REVIEWARTICLE

BHalf a Century of Evolution of Neonatology: AWitness’s Story^Dr. K. C. Chaudhuri Lifetime Achievement Award Oration Delivered at AIIMS, New Delhion 7th September 2014

Dharmapuri Vidyasagar1,2,3

Received: 24 June 2015 /Accepted: 24 June 2015 /Published online: 5 August 2015# Dr. K C Chaudhuri Foundation 2015

Abstract Lifetime achievement awards are awarded to rec-ognize contributions during the career of an individual, ratherthan for a single or multiple contributions of a person in his/her field of specialty. I am highly honored being the recipientof the Dr. K. C. Chaudhuri Lifetime Achiement AwardOration. The award for me is significant for several reasons:First being associated with legendary figure such as Dr.Chaudhuri, secondly being recognized by my fellow Indiancolleagues. Finally, it also marks half a century of my experi-ence in development of subspecialty of neonatology in US.Some fifty and odd years ago, as an young novice from India Ijoined the mainstream of this evolution, thanks to myprofessors and mentors in US and thanks to America, the landof opportunity. During this odyssey, I met many great men andwomen of science and intellect, saw great scientific discover-ies, many innovations, combined with social changes that ledto significant reduction of neonatal mortality rates in the in-dustrialized Western countries. I also saw the BGlobalization^of BModern Neonatology^ in which I participated with vigor;thus, improving the newborn care in four corners of the world.I am proud that I had the opportunity to contribute a little togrowth of neonatology in US and outside the US. This is thestory of my professional life. The message of my life story forthe younger generation is : Dream big, never give up yourdreams. Hardwork, maintaining your integrity, and honesty

are the three precepts that will define your character and youwill be rewarded in the long run.

Keywords Neonatology . Evolution . Advances .

Globalization NMR

Introduction

I am honored to be invited to deliver the very prestigious BDr.K. C. Chaudhuri Lifetime Achievement Award Oration^. ProfChaudhuri’s academic achievements and his interest in pro-moting child health in India, inspire me to tell my story of thejourney in the path of evolution of neonatology during last50 y. My odyssey started on May 16th 1963 when I left Indiawith a degree of MBBS and few dollars (8$) in my pocket towork as an intern to a little known Vassar Brothers Hospital inPoughkeepsie, New York, NY. My sole purpose at that time ofgoing to US was to earn enough money to go to UK to obtainMRCP and return home for good.

Once I experienced the warmth of people in US and theexcellent academic environment with many opportunities forprofessional growth, I made use of full 5 y stay in US allowedunder J1 visa. During these years I was introduced to myspecialty of interest: Pediatrics and later to the subspecialtyof neonatology. As a Resident in pediatrics at AlbanyMedical Center NY, later at Pittsburg Children Hospital,Pittsburg, I discovered that neonatology was a very excitingnew subject which was in its early infancy. In fact the termBNeonatology^ was coined in 1961 by Professor AlexanderSchaefer of Johns Hopkins as the science of newborn healthand the BNeonatologist^ as an expert in neonatal medicine, thefirst 28 d of life being the neonatal period [1]. Perhaps my pulltowards neonatology was the result of events that occurred inmy early career.

* Dharmapuri Vidyasagardvsagarmd@yahoo.com

1 Department of Pediatrics, Center for Global Health, University ofIllinois at Chicago, Chicago, USA

2 Public Health Foundation of India, Delhi, India3 MS Ramaih Medical College, Bangalore, Karnataka, India

Indian J Pediatr (December 2015) 82(12):1117–1125DOI 10.1007/s12098-015-1838-8

On August 7, 1963 Jacqueline Kennedy, wife of PresidentKennedy gave birth to a premature baby (34 wk GA, birthweight of 2.1 kg [2] (Fig. 1) in Boston who developed breath-ing difficulties, nowwhat is known as the BHyalinemembranedisease^(HMD). Usher’s regime [3], infusion of 10 % dex-trose water with NaHCO3 was the only known treatment forHMD. Neonatal ventilator care was not available even for thePresident’s baby in US in 1963. And sending president’s babyto neighboring Canada where neonatal ventilation was avail-able was not an option. The baby died after 2 d on August 9th1963. The death of President Kennedy’s baby was a day fornational mourning. As the story of demise of baby Kennedyunfolded BHMD^ a disease of premature babies becameknown to all in America. It was estimated that about 25,000babies died of HMD annually in USA.With the death of babyKennedy, the interest in research in the disease HMD acceler-ated. The interest in newborn care increased.

In 1960s and early 1970’s although there were no formalFellowship training programs in BNeonatology ,̂ a few centersfocused research in neonatology. Pennsylvania Hospital inPhiladelphia was one of the few centers engaged in neonatalresearch under the leadership of Dr. Thomas Boggs, a selfmade neonatologist, a rare breed at that time, and his col-league, Dr. Jack Downes, a pediatric anesthesiologist atChildren Hospital of Philadelphia. Together they were therecipients of a NIH grant to study BRespiratory failure in pre-mature infant with HMD^ (1964/65); the objectives of thegrant were to establish clinical and blood gas criteria for the

diagnosis of respiratory failure in the premature baby sufferingfrom RDS/HMD, and develop indications for assisted venti-lation. Just as I was finishing my Pediatric Residency and waslooking for Fellowship in neonatology, a chance meeting withDr. Subhash Arya who had worked with Dr. Downes, intro-duced me to him and I landed with a job as BNeonatal researchfellow^ under his tutelage. During these formative years oftraining in neonatology, my mentors Downes, the brightyoung anesthesiologist with keen mind for research and Dr.Boggs, a great clinician, shaped my academic career and myfuture work. The 2-y fellowship gave me great experience inclinical neonatology, physiology of neonatal ventilation andintroduction to clinical research. The results of NIH fundedresearch describing the serial blood gas andmetabolic changesin infants with HMD, were accepted for presentation at theAnnual Pediatric Research meetings in 1967 in Atlantic City.This was my very 1st presentation at a national scientific ses-sion. It was, of course, a memorable event in my early career.During this period we developed the now well knownDownes-RDS score [4], learnt and taught others how to placeumbilical arterial and venous catheters [5], and learnt to initi-ate artificial positive and negative ventilation in infants withRDS. I had the privilege to conduct the first workshop onumbilical vascular catheterization at the annual AmericanAcademy of Pediatrics (Fig. 2). During this period I crossedanother major milestone of my life. I met my future wife Dr.Nagamani Beligere, a fellow in pediatric cardiology with Dr.William Rashkind, the inventor of BBalloon Septostomy^ ininfants with transposition of great vessels.

By the end of 1968, having spent 5 y on J1 visa, it was timefor me to move out of US. I could re-enter US after 2 y on apermanent visa. Short of returning home, I was advised to joinDr. Victor Chernick, working at Winnipeg Children Hospital,Winnipeg, Canada for further training in neonatal physiology.I spent next 3 y with Dr. Victor Chernick and his colleague,Dr. Jim Haworth, a specialist in neonatal metabolism. My 3 yin Canada were most rewarding to me academically. This wasthe time many major discoveries and innovations in

Fig. 1 Front page of news papers like The Boston Globe covered theillness and later the death of President Kennedy Baby suffering fromHMD, little known disease of the premature at that time. But thetragedy gave a great impetus to medical research in USA to study thediseases of the newborn

Fig. 2 Program of American Academy of Pediatrics 1968, showing theUmbilical Catheterization lecture and workshop conducted by the author

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neonatology were shaping up. Dr. Mary Ellen Avery [6], thementor of mymentor Dr. Chernick at Hopkins, had discoveredsurfactant deficiency as the underlying cause of neonatalHMD. Liggins had demonstrated that antenatal steroids accel-erated pulmonary maturation [7] and George Gregory haddemonstrated increased survival of infants with applicationof Constant Positive Airway Pressure (CPAP) [8].

Working with Dr. Chernick, we showed that blocking ofsteroid synthesis, using Metopirone, in the rabbit fetus woulddepress surfactant production in fetal rabbit lung [9], thusestablishing the role of innate steroids in fetal lungmaturation.Another area of our study was the use of Negative Pressureventilator to treat infants with RDS (Fig. 3). Negative pressureventilation did not need the use of invasive endotracheal tubeplacement. We thought while Gregory had applied CPAPusing an endotracheal tube; application of noninvasive con-stant negative pressure (CNP) to chest wall would have thesame effect. With some changes in the negative pressure ven-tilator to produce desired CNP, we showed dramatic improve-ment in blood oxygenation in infants with RDS [10, 11].These papers were published and presented at PediatricResearch meetings. Along with carrying out clinical and lab-oratory research, I also worked towards masters degree inphysiology which I completed in 1971.

The Age of Reckoning

Having finished 5 y Fellowship training in neonatologyand masters degree in physiology, and a few publica-tions, I had come to a fork of my academic journey:Either to return to India or continue working in Canadaor US. There was an intense pull towards returninghome-India but the prospects for a job as a neonatolo-gist in India proved to be bleak. I looked for a full time

job of academic neonatologist in US. As a foreign med-ical graduate, I faced uphill battle gaining an academicposition. After several failed interviews and with nohope in sight to get an academic position I decided totake up pediatric practice. This news did not go wellwith my mentor Dr. Chernick who insisted that I lookfor an academic job at the forthcoming PediatricResearch Meeting (May 1971) where our paper onConstant Negative Pressure (CNP) ventilation in HMDwas being presented. He introduced me to several pro-spective program directors including Dr. Rosita Pildes atCook County Hospital (now the Stroger Hospital) inChicago, who offered me the job of Associate Directorof neonatology and Asst. Prof. at the University ofIllinois at Chicago. (Sept 1971).

The Cook County Hospital in 1970s was a well knowncenter for training and patient care. The annual deliveries were20,000, with neonatal mortality of 30/1000. On joining thehospital, I established a modern NICUwith ventilator support,trained doctors and nurses. With these improvements we wereable to bring down the neonatal mortality rate (NMR) to 17/1000 in 2 y. We also started a Neonatal Fellowship programand initiated modern neonatal transport of infants requiringassisted ventilation. Dr. Rajam Ramamurthy who recently re-tired after a distinguished career at University of Texas, SanAntonio and Dr. T F Yeh, currently the Dean of MedicalSchool in Taiwan, were first two fellows in my early careerat Cook County Hospital. Both are recognized for their con-tribution to neonatology. My research activity here includedseveral papers; among them, the experience with assisted ven-tilation in infants with meconium aspiration syndrome (MAS)was the most significant one [12].

My next major milestone was a move to University ofIllinois at Chicago. In 1974, I took over as the Chief of divi-sion of neonatology at the University of Illinois at Chicago

Fig. 3 The photograph of a babybeing treated with negativepressure ventilator. Note the bodyof the baby is inside a chamberand head is outside the box. Aflexible collar around the neckseparates the body inside the box.There is no endotracheal tube inplace. Head is covered withplastic head hood filled withoxygen. Intermittent negativepressure inside body box expandsthe chest intermittently. Thepressure inside the box creates aconstant negative pressure (CNP)similar to CPAP, keeping thealveoli open. CNP was effectivein improving PaO2 in babies withHMD. (see text for details)

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(UIC). I remained there for next 33 y (1974 to 2007) until myretirement in 2007. Thus began the era of reconstruction of mycareer as an independent division head and an independentresearcher. Six months later I recruited first of my two fellowsat UIC: Drs. Raju and Andreou. Dr. Raju, after 25 y at UICcatapulted to assume the position at NICHD. Dr. AlexAndreou would later become a leading figure in neonatologyin Greece. During my tenure of 33 y at UIC, we achievednumerous things in the field of patient care, teaching, researchand global health.

The Age of Renasience

During these years at University of Illinois Hospital, we de-veloped world class Neonatal Intensive Care Unit, and didextensive capacity building work of nursing staff and pedia-tricians in level II hospitals of the city. Working with city andstate health departments we organized regional perinatal cen-ters in Chicago area. Research activities included studies innoise pollution [13], development of methods of non invasivemethod of measuring intracranial pressure in the newbornusing a fiber optic technique [14, 15], and follow up of<1000 g babies [16] were some of the earliest publica-tions. This was the period also when we defined thepathophysiology of Meconium Aspiration Syndrome(MAS) [12]. We also were the first to study thetranscutanoeus blood gases and tissue ph monitoring inbabies [17, 18].

For me the decade of 1980s was a period of rapid growth,both in research and in international activities, which led toWHO recognition as the collaborating center in perinatalmedicine. The decade of 1980 was a period of rapid growthin neonatology (Fig. 4). There was introduction of noninvasive monitoring tools, and the surfactant therapy acrossthe developed world. With these advances came the reportsof improving survival of <1500 g babies. In these times wewere not mere observers but we innovated some advancesand participated in many other clinical trials which were ofseminal importance. Thus I was both a witness and a par-ticipant of many a developments in the field of neonatalmedicine.

Then came the major opportunity to work with Dr.Fujiwara, the innovator of surfactant therapy in HMD. In1980 Dr. Fujiwara published his classic paper of improvedsurvival of babies with HMD with surfactant therapy [19].Within couple of years of his publication, by chance, I devel-oped close working relationship to study the effect of surfac-tant TA to be tested in premature Baboon model in our labo-ratory (Fig. 5). Dr. Fujiwara enthusiastically provided the sur-factant and sent his junior faculty to work with us at UIC for 6y. Our surfactant studies in non human primate model of HMDoffered some of the insights that studies in human babies could

not. We showed besides surfactant TA being highly beneficialto improve blood gases similar to seen in human babies, it alsoimproved lung histology [20]. Chest radiographs also im-proved. We could demonstrate an increased blood flow tolungs and through ductus arteriosus, following surfactant treat-ment. These studies formed the basis for embarking clinicaltrials on surfactant. We conducted one of the earliest doubleblind clinical trials in USA using Fujiwara’s surfactant TApublished in Lancet in 1987 [21]. Later we participated in otherclinical trials of surfactant therapy in USA [22]. Other studiesincluded clinical trial of surgical ligation of patent ductusarteriosus (PDA) [23] and pharmacokinetics of indomethicin[24, 25]. We published one of the first paper explaining thepathophysiology MAS [12]. Later we focused our attention tothe study of molecular basis of Meconium Induced LungInjury (MILI) [26]. Our studies showed that MILI is, throughcytokine pathways, endothelin induced injury and studied therole of caspase. In 2007 we organized a first of its kind NIHsponsored symposium on MILI where investigators from allover the world shared their research on MILI [27]. We alsopresented long term outcome of babies with MAS [28].

Contributions and Educational Programs

Several educational programs were developed for the ben-efit of local and nationwide practitioners, neonatologistsand the nursing staff. These included physiology semi-nars, which later became the most popular one of its kind,Neonatal Perinatal Board Review Course in USA. After35 successive years it continues to flourish under the flag-ship of MEDNAX/Pediatrix [29]. The week long programhas been attended at least by large number of neonatolo-gists in US.

The Neonatal Fellowship training Program at UICcontinued for 4 decades under my tenure. The programproduced several of the best fellows who now occupyvery high academic positions in USA and abroad. Ourtrainees are now doing phenomenal jobs in US. My for-mer trainees, Dr. Raju is the Director of Pregnancy andProgram at NICHD, a branch of NIH; Dr. Rama Bhat, agreat clinician, researcher and teacher focused on neona-tal pharmacology; Dr. Jain, another former trainee is theVice President of Medical Services at Emory Universityand Vice head of Dept. of pediatrics. Dr. Rama Bhat is aresearcher, a clinician and a great teacher still working atMilwaukee Children’s Hospital. Dr. Nagamani Beligere, amember of our team is a specialist in DevelopmentalPediatrics following the Neuro development of graduatesof NICU. She is currently a co- investigator with Dr.Vijaylaxmi of Arvin Eye hospital in Madurai, India.

Inpatient care, NICU at UIC became the model center fortertiary care of the newborn in the city, country and on

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international arena for our innovative approaches to care.Physicians and nurses from around the world pay visit toNICU at UIC to learn neonatology. We also developed astrong multidisciplinary Perinatal team to provide perinatalservices to community. The model of our perinatal programwas adopted by other countries: Poland, Lithuanian andUzbekistan. Our involvement at global level will be describedin later pages of this article.

Association with Society of Critical Care Medicine(SCCM)

A little less known is my work with SCCM of USA. I was oneof the first few pediatricians to join SCCM in 1975. I servedon the editorial board of Journal of Critical Medicine. Soon Irose through the ranks to be elected to the ExecutiveCommittee, then to become the President of Society of

Fig. 4 The time line of different therapeutic innovations in neonatology from year 1900 to 2010. It also shows the neonatal mortality trends in USA andEngland, both steadily decreasing by 2010. It demonstrates the impact of innovations in decreasing NMR

Fig. 5 Baboon baby delivered at80 % of gestational age is placedin a plastic box. Chest X-ray,findings are of typical HMD. Thismodel was used to test theefficacy of surfactant TA ofFujiwara to treat HMD. Seedetails in text

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Critical CareMedicine (1984–1985), the first pediatrician everto assume such important position. The historians of SCCMrecorded: BPediatric critical care medicine, including neonatalcare was arguably most deserving area for a separate boardcertification. But not until 1984 did SCCM have its first pedi-atric critical care president: Dharmapuri Vidyasagar, Professorof pediatrics and director of neonatology at the University ofIllinois at Chicago. Vidyasagar greatly influenced the devel-opment of pediatric and neonatal critical care medicine bothwithin SCCM and as a worldwide Ambassador^ [30].

The Age of Globalization

The decade of 1980s was also the period when I expanded myhorizon into the international arena long before the wordBGlobalization^ came into vogue. I recognized the dire needfor transfer of new technology and scientific knowledge relat-ed to neonatal and perinatal medicine to developing countries.For a long time reducing the high maternal mortality rate(MMR), NMR and infant mortality rate (IMR) in developingcountries has been the major focus of WHO. As a migrantpediatrician to US and the beneficiary of training at some ofthe best academic centers under the best scientific mindedmentors, I always wanted to give back my services to improvenewborn health to my country of birth -India and other devel-oping countries. According to WHO, three major barriers toimproving neonatal health in resource poor countries were:Lack of skilled personnel, lack of equipment and lack of ac-cess to health care facilities. I thought we could contribute toimprove newborn health and better survival in India and else-where through BTransfer of technology^ and capacity build-ing of health care personnel. My BInternational^ activitystarted in my home country India in 1971. It was the initialwarm welcome of senior members like Dr. Athavale, Head ofthe department of pediatrics at Sion Hospital in (1971) andDr. O. P. Ghai (1975), Head of the department of pediatrics atAIIMS that led to long lasting relationship with other stalwartsand advocates of neonatology in India: Dr. Meharban Singhof AIIMS, Dr. Bhakoo of PGI, Dr. Santosh Bhargav ofSafdarjung Hospital and Dr. Deepak Guha. This was the pe-riod when the National Neonatal Forum (NNF) was beingformed with the purpose of improving neonatal health anddecreasing neonatal mortality in India. Since then I have hadnothing but memorable relationship with NNF and its leadersover last 35 y that resulted in many memorable collaborativeprojects. The Faculty Exchange program for neonatologistsfrom India to attend a 6 wk program at UIC at Chicago wassupported by NNF (Fig. 6) [31]. Locally in Chicago I wassupported by many expatriate physicians, Drs. Bhutani,Raju, Bhat, Ramamurthy, Jain, Shukla, Beligere, Velamatiand Vasa to name a few. Over 70 faculty members from allover India were sponsored to participate in the program over

4–5 y. Soon after that in 1989, working with NNF, we intro-duced the newly released Neonatal Resuscitation Program(NRP) developed by American Heart Association andAmerican Academy of Pediatrics, in the US [32].We conduct-ed the first ever BTrain the Trainor^ workshop in India atManipal Medical College. One hundred faculties from allstates attended the course and were certified in NRP. NNFwas also provided 5 sets of training modules to be distributedaround the country’s five geographic zones. Together with thehelp of my colleagues fromUS, we conducted, several CME’sand workshops all over India. Dr. Viny Bhutani and manycolleagues from US joined hands in all my CME activitiesin India. We also evaluated the effect of NRP training andoutcome [33]. I cannot thank them enough for their supportin my work in India [34]. Another area of major success wascapacity building of faculty at KLES University, Belgaum,Karnataka [34] and helping KLES University team to jointhe NIH Global Neonatal Network consortium (1998). LaterI mentored the first Ph.D. candidate (Dr. Manisha Bhandankar2011) in neonatology. What began as series of visits to India,soon evolved into a lasting collaborative relationship withmany other countries. These collaborations were mostly as aresult of geopolitical changes that occurred in late 1980s.

The first country that opened its doors in 1983 was theliberalized post-Mao China. I was invited as WHO technicalconsultant to visit China Medical College, Shenyang to devel-op neonatology in modern China. I conducted a week longBNeonatology course^ for 100 neonatologists drawn from allover China (Fig. 7). The first course was held by a Westernneonatologist in China. Following that, several bilateral ex-change program between UIC and China Medical CollegeShenyang, took place until 1995. During my trips toShenyang, I also met faculty at Beijing Children’s Hospitaland other medical colleges in Beijing. Dr. Wei Ku Lun,Professor of pediatrics, who spent 6 mo as a visiting professorto UIC in Chicago later rose to high level leadershipposition in China: “President of Association of ChineseNeonatologists”. Later he wrote that Bthe advances in neona-tology in China were helped with the introduction of modernneonatology by Prof. Dr. Vidyasagar^ (personal communica-tion). In recognition of my work I received the award ofHonorary Professor in China Medical College. On a personalnote, my visit to China in 1983 was one of the most unforget-table experiences of my life. I enjoyed the extreme hospitalityof both the Govt. officials and the officials of the ChinaMedical College and professional colleagues. My being ofIndian origin was a great interest to Chinese hosts and theywere eager to show the statue of Dr. Chitnis of India on thecampus of Shenyang Medical College. Dr. Chitnis fromBombay Province was close to Maodezang and took part inthe Long march with him.

In 1989 when Soviet Union dissolvedwewere introduced toneonatologists in Poland and Lithuania through their contacts

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in Chicago and the Ministries of Health of respective countries.The program in Poland, under the leadership of Dr.Gadzinowski of Poznan Medical School was one of the mostsuccessful programs we undertook to introduce how to reduceNMR in other countries. Later we were asked by a newly or-ganized consortium, American International Health Alliance(AIHA) to help Tashkent Medical Institute in Tashkent,Uzbekistan, one of the former Republics of Soviet Union[35]. These relationships lasted for a decade and longer. Ourwork in different countries to improve newborn care throughseveral global collaborations were recognized by WHO ingranting UIC a collaborating center for training in perinatology.I am also humbled for the recognition of my contributions toneonatology recorded in the US Congressional Record [36].

In spite of the major scientific advances, NMR and IMRcontinue to remain high in resource poor countries. At thecurrent rate of progress some countries may take as long as100–200 y to lower NMR in par withWestern countries unlesswe accelerate the improvements in newborn care. That is thechallenge for coming generations of neonatologists during thenext 50 y.

Conclusions

As I reflect on my life of last 50 y in USA; it has been a longbut memorable ride in my professional career. The US, myadopted country, has given me ample opportunities to develop

Fig. 6 The photo shows the firstbatch of faculty from all overIndia who came to University ofIllinois at Chicago in 1987.Mayor Harold Washington ofCity of Chicago entertained themat City Hall of Chicago. Similarexchanges were carried for nextseveral years, inviting over 70faculty from all over India

Fig. 7 The photo shows a grouppicture of hundred neonatologistsdrawn from all over China for aweek long course in neonatology.You see Dr. Vidyasagar in themiddle of front row is the onlyone in western suit, others are allin Mao Suit (1983). See text fordetails

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my career of interest. For that, I owe gratitude to this greatcountry of opportunities. During this journey I met many greatmen and women of science and intellect, saw great scientificdiscoveries, many innovations, combined with social changesthat led to significant reduction of neonatal mortality rates inthe industrialized western countries. I also saw theBGlobalization^ of BModern Neonatal^ care, thus improvingthe newborn care in four corners of the world [34]. I considermyself to be fortunate and privileged to be part of the BHistoryof Modern Neonatology in US^. In my profession, an invita-tion from Pakistan Pediatric Society and Agakhan University(thanks to Dr. Zulfiquar Bhutta) in March 2007 was the mostexciting experience, second only to the invitation from Chinain 1983!

My message to younger generation is that hard work, fo-cused goal and good work ethics are the three precepts thatwill define ones’ character and success in professional life.You must always think of greater good in every step of yourlife than for narrow success of self. Such actions will makeones’ life meaningful.

I wish to end my talk with a quote from late ThurgoodMarshall [37], first Afro American Judge on the SupremeCourt of US. When he was asked what he did for the causeof Afro Americans in US, he responded saying BI did what Icould, with what I had^. Friends with humility I say, BI havenot done much for India but I did what I could within myprofessional capability with what little I had^.

Acknowledgments My special thanks to Dr. I. C. Verma, the Editor-in-Chief of IJP for his professional encouragement over the last four de-cades. And today for choosing me for this prestigious award. I thankmany generous souls, mentors in USA, long term colleagues for theirunwavering support all through my national and international work. Myspecial thanks to past and present leaders of NNF and all those whowelcomed me with open arms and supported my lifelong work in India.My thanks to my overseas friends in each country who were mentioned inthe text. I thank my wife Dr. Nagamani Beligere and my children whofully supported my academic pursuit.

Conflict of Interest None.

Source of Funding None.

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