| 51. |
- Jain, Prakhar, et al.
(författare)
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Linear actuator–based knee exoskeleton for stand–sit–stand motions: a bond graph approach
- 2022
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Ingår i: Simulation (San Diego, Calif.). - : Sage. - 0037-5497 .- 1741-3133. ; 98:8, s. 627-644
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Tidskriftsartikel (refereegranskat)abstract
- People with knee disorders often find it difficult to perform common mobility tasks, such as stand–sit–stand motions. High knee torque is required to complete such transitions, as the chances of toppling increase during these motions. Most of the existing conventional approaches, such as wheelchairs and crutches, have failed to provide complete independence to the users. Conversely, contemporary systems like lower body exoskeletons which are bulky, complex, and expensive do not specifically target the knee joint instead of assisting other joints. Hence, there is a need to aid the knee joint using a robotic knee exoskeleton capable of accurately providing the desired knee torque. In the present work, to assist the user in performing the stand–sit–stand motions, an electromyography sensor-based four-bar knee exoskeleton actuated by a linear actuator is proposed. The modeling of the complete exoskeleton is developed using bond graph technique, as the components exist in different energy domains and it is possible to frame a dynamic bond graph model using only kinematic equations. The prototype is fabricated, and experiments are carried out on an artificial limb to prove the efficacy of the design of the current knee exoskeleton. The assistive torque developed by the actuator at the knee joint of the exoskeleton is found to be suitable to assist the wearer. As a result, little effort is required by the wearer for performing the stand–sit–stand motions. The rotation of the thigh link of the developed exoskeleton was found to be suitable for performing the stand–sit–stand activity.
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| 52. |
- Kasundriya, Sunil Kumar, et al.
(författare)
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Incidence and Risk Factors for Severe Pneumonia in Children Hospitalized with Pneumonia in Ujjain, India
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:13
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Tidskriftsartikel (refereegranskat)abstract
- Childhood pneumonia is a major public health problem. The aim of this prospective hospital-based study is to determine the incidence and risk factors for community-acquired severe pneumonia in children in Ujjain, India. The study includes 270 children, 161 (60%) boys and 109 (40%) girls, aged between 2 months and 5 years with World Health Organization defined and radiologically confirmed severe pneumonia. Considering the 270 children, 64% (95% confidence interval (CI) 57.9-69.4) have severe pneumonia. The following are identified as risk factors for severe pneumonia from the generalized logistic regression model: Born premature (adjusted odds ratio (AOR) 7.50; 95% CI 2.22-25.31;p= 0.001); history of measles (AOR 6.35; 95% CI 1.73-23.30;p= 0.005); incomplete vaccination (AOR 2.66; 95% CI 1.09-6.48;p= 0.031); acyanotic congenital heart disease (AOR 9.21; 95% CI 2.29-36.99;p= 0.002); home treatment tried (AOR 3.84; 95% CI 1.42-10.39;p= 0.008); living in a kuchha house (AOR 3.89; 95% CI 1.51-10.01;p= 0.027); overcrowding (AOR 4.50; 95% CI 1.75-11.51;p= 0.002);poor ventilation in living area (AOR 16.37; 95% CI 4.67-57.38;p< 0.001); and practicing open defecation (AOR 16.92; 95% CI 4.95-57.85;p< 0.001). Awareness of these risk factors can reduce mortality due to severe pneumonia.
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| 53. |
- KC, Ashish, 1982-, et al.
(författare)
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Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal : A stepped-wedge cluster randomized controlled trial
- 2019
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Ingår i: PLoS Medicine. - : PUBLIC LIBRARY SCIENCE. - 1549-1277 .- 1549-1676. ; 16:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal. Methods and findings We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 +/- 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided. Conclusion These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.
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| 54. |
- KC, Ashish, 1982, et al.
(författare)
-
Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial.
- 2019
-
Ingår i: PLoS medicine. - : Public Library of Science (PLoS). - 1549-1676 .- 1549-1277. ; 16:9
-
Tidskriftsartikel (refereegranskat)abstract
- Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal.We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided.These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care.ISRCTN30829654.
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| 55. |
- KC, Ashish, 1982, et al.
(författare)
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Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal.
- 2020
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Ingår i: Maternal and child health journal. - : Springer Science and Business Media LLC. - 1573-6628 .- 1092-7875. ; 24:Suppl 1, s. 31-38
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Tidskriftsartikel (refereegranskat)abstract
- Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal.Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities.Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals.These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.
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| 56. |
- KC, Ashish, 1982, et al.
(författare)
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Trends for Neonatal Deaths in Nepal (2001-2016) to Project Progress Towards the SDG Target in 2030, and Risk Factor Analyses to Focus Action.
- 2020
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Ingår i: Maternal and child health journal. - : Springer Science and Business Media LLC. - 1573-6628 .- 1092-7875. ; 24:Suppl 1, s. 5-14
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Tidskriftsartikel (refereegranskat)abstract
- Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030.This study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016.In NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38; 95% confidence interval [CI] 1.20-9.55), followed by women who had no education (AOR 1.87; 95% CI 1.62-2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76; CI 95% 1.17-2.59), household air pollution (AOR 1.37; CI 95% 1.59-1.62), belonging to a poorest quintile (AOR 1.37; CI 95% 1.21-1.54), residing in a rural area (AOR 1.28; CI 95% 1.13-1.44), and having no toilet at home (AOR 1.21; CI 95% 1.06-1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067.Although neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families.
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| 57. |
- Khalil, Ibrahim, et al.
(författare)
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Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013 : Findings from the Global Burden of Disease Study 2013
- 2016
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Ingår i: American Journal of Tropical Medicine and Hygiene. - : American Society of Tropical Medicine and Hygiene. - 1476-1645 .- 0002-9637. ; 95:6, s. 1319-1329
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Tidskriftsartikel (refereegranskat)abstract
- Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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| 58. |
- Kishore, Kamal, et al.
(författare)
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Technological challenges in nanoparticle-modified geopolymer concrete : a comprehensive review on nanomaterial dispersion, characterization techniques and its mechanical properties
- 2023
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Ingår i: Case Studies in Construction Materials. - : Elsevier. - 2214-5095. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- The use of geopolymer-based concrete has many advantages over conventional cement concrete. Geopolymer, which derives its basic ingredients from industrial waste, has considerable opportunity to dump the industrial waste and reduce the carbon dioxide emissions that could be emitted during cement manufacturing. Geopolymer concrete is potentially suitable for structural engineering applications; however, its unskilled manufacturing leads to several deficits such as cracking, weak mechanical characteristics, and reduced serviceability of the geopolymer structures. Nanomaterials are now being applied and developed in the realm of materials, where they have shown strong filling effects on composite materials that significantly enhance the integrity of composite materials. Research into how nanomaterials might enhance the performance of geopolymer concrete (GPC) in engineering applications is gaining a lot of attention. The past literature revealed that the GPC characteristics can be enhanced by adding nanoparticles; thereby increasing its engineering applications in practical usage. This study highlighted the primary technical issues of nanomaterial-or modified GPC during the last decade in light of widespread fascination with the subject and the need to provide an up-to-date and comprehensive study for future related research. This review study has covered the most up-to-date information and data on geopolymer concrete, including its methods of dispersion, characterization methodologies, interface mechanisms of nanoparticles, and mechanical characteristics. Concurrently, the limitations and major issues associated with using nanomaterials to modify GPC in practical applications are thoroughly examined. Finally, the future potential and difficulties of this area of study are highlighted.
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| 59. |
- Kumar, Ashish, et al.
(författare)
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Contactless Cost-effective Polarizer for mm-Wave Dielectric Rod Waveguide
- 2022
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Ingår i: 2022 47TH INTERNATIONAL CONFERENCE ON INFRARED, MILLIMETER AND TERAHERTZ WAVES (IRMMW-THZ 2022). - : Institute of Electrical and Electronics Engineers (IEEE).
-
Konferensbidrag (refereegranskat)abstract
- We present a method to control the polarization of guided waves in a mm-wave dielectric rod waveguide. A pair of optical posts is situated on either side of the waveguide, and this markedly raises the cutoff of the undesired mode. The isolation is 20 dB over a frequency span from (55-87) GHz. This can be viewed as a proof-of-concept for reconfigurable, general-purpose polarization control and dispersion engineering in mm-wave and terahertz-range dielectric waveguides.
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| 60. |
- Kumar, Nitish, 1995-, et al.
(författare)
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Understanding the influence of microstructure on hot corrosion and erosion behavior of suspension plasma sprayed thermal barrier coatings
- 2021
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Ingår i: Surface & Coatings Technology. - : Elsevier BV. - 0257-8972 .- 1879-3347. ; 419
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Tidskriftsartikel (refereegranskat)abstract
- Thermal barrier coatings (TBCs) are bilayer systems comprising a 7–8 wt% yttria partially stabilized zirconia (YSZ) top coat deposited over a metallic bond coat. Suspension plasma spraying (SPS) is an advanced and attractive top coat processing technique due to its capability to yield a variety of microstructures, including the desired columnar microstructure for enhanced strain tolerance and durability. This work attempts to investigate the desirable microstructural features in an SPS processed TBCs to mitigate hot corrosion and minimize erosion related losses that are often responsible for coating degradation. SPS processed TBCs were deposited utilizing three different spray conditions to obtain distinct microstructural features (column density, interpass [IP] porosity bands, column width), porosity content, and mechanical properties. Apart from comprehensive characterization utilizing SEM, XRD and micro-indentation tests, the as-deposited TBCs were subjected to hot-corrosion tests in the presence of vanadium pentoxide and sodium sulfate as corrosive salts. Post-corrosion analysis revealed complete infiltration of the molten salts in all the investigated TBCs. However, the delamination cracks generated due to the infiltrated corrosive species were minimal in case of TBCs with higher fracture toughness. The differences in microstructure and mechanical properties also led to differences in erosion performance, with TBCs possessing minimal total porosity content and high fracture toughness best resisting erosion related damage. Post-erosion analysis revealed that the TBCs with higher fracture toughness and micro-hardness showed superior erosion resistance. Based on the erosion and corrosion results and subsequent post-mortem of failed specimens, plausible damage mechanisms are proposed. Findings from this work provide new insights on developing damage tolerant TBCs microstructures with enhanced durability when exposed to erosion and hot corrosion environments.
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