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We developed this web based ‘Dysmetabolism-Risk Calculator’ after analysing 1800 individuals, who underwent ‘standard two hour 75 gram OGTT’ along with insulin levels. It calculates the basal and post-glucose indexes of insulin secretion (ISec), insulin resistance (IRes) and beta cell function (BCF), based on areas under the curve of both glucose (AUCg) and insulin (AUCi). It generates dynamic graphs of glucose and insulin along with population-norm values and determines various stages of dys-insulinemia, obesity, and diabetes. On the dysmetabolism time-line, ‘Euglycemic Hyperinsulinemia’ and ‘Midzone Hyperglycemia’, are specially important categories. These categories, characteristically, occur before ‘Prediabetes’ stage, (Pre-Prediabetes), and are known to be associated with increased cardio-vascular morbidity such as hypertension, dyslipidemia, endothelial dysfunction, and stroke. IRes is calculated using “AUCg*AUCi*k” formula. ISec and central IRes is calculated by measuring ‘rate of rise of insulin’ and the angle theta, which is subtended by the 30 min insulin curve with ‘x’ axis. Insulin disposal and peripheral IRes is determined by calculating angle zeta which is subtended by the 90-120 min insulin curve with ‘y’ axis. Disposition index (Isec*Ires*k) is calculated by the formula “1/(AUCg) 2”, which, noticeably, is independent of AUCi. The discordance between Insulin Secretion Index and OGTT Disposition Index will be useful in predicting the reversibility of diabetes and dysmetabolism. BMI, 0-30 & 90-120 min AUCis are used as parameters, while calculating the probable site of ‘Tissue IRes’. Cardio-Vascular risk calculations are based on hyperinsulinemia (as macrovascular risk), hyperglycemia (as microvascular risk), and their combination as they occur on dysmetabolism time-time.

Wind energy is one of the most abundantly available renewable energy, which is clean and promising source for electric energy conversion. Vertical Axis Wind Turbine (VAWT) possesses technological, environmental, and economic benefits over Horizontal Axis Wind Turbine. Thus, the present work investigates on the design and analysis of two airfoil profiles (NACA 0012 & NACA 0018) with VAWT using ANSYS Fluent 2020 R2 solver. The structural stability (deformation) of Aluminum blades at varied wind speeds throughout the energy conversion is the prime focus of the present work. Developed airfoil models showed the structural stability even at extreme pressure, with minimal deformation, stress and strain. The velocity and pressure contours at diverse wind speeds (3, 5 and 10 m/s) are analyzed. It is evident that, the turbine blade were with uniform rotation even under turbulent flow. The outcomes of the analysis on the developed models showed good agreement to predict the torque and power. Therefore, it can be practically implemented to form and join using Friction Stir Processing.

Background and objectiveCardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is, however, cheaper and more accessible. This study evaluated the ability of NPO indices to predict OSA in typically developing (TD) children.MethodsIndices from simultaneous NPO and CRP recordings were compared in TD children (aged 1–16 years) referred to evaluate OSA in three tertiary centres. OSA was defined as an obstructive apnoea–hypopnoea index (OAHI) ≥1 event/hour. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices including ODI3 (3% Oxygen Desaturation Index, ODI4 (4% Oxygen Desaturation Index), delta 12 s index and minimum oxygen saturation. Two-by-two tables were generated to determine the sensitivities and specificities of whole number cut-off values for predicting OAHIs ≥1, 5 and 10 events/hour.ResultsRecordings from 322 TD children, 197 male (61.2%), median age 4.9 years (range 1.1–15.6), were reviewed. OAHI was ≥1/hour in 144 (44.7%), ≥5/hour in 61 (18.9%) and ≥10/hour in 28 (8.7%) cases. ODI3 and ODI4 had the best diagnostic accuracy. ODI3 ≥7/hour and ODI4 ≥4/hour predicted OSA in TD children with sensitivities/specificities of 57.6%/85.4% and 46.2%/91.6%, respectively. ODI3 ≥8/hour was the best predictor of OAHI ≥5/hour (sensitivity 82.0%, specificity 84.3%).ConclusionRaised ODI3 and ODI4 predict OSA in TD children with high specificity but variable sensitivity. NPO may be an alternative to diagnose moderate-severe OSA if access to CRP is limited. Low sensitivities to detect mild OSA mean that confirmatory CRP is needed if NPO is normal.

BackgroundDirect-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.MethodsWe conducted an individually randomised controlled trial in four districts of Madhya Pradesh, India. Study participants included Hindi speaking women 4–7 months pregnant (n=5095) with access to a mobile phone and their husbands (n=3842). Women were randomised to either an intervention group where they received up to 72 Kilkari messages or a control group where they received none. Intention-to-treat (ITT) and instrumental variable (IV) analyses are presented.ResultsAn average of 65% of the 2695 women randomised to receive Kilkari listened to ≥50% of the cumulative content of calls answered. Kilkari was not observed to have a significant impact on the primary outcome of exclusive breast feeding (ITT, relative risk (RR): 1.04, 95% CI 0.88 to 1.23, p=0.64; IV, RR: 1.10, 95% CI 0.67 to 1.81, p=0.71). Across study arms, Kilkari was associated with a 3.7% higher use of modern reversible contraceptives (RR: 1.12, 95% CI 1.03 to 1.21, p=0.007), and a 2.0% lower proportion of men or women sterilised since the birth of the child (RR: 0.85, 95% CI 0.74 to 0.97, p=0.016). Higher reversible method use was driven by increases in condom use and greatest among those women exposed to Kilkari with any male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). Immunisation at 10 weeks was higher among the children of Kilkari listeners (2.8% higher; RR: 1.03, 95% CI 1.00 to 1.06, p=0.048). Significant differences were not observed for other maternal, newborn and child health outcomes assessed.ConclusionStudy findings provide evidence to date on the effectiveness of the largest mobile health messaging programme in the world.Trial registration numberTrial registration clinicaltrials.gov; ID 90075552, NCT03576157.

IntroductionKilkari is one of the world’s largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged.MethodsWe used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari’s calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices.ResultsWhile women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari’s recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding.ConclusionTo deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.

IntroductionImmunisation plays a vital role in reducing child mortality and morbidity against preventable diseases. As part of a randomised controlled trial in rural Madhya Pradesh, India to assess the impact of Kilkari, a maternal messaging programme, we explored determinants of parental immunisation knowledge and immunisation practice (completeness and timeliness) for children 0–12 months of age from four districts in Madhya Pradesh.MethodsData were drawn from a cross-sectional survey of women (n=4423) with access to a mobile phone and their spouses (n=3781). Parental knowledge about immunisation and their child’s receipt of vaccines, including timeliness and completeness, was assessed using self-reports and vaccination cards. Ordered logistic regressions were used to analyse the factors associated with parental immunisation knowledge. A Heckman two-stage probit model was used to analyse completeness and timeliness of immunisation after correcting for selection bias from being able to produce the immunisation card.ResultsOne-third (33%) of women and men knew the timing for the start of vaccinations, diseases linked to immunisations and the benefits of Vitamin-A. Less than half of children had received the basic package of 8 vaccines (47%) and the comprehensive package of 19 vaccines (44%). Wealth was the most significant determinant of men’s knowledge and of the child receiving complete and timely immunisation for both basic and comprehensive packages. Exposure to Kilkari content on immunisation was significantly associated with an increase in men’s knowledge (but not women’s) about child immunisation (OR: 1.23, 95% CI 1.02 to1.48) and an increase in the timeliness of the child receiving vaccination at birth (Probit coefficient: 0.08, 95% CI 0.08 to 0.24).ConclusionGaps in complete and timely immunisation for infants persist in rural India. Mobile messaging programmes, supported by mass media messages, may provide one important source for bolstering awareness, uptake and timeliness of immunisation services.Trial registration numberNCT03576157.

Khajnawar village in Saharanpur district of western Utter Pradesh is inhabited over the remains of an ancient archaeological settlement. Field observations and archaeological investigation reveal two periods of settlement: settlement I with grey ware and iron objects and settlement II with painted red ware. Radiocarbon and optical stimulated luminescence (OSL) dating indicate 2600a–1400a age for settlement I and 850a–350a for settlement II. A hiatus of ~550a between the two settlements may have been caused either by an earthquake or climate change. A south-facing and NW–SE trending scarp on the southern end of the Khajnawar has been interpreted as a tectonic scarp that is a continuation of the Piedmont Fault with right-step. The scarp should have formed due to an earlier earthquake that may have caused the hiatus. Climate change can be another possibility for the hiatus, because periods of settlement and occupation seem to coincide with drier and wetter conditions recorded in the subcontinent. Collapsed and tilted walls with brick rubble and infilling by sands in the settlement II layers was probably caused by a later earthquake post-dating 350a (OSL age), suggesting that this most likely corresponds to the large MW > 7 1803 earthquake of Garhwal Himalaya.