced its disease enhancing nature both in-vitro and in-vivo. But combination of H11 with LETscFv (an scFv with VH and VL identical to H10 but lacking Fc region) could not abrogate the disease-enhancing character of H11 mAb. Therefore it was concluded that for suppression of disease enhancement, Fc portion was absolutely essential for interaction of H10 with H11. Our study indicates that the protective potential of an antibody depends equally on its idiotype/ antigen specificity and its isotype. A number of monoclonal and engineered antibodies are being explored as immunotherapeutics but it is absolutely essential to characterize each one for their individual and combined protective potential. Although new in the sphere of toxin-based diseases, it is extremely important to characterize the disease-enhancing nature of polyclonal as well as monoclonal antibodies. This is because several anti-viral therapeutics and vaccines have failed in the face of this phenomenon. The passive –immunotherapy thus needs to be well formulated to avoid any contraindications.

Keywords: immunotherapy, polyclonal, monoclonal, antibody-dependent disease enhancement

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Authors: Ashish Trivedi, Amol Singh

Abstract:

In the recent years, the magnitude and frequency of disasters have increased at an alarming rate. Every year, more than 400 natural disasters affect global population. A large-scale disaster leads to destruction or damage to houses, thereby rendering a notable number of residents homeless. Since humanitarian response and recovery process takes considerable time, temporary establishments are arranged in order to provide shelter to affected population. These shelter areas are vital for an effective humanitarian relief; therefore, they must be strategically planned. Choosing the locations of temporary shelter areas for accommodating homeless people is critical to the quality of humanitarian assistance provided after a large-scale emergency. There has been extensive research on the facility location problem both in theory and in application. In order to deliver sufficient relief aid within a relatively short timeframe, humanitarian relief organisations pre-position warehouses at strategic locations. However, such approaches have received limited attention from the perspective of providing shelters to disaster-affected people. In present research work, this aspect of humanitarian logistics is considered. The present work proposes a hybrid decision support model to determine relative preference of potential shelter locations by assessing them based on key subjective criteria. Initially, the factors that are kept in mind while locating potential areas for establishing temporary shelters are identified by reviewing extant literature and through consultation from a panel of disaster management experts. In order to determine relative importance of individual criteria by taking into account subjectivity of judgements, a hybrid approach of fuzzy sets and Analytic Hierarchy Process (AHP) was adopted. Further, Technique for order preference by similarity to ideal solution (TOPSIS) was applied on an illustrative data set to evaluate potential locations for establishing temporary shelter areas for homeless people in a disaster scenario. The contribution of this work is to propose a range of possible shelter locations for a humanitarian relief organization, using a robust multi criteria decision support framework.

Keywords: AHP, disaster preparedness, fuzzy set theory, humanitarian logistics, TOPSIS, temporary shelters

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Authors: Ashish Sinha, Pushpend Agrawal

Abstract:

Background: Patients with undiagnosed pulmonary TB predominantly act as reservoirs for its transmission through 10-15 secondary infections in the next 1-5 Yrs. Delays in the diagnosis and treatment may worsen the disease with increase the risk of death. Factors responsible for such delays by tracking patient pathways to treatment may help in planning better interventions. The provision of ‘free diagnosis and treatment’ forms the cornerstone of the National Tuberculosis Elimination Programme (NTEP). OOPE is defined as the money spent by the patient during TB care other than public health facilities. Free TB care at all health facilities could reduce out-of-pocket expenses to the minimum possible levels. Material and Methods: This cross-sectional study was conducted among randomly selected 252 TB patients from Nov – Oct 2022 by taking in-depth interviews following informed verbal consent. We documented their journey from initial symptoms until they reached the public health facility, along with their ‘out-of-pocket expenditure’ (OOPE) pertaining to TB care. Results: Total treatment delay was 91±72 days on average (median: 77days, IQR: 45-104 days), while the isolated patient delay was 31±45 days (median: 15 days, IQR: 0 days to 43 days); diagnostic delay; 57±60 days (median: 42days, IQR 14-78 days), treatment delay 19 ± 18 days (median: 15days, IQR: 11-19 days). A patient delay (> 30 days) was significantly associated with ignorance about classic symptoms of pulmonary TB, adoption of self-medication, illiteracy, and middle and lower social class. Diagnostic delay was significantly higher among those who contacted private health facilities, were unaware of signs and symptoms, had >2 consultations, and not getting an appropriate referral for TB care. Most (97%) of the study participants interviewed claimed to have incurred some expenditure.Median total expenses were 6155(IQR: 2625-15175) rupees. More than half 141 (56%) of the study participants had expenses >5000 rupees. Median transport expenses were 525(IQR: 200-1012) rupees; Median consultation expenses were 700(IQR: 200-1600) rupees; Median investigation expenses were 1000(IQR: 0-3025) rupees and the Median medicine expenses were 3350(IQR: 1300-7525).OOPE for consultation, investigation, and medicine was observed to be significantly higher among patients who ignored classical signs& symptoms of TB, repeated visits to private health facilities, and due to self-medication practices. Transport expenses and delays in seeking care at facilities were observed to have an upward trend with OOP Expenses (r =1). Conclusion: Delay in TB care due to low awareness about signs and symptoms of TB and poor seeking care, lack of proper consultation, and appropriate referrals reported by the study subjects indicate the areas which need proper attention by the program managers. Despite a centrally sponsored programme, the financial burden on TB patients is still in the unacceptable range. OOPE could be reduced as low as possible by addressing the responsible factors linked to it.

Keywords: patient pathway, delay, pulmonary tuberculosis, out of pocket expenses

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