Whither human capital? The woeful tale of transition to tertiary education in India

In this article, we examine the issue of high dropout rates in India which has adverse implications for human capital formation and hence for the country's long-term growth potential. Using the 2004–2005 National Sample Survey (NSS) employment–unemployment data, we estimate transition probabilities of moving from a number of different educational levels to higher educational levels using a sequential logit model. Our results suggest that the overall probability of reaching tertiary education is very low. Further, even by the woeful overall standards, women are significantly worse off, particularly in rural areas.

Switching the mode of metabolism in the yeast Saccharomyces cerevisiae

The biochemistry of most metabolic pathways is conserved from bacteria to humans, although the control mechanisms are adapted to the needs of each cell type. Oxygen depletion commonly controls the switch from respiration to fermentation. However, Saccharomyces cerevisiae also controls that switch in response to the external glucose level. We have generated an S. cerevisiae strain in which glucose uptake is dependent on a chimeric hexose transporter mediating reduced sugar uptake. This strain shows a fully respiratory metabolism also at high glucose levels as seen for aerobic organisms, and switches to fermentation only when oxygen is lacking. These observations illustrate that manipulating a single step can alter the mode of metabolism. The novel yeast strain is an excellent tool to study the mechanisms underlying glucose-induced signal transduction. © 2004 European Molecular Biology Organization.

The effect of innate compliance on the performance of a counterpulsation device

Cardiovascular disease (CVD) continues to be one of the top causes of mortality in the world. World Heart Organization (WHO) reported that in 2004, CVD contributed to almost 30% of death from estimated worldwide death figures of 58 million[1]. Heart failure treatment varies from lifestyle adjustment to heart transplantation; its aims are to reduce HF symptoms, prolong patient survival and minimize risk [2]. One alternative available in the market for HF treatment is Left Ventricular Assist Device (LVAD). Chronic Intermittent Mechanical Support (CIMS) device is a novel (LVAD) heart failure treatment using counterpulsation similar to Intra Aortic Balloon Pumps (IABP). However, the implantation site of the CIMS balloon is in the ascending aorta just distal to aortic valve contrasted with IABP in the descending aorta. Counterpulsation coupled with implantation close to the aortic valve enables comparable flow augmentation with reduced balloon volume. Two prototypes of the CIMS balloon were constructed using rapid prototyping: the straight-body model is a cylindrical tube with a silicone membrane lining with zero expansive compliance. The compliant-body model had a bulging structure that allowed the membrane to expand under native systolic pressure increasing the device’s static compliance to 1.5 mL/mmHg. This study examined the effect of device compliance and vascular compliance on counterpulsating flow augmentation. Both prototypes were tested on a two-element Windkessel model human mock circulatory loop (MCL). The devices were placed just distal to aortic valve and left coronary artery. The MCL mimicked HF with cardiac output of 3 L/min, left ventricular pressure of 85/15 mmHg, aortic pressure of 70/50 mmHg and left coronary artery flow rate of 66 mL/min. The mean arterial pressure (MAP) was calculated to be 57 mmHg. Arterial compliance was set to be1.25 mL/mmHg and 2.5 mL/mmHg. Inflation of the balloon was triggered at the dicrotic notch while deflation was at minimum aortic pressure prior to systole. Important haemodynamics parameters such as left ventricular pressure (LVP), aortic pressure (AoP), cardiac output (CO), left coronary artery flowrate (QcorMean), and dP (Peak aortic diastolic augmentation pressure – AoPmax ) were simultaneously recorded for both non-assisted mode and assisted mode. ANOVA was used to analyse the effect of both factors (balloon and arterial compliance) to flow augmentation. The results showed that for cardiac output and left coronary artery flowrate, there were significant difference between balloon and arterial compliance at p < 0.001. Cardiac output recorded maximum output at 18% for compliant body and stiff arterial compliance. Left coronary artery flowrate also recorded around 20% increase due to compliant body and stiffer arterial compliance. Resistance to blood ejection recorded highest difference for combination of straight body and stiffer arterial compliance. From these results it is clear that both balloon and arterial compliance are statistically significant factors for flow augmentation on peripheral artery and reduction of resistance. Although the result for resistance reduction was different from flow augmentation, these results serves as an important aspect which will influence the future design of the CIMS balloon and its control strategy. References: 1. Mathers C, Boerma T, Fat DM. The Global Burden of disease:2004 update. Geneva: World Heatlh Organization; 2008. 2. Jessup M, Brozena S. Heart Failure. N Engl J Med 2003;348:2007-18.

Development and trialling of a behavioural intervention for patients with atrial fibrillation initiating oral anticoagulation:the 'treat' study

Purpose: Atrial fibrillation (AF) is the most common heart arrhythmia and is associated with an increased risk of stroke. Stroke risk is commonly treated with oral anticoagulation (OAC) with a narrow therapeutic range (INR 2.0 to 3.0); which is poorly controlled in practice. Barriers to adherence include poor knowledge, and inaccurate perceptions surrounding illness and medications. Trial registration: ISRCTN93952605. Systematic review: Seven trials of educational, self-monitoring and decision aid interventions were included in a systematic review. Pooled analysis suggested education OR, 95% CI 7.89 (5.54-10.24) and self monitoring OR (95% CI) 5.47(2.55-8.39) significantly improve TTR; whereas decision aids are no more effective in reducing decision conflict than usual care, OR (95% CI) -0.10 (-0.17 to -0.02). Intervention development: The intervention was theoretically-driven (utilising the common sense and beliefs about medication models) and developed with expert patient feedback. Described using behavioural change techniques, the one-off group session included an educational booklet, ‘expert-patient’ focussed DVD, and worksheet. Methods: Ninety seven warfarin-naïve AF patients were randomised to receive the intervention (n=43), or usual care (n=54). The primary endpoint was time within therapeutic range (TTR), secondary endpoints included knowledge, quality of life (AF-QoL-18), beliefs about medication (BMQ), illness perceptions (IPQ-B), and anxiety and depression (HADS). Results: Intervention group had significantly higher TTR than usual care (78.5% vs. 66.7%; p=0.01). Knowledge changed significantly across time (F (3, 47) = 6.4; p<0.01), but not between groups (F (1, 47) = 3.3; p = 0.07). At six months knowledge predicted TTR (r=0.245; p=0.04). Illness concern negatively correlated with TTR (r= - 0.199; p=0.05). General Harm scores at one month predicted TTR (F (1, 72) = 4.08; p=0.048). There were significant differences in emotional representations (F (3, 49) = 3.3 (3, 49); p= 0.03), anxiety (F (3, 46) = 25.2; p<0.01) and depression (F (3, 46) = 37.7; p<0.01) across time. Conclusion: A theory-driven educational intervention can improve TTR in AF patients and potentially reduce the risk of adverse clinical outcomes. Improving education provision for AF patients is essential to ensure efficacious treatment.