Do Tax Revenues Reduce Agency Costs and Increase Hospital Efficiency? Empirical Evidence from Washington State

Shantanu Namjoshi,Matthew Q. McPherson,Dan Friesner 사람과세계경영학회 2012 Global Business and Finance Review Vol.17 No.2

In Washington State some hospitals have access to tax revenues as a means to reduce volatility in cash flows and others do not. To investigate the potential efficiency differences, and by extension differences in agency costs, between these types of hospitals, a panel of Washington State, acute care hospitals is examined. Based on a maximum entropy analysis, hospitals receiving tax revenues are at greater risk of inefficiency, and by extension experience higher agency costs, than hospitals that do not receive such revenues. While managerial efficiency may not be the primary objective of non-profit hospitals, the existence of inefficiency necessitates that policy makers re-examine the flow of public funds to these facilities to ensure tax revenues are being used in a socially responsible manner.

Mitogenomics provides new insights into the unparalleled genetic diversity and matrilineal evolution of freshwater fishes in Cameroon, Africa

Shantanu Kundu,Piyumi De Alwis,Ah ran Kim,Soo-Rin Lee,Hye-Eun Kang,Flandrianto Sih Palimirmo,Fantong Zealous Gietbong,Hyun-woo Kim 한국수산과학회 양식분과 2023 한국수산과학회 양식분과 학술대회 Vol.2023 No.6

Mass Vaccination with a New, Less Expensive Oral Cholera Vaccine Using Public Health Infrastructure in India: The Odisha Model

Kar, Shantanu K.,Sah, Binod,Patnaik, Bikash,Kim, Yang Hee,Kerketta, Anna S.,Shin, Sunheang,Rath, Shyam Bandhu,Ali, Mohammad,Mogasale, Vittal,Khuntia, Hemant K.,Bhattachan, Anuj,You, Young Ae,Puri, Mah Public Library of Science 2014 PLoS neglected tropical diseases Vol.8 No.2

<▼1><P><B>Introduction</B></P><P>The substantial morbidity and mortality associated with recent cholera outbreaks in Haiti and Zimbabwe, as well as with cholera endemicity in countries throughout Asia and Africa, make a compelling case for supplementary cholera control measures in addition to existing interventions. Clinical trials conducted in Kolkata, India, have led to World Health Organization (WHO)-prequalification of Shanchol, an oral cholera vaccine (OCV) with a demonstrated 65% efficacy at 5 years post-vaccination. However, before this vaccine is widely used in endemic areas or in areas at risk of outbreaks, as recommended by the WHO, policymakers will require empirical evidence on its implementation and delivery costs in public health programs. The objective of the present report is to describe the organization, vaccine coverage, and delivery costs of mass vaccination with a new, less expensive OCV (Shanchol) using existing public health infrastructure in Odisha, India, as a model.</P><P><B>Methods</B></P><P>All healthy, non-pregnant residents aged 1 year and above residing in selected villages of the Satyabadi block (Puri district, Odisha, India) were invited to participate in a mass vaccination campaign using two doses of OCV. Prior to the campaign, a <I>de jure</I> census, micro-planning for vaccination and social mobilization activities were implemented. Vaccine coverage for each dose was ascertained as a percentage of the censused population. The direct vaccine delivery costs were estimated by reviewing project expenditure records and by interviewing key personnel.</P><P><B>Results</B></P><P>The mass vaccination was conducted during May and June, 2011, in two phases. In each phase, two vaccine doses were given 14 days apart. Sixty-two vaccination booths, staffed by 395 health workers/volunteers, were established in the community. For the censused population, 31,552 persons (61% of the target population) received the first dose and 23,751 (46%) of these completed their second dose, with a drop-out rate of 25% between the two doses. Higher coverage was observed among females and among 6–17 year-olds. Vaccine cost at market price (about US$1.85/dose) was the costliest item. The vaccine delivery cost was $0.49 per dose or $1.13 per fully vaccinated person.</P><P><B>Discussion</B></P><P>This is the first undertaken project to collect empirical evidence on the use of Shanchol within a mass vaccination campaign using existing public health program resources. Our findings suggest that mass vaccination is feasible but requires detailed micro-planning. The vaccine and delivery cost is affordable for resource poor countries. Given that the vaccine is now WHO pre-qualified, evidence from this study should encourage oral cholera vaccine use in countries where cholera remains a public health problem.</P></▼1><▼2><P><B>Author Summary</B></P><P>Cholera – an acute life-threatening diarrheal illness – continues to disrupt public health in resource poor countries. The devastating outbreaks in Haiti and Zimbabwe – to name just two of many occurrences – calls for the use of available oral cholera vaccines as an additional tool in the arsenal of cholera control measures. An oral cholera vaccine (Shanchol) has been licensed in India since 2009; however, there has only been limited use of this vaccine in government public health programs. A vaccination campaign using 2 doses of Shanchol was conducted in Odisha, India, during May and June, 2011, where 31,552 persons (61% of the target population) received the first dose and 23,751 of them completed their second dose. The vaccine delivery cost was $0.49 per dose. Through our findings and experience, we discuss the organization of the cholera vaccination campaign in Odisha, the challenges met for conducting the campaign and the strategies designed to overcome those challenges, and the delivery costs incurred in the use of this vaccine, the first of

Uptake during an oral cholera vaccine pilot demonstration program, Odisha, India.

Kar, Shantanu K,Pach, Alfred,Sah, Binod,Kerketta, Anna S,Patnaik, Bikash,Mogasale, VijayaLaxmi,Kim, Yang Hee,Rath, Shyam Bandhu,Shin, Sunheang,Khuntia, Hemant K,Bhattachan, Anuj,Puri, Mahesh K,Wierzba Landes Bioscience 2014 Human Vaccines & Immunotherapeutics Vol.10 No.10

<P>Approximately 30% of reported global cholera cases occur in India. In 2011, a household survey was conducted 4 months after an oral cholera vaccine pilot demonstration project in Odisha India to assess factors associated with vaccine up-take and exposure to a communication and social mobilization campaign. Nine villages were purposefully selected based on socio-demographics and demonstration participation rates. Households were stratified by level of participation and randomly selected. Bivariate and ordered logistic regression analyses were conducted. 517/600 (86%) selected households were surveyed. At the household level, participant compared to non-participant households were more likely to use the local primary health centers for general healthcare (P < 0.001). Similarly, at the village level, higher participation was associated with use of the primary health centers (P < 0.001) and private clinics (p = 0.032). Also at the village level, lower participation was associated with greater perceived availability of effective treatment for cholera (p = 0.013) and higher participation was associated with respondents reporting spouse as the sole decision-maker for household participation in the study. In terms of pre-vaccination communication, at the household level verbal communication was reported to be more useful than written communication. However written communication was perceived to be more useful by respondents in low-participating villages compared to average-participating villages (p = 0.007) These data on participation in an oral cholera vaccine demonstration program are important in light of the World Health Organization's (WHO) recommendations for pre-emptive use of cholera vaccine among vulnerable populations in endemic settings. Continued research is needed to further delineate barriers to vaccine up-take within and across targeted communities in low- and middle-income countries.</P>

Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation

Kartick Rastogi,Shantanu Sharma,Shivani Gupta,Nikesh Agarwal,MBBS,Sandeep Bhaskar,Sandeep Jain 대한방사선종양학회 2018 Radiation Oncology Journal Vol.36 No.1

Purpose: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. Materials and Methods: One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters-D near-max (D 2 ), D near-min (D 98 ), D mean , V 95 , and V 107 -homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V 5 ), 20 Gy (V 20 ), and 55 Gy (V 55 ) and that of heart receiving 5 Gy (V 5 ), 25 Gy (V 25 ), and 45 Gy (V 45 ) were extracted from dose-volume histograms and compared. Results: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V 20 , 22.09% vs. 30.16%; V 55 , 5.16% vs. 10.27%; p < 0.001) and heart (V 25 , 4.59% vs. 9.19%; V 45 , 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V 5 lung, 61.48% vs. 51.05%; V 5 heart, 31.02% vs. 23.27%; p < 0.001). Conclusions: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.

Osteochondral Lesion in Diffuse Pigmented Villonodular Synovitis of the Knee

Anshu Shekhar,Savneet Singh,Shantanu Sudhakar Patil,Sachin Ramchandra Tapasvi 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Pigmented villonodular synovitis (PVNS) is a rare benign condition that is locally aggressive and may destructively invade the surrounding soft tissues and bone causing functional loss of the joint and the limb. The knee is the most affected joint (range, 28% to 70%) but involvement of the bone is not a common feature seen at this site. We present a rare case of diffuse PVNS of the knee associated with subchondral cyst of the lateral femoral condyle. This posed a diagnostic dilemma because of bone invasion. The radiological image of synovitis was pathognomonic of PVNS but etiology of the osteolytic lesion was confirmed only on histopathology. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer.

Structure-Activity Relationships of Truncated D- and L-4´-Thioadenosine Derivatives as Species-Independent A₃Adenosine Receptor Antagonists¹

Jeong, Lak Shin,Shantanu Pal,Choe, Seung Ah,Choi, Won Jun,Kenneth A. Jacobson,Zhan-Guo Gao,Athena M. Klutz,Xiyan Hou,Kim, Hea Ok,Lee, Hyuk Woo,Lee, Sang Kook,Dilip K. Tosh,Moon, Hyung Ryong 이화여자대학교 약학연구소 2009 藥學硏究論文集 Vol.- No.19

Novel D- and L-4´-thioadenosine derivatives lacking the 4´-hydroxymethyl moiety were synthesized, starting from D-mannose and D-gulonic γ-lactone, respectively, as potent and selective species-independent A₃ adenosine receptor (AR) antagonists. Among the novel 4´-truncated 2-H nucleosides tested, a N^(6)-(3-chlorobenzyl) derivative 7c was the most potent at the human A₃ AR (K_(i) = 1.5 nM), but a N^(6)-(3-bromobenzyl) derivative 7d showed the optimal species-independent binding affinity.

Ginkgo biloba Administered Singly and Combined With Antioxidants in Tinnitus Patients

Chauhan Bhushan,Arya Shantanu,Chauhan Komal 대한청각학회 2023 Journal of Audiology & Otology Vol.27 No.1

Background and Objectives: Tinnitus, or ear ringing, involves impulsive and spontaneous activity in the auditory neurons. Its prevalence is high in the elderly, but 10%–15% of adults suffer from tinnitus, affecting their quality of life. Therefore, this study aimed to evaluate the efficacy of <i>Ginkgo biloba</i> administered singly and in combination with antioxidants in tinnitus patients.Subjects and Methods: Patients were randomly allocated to Placebo (T0, n=22), Treatment 1 (T1, n=24), and Treatment 2 (T2, n=23) groups. The patients were educated on the study’s methodology and were instructed to visit at 0, 4, 8, 12, and 14 weeks. The placebo group received starch capsule supplements. Conversely, the treatment groups received <i>Ginkgo biloba</i> (60 mg twice a day) singly and in combination with antioxidants. We enrolled 69 patients aged 40–70 years (41 men, 28 women). The Tinnitus Handicap Index (THI), Visual Analogue Score (VAS), and Short Form 36 (SF-36) Health Scores were determined pre- and post-treatment at each visit.Results: Supplementation of <i>Ginkgo biloba</i>, along with antioxidants, provided marked improvement (<i>p</i><0.05) in post-treatment THI and VAS scores in the T2 group compared to those in the T1 and T0 groups. The greatest (<i>p</i><0.05) percent difference was observed in the pre- and post-treatment THI (-36%) and VAS scores (-22.6%) of T2 patients. Likewise, the SF-36 scores improved significantly (<i>p</i><0.05) in the T2 group in varied parameters.Conclusions: <i>Ginkgo biloba</i>, along with antioxidants, can be a promising therapy for tinnitus patients, providing marked improvement in THI, VAS, and SF-36 scores.

Molecular identification of selected bees from the Indian Himalaya: A preliminary effort

Pakrashi Avas,Kundu Shantanu,Saini Jagdish,Tyagi Kaomud,Chandra Kailash,Kumar Vikas 한국응용곤충학회 2020 Journal of Asia-Pacific Entomology Vol.23 No.4

DNA barcoding has largely been tested for a wide range of taxa and evidenced as a reliable and rapid molecular tool for species-level identification. The present study lends to generate 156 DNA barcodes, of which 141 belonged to 30 morphologically identified bees from the Indian Himalayan Regions (IHRs). The generated barcode data along with 84 sequences of global database distinctly discriminated all the studied species with sufficient genetic distances and cohesive monophyletic clustering in Bayesian analysis (BA) phylogeny. The species delimitation methods, Automatic Barcode Gap Discovery (ABGD), Bayesian Poisson-Tree-Processes (bPTP), and General Mixed Yule-coalescent (GMYC) yielded 68, 70, and 71 molecular operational taxonomic units (MOTUs) respectively. The present DNA barcode-based examination detected the possible cryptic diversity in two Apis species (A. cerana and A. dorsata), Bombus hypnorum, Lepidotrigona arcifera, and Ceratina sutepensis. The present study also evidenced the species complexes within Bombus albopleuralis and Bombus trifasciatus in the IHRs. The species delimitation methods also detected an additional seven putative species from the IHRs, which were identified up to the genus level. In conclusion, this preliminary effort helps to develop a reliable barcode database of bees from the Indian IHRs to facilitate the future systematics study. These molecular data can be utilized to evaluate the population structures and assist to formulate the effective plans for bee conservation.

Long-Term Evolution of Decaying MHD Turbulence in the Multiphase ISM

Chang-Goo Kim,Shantanu Basu 한국천문학회 2013 天文學會報 Vol.38 No.1