Objectives

Vital statistics generated by the Civil Registration System (CRS) are essential for developing healthcare interventions at all administrative levels. Bihar had one of the lowest levels of mortality registration among India's states. This study investigates CRS's performance barriers from the perspective of CRS staff and community members in Bihar.

Methods

We conducted a primary qualitative survey in the two districts of Bihar during February-March 2020 with CRS staff (n = 15) and community members (n = 90). We purposively selected the Patna and Vaishali districts of Bihar for the survey. Thematic analysis was done to identify the pattern across the data using the Atlas-ti software.

Results

Most participants showed a good understanding of registration procedures and birth and death registration benefits. The perceived need for death registration is lower than birth registration. Birth registration was higher among female children than male children. We found that most participants did not report children or adult female death due to lack of financial or property-related benefits. Most participants faced challenges in reporting birth and death due to poor delivery of services at the registration centres, higher indirect opportunity cost, and demand of bribes by the CRS staff for providing certificates. We found a lack of adequate investment, shortage of dedicated staff, and limited computer and internet services at the registration centres.

Conclusions

Poor data on birth and death registration could lead decision-makers to target health services inappropriately. Strengthening health institutions' linkage with the registration centres, mobile registration in far-flung areas and regular CRS staff training could increase death registration levels. An adequate awareness campaign on the benefits of birth and death registration is required to increase the reporting of vital events.

Geothermal heat, as renewable energy, shows great advantage with respect to its environmental impact due to its significantly lower CO2 emissions than conventional fossil fuel. Open and closed-loop geothermal heat pumps, which utilize shallow geothermal systems, are an efficient technology for cooling and heating buildings, especially in urban areas. Integrated use of geothermal energy technologies for district heating, cooling, and thermal energy storage can be applied to optimize the subsurface for communities to provide them with multiple sustainable energy and community resilience benefits. The utilization of the subsurface resources may lead to a variation in the underground environment, which might further impact local environmental conditions. However, very few simulators can handle such a highly complex set of coupled computations on a regional or city scale. We have developed high-performance computing (HPC) based hydrothermal finite element (FE) simulator that can simulate the subsurface and its hydrothermal conditions at a scale of tens of km. The HPC simulator enables us to investigate the subsurface thermal and hydrologic response to the built underground environment (such as basements and subways) at the community scale. In this study, a coupled hydrothermal simulator is developed based on the open-source finite element library deal.II. The HPC simulator was validated by comparing the results of a benchmark case study against COMSOL Multiphysics, in which Aquifer Thermal Energy Storage (ATES) is modeled and a process of heat injection into ATES is simulated. The use of an energy pile system at the Treasure Island redevelopment site (San Francisco, CA, USA) was selected as a case study to demonstrate the HPC capability of the developed simulator. The simulator is capable of modeling multiple city-scale geothermal scenarios in a reasonable amount of time.

BACKGROUND: Preventable medical errors in hospital settings are the third leading cause of deaths in the United States. However, less is known about harm that occurs in patients in outpatient settings, where the majority of care is delivered. We do not know the likelihood that a patient sitting in a dentist chair will experience harm. Additionally, we do not know if patients of certain race, age, sex, or socioeconomic status disproportionately experience iatrogenic harm. METHODS: We initiated the Dental Practice Study (DPS) with the aim of determining the frequency and types of adverse events (AEs) that occur in dentistry on the basis of retrospective chart audit. This article discusses the 6-month pilot phase of the DPS during which we explored the feasibility and efficiency of our multistaged review process to detect AEs. RESULTS: At sites 1, 2, and 3, respectively, 2 reviewers abstracted 21, 11, and 23 probable AEs, respectively, from the 100 patient charts audited per site. At site 2, a third reviewer audited the same 100 charts and found only 1 additional probable AE. Of the total 56 probable AEs (from 300 charts), the expert panel confirmed 9 AE cases. This equals 3 AEs per 100 patients per year. Patients who experienced an AE tended to be male and older and to have undergone more procedures within the study year. CONCLUSIONS: This article presents an overview of the DPS. It describes the methods used and summarizes the results of its pilot phase. To minimize threats to dental patient safety, a starting point is to understand their basic epidemiology, both in terms of their frequency and the extent to which they affect different populations.