In this paper we develop closed form solutions for anti-plane mechanical and in-plane electric and magnetic fields for two collinear cracks in magneto-electro-elastic layer of finite thickness under ...the conditions of permeable crack faces using integral transform method. The anti-plane mechanical shear or displacement and in-plane electrical and magnetic loading are applied to the top and bottom surfaces of the layer for the two cases considered. Expressions for shear stresses, electric displacements and magnetic inductions in the vicinity of the cracks are derived as well as intensity factors for two cracks in magneto-electro-elastic layer. Numerical results for stress intensity factors and energy release rate are shown graphically.
A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of ...neurological disorders at the state level in India.
Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates.
The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2–5·0) in 1990 to 8·2% (6·6–10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2–0·3) to 0·6% (0·5–0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5–4·8) to 1·1% (0·9–1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% 29·9–46·1), headache disorders (17·5% 3·6–32·5), epilepsy (11·3% 9·0–14·3), cerebral palsy (5·7% 4·2–7·7), and encephalitis (5·3% 3·7–8·9). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution.
The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation.
Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
High prevalence of chronic kidney disease (CKD) not associated with known risk factors has been reported from coastal districts of Andhra Pradesh. The Study to Test and Operationalize Preventive ...Approaches for Chronic Kidney Disease of Undetermined Etiology in Andhra Pradesh (STOP CKDu AP) aims to ascertain the burden (prevalence and incidence) of CKD, the risk factor profile, and the community perceptions about the disease in the Uddanam area of Andhra Pradesh.
Study participants will be sampled from the Uddanam area using multistage cluster random sampling. Information will be collected on the demographic profile, occupational history, and presence of conventional as well as nonconventional risk factors. Glomerular filtration rate (GFR) will be estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and proteinuria will be measured. All abnormal values will be confirmed by repeat testing after 3 months. Cases of CKD not associated with identified etiologies will be identified. Biospecimens will be stored to explore future hypotheses. The entire cohort will be followed up every 6 months to determine the incidence of CKD and to identify risk factors for decline in kidney function. Qualitative studies will be performed to understand the community perceptions and expectations with respect to the interventions.
CKD is an important public health challenge in low- and middle-income countries. This study will establish the prevalence and determine the incidence of CKD not associated with known risk factors in a reported high-burden region, and will provide insights to help design targeted health systems responses. The findings will contribute to the policy development to tackle CKD in the region and will permit international comparisons with other regions with similar high prevalence.
Introduction: In India, approximately 35,000 new cleft patients are born every year. Many patients receive suboptimum, improper, little, or no treatment. The cumulative burden of cleft care is up to ...1 million cases. The spectrum of problems is varied, the caseload is enormous, and the logistics of treatment delivery are complicated. The Indian Council of Medical Research (ICMR) task force project was launched in 2012 to evaluate the status of cleft care in India and develop strategies to provide comprehensive cleft care through a dynamic multidisciplinary and multidimensional tool. ICMR task force project (2012-14) was conducted in Delhi, and the National Capital Region reported that at least 50% of studied cases had complex and multiple treatment needs. The needs identified were related to surgical, orthodontic, dental, ENT and Speech, rehabilitation of mutilated dentition, and various psychological disturbances among patients with Cleft anomalies. Aim: The aim of this study was to develop and test web-based application to create a system for national data of patients with cleft anomalies and digitize the patient records in a standardized preagreed format. Methods and Results: Corresponding to contemporary digital technologies and evolutionary improvements in data collection, web-based data collection instrument, including text, photographs, X-rays, and audio files, was considered the most appropriate. The experts from varied domains in consultation with ICMR and National Informatics Centre evolved a web-based data collection instrument which is named the "IndiCleft tool." The tool has been tested and used over the years and is presently being upgraded to dynamic version for a national data and patient care registry. Conclusion: The present article describes the process of the development of a "dynamic" web-based data collection instrument. The IndiCleft tool is the national resource on cleft data in India.
Data from longitudinal studies indicate that the use of ENDS by minors doubles their chances of starting to smoke. ...the increasing use of e-cigarettes by youth is a significant public health ...concern since the extent of potentially harmful effects, beyond the demonstrated nicotine addiction, is still to be fully revealed and remains a cause for concern. ...on the balance these products have a net negative impact on public health.Use of ENDS can open a gateway for new tobacco addiction which is a potential threat to the country's tobacco control laws and on-going tobacco control programmes.The rapidly increasing trend of use of ENDS or e-cigarettes by young persons, in countries where it was introduced, underscores a potential threat to public health. A rapid increase in the use of ENDS has also been reported amongst adolescents in various other parts of the world6. ...the increasing use of e-cigarettes by youth is a significant public health concern since the extent of potential harmful effects, beyond the demonstrated nicotine addiction of e-cigarettes, is still to be fully revealed and remains a cause for concern. ...on the balance these products have a net negative impact on public health.The marketing of ENDS can open the gateway to a new form of tobacco addiction, which is a potential threat to the country's tobacco control laws and on-going tobacco control programmes.The documented trend of a rapid increase in the use of ENDS or e-cigarettes by young persons, in countries where it was introduced, portends a major potential threat to public health if the products are marketed in India.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We consider the problem of a half-space with a stress-free semielliptic hole in the following two loading cases through antiplane contacts: (i) an antiplane shear contact applied through an ...infinitely long rigid strip bonded to a line on the surface of the half-space, and (ii) two collinear antiplane shear contacts applied through two infinitely long rigid strips. The integral transform technique for each problem is reduced to triple integral equations with cosine kernels and weight functions. Closed-form solutions of this set of triple integral equations are then obtained. Closed-form expressions are also obtained for the distribution of surface stress under the contacts and for the total pressure on the pressed area. Numerical results for displacements, surface stress, and total pressure are given in graph form.
Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research-INdia DIABetes study is to ...estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state.
We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes.
The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0-7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7-5·0) to 10·0% (8·7-11·2) in Punjab and was higher in urban areas (11·2%, 10·6-11·8) than in rural areas (5·2%, 4·9-5·4; p<0·0001) and higher in mainland states (8·3%, 7·9-8·7) than in the northeast (5·9%, 5·5-6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6%, 12.8-15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0-10·6). The prevalence of prediabetes varied from 6·0% (5·1-6·8) in Mizoram to 14·7% (13·6-15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas.
There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures.
Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
A baseline contrast-enhanced computed tomography (CT) scan of the chest, abdomen, and pelvis should be consideredPatients should receive multidisciplinary care under the care of a surgical, medical, ...and radiation oncologistThe indication for endobiliary stenting in patients with obstructive jaundice includes symptoms of cholangitis and/or sepsis, resultant coagulopathy and/or renal insufficiency, or if significant delays in surgery are anticipatedThe patient's malignancy should be classified as resectable, borderline resectable, or locally advanced on the basis of radiologic criteria at diagnosis and treatment plan discussed accordinglyResectable pancreatic cancer – Primary surgery remains the standard of care. Purpose Although International Guidelines are available for the management of pancreatic cancer, it is not entirely feasible to apply these guidelines to the Indian population owing to differences in incidence of the disease in different parts of India, socioeconomic factors, and availability of resources. ...it is essential to analyze the evidence pertaining to pancreatic cancer from India and the rest of the world9,10 with an aim to formulate evidence-based guidelines that could be applicable to Indian patients. Both of the above contribute to the late presentation of the cancer and its notoriously poor outcomes. ...clinicians must be aware of specific clinical presentations linked with pancreatic cancer. 28,29 Based on the limited data available, these resections are associated with a high morbidity and even mortality but an improved survival (5-year survival rates of 16%–22%)30,31 when compared to no resection. ...resections should only be performed if there exists a clear and objective possibility of achieving a complete resection (R0).
Patients with advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) should be assessed on an individual basis to determine whether chemotherapy, targeted therapy, PRRT, or best ...supportive care should be providedPreferred regimens for chemotherapy include – capecitabine-temozolomide, cisplatin-etoposide and for targeted therapy – everolimus and sunitinibPatients should be offered regular surveillance after completion of curative resection or treatment of advanced diseaseEncourage participation in institutional and ethical review board-approved, registered controlled clinical trialsRefer for early palliative care, if indicated. 7 Purpose Although international guidelines are available for the management of GEP-NENs, it is not entirely feasible to apply these guidelines to the Indian population owing to differences in the incidence of the disease in different parts of India, varying socioeconomic factors, and availability of resources. ...it is essential to analyze the evidence pertaining to GEP-NENs from India and the rest of the world13 with an aim to formulate evidence-based guidelines that could be applicable to Indian patients. Grading of gastroenteropancreatic neuroendocrine neoplasms Immunohistochemistry (IHC) estimation of the Ki-67 expression and mitotic index count are used to grade GEP-NENs Table 1, as per the World Health Organization (WHO) classification Table 2, into low-grade (G1), intermediate-grade (G2), and high-grade (G3) categories. ...since the emerging evidence suggested that the G3 pancreatic NEN are heterogeneous in morphology and biology, the recent WHO 2017 classification has introduced a new category of well-differentiated pancreatic neuroendocrine tumors (WD-pNETs) G3, that show lower response rate to platinum-based chemotherapy while better outcomes compared with poorly differentiated pancreatic NECs (PD-pNECs) G3.
Aims
Limited data on the uptake of guideline‐directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure ...Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India.
Methods and results
The NHFR is a facility‐based, multi‐centre clinical registry of consecutive ADHF patients with prospective follow‐up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All‐cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re‐admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log‐rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality.
Conclusion
One of seven ADHF patients in the NHFR died during the first 90 days of follow‐up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
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