Purpose The purpose of this research paper is to assess efficacy of e-governance implementation, influenced under the Indian-EU (European Union – EU) strategic dialogue. For the same purpose, this study aims to analyse and measure penetration level of information and communication technology (ICT) applications across ten select gross domestic product-dependent sectors (gross domestic product – GDP) in Indian economy. Design/methodology/approach Multi-criteria decision-making (MCDM) approach of PROMETHEE, using its partial and complete versions in fuzzy environment, is applied. The approach assesses e-governance efficacy in various sectors, which is chosen based on their contribution to GDP, where criteria values are assigned by expert opinions, feedback is received and lessons are learnt from training and initiatives taken under the Digital India programme launched by the Government of India. These criteria related to IT policy implementation, cyber security breaches, IT infrastructure development initiatives in select sectors are identified. Later, sectors outranking results have been highlighted using both fuzzy set theory along with PROMETHEE (F-PROMETHEE) and its visual application. Findings On applying F-PROMETHEE, studies found that industrial, railways, health and finance and education sectors outrank in their high merit orders. Contrary, outranking shows that agriculture, defence and aerospace sectors should be more open and accessible to adopt ICT applications in order to promote e-governance processes and their implementation to make e-services available to common citizens. For better interpretation of results, graphical analysis for interactive aid is used to present the analyses. Research limitations/implications Research study was found useful in the assessment of ICT penetration level in to support Indo-EU relations, where PROMETHEE method is used to outrank sectors alternatives. Criteria are also weighted using fuzzy scale, and the impact of criteria on all alternatives has also been assessed. MCDM framework addresses that subjectivity lies in sectors to implement ICTs bases services. However, few other MCDM frameworks, methods such as COPRAS, GST, GRA, SAW and SWARA, can be used for the same purpose. Practical implications Sectors alternative involve high degree of complexity to adopt ICT applications for smooth e-governance and seek effective decision-making for investment prioritization and future development. This study also aims to address cyber security concerns of policymakers. Outranking methods of F-PROMETHEE are able to address the criteria-to-criteria impact and support decision-making in a more precise way. Social implications This study is inspired from the strategic implementation of the framework of the e-Government Action Plan 2016-2020 of the EU. The findings from the paper can provide referential support to the Indian Government and policymakers to support information delivery, implement cyber security policies and various sector developments. Originality/value This research study can act as a strong base in the decision-making process in conflicting situations of e-governance in India. This study not only can synergize conflicting ideas of various stakeholders, academicians in the Indian IT-sector but also can act as support to administrators and the policymakers to monitor the status of the India-EU Information Society Dialogue.
'Single-sitting' laparoscopic cholecystectomy followed by endoscopic common bile duct clearance is emerging as a viable option for management of cholelithiasis and concomitant choledocholithiasis. The only disadvantage of the procedure is logistical since it requires co-ordination between two teams-the surgeons and the endoscopists. This limitation can be overcome in centres where both the procedures are performed by one team. With a considerable experience in endoscopy, we conducted a prospective study in a select group of patients to assess the feasibility of this single-sitting approach. The study included 38 patients with a radiological diagnosis of choledocholithiasis or jaundice at presentation. After laparoscopic cholecystectomy, the patients were turned prone and subjected to endoscopic retrograde cholangiogram, sphincterotomy and extraction of the common bile duct stone. The procedure was successful in 33 (87 %) of patients. The mean procedure time and hospital stay were 2 h, 20 min and 2 days, respectively. None of the patients had any major complications. We conclude that in a select group of patients, single-sitting laparoscopic cholecystectomy followed by endoscopic clearance of the common bile duct stone is safe and effective.Keywords Choledocholithiasis . CBD Stone . Laparoscopic Cholecystectomy Common bile duct (CBD) stone occurs in about 3-15 % of patients undergoing laparoscopic cholecystectomy (LC) [1][2][3]. In the era of open cholecystectomy, preoperative endoscopic clearance of CBD followed by open cholecystectomy was comparable [4][5][6] or even considered inferior [7] to single-stage cholecystectomy and choledocholithotomy. With minimally invasive surgery becoming the 'gold standard,' the endoscopic approach has seen a revival and has been considered a viable alternative to laparoscopic CBD exploration for concomitant CBD stone. Traditionally, gallstones with CBD stones are managed in two sittings i.e., endoscopic clearance of CBD stone followed by laparoscopic cholecystectomy or vice versa [8]. This entails involvement of two teams led by the endoscopist and surgeon for CBD stones and gallstones, respectively. The endoscopic approach has been found to be similar to laparoscopic CBD exploration in terms of successful stone clearance, morbidity, and mortality except for longer hospital stay [9,10]. The latter disadvantage can be countered by carrying out the endoscopic CBD stone clearance as a single-sitting procedure in conjunction with LC [11]. The single-sitting approach, however, suffers from the logistic problem as it requires proper coordination between the surgeon and the endoscopist. We were encouraged to try this approach because of our considerable experience with both laparoscopy as well as endoscopy. We attempted to perform laparoscopic cholecystectomy as well as endoscopic clearance of the CBD stone ourselves without having the need to involve another team. In this report, we have presented our initial experience with this 'single-sitting' approach with respect to its...
BACKGROUNDVitamin D is necessary for calcium homeostasis, skeletal growth, development, maintenance and overall wellbeing. It is synthesized in the body by exposure to UV-B rays of the sunlight by the skin. India though is a tropical country with no scarcity of sunlight; vitamin D deficiency/insufficiency is more common than is suspected.The study was designed to assess vitamin D levels in patients complaining of non-specific chronic pain of more than six months duration in urban population.
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