Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021.

OBJECTIVE: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN: Descriptive multi-country secondary data analysis. SETTING: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION: Liveborn infants. METHODS: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.

Harnessing island-ocean connections to maximize marine benefits of island conservation.

Islands support unique plants, animals, and human societies found nowhere else on the Earth. Local and global stressors threaten the persistence of island ecosystems, with invasive species being among the most damaging, yet solvable, stressors. While the threat of invasive terrestrial mammals on island flora and fauna is well recognized, recent studies have begun to illustrate their extended and destructive impacts on adjacent marine environments. Eradication of invasive mammals and restoration of native biota are promising tools to address both island and ocean management goals. The magnitude of the marine benefits of island restoration, however, is unlikely to be consistent across the globe. We propose a list of six environmental characteristics most likely to affect the strength of land-sea linkages: precipitation, elevation, vegetation cover, soil hydrology, oceanographic productivity, and wave energy. Global databases allow for the calculation of comparable metrics describing each environmental character across islands. Such metrics can be used today to evaluate relative potential for coupled land-sea conservation efforts and, with sustained investment in monitoring on land and sea, can be used in the future to refine science-based planning tools for integrated land-sea management. As conservation practitioners work to address the effects of climate change, ocean stressors, and biodiversity crises, it is essential that we maximize returns from our management investments. Linking efforts on land, including eradication of island invasive mammals, with marine restoration and protection should offer multiplied benefits to achieve concurrent global conservation goals.

A simplified seasonal forecasting strategy, applied to wind and solar power in Europe.

We demonstrate levels of skill for forecasts of seasonal-mean wind speed and solar irradiance in Europe, using seasonal forecast systems available from the Copernicus Climate Change Service (C3S). While skill is patchy, there is potential for the development of climate services for the energy sector. Following previous studies, we show that, where there is skill, a simple linear regression-based method using the hindcast and forecast ensemble means provides a straightforward approach for producing calibrated probabilistic seasonal forecasts. This method extends naturally to using a larger-scale feature of the climate, such as the North Atlantic Oscillation, as the climate model predictor, and we show that this provides opportunities to improve the skill in some cases. We further demonstrate that, on seasonal-average and regional (e.g. national) average scales, wind and solar power generation are highly correlated with single climate variables (wind speed and irradiance). The detailed non-linear transformations from meteorological quantities to energy quantities, which are essential for detailed simulation of power system operations, are usually not necessary when forecasting gross wind or solar generation potential at seasonal-mean regional-mean scales. Together, our results demonstrate that where there is skill in seasonal forecasts of wind speed and irradiance, or a correlated larger-scale climate predictor, skilful forecasts of seasonal mean wind and solar power generation can be made based on the climate variable alone, without requiring complex transformations. This greatly simplifies the process of developing a useful seasonal climate service.

How does working in pandemic units affect the risk of occupational hand eczema in healthcare workers during the coronavirus disease-2019 (COVID-19) pandemic: A comparative analysis with nonpandemic units.

BACKGROUND: Hand eczema (HE) has increased among healthcare workers (HCWs) working in coronavirus disease-2019 (COVID-19) units, and was associated with increased hand hygiene practices. OBJECTIVES: To compare the prevalence and clinical characteristics of HE, and hand hygiene practices in HCWs working in COVID-19 and non-COVID-19 units. METHODS: A total of 244 HCWs working in COVID-19 (n = 118) and non-COVID-19 patient care units (n = 126) were examined by dermatologists with regard to demographic parameters and hand hygiene practices. The COVID-19 and non-COVID-19 groups were matched at a 1:1 ratio according to age, atopy, and generalized dry skin. RESULTS: HE was more frequent in the COVID-19 group (48.3% vs 12.7%, P < .001), whereas working years (P < .05) and additional housework at home (P < .001) were longer in the non-COVID-19 group. After the development of HE, moisturizing creams were reported to be more frequently used in the COVID group (P < .001). Topical corticosteroids were used in a minority (40% in the COVID group and 26.7% in the non-COVID group). CONCLUSIONS: HCWs in COVID-19 units developed HE more frequently. A majority increased the frequency of moisturizer use, instead of using topical corticosteroids, after the development of HE for the purpose of treating eczema. New approaches are needed for the prevention and management of HE in HCWs, especially by facilitating access to dermatologists.

Static and Dynamic Postannealing Strategies for Roll-to-Roll Fabrication of DC Magnetron Sputtered Bismuth Telluride Thin Films onto Polymer Webs.

High-throughput roll-to-roll processes are desirable to scale up the manufacture of flexible thermoelectric generators. While vacuum deposition onto a heated dynamic substrate presents a considerable engineering challenge, viable postdeposition in-line annealing processes are considered as an alternative to improve the functional performance of as-deposited films. The effect of infrared and electron-beam irradiations of 1 µm thick bismuth telluride thin films, produced by a vacuum roll-to-roll process for use as thermoelectric materials, was examined. A static vacuum oven and pulsed high-energy electron beam were also studied as control groups. All annealing strategies increased the crystallite size and decreased the Te content. Only the static vacuum oven treatment was shown to significantly improve the film's crystallinity. After 1 h annealing, the power factor improved by 400% (from 2.8 to 14 × 10-4 W/mK2), which, to the knowledge of the authors, is the highest reported thermoelectric performance of postannealed or hot-deposited Bi-Te films. As for in-line annealing, infrared and electron-beam post treatments improved the power factor by 146% (from 2.8 to 6.9 × 10-4 W/mK2) and 64% (from 2.8 to 4.6 × 10-4 W/mK2), respectively.

Late mortality from other diseases following childhood cancer in Australia and the impact of intensity of treatment.

BACKGROUND: People who receive treatment for cancer during childhood often experience subsequent complications of therapy, known as late effects, which can lead to an increased risk of death. PROCEDURE: Using deidentified population-based data from the Australian Childhood Cancer Registry for children aged 0-14 diagnosed with cancer during the period 1983-2011 and who survived for a minimum of 5 years, we examined disease-related deaths (other than cancer recurrence or second primary cancers) that occurred up to 31 December 2016. Risk of death relative to the general population was approximated using standardised mortality ratios (SMRs). Treatment received was stratified according to the intensity of treatment rating, version 3 (ITR-3). RESULTS: During the study period, 82 noncancer disease-related deaths were recorded among 13 432 childhood cancer survivors, four times higher than expected (SMR = 4.43, 95% CI = 3.57-5.50). A clear link to treatment intensity was observed, with the relative risk of noncancer disease-related mortality being twice as high for children who underwent 'most intensive' treatment (SMR = 5.94, 95% CI = 3.69-9.55) compared to the 'least intensive' treatment group (SMR = 2.98, 95% CI = 1.42-6.24; Ptrend  = .01). Thirty-year cumulative mortality from noncancer disease-related deaths was estimated at 1.4% (95% CI = 1.1-1.9) after adjusting for competing causes of death such as cancer, accidents, or injuries. CONCLUSIONS: Although childhood cancer survivors are at increased relative risk of death from noncancer diseases, particularly those who undergo more intensive treatment, the cumulative mortality within 30 years of diagnosis remains small. Knowledge of late effects can guide surveillance of survivors and treatment modification, without wanting to compromise the high rates of survival.

Challenges to optimal rheumatology care: a patient-centered focus group study.

OBJECTIVE: To assess challenges to optimal rheumatology care from the perspective of patients served by our institution's rheumatology division. DESIGN SETTING AND PARTICIPANTS: Focus group study of adult rheumatic disease patients who attend clinics at a university teaching hospital in Montreal, Canada. INTERVENTIONS: Individuals participated in 1-h focus group discussions concerning their experiences and beliefs regarding rheumatology care. Sessions were recorded and transcripts generated. A thematic analysis approach was used by two individual analyzers. MAIN OUTCOME MEASURES AND RESULTS: Eighteen patients participated in three focus groups (group one = 8 patients; group two = 5; group three = 5). Eleven patients had systemic lupus erythematosus, 6 had rheumatoid arthritis, and 1 patient had psoriatic arthritis. The average age (standard deviation) was 51.2 (14.0) years, disease duration 23.5 (14.5) years, and in the majority had at least a high school education. All participants were female and 72.2% were Caucasian. Three main themes emerged: theme 1 identified patients' needs for information and support, at diagnosis and throughout the disease trajectory; theme 2 identified barriers to accessing health care: theme 3 identified patients' beliefs regarding improvements needed to optimize their experiences throughout the disease course. CONCLUSIONS: Our focus group study not only clarified the needs of rheumatology patients with chronic inflammatory disease, and identified barriers to optimal rheumatology care, but also was a source of recommendations that might improve patient experiences in seeking health care in a rheumatology setting. Limitations include the fact that our participants were all female, and mostly were middle aged, Caucasian and well educated. Regardless, the findings can help inform efforts to improve rheumatology care. Key Points • Our focus group study clarified the needs of chronic inflammatory rheumatic disease, and identified barriers to optimal rheumatology care. • Despite some potential limitations, our work provides recommendations that could improve patient experiences when seeking health care in a rheumatology setting.

Selective ozone treatment of PDMS printing stamps for selective Ag metallization: A new approach to improving resolution in patterned flexible/stretchable electronics.

HYPOTHESIS: Selective ozone treatment of Polydimethylsiloxane (PDMS) print-stamps may facilitate local de-wetting of Krytox®1506 oil; the resulting printed pattern can be used as a masking liquid during roll-to-roll vacuum-metallization, exemplified with Ag. This novel method may exploit high-throughput manufacture without chemical etchants or elevated temperatures for thin-film electronics. EXPERIMENTS: The mechanism for selective wetting arose from O3 treatment of PDMS through a shadow-mask to vary surface-energy due to formation of polar silanol (Si-OH) replacing surface methyl groups leading to contact angle reduction from 40°-9° for oil on PDMS. Oiled PDMS was (1) metalized itself and (2) used as a stamp to print onto polyethylene-terephthalate, consisting of oil pick-up/de-wetting/transfer-to-substrate/metallization. FINDINGS: Ag (520-568 nm) thick was deposited outside oiled regions, surpassing ~20 µm resolution of commercial printing. On metalized PDMS, minimum line widths were 2.6 µm (with 10 µm edge-grading from centrifugal oil spreading) or widths of 24 µm (no Ag grading) following spin-coating/roll-coating oil respectively. The progressive effect of thinning oil via five successive stamp-to-substrate impressions, produced line widths of 14 µm (with graded edge of 7.6 µm via spreading from stamp-substrate compression). Developments may reduce reliance on laser engraving/photocuring, and could enhance micro-contact printing through liquid dynamics vs. topographical relief structures.

Developing a mobile data collection tool to manage a dispersed mental health workforce.

CONTEXT: The Rural Adversity Mental Health Program (RAMHP) connects people who need mental health assistance in rural and remote New South Wales (NSW), Australia with appropriate services and resources. In 2016, RAMHP underwent a comprehensive reorientation to meet new state and federal priorities. A full assessment of program data collection methods for management, monitoring and evaluation was undertaken. Reliable data were needed to ensure program fidelity and to assess program performance. ISSUES: The review indicated that existing data collection methods provided limited and unreliable information, were inconvenient for RAMHP coordinators to use and unsuited to their itinerant role. A mobile collection tool (app) was developed to address RAMHP activity data needs. A design and implementation process was followed to optimise data collection and to ensure the successful use of the app by coordinators. LESSONS LEARNED: The early planning investment was worthwhile, the app was successfully adopted by the coordinators and a much improved data collection capability was achieved. Moreover, data capture increased, while errors decreased. Data are more reliable, specific, timely and informative and are used for strategic and operational planning and to demonstrate program performance.

Towards Wearable and Flexible Sensors and Circuits Integration for Stress Monitoring.

Excessive stress is one of the main causes of mental illness. Long-term exposure of stress could affect one's physiological wellbeing (such as hypertension) and psychological condition (such as depression). Multisensory information such as heart rate variability (HRV) and pH can provide suitable information about mental and physical stress. This paper proposes a novel approach for stress condition monitoring using disposable flexible sensors. By integrating flexible amplifiers with a commercially available flexible polyvinylidene difluoride (PVDF) mechanical deformation sensor and a pH-type chemical sensor, the proposed system can detect arterial pulses from the neck and pH levels from sweat located in the back of the body. The system uses organic thin film transistor (OTFT)-based signal amplification front-end circuits with modifications to accommodate the dynamic signal ranges obtained from the sensors. The OTFTs were manufactured on a low-cost flexible polyethylene naphthalate (PEN) substrate using a coater capable of Roll-to-Roll (R2R) deposition. The proposed system can capture physiological indicators with data interrogated by Near Field Communication (NFC). The device has been successfully tested with healthy subjects, demonstrating its feasibility for real-time stress monitoring.

Reorientation of the Rural Adversity Mental Health Program: the value of a program logic model.

CONTEXT: The Rural Adversity Mental Health Program (RAMHP) was founded in 2007 with the specific focus of responding to drought-related mental health needs among farmers in rural and remote New South Wales (NSW), Australia. Successive re-funding enabled the program to evolve strategically and increase its reach. Over a decade, the program's focus has expanded to include all people in rural and remote NSW in need of mental health assistance, and not just in times of adversity such as drought. ISSUE: The program's longest re-funding period, 2016-2020, provided the opportunity for a comprehensive review and longer term planning. Several priorities influencing program renewal were evident at this time: the need to improve data collection and evaluation methods, a reassessment of the program's primary focus and the need to align with significant government mental health reforms. A program logic model (PLM) was developed, in collaboration with frontline RAMHP coordinators, to steer reorientation, clarify objectives, activities and outcomes, and improve data collection. A PLM is a graphic depiction of a program, showing the rationale of how inputs and activities lead to outcomes. LESSONS LEARNED: Four key lessons were identified. (1) The development of the PLM in collaboration with the RAMHP coordinators (frontline staff) was found to be an important vehicle for ensuring their acceptance and adoption of strategic changes. (2) The collaborative development process also provided the opportunity to decide upon consistent terminology to describe the program, facilitating communication of the value of RAMHP to external stakeholders. (3) The PLM enabled a clear but flexible program structure that aligned with changes in the mental health system to be described. (4) The PLM provided the foundation for the development of an evaluation framework, including a mobile app, to aid data collection to underpin accountability. Investing in the development of a PLM early in program reorientation provided many benefits for RAMHP, including improved role clarity and communication, staff commitment to program changes and a foundation for comprehensive program evaluation that integrates with program planning. The PLM proved a key foundational tool to reorient RAMHP by producing a clear program structure that was agreed upon by all staff.

Regulation of the divalent metal ion transporter via membrane budding.

The release of extracellular vesicles (EVs) is important for both normal physiology and disease. However, a basic understanding of the targeting of EV cargoes, composition and mechanism of release is lacking. Here we present evidence that the divalent metal ion transporter (DMT1) is unexpectedly regulated through release in EVs. This process involves the Nedd4-2 ubiquitin ligase, and the adaptor proteins Arrdc1 and Arrdc4 via different budding mechanisms. We show that mouse gut explants release endogenous DMT1 in EVs. Although we observed no change in the relative amount of DMT1 released in EVs from gut explants in Arrdc1 or Arrdc4 deficient mice, the extent of EVs released was significantly reduced indicating an adaptor role in biogenesis. Furthermore, using Arrdc1 or Arrdc4 knockout mouse embryonic fibroblasts, we show that both Arrdc1 and Arrdc4 are non-redundant positive regulators of EV release. Our results suggest that DMT1 release from the plasma membrane into EVs may represent a novel mechanism for the maintenance of iron homeostasis, which may also be important for the regulation of other membrane proteins.

Narrow Band Gap Lead Sulfide Hole Transport Layers for Quantum Dot Photovoltaics.

The band structure of colloidal quantum dot (CQD) bilayer heterojunction solar cells is optimized using a combination of ligand modification and QD band gap control. Solar cells with power conversion efficiencies of up to 9.33 ± 0.50% are demonstrated by aligning the absorber and hole transport layers (HTL). Key to achieving high efficiencies is optimizing the relative position of both the valence band and Fermi energy at the CQD bilayer interface. By comparing different band gap CQDs with different ligands, we find that a smaller band gap CQD HTL in combination with a more p-type-inducing CQD ligand is found to enhance hole extraction and hence device performance. We postulate that the efficiency improvements observed are largely due to the synergistic effects of narrower band gap QDs, causing an upshift of valence band position due to 1,2-ethanedithiol (EDT) ligands and a lowering of the Fermi level due to oxidation.

High Performance PbS Quantum Dot/Graphene Hybrid Solar Cell with Efficient Charge Extraction.

Hybrid colloidal quantum dot (CQD) solar cells are fabricated from multilayer stacks of lead sulfide (PbS) CQD and single layer graphene (SG). The inclusion of graphene interlayers is shown to increase power conversion efficiency by 9.18%. It is shown that the inclusion of conductive graphene enhances charge extraction in devices. Photoluminescence shows that graphene quenches emission from the quantum dot suggesting spontaneous charge transfer to graphene. CQD photodetectors exhibit increased photoresponse and improved transport properties. We propose that the CQD/SG hybrid structure is a route to make CQD thin films with improved charge extraction, therefore resulting in improved solar cell efficiency.

Poly(3-hexylthiophene-2,5-diyl) as a Hole Transport Layer for Colloidal Quantum Dot Solar Cells.

Lead sulfide colloidal quantum dot (CQD) solar cells demonstrate extremely high short-circuit currents (Jsc) and are making decent progress in power conversion efficiencies. However, the low fill factors (FF) and open-circuit voltages have to be addressed with urgency to prevent the stalling of efficiency improvements. This paper highlights the importance of improving hole extraction, which received much less attention as compared to the electron-accepting component of the device architecture (e.g., TiO2 or ZnO). Here, we show the use of semiconducting polymer poly(3-hexylthiophene-2,5-diyl) to create efficient CQD devices by improving hole transport, removing interfacial barriers, and minimizing shunt pathways, thus resulting in an overall improvement in device performance stemming from better Jsc and FF.

Clinical Agreement between Nurses in the Ultrasound Measurement of Abdominal Aortic Diameter within a National Screening Programme.

BACKGROUND: Accurate measurement is central to abdominal aortic aneurysm screening, but information concerning differences between observers using modern ultrasound devices is lacking. Our aim was to assess clinical agreement among nurses within a national screening programme. METHODS: Between-observer repeatability was assessed among 2 pairs of nurses (A & B and C & D) screening a consecutive series of men at a single-community clinic in Grampian, Scotland. All 4 nurses used the same ultrasound device (GE-LOGIQe 1.5-4.6 MHz curvilinear probe) to measure maximal infrarenal inner-to-inner (ITI) anteroposterior diameter in longitudinal and transverse planes. Nurses alternated in their measurements and were blinded to their partners' measurements. Participants remained supine while "double-scanned." Clinical agreement was assessed as twice the standard deviation (2 SD) of mean differences. Analysis was undertaken using IBM-SPSS-Statistics (version 22) using the Bland-Altman "limits of agreement" (95% LoA) approach (mean difference ±2 SD) and related plots. RESULTS: A total of 63 consecutive men underwent assessment (30 men by nurses A & B; 33 men by nurses C & D). Mean age 65.5 years, brachial blood pressure 145/88 mm Hg, current smokers 14%, never smoked 41%, diabetic 18%, arterial disease 11%, daily aspirin 16%, antihypertensives 35%, and statin therapy 44%. Mean aortic diameter (ITI) was 1.81 centimeters (cm; range 1.28-2.45; SD 0.18). Pooled mean differences between nurses was 0.05 cm (95% confidence interval 0.02-0.08); 2 SD ± 0.23 with 95% LoA -0.18 to 0.28 cm. Repeatability was similar in both planes and for both pairs of nurses. CONCLUSIONS: Nurses can achieve a high level of agreement in the measurement of aortic diameter in a routine clinical setting.

Transfer printed silver nanowire transparent conductors for PbS-ZnO heterojunction quantum dot solar cells.

Transfer-printed silver nanowire transparent conducting electrodes are demonstrated in lead sulfide-zinc oxide quantum dot solar cells. Advantages of using this transparent conductor technology are increased junction surface energy, solution processing, and the potential cost reduction of low temperature processing. Joule heating, device aging, and film thickness effects are investigated to understand shunt pathways created by nanowires protruding perpendicular to the film. A V(oc) of 0.39 ± 0.07 V, J(sc) of 16.2 ± 0.2 mA/cm(2), and power conversion efficiencies of 2.8 ± 0.4% are presented.

Two-stage genome-wide methylation profiling in childhood-onset Crohn's Disease implicates epigenetic alterations at the VMP1/MIR21 and HLA loci.

BACKGROUND: As a result of technological and analytical advances, genome-wide characterization of key epigenetic alterations is now feasible in complex diseases. We hypothesized that this may provide important insights into gene-environmental interactions in Crohn's disease (CD) and is especially pertinent to early onset disease. METHODS: The Illumina 450K platform was applied to assess epigenome-wide methylation profiles in circulating leukocyte DNA in discovery and replication pediatric CD cohorts and controls. Data were corrected for differential leukocyte proportions. Targeted replication was performed in adults using pyrosequencing. Methylation changes were correlated with gene expression in blood and intestinal mucosa. RESULTS: We identified 65 individual CpG sites with methylation alterations achieving epigenome-wide significance after Bonferroni correction (P < 1.1 × 10(-7)), and 19 differently methylated regions displaying unidirectional methylation change. There was a highly significant enrichment of methylation changes around GWAS single nucleotide polymorphisms (P = 3.7 × 10(-7)), notably the HLA region and MIR21. Two-locus discriminant analysis in the discovery cohort predicted disease in the pediatric replication cohort with high accuracy (area under the curve, 0.98). The findings strongly implicate the transcriptional start site of MIR21 as a region of extended epigenetic alteration, containing the most significant individual probes (P = 1.97 × 10(-15)) within a GWAS risk locus. In extension studies, we confirmed hypomethylation of MIR21 in adults (P = 6.6 × 10(-5), n = 172) and show increased mRNA expression in leukocytes (P < 0.005, n = 66) and in the inflamed intestine (P = 1.4 × 10(-6), n = 99). CONCLUSIONS: We demonstrate highly significant and replicable differences in DNA methylation in CD, defining the disease-associated epigenome. The data strongly implicate known GWAS loci, with compelling evidence implicating MIR21 and the HLA region.