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Mallik G, Kabiraj A, Swain DK, Dash PP, Kumari P, Rath S. Entropy-driven nonequilibrium phonon-stimulated electron-phonon coupling in tin dioxide nanorods. Phys Rev E 2024; 109:024213. [PMID: 38491670 DOI: 10.1103/physreve.109.024213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/15/2024] [Indexed: 03/18/2024]
Abstract
Nonequilibrium (NEQ) phonon fluctuation in a nanosystem has been studied through the statistical assessment of the entropy-production and -consumption events in ultrasmall tin dioxide (SnO_{2}) nanorods. Size- and shape-dependent alteration in free energy leading to modulation of the probability distribution function of the phonon dynamics has been observed from the x-ray diffraction and Raman scattering characterizations. The Gallavotti-Cohen nonequilibrium fluctuation theorem has been utilized to qualitatively describe the aforementioned behaviors under the influence of a global flux. The observation of entropy consumption and thermodynamically favorable entropy-production events indicates the presence of NEQ fluctuations in the phonon modes. The effective energy scale of fluctuation in driven phonon modes, dissipating energy faster than relaxation time, is quantified on the order of nanojoules. From optical absorption and photoluminescence studies, the observation of the electron-phonon coupled state confirms the interaction of the NEQ phonons with electrons. The strength of the coupling has been estimated from the temperature-independent Barry center shift and found to be enhanced to 5.35. Valence band x-ray photoelectron spectroscopy and Fourier transformed infrared spectroscopy analyses reconcile NEQ phonon mediated alteration of the valence band density of states, activation of silent phonon modes, and superior excitonic transitions, suitable for the new generation of ultrafast quantum device applications.
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Affiliation(s)
- G Mallik
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni-752050, Khordha, Odisha, India
| | - A Kabiraj
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni-752050, Khordha, Odisha, India
| | - D K Swain
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni-752050, Khordha, Odisha, India
| | - P P Dash
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni-752050, Khordha, Odisha, India
| | - P Kumari
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni-752050, Khordha, Odisha, India
| | - S Rath
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni-752050, Khordha, Odisha, India
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Kabiraj A, Mallik G, Dash PP, Kumari P, Bandyopadhyay M, Rath S. Observation of non-equilibrium fluctuation in the shear-stress-driven hemoglobin aggregates. Eur Phys J E Soft Matter 2023; 46:131. [PMID: 38123828 DOI: 10.1140/epje/s10189-023-00389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Non-equilibrium fluctuations caused by the rearrangement of hemoglobin molecules into an aggregate state under shear stress have been investigated experimentally. The flow response under the shear stress (σ) corroborates the presence of contrasting aggregate and rejuvenation states governed by entropy production and consumption events. From the time-dependent shear rate fluctuation studies of aggregate states, the probability distribution function (PDF) of the rate of work done is observed to be spread from negative to positive values with a net positive mean. The PDFs follow the steady-state fluctuation theorem, even at a smaller timescale than that desired by the theorem. The behavior of the effective temperature (Teff) that emerges from a non-equilibrium fluctuation and interconnects with the structural restrictions of the aggregate state of our driven system is observed to be within the boundary of the thermodynamic uncertainty. The increase in Teff with the applied σ illustrates a phenomenal nonlinear power flux-dependent aggregating behavior in a classic bio-molecular-driven system.
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Affiliation(s)
- A Kabiraj
- Nanostructure and Soft Matter Physics Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, Bhubaneswar, 752050, India
| | - G Mallik
- Nanostructure and Soft Matter Physics Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, Bhubaneswar, 752050, India
| | - P P Dash
- Nanostructure and Soft Matter Physics Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, Bhubaneswar, 752050, India
| | - P Kumari
- Nanostructure and Soft Matter Physics Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, Bhubaneswar, 752050, India
| | - M Bandyopadhyay
- Statistical Mechanics Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, Bhubaneswar, 752050, India
| | - S Rath
- Nanostructure and Soft Matter Physics Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, Bhubaneswar, 752050, India.
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Iv NB, Jain K, Parikh A, Rath S, Suryanarayan U, Ratanchandani KK. Correlation of Dose Volume Parameters with Dysphagia and Pharyngeal Constrictor Muscle Thickness in Dysphagia Optimized IMRT. Int J Radiat Oncol Biol Phys 2023; 117:e566-e567. [PMID: 37785732 DOI: 10.1016/j.ijrobp.2023.06.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Reduced radiation dose to the pharyngeal constrictor muscles (PCM) using dysphagia optimized intensity-modulated RT (DO-IMRT) is associated with improved swallowing outcomes in oropharyngeal cancers (OPCs). Purpose was to evaluate the relationship between dose of radiation delivered and acute dysphagia in patients with OPC treated with IMRT, after delineation of PCM. MATERIALS/METHODS Twenty-five patients with newly diagnosed OPC who underwent definitive IMRT with concurrent cisplatin were included in the study. PCM mean dose < 50 Gy was used as the dose constraint. Target volume was divided into high, intermediate and low risk areas receiving doses in the range of 60-66 Gy, 54-58 Gy, 51-56 Gy in 30-33 fractions over 6-6.5 weeks, respectively. PCM dose-volume parameters were collected and logistic regression was used to analyze these data relative to percent weight loss during RT and duration of feeding tube use. Thickness of constrictor muscle in pre-treatment and 3 months post-therapy CT scan were assessed. Weekly assessment of dysphagia was based on RTOG toxicity gradings. Aim of the study was to evaluate the correlation between dysphagia grades with dose-volume parameters and PCM thickness. RESULTS Median age was 55.0 years (mean 54.3) with 24 males and stage II:III-16:9 patients. Dmean to PCM was 49.86 Gy (range 48.22 -57.63) with median Dmax of 70.24 Gy. For patients with dysphagia (grade ≥1), V50 ranged from 48.2-57.23%, while in those with no dysphagia, it ranged from 47.92-52.18 % (Mean 51.36%). Nine patients needed feeding tube after RT end. Median feeding tube duration was 64 days. The correlation between Dmean ≥ 50 Gy and dysphagia at 1st, 2nd, 3rd and 6th month was found statistically significant (p < 0.01). Table 1 shows the Pearson correlation and P-value of the dosimetric parameters with dysphagia. The correlation of V50 was found statistically significant with grade of dysphagia at 3rd and 6th month post-treatment (p<0.001). The mean thickness range and median thickness of constrictors before and 3 months after treatment were 1.8-3.2 mm, 2.4 mm, and 2.8-6.2 mm,4.1 mm, respectively. The increase in thickness of constrictor muscle correlated significantly (p<0.05) with dysphagia grades and also with V50, V60 and Dmean (p<0.001) but no statistical significance was seen with Dmax (p = 0.232). With a median follow-up of 18 months (range 7-24), 1-year actuarial local control was 92%. CONCLUSION DO-IMRT may prove beneficial in the OPC by preventing dysphagia and aspiration post therapy and hence improving the quality of life of patients. Dmean ≥ 50Gy, V50 > 51.4% and V60 > 35.5% are the parameters correlating significantly with dysphagia (p<0.001) and change in mean thickness of PCM (p<0.001).
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Affiliation(s)
- N Bathija Iv
- The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - K Jain
- The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - A Parikh
- The Gujarat Cancer and Research Institute, Ahmedabad, India
| | - S Rath
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - U Suryanarayan
- Department of Radiation Oncology, Gujarat Cancer Research Institute, Ahmedabad, India
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Haghparast-Bidgoli H, Ojha A, Gope R, Rath S, Pradhan H, Rath S, Kumar A, Nath V, Basu P, Copas A, Houweling TAJ, Minz A, Baskey P, Ahmed M, Chakravarthy V, Mahanta R, Palmer T, Skordis J, Nair N, Tripathy P, Prost A. Economic evaluation of participatory women's groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India. PLOS Glob Public Health 2023; 3:e0001128. [PMID: 37384595 DOI: 10.1371/journal.pgph.0001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/08/2023] [Indexed: 07/01/2023]
Abstract
An estimated 2.4 million newborn infants died in 2020, 80% of them in sub-Saharan Africa and South Asia. To achieve the Sustainable Development Target for neonatal mortality reduction, countries with high mortality need to implement evidence-based, cost-effective interventions at scale. Our study aimed to estimate the cost, cost-effectiveness, and benefit-cost ratio of a participatory women's groups intervention scaled up by the public health system in Jharkhand, eastern India. The intervention was evaluated through a pragmatic cluster non-randomised controlled trial in six districts. We estimated the cost of the intervention at scale from a provider perspective, with a 42-month time horizon for 20 districts. We estimated costs using a combination of top-down and bottom-up approaches. All costs were adjusted for inflation, discounted at 3% per year, and converted to 2020 International Dollars (INT$). Incremental cost-effectiveness ratios (ICERs) were estimated using extrapolated effect sizes for the impact of the intervention in 20 districts, in terms of cost per neonatal deaths averted and cost per life year saved. We assessed the impact of uncertainty on results through one-way and probabilistic sensitivity analyses. We also estimated benefit-cost ratio using a benefit transfer approach. Total intervention costs for 20 districts were INT$ 15,017,396. The intervention covered an estimated 1.6 million livebirths across 20 districts, translating to INT$ 9.4 per livebirth covered. ICERs were estimated at INT$ 1,272 per neonatal death averted or INT$ 41 per life year saved. Net benefit estimates ranged from INT$ 1,046 million to INT$ 3,254 million, and benefit-cost ratios from 71 to 218. Our study suggests that participatory women's groups scaled up by the Indian public health system were highly cost-effective in improving neonatal survival and had a very favourable return on investment. The intervention can be scaled up in similar settings within India and other countries.
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Affiliation(s)
| | - Amit Ojha
- Ekjut, Chakradharpur, Jharkhand, India
| | | | | | | | | | | | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, United Kingdom
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Akay Minz
- National Health Mission, Ranchi, Jharkhand, India
| | | | - Manir Ahmed
- National Health Mission, Ranchi, Jharkhand, India
| | | | | | - Tom Palmer
- Institute for Global Health, University College London, London, United Kingdom
| | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Audrey Prost
- Institute for Global Health, University College London, London, United Kingdom
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Harris-Fry H, Prost A, Beaumont E, Fivian E, Mohanty S, Parida M, Pradhan R, Sahu S, Padhan S, Mishra NK, Rath S, Rath S, Koniz-Booher P, Allen E, Kadiyala S. Intrahousehold power inequalities and cooperation: Unpacking household responses to nutrition-sensitive agriculture interventions in rural India. Matern Child Nutr 2023:e13503. [PMID: 36939121 DOI: 10.1111/mcn.13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
Nutrition-sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed-methods design to describe the links between household dynamics-specifically intrahousehold power inequalities and intrahousehold cooperation-and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster-randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross-sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision-making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family-centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate.
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Affiliation(s)
- Helen Harris-Fry
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Emma Beaumont
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Manoj Parida
- DCOR (Development Corner) Consulting Pvt. Ltd., Bhubaneswar, India
| | | | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | - Naba K Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | | | | | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Dey S, Anne S, Rath S, Nandhana R, Gulia S, Menon S, Rekhi B, Tandon S, Sable N, Baheti A, Popat P, Lavanya G. N, Jadhav S, Chopra S, Shylasree T, Deodhar K, Maheshwari A, Ghosh J, Gupta S. 67P Survival and reproductive outcomes of patients with malignant ovarian germ cell tumors, a retrospective analysis from a tertiary care center in India. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Shivhare V, Rath S, Rathod H, Dash NK, Parikh A, Suryanarayan Kunikullaya U. Analyzing the impact of close margins and extra-resection margins on failure rates in postoperative oral cavity cancers. Klin Onkol 2023; 37:467-472. [PMID: 38158236 DOI: 10.48095/ccko2023467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Postoperative oral cancers with close margins belong to medium- to high-risk category for local failure. During re-surgery for close margins, there is sufficient doubt as to whether the re-excised tissue is from the same region as the close margin. Therefore, we planned a retrospective review of these cases of close margins that were re-excised with extra-resection margins (ERMs). MATERIAL AND METHODS Details of 2011 oral cavity patients resected at our hospital were retrieved. Cases with close margins were segregated and the status of ERMs was noted. The postoperative histopathological details, radiotherapy details, and failure patterns in all these cases were documented. The primary objective of the study was to assess the overall survival (OS) and disease-free survival (DFS) in cases with ERMs. The secondary objective was to assess the local and regional control rates and variation with the number and status of close and ERMs. OS, DFS, and local failure rates were defined from the date of registration. Statistical analysis was performed with the SPSS statistical software package. All survival analyses were performed using the Kaplan-Meier method. Log-rank test was used to test the statistical significance. A P-value of 0.05 was considered statistically significant. RESULTS Sixty-four cases with a median age of 47 years (range: 29-76) were considered for the final analysis. The median follow-up was 40 months (range: 9.5-56.5). The 2-year OS and DFS rates were 91.5% and 88.5%, respectively. The crude local and regional failure rates were 10.9% and 3.1%, respectively. The 3-year locoregional control rate was 90.2%. The 2-year locoregional control rate for one close margin was significantly better as compared to more than one close margin (P = 0.049). No difference in survival and failure rates was found between the number of ERMs resected (one vs. two) and ≤ vs. > 3 mm close margin status. Two patients developed bone metastases. CONCLUSION The survival rates and locoregional control rates did not differ much between the groups that had one or more ERMs. However, the locoregional control rates were better in cases with one close margin as compared to those with more than one close margin. A larger study with longer follow-up is needed to detect statistically significant differences in outcomes and identify the factors that portend poor prognosis in these cases with close margins and ERMs.
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Bhatia K, Rath S, Pradhan H, Samal S, Copas A, Gagrai S, Rath S, Gope RK, Nair N, Tripathy P, Rose-Clarke K, Prost A. Effects of community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India (JIAH trial): A cluster-randomised controlled trial. SSM Popul Health 2022; 21:101330. [PMID: 36618545 PMCID: PMC9811248 DOI: 10.1016/j.ssmph.2022.101330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives To evaluate whether and how community youth teams facilitating participatory adolescent groups, youth leadership and livelihood promotion improved school attendance, dietary diversity, and mental health among adolescent girls in rural India. Design A parallel group, two-arm, superiority, cluster-randomised controlled trial with an embedded process evaluation. Setting intervention and participants 38 clusters (19 intervention, 19 control) in West Singhbhum district in Jharkhand, India. The intervention included participatory adolescent groups and youth leadership for boys and girls aged 10-19 (intervention clusters only), and family-based livelihood promotion (intervention and control clusters) between June 2017 and March 2020. We surveyed 3324 adolescent girls aged 10-19 in 38 clusters at baseline, and 1478 in 29 clusters at endline. Four intervention and five control clusters were lost to follow up when the trial was suspended due to the COVID-19 pandemic. Adolescent boys were included in the process evaluation only. Primary and secondary outcome measures Primary: school attendance, dietary diversity, and mental health; 12 secondary outcomes related to education, empowerment, experiences of violence, and sexual and reproductive health. Results In intervention vs control clusters, mean dietary diversity score was 4·0 (SD 1·5) vs 3·6 (SD 1·2) (adjDiff 0·34; 95%CI -0·23, 0·93, p = 0·242); mean Brief Problem Monitor-Youth (mental health) score was 12·5 (SD 6·0) vs 11·9 (SD 5·9) (adjDiff 0·02, 95%CI -0·06, 0·13, p = 0·610); and school enrolment rates were 70% vs 63% (adjOR 1·39, 95%CI 0·89, 2·16, p = 0·142). Uptake of school-based entitlements was higher in intervention clusters (adjOR 2·01; 95%CI 1·11, 3·64, p = 0·020). Qualitative data showed that the community youth team had helped adolescents and their parents navigate school bureaucracy, facilitated re-enrolments, and supported access to entitlements. Overall intervention delivery was feasible, but positive impacts were likely undermined by household poverty. Conclusions Participatory adolescent groups, leadership training and livelihood promotion delivered by a community youth team did not improve adolescent girls' mental health, dietary diversity, or school attendance in rural India, but may have increased uptake of education-related entitlements. Trial registration ISRCTN17206016.
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Affiliation(s)
- Komal Bhatia
- Institute for Global Health, University College London, London, UK,Corresponding author. Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
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Anuja I, Desurkar V, Juvekar N, Deshpande S, Gaidu J, Rath S. OPTIMIZATION OF ANAESTHETIC AND SURGICAL TIME SYNCHRONISED TO PERIOPERATIVE PROCESS FOR CARDIAC SURGICAL PATIENTS. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Gulia S, Kannan S, Ghosh J, Rath S, Maheshwari A, Gupta S. 181MO Secondary cytoreduction in platinum-sensitive relapsed ovarian cancer: An individual patient level meta-analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Verma S, Sapru S, Rath S, Khurana R, Rastogi M, Gandhi A, Mishra S, Srivastava A, Bharati A. A Study to Evaluate the Efficacy of Purely Accelerated 6 Fraction-per-Week Radiotherapy in Post-Operative Oral Cavity Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bajaj K, Vora D, Parab P, Shaikh H, Gulia S, Rath S, Bajpai J, Shet T, Desai S, Popat P, Rajan R, Nair N, Joshi S, Pathak R, Sarin R, Kembhavi Y, Rane S, Ghosh J, Badwe R, Gupta S. 23P Combination chemotherapy and hormone therapy (CHT) in patients with hormone receptor (HR) positive, HER2 negative metastatic breast cancer (MBC): A single-centre retrospective analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Kajawo S, Linn M, Maher M, Rath S, Fitzmaurice K, Brolly A, Buckley M. 222 TOWARDS A DELIRIUM FRIENDLY EMERGENCY DEPARTMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Delirium affects approx. 10-30 % of patients over the age of 65. Up to 70% of cases are missed in the Emergency Department (ED). Delirium results in increased morbidity, mortality, increased length of stay and decreased functional status with increased discharges to residential care centres. Delirium in the ED is an independent predictor of death within 6 months.
Methods
We completed an audit which showed 40% of those > 65 years of age in the ED were delirious and 60% of those had dementia. None of these had been identified as delirious prior to review. We have approx. 5,000 patients >75 years of age attending our ED annually (1/7th of presentations). This audit was used as a catalyst for our quality improvement project. We established a steering group with a small quality improvement sub-committee. We combed the literature, identified areas for improvement and costed our project. We also looked at reliance on 1:1 carers for those with delirium and potential benefits to patient, staff and management.
Results
We used the SPARK ignite programme as a means to gain momentum and also educate ourselves on business management and change management. We competed in the finals with our “delirium package” – focussing on orientation, stimulation, safety and education. These 4 pillars of delirium care have been shown to prevent delirium, reduce hospital stay for those with delirium and also augment their delirium cycle. Competing and winning a prize highlighted the importance of delirium care and brought our project to a bigger stage.
Conclusion
Due to our multi-disciplinary team composed of non-consultant hospital doctors, advanced nurse practitioners and occupational therapists, we have been able to introduce the national dementia programme for early identification of delirium in the emergency department. We now have a space for managing those with delirium and have received funding to put our package in place. This can be replicated in hospitals around the country highlighting the non-pharmacological treatments for delirium.
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Affiliation(s)
- S Kajawo
- University Hospital Kerry , Tralee, Ireland
| | - M Linn
- University Hospital Kerry , Tralee, Ireland
| | - M Maher
- University Hospital Kerry , Tralee, Ireland
| | - S Rath
- University Hospital Kerry , Tralee, Ireland
| | | | - A Brolly
- University Hospital Kerry , Tralee, Ireland
| | - M Buckley
- University Hospital Kerry , Tralee, Ireland
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Prost A, Harris‐Fry H, Mohanty S, Parida M, Krishnan S, Fivian E, Rath S, Nair N, Mishra NK, Padhan S, Pradhan R, Sahu S, Skordis J, Danton H, Koniz‐Booher P, Beaumont E, James P, Allen E, Elbourne D, Kadiyala S. Understanding the effects of nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutrition in rural Odisha, India: A mixed‐methods process evaluation. Maternal & Child Nutrition 2022; 18:e13398. [PMID: 35851750 PMCID: PMC9480959 DOI: 10.1111/mcn.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/14/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
A trial of three nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children's nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions' effects. We also examined how context affected implementation, mechanisms, and outcomes. We used data from intervention monitoring systems, review notes, trial surveys, 32 case studies with families (n = 91 family members), and 20 group discussions with women's group members and intervention workers (n = 181 and 32, respectively). We found that interventions were implemented with high fidelity. Groups reached around half of the mothers of children under 2 years. Videos and meetings increased women's knowledge, motivation and confidence to suggest or make changes to their diets and agricultural production. Families responded in diverse ways. Many adopted or improved rainfed homestead garden cultivation for consumption, which could explain gains in maternal and child dietary diversity seen in the impact evaluation. Cultivation for income was less common. This was often due to small landholdings, poor access to irrigation and decision‐making dominated by men. Interventions helped change norms about heavy work during pregnancy, but young women with little family support still did considerable work. Women's ability to shape cultivation, income and workload decisions was strongly influenced by support from male relatives. Future nutrition‐sensitive agriculture interventions could include additional flexibility to address families’ land, water, labour and time constraints, as well as actively engage with spouses and in‐laws. In rural eastern India, participatory videos and women's group meetings on agriculture and maternal and child nutrition increased women's knowledge, motivation and confidence to improve their and their children's diets. Given strong constraints linked to small landholdings, poor access to water and gender norms which meant that in‐laws' and husbands' assent or support were often required for cultivation decisions, many women responded to interventions by increasing rainfed homestead garden cultivation for consumption rather than cultivating for income. Women's and children's diets may have improved because of discussions about nutrition and an increase in homestead garden cultivation. These dietary changes alone were likely insufficient to improve women's and children's nutritional status. The interventions’ ability to influence the adoption of nutrition‐sensitive agriculture practices could be improved by being family‐centric: understanding women's decision‐making power in a family context, using tailored problem‐solving to address households' individual constraints to cultivation, and including women's husbands and in‐laws.
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Affiliation(s)
- Audrey Prost
- Institute for Global Health University College London London UK
| | - Helen Harris‐Fry
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | | | | | - Sneha Krishnan
- Jindal School of Environment and Sustainability Jindal Global University Haryana India
| | - Emily Fivian
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | | | | | - Naba K. Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT) Kendrapara India
| | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT) Kendrapara India
| | | | | | - Jolene Skordis
- Institute for Global Health University College London London UK
| | - Heather Danton
- JSI Research & Training Institute, Inc. Arlington Virginia USA
| | | | - Emma Beaumont
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Philip James
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | - Elizabeth Allen
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Diana Elbourne
- Department of Medical Statistics London School of Hygiene & Tropical Medicine London UK
| | - Suneetha Kadiyala
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
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Gulia S, Kannan S, Ghosh J, Rath S, Maheshwari A, Gupta S. Maintenance therapy with a poly(ADP-ribose) polymerase inhibitor in patients with newly diagnosed advanced epithelial ovarian cancer: individual patient data and trial-level meta-analysis. ESMO Open 2022; 7:100558. [PMID: 36007449 PMCID: PMC9588903 DOI: 10.1016/j.esmoop.2022.100558] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/29/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background We synthesize the efficacy and toxicity of poly(ADP-ribose) polymerase inhibitors (PARPis) in patients with newly diagnosed advanced ovarian cancer. Patients and methods We manually extracted individual patient data (IPD) for progression-free survival (PFS) from published survival curves of randomized controlled trials (RCTs) that compared PARPi versus placebo as maintenance therapy in first-line treatment, for whole study populations and subgroups, based on BRCA1/BRCA2 mutation (germline and/or somatic) and homologous recombination deficiency (HRD) status, using WebPlotDigitizer software. The respective PFS curves for each study and combined population were reconstructed from extracted IPD. The primary outcome was PFS in combined whole population and subgroups. Results In IPD analysis of combined population from three RCTs, with 2296 patients and 1287 events, PFS was significantly longer in PARPi versus placebo [median 20.4 (95% confidence interval (CI) 18.6-21.9) versus 14.9 (95% CI 13.9-16.5) months, respectively; hazard ratio (HR) 0.67, 95% CI 0.60-0.75; P < 0.001]. In IPD subgroup analyses from four eligible RCTs (2687 patients and 1485 events), median PFS was significantly longer in PARPi versus placebo arm, in the BRCA-mutated (45.7 versus 17.7 months, respectively; HR 0.38, 95% CI 0.32-0.46; P < 0.001), HRD-positive including BRCA-mutated (34.7 versus 17.9 months, respectively; HR 0.45, 95% CI 0.38-0.54; P < 0.001), and HRD positive excluding BRCA-mutated (22.3 versus 13.1 months, respectively; HR 0.47, 95% CI 0.34-0.65; P < 0.001) subgroups, but not in the HRD-negative (15.0 versus 11.3 months, respectively; HR 0.90, 95% CI 0.76-1.05; P = 0.75) subgroup. Results of trial-level meta-analysis were concordant with IPD analysis in whole population and subgroups. Conclusions Among newly diagnosed ovarian cancer patients, PARPi maintenance therapy significantly improves PFS in those with germline and/or somatic BRCA mutation and/or HRD-positive tumor but not in those with HRD-negative tumor. Maintenance PARPi resulted in significant PFS improvement in total population, but benefit varied in subgroups. PARPi showed PFS gain in BRCA-mutated (45.7 versus 17.7 m) and HRD-positive subgroups. No significant PFS benefit was seen in the HRD-negative subgroup (15.0 versus 11.3 months; P = 0.75). PARPi should be a standard treatment in newly diagnosed ovarian cancer patients except those with HRD-negative tumors.
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Affiliation(s)
- S Gulia
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - S Kannan
- Homi Bhabha National Institute, Mumbai, India; Biostatistics, Tata Memorial Centre, Mumbai, India
| | - J Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - S Rath
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - A Maheshwari
- Homi Bhabha National Institute, Mumbai, India; Gynecologic Oncology, Tata Memorial Centre, Mumbai, India
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
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Haghparast-Bidgoli H, Harris-Fry H, Kumar A, Pradhan R, Mishra NK, Padhan S, Ojha AK, Mishra SN, Fivian E, James P, Ferguson S, Krishnan S, O'Hearn M, Palmer T, Koniz-Booher P, Danton H, Minovi S, Mohanty S, Rath S, Rath S, Nair N, Tripathy P, Prost A, Allen E, Skordis J, Kadiyala S. Economic Evaluation of Nutrition-Sensitive Agricultural Interventions to Increase Maternal and Child Dietary Diversity and Nutritional Status in Rural Odisha, India. J Nutr 2022; 152:2255-2268. [PMID: 35687367 PMCID: PMC9535442 DOI: 10.1093/jn/nxac132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/01/2021] [Accepted: 06/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Economic evaluations of nutrition-sensitive agriculture (NSA) interventions are scarce, limiting assessment of their potential affordability and scalability. OBJECTIVES We conducted cost-consequence analyses of 3 participatory video-based interventions of fortnightly women's group meetings using the following platforms: 1) NSA videos; 2) NSA and nutrition-specific videos; or 3) NSA videos with a nutrition-specific participatory learning and action (PLA) cycle. METHODS Interventions were tested in a 32-mo, 4-arm cluster-randomized controlled trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) in the Keonjhar district, Odisha, India. Impacts were evaluated in children aged 0-23 mo and their mothers. We estimated program costs using data collected prospectively from expenditure records of implementing and technical partners and societal costs using expenditure assessment data collected from households with a child aged 0-23 mo and key informant interviews. Costs were adjusted for inflation, discounted, and converted to 2019 US$. RESULTS Total program costs of each intervention ranged from US$272,121 to US$386,907. Program costs per pregnant woman or mother of a child aged 0-23 mo were US$62 for NSA videos, US$84 for NSA and nutrition-specific videos, and US$78 for NSA videos with PLA (societal costs: US$125, US$143, and US$122, respectively). Substantial shares of total costs were attributable to development and delivery of the videos and PLA (52-69%) and quality assurance (25-41%). Relative to control, minimum dietary diversity was higher in the children who underwent the interventions incorporating nutrition-specific videos and PLA (adjusted RRs: 1.19 and 1.27; 95% CIs: 1.03-1.37 and 1.11, 1.46, respectively). Relative to control, minimum dietary diversity in mothers was higher in those who underwent NSA video (1.21 [1.01, 1.45]) and NSA with PLA (1.30 [1.10, 1.53]) interventions. CONCLUSION NSA videos with PLA can increase both maternal and child dietary diversity and have the lowest cost per unit increase in diet diversity. Building on investments made in developing UPAVAN, cost-efficiency at scale could be increased with less intensive monitoring, reduced startup costs, and integration within existing government programs. This trial was registered at clinicaltrials.gov as ISRCTN65922679.
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Affiliation(s)
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Naba Kishore Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapada, Odisha, India
| | - Shibananth Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapada, Odisha, India
| | | | - Sailendra Narayan Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapada, Odisha, India
| | - Emily Fivian
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philip James
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Sneha Krishnan
- Jindal School of Environment and Sustainability, OP Jindal Global University and ETCH Consultancy Services, Mumbai, Maharashtra, India
| | - Meghan O'Hearn
- Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Tom Palmer
- University College London, Institute for Global Health, London, United Kingdom
| | | | - Heather Danton
- SI Research & Training Institute, Inc. Arlington, VA, USA
| | - Sandee Minovi
- SI Research & Training Institute, Inc. Arlington, VA, USA
| | | | | | | | | | | | - Audrey Prost
- University College London, Institute for Global Health, London, United Kingdom
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jolene Skordis
- University College London, Institute for Global Health, London, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Bajpai J, Kashyap L, Vallathol D, Pathak R, Rath S, Sekar A, Mohanta S, Reddy A, Joshi S, Wadasadawala T, Nair N, Parmar V, Desai S, Shet T, Thakur M, Sarin R, Gupta S, Badwe R, Das A, Singh M. 100P Outcomes of non-metastatic triple negative breast cancers: Real-world data from a large Indian cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Chopra S, Mulani J, Singh M, Shinde A, Mittal P, Gurram L, Scaria L, A D, Kohle S, Rane P, Ghadi Y, Rath S, Ghosh J, Gulia S, Gupta S, Kinhikar R, Laskar S, Agarwal J. PD-0910 Early outcomes of abbreviated brachytherapy schedule for cervix cancer during COVID pandemic. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02989-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nalawala T, Rath S, Kunikullaya S, Ratanchandani K. PO-1097 Helium-Neon laser to treat radiation induced oral mucositis in oral cancer- A comparative study. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chopra S, Charnalia M, Mulani J, Popat P, Rath S, Gurram L, Mittal P, Boere I, Gupta S, Nout R. PO-1341 RECIST 1.1 in cervix cancer radiation and drug trials: Is there a difference in measured outcomes? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Malukar S, Kunikullaya U, Parikh A, Mehta M, Patel Shah S, Shivhare V, Rath S, Kulshrestha A, T A, Singh J, Dash N, Patel D. PO-1346 Single Institute Retrospective Audit of protracted hypo-fractionated RT in Advanced Carcinoma Cervix. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Mishra B, Rath S, Mohapatra P, Dutta A, Durgeshwar G, Vedala M, Panigrahi M, Bhuniya S. Tuberculosis and COVID 19: An epidemic submerged in the pandemic: A case series from Eastern India. Int J Infect Dis 2022. [PMCID: PMC8884738 DOI: 10.1016/j.ijid.2021.12.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Nair N, Tripathy PK, Gope R, Rath S, Pradhan H, Rath S, Kumar A, Nath V, Basu P, Ojha A, Copas A, Houweling TA, Haghparast-Bidgoli H, Minz A, Baskey P, Ahmed M, Chakravarthy V, Mahanta R, Prost A. Effectiveness of participatory women's groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial. BMJ Glob Health 2021; 6:bmjgh-2021-005066. [PMID: 34732513 PMCID: PMC8572384 DOI: 10.1136/bmjgh-2021-005066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/08/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The WHO recommends community mobilisation with women's groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers. METHODS We did a pragmatic cluster non-randomised controlled trial of women's groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand's 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017-31 August 2017) and evaluation periods (1 September 2017-31 August 2019). The primary outcome was neonatal mortality. RESULTS We identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand's 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026-max: 20 527) over 42 months, and cost 41 international dollars per life year saved. CONCLUSION Participatory women's groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings. TRIAL REGISTRATION ISRCTN99422435.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Tanja Aj Houweling
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Akay Minz
- Jharkhand State Health Mission, Ranchi, India
| | | | - Manir Ahmed
- Jharkhand State Health Mission, Ranchi, India
| | | | | | - Audrey Prost
- Institute for Global Health, University College London, London, UK
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Ratanchandani K, Kunikullaya S, Parikh A, Mehta M, Patel S, Shivhare V, Rath S, Modi V, Jain H, Anand D, Bathija N. PO-1038 Radiotherapy with Temozolomide for Pediatric Glioblastoma:A single institute retrospective analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bathija N, Rathod H, Kunikullaya S, Parikh A, Mehta M, Patel S, Shivhare V, Rath S, Modi V, Jain H, Anand D, Ratanchandani K. PO-1211 Intraluminal brachytherapy boost in esophageal cancer: A single institute retrospective analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Harris-Fry H, O'Hearn M, Pradhan R, Krishnan S, Nair N, Rath S, Rath S, Koniz-Booher P, Danton H, Aakesson A, Pradhan S, Mishra NK, Kumar A, Upadhay A, Prost A, Kadiyala S. How to design a complex behaviour change intervention: experiences from a nutrition-sensitive agriculture trial in rural India. BMJ Glob Health 2021; 5:bmjgh-2020-002384. [PMID: 32513863 PMCID: PMC7282327 DOI: 10.1136/bmjgh-2020-002384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022] Open
Abstract
Many public health interventions aim to promote healthful behaviours, with varying degrees of success. With a lack of existing empirical evidence on the optimal number or combination of behaviours to promote to achieve a given health outcome, a key challenge in intervention design lies in deciding what behaviours to prioritise, and how best to promote them. We describe how key behaviours were selected and promoted within a multisectoral nutrition-sensitive agriculture intervention that aimed to address maternal and child undernutrition in rural India. First, we formulated a Theory of Change, which outlined our hypothesised impact pathways. To do this, we used the following inputs: existing conceptual frameworks, published empirical evidence, a feasibility study, formative research and the intervention team’s local knowledge. Then, we selected specific behaviours to address within each impact pathway, based on our formative research, behaviour change models, local knowledge and community feedback. As the intervention progressed, we mapped each of the behaviours against our impact pathways and the transtheoretical model of behaviour change, to monitor the balance of behaviours across pathways and along stages of behaviour change. By collectively agreeing on definitions of complex concepts and hypothesised impact pathways, implementing partners were able to communicate clearly between each other and with intervention participants. Our intervention was iteratively informed by continuous review, by monitoring implementation against targets and by integrating community feedback. Impact and process evaluations will reveal whether these approaches are effective for improving maternal and child nutrition, and what the effects are on each hypothesised impact pathway.
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Affiliation(s)
- Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
| | | | - Sneha Krishnan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | | | - Audrey Prost
- University College London Institute of Child Health, London, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Kadiyala S, Harris-Fry H, Pradhan R, Mohanty S, Padhan S, Rath S, James P, Fivian E, Koniz-Booher P, Nair N, Haghparast-Bidgoli H, Mishra NK, Rath S, Beaumont E, Danton H, Krishnan S, Parida M, O'Hearn M, Kumar A, Upadhyay A, Tripathy P, Skordis J, Sturgess J, Elbourne D, Prost A, Allen E. Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial. Lancet Planet Health 2021; 5:e263-e276. [PMID: 33811818 PMCID: PMC8099729 DOI: 10.1016/s2542-5196(21)00001-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Almost a quarter of the world's undernourished people live in India. We tested the effects of three nutrition-sensitive agriculture (NSA) interventions on maternal and child nutrition in India. METHODS We did a parallel, four-arm, observer-blind, cluster-randomised trial in Keonjhar district, Odisha, India. A cluster was one or more villages with a combined minimum population of 800 residents. The clusters were allocated 1:1:1:1 to a control group or an intervention group of fortnightly women's groups meetings and household visits over 32 months using: NSA videos (AGRI group); NSA and nutrition-specific videos (AGRI-NUT group); or NSA videos and a nutrition-specific participatory learning and action (PLA) cycle meetings and videos (AGRI-NUT+PLA group). Primary outcomes were the proportion of children aged 6-23 months consuming at least four of seven food groups the previous day and mean maternal body-mass index (BMI). Secondary outcomes were proportion of mothers consuming at least five of ten food groups and child wasting (proportion of children with weight-for-height Z score SD <-2). Outcomes were assessed in children and mothers through cross-sectional surveys at baseline and at endline, 36 months later. Analyses were by intention to treat. Participants and intervention facilitators were not blinded to allocation; the research team were. This trial is registered at ISRCTN, ISRCTN65922679. FINDINGS 148 of 162 clusters assessed for eligibility were enrolled and randomly allocated to trial groups (37 clusters per group). Baseline surveys took place from Nov 24, 2016, to Jan 24, 2017; clusters were randomised from December, 2016, to January, 2017; and interventions were implemented from March 20, 2017, to Oct 31, 2019, and endline surveys done from Nov 19, 2019, to Jan 12, 2020, in an average of 32 households per cluster. All clusters were included in the analyses. There was an increase in the proportion of children consuming at least four of seven food groups in the AGRI-NUT (adjusted relative risk [RR] 1·19, 95% CI 1·03 to 1·37, p=0·02) and AGRI-NUT+PLA (1·27, 1·11 to 1·46, p=0·001) groups, but not AGRI (1·06, 0·91 to 1·23, p=0·44), compared with the control group. We found no effects on mean maternal BMI (adjusted mean differences vs control, AGRI -0·05, -0·34 to 0·24; AGRI-NUT 0·04, -0·26 to 0·33; AGRI-NUT+PLA -0·03, -0·3 to 0·23). An increase in the proportion of mothers consuming at least five of ten food groups was seen in the AGRI (adjusted RR 1·21, 1·01 to 1·45) and AGRI-NUT+PLA (1·30, 1·10 to 1·53) groups compared with the control group, but not in AGRI-NUT (1·16, 0·98 to 1·38). We found no effects on child wasting (adjusted RR vs control, AGRI 0·95, 0·73 to 1·24; AGRI-NUT 0·96, 0·72 to 1·29; AGRI-NUT+PLA 0·96, 0·73 to 1·26). INTERPRETATION Women's groups using combinations of NSA videos, nutrition-specific videos, and PLA cycle meetings improved maternal and child diet quality in rural Odisha, India. These components have been implemented separately in several low-income settings; effects could be increased by scaling up together. FUNDING Bill & Melinda Gates Foundation, UK AID from the UK Government, and US Agency for International Development.
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Affiliation(s)
- Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | - Philip James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Naba Kishor Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | - Emma Beaumont
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sneha Krishnan
- Environment, Technology and Community Health Consultancy Service, Mumbai, India; Jindal School of Environment and Sustainability, Jindal Global University, Haryana, India
| | | | - Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Bajpai J, Pradeep V, Nandhana R, Mohanty S, Chougle Q, Engineer M, Rath S, Joshi S, Wadasadawala T, Popat P, Pathak R, Gulia S, Ghosh J, Bhargava P, Srinivas S, Shet T, Sarin R, Badwe R, Gupta S. 162P Unique challenges and outcomes of young breast cancers from a tertiary care cancer centre in India. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Rastogi M, Gandhi A, Khurana R, Hadi R, Sapru S, Mishra S, Srivastava A, Bharati A, Rath S, Nanda S, Singh H, Kumar S, Singh N, Husain N, Husain M, Singh D. PO-0862: Clinical outcome of anaplastic oligodendroglioma treated with adjuvant radiotherapy and temozolomide. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nanda S, Gandhi A, Rastogi M, Patni A, Khurana R, Hadi R, Sapru S, Rath S, Singh H, Kumar S, Singh N, Husain N. PO-0844: Worst pattern of invasion and its association with histopathological features in oral cavity cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00861-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gandhi A, Rastogi M, Rath S, Kumar S, Singh H, Khurana R, Hadi R, Agarwal A, Sharma V, Singhal A, Srivastva A, Bharati A, Mishra S, Hussain N. A Single Institutional Retrospective Analysis Of 116 Patients Of Post-Operative Buccal Mucosa Cancers Treated With Ipsilateral Radiotherapy Analyzing Predictors Of Failure. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rastogi M, Gandhi A, Singh H, Nanda S, Rath S, Khurana R, Hadi R, Mishra S, Srivastva A, Bharati A. Clinical Outcome And Toxicity Of Induction Followed By Definitive Concurrent Chemoradiotherapy With Weekly Paclitaxel Plus Carboplatin In Squamous Cell Carcinoma Of Esophagus Unsuitable For Surgery. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mandal T, Bajpai J, Kapoor A, Kumar A, Ghosh J, Gulia S, Rath S, Gupta S. 55P Eribulin in heavily pretreated metastatic breast cancer: A real-world data from India. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Srivastava S, Rastogi M, Gandhi A, Rath S, Pandey A, Masood S, Agarwal A, Singhal A, Khurana R, Hadi R, Sapru S, Srivastva A, Bharati A, Mishra S. Complete Pathological Response Rates and Outcome of Two Cycles Neoadjuvant Chemotherapy Followed by Long Course Concurrent Chemoradiotherapy in Patients of Locally Advanced Carcinoma Rectum. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patni A, Rastogi M, Gandhi A, Rath S, Nanda S, Khurana R, Hadi R, Sapru S, Srivastva A, Bharati A, Mishra S, Agarwal A. Clinico-Dosimetric Correlation Of Doses To Dysphagia Aspiration Related Structures (DARS) With Acute Toxicities In Post-Operative Patients Of Oral Cavity Carcinoma Treated With Dysphagia Optimized Versus Standard IMRT. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ghosh J, Agarwal P, Kapoor A, Philip D, Choudhary V, Bajpai J, Gulia S, Rath S, Maheshwari A, Chopra S, Mahantshetty U, Sable N, Popat P, Shetty N, Thakur M, Kulkarni S, Menon S, Rekhi B, Deodhar K, Jadhav S, Balsarkar G, Bansal V, Gupta S. Clinical, socioeconomic characteristics, treatment and reproductive outcomes of patients with gestational trophoblastic neoplasia at a tertiary care hospital in India. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nair N, Daruwalla N, Osrin D, Rath S, Gagrai S, Sahu R, Pradhan H, De M, Ambavkar G, Das N, Dungdung GP, Mohan D, Munda B, Singh V, Tripathy P, Prost A. Community mobilisation to prevent violence against women and girls in eastern India through participatory learning and action with women's groups facilitated by accredited social health activists: a before-and-after pilot study. BMC Int Health Hum Rights 2020; 20:6. [PMID: 32213182 PMCID: PMC7093987 DOI: 10.1186/s12914-020-00224-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
Background Almost one in three married Indian women have ever experienced physical, sexual, or emotional violence from husbands in their lifetime. We aimed to investigate the preliminary effects of community mobilisation through participatory learning and action groups facilitated by Accredited Social Health Activists (ASHAs), coupled with access to counselling, to prevent violence against women and girls in Jharkhand, eastern India. Methods We piloted a cycle of 16 participatory learning and action meetings with women’s groups facilitated by ASHAs in rural Jharkhand. Participants identified common forms of violence against women and girls, prioritised the ones they wanted to address, developed locally feasible strategies to address them, implemented the strategies, and evaluated the process. We also trained two counsellors and two ASHA supervisors to support survivors, and gave ASHAs information about legal, health, and police services. We did a before-and-after pilot study involving baseline and endline surveys with group members to estimate preliminary effects of these activities on the acceptability of violence, prevalence of past year emotional and physical violence, and help-seeking. Results ASHAs successfully conducted monthly participatory learning and action meetings with 39 women’s groups in 22 villages of West Singhbhum district, Jharkhand, between June 2016 and September 2017. We interviewed 59% (679/1149) of women registered with groups at baseline, and 63% (861/1371) at endline. More women reported that violence was unacceptable in all seven scenarios presented to them at endline compared to baseline (adjusted Odds Ratio [aOR]: 1.87, 95%: 1.39–2.52). Fewer women reported experiencing emotional violence from their husbands in the last 12 months (aOR: 0.55, 95% CI: 0.43–0.71), and more sought help if it occurred (aOR: 2.19, 95% CI: 1.51–3.17). In addition, fewer women reported experiencing emotional or physical violence from family members other than their husbands in the last 12 months (aOR: 0.41, 95% CI: 0.32–0.53, and aOR: 0.36, 95% CI: 0.26–0.50, respectively). Conclusion Combining participatory learning and action meetings facilitated by ASHAs with access to counselling was an acceptable strategy to address violence against women and girls in rural communities of Jharkhand. The approach warrants further implementation and evaluation as part of a comprehensive response to violence.
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Affiliation(s)
| | - Nayreen Daruwalla
- Society for Nutrition, Education and Health Action, Mumbai, Maharashtra, India
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | - Megha De
- Ekjut, Chakradharpur, Jharkhand, India
| | - Gauri Ambavkar
- Society for Nutrition, Education and Health Action, Mumbai, Maharashtra, India
| | - Nibha Das
- Ekjut, Chakradharpur, Jharkhand, India
| | | | - Damini Mohan
- Society for Nutrition, Education and Health Action, Mumbai, Maharashtra, India
| | | | | | | | - Audrey Prost
- Institute for Global Health, University College London, London, UK.
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Harris-Fry H, Krishnan S, Beaumont E, Prost A, Gouda S, Mohanty S, Pradhan R, Rath S, Rath S, Pradhan S, Mishra NK, Allen E, Kadiyala S. Agricultural and empowerment pathways from land ownership to women's nutrition in India. Matern Child Nutr 2020; 16:e12995. [PMID: 32196969 PMCID: PMC7507043 DOI: 10.1111/mcn.12995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
Abstract
Land size is an important equity concern for the design of ‘nutrition‐sensitive’ agricultural interventions. We unpack some of the pathways between land and nutrition using a cross‐sectional baseline survey data set of 4,480 women from 148 clusters from the ‘Upscaling Participatory Action and Videos for Agriculture and Nutrition’ trial in Keonjhar district in Odisha, India. Variables used are household ln‐land size owned (exposure) and maternal dietary diversity score out of 10 food groups and body mass index (BMI; kg/m2) (outcomes); and mediators investigated are production diversity score, value of agricultural production, and indicators for women's empowerment (decision‐making in agriculture, group participation, work‐free time and land ownership). We assessed mediation using a non‐parametric potential outcomes framework method. Land size positively affects maternal dietary diversity scores [β 0.047; 95% confidence interval (CI) (0.011, 0.082)] but not BMI. Production diversity, but not value of production, accounts for 17.6% of total effect mediated. We observe suppression of the effect of land size on BMI, with no evidence of a direct effect for either of the agricultural mediators but indirect effects of β −0.031 [95% CI (−0.048, −0.017)] through production diversity and β −0.047 [95% CI (−0.075, −0.021)] through value of production. An increase in land size positively affects women's decision‐making, which in turn negatively affects maternal BMI. The positive effect of work‐free time on maternal BMI is suppressed by the negative effect of household land size on work‐free time. Agriculture interventions must consider land quality, women's decision‐making and implications for women's workload in their design.
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Affiliation(s)
- Helen Harris-Fry
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sneha Krishnan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Beaumont
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Shibnath Pradhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Keonjhar, India
| | - Naba Kishore Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Keonjhar, India
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Rath S, Prost A, Samal S, Pradhan H, Copas A, Gagrai S, Rath S, Gope RK, Nair N, Tripathy P, Bhatia K, Rose-Clarke K. Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial. Trials 2020; 21:52. [PMID: 31915039 PMCID: PMC6950906 DOI: 10.1186/s13063-019-3984-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the health and development of adolescents aged 10-19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India's national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10-19 years in rural Jharkhand, eastern India. METHODS The JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents' confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10-19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience. TRIAL REGISTRATION ISRCTN17206016. Registered on 27 June 2018.
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Affiliation(s)
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | | | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | | | - Komal Bhatia
- Institute for Global Health, University College London, London, UK
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, Bush House NE Wing, London, WC2B 4BG, UK.
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Bhargava P, Shenoy R, Rathnasamy N, Gulia S, Bajpai J, Ghosh J, Rath S, Budrukkar A, Shet T, Patil A, Nair N, Popat P, Wadasadawala T, Sarin R, Kannan S, Badwe R, Gupta S. Clinical profile and outcome of HER2 positive breast cancer patients with brain metastases treated with HER2 targeted therapy: Real-world experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prost A, Nair N, Copas A, Pradhan H, Saville N, Tripathy P, Gope R, Rath S, Rath S, Skordis J, Bhattacharyya S, Costello A, Sachdev HS. Mortality and recovery following moderate and severe acute malnutrition in children aged 6-18 months in rural Jharkhand and Odisha, eastern India: A cohort study. PLoS Med 2019; 16:e1002934. [PMID: 31613883 PMCID: PMC6793843 DOI: 10.1371/journal.pmed.1002934] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent data suggest that case fatality from severe acute malnutrition (SAM) in India may be lower than the 10%-20% estimated by the World Health Organization (WHO). A contemporary quantification of mortality and recovery from acute malnutrition in Indian community settings is essential to inform policy regarding the benefits of scaling up prevention and treatment programmes. METHODS AND FINDINGS We conducted a cohort study using data collected during a recently completed cluster-randomised controlled trial in 120 geographical clusters with a total population of 121,531 in rural Jharkhand and Odisha, eastern India. Children born between October 1, 2013, and February 10, 2015, and alive at 6 months of age were followed up at 9, 12, and 18 months. We measured the children's anthropometry and asked caregivers whether children had been referred to services for malnutrition in the past 3 months. We determined the incidence and prevalence of moderate acute malnutrition (MAM) and SAM, as well as mortality and recovery at each follow-up. We then used Cox-proportional models to estimate mortality hazard ratios (HRs) for MAM and SAM. In total, 2,869 children were eligible for follow-up at 6 months of age. We knew the vital status of 93% of children (2,669/2,869) at 18 months. There were 2,704 children-years of follow-up time. The incidence of MAM by weight-for-length z score (WLZ) and/or mid-upper arm circumference (MUAC) was 406 (1,098/2,704) per 1,000 children-years. The incidence of SAM by WLZ, MUAC, or oedema was 190 (513/2,704) per 1,000 children-years. There were 36 deaths: 12 among children with MAM and six among children with SAM. Case fatality rates were 1.1% (12/1,098) for MAM and 1.2% (6/513) for SAM. In total, 99% of all children with SAM at 6 months of age (227/230) were alive 3 months later, 40% (92/230) were still SAM, and 18% (41/230) had recovered (WLZ ≥ -2 standard deviation [SD]; MUAC ≥ 12.5; no oedema). The adjusted HRs using all anthropometric indicators were 1.43 (95% CI 0.53-3.87, p = 0.480) for MAM and 2.56 (95% CI 0.99-6.70, p = 0.052) for SAM. Both WLZ < -3 and MUAC ≥ 11.5 and < 12.5 were associated with increased mortality risk (HR: 3.33, 95% CI 1.23-8.99, p = 0.018 and HR: 3.87, 95% CI 1.63-9.18, p = 0.002, respectively). A key limitation of our analysis was missing WLZ or MUAC data at all time points for 2.5% of children, including for two of the 36 children who died. CONCLUSIONS In rural eastern India, the incidence of acute malnutrition among children older than 6 months was high, but case fatality following SAM was 1.2%, much lower than the 10%-20% estimated by WHO. Case fatality rates below 6% have now been recorded in three other Indian studies. Community treatment using ready-to-use therapeutic food may not avert a substantial number of SAM-related deaths in children aged over 6 months, as mortality in this group is lower than expected. Our findings strengthen the case for prioritising prevention through known health, nutrition, and multisectoral interventions in the first 1,000 days of life, while ensuring access to treatment when prevention fails.
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Affiliation(s)
- Audrey Prost
- University College London, Institute for Global Health, London, United Kingdom
- Ekjut, Chakradharpur, Jharkhand, India
| | | | - Andrew Copas
- University College London, Institute for Global Health, London, United Kingdom
| | | | - Naomi Saville
- University College London, Institute for Global Health, London, United Kingdom
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Rath S, Gandhi A, Rastogi M, Pandey A, Noman K, Masood S, Chauhan S, Nanda S, Singh H, Khurana R, Hadi R, Bharati A, Srivastva A. Long Course Neoadjuvant Concurrent Chemo-Radiotherapy with or Without Pre-Radiation Induction Chemotherapy in the Management of Rectal Cancers: A Mono-Institutional Retrospective Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gandhi A, Rastogi M, Tiwari R, Khurana R, Hadi R, Sapru S, Rath S, Nanda S, Srivastva A, Bharati A, Mishra S. Prospective Evaluation of Definitive Chemoradiotherapy with Volumetric Modulated Arc Therapy (VMAT) in Patients of Muscle Invasive Carcinoma of Urinary Bladder Unsuitable for Radical Surgery. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Srivastava S, Sahni K, Rastogi M, Hussain N, Khurana R, Hadi R, Sapru S, Gandhi A, Mishra S, Srivastva A, Bharati A, Nanda S, Rath S, Singh H, Ahmad M, Parida S, Yadav U. Correlation of Toxicity and Response with PD-L1 Expression in Oropharyngeal Cancers Receiving Definitive Chemo-Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rose-Clarke K, Pradhan H, Rath S, Rath S, Samal S, Gagrai S, Nair N, Tripathy P, Prost A. Adolescent girls' health, nutrition and wellbeing in rural eastern India: a descriptive, cross-sectional community-based study. BMC Public Health 2019; 19:673. [PMID: 31151394 PMCID: PMC6544920 DOI: 10.1186/s12889-019-7053-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background India is home to 243 million adolescents. Two million (9%) of them belong to Scheduled Tribes living in underserved, rural areas. Few studies have examined the health of tribal adolescents. We conducted a cross-sectional survey to assess the health, nutrition and wellbeing of adolescent girls in rural Jharkhand, eastern India, a state where 26% of the population is from Scheduled Tribes. We aimed to identify priorities for community interventions to serve adolescents and their families. Methods Between June 2016 and January 2017, interviewers visited all households in 50 purposively sampled villages of West Singhbhum district, Jharkhand. They aimed to interview all girls aged 10–19. Interviewers conducted face-to-face interviews with girls to administer a survey about physical and mental health, disability, nutrition, sexual and reproductive health, gender norms, decision-making, education and violence. Interviewers also measured girls’ height, weight, and Mid-Upper Arm Circumference. Results Interviewers collected data from 3324 (82%) of an estimated 4068 girls residing in the study area. Their mean age was 14.3 (SD 2.9). 82% were from Scheduled Tribes. 89% of younger girls aged 10–14 and 46% of older girls aged 15–19 were in school or college. Girls dropped out of school because they were required for household work (37%) or work on the family farm or business (22%). Over a third reported symptoms of anaemia in the past month, but less than a fifth had a blood test. The prevalence of thinness (<−2SD median BMI for age and sex) was 14% for younger girls and 6% for older girls. 45% of girls were stunted (<−2SD median height for age and sex). 40% reported emotional violence in the past year, 14% physical violence, and 0.7% sexual violence. 12% had problems associated with depression or anxiety. 30% aged 15–19 had heard of contraception. Among married girls and their husbands, only 10% had ever used methods to prevent or delay pregnancy. Conclusions Our study identified several priorities to improve adolescent girls’ health, nutrition and wellbeing in largely tribal areas of Jharkhand: reducing violence, early marriage and undernutrition, as well as improving mental health, knowledge about contraception and school retention. Electronic supplementary material The online version of this article (10.1186/s12889-019-7053-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, Bush House NE Wing, London, WC2B 4BG, UK.
| | | | | | | | | | | | | | | | - Audrey Prost
- Institute for Global Health, University College London, London, UK
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Rastogi M, Gandhi A, Khurana R, Nanda S, Singh H, Rath S, Rai P, Kumar S, Bharati A, Srivastava A, Mishra S. EP-1485 Role of PET-CT in patients of recurrent carcinoma cervix treated with definitive chemoradiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Halder O, Satpati B, Rajput P, Mohapatra N, Jha SN, Suffczyński J, Pacuski W, Rath S. Light Emitting Spin Active Electronic States in Ultra-Thin Mn Doped CdSe Layered Nanosheets. Sci Rep 2019; 9:1804. [PMID: 30755677 PMCID: PMC6372604 DOI: 10.1038/s41598-019-38974-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
The layered nanosheets exhibit a variety of physical and optical properties originating from amalgamation of intra- and inter- layer electronic interactions, which makes them promising materials for advanced devices with varsatile controlling channels. In particular, the dilute magnetic semiconductor multilayered nanosheets have promising optical, electrical and magnetic properties that have been less explored so far. Here, the spin permissible optical properties from solvothermally grown Mn doped CdSe (thickness ~2.26 nm) multilayered nanosheets are reported on. The presence of multi-phase magnetic orderings with a sharp ferromagnetic transition at temperature ~48 K pertinent to the stabilization and co-existence of Mn2+ and Mn3+ based local phases have been observed from the (Cd,Mn)Se layered nanosheets corroborating to the x-ray absorption near edge structure, electron paramagnetic resonance, Raman scattering and magnetic measurements. The optical absorption and photoluminescence (PL) studies at room temperature affirm wide array of optical properties in the visible regime corresponding to the band edge and intriguing dopant-phase mediated spin approved transitions. The circularly polarized magneto-PL and life time analysis exhibits the spin-polarized fast radiative transitions confirming the presence of spin-active electronic states.
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Affiliation(s)
- O Halder
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, 752 050, Khurda, India
| | - B Satpati
- Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700 064, India
| | - P Rajput
- Atomic & Molecular Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai, 400085, India
| | - N Mohapatra
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, 752 050, Khurda, India
| | - S N Jha
- Atomic & Molecular Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai, 400085, India
| | - J Suffczyński
- Institute of Experimental Physics, Faculty of Physics, University of Warsaw, Pasteura 5 St., Warsaw, 02-093, Poland
| | - W Pacuski
- Institute of Experimental Physics, Faculty of Physics, University of Warsaw, Pasteura 5 St., Warsaw, 02-093, Poland
| | - S Rath
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Jatni, 752 050, Khurda, India.
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Hanumanta S, Shetty RM, Khandwal O, Rath S, Shetty SY, Diwan RK. Acquisition of Streptococcus mutans and dental caries experience in pediatric sickle cell anaemia patients under various prophylactic therapies. Eur Arch Paediatr Dent 2019; 20:409-415. [DOI: 10.1007/s40368-019-00415-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022]
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Rath S, Gandhi A, Rastogi M, Sahni K, Nanda S, Azam M, Singh H, Khurana R, Hadi R, Mishra S, Srivastva A, Farzana S. Patterns of Failure and Clinical Outcomes of Post-operative Buccal Mucosa Cancers Treated with Ipsilateral Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Singh H, Rastogi M, Gandhi A, Khurana R, Rath S, Nanda S, Sahni K, Hadi R, Mishra S, Srivastva A, Bharati A. Dosimetric Comparison of Volumetric Modulated Arc Therapy Versus 3-Dimensional Conformal Radiation Therapy in Post-Operative Patients of High Grade Glioma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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