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Ashtankar Vijaykumar B.,Municipal Corporation of Greater Mumbai
Water and Energy International

In the recent 30 years ,after completion of various all RCC dams across the world, the experience and knowledge gained through the completion of over 350 RCC dams are almost a reality with our neighbouring country Pakistan soon to embark on the construction of a 272 m high RCC dam on the Indus river, the paper deals with two most important developments in history of RCC. One being the solution to the problem of achieving bond by placing the RCC lifts within the initial set time of the RCC, the other achieving a durable, impermeable and aesthetic facing to the RCC by altering in-situ the proportions of the RCC with the addition of grout to the uncompacted as spread RCC so that it will behave as conventional concrete when internally vibrated. © 2015, Central Board of Irrigation and Power. All rights reserved. Source

Dholakia Y.N.,Larsen and Toubro Ltd | Shah D.P.,Municipal Corporation of Greater Mumbai
Lung India

Background: Characteristics and treatment outcomes of patients with drug-resistant tuberculosis (DR TB) before introduction of directly observed treatment strategy (DOTS) plus are infrequently reported. Aims: To study clinical characteristics and treatment outcomes of drug-resistant TB patients. Setting: A TB unit in Mumbai. Materials and Methods: A retrospective analysis of DR TB patients attending a TB unit and taking treatment at NGOs was performed. Of the 34 cases, 5 (14%) had mycobacterium other than tuberculosis, 24 were pulmonary TB, 4 extra-pulmonary TB, and one both. Three were HIV-infected, two had diabetes. Two cases were treatment naive. Of the 29 cases studied, 3 (11%) were mono-resistant, 20 (69%) were multidrug-resistant (MDR) TB with E/Z/EZ resistance; 4 were pure MDR TB. One case had XDR TB, 13 (44.8%) had resistance to at least one conventional second-line drug. Seven cases had adverse drug reaction, four requiring drug substitution. Two patients are on treatment; 14 of the remaining 27 (51%) were successfully treated, 5 (18%) died, 2 (7%) failed treatment, 5 (18%) were lost to follow-up, one migrated. Conclusion: DST profiles suggest high levels of drug resistance due to amplification which leads to poor outcomes. There is an urgent need for Indian Revised National TB Control Program to introduce daily DOTS for susceptible cases, DST for all new cases, and scaling up DST for second-line drugs. There is also a need to use individualized treatment for DR TB. Source

Pradhan A.,Center for Health Research and Development | Kielmann K.,London School of Hygiene and Tropical Medicine | Gupte H.,Inter Aide Development India | Bamne A.,Municipal Corporation of Greater Mumbai | And 2 more authors.
BMC Public Health

Background. India's Revised National Tuberculosis Control Programme (RNTCP) is deemed highly successful in terms of detection and cure rates. However, some patients experience delays in accessing diagnosis and treatment. Patients falling between the 96th and 100th percentiles for these access indicators are often ignored as atypical 'outliers' when assessing programme performance. They may, however, provide clues to understanding why some patients never reach the programme. This paper examines the underlying vulnerabilities of patients with extreme values for delays in accessing the RNTCP in Mumbai city, India. Methods. We conducted a cross-sectional study with 266 new sputum positive patients registered with the RNTCP in Mumbai. Patients were classified as 'outliers' if patient, provider and system delays were beyond the 95th percentile for the respective variable. Case profiles of 'outliers' for patient, provider and system delays were examined and compared with the rest of the sample to identify key factors responsible for delays. Results. Forty-two patients were 'outliers' on one or more of the delay variables. All 'outliers' had a significantly lower per capita income than the remaining sample. The lack of economic resources was compounded by social, structural and environmental vulnerabilities. Longer patient delays were related to patients' perception of symptoms as non-serious. Provider delays were incurred as a result of private providers' failure to respond to tuberculosis in a timely manner. Diagnostic and treatment delays were minimal, however, analysis of the 'outliers' revealed the importance of social support in enabling access to the programme. Conclusion. A proxy for those who fail to reach the programme, these case profiles highlight unique vulnerabilities that need innovative approaches by the RNTCP. The focus on 'outliers' provides a less resource- and time-intensive alternative to community-based studies for understanding the barriers to reaching public health programmes. © 2010 Pradhan et al; licensee BioMed Central Ltd. Source

Malik S.S.,Municipal Corporation of Greater Mumbai | D'Souza R.C.,Municipal Corporation of Greater Mumbai | Pashte P.M.,Municipal Corporation of Greater Mumbai | Satoskar S.M.,Municipal Corporation of Greater Mumbai | D'Souza R.J.,Information Technology Consultant

Background: The Qualitative aspect of health care delivery is one of the major factors in reducing morbidity and mortality in a health care setup. The expanding suburban secondary health care delivery facilities of the Municipal Corporation of Greater Mumbai are an important part of the healthcare backbone of Mumbai and therefore the quality of care delivered here needed standardization. Material and Methods: The project was completed over a period of one year from Jan to Dec, 2013 and implemented in three phases. The framework with components and sub-components were developed and formats for data collection were standardized. The benchmarks were based on past performance in the same hospital and probability was used for development of normal range. An Excel spreadsheet was developed to facilitate data analysis. Results: The indicators comprise of 3 components - Statutory Requirements, Patient care & Cure and Administrative efficiency. The measurements made, pointed to the broad areas needing attention. Conclusion: The Indicators for patient care and monitoring standards can be used as a self assessment tool for health care setups for standardization and improvement of delivery of health care services. © 2015 Malik et al. Source

Bamne A.,Municipal Corporation of Greater Mumbai | Shah D.,Municipal Corporation of Greater Mumbai | Palkar S.,Municipal Corporation of Greater Mumbai | Uppal S.,Eli Lilly and Company | And 2 more authors.
Indian Journal of Community Medicine

Context : Rising number of diabetes cases in India calls for collaboration between the public and private sectors. Aims: Municipal Corporation of Greater Mumbai (MCGM) partnered with Eli Lilly and Company (India) [Eli Lilly] to strengthen the capacity of their diabetes clinics. Materials and Methods : Medical Officers, dispensaries and Assistant Medical Officers (AMOs) located at attached health posts were trained on an educational tool, Diabetes Conversation Map™ (DCM) by a Master Trainer. This tool was then used to educate patients and caregivers visiting the MCGM diabetes clinics. Results : Twenty-eight centers conducted 168 sessions, and 1616 beneficiaries availed the education over six months. General feedback from health providers was that DCM helps clear misconceptions among patients and caregivers in an interactive way and also improves compliance of patients. Conclusions : This communication highlights a unique public-private partnership where the sincere efforts of public sector organization (MCGM) were complemented by the educational expertise lent by a private firm. © 2016 Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow. Source

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