Search

Rapid Automatic Naming (RAN) has been widely recognized as a reliable predictor of reading proficiency. Although RAN represents the speed of cognitive processing, there are few studies that have addressed RAN as a cognitive process in its own right Furthermore, RAN performance of ELL (English Language Learners) has been less frequently investigated. We have two parts to this study. First, we examine the factor structure of an enlarged composite measure of speed measure by adding four additional tests comprising color naming, and two number naming tasks to the traditional RAN of digit and letter naming. In the second part, we determine the association of Speed with broad cognitive processes comprising Executive Functions, and Information processing. Participants were students in English medium schools in India. They were divided into two age groups (8-14 and 15-20) for statistical analyses of six Speed measures Results show a strong unitary speed factor in the 8 to 14 age group. In contrast, in the 15 to 20 group RAN tests comprising digits and letters showed a very small loading on the same factor. Addressing the second objective, which is the impact of speed on various cognitive tasks, the results show that response speed has a minimal influence on Nonverbal Configurations (simultaneous) tasks, and tasks of executive functions comprising Working Memory, and Visual-Spatial Processing. These tests will enable us to isolate specific cognitive deficiencies from response speed. In a re-examination of the relation between Reading & RAN-type tests, we could suggest that serial articulation is the common and essential feature that binds rapid naming tasks and reading fluency.

The efficacy of a cognitive-based remediation program was investigated with 14 English-as-a-second-language (ESL) poor readers in Grade 4 who had significant difficulty in comprehension and 14 normal ESL readers in Grade 4 who received no remediation. Both groups were selected from 2 English-medium schools in India. We examined pretest-to-posttest changes in word reading, comprehension, and planning-attention-simultaneous-successive cognitive processes. Analyses of variance (ANOVAs) showed marked improvement in comprehension and some improvement in simultaneous processing for the treated group. The results indicate that the cognitive-based remediation program has potential for substantially improving comprehension and its underlying cognitive process among ESL children. (Contains 1 table.)

The sincerity and diligence of health care providers regarding their timely interventions for the spectrum of ailments at all levels of stressful occupational environments even in the usual infrastructure poor compromised health care facilities of hospitals in our country is appreciable. In last one decade the scenarios evidently showed that integrity and trustworthiness of health care providers are being questioned by the health care seekers in spite of well known fact of widespread deficiency of basic amenities. As the downstream effects, all the unfulfilled expectations of receiving comprehensive public health care are being vented out as the wrath to the doctors leading to series of attacks on doctors and creating chaos in the health care facilities of all levels across the country. The source of this intolerance towards health care providers stems from higher expectations (? magic cure for all morbidities) from doctors on one hand and the limited health awareness, education of patients and their caregivers (attendants and bystanders) on the other hand. There is multifactorial causation of this sensitive issue that is increasing at an alarming momentum as the doctors are treated as 'soft targets'. The primary aim of this article is to sensitize stakeholders and policy makers regarding barbaric attacks on the modesty of doctors; secondly to strengthen the awareness of first contact physicians of the legal and administrative safety measures to protect themselves from the unpredicted situations of outrage and distrust. [ABSTRACT FROM AUTHOR]

The basement in Upper Assam foreland basin exhibits a typical flexure pattern. An elongated continuous subsurface basement high has developed between Himalaya and Naga-Patkai ranges. A few prominent basement lows have developed adjacent to the foothill regions. It is noticed that the general topographic slope near the foothill regions is not only controlled by aggradation process, but also influenced by the flexured basement of the region. The basement lows have influenced the overlying topography significantly. Rivers flowing over those regions have shown unidirectional lateral migration. North bank tributaries like Subansiri, Jiadhal and Dikrang have been affected by the Subansiri basement low. Coseismic subsidence of sediments over Subansiri basement low had resulted subsidence of the North Lakhimpur-Ranga Nadi region in 1950 Assam earthquake. Some south bank tributaries like Disang and Dikhow have been affected by Nazira basement low. Topographic elevation along the Subansiri river is lower than that part of the Brahmaputra located south of Majuli. This typical topographic setting of the region makes the mouth of the Subansiri river and Majuli region highly susceptible to erosion. [ABSTRACT FROM AUTHOR]

Tourism encompasses economic activities viz. accommodation, transportation, food and beverage, information dissemination and entertainments etc. This sector generates a large investment and financing opportunities. As per the estimate of the World Tourism Organisation, India is projected to become the world's fifth largest business travel destination. Indian tourism sector is expected to get USD109.30 billion investment by 2020. The growth of tourism is heavily depended upon the availability and accessibility of financial resources over above the geographic attributes for tourist attractions. West Bengal, a state of India has a great scope to be the destination of tourism due to well developed communication links & strategic location ; above all its diversified and rich tourism resources such as mountains, sea, jungle, mangrove area, religious sites, heritage, culture, fairs and festivals. Developing tourism and attracting tourists need substantial financing investment. Tourism projects require large initial investment and then tourism business organisations/tourism entrepreneurs need funds for staring entreprises. This paper is an attempt to analyse and understand empirically the financial aspects of the tourism industry of West Bengal. The present study is based on both primary and secondary data. The scope of tourism investment and financing at different nodes of tourism development across West Bengal have been identified on the basis of published reports by the Central Government, the State Government and private institutions. Primary data on financial perspective have been gathered through a survey on selected tourism business organisations/tourism entrepreneurs located in West Bengal to understand their views and opinions regarding tourism in West Bengal. Findings of this paper related to problems and prospects of the financial aspects of tourism shall help to formulate strategy for tourism development in West Bengal at desired level. [ABSTRACT FROM AUTHOR]

Background: Indian tea industry workers are exposed to various exposures at their workplace. Objective: To investigate the respiratory health of Indian tea industry workers. Methods: We administered a respiratory questionnaire to and measured lung function in workers of 34 tea gardens and 46 tea factories. We used correlation matrices to test the association between their respiratory symptoms and lung functions. Results: The garden workers complained of shortness of breath 3 times higher than the factory workers. However, nasal allergy was more predominant among the factory workers compared to garden workers (69.6% vs 41.2%, p=0.02). The factory workers had higher total (median 107.3% vs 92.9%, p=0.05, as measured by R at 5 Hz) and peripheral airway resistance (143.8% vs 61.1%, p=0.005, as measured by R at 5–20 Hz) than the garden workers. Respiratory symptoms were inversely associated with airway obstruction as measured by the ratio between forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) and positively correlated with increased overall airway reactance among the workers. Conclusion: Respiratory symptoms and increased allergen susceptibility of Indian tea industry workers due to occupational exposures warrant routine systematic surveillance of their workplace air quality and health monitoring. [ABSTRACT FROM AUTHOR]

Satellite images are capable of displaying prominently the geometry and morphology of folds, especially when these have large spatial extent. The frontal part of the Indo-Burman fold belt, falling in parts of Bangladesh and north-east India, has developed into exemplary linear N-S oriented doubly plunging folds in late Tertiary sedimentary rock sequences and are arranged in a set of alternating ridge-forming anticlines and valley-forming synclines. Formation of these folds is attributed to E-W oriented compressional tectonics resulting out of eastward subduction of the Indian plate below the Burmese plate. Fold types present in the area appear to be simple but the present fold geometrical arrangement reveal some interesting features. The 90-m SRTM-DEM (Shuttle Radar Topographic Mission-Digital Elevation Model), remote sensing techniques, principal component analysis and resolution merging were used to understand the geometry and morphology of the folds covering a large area, through comparative assessment and enhancement of the structural features. This study includes identification of: multi-folds within a visibly single entity; the overlapping nature of folds and the interrelation between anticlines; the geometry of fold noses; fault-affected fold limbs causing bulging; and anticline bifurcation and formation of elliptical and cuspate synclines; as well as recognition of exposed eroded-out folded layers of the anticline and the effect of deformation and faulting. The doubly plunging nature of the folds and higher topography at the middle latitudes of the study area could have formed due to up-arching tectonic activity. [ABSTRACT FROM AUTHOR]

Gibbon Wildlife Sanctuary (GWLS) in the Jorhat District of Assam in northeastern India is rich in primate diversity with seven species. The plains alluvial semi-evergreen forest patches with high canopy cover support a variety of fauna. In October-November 2008, we carried out a survey to estimate the population status of Bengal Slow Loris (Nycticebus bengalensis) in GWLS, a species for which little data are available in India, and whose conservation status has only recently been changed from Data Deficient to Vulnerable. We estimated population abundance of 0.18 loris individuals/km using recce-survey transects' method in GWLS. [ABSTRACT FROM AUTHOR]

A total of 120 water and sewage samples were collected from 20 stations over six consecutive seasons in two years in order to study the possible impact of domestic sewage on the lotic water in and around Cuttack, India. A majority of samples exceeded the maximum permissible limit set by WHO for NH4+ and NO3- contents. Total viable count (TVC) and Escherichia coli (E. coli) counts in all the samples were high and the waters were not potable. The nutrient characteristics of the study area exhibited drastic temporal variation indicating highest concentration during the summer season compared to winter and rains. The persistence of dissolved oxygen (DO) deficit and very high biochemical oxygen demands (BOD) all along the water courses suggest that the deoxygenation rate of lotic water was much higher than reoxygenation. Hierarchical cluster analysis of the various physico-chemical and microbial parameters established three different zones and the most contaminated zone was found to be near the domestic sewage mixing points. [ABSTRACT FROM AUTHOR]

The distribution of golden langurs (Trachypithecus geei ) is limited to a small area of western Assam in northeast India and Bhutan between the rivers Manas in the east, Sankosh in the west, and Brahmaputra in the south. It is one of the most seriously endangered primate species of India. A comparative analysis based on satellite images taken in 1988 and 1998 showed a 50% loss of original golden langur habitat. Data on population dynamics collected using line transect and total count methods are presented here. An average group size of 8.2 (range 4.0–22.0) individuals was recorded. A total of 1,064 individuals were counted living in 130 groups. The sex ratio was 1.9–2.5 adult females for each adult male. A low percentage of juveniles and infants suggests that the population is unstable. Most of the groups had only one adult male. Small group sizes, isolated distribution, proportionately few infants and juveniles, and degrading habitat are all causes of concern. Demographic trends indicate a decline in the golden langur population. Am. J. Primatol. 55:15–23, 2001. © 2001 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The study was conducted in a society pond of Gandhibasti village of Abhayapuri, Bongaigaon, Assam to assess the impact of duck droppings on water quality and pond productivity. The pond was integrated with ducks (Anas platyrhynchos) to obtain the benefit of duck litters on the pond productivity and fish growth. The mean dry weight of 80 ducks excreta was estimated as 3.864 kg/ha/day, discharging into the pond. 18,000 fingerlings. Indian major carps along with few exotic carp were stocked in the month of April, 2013. Supplementary feed was also given to the fishes in alternate days to ensure their steady growth. All the studied physico-chemical parameters were found within the permissible limit and the growth of fishes was also satisfactory. The maximum growth was recorded in Catla followed by silver carp, common carp, Rohu and Mrigala. [ABSTRACT FROM AUTHOR]

The article presents a literary review of the care, training, research, and rehabilitation programs of the mentally retarded in India. Institutions for the training and care of the mentally retarded in India are coming out from the personal efforts of either a committed individual or of a philanthropic organization. Research regarding the mental retardation in the country are categorized into: survey and rehabilitation projects, psychological and educational research, and medical research.

The article analyzes the discrimination of geometrical patterns in tribal, rural, and urban children. In this study, three samples of children from three separate cultural environments were tested for their ability to discriminate between the following pairs of figures: circle versus ellipse, rectangle versus parallelogram, obtuse-angled versus acute-angled triangle, and a circle within a triangle versus a triangle within a circle. The children ranged in age between 6 and 10 and lacked appropriate verbal labels for the test figures. The study was conducted in three parts, starting with the children from an aboriginal tribe in the southern part of Orissa, India. The tribal children were from two tribal villages. The villages can be called remote because they are not approachable by roads and do not have an elementary school or hospital within a distance of five miles. The children were illiterate and could never have come across geometrical pattern in print. The results suggest that a more sensitive measure, like the number of trials required to discriminate the figures, fails to show any difference in the performance of the three cultural groups selected in this study.

The article presents a cross cultural study of film preferences on an Indian student population. Studies on film preferences of children and adolescents have been undertaken using indirect techniques. In previous studies, it had become difficult to assess what it was in a particular film that made an appeal. Furthermore, no attempt was made to find out whether film preference was a function of the students' age, sex, and educational background. The present authors therefore, propose to take into account the age, sex and educational background of students while investigating this problem through direct techniques. Research in this area seems to be somewhat limited in number. In India, no significant attempt has been made to understand the film preference of students even though recent years have recognized the need for and importance of audiovisual education. No less important are the factors which determine their film preferences. The main objective of the study is to make a comparative analysis of the film preferences of students of various groups.

The article discusses ethnocentrism and stereotypes among Santhals in India. Santhals in Midnapoore live like small pockets of minorities surrounded for ages by their more civilized usurpers. Although they are not fully integrated with the majority groups, they have taken in many of their virtues and vices. Very often, the stereotypes attributed to the minority group by the majority groups tally with those the minority groups ascribe themselves. This a repeated finding in several social psychological studies. In that light it is expected that the self-images of Santhals may be very much akin to what their more civilized neighbours think about them. An overview of the beliefs and practices among Santhals does not suggest any characteristic infantilism in their personality. The Santhals appear to have quite rational attitudes about child rearing and relation between man and woman. The Santhals are found to have many similarities with average Hindus. They show great respect for age and parental authorities. Intimate relation between parent and child does exist. Their family structure is much like Hindu families. The children are weaned late.

The purpose of this investigation was to assess the stereotypes of 100 college freshmen and 100 service holders of Orissa towards their own nationality namely "Indian" and four other out-groups namely American, British, Russian, and Chinese. All the subjects were the genuine inhabitants of the State of Orissa (India). A list of .60 adjectives was prepared after the necessary pre-test. The scores of the student and the service holder groups were kept separately for comparison. Attributes checked by at least 20 per cent of either group were selected for discussion in this paper. It was interesting to note that the subjects chose the largest number of derogatory traits for the Americans and the British whereas they chose only two bad traits out of 16 selected for the Russians, and not a single such trait for the Chinese for whom there were 15 good attributes. For the we-group they selected 18 good and 5 bad traits. The rank correlation between the two sets of scores (i.e., the scores of students and service holders) in relation to these five reference groups were highly significant. This means that though the samples belonged to two dissimilar populations yet they very closely agreed in choosing the attributes for these groups. The mean scores of the service holders were higher than those of the student group in all cases. The results might suggest that the traits which had been selected by the two groups were perhaps the commonly held attributes for these groups in this region. [ABSTRACT FROM AUTHOR]

The article focuses on the lack of biotechnological implementation in the Northeast India. It is said that India has a large number of species of plants that are used in modern medicine, and that the region has been prospering for many centuries due to its tradition of healthcare system. It is suggested that biotechnology should be applied so that the plant metabolites will be evaluated properly.

The article discusses a study in India which analyzed the presence of the Janus Kinase 2 (JAK2) V617F mutation in patients with thrombosis with no signs of overt myeloproliferative neoplasms (MPN). Blood samples were obtained from 32 patients who had portal vein thrombosis (PVT) and from 20 patients who had hepatic vein thrombosis (HVT). The study has identified JAK V617F mutation in six patients among 32 with PVT and four among the 20 patients with HVT.

In general, the impact of two different connected extreme events is noticed on the same duration and spatial area. However, the connected extreme events can have footprint over different temporal and spatial scales. Thus, this article analyses the connected extreme events over India using the spatio-temporal compounding technique to understand the impact at different temporal and spatial scales. This approach is applied to analyse the historical and future connected extreme events. In the present study, coincident heat waves and droughts (Event C1), coincident heat waves and extreme precipitation (Event C2) are considered as connected extreme events. The future events are investigated using the suitable global climate models (GCMs) projections under three climate change scenarios (Shared Socioeconomic Pathways (SSP) 2-4.5, SSP3-7.0, and SSP5-8.5). The suitable GCMs are identified with the help of compromise programming. Subsequently, the hotspot regions are identified applying the Regional Climate Change Index (RCCI) method. The outcomes from the study suggest that with increasing temporal compounding, the mean duration of extreme events also increases. Highest increase in mean duration is observed for Event C1 over PI (Peninsular India), WCI (West Central India), and some parts of CNI (Central Northeast India) regions. The regions with high magnitude of duration have low magnitude of occurrence. The duration of Event C1 is likely to increase with respect to climate change scenarios and temporal compounding, especially in the PI region and some parts of WCI. However, there is insignificant change in the duration of Event C2. The PI region identified as the most vulnerable region followed by WCI and HR regions. The highest percentage of area under the emerging hotspot category is noticed under SSP5-8.5 climate change scenario., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors-with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients' web of kinship. Providers would take patients' kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as 'kin testing' to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. 'Kin testing' allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers' actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well.

Fluoride (F - ) enrichment in groundwater of the lower Gangetic plain in West Bengal, India is a major concern. Fluoride contamination and its toxicity were reported earlier in this region; however, limited evidence was available on the precise site of contamination, hydro-geochemical attributions of F - mobilization and probabilistic health risk caused by fluoridated groundwater. The present study addresses the research gap by exploring the spatial distribution and physico-chemical parameters of fluoridated groundwater along with the depth-wise sedimental distribution of F - . Approximately, 10 % of the groundwater samples (n = 824) exhibited high F -  ≥ 1.5 mg/l from 5, out of 19 gram-panchayats and Baruipur municipality area and the maximum F - was observed in Dhapdhapi-II gram-panchayat with 43.7 % of samples showed ≥1.5 mg/l (n = 167). The distribution patterns of cations and anions in fluoridated groundwater were Na +  > Ca 2+  > Mg 2+  > Fe > K + and Cl -  > HCO 3 -  > SO 4 2-  > CO 3 2-  > NO 3 -  > F - . Different statistical models like Piper and Gibbs diagram, Chloro Alkaline plot, Saturation index were applied to better understand the hydro-geochemical characteristics for F - leaching in groundwater. Fluoridated groundwater is of Na-Cl type which implies strong saline character. The intermediate zone between evaporation and rock dominance area controls F - mobilization along with ion-exchange process occurring between groundwater and host silicate mineral. Furthermore, saturation index proves geogenic activities related to groundwater F - mobilization. All cations present in sediment samples are closely interlinked with F - in the depth range of 0-18.3 m. Mineralogical analyses revealed that muscovite is the most responsible mineral for F - mobilization. The probabilistic health risk assessment disclosed severe health hazard in the order of infants > adults > children > teenagers through F - tainted groundwater. At P95 percentile dose, all the studied age groups showed THQ >1 from Dhapdhapi-II gram-panchayat. Supply of F - safe drinking water is required through reliable water supply strategies in the studied area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research., Methods: We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist., Results: From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types- 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more., Conclusion: Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mazumder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Due to changes in demographic and epidemiological scenarios, and the gradual increase in the older population, India is yet to prepare for rising nutrition and health-related issues among older adults in the coming decades. While the process of ageing and its associated aspect has been found to have an urban-rural divide. Thus, this study examines rural/urban differences in unmet needs for food and healthcare among Indian older adults., Methods: A sample of 31,464 older adults aged 60 years and above were considered in the study from the Longitudinal and Ageing Survey of India (LASI). The bivariate analysis was done using the sampling weights. Logistic regression and decomposition analysis was used to explain the rural-urban gap in the unmet needs for food and healthcare among Indian older adults., Results: Rural older adults were more vulnerable to meeting the need for health and food than their urban counterparts. While factors that contributed majorly to the difference in unmet need for food between urban and rural were education (34.98%), social group (6.58%), living arrangements (3.34%) and monthly per capita expenditure (MPCE) (2.84%). Similarly, for the unmet need for health, the factors that contributed the most to the rural-urban gap are education (28.2%), household size (2.32%), and MPCE (1.27%)., Conclusion: The study indicates more vulnerability among rural older adults than compared to urban older individuals. The targeted policy-level efforts should be initiated considering the economic and residential vulnerability identified in the study. There is a need for primary care services that can provide targeted help to older adults in rural communities., (© 2023. The Author(s).)

Rice arsenic (As) contamination and its consumption poses a significant health threat to humans. The present study focuses on the contribution of arsenic, micronutrients, and associated benefit-risk assessment through cooked rice from rural (exposed and control) and urban (apparently control) populations. The mean decreased percentages of As from uncooked to cooked rice for exposed (Gaighata), apparently control (Kolkata), and control (Pingla) areas are 73.8, 78.5, and 61.3%, respectively. The margin of exposure through cooked rice (MoE cooked rice ) < 1 signifies the existence of health risk for all the studied exposed and control age groups. The respective contributions of iAs (inorganic arsenic) in uncooked and cooked rice are nearly 96.6, 94.7, and 100% and 92.2, 90.2, and 94.2% from exposed, apparently control, and control areas. LCR analysis for the exposed, apparently control, and control populations (adult male: 2.1 × 10 -3 , 2.8 × 10 -4 , 4.7 × 10 -4 ; adult female: 1.9 × 10 -3 , 2.1 × 10 -4 , 4.4 × 10 -4 ; and children: 5.8 × 10 -4 , 4.9 × 10 -5 , 1.1 × 10 -4 ) through cooked rice is higher than the recommended value, i.e., 1 × 10 -6 , respectively, whereas HQ > 1 has been observed for all age groups from the exposed area and adult male group from the control area. Adults and children from rural area showed that ingestion rate (IR) and concentration are the respective influencing factors towards cooked rice As, whereas IR is solely responsible for all age groups from urban area. A vital suggestion is to reduce the IR of cooked rice for control population to avoid the As-induced health risks. The average intake (μg/day) of micronutrients is in the order of Zn > Se for all the studied populations and Se intake is lower for the exposed population (53.9) compared to the apparently control (140) and control (208) populations. Benefit-risk assessment supported that the Se-rich values in cooked rice are effective in avoiding the toxic effect and potential risk from the associated metal (As)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The suffering from arsenic toxicity is a long-standing concern in Asian countries. The role of the key factors (arsenic intake, age and sex) regulating arsenic toxicity is aimed to evaluate for a severely exposed population from Murshidabad district, West Bengal. Mean arsenic concentrations in drinking water supplied through tube well, Sajaldhara treatment plant and pipeline were observed as 208, 27 and 54 µg/l, respectively. Urinary arsenic concentration had been observed as < 3-42.1, < 3-56.2 and < 3-80 µg/l in children, teenagers and adults, respectively. Mean concentrations of hair and nail arsenic were found to be 0.84 and 2.38 mg/kg; 3.07 and 6.18 mg/kg; and 4.41 and 9.07 mg/kg, respectively, for the studied age-groups. Water arsenic was found to be associated with hair and nail (r = 0.57 and 0.60), higher than urine (r = 0.37). Arsenic deposition in biomarkers appeared to be dependent on age; however, it is independent of sex. Principal component analysis showed a direct relationship between dietary intake of arsenic and chronic biomarkers. Nail was proved as the most fitted biomarker of arsenic toxicity by Dunn's post hoc test. Monte Carlo sensitivity analysis and cluster analysis showed that the most significant factor regulating health risk is 'concentration of arsenic' than 'exposure duration', 'body weight' and 'intake rate'. The contribution of arsenic concentration towards calculated health risk was highest in teenagers (45.5-61.2%), followed by adults (47.8-49%) and children (21-27.6%). Regular and sufficient access to arsenic-safe drinking water is an immediate need for the affected population., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

As a widespread natural hazard, droughts impact several aspects of human society adversely. Thus, the present study aims to answer the following research questions; (i) What are the expected variabilities in different drought conditions over India in the future? (ii) How the population exposure to drought varies under different climate change and population scenarios? (iii) How is the total exposure attributed to the individual exposure (climate, population, and interaction) in future climate change scenarios? In this sense, the study is performed under four Shared Socioeconomic Pathways scenarios (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5) using thirteen Global Climate Models from Coupled Model Intercomparison Project Phase 6 and Standardized Precipitation Evapotranspiration Index as a drought indicator. The future period is divided into two parts i.e., 2023-2061 (T1) and 2062-2100 (T2), and compared with the historical period during 1967-2005. The results show that the severe (56 % to 72 % of the area) and extreme (99 % of the area) droughts are likely to increase under all the scenarios for 3-month scale conditions, respectively. The drought intensity is projected to increase under 3-and 12-month scale drought conditions. The population exposure to the extreme drought severity is anticipated to increase for both the drought conditions and the highest exposure is noticed under the SSP3-7.0 scenario. The significant contribution from climate or interaction effects is observed in the case of 3- and 9-month scale extreme drought conditions. The present study necessitates a call for effective measures to alleviate the risk, especially in the high-risk areas of India., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

In the Sub-Himalayan foothills region of eastern India, floods are considered the most powerful annually occurring natural disaster, which cause severe losses to the socio-economic life of the inhabitants. Therefore, the present study integrated geographic information system (GIS) and three comprehensive and systematic multicriteria decision-making (MCDM) techniques such as Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), Vise Kriterijumska Optimizacijaik Ompromisno Resenje (VIKOR), and Evaluation Based on Distance from Average Solution (EDAS) in Koch Bihar district for comparative assessment of the flood-susceptible zones. The multi-dimensional 21 indicators were considered, and multicollinearity statistics were employed to erase the issues regarding highly correlated parameters (i.e., MFI and long-term annual rainfall). Results of MCDM models depicted that the riparian areas and riverine "chars" (islands) are the most susceptible sectors, accounting for around 40% of the total area. The microlevel assessment revealed that flooding was most susceptible in the Tufanganj-I, Tufanganj-II, and Mathabhanga-I blocks, while Haldibari, Sitalkuchi, and Sitai blocks were less susceptible. Spearman's rank (r s ) tests among the three MCDM models revealed that TOPSIS-EDAS persisted in a high correlation (r s = 0.714) in contrast to the relationships between VIKOR-EDAS (r s = 0.651) and TOPSIS-VIKOR (r s = 0.639). The model's efficiency was statistically judged by applying the receiver operating characteristic-area under the curve (ROC-AUC), mean absolute error (MAE), mean square error (MSE), and root mean square error (RMSE) techniques to recognize the better-suited models for mapping the flood susceptibility. The performance of all techniques is found good enough (ROC-AUC =  > 0.700 and MAE, MSE and RMSE =  < 0.300). However, TOPSIS and VIKOR have manifested an excellent outcome and are highly recommended for identifying flood susceptibility in such active flood-prone areas. Thus, this kind of study addresses the role of GIS in the construction of the flood susceptibility of the region and the performance of the respective models in a very lucid manner., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors., Methods: We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai., Results: SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3)., Conclusions: While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Social exclusion has far-reaching consequences that extend beyond regular activities and access to resources and knowledge; social exclusion is a major social determinant of health. However, there is a lack of evidence on social exclusion and health outcomes among India's older adults. Thus, the current study investigates the association of social exclusion with depressive symptoms among Indian older adults., Methods: This study used information on 30,366 older adults from Longitudinal Ageing Study in India (LASI) wave-1, 2017-2018. Social exclusion scores were calculated, and two broad domains of social exclusion, i.e., exclusion from civic activity & social relations and exclusion from services, were considered in the study. The depressive symptom was calculated using the CES-D score. Using logistic regression models, the average marginal effects of selected covariates and domains of social exclusion on depressive symptoms were estimated to assess the links between social exclusion and depressive symptoms., Results: With the increase in the social exclusion score in the selected domains, the prevalence of depressive symptoms among older also increased. Elderly persons who do not vote or live alone in the domain of being excluded from civic & social activities and older adults excluded from services were observed to have a higher prevalence of depressive symptoms. Adjusting for sociodemographic factors, the average marginal effects suggested that older with four scores of civic activity & social relation exclusion, two scores of service exclusion and four scores of overall social exclusion were estimated to have a higher prevalence of depressive symptoms, respectively., Conclusions: This study's findings shed light on social exclusion and its relationship to depressive symptoms among older Indians. Older health care services should be expanded in breadth while also addressing social exclusion, resulting in considerable improvements in older individuals' mental health., (© 2022. The Author(s).)

We visited 1519 villages across 19 Indian states in 2009 to (a) count all health care providers and (b) elicit their quality as measured through tests of medical knowledge. We document three main findings. First, 75% of villages have at least one health care provider and 64% of care is sought in villages with 3 or more providers. Most providers are in the private sector (86%) and, within the private sector, the majority are 'informal providers' without any formal medical training. Our estimates suggest that such informal providers account for 68% of the total provider population in rural India. Second, there is considerable variation in quality across states and formal qualifications are a poor predictor of quality. For instance, the medical knowledge of informal providers in Tamil Nadu and Karnataka is higher than that of fully trained doctors in Bihar and Uttar Pradesh. Surprisingly, the share of informal providers does not decline with socioeconomic status. Instead, their quality, along with the quality of doctors in the private and public sector, increases sharply. Third, India is divided into two nations not just by quality of health care providers, but also by costs: Better performing states provide higher quality at lower per-visit costs, suggesting that they are on a different production possibility frontier. These patterns are consistent with significant variation across states in the availability and quality of medical education. Our results highlight the complex structure of health care markets, the large share of private informal providers, and the substantial variation in the quality and cost of care across and within markets in rural India. Measuring and accounting for this complexity is essential for health care policy in India., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

It is well understood that India is largely exposed to different climate extremes including floods, droughts, heat waves, among others. However, the exposure of co-occurrence of these events is still unknown. The present analysis, first study of its kind, provides the projected changeability of five different compound extremes under three different emission scenarios (SSP2-4.5, SSP3-7.0, and SSP5-8.5). These changes are combined with population projection under SSP2, SSP3, and SSP5 scenarios to examine the total exposure in terms of number of persons exposed during 2021-2060 (T1) and 2061-2100 (T2). Here, the outputs from thirteen GCMs are used under CMIP6 experiment. The findings from the study show that all the compound extremes are expected to increase in future under all the emission scenarios being greater in case of SSP5-8.5. The population exposure is highest (2.51- to 4.96-fold as compared to historical) under SSP3-7.0 scenario (2021-2100 i.e., T1 and T2) in case of coincident heat waves and droughts compound extreme. The total exposure in Central Northeast India is projected to be the highest while Hilly Regions are likely to have the lowest exposure in future. The increase in the exposure is mainly contributed from climate change, population growth and their interaction depending on different kinds of compound extremes. The findings would help in devising sustainable policy strategies to climate mitigation and adaptation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The novel SARS-CoV-2 virus, as it manifested in India in April 2020, showed marked heterogeneity in its transmission. Here, we used data collected from contact tracing during the lockdown in response to the first wave of COVID-19 in Punjab, a major state in India, to quantify this heterogeneity, and to examine implications for transmission dynamics. We found evidence of heterogeneity acting at multiple levels: in the number of potentially infectious contacts per index case, and in the per-contact risk of infection. Incorporating these findings in simple mathematical models of disease transmission reveals that these heterogeneities act in combination to strongly influence transmission dynamics. Standard approaches, such as representing heterogeneity through secondary case distributions, could be biased by neglecting these underlying interactions between heterogeneities. We discuss implications for policy, and for more efficient contact tracing in resource-constrained settings such as India. Our results highlight how contact tracing, an important public health measure, can also provide important insights into epidemic spread and control., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Mendelian Susceptibility to Mycobacterial diseases (MSMD) are a group of innate immune defects with more than 17 genes and 32 clinical phenotypes identified. Defects in the IFN-γ mediated immunity lead to an increased susceptibility to intracellular pathogens like mycobacteria including attenuated Mycobacterium bovis -Bacillus Calmette-Guérin (BCG) vaccine strains and non-tuberculous environmental mycobacteria (NTM), Salmonella , fungi, parasites like Leishmania and some viruses, in otherwise healthy individuals. Mutations in the IL12RB1 gene are the commonest genetic defects identified. This retrospective study reports the clinical, immunological, and molecular characteristics of a cohort of 55 MSMD patients from 10 centers across India. Mycobacterial infection was confirmed by GeneXpert, Histopathology, and acid fast bacilli staining. Immunological workup included lymphocyte subset analysis, Nitro blue tetrazolium (NBT) test, immunoglobulin levels, and flow-cytometric evaluation of the IFN-γ mediated immunity. Genetic analysis was done by next generation sequencing (NGS). Disseminated BCG-osis was the commonest presenting manifestation (82%) with a median age of presentation of 6 months due to the practice of BCG vaccination at birth. This was followed by infection with Salmonella and non-typhi Salmonella (13%), Cytomegalovirus (CMV) (11%), Candida (7%), NTM (4%), and Histoplasma (2%). Thirty-six percent of patients in cohort were infected by more than one organism. This study is the largest cohort of MSMD patients reported from India to the best of our knowledge and we highlight the importance of work up for IL-12/IL-23/ISG15/IFN-γ circuit in all patients with BCG-osis and suspected MSMD irrespective of age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Taur, Gowri, Pandrowala, Iyengar, Chougule, Golwala, Chandak, Agarwal, Keni, Dighe, Bodhanwala, Prabhu, George, Fouzia, Edison, Arunachalam, Madkaikar, Dalvi, Yadav, Bargir, Kambli, Rawat, Das, Joshi, Pilania, Jindal, Bhat, Bhattad, Unni, Radhakrishnan, Raj, Uppuluri, Patel, Lashkari, Aggarwal, Kalra, Udwadia, Bafna, Kanade, Puel, Bustamante, Casanova and Desai.)

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2., Competing Interests: The authors have declared that no competing interests exist.

Leptospirosis is a re-emerging bacterial zoonosis caused by pathogenic Leptospira, with a worldwide distribution and becoming a major public health concern. Prophylaxis of this disease is difficult due to several factors such as non-specific variable clinical manifestation, presence of a large number of serovar, species and asymptomatic reservoir hosts, lack of proper diagnostics and vaccines. Despite its global importance and severity of the disease, knowledge about the molecular mechanism of pathogenesis and evolution of pathogenic species of Leptospira remains limited. In this study, we sequenced and analyzed three highly pathogenic species of Indian isolates of Leptospira (interrogans, santarosai, and kirschneri). Additionally, we identified some virulence-related and CRISPR-Cas genes. The virulent analysis showed 232 potential virulence factors encoding proteins in L. interrogans strain Salinem and L. santarosai strain M-4 genome. While the genome of L. kirschneri strain Wumalasena was predicted to encode 198 virulence factor proteins. The variant calling analysis revealed 1151, 19,786, and 22,996 single nucleotide polymorphisms (SNPs) for L. interrogans strain Salinem, L. kirschneri strain Wumalasena and L. santarosai strain M-4, respectively, with a maximum of 5315 missense and 12,221 synonymous mutations for L. santarosai strain M-4. The structural analyses of genomes indicated potential evidence of inversions and structural rearrangment in all three genomes. The availability of these genome sequences and in silico analysis of Leptospira will provide a basis for a deeper understanding of their molecular diversity and pathogenesis mechanism, and further pave a way towards proper management of the disease., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients' underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions., Methods: Secondary analyses of data from nine SP studies were performed to estimate the proportion of SP-provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overprescribing by healthcare sector, location, provider qualification and case. The WHO Access-Watch-Reserve framework was used to categorise antibiotics based on their potential for selecting resistance. As richer data were available from India, we examined factors associated with antibiotic overuse in that country through hierarchical Poisson models., Results: Across health facilities, antibiotics were given inappropriately in 2392/4798 (49.9%, 95% CI 40.8% to 54.5%) interactions in India, 83/166 (50.0%, 95% CI 42.2% to 57.8%) in Kenya and 259/899 (28.8%, 95% CI 17.8% to 50.8%) in China. Prevalence ratios of antibiotic overuse in India were significantly lower in urban versus rural areas (adjusted prevalence ratio (aPR) 0.70, 95% CI 0.52 to 0.96) and higher for qualified versus non-qualified providers (aPR 1.55, 95% CI 1.42 to 1.70), and for presumptive TB cases versus other conditions (aPR 1.19, 95% CI 1.07 to 1.33). Access antibiotics were predominantly used in Kenya (85%), but Watch antibiotics (mainly quinolones and cephalosporins) were highly prescribed in India (47.6%) and China (32.9%)., Conclusion: Good-quality SP data indicate alarmingly high levels of antibiotic overprescription for key conditions across primary care settings in India, China and Kenya, with broad-spectrum agents being excessively used in India and China., Competing Interests: Competing interests: MP is on the editorial boards of BMJ Global Health. All other authors declare that they have no conflicts of interest., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

In this Minireview, the importance and implementation of green chemistry practices in the pharmaceutical industry are illustrated. With notable examples, some of the most important industrial organic transformations are discussed along with their applications in the synthesis of drug molecules. A brief comparison between traditional unsustainable methods and modern green methods is made to shed light on the economic and environmental benefits of greener methods. Finally, green chemistry practices in the pharmaceutical industries of India and China are also discussed., (© 2020 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Gymnema sylvestre is a highly valuable medicinal plant in traditional Indian system of medicine and used in many polyherbal formulations especially in treating diabetes. However, the lack of genomic resources has impeded its research at molecular level. The present study investigated functional gene profile of G. sylvestre via RNA sequencing technology. The de novo assembly of 88.9 million high quality reads yielded 23,126 unigenes, of which 18116 were annotated against databases such as NCBI nr database, gene ontology (GO), KEGG, Pfam, CDD, PlantTFcat, UniProt & GreeNC. Total 808 unigenes mapped to 78 different Transcription Factor families, whereas 39 unigenes assigned to CYP450 and 111 unigenes coding for enzymes involved in the biosynthesis of terpenoids including transcripts for synthesis of important compounds like Vitamin E, beta-amyrin and squalene. Among them, presence of six important enzyme coding transcripts were validated using qRT-PCR, which showed high expression of enzymes involved in methyl-erythritol phosphate (MEP) pathway. This study also revealed 1428 simple sequence repeats (SSRs), which may aid in molecular breeding studies. Besides this, 8 putative long non-coding RNAs (lncRNAs) were predicted from un-annotated sequences, which may hold key role in regulation of essential biological processes in G. sylvestre. The study provides an opportunity for future functional genomic studies and to uncover functions of the lncRNAs in G. sylvestre.

Flow cytometry has emerged as a useful technology that has facilitated our understanding of the human immune system. Primary immune deficiency disorders (PIDDs) are a heterogeneous group of inherited disorders affecting the immune system. More than 350 genes causing various PIDDs have been identified. While the initial suspicion and recognition of PIDDs is clinical, laboratory tools such as flow cytometry and genetic sequencing are essential for confirmation and categorization. Genetic sequencing, however, are prohibitively expensive and not readily available in resource constrained settings. Flow cytometry remains a simple, yet powerful, tool for multi-parametric analysis of cells. While it is confirmatory of diagnosis in certain conditions, in others it helps in narrowing the list of putative genes to be analyzed. The utility of flow cytometry in diagnosis of PIDDs can be divided into four major categories: (a) Enumeration of lymphocyte subsets in peripheral blood. (b) Detection of intracellular signaling molecules, transcription factors, and cytokines. (c) Functional assessment of adaptive and innate immune cells (e.g., T cell function in severe combined immune deficiency and natural killer cell function in familial hemophagocytic lymphohistiocytosis). (d) Evaluation of normal biological processes (e.g., class switching in B cells by B cell immunophenotyping). This review focuses on use of flow cytometry in disease-specific diagnosis of PIDDs in the context of a developing country., (Copyright © 2019 Rawat, Arora, Shandilya, Vignesh, Suri, Kaur, Rikhi, Joshi, Das, Mathew and Singh.)

C-C chemokine receptor type 5 (CCR5) serves as a co-receptor for Human immunodeficiency virus (HIV), enabling the virus to enter human CD4 T cells and macrophages. In the absence of CCR5, HIV strains that require CCR5 (R5 or M-tropic HIV) fail to successfully initiate infection. Various natural mutations of the CCR5 gene have been reported to interfere with the HIV-CCR5 interaction, which influences the rate of AIDS progression. Genetic characterization of the CCR5 gene in individuals from the National Capital Regions (NCRs) of India revealed several natural point mutations in HIV seropositive/negative individuals. Furthermore, we identified novel frame-shifts mutations in the CCR5 gene in HIV seronegative individuals, as well as the well reported CCR5Δ32 mutation. Additionally, we observed a number of mutations present only in HIV seropositive individuals. This is the first report to describe the genetic variations of CCR5 in individuals from the NCRs of India and demonstrates the utility of investigating understudied populations to identify novel CCR5 polymorphisms.

Background: In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice., Methods: We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender., Findings: Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76-1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification., Interpretation: Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India., Funding: Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: India has the highest burden of tuberculosis (TB). Although most patients with TB in India seek care from the private sector, there is limited evidence on quality of TB care or its correlates. Following our validation study on the standardized patient (SP) method for TB, we utilized SPs to examine quality of adult TB care among health providers with different qualifications in 2 Indian cities., Methods and Findings: During 2014-2017, pilot programs engaged the private health sector to improve TB management in Mumbai and Patna. Nested within these projects, to obtain representative, baseline measures of quality of TB care at the city level, we recruited 24 adults to be SPs. They were trained to portray 4 TB "case scenarios" representing various stages of disease and diagnostic progression. Between November 2014 and August 2015, the SPs visited representatively sampled private providers stratified by qualification: (1) allopathic providers with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees or higher and (2) non-MBBS providers with alternative medicine, minimal, or no qualifications. Our main outcome was case-specific correct management benchmarked against the Standards for TB Care in India (STCI). Using ANOVA, we assessed variation in correct management and quality outcomes across (a) cities, (b) qualifications, and (c) case scenarios. Additionally, 2 micro-experiments identified sources of variation: first, quality in the presence of diagnostic test results certainty and second, provider consistency for different patients presenting the same case. A total of 2,652 SP-provider interactions across 1,203 health facilities were analyzed. Based on our sampling strategy and after removing 50 micro-experiment interactions, 2,602 interactions were weighted for city-representative interpretation. After weighting, the 473 Patna providers receiving SPs represent 3,179 eligible providers in Patna; in Mumbai, the 730 providers represent 7,115 eligible providers. Correct management was observed in 959 out of 2,602 interactions (37%; 35% weighted; 95% CI 32%-37%), primarily from referrals and ordering chest X-rays (CXRs). Unnecessary medicines were given to nearly all SPs, and antibiotic use was common. Anti-TB drugs were prescribed in 118 interactions (4.5%; 5% weighted), of which 45 were given in the case in which such treatment is considered correct management. MBBS and more qualified providers had higher odds of correctly managing cases than non-MBBS providers (odds ratio [OR] 2.80; 95% CI 2.05-3.82; p < 0.0001). Mumbai non-MBBS providers had higher odds of correct management than non-MBBS in Patna (OR 1.79; 95% CI 1.06-3.03), and MBBS providers' quality of care did not vary between cities (OR 1.15; 95% CI 0.79-1.68; p = 0.4642). In the micro-experiments, improving diagnostic certainty had a positive effect on correct management but not across all quality dimensions. Also, providers delivered idiosyncratically consistent care, repeating all observed actions, including mistakes, approximately 75% of the time. The SP method has limitations: it cannot account for patient mix or care-management practices reflecting more than one patient-provider interaction., Conclusions: Quality of TB care is suboptimal and variable in urban India's private health sector. Addressing this is critical for India's plans to end TB by 2025. For the first time, we have rich measures on representative levels of care quality from 2 cities, which can inform private-sector TB interventions and quality-improvement efforts., Competing Interests: We have read the journal’s policy, and the authors of this manuscript have the following competing interests: MP is a member of the Editorial Boards of PLOS Medicine and PLOS ONE and is also an editor of the PLOS Tuberculosis Channel. MP previously served as a consultant to the Bill & Melinda Gates Foundation. The other authors have no competing interests to declare.

Health care providers without formal medical qualifications provide more than 70% of all primary care in rural India. Training these informal providers may be one way to improve the quality of care where few alternatives exist. We report on a randomized controlled trial assessing a program that provided 72 sessions of training over 9 months to 152 informal providers (out of 304). Using standardized patients ("mystery clients"), we assessed clinical practice for three different conditions to which both providers and trainers were blinded during the intervention, representative of the range of conditions that these providers normally diagnose and treat. Training increased correct case management by 7.9 percentage points (14.2%) but did not affect the use of unnecessary medicines and antibiotics. At a program cost of $175 per trainee, our results suggest that multitopic medical training offers an effective short-run strategy to improve health care., (Copyright © 2016, American Association for the Advancement of Science.)

Background: Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients., Methods: We did a pilot, cross-sectional validation study of a convenience sample of consenting private health-care providers in low-income and middle-income areas of Delhi, India. We recruited standardised patients in apparently good health from the local community to present four cases (two of presumed tuberculosis and one each of confirmed tuberculosis and suspected multidrug-resistant tuberculosis) to a randomly allocated health-care provider. The key objective was to validate the standardised-patient method using three criteria: negligible risk and ability to avoid adverse events for providers and standardised patients, low detection rates of standardised patients by providers, and data accuracy across standardised patients and audio verification of standardised-patient recall. We also used medical vignettes to assess providers' knowledge of presumed tuberculosis. Correct case management was benchmarked using Standards for Tuberculosis Care in India (STCI)., Findings: Between Feb 2, and March 28, 2014, we recruited and trained 17 standardised patients who had 250 interactions with 100 health-care providers, 29 of whom were qualified in allopathic medicine (ie, they had a Bachelor of Medicine & Surgery [MBBS] degree), 40 of whom practised alternative medicine, and 31 of whom were informal health-care providers with few or no qualifications. The interactions took place between April 1, and April 23, 2014. The proportion of detected standardised patients was low (11 [5%] detected out of 232 interactions among providers who completed the follow-up survey), and standardised patients' recall correlated highly with audio recordings (r=0·63 [95% CI 0·53-0·79]), with no safety concerns reported. The mean consultation length was 6 min (95% CI 5·5-6·6) with a mean of 6·18 (5·72-6·64) questions or examinations completed, representing 35% (33-38) of essential checklist items. Across all cases, only 52 (21% [16-26]) of 250 were correctly managed. Correct management was higher among MBBS-qualified doctors than other types of health-care provider (adjusted odds ratio 2·41 [95% CI 1·17-4·93]; p=0·0166). Of the 69 providers who completed the vignette, knowledge in the vignettes was more consistent with STCI than their actual clinical practice-eg, 50 (73%) ordered a chest radiograph or sputum test during the vignette compared with seven (10%) during the standardised-patient interaction; OR 0·04 (95% CI 0·02-0·11); p<0·0001., Interpretation: Standardised patients can be successfully implemented to assess tuberculosis care. Our data suggest a big gap between private provider knowledge and practice. Additional work is needed to substantiate our pilot data, understand the know-do gap in provider behaviour, and to identify the best approach to measure and improve the quality of tuberculosis care in India., Funding: Grand Challenges Canada, the Bill & Melinda Gates Foundation, Knowledge for Change Program, and the World Bank Development Research Group., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Noncompliance to the DOTS regimen leads to treatment failure, relapse, MDR tuberculosis, XDR tuberculosis etc. requiring more prolonged & expensive therapy., Aim: To assess the adherence rate among pulmonary tuberculosis patients in west Tripura district and to study the factors affecting adherence to DOTS regimen among pulmonary tuberculosis patients., Material and Methods: This community based cross-sectional study was conducted among 220 pulmonary tuberculosis patients registered for treatment with DOTS therapy; under six randomly selected DMC of West Tripura District., Results: The study revealed that the adherence rate among the pulmonary TB patients was 84.50 percent. Male tuberculosis patients had 87.10 percent less chance of being adherent to the DOTS regimen in reference to females, and Cat I patients were 8.96 times (C.I. 2.689-29.857) more adherent to the therapy compared to the retreatment cases. Again, patients whose continuation phase was supervised as per the guidelines of DOTS were 12.07 times more adherent to the therapy. PTB patients who had the knowledge of supervised therapy in DOTS and curability of the disease, were 4.70 times (C.I. 1.39-15.79) and 9.39 times (C.I. 1.03-85.99) more adherent to the therapy, respectively., Conclusion: The study showed good adherence to the regimen among pulmonary tuberculosis patients in spite of being a difficult area. It may also help in planning and implementation of tuberculosis control measures by addressing and overcoming the barriers regarding treatment completion., (Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Minimally invasive approaches to kidney transplantation (KT) have been described recently. However, information concerning perioperative management in these patients is lacking. Accordingly, in the current study, we describe our perioperative management strategy in patients undergoing robotic KT with regional hypothermia and report its safety and efficacy. Further, we describe key 6-month outcomes in these patients., Methods: Sixty-seven consecutive end-stage renal disease patients underwent live-donor robotic KT at a single tertiary care institution between January 2013 and June 2014. Outcomes including patient/graft survival, graft function, operative parameters, and perioperative complications are reported in patients with a minimum of 6-month follow-up (n=54)., Results: All patients successfully underwent robotic KT with regional hypothermia using a modified intraoperative management protocol. None of the cases required conversion to open surgery (0%). Mean console, warm ischemia, and rewarming times were 130.8 minutes, 2.3 minutes and 42.9 minutes, respectively. Mean graft-surface temperature was 19.2°C with zero incidence of systemic hypothermia. Routine extraperitonealization of the graft insured against graft-torsion (0%) despite a transperitoneal approach to graft placement. There were no instances of graft vascular thromboses/stenoses/leaks (0%). Three patients (5.6%) developed clinical head-neck edema but were successfully extubated on table. There was no delayed graft function (0%). Mean 6-month serum creatinine was 1.2 mg/dL. Patient survival was 96.3% (n=52), and death-censored graft survival was 100% at a median follow-up of 13.4 months., Conclusions: Significant differences exist in intraoperative management of patients undergoing robotic KT and open KT. By tweaking fluid infusion rates and pneumatic pressures and maintaining core body temperature, optimal patient outcomes can be achieved. Pretransplant and posttransplant management is essentially the same.