Ageing in North East India, 3, Arunachal Pradesh perspectives
In: Ageing in North East India 3
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In: Ageing in North East India 3
In: Hoppe-Seyler´s Zeitschrift für physiologische Chemie, Volume 326, Issue Jahresband, p. 197-199
SSRN
Working paper
In: Journal of Nepal Health Research Council, Volume 7, Issue 2, p. 89-92
ISSN: 1999-6217
Background: Despite increasing numbers of MDR TB cases seen in Nepal, a lot remains to be understood about the disease in the local context. We evaluated possible risk factors for MDR TB among patients enrolled for treatment at a district hospital in western Nepal. Methods: A descriptive case-series study using structured interviews and abstraction of treatment records of all patients registered at the DOTS Plus clinic at Bhim Hospital, Bhairahawa from April 2008 to Dec 2008 was done. Descriptive analysis was done to find out frequencies and relations. Results: Of the total 31 patients, 22 were males (age range 18-68, median 36.7) and the remaining 9 females (age range 23-56, median 33.7). 27(87%) of the patients had monthly income below Rs 3000 and 24 (77%) of them were illiterate. 21(67%) had missed at least a few weeks of drugs during their previous treatment and 4 (13%) had been marked as defaulters. 6 (20%) had treatment failure. 74% of the patients were smokers, 2 were HIV positive. 20 (58%) had lived in India for at least 6 months where they had incomplete treatment of TB. 30 (97%) patients had disclosed their MDR status to their families; however 70% said they did not do so immediately. Conclusions: Previous TB treatment, male sex, poverty, migration to India, illiteracy and smoking have been observed in a majority of the cases in this study. These findings need to be corroborated with multi-centre casecontrol studies to bring out nationally relevant risk factors for MDR TB. Key words: directly observed treatment short course-plus; multi- drug resistance; risk factors; tuberculosis. DOI: 10.3126/jnhrc.v7i2.3013 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 89-92
SSRN
Working paper
In: Ridoutt , B , Pfister , S , Manzardo , A , Bare , J , Boulay , A , Cherubini , F , Fantke , P , Frischknecht , R , Hauschild , M Z , Henderson , A , Jolliet , O , Levasseur , A , Margni , M , McKone , T , Michelsen , O , Mila i Canals , L , Page , G , Pant , R , Raugei , M , Sala , S & Verones , F 2016 , Mainstreaming life cycle thinking through a consistent approach to footprints . in Abstract book - EcoBalannce 2016 . 12th Biennial International Conference on Ecobalance 2016 , Kyoto , Japan , 03/10/2016 .
Over recent years, footprints have emerged as an important means of reporting environmental performance. Some individual footprints have become quite sophisticated in their calculation procedures. However, as an overallclass of environmental metrics they have been poorly defined, having a variety of conceptual foundations and an unclear relationship to LCA. The variety and sometimes contradictory approaches to quantification have also led to confusing and contradictory messages in the marketplace which have undermined their acceptance by industry and governments.In response, a task force operating under the auspices of the UNEP/SETAC Life Cycle Initiative project on environmental Life Cycle Impact Assessment has been working to develop generic guidance for developers of footprint metrics. The initial work involved forming a consensual position on the difference between footprints and existing LCA impact category indicators. In short, footprints are deemed to have a primary orientation toward society and nontechnical stakeholders and report only on selected topics of concern. On the other hand, LCA impact category indicators have a primary orientation toward technical stakeholders and report in relation to a larger framework designed for comprehensive evaluation of environmental performance and trade-offs. The task force has also developed a univers al footprint definition. In parallel to Area of Protection, we introduce Area of Concern. In the same way that LCA uses impact category indicators to assess impacts that follow a common cause-effect pathway toward Areas of rotection, ootprint metrics address Areas of Concern. The critical difference is that Areas of Concern are defined by the interests of stakeholders in society rather than the LCA community. In addition, Areas of Concern are stand-alone and not part of a framework intended for comprehensive environmental performance assessment. Accordingly, footprints are universally defined as metrics used to report life cycle assessment results addressing an Area of Concern.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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