Ending the Energy-Poverty Nexus: An Ethical Imperative for Just Transitions.

Arguments for a just transition are integral to debates about climate change and the drive to create a carbon-neutral economy. There are currently two broad approaches rooted in ethics and justice for framing just energy transitions. The first can be described as internal to the transition and emphasizes the anticipation, assessment, and redressing of harms created by the transition itself and the inclusion in transition governance of groups or communities potentially harmed by its disruptions. In this article, we propose a second approach to ethics and justice in an energy transition, which we describe as systemic or societal in scope. This approach complements attention to the proximate dynamics and impacts of the transition process with a focus on the distant societal and economic outcomes the transition brings into being and how they compare to conditions prior to the transition. It poses the question: do the transformative social, economic, and technological changes wrought by energy systems create more just societies and economies, or do they instead reinforce or recreate long-standing injustices and inequalities? We illustrate this approach with an assessment of one of the most significant existing forms of energy injustice: the energy-poverty nexus. We argue that the energy-poverty nexus reflects configurations of socio-energy systems that create complex, extractive feedbacks between energy insecurity and economic insecurity and, over time, reinforce or exacerbate poverty. We further argue that just energy transitions should work to disentangle these configurations and re-design them so as to create generative rather than extractive feedbacks, thus ending the energy-poverty nexus and creating long-term outcomes that are more just, equitable, and fair.

Electrical Characterization of the Tongue and the Soft Palate Using Lumped-Element Model for Intraoral Neuromodulation.

Intraoral functions are results of complex and well-orchestrated sensorimotor loop operations, and therefore vulnerable to small functional or neural defects. To secure the vital intraoral functions, it is important to find a way to favorably intervene the intraoral sensorimotor loop operations. The tongue and the soft palate are heavily associated with intraoral sensorimotor loops, with their dense neural innervations and occupancy of intraoral space. Therefore, electrical stimulation onto the tongue and the soft palate has a great potential to solve the problems in the intraoral functions. However, the electrical interface for both of them have not been characterized yet as a lumped-element model, for designing electrical stimulation and analyzing its effect. In this study, we measured stimulation thresholds to evoke electrotactile feedback and characterized electrical impedance across electrodes using lumped-element models. We found that average perception/discomfort thresholds for the tongue tip, lateral-inferior side of the tongue, and anterolateral side of the soft palate as 0.18/1.31, 0.37/3.99, and 1.19/7.55 mA, respectively. An R-C-R-R-C model represented the electrical interface across the tongue and the soft palate with the highest accuracy. The average component values of the R-C-R-R-C model were found as 2.72kΩ, 45.25nF, 1.27kΩ, 22.09GΩ, and 53.00nF, on average.

Resuming eye bank services during the COVID-19 pandemic: Experience and inferences.

PURPOSE: The aim of this study was to formulate a methodological approach for resuming eye bank services during COVID-19 pandemic. METHODS: Eye bank operations were temporarily halted in March after the government-mandated "Lockdown" in response to COVID-19 pandemic. Before restarting eye bank operations in May, we studied sources of exposure, performed risk assessment, instituted additional process validations and redefined the Standard Operating Procedures (SOPs) in consultation with the guidelines published by the Eye bank Association of India and All India Ophthalmological Society. The eye bank staff were rigorously trained before and after operations were restarted. We conducted a survey at the end of July to gauge staff attitude and reaction. RESULTS: Eye banks services resumed on 20th May 2020. Since reopening till the end of July total 41 keratoplasties have been done. 91.75% of all keratoplasties done were therapeutic surgeries and 17% of the surgeries were done using glycerine preserved tissues. No staff had COVID-19 symptoms when the operations restarted and none developed symptoms up to the end of July. All eye bank staff were aware of COVID-19 pandemic and 86% said they felt safe working at the eye bank. 86% of the staff said that they received adequate training and 66% of the staff expressed that they always received proper PPE and kits. Overall, 93% of the staff expressed that the measures taken by the eye bank ensured their safety. CONCLUSION: Based on our experience we suggest the following activities for planned resumption of eye bank services during the pandemic: Exposure Risk Analysis, Personal Protective Equipment usage training, SOP Revision and staff training on modified SOPs. Criteria based selection of donor sources, participatory planning involving the staff and double-checking at critical process junctions helped us in managing a smooth transition.

Awareness regarding eye donation among staff of a tertiary eye care hospital in North India.

PURPOSE: To assess the awareness, knowledge and attitude regarding eye donation in staff of a tertiary eye care hospital in North India. METHODS: A prospective, cross-sectional study was conducted on the employees of a tertiary eye care centre (urban area) along with its four secondary centres (rural area). Socio-demographic profile, awareness, knowledge and attitude of 507 employees regarding eye donation were evaluated through a pretested, self-administered questionnaire. Knowledge-based questions were scored. RESULTS: Of the 507 participants, 327 (64.5%) participants were from medical/paramedical field (Group 1) and 180 (35.5%) were from non-medical field (Group 2). Awareness about eye donation was 99%. Twenty (3.95%) participants scored poor (0-8), 90 (17.75%) had a fair score (9-16) and 397 (78.30%) had a good score (17-24). Good knowledge was found in significantly more (P = 0.01) participants in Group 1 (77.37%) as compared to Group 2 (70.1%). Four hundred and fifty-seven (90.13%) participants were willing to pledge their eyes for donation, the prime motivational force being spreading vision to the blind [346 (68.24%)]. The perceived reasons for not pledging were religious [28 (5.52%)], thought of family getting upset [29 (5.72%)] and scepticism regarding proper usage of tissue [64 (12.62%)]. CONCLUSION: The study demonstrated that although there is a substantial awareness about eye donation, there are certain lacunae in the knowledge and perceptions among staff of an eye care hospital. With the correct knowledge and attitude, they can contribute by creating awareness and motivating the people for eye donation while carrying out their routine hospital activities.

Impact of quality assurance on utilization of corneal tissues in a community Eye Bank.

PURPOSE: To determine the linkage between Quality Assurance Program (QAP) and increase in utilization of donor corneas at a community Eye Bank. METHODS: A donor cornea is defined as utilized when it is used for cornea transplant. Two metrics, utilization rate (UR) and non-utilization rate (NUR), were defined. The Eye Bank implemented QAP from 2011. As a part of QAP, detailed gap analysis of tissue utilization was performed. Four major categories causing non-utilization of recovered corneas were identified. These categories were poor "Tissue Quality", "Seropositive" donor blood sample, "Medical History" of donor, and donor "Blood Sample Issues." The years 2008-2011 were labelled the pre-intervention period, and the years 2012-2017 were labelled the post-intervention period. Annual UR and annual NUR for the four categories of non-utilization from the pre and the post-intervention periods were statistically compared. RESULTS: In the pre-intervention period, the Eye Bank recovered 1425 donor corneas in total and transplanted 762. In the post-intervention period, the Eye Bank recovered 6661 corneas in total and transplanted 4393. The UR improved from 53.47% (762/1425) in the pre-intervention period to 65.95% (4393/6661) in the post-intervention period (P < 0.001). NUR in "Tissue Quality" category decreased from 34.32% to 29.7% from the pre to the post-intervention period (P < 0.001). NUR in "Blood Sample Issues" category reduced from 3.23% to 0.32% from the pre to the post-intervention period (P < 0.001). NUR in "Medical History" category decreased from 5.68% to 0.33% from the pre to the post-intervention period (P < 0.001). CONCLUSIONS: The study indicates that QAP improves UR of recovered corneas. In countries with a shortage of donor corneas, increasing utilization of recovered corneas can lead to an increase in corneal transplants. Implementation of QAP at the Eye Bank can be a means of achieving this outcome.

Quality indicators for eye bank.

PURPOSE: The aim of this study is to identify quality indicators of the eye bank and validate their effectivity. METHODS: Adverse reaction rate, discard rate, protocol deviation rate, and compliance rate were defined as Quality Indicators of the eye bank. These were identified based on definition of quality that captures two dimensions - "result quality" and "process quality." The indicators were measured and tracked as part of quality assurance (QA) program of the eye bank. Regular audits were performed to validate alignment of standard operating procedures (SOP) with regulatory and surgeon acceptance standards and alignment of activities performed in the eye bank with the SOP. Prospective study of the indicators was performed by comparing their observed values over the period 2011-2016. RESULTS: Adverse reaction rate decreased more than 8-fold (from 0.61% to 0.07%), discard rate decreased and stabilized at 30%, protocol deviation rate decreased from 1.05% to 0.08%, and compliance rate reported by annual quality audits improved from 59% to 96% at the same time. In effect, adverse reaction rate, discard rate, and protocol deviation rate were leading indicators, and compliance rate was the trailing indicator. CONCLUSION: These indicators fulfill an important gap in available literature on QA in eye banking. There are two ways in which these findings can be meaningful. First, eye banks which are new to quality measurement can adopt these indicators. Second, eye banks which are already deeply engaged in quality improvement can test these indicators in their eye bank, thereby incorporating them widely and improving them over time.

A two-state hysteresis model from high-dimensional friction.

In prior work (Biswas & Chatterjee 2014 Proc. R. Soc. A 470, 20130817 (doi:10.1098/rspa.2013.0817)), we developed a six-state hysteresis model from a high-dimensional frictional system. Here, we use a more intuitively appealing frictional system that resembles one studied earlier by Iwan. The basis functions now have simple analytical description. The number of states required decreases further, from six to the theoretical minimum of two. The number of fitted parameters is reduced by an order of magnitude, to just six. An explicit and faster numerical solution method is developed. Parameter fitting to match different specified hysteresis loops is demonstrated. In summary, a new two-state model of hysteresis is presented that is ready for practical implementation. Essential Matlab code is provided.

A reduced-order model from high-dimensional frictional hysteresis.

Hysteresis in material behaviour includes both signum nonlinearities as well as high dimensionality. Available models for component-level hysteretic behaviour are empirical. Here, we derive a low-order model for rate-independent hysteresis from a high-dimensional massless frictional system. The original system, being given in terms of signs of velocities, is first solved incrementally using a linear complementarity problem formulation. From this numerical solution, to develop a reduced-order model, basis vectors are chosen using the singular value decomposition. The slip direction in generalized coordinates is identified as the minimizer of a dissipation-related function. That function includes terms for frictional dissipation through signum nonlinearities at many friction sites. Luckily, it allows a convenient analytical approximation. Upon solution of the approximated minimization problem, the slip direction is found. A final evolution equation for a few states is then obtained that gives a good match with the full solution. The model obtained here may lead to new insights into hysteresis as well as better empirical modelling thereof.

The role of induced sputum in the diagnosis of pulmonary tuberculosis.

BACKGROUND: Microbiological confirmation of pulmonary tuberculosis (TB) is of paramount importance in the era of immunocompromised host and emergence of multi-drug resistance. OBJECTIVES: To assess the value of sputum induction (SI) with hypertonic saline nebulization as a diagnostic tool in patients with suspected pulmonary TB who have no/inadequate sputum or have a sputum smear negative for acid fast bacillus (AFB). MATERIALS AND METHODS: One hundred patients with clinical and radiological evidence of pulmonary TB with no/inadequate sputum or smear negative with spontaneous sputum were studied. Sputum was induced with 20 mL of 3% hypertonic saline solution delivered through ultrasonic nebulizer. The specimens were subjected to Ziehl Neelsen staining and were examined under oil immersion lens for the presence of AFB. The specimens were also subjected to mycobacterial culture in BACTEC 460 TB system. RESULTS: Ninety five patients could produce adequate sputum after SI. Sputum from thirty two patients were found to be positive both in smear and culture while sputum from another three patients were smear negative, but culture positive. CONCLUSION: SI is a safe, cheap and non-invasive procedure and provides significant yield in the diagnosis of pulmonary TB; thus, increasing the case detection rate of smear positive pulmonary TB.

Diagnostic yield of broncho-alveolar lavage fluid and postbronchoscopic sputum cytology in endoscopically non-visible lung cancers.

Diagnostic yield of broncho-alveolar lavage (BAL) fluid and postbronchoscopic sputum (PBS) cytology is very high in endoscopically visible bronchogenic carcinoma, but they are also helpful in diagnosis of those lung cancers which are not visible bronchoscopically. Objective of this prospective study is to analyse the diagnostic yield of BAL fluid and PBS cytology in endoscopically non-visible lung cancer. Thirty patients with chest radiographic abnormality suspicious of lung cancer without endobronchial abnormality underwent BAL fluid and PBS cytology examination in the department of respiratory medicine of Calcutta National Medical College and Hospital over 1 year and 3 months. The final diagnosis was bronchogenic carcinoma in 21, tuberculoma/tuberculosis in 5, bacterial pneumonia in 3 and encysted empyema in 1. Among the 21 patients with bronchogenic carcinoma, BAL was positive for malignant cell in 13 patients (62%). The diagnostic yield of the BAL was influenced by size, location, radiographic pattern and cell type of the tumour. PBS cytology was positive in 3 patients (14%) only, all of which were positive with BAL fluid also. BAL fluid cytology proved to be a valuable diagnostic tool in diagnosis of endoscopically non-visible lung cancer. Size, location, radiographic pattern and cytological type of the lesions were important determinants of the diagnostic yield. PBS cytology provided no additional benefit.

Serum magnesium and stable asthma: Is there a link?

BACKGROUND: Although magnesium is used through intravenous and inhalation route in the management of asthma, actual prevalence of hypomagnesemia in asthma is not known. We conducted this study: 1) to detect the prevalence of hypomagnesemia in stable asthma and 2) to assess the significance of hypomagnesemia in these patients. DESIGN: Prospective clinical study. SETTING: Department of Respiratory Medicine, Calcutta National Medical College, Kolkata. PERIOD OF STUDY: Four months from January, 2007, to April, 2007. MATERIALS AND METHODS: Fifty patients attending outpatients department of respiratory medicine with stable asthma were randomly selected. They were assessed clinically and their serum magnesium levels were measured. This was compared with the serum magnesium values of 45 nonasthmatic healthy controls. RESULTS: Out of 50 patients, 14 had hypomagnesemia. Possible relationship of hypomagnesemia with tachycardia, tachypnoea, severity of asthma, medication use, and previous and future exacerbations were analyzed. CONCLUSION: There was statistically significant association of hypomagnesemia with tachypnoea, severe asthma, use of long-acting ß-agonist, inhaled corticosteroids, theophylline, use of ≥ 3 medications, previous and future exacerbations but not with tachycardia or use of short-acting ß(2) -agonist or montelukast.

Pulmonary arteriovenous malformation: An uncommon disease with common presentation.

A 45-year-old male presented with massive hemoptysis, clubbing in all limbs, disproportionate hypoxia and persistent ill-defined shadow in left lower zone in chest radiograph since his childhood. The patient received empirical anti-tuberculosis treatment and the chest X-ray finding was misinterpreted as tuberculoma. Subsequently, CT pulmonary angiography proved it to be a case of a simple type solitary pulmonary arteriovenous malformation with a saccular aneurysm in left lower lobe.

It's easy to miss complicated hydatid cyst of lung.

A 60-year-old female presented with pneumonitis of right lower zone. CT scan revealed mass like lesion with multiple air pockets. FNAC and ultrasound confirmed the diagnosis as isolated active pulmonary hydatid cyst, which is not common finding in adult population.