Search results for: Geoffrey Sinha
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 127

Search results for: Geoffrey Sinha

37 Assessment of Community Perceptions of Mangrove Ecosystem Services and Their Link to SDGs in Vanga, Kenya

Authors: Samson Obiene, Khamati Shilabukha, Geoffrey Muga, James Kairo

Abstract:

Mangroves play a vital role in the achievement of multiple goals of global sustainable development (SDG’s), particularly SDG SDG 14 (life under water). Their management, however, is faced with several shortcomings arising from inadequate knowledge on the perceptions of their ecosystem services, hence a need to map mangrove goods and services within SDGs while interrogating the disaggregated perceptions. This study therefore aimed at exploring the parities and disparities in attitudes and perceptions of mangrove ecosystem services among community members of Vanga and the link of the ecosystem services (ESs) to specific SDG targets. The study was based at the Kenya-Tanzania transboundary area in Vanga; where a carbon-offset project on mangroves is being up scaled. Mixed methods approach employing surveys, focus group discussions (FGDs) and reviews of secondary data were used in the study. A two stage cluster samplings was used to select the study population and the sample size. FGDs were conducted purposively selecting active participants in mangrove related activities with distinct socio-demographic characteristics. Sampled respondents comprised of males and females of different occupations and age groups. Secondary data review was used to select specific SDG targets against which mangrove ecosystem services identified through a value chain analysis were mapped. In Vanga, 20 ecosystem services were identified and categorized under supporting, cultural and aesthetic, provisioning and regulating services. According to the findings of this study, 63.9% (95% ci 56.6-69.3) perceived of the ESs as very important for economic development, 10.3% (95% ci 0-21.3) viewed them as important for environmental and ecological development while 25.8% (95% ci 2.2-32.8) were not sure of any role they play in development. In the social-economic disaggregation, ecosystem service values were found to vary with the level of interaction with the ecosystem which depended on gender and other social-economic classes within the study area. The youths, low income earners, women and those with low education levels were also identified as the primary beneficiaries of mangrove ecosystem services. The study also found that of the 17 SDGs, mangroves have a potential of influencing the achievement 12, including, SDGs 1, 2, 3, 4, 6, 8 10, 12, 13, 14, 15 and 17 either directly or indirectly. Generally therefore, the local community is aware of the critical importance mangroves for enhanced livelihood and ecological services but challenges in sustainability still occur as a result the diverse values and of the services and the contradicting interests of the different actors around the ecosystem. It is therefore important to consider parities in values and perception to avoid a ‘tragedy of the commons’ while striving to enhance sustainability of the Mangrove ecosystem.

Keywords: sustainable development, community values, socio-demographics, Vanga, mangrove ecosystem services

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36 Hyper-Immunoglobulin E (Hyper-Ige) Syndrome In Skin Of Color: A Retrospective Single-Centre Observational Study

Authors: Rohit Kothari, Muneer Mohamed, Vivekanandh K., Sunmeet Sandhu, Preema Sinha, Anuj Bhatnagar

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Introduction: Hyper-IgE syndrome is a rare primary immunodeficiency syndrome characterised by triad of severe atopic dermatitis, recurrent pulmonary infections, and recurrent staphylococcal skin infections. The diagnosis requires a high degree of suspicion, typical clinical features, and not mere rise in serum-IgE levels, which may be seen in multiple conditions. Genetic studies are not always possible in a resource poor setting. This study highlights various presentations of Hyper-IgE syndrome in skin of color children. Case-series: Our study had six children of Hyper-IgE syndrome aged twomonths to tenyears. All had onset in first ten months of life except one with a late-onset at two years. All had recurrent eczematoid rash, which responded poorly to conventional treatment, secondary infection, multiple episodes of hospitalisation for pulmonary infection, and raised serum IgE levels. One case had occasional vesicles, bullae, and crusted plaques over both the extremities. Genetic study was possible in only one of them who was found to have pathogenic homozygous deletions of exon-15 to 18 in DOCK8 gene following which he underwent bone marrow transplant (BMT), however, succumbed to lower respiratory tract infection two months after BMT and rest of them received multiple courses of antibiotics, oral/ topical steroids, and cyclosporine intermittently with variable response. Discussion: Our study highlights various characteristics, presentation, and management of this rare syndrome in children. Knowledge of these manifestations in skin of color will facilitate early identification and contribute to optimal care of the patients as representative data on the same is limited in literature.

Keywords: absolute eosinophil count, atopic dermatitis, eczematous rash, hyper-immunoglobulin E syndrome, pulmonary infection, serum IgE, skin of color

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35 Examining the Missing Feedback Link in Environmental Kuznets Curve Hypothesis

Authors: Apra Sinha

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The inverted U-shaped Environmental Kuznets curve (EKC) demonstrates(pollution-income relationship)that initially the pollution and environmental degradation surpass the level of income per capita; however this trend reverses since at the higher income levels, economic growth initiates environmental upgrading. However, what effect does increased environmental degradation has on growth is the missing feedback link which has not been addressed in the EKC hypothesis. This paper examines the missing feedback link in EKC hypothesis in Indian context by examining the casual association between fossil fuel consumption, carbon dioxide emissions and economic growth for India. Fossil fuel consumption here has been taken as a proxy of driver of economic growth. The casual association between the aforementioned variables has been analyzed using five interventions namely 1) urban development for which urbanization has been taken proxy 2) industrial development for which industrial value added has been taken proxy 3) trade liberalization for which sum of exports and imports as a share of GDP has been taken as proxy 4)financial development for which a)domestic credit to private sector and b)net foreign assets has been taken as proxies. The choice of interventions for this study has been done keeping in view the economic liberalization perspective of India. The main aim of the paper is to investigate the missing feedback link for Environmental Kuznets Curve Hypothesis before and after incorporating the intervening variables. The period of study is from 1971 to 2011 as it covers pre and post liberalization era in India. All the data has been taken from World Bank country level indicators. The Johansen and Juselius cointegration testing methodology and Error Correction based Granger causality have been applied on all the variables. The results clearly show that out of five interventions, only in two interventions the missing feedback link is being addressed. This paper can put forward significant policy implications for environment protection and sustainable development.

Keywords: environmental Kuznets curve hypothesis, fossil fuel consumption, industrialization, trade liberalization, urbanization

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34 Recovery of Draw Solution in Forward Osmosis by Direct Contact Membrane Distillation

Authors: Su-Thing Ho, Shiao-Shing Chen, Hung-Te Hsu, Saikat Sinha Ray

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Forward osmosis (FO) is an emerging technology for direct and indirect potable water reuse application. However, successful implementation of FO is still hindered by the lack of draw solution recovery with high efficiency. Membrane distillation (MD) is a thermal separation process by using hydrophobic microporous membrane that is kept in sandwich mode between warm feed stream and cold permeate stream. Typically, temperature difference is the driving force of MD which attributed by the partial vapor pressure difference across the membrane. In this study, the direct contact membrane distillation (DCMD) system was used to recover diluted draw solution of FO. Na3PO4 at pH 9 and EDTA-2Na at pH 8 were used as the feed solution for MD since it produces high water flux and minimized salt leakage in FO process. At high pH, trivalent and tetravalent ions are much easier to remain at draw solution side in FO process. The result demonstrated that PTFE with pore size of 1 μm could achieve the highest water flux (12.02 L/m2h), followed by PTFE 0.45 μm (10.05 L/m2h), PTFE 0.1 μm (7.38 L/m2h) and then PP (7.17 L/m2h) while using 0.1 M Na3PO4 draw solute. The concentration of phosphate and conductivity in the PTFE (0.45 μm) permeate were low as 1.05 mg/L and 2.89 μm/cm respectively. Although PTFE with the pore size of 1 μm could obtain the highest water flux, but the concentration of phosphate in permeate was higher than other kinds of MD membranes. This study indicated that four kinds of MD membranes performed well and PTFE with the pore size of 0.45 μm was the best among tested membranes to achieve high water flux and high rejection of phosphate (99.99%) in recovery of diluted draw solution. Besides that, the results demonstrate that it can obtain high water flux and high rejection of phosphate when operated with cross flow velocity of 0.103 m/s with Tfeed of 60 ℃ and Tdistillate of 20 ℃. In addition to that, the result shows that Na3PO4 is more suitable for recovery than EDTA-2Na. Besides that, while recovering the diluted Na3PO4, it can obtain the high purity of permeate water. The overall performance indicates that, the utilization of DCMD is a promising technology to recover the diluted draw solution for FO process.

Keywords: membrane distillation, forward osmosis, draw solution, recovery

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33 Proposed Design Principles for Low-Income Housing in South Africa

Authors: Gerald Steyn

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Despite the huge number of identical, tiny, boxy, freestanding houses built by the South African government after the advent of democracy in 1994, squatter camps continue to mushroom, and there is no evidence that the backlog is being reduced. Not only is the wasteful low-density detached-unit approach of the past being perpetuated, but the social, spatial, and economic marginalization is worse than before 1994. The situation is precarious since squatters are vulnerable to fires and flooding. At the same time, the occupants of the housing schemes are trapped far from employment opportunities or any public amenities. Despite these insecurities, the architectural, urban design, and city planning professions are puzzlingly quiet. Design projects address these issues only at the universities, albeit inevitably with somewhat Utopian notions. Geoffrey Payne, the renowned urban housing and urban development consultant and researcher focusing on issues in the Global South, once proclaimed that “we do not have a housing problem – we have a settlement problem.” This dictum was used as the guiding philosophy to conceptualize urban design and architectural principles that foreground the needs of low-income households and allow them to be fully integrated into the larger conurbation. Information was derived from intensive research over two decades, involving frequent visits to informal settlements, historic Black townships, and rural villages. Observations, measured site surveys, and interviews resulted in several scholarly articles from which a set of desirable urban and architectural criteria could be extracted. To formulate culturally appropriate design principles, existing vernacular and informal patterns were analyzed, reconciled with contemporary designs that align with the requirements for the envisaged settlement attributes, and reimagined as residential design principles. Five interrelated design principles are proposed, ranging in scale from (1) Integrating informal settlements into the city, (2) linear neighborhoods, (3) market streets as wards, (4) linear neighborhoods, and (5) typologies and densities for clustered and aggregated patios and courtyards. Each design principle is described, first in terms of its context and associated issues of concern, followed by a discussion of the patterns available to inform a possible solution, and finally, an explanation and graphic illustration of the proposed design. The approach is predominantly bottom-up since each of the five principles is unfolded from existing informal and vernacular practices studied in situ. They are, however, articulated and represented in terms of contemporary design language. Contrary to an idealized vision of housing for South Africa’s low-income urban households, this study proposes actual principles for critical assessment by peers in the tradition of architectural research in design.

Keywords: culturally appropriate design principles, informal settlements, South Africa’s housing backlog, squatter camps

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32 Memorializing the Holocaust in the Present Century

Authors: Mehak Burza

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As we pause to observe the Holocaust Remembrance Day each year on 27 January, it becomes important to consider how the Holocaust is witnessed, and its education is perceived across the globe. The dissemination of knowledge of the Holocaust becomes more pertinent in the countries that were not directly affected by it. The Holocaust education is not widespread in Asian countries and is thus not mandatory as an academic discipline for school and university students. One such Asian country that often considers Holocaust as an isolated event is India. Though the struggle for freedom began with the 1857 mutiny (the first war of Indian independence) but the freedom revolts gained momentum specifically during the years 1944-1947, when India was steeped in a battery of rebellions. However, freedom for the Indian subcontinent from the domination of British Raj came at the cost of partition of India that resulted in widespread bloodshed and immigration. For India, it is this backdrop of her freedom struggle that always outweighs the incidents of the Second World War, including the catastrophic event of the Holocaust. As a result, the knowledge about the Holocaust is available through secondary sources such as Holocaust documentaries and movies. Besides Anne Frank’s diary, the knowledge about the Holocaust is disseminated through the course readings in the universities. The most common literary acquaintances with the Jewish faith for university students are when they come across the Jewish characters in their course readings. The Prioress’s Tale in Geoffrey Chaucer’s Canterbury Tales, the character of Shylock in William Shakespeare’s The Merchant of Venice, and the Jewish protagonist, Barabas, in Christopher Marlow’s Jew of Malta. Apart from this, the school textbooks mention a detailed chapter on Holocaust and Hitler, which is an encouraging turn. However, there still exists a yawning gap between dissemination and sensitization of Holocaust education owing to different geographical locales. My paper presentation aims to trace the intersectional elements between India and the Holocaust that can serve as the required pivotal stand-board to foster sensitization towards Holocaust education in the Indian subcontinent. For instance, Maharaja Jam SahebDigvijaysinhjiRanjitsinhji, the ruler of Nawanagar, a princely state in British India, helped save thousand Polish Jewish children in 1945 at the time when India herself was steeped in its struggle for freedom. Famously known as the ‘Indian Oskar Schindler’ Polish government has named a street after him in Krakow, Poland. Another example that deserves mention is the spy princess, Noor Inayat Khan, a descendent of Tipu Sultan, who became the most celebrated British spyand fought against the Nazis. Additionally, by offering refuge to Jews, India has proved to be a distant haven for them. Researching further the domain of Jewish refugees in India will not only illuminate a dull/gray zone of investigation but also enable the educators to provide appropriate entry points for introducing the subject of Shoah/Holocaust in India, a subject which unfortunately hitherto is either seldom discussed or is equated with the Partition of India.

Keywords: awareness, dissemination, holocaust, India

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31 Exploration of Copper Fabric in Non-Asbestos Organic Brake-Pads for Thermal Conductivity Enhancement

Authors: Vishal Mahale, Jayashree Bijwe, Sujeet K. Sinha

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Range of thermal conductivity (TC) of Friction Materials (FMs) is a critical issue since lower TC leads to accumulation of frictional heat on the working surface, which results in excessive fade while higher TC leads to excessive heat flow towards back-plate resulting in boiling of brake-fluid leading to ‘spongy brakes’. This phenomenon prohibits braking action, which is most undesirable. Therefore, TC of the FMs across the brake pads should not be high while along the brake pad, it should be high. To enhance TC, metals in the forms of powder and fibers are used in the FMs. Apart from TC improvement, metals provide strength and structural integrity to the composites. Due to higher TC Copper (Cu) powder/fiber is a most preferred metallic ingredient in FM industry. However, Cu powders/fibers are responsible for metallic wear debris generation, which has harmful effects on aquatic organisms. Hence to get rid of a problem of metallic wear debris generation and to keep the positive effect of TC improvement, incorporation of Cu fabric in NAO brake-pads can be an innovative solution. Keeping this in view, two realistic multi-ingredient FM composites with identical formulations were developed in the form of brake-pads. Out of which one composite series consisted of a single layer of Cu fabric in the body of brake-pad and designated as C1 while double layer of Cu fabric was incorporated in another brake-pad series with designation of C2. Distance of Cu fabric layer from the back-plate was kept constant for C1 and C2. One more composite (C0) was developed without Cu fabric for the sake of comparison. Developed composites were characterized for physical properties. Tribological performance was evaluated on full scale inertia dynamometer by following JASO C 406 testing standard. It was concluded that Cu fabric successfully improved fade resistance by increasing conductivity of the composite and also showed slight improvement in wear resistance. Worn surfaces of pads and disc were analyzed by SEM and EDAX to study wear mechanism.

Keywords: brake inertia dynamometer, copper fabric, non-asbestos organic (NAO) friction materials, thermal conductivity enhancement

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30 A Prospective Audit to Look into Antimicrobial Prescribing in the Clinical Setting: In a Teaching Hospital in the UK

Authors: Richa Sinha, Mohammad Irfan Javed, Sanjay Singh

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Introduction: Good antimicrobial prescribing reduces length of stay in hospital, risk of adverse events, antimicrobial resistance, and unnecessary hospital expenditure. The aim of this prospective audit was to identify any problems with antimicrobial prescribing including documentation of the relevant aspects as well as appropriateness of antibiotics use. The audit was conducted on the surgical wards in a teaching hospital in the UK. Methods: Standards included the indication, duration, choice, and prescription of antibiotic should be in line with current Regional Guidelines and should be clearly documented on the prescription chart. There should be an entry in each patients’ medical record of the diagnosis and indication for each acute antibiotic prescription issued. All prescriptions should clearly document the route, frequency and dose of antibiotic. Data collection was done for 2 weeks in the month of March 2014. A proforma including all the questions above was completed for all the patients. The results were analysed using Excel. Results: 35 patients in total were selected for the audit. 85.7% of patients had indication of antibiotic documented on the prescription chart and 68.5% of patients had indication documented in the notes. The antibiotic used was in line with hospital guidelines in 45.7% of patients, however, in a further 28.5% of patients the reason for the antibiotic prescription was microbiology approved. Therefore, in total 74.2% of patients had been prescribed appropriate antibiotics. The duration of antibiotic was documented in 68.6% of patients and the antibiotic was reviewed in 37.1% of patients. The dose, frequency and route was documented clearly in 100% of patients. Conclusion: Overall, prescribing can be improved on the surgical wards in this hospital. Only 37.1% of patients had clear documentation of a review of antibiotics. It may be that antibiotics have been reviewed but this should be clearly highlighted on the prescription chart or the notes. Failure to review antibiotics can lead to poor patient care and antimicrobial resistance and therefore it is important to address this. It is also important to address the appropriateness of antibiotics as inappropriate antibiotic prescription can lead to failure of treatment as well as antimicrobial resistance. The good points from the audit was that all patients had clear documentation of dose, route and frequency which is extremely important in the administration of antibiotics. Recommendations from this audit included to emphasize good antimicrobial prescribing at induction (twice yearly), an antimicrobial handbook for junior doctors, and re-audit in 6 months time.

Keywords: prescribing, antimicrobial, indication, duration

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29 A Computational Fluid Dynamics Simulation of Single Rod Bundles with 54 Fuel Rods without Spacers

Authors: S. K. Verma, S. L. Sinha, D. K. Chandraker

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The Advanced Heavy Water Reactor (AHWR) is a vertical pressure tube type, heavy water moderated and boiling light water cooled natural circulation based reactor. The fuel bundle of AHWR contains 54 fuel rods arranged in three concentric rings of 12, 18 and 24 fuel rods. This fuel bundle is divided into a number of imaginary interacting flow passage called subchannels. Single phase flow condition exists in reactor rod bundle during startup condition and up to certain length of rod bundle when it is operating at full power. Prediction of the thermal margin of the reactor during startup condition has necessitated the determination of the turbulent mixing rate of coolant amongst these subchannels. Thus, it is vital to evaluate turbulent mixing between subchannels of AHWR rod bundle. With the remarkable progress in the computer processing power, the computational fluid dynamics (CFD) methodology can be useful for investigating the thermal–hydraulic characteristics phenomena in the nuclear fuel assembly. The present report covers the results of simulation of pressure drop, velocity variation and turbulence intensity on single rod bundle with 54 rods in circular arrays. In this investigation, 54-rod assemblies are simulated with ANSYS Fluent 15 using steady simulations with an ANSYS Workbench meshing. The simulations have been carried out with water for Reynolds number 9861.83. The rod bundle has a mean flow area of 4853.0584 mm2 in the bare region with the hydraulic diameter of 8.105 mm. In present investigation, a benchmark k-ε model has been used as a turbulence model and the symmetry condition is set as boundary conditions. Simulation are carried out to determine the turbulent mixing rate in the simulated subchannels of the reactor. The size of rod and the pitch in the test has been same as that of actual rod bundle in the prototype. Water has been used as the working fluid and the turbulent mixing tests have been carried out at atmospheric condition without heat addition. The mean velocity in the subchannel has been varied from 0-1.2 m/s. The flow conditions are found to be closer to the actual reactor condition.

Keywords: AHWR, CFD, single-phase turbulent mixing rate, thermal–hydraulic

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28 Design of a Human-in-the-Loop Aircraft Taxiing Optimisation System Using Autonomous Tow Trucks

Authors: Stefano Zaninotto, Geoffrey Farrugia, Johan Debattista, Jason Gauci

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The need to reduce fuel and noise during taxi operations in the airports with a scenario of constantly increasing air traffic has resulted in an effort by the aerospace industry to move towards electric taxiing. In fact, this is one of the problems that is currently being addressed by SESAR JU and two main solutions are being proposed. With the first solution, electric motors are installed in the main (or nose) landing gear of the aircraft. With the second solution, manned or unmanned electric tow trucks are used to tow aircraft from the gate to the runway (or vice-versa). The presence of the tow trucks results in an increase in vehicle traffic inside the airport. Therefore, it is important to design the system in a way that the workload of Air Traffic Control (ATC) is not increased and the system assists ATC in managing all ground operations. The aim of this work is to develop an electric taxiing system, based on the use of autonomous tow trucks, which optimizes aircraft ground operations while keeping ATC in the loop. This system will consist of two components: an optimization tool and a Graphical User Interface (GUI). The optimization tool will be responsible for determining the optimal path for arriving and departing aircraft; allocating a tow truck to each taxiing aircraft; detecting conflicts between aircraft and/or tow trucks; and proposing solutions to resolve any conflicts. There are two main optimization strategies proposed in the literature. With centralized optimization, a central authority coordinates and makes the decision for all ground movements, in order to find a global optimum. With the second strategy, called decentralized optimization or multi-agent system, the decision authority is distributed among several agents. These agents could be the aircraft, the tow trucks, and taxiway or runway intersections. This approach finds local optima; however, it scales better with the number of ground movements and is more robust to external disturbances (such as taxi delays or unscheduled events). The strategy proposed in this work is a hybrid system combining aspects of these two approaches. The GUI will provide information on the movement and status of each aircraft and tow truck, and alert ATC about any impending conflicts. It will also enable ATC to give taxi clearances and to modify the routes proposed by the system. The complete system will be tested via computer simulation of various taxi scenarios at multiple airports, including Malta International Airport, a major international airport, and a fictitious airport. These tests will involve actual Air Traffic Controllers in order to evaluate the GUI and assess the impact of the system on ATC workload and situation awareness. It is expected that the proposed system will increase the efficiency of taxi operations while reducing their environmental impact. Furthermore, it is envisaged that the system will facilitate various controller tasks and improve ATC situation awareness.

Keywords: air traffic control, electric taxiing, autonomous tow trucks, graphical user interface, ground operations, multi-agent, route optimization

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27 Treatment of High Concentration Cutting Fluid Wastewater by Ceramic Membrane Bioreactor

Authors: Kai-Shiang Chang, Shiao-Shing Chen, Saikat Sinha Ray, Hung-Te Hsu

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In recent years, membrane bioreactors (MBR) have been widely utilized as it can effectively replace conventional activated sludge process (CAS). Membrane bioreactor (MBR) is found to be more effective technology compared to other conventional activated sludge process and advanced membrane separation technique. Additionally, as far as the MBR is concerned, it is having excellent control of sludge retention time (SRT) and hydraulic retention time (HRT) and conducive to the retention of high concentration of sludge biomass. The membrane bioreactor (MBR) can effectively reduce footprint in terms of area and omit the secondary processing procedures in the conventional activated sludge process (CAS). Currently, as per the membrane technology, the ceramic membrane is found to have highly strong anti-acid-base properties, and it is more suitable than polymeric membrane while using for backwash and chemical cleaning. This study is based upon the treatment of Cutting Fluid wastewater, as the Cutting Fluid is widely used in the cutting equipment. However, the Cutting Fluid wastewater is very difficult to treat. In this study, the ceramic membrane was used and combine with of MBR system to treat the Cutting Fluid wastewater. In this present study, different kind of chemical coagulants have been utilized for pretreatment purpose in order to get the supernatant and simultaneously this wastewater (supernatant) was treated by MBR process. Nevertheless, ceramic membrane has three advantages such as high mechanical strength, drug resistance and reuse. During the experiment, the backwash technique was used for every interval of 10 minutes in order to avoid fouling of the membrane. In this study, during pretreatment the Chemical Oxygen Demand (COD) removal efficiency was found to be 71-86% and oil removal efficiency was analyzed to be 83-92%. This pretreatment study suggests that it is quiet effective methodology to reduce COD and oil concentration. Finally, In the MBR system when the HRT is more than 7.5 hour, the COD removal efficiency was found to be 87-93% and could achieve 100% oil removal efficiency. Coagulation test series were seen in Refs coagulants for the treatment of wastewater containing cutting oil with better oil and COD removal efficiency. The results also showed that the oil removal efficiency in the MBR system could reduce the oil content to less than 1 mg / L when the oil quality was 126 mg / L. Therefore, in this paper, the performance of membrane bioreactor by utilizing ceramic membrane has been demonstrated for treatment of Cutting Fluid wastewater.

Keywords: membrane bioreactor, cutting fluid, oil, chemical oxygen demand

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26 Radiofrequency and Near-Infrared Responsive Core-Shell Multifunctional Nanostructures Using Lipid Templates for Cancer Theranostics

Authors: Animesh Pan, Geoffrey D. Bothun

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With the development of nanotechnology, research in multifunctional delivery systems has a new pace and dimension. An incipient challenge is to design an all-in-one delivery system that can be used for multiple purposes, including tumor targeting therapy, radio-frequency (RF-), near-infrared (NIR-), light-, or pH-induced controlled release, photothermal therapy (PTT), photodynamic therapy (PDT), and medical diagnosis. In this regard, various inorganic nanoparticles (NPs) are known to show great potential as the 'functional components' because of their fascinating and tunable physicochemical properties and the possibility of multiple theranostic modalities from individual NPs. Magnetic, luminescent, and plasmonic properties are the three most extensively studied and, more importantly biomedically exploitable properties of inorganic NPs. Although successful attempts of combining any two of them above mentioned functionalities have been made, integrating them in one system has remained challenge. Keeping those in mind, controlled designs of complex colloidal nanoparticle system are one of the most significant challenges in nanoscience and nanotechnology. Therefore, systematic and planned studies providing better revelation are demanded. We report a multifunctional delivery platform-based liposome loaded with drug, iron-oxide magnetic nanoparticles (MNPs), and a gold shell on the surface of liposomes, were synthesized using a lipid with polyelectrolyte (layersomes) templating technique. MNPs and the anti-cancer drug doxorubicin (DOX) were co-encapsulated inside liposomes composed by zwitterionic phophatidylcholine and anionic phosphatidylglycerol using reverse phase evaporation (REV) method. The liposomes were coated with positively charge polyelectrolyte (poly-L-lysine) to enrich the interface with gold anion, exposed to a reducing agent to form a gold nanoshell, and then capped with thio-terminated polyethylene glycol (SH-PEG2000). The core-shell nanostructures were characterized by different techniques like; UV-Vis/NIR scanning spectrophotometer, dynamic light scattering (DLS), transmission electron microscope (TEM). This multifunctional system achieves a variety of functions, such as radiofrequency (RF)-triggered release, chemo-hyperthermia, and NIR laser-triggered for photothermal therapy. Herein, we highlight some of the remaining major design challenges in combination with preliminary studies assessing therapeutic objectives. We demonstrate an efficient loading and delivery system to significant cell death of human cancer cells (A549) with therapeutic capabilities. Coupled with RF and NIR excitation to the doxorubicin-loaded core-shell nanostructure helped in securing targeted and controlled drug release to the cancer cells. The present core-shell multifunctional system with their multimodal imaging and therapeutic capabilities would be eminent candidates for cancer theranostics.

Keywords: cancer thernostics, multifunctional nanostructure, photothermal therapy, radiofrequency targeting

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25 Therapeutic Role of T Subpopulations Cells (CD4, CD8 and Treg (CD25 and FOXP3+ Cells) of UC MSC Isolated from Three Different Methods in Various Disease

Authors: Kumari Rekha, Mathur K Dhananjay, Maheshwari Deepanshu, Nautiyal Nidhi, Shubham Smriti, Laal Deepika, Sinha Swati, Kumar Anupam, Biswas Subhrajit, Shiv Kumar Sarin

Abstract:

Background: Mesenchymal stem cells are multipotent stem cells derived from mesoderm and are used for therapeutic purposes because of their self-renewal, homing capacity, Immunomodulatory capability, low immunogenicity and mitochondrial transfer signaling. MSCs have the ability to regulate the mechanism of both innate as well as adaptive immune responses through the modulation of cellular response and the secretion of inflammatory mediators. Different sources of MSC are UC MSC, BM MSC, Dental Pulp, and Adipose MSC. The most frequent source used is umbilical cord tissue due to its being easily available and free of limitations of collection procedures from respective hospitals. The immunosuppressive role of MSCs is particularly interesting for clinical use since it confers resistance to rejection by the host immune response. Methodology: In this study, T helper cells (TH4), Cytotoxic T cells (CD-8), immunoregulatory cells (CD25 +FOXP3+) are compared from isolated MSC from three different methods, UC Dissociation Kit (Miltenyi), Explant Culture and Collagenase Type-IV. To check the immunomodulatory property, these MSCs were seeded with PBMC(Coculture) in CD3 coated 24 well plates. Cd28 antibody was added in coculture for six days. The coculture was analyzed in FACS Verse flow cytometry. Results: From flow cytometry analysis of coculture, it found that All over T helper cells (CD4+) number p<0.0264 increases in (All Enzymes) MSC rather than explant MSC(p>0.0895) as compared to Collagenase(p>0.7889) in a coculture of Activated T cell and Mesenchymal Stem Cell. Similar T reg cells (CD25+, FOXP3+) expression p<0.0234increases in All Enzymes), decreases in Explant and Collagenase. Experiments have shown that MSCs can also directly prevent the cytotoxic activity of CD8 lymphocytes mainly by blocking their proliferation rather than by inhibiting the cytotoxic effect. And promoting the t-reg cells, which helps in the mediation of immune response in various diseases. Conclusion: MSC suppress Cytotoxic CD8 T cell and Enhance immunoregulatory T reg (CD4+, CD25+, FOXP3+) Cell expression. Thus, MSC maintains a proper balance(ratio) between CD4 T cells and Cytotoxic CD8 T cells.

Keywords: MSC, disease, T cell, T regulatory

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24 CFD Simulation of Spacer Effect on Turbulent Mixing Phenomena in Sub Channels of Boiling Nuclear Assemblies

Authors: Shashi Kant Verma, S. L. Sinha, D. K. Chandraker

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Numerical simulations of selected subchannel tracer (Potassium Nitrate) based experiments have been performed to study the capabilities of state-of-the-art of Computational Fluid Dynamics (CFD) codes. The Computational Fluid Dynamics (CFD) methodology can be useful for investigating the spacer effect on turbulent mixing to predict turbulent flow behavior such as Dimensionless mixing scalar distributions, radial velocity and vortices in the nuclear fuel assembly. A Gibson and Launder (GL) Reynolds stress model (RSM) has been selected as the primary turbulence model to be applied for the simulation case as it has been previously found reasonably accurate to predict flows inside rod bundles. As a comparison, the case is also simulated using a standard k-ε turbulence model that is widely used in industry. Despite being an isotropic turbulence model, it has also been used in the modeling of flow in rod bundles and to produce lateral velocities after thorough mixing of coolant fairly. Both these models have been solved numerically to find out fully developed isothermal turbulent flow in a 30º segment of a 54-rod bundle. Numerical simulation has been carried out for the study of natural mixing of a Tracer (Passive scalar) to characterize the growth of turbulent diffusion in an injected sub-channel and, afterwards on, cross-mixing between adjacent sub-channels. The mixing with water has been numerically studied by means of steady state CFD simulations with the commercial code STAR-CCM+. Flow enters into the computational domain through the mass inflow at the three subchannel faces. Turbulence intensity and hydraulic diameter of 1% and 5.9 mm respectively were used for the inlet. A passive scalar (Potassium nitrate) is injected through the mass fraction of 5.536 PPM at subchannel 2 (Upstream of the mixing section). Flow exited the domain through the pressure outlet boundary (0 Pa), and the reference pressure was 1 atm. Simulation results have been extracted at different locations of the mixing zone and downstream zone. The local mass fraction shows uniform mixing. The effect of the applied turbulence model is nearly negligible just before the outlet plane because the distributions look like almost identical and the flow is fully developed. On the other hand, quantitatively the dimensionless mixing scalar distributions change noticeably, which is visible in the different scale of the colour bars.

Keywords: single-phase flow, turbulent mixing, tracer, sub channel analysis

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23 Relationship Between Brain Entropy Patterns Estimated by Resting State fMRI and Child Behaviour

Authors: Sonia Boscenco, Zihan Wang, Euclides José de Mendoça Filho, João Paulo Hoppe, Irina Pokhvisneva, Geoffrey B.C. Hall, Michael J. Meaney, Patricia Pelufo Silveira

Abstract:

Entropy can be described as a measure of the number of states of a system, and when used in the context of physiological time-based signals, it serves as a measure of complexity. In functional connectivity data, entropy can account for the moment-to-moment variability that is neglected in traditional functional magnetic resonance imaging (fMRI) analyses. While brain fMRI resting state entropy has been associated with some pathological conditions like schizophrenia, no investigations have explored the association between brain entropy measures and individual differences in child behavior in healthy children. We describe a novel exploratory approach to evaluate brain fMRI resting state data in two child cohorts, and MAVAN (N=54, 4.5 years, 48% males) and GUSTO (N = 206, 4.5 years, 48% males) and its associations to child behavior, that can be used in future research in the context of child exposures and long-term health. Following rs-fMRI data pre-processing and Shannon entropy calculation across 32 network regions of interest to acquire 496 unique functional connections, partial correlation coefficient analysis adjusted for sex was performed to identify associations between entropy data and Strengths and Difficulties questionnaire in MAVAN and Child Behavior Checklist domains in GUSTO. Significance was set at p < 0.01, and we found eight significant associations in GUSTO. Negative associations were found between two frontoparietal regions and cerebellar posterior and oppositional defiant problems, (r = -0.212, p = 0.006) and (r = -0.200, p = 0.009). Positive associations were identified between somatic complaints and four default mode connections: salience insula (r = 0.202, p < 0.01), dorsal attention intraparietal sulcus (r = 0.231, p = 0.003), language inferior frontal gyrus (r = 0.207, p = 0.008) and language posterior superior temporal gyrus (r = 0.210, p = 0.008). Positive associations were also found between insula and frontoparietal connection and attention deficit / hyperactivity problems (r = 0.200, p < 0.01), and insula – default mode connection and pervasive developmental problems (r = 0.210, p = 0.007). In MAVAN, ten significant associations were identified. Two positive associations were found = with prosocial scores: the salience prefrontal cortex and dorsal attention connection (r = 0.474, p = 0.005) and the salience supramarginal gyrus and dorsal attention intraparietal sulcus (r = 0.447, p = 0.008). The insula and prefrontal connection were negatively associated with peer problems (r = -0.437, p < 0.01). Conduct problems were negatively associated with six separate connections, the left salience insula and right salience insula (r = -0.449, p = 0.008), left salience insula and right salience supramarginal gyrus (r = -0.512, p = 0.002), the default mode and visual network (r = -0.444, p = 0.009), dorsal attention and language network (r = -0.490, p = 0.003), and default mode and posterior parietal cortex (r = -0.546, p = 0.001). Entropy measures of resting state functional connectivity can be used to identify individual differences in brain function that are correlated with variation in behavioral problems in healthy children. Further studies applying this marker into the context of environmental exposures are warranted.

Keywords: child behaviour, functional connectivity, imaging, Shannon entropy

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22 Functional Performance of Unpaved Roads Reinforced with Treated Coir Geotextiles

Authors: Priya Jaswal, Vivek, S. K. Sinha

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One of the most important and complicated factors influencing the functional performance of unpaved roads is traffic loading. The complexity of traffic loading is caused by the variable magnitude and frequency of load, which causes unpaved roads to fail prematurely. Unpaved roads are low-volume roads, and as peri-urbanization increases, unpaved roads act as a means to boost the rural economy. This has also increased traffic on unpaved roads, intensifying the issue of settlement, rutting, and fatigue failure. This is a major concern for unpaved roads built on poor subgrade soil, as excessive rutting caused by heavy loads can cause driver discomfort, vehicle damage, and an increase in maintenance costs. Some researchers discovered that when a consistent static load is exerted as opposed to a rapidly changing load, the rate of deformation of unpaved roads increases. Previously, some of the most common methods for overcoming the problem of rutting and fatigue failure included chemical stabilisation, fibre reinforcement, and so on. However, due to their high cost, engineers' attention has shifted to geotextiles which are used as reinforcement in unpaved roads. Geotextiles perform the function of filtration, lateral confinement of base material, vertical restraint of subgrade soil, and the tension membrane effect. The use of geotextiles in unpaved roads increases the strength of unpaved roads and is an economically viable method because it reduces the required aggregate thickness, which would need less earthwork, and is thus recommended for unpaved road applications. The majority of geotextiles used previously were polymeric, but with a growing awareness of sustainable development to preserve the environment, researchers' focus has shifted to natural fibres. Coir is one such natural fibre that possesses the advantage of having a higher tensile strength than other bast fibres, being eco-friendly, low in cost, and biodegradable. However, various researchers have discovered that the surface of coir fibre is covered with various impurities, voids, and cracks, which act as a plane of weakness and limit the potential application of coir geotextiles. To overcome this limitation, chemical surface modification of coir geotextiles is widely accepted by researchers because it improves the mechanical properties of coir geotextiles. The current paper reviews the effect of using treated coir geotextiles as reinforcement on the load-deformation behaviour of a two-layered unpaved road model.

Keywords: coir, geotextile, treated, unpaved

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21 Surveillance of Artemisinin Resistance Markers and Their Impact on Treatment Outcomes in Malaria Patients in an Endemic Area of South-Western Nigeria

Authors: Abiodun Amusan, Olugbenga Akinola, Kazeem Akano, María Hernández-Castañeda, Jenna Dick, Akintunde Sowunmi, Geoffrey Hart, Grace Gbotosho

Abstract:

Introduction: Artemisinin-based Combination Therapy (ACTs) is the cornerstone malaria treatment option in most malaria-endemic countries. Unfortunately, the malaria control effort is constantly being threatened by resistance of Plasmodium falciparum to ACTs. The recent evidence of artemisinin resistance in East Africa and its possibility of spreading to other African regions portends an imminent health catastrophe. This study aimed at evaluating the occurrence, prevalence, and influence of artemisinin-resistance markers on treatment outcomes in Ibadan before and after post-adoption of artemisinin combination therapy (ACTs) in Nigeria in 2005. Method: The study involved day zero dry blood spot (DBS) obtained from malaria patients during retrospective (2000-2005) and prospective (2021) studies. A cohort in the prospective study received oral dihydroartemisinin-piperaquine and underwent a 42-day follow-up to observe treatment outcomes. Genomic DNA was extracted from the DBS samples using a QIAamp blood extraction kit. Fragments of P. falciparum kelch13 (Pfkelch13), P. falciparum coronin (Pfcoronin), P. falciparum multidrug resistance 2 (PfMDR2), and P. falciparum chloroquine resistance transporter (PfCRT) genes were amplified and sequenced on a sanger sequencing platform to identify artemisinin resistance-associated mutations. Mutations were identified by aligning sequenced data with reference sequences obtained from the National Center for Biotechnology Information. Data were analyzed using descriptive statistics and student t-tests. Results: Mean parasite clearance time (PCT) and fever clearance time (FCT) were 2.1 ± 0.6 days (95% CI: 1.97-2.24) and 1.3 ± 0.7 days (95% CI: 1.1-1.6) respectively. Four mutations, K189T [34/53(64.2%)], R255K [2/53(3.8%)], K189N [1/53(1.9%)] and N217H [1/53(1.9%)] were identified within the N-terminal (Coiled-coil containing) domain of Pfkelch13. No artemisinin resistance-associated mutation usually found within the β-propeller domain of the Pfkelch13 gene was found in these analyzed samples. However, K189T and R255K mutations showed a significant correlation with longer parasite clearance time in the patients (P<0.002). The observed Pfkelch13 gene changes did not influence the baseline mean parasitemia (P = 0.44). P76S [17/100 (17%)] and V62M [1/100 (1%)] changes were identified in the Pfcoronin gene fragment without any influence on the parasitological parameters. No change was observed in the PfMDR2 gene, while no artemisinin resistance-associated mutation was found in the PfCRT gene. Furthermore, a sample each in the retrospective study contained the Pfkelch13 K189T and Pfcoronin P76S mutations. Conclusion: The study revealed absence of genetic-based evidence of artemisinin resistance in the study population at the time of study. The high frequency of K189T Pfkelch13 mutation and its correlation with increased parasite clearance time in this study may depict geographical variation of resistance mediators and imminent artemisinin resistance, respectively. The study also revealed an inherent potential of parasites to harbour drug-resistant genotypes before the introduction of ACTs in Nigeria.

Keywords: artemisinin resistance, plasmodium falciparum, Pfkelch13 mutations, Pfcoronin

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20 Poly (3,4-Ethylenedioxythiophene) Prepared by Vapor Phase Polymerization for Stimuli-Responsive Ion-Exchange Drug Delivery

Authors: M. Naveed Yasin, Robert Brooke, Andrew Chan, Geoffrey I. N. Waterhouse, Drew Evans, Darren Svirskis, Ilva D. Rupenthal

Abstract:

Poly(3,4-ethylenedioxythiophene) (PEDOT) is a robust conducting polymer (CP) exhibiting high conductivity and environmental stability. It can be synthesized by either chemical, electrochemical or vapour phase polymerization (VPP). Dexamethasone sodium phosphate (dexP) is an anionic drug molecule which has previously been loaded onto PEDOT as a dopant via electrochemical polymerisation; however this technique requires conductive surfaces from which polymerization is initiated. On the other hand, VPP produces highly organized biocompatible CP structures while polymerization can be achieved onto a range of surfaces with a relatively straight forward scale-up process. Following VPP of PEDOT, dexP can be loaded and subsequently released via ion-exchange. This study aimed at preparing and characterising both non-porous and porous VPP PEDOT structures including examining drug loading and release via ion-exchange. Porous PEDOT structures were prepared by first depositing a sacrificial polystyrene (PS) colloidal template on a substrate, heat curing this deposition and then spin coating it with the oxidant solution (iron tosylate) at 1500 rpm for 20 sec. VPP of both porous and non-porous PEDOT was achieved by exposing to monomer vapours in a vacuum oven at 40 mbar and 40 °C for 3 hrs. Non-porous structures were prepared similarly on the same substrate but without any sacrificial template. Surface morphology, compositions and behaviour were then characterized by atomic force microscopy (AFM), scanning electron microscopy (SEM), x-ray photoelectron spectroscopy (XPS) and cyclic voltammetry (CV) respectively. Drug loading was achieved by 50 CV cycles in a 0.1 M dexP aqueous solution. For drug release, each sample was exposed to 20 mL of phosphate buffer saline (PBS) placed in a water bath operating at 37 °C and 100 rpm. Film was stimulated (continuous pulse of ± 1 V at 0.5 Hz for 17 mins) while immersed into PBS. Samples were collected at 1, 2, 6, 23, 24, 26 and 27 hrs and were analysed for dexP by high performance liquid chromatography (HPLC Agilent 1200 series). AFM and SEM revealed the honey comb nature of prepared porous structures. XPS data showed the elemental composition of the dexP loaded film surface, which related well with that of PEDOT and also showed that one dexP molecule was present per almost three EDOT monomer units. The reproducible electroactive nature was shown by several cycles of reduction and oxidation via CV. Drug release revealed success in drug loading via ion-exchange, with stimulated porous and non-porous structures exhibiting a proof of concept burst release upon application of an electrical stimulus. A similar drug release pattern was observed for porous and non-porous structures without any significant statistical difference, possibly due to the thin nature of these structures. To our knowledge, this is the first report to explore the potential of VPP prepared PEDOT for stimuli-responsive drug delivery via ion-exchange. The produced porous structures were ordered and highly porous as indicated by AFM and SEM. These porous structures exhibited good electroactivity as shown by CV. Future work will investigate porous structures as nano-reservoirs to increase drug loading while sealing these structures to minimize spontaneous drug leakage.

Keywords: PEDOT for ion-exchange drug delivery, stimuli-responsive drug delivery, template based porous PEDOT structures, vapour phase polymerization of PEDOT

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19 Structural and Binding Studies of Peptidyl-tRNA Hydrolase from Pseudomonas aeruginosa Provide a Platform for the Structure Based Inhibitor Design against Peptidyl-tRNA Hydrolase

Authors: Sujata Sharma, Avinash Singh, Lovely Gautam, Pradeep Sharma, Mau Sinha, Asha Bhushan, Punit Kaur, Tej P. Singh

Abstract:

Peptidyl-tRNA hydrolase (Pth) Pth is an essential bacterial enzyme that catalyzes the release of free tRNA and peptide moeities from peptidyl tRNAs during stalling of protein synthesis. In order to design inhibitors of Pth from Pseudomonas aeruginosa (PaPth), we have determined the structures of PaPth in its native state and in the bound states with two compounds, amino acylate-tRNA analogue (AAtA) and 5-azacytidine (AZAC). The peptidyl-tRNA hydrolase gene from Pseudomonas aeruginosa was amplified by Phusion High-Fidelity DNA Polymerase using forward and reverse primers, respectively. The E. coliBL21 (λDE3) strain was used for expression of the recombinant peptidyl-tRNA hydrolase from Pseudomonas aeruginosa. The protein was purified using a Ni-NTA superflow column. The crystallization experiments were carried out using hanging drop vapour diffusion method. The crystals diffracted to 1.50 Å resolution. The data were processed using HKL-2000. The polypeptide chain of PaPth consists of 194 amino acid residues from Met1 to Ala194. The centrally located β-structure is surrounded by α-helices from all sides except the side that has entrance to the substrate binding site. The structures of the complexes of PaPth with AAtA and AZAC showed the ligands bound to PaPth in the substrate binding cleft and interacted with protein atoms extensively. The residues that formed intermolecular hydrogen bonds with the atoms of AAtA included Asn12, His22, Asn70, Gly113, Asn116, Ser148, and Glu161 of the symmetry related molecule. The amino acids that were involved in hydrogen bonded interactions in case of AZAC included, His22, Gly113, Asn116, and Ser148. As indicated by fittings of two ligands and the number of interactions made by them with protein atoms, AAtA appears to be a more compatible with the structure of the substrate binding cleft. However, there is a further scope to achieve a better stacking than that of O-tyrosyl moiety because it is not still ideally stacked. These observations about the interactions between the protein and ligands have provided the information about the mode of binding of ligands, nature and number of interactions. This information may be useful for the design of tight inhibitors of Pth enzymes.

Keywords: peptidyl tRNA hydrolase, Acinetobacter baumannii, Pth enzymes, O-tyrosyl

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18 Perceived Competence toward Helping an Accident Victim in Pre-Hospital Setting among Medical Graduates: A Cross Sectional Study from Jodhpur, Rajasthan

Authors: Neeti Rustagi, Naveen Dutt, Arvind Sinha, Mahaveer S. Rhodha, Pankaja R. Raghav

Abstract:

Background: Pre-hospital trauma care services are in developing stage in fast-urbanizing cities of India including Jodhpur. Training of health professionals in providing necessary pre-hospital trauma care is an essential step in decreasing accident related morbidity and mortality. The current study explores the response of a medical graduate toward helping an accident victim in a pre-hospital setting before patient can be transferred to definitive trauma facility. Methodology: This study examines the perceived competence in predicting response to an accident victim by medical graduates in Jodhpur, Rajasthan. Participants completed measures of attitude, normative influence and perceived behavior control toward providing pre-hospital care to an accident victim. Likert scale was used to measure the participant responses. Preliminary and descriptive analysis were used using SPSS 21.0. Internal consistency of the responses received was measured using Cronbach’s alpha. Results: Almost all medical graduates agreed that road accidents are common in their area (male: 92%; female: 78%). More male medical graduates (28%) reported helping an accident victim as compared to female physicians (9%) in the previous three months. Majority of study participants (96%) reported that providing immediate care to an accident victim is essential to save the life of an individual. Experience of helping an accident victim was considered unpleasant by the majority of female participants (70%) as compared to male participants (36%). A large number of participants believed that their friends (80%) and colleagues (96%) would appreciate them helping an accident victim in a pre-hospital setting. A large number of participants also believed that they possess the necessary skills and competencies (80%) towards helping a roadside accident victim in the pre-hospital care environment. Perceived competence of helping a roadside accident victim until they are transferred to a health facility was reported by less than half of the participants (male: 56%; female: 43%). Conclusion: Medical graduates have necessary attitude, competencies, and intention of helping a roadside accident victim. The societal response towards helping a road side accident victim is also supportive. In spite of positive determinants, a large proportion of medical graduates have perceived lack of competence in helping a roadside accident victim. This is essential to explore further as providing pre-hospital care to a roadside accident victim is an essential step in establishing the continuum of care to an accident victim especially in countries where pre-hospital services are in developing phase.

Keywords: prehospital care, perceived behavior, perceived competence, medical graduates

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17 Multi-Criteria Assessment of Biogas Feedstock

Authors: Rawan Hakawati, Beatrice Smyth, David Rooney, Geoffrey McCullough

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Targets have been set in the EU to increase the share of renewable energy consumption to 20% by 2020, but developments have not occurred evenly across the member states. Northern Ireland is almost 90% dependent on imported fossil fuels. With such high energy dependency, Northern Ireland is particularly susceptible to the security of supply issues. Linked to fossil fuels are greenhouse gas emissions, and the EU plans to reduce emissions by 20% by 2020. The use of indigenously produced biomass could reduce both greenhouse gas emissions and external energy dependence. With a wide range of both crop and waste feedstock potentially available in Northern Ireland, anaerobic digestion has been put forward as a possible solution for renewable energy production, waste management, and greenhouse gas reduction. Not all feedstock, however, is the same, and an understanding of feedstock suitability is important for both plant operators and policy makers. The aim of this paper is to investigate biomass suitability for anaerobic digestion in Northern Ireland. It is also important that decisions are based on solid scientific evidence. For this reason, the methodology used is multi-criteria decision matrix analysis which takes multiple criteria into account simultaneously and ranks alternatives accordingly. The model uses the weighted sum method (which follows the Entropy Method to measure uncertainty using probability theory) to decide on weights. The Topsis method is utilized to carry out the mathematical analysis to provide the final scores. Feedstock that is currently available in Northern Ireland was classified into two categories: wastes (manure, sewage sludge and food waste) and energy crops, specifically grass silage. To select the most suitable feedstock, methane yield, feedstock availability, feedstock production cost, biogas production, calorific value, produced kilowatt-hours, dry matter content, and carbon to nitrogen ratio were assessed. The highest weight (0.249) corresponded to production cost reflecting a variation of £41 gate fee to 22£/tonne cost. The weights calculated found that grass silage was the most suitable feedstock. A sensitivity analysis was then conducted to investigate the impact of weights. The analysis used the Pugh Matrix Method which relies upon The Analytical Hierarchy Process and pairwise comparisons to determine a weighting for each criterion. The results showed that the highest weight (0.193) corresponded to biogas production indicating that grass silage and manure are the most suitable feedstock. Introducing co-digestion of two or more substrates can boost the biogas yield due to a synergistic effect induced by the feedstock to favor positive biological interactions. A further benefit of co-digesting manure is that the anaerobic digestion process also acts as a waste management strategy. From the research, it was concluded that energy from agricultural biomass is highly advantageous in Northern Ireland because it would increase the country's production of renewable energy, manage waste production, and would limit the production of greenhouse gases (current contribution from agriculture sector is 26%). Decision-making methods based on scientific evidence aid policy makers in classifying multiple criteria in a logical mathematical manner in order to reach a resolution.

Keywords: anaerobic digestion, biomass as feedstock, decision matrix, renewable energy

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16 Amniotic Fluid Stem Cells Ameliorate Cisplatin-Induced Acute Renal Failure through Autophagy Induction and Inhibition of Apoptosis

Authors: Soniya Nityanand, Ekta Minocha, Manali Jain, Rohit Anthony Sinha, Chandra Prakash Chaturvedi

Abstract:

Amniotic fluid stem cells (AFSC) have been shown to contribute towards the amelioration of Acute Renal Failure (ARF), but the mechanisms underlying the renoprotective effect are largely unknown. Therefore, the main goal of the current study was to evaluate the therapeutic efficacy of AFSC in a cisplatin-induced rat model of ARF and to investigate the underlying mechanisms responsible for its renoprotective effect. To study the therapeutic efficacy of AFSC, ARF was induced in Wistar rats by an intra-peritoneal injection of cisplatin, and five days after administration, the rats were randomized into two groups and injected with either AFSC or normal saline intravenously. On day 8 and 12 after cisplatin injection, i.e., day 3 and day7 post-therapy respectively, the blood biochemical parameters, histopathological changes, apoptosis and expression of pro-apoptotic, anti-apoptotic and autophagy-related proteins in renal tissues were studied in both groups of rats. Administration of AFSC in ARF rats resulted in improvement of renal function and attenuation of renal damage as reflected by significant decrease in blood urea nitrogen, serum creatinine levels, tubular cell apoptosis as assessed by Bax/Bcl2 ratio, and expression of the pro-apoptotic proteins viz. PUMA, Bax, cleaved caspase-3 and cleaved caspase-9 as compared to saline-treated group. Furthermore, in the AFSC-treated group as compared to saline-treated group, there was a significant increase in the activation of autophagy as evident by increased expression of LC3-II, ATG5, ATG7, Beclin1 and phospho-AMPK levels with a concomitant decrease in phospho-p70S6K and p62 expression levels. To further confirm whether the protective effects of AFSC on cisplatin-induced apoptosis were dependent on autophagy, chloroquine, an autophagy inhibitor was administered by the intra-peritoneal route. Chloroquine administration led to significant reduction in the anti-apoptotic effects of the AFSC therapy and further deterioration in the renal structure and function caused by cisplatin. Collectively, our results put forth that AFSC ameliorates cisplatin-induced ARF through induction of autophagy and inhibition of apoptosis. Furthermore, the protective effects of AFSC were blunted by chloroquine, highlighting that activation of autophagy is an important mechanism of action for the protective role of AFSC in cisplatin-induced renal injury.

Keywords: amniotic fluid stem cells, acute renal failure, autophagy, cisplatin

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15 Integration of EEG and Motion Tracking Sensors for Objective Measure of Attention-Deficit Hyperactivity Disorder in Pre-Schoolers

Authors: Neha Bhattacharyya, Soumendra Singh, Amrita Banerjee, Ria Ghosh, Oindrila Sinha, Nairit Das, Rajkumar Gayen, Somya Subhra Pal, Sahely Ganguly, Tanmoy Dasgupta, Tanusree Dasgupta, Pulak Mondal, Aniruddha Adhikari, Sharmila Sarkar, Debasish Bhattacharyya, Asim Kumar Mallick, Om Prakash Singh, Samir Kumar Pal

Abstract:

Background: We aim to develop an integrated device comprised of single-probe EEG and CCD-based motion sensors for a more objective measure of Attention-deficit Hyperactivity Disorder (ADHD). While the integrated device (MAHD) relies on the EEG signal (spectral density of beta wave) for the assessment of attention during a given structured task (painting three segments of a circle using three different colors, namely red, green and blue), the CCD sensor depicts movement pattern of the subjects engaged in a continuous performance task (CPT). A statistical analysis of the attention and movement patterns was performed, and the accuracy of the completed tasks was analysed using indigenously developed software. The device with the embedded software, called MAHD, is intended to improve certainty with criterion E (i.e. whether symptoms are better explained by another condition). Methods: We have used the EEG signal from a single-channel dry sensor placed on the frontal lobe of the head of the subjects (3-5 years old pre-schoolers). During the painting of three segments of a circle using three distinct colors (red, green, and blue), absolute power for delta and beta EEG waves from the subjects are found to be correlated with relaxation and attention/cognitive load conditions. While the relaxation condition of the subject hints at hyperactivity, a more direct CCD-based motion sensor is used to track the physical movement of the subject engaged in a continuous performance task (CPT) i.e., separation of the various colored balls from one table to another. We have used our indigenously developed software for the statistical analysis to derive a scale for the objective assessment of ADHD. We have also compared our scale with clinical ADHD evaluation. Results: In a limited clinical trial with preliminary statistical analysis, we have found a significant correlation between the objective assessment of the ADHD subjects with that of the clinician’s conventional evaluation. Conclusion: MAHD, the integrated device, is supposed to be an auxiliary tool to improve the accuracy of ADHD diagnosis by supporting greater criterion E certainty.

Keywords: ADHD, CPT, EEG signal, motion sensor, psychometric test

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14 A Fresh Approach to Learn Evidence-Based Practice, a Prospective Interventional Study

Authors: Ebtehal Qulisy, Geoffrey Dougherty, Kholoud Hothan, Mylene Dandavino

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Background: For more than 200 years, journal clubs (JCs) have been used to teach the fundamentals of critical appraisal and evidence-based practice (EBP). However, JCs curricula face important challenges, including poor sustainability, insufficient time to prepare for and conduct the activities, and lack of trainee skills and self-efficacy with critical appraisal. Andragogy principles and modern technology could help EBP be taught in more relevant, modern, and interactive ways. Method: We propose a fresh educational activity to teach EBP. Educational sessions are designed to encourage collaborative and experiential learning and do not require advanced preparation by the participants. Each session lasts 60 minutes and is adaptable to in-person, virtual, or hybrid contexts. Sessions are structured around a worksheet and include three educational objectives: “1. Identify a Clinical Conundrum”, “2. Compare and Contrast Current Guidelines”, and “3. Choose a Recent Journal Article”. Sessions begin with a short presentation by a facilitator of a clinical scenario highlighting a “grey-zone” in pediatrics. Trainees are placed in groups of two to four (based on the participants’ number) of varied training levels. The first task requires the identification of a clinical conundrum (a situation where there is no clear answer but only a reasonable solution) related to the scenario. For the second task, trainees must identify two or three clinical guidelines. The last task requires trainees to find a journal article published in the last year that reports an update regarding the scenario’s topic. Participants are allowed to use their electronic devices throughout the session. Our university provides full-text access to major journals, which facilitated this exercise. Results: Participants were a convenience sample of trainees in the inpatient services at the Montréal Children’s Hospital, McGill University. Sessions were conducted as a part of an existing weekly academic activity and facilitated by pediatricians with experience in critical appraisal. There were 28 participants in 4 sessions held during Spring 2022. Time was allocated at the end of each session to collect participants’ feedback via a self-administered online survey. There were 22 responses, were 41%(n=9) pediatric residents, 22.7%(n=5) family medicine residents, 31.8%(n=7) medical students, and 4.5%(n=1) nurse practitioner. Four respondents participated in more than one session. The “Satisfied” rates were 94.7% for session format, 100% for topic selection, 89.5% for time allocation, and 84.3% for worksheet structure. 60% of participants felt that including the sessions during the clinical ward rotation was “Feasible.” As per self-efficacy, participants reported being “Confident” for the tasks as follows: 89.5% for the ability to identify a relevant conundrum, 94.8% for the compare and contrast task, and 84.2% for the identification of a published update. The perceived effectiveness to learn EBP was reported as “Agreed” by all participants. All participants would recommend this session for further teaching. Conclusion: We developed a modern approach to teach EBP, enjoyed by all levels of participants, who also felt it was a useful learning experience. Our approach addresses known JCs challenges by being relevant to clinical care, fostering active engagement but not requiring any preparation, using available technology, and being adaptable to hybrid contexts.

Keywords: medical education, journal clubs, post-graduate teaching, andragogy, experiential learning, evidence-based practice

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13 Development and Characterization of Topical 5-Fluorouracil Solid Lipid Nanoparticles for the Effective Treatment of Non-Melanoma Skin Cancer

Authors: Sudhir Kumar, V. R. Sinha

Abstract:

Background: The topical and systemic toxicity associated with present nonmelanoma skin cancer (NMSC) treatment therapy using 5-Fluorouracil (5-FU) make it necessary to develop a novel delivery system having lesser toxicity and better control over drug release. Solid lipid nanoparticles offer many advantages like: controlled and localized release of entrapped actives, nontoxicity, and better tolerance. Aim:-To investigate safety and efficacy of 5-FU loaded solid lipid nanoparticles as a topical delivery system for the treatment of nonmelanoma skin cancer. Method: Topical solid lipid nanoparticles of 5-FU were prepared using Compritol 888 ATO (Glyceryl behenate) as lipid component and pluronic F68 (Poloxamer 188), Tween 80 (Polysorbate 80), Tyloxapol (4-(1,1,3,3-Tetramethylbutyl) phenol polymer with formaldehyde and oxirane) as surfactants. The SLNs were prepared with emulsification method. Different formulation parameters viz. type and ratio of surfactant, ratio of lipid and ratio of surfactant:lipid were investigated on particle size and drug entrapment efficiency. Results: Characterization of SLNs like–Transmission Electron Microscopy (TEM), Differential Scannig calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), Particle size determination, Polydispersity index, Entrapment efficiency, Drug loading, ex vivo skin permeation and skin retention studies, skin irritation and histopathology studies were performed. TEM results showed that shape of SLNs was spherical with size range 200-500nm. Higher encapsulation efficiency was obtained for batches having higher concentration of surfactant and lipid. It was found maximum 64.3% for SLN-6 batch with size of 400.1±9.22 nm and PDI 0.221±0.031. Optimized SLN batches and marketed 5-FU cream were compared for flux across rat skin and skin drug retention. The lesser flux and higher skin retention was obtained for SLN formulation in comparison to topical 5-FU cream, which ensures less systemic toxicity and better control of drug release across skin. Chronic skin irritation studies lacks serious erythema or inflammation and histopathology studies showed no significant change in physiology of epidermal layers of rat skin. So, these studies suggest that the optimized SLN formulation is efficient then marketed cream and safer for long term NMSC treatment regimens. Conclusion: Topical and systemic toxicity associated with long-term use of 5-FU, in the treatment of NMSC, can be minimized with its controlled release with significant drug retention with minimal flux across skin. The study may provide a better alternate for effective NMSC treatment.

Keywords: 5-FU, topical formulation, solid lipid nanoparticles, non melanoma skin cancer

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12 Application of a Submerged Anaerobic Osmotic Membrane Bioreactor Hybrid System for High-Strength Wastewater Treatment and Phosphorus Recovery

Authors: Ming-Yeh Lu, Shiao-Shing Chen, Saikat Sinha Ray, Hung-Te Hsu

Abstract:

Recently, anaerobic membrane bioreactors (AnMBRs) has been widely utilized, which combines anaerobic biological treatment process and membrane filtration, that can be present an attractive option for wastewater treatment and water reuse. Conventional AnMBR is having several advantages, such as improving effluent quality, compact space usage, lower sludge yield, without aeration and production of energy. However, the removal of nitrogen and phosphorus in the AnMBR permeate was negligible which become the biggest disadvantage. In recent years, forward osmosis (FO) is an emerging technology that utilizes osmotic pressure as driving force to extract clean water without additional external pressure. The pore size of FO membrane is kindly mentioned the pore size, so nitrogen or phosphorus could effectively improve removal of nitrogen or phosphorus. Anaerobic bioreactor with FO membrane (AnOMBR) can retain the concentrate organic matters and nutrients. However, phosphorus is a non-renewable resource. Due to the high rejection property of FO membrane, the high amount of phosphorus could be recovered from the combination of AnMBR and FO. In this study, development of novel submerged anaerobic osmotic membrane bioreactor integrated with periodic microfiltration (MF) extraction for simultaneous phosphorus and clean water recovery from wastewater was evaluated. A laboratory-scale AnOMBR utilizes cellulose triacetate (CTA) membranes with effective membrane area of 130 cm² was fully submerged into a 5.5 L bioreactor at 30-35℃. Active layer-facing feed stream orientation was utilized, for minimizing fouling and scaling. Additionally, a peristaltic pump was used to circulate draw solution (DS) at a cross flow velocity of 0.7 cm/s. Magnesium sulphate (MgSO₄) solution was used as DS. Microfiltration membrane periodically extracted about 1 L solution when the TDS reaches to 5 g/L to recover phosphorus and simultaneous control the salt accumulation in the bioreactor. During experiment progressed, the average water flux was achieved around 1.6 LMH. The AnOMBR process show greater than 95% removal of soluble chemical oxygen demand (sCOD), nearly 100% of total phosphorous whereas only partial removal of ammonia, and finally average methane production of 0.22 L/g sCOD was obtained. Therefore, AnOMBR system periodically utilizes MF membrane extracted for phosphorus recovery with simultaneous pH adjustment. The overall performance demonstrates that a novel submerged AnOMBR system is having potential for simultaneous wastewater treatment and resource recovery from wastewater, and hence, the new concept of this system can be used to replace for conventional AnMBR in the future.

Keywords: anaerobic treatment, forward osmosis, phosphorus recovery, membrane bioreactor

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11 Deep Convolutional Neural Network for Detection of Microaneurysms in Retinal Fundus Images at Early Stage

Authors: Goutam Kumar Ghorai, Sandip Sadhukhan, Arpita Sarkar, Debprasad Sinha, G. Sarkar, Ashis K. Dhara

Abstract:

Diabetes mellitus is one of the most common chronic diseases in all countries and continues to increase in numbers significantly. Diabetic retinopathy (DR) is damage to the retina that occurs with long-term diabetes. DR is a major cause of blindness in the Indian population. Therefore, its early diagnosis is of utmost importance towards preventing progression towards imminent irreversible loss of vision, particularly in the huge population across rural India. The barriers to eye examination of all diabetic patients are socioeconomic factors, lack of referrals, poor access to the healthcare system, lack of knowledge, insufficient number of ophthalmologists, and lack of networking between physicians, diabetologists and ophthalmologists. A few diabetic patients often visit a healthcare facility for their general checkup, but their eye condition remains largely undetected until the patient is symptomatic. This work aims to focus on the design and development of a fully automated intelligent decision system for screening retinal fundus images towards detection of the pathophysiology caused by microaneurysm in the early stage of the diseases. Automated detection of microaneurysm is a challenging problem due to the variation in color and the variation introduced by the field of view, inhomogeneous illumination, and pathological abnormalities. We have developed aconvolutional neural network for efficient detection of microaneurysm. A loss function is also developed to handle severe class imbalance due to very small size of microaneurysms compared to background. The network is able to locate the salient region containing microaneurysms in case of noisy images captured by non-mydriatic cameras. The ground truth of microaneurysms is created by expert ophthalmologists for MESSIDOR database as well as private database, collected from Indian patients. The network is trained from scratch using the fundus images of MESSIDOR database. The proposed method is evaluated on DIARETDB1 and the private database. The method is successful in detection of microaneurysms for dilated and non-dilated types of fundus images acquired from different medical centres. The proposed algorithm could be used for development of AI based affordable and accessible system, to provide service at grass root-level primary healthcare units spread across the country to cater to the need of the rural people unaware of the severe impact of DR.

Keywords: retinal fundus image, deep convolutional neural network, early detection of microaneurysms, screening of diabetic retinopathy

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10 An Assessment of Suitable Alternative Public Transport System in Mid-Sized City of India

Authors: Sanjeev Sinha, Samir Saurav

Abstract:

The rapid growth of urban areas in India has led to transportation challenges like traffic congestion and an increase in accidents. Despite efforts by state governments and local administrations to improve urban transport, the surge in private vehicles has worsened the situation. Patna, located in Bihar State, is an example of the trend of increasing reliance on private motor vehicles, resulting in vehicular congestion and emissions. The existing transportation infrastructure is inadequate to meet future travel demands, and there has been a notable increase in the share of private vehicles in the city. Additionally, there has been a surge in economic activities in the region, which has increased the demand for improved travel convenience and connectivity. To address these challenges, a study was conducted to assess the most suitable transit mode for the proposed transit corridor outlined in the Comprehensive Mobility Plan (CMP) for Patna. The study covered four stages: developing screening criteria, evaluating parameters for various alternatives, qualitative and quantitative evaluations of alternatives, and implementation options for the most viable alternative. The study suggests that a mass transit system such as a metro rail is necessary to enhance Patna's urban public transport system. The New Metro Policy 2017 outlines specific prerequisites for submitting a Metro Rail Project Proposal to the Ministry of Housing and Urban Affairs (MoHUA), including the preparation of a CMP, the formation of an Urban Metropolitan Transport Authority (UMTA), the creation of an Alternative Analysis Report, the development of a Detailed Project Report, a Multi-Modal Integration Plan, and a Transit-Oriented Development (TOD) Plan. In 2018, the Comprehensive Mobility Plan for Patna was prepared, setting the stage for the subsequent steps in the metro rail project proposal. The results indicated that from the screening and analysis of qualitative parameters for different alternative modes in Patna, it is inferred that the Metro Rail and Monorail score 82.25 and 70.50, respectively, on a scale of 100. Based on the initial analysis and alternative evaluation in the form of quantitative analysis, the Metro Rail System significantly outperformed the Monorail system. The Metro Rail System has a positive Economic Net Present Value (ENPV) at a 14% internal rate of return, while the Monorail has a negative value. In conclusion, the study recommends choosing metro rail over monorail for the proposed transit corridor in Patna. However, the lack of broad-based technical expertise may result in implementation delays and increased costs for monorail.

Keywords: comprehensive mobility plan, alternative analysis, mobility corridors, mass transit system

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9 Re-Entrant Direct Hexagonal Phases in a Lyotropic System Induced by Ionic Liquids

Authors: Saheli Mitra, Ramesh Karri, Praveen K. Mylapalli, Arka. B. Dey, Gourav Bhattacharya, Gouriprasanna Roy, Syed M. Kamil, Surajit Dhara, Sunil K. Sinha, Sajal K. Ghosh

Abstract:

The most well-known structures of lyotropic liquid crystalline systems are the two dimensional hexagonal phase of cylindrical micelles with a positive interfacial curvature and the lamellar phase of flat bilayers with zero interfacial curvature. In aqueous solution of surfactants, the concentration dependent phase transitions have been investigated extensively. However, instead of changing the surfactant concentrations, the local curvature of an aggregate can be altered by tuning the electrostatic interactions among the constituent molecules. Intermediate phases with non-uniform interfacial curvature are still unexplored steps to understand the route of phase transition from hexagonal to lamellar. Understanding such structural evolution in lyotropic liquid crystalline systems is important as it decides the complex rheological behavior of the system, which is one of the main interests of the soft matter industry. Sodium dodecyl sulfate (SDS) is an anionic surfactant and can be considered as a unique system to tune the electrostatics by cationic additives. In present study, imidazolium-based ionic liquids (ILs) with different number of carbon atoms in their single hydrocarbon chain were used as the additive in the aqueous solution of SDS. At a fixed concentration of total non-aqueous components (SDS and IL), the molar ratio of these components was changed, which effectively altered the electrostatic interactions between the SDS molecules. As a result, the local curvature is observed to modify, and correspondingly, the structure of the hexagonal liquid crystalline phases are transformed into other phases. Polarizing optical microscopy of SDS and imidazole-based-IL systems have exhibited different textures of the liquid crystalline phases as a function of increasing concentration of the ILs. The small angle synchrotron x-ray diffraction (SAXD) study has indicated the hexagonal phase of direct cylindrical micelles to transform to a rectangular phase at the presence of short (two hydrocarbons) chain IL. However, the hexagonal phase is transformed to a lamellar phase at the presence of long (ten hydrocarbons) chain IL. Interestingly, at the presence of a medium (four hydrocarbons) chain IL, the hexagonal phase is transformed to another hexagonal phase of direct cylindrical micelles through the lamellar phase. To the best of our knowledge, such a phase sequence has not been reported earlier. Even though the small angle x-ray diffraction study has revealed the lattice parameters of these phases to be similar to each other, their rheological behavior has been distinctly different. These rheological studies have shed lights on how these phases differ in their viscoelastic behavior. Finally, the packing parameters, calculated for these phases based on the geometry of the aggregates, have explained the formation of the self-assembled aggregates.

Keywords: lyotropic liquid crystals, polarizing optical microscopy, rheology, surfactants, small angle x-ray diffraction

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8 Tracking Patient Pathway for Assessing Public Health and Financial Burden to Community for Pulmonary Tuberculosis: Pointer from Central India

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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