Impact of personal protective equipment on the clarity of vision among trachoma survey graders and trichiasis surgeons in the context of COVID-19.

BACKGROUND/AIMS: The COVID-19 pandemic necessitated the use of personal protective equipment for those involved in trachoma survey grading and trichiasis surgery. We sought to determine which configuration of a face shield would be less likely to impact grading accuracy and ability to conduct trichiasis surgery. The research also included assessment of comfort, ease of cleaning and robustness. METHODS: There were three research phases. In phase 1, assessment of four potential face shield configurations was undertaken with principal trachoma graders and trichiasis surgeon trainers to decide which two options should undergo further testing. In phase 2, clarity of vision and comfort (in a classroom environment) of the two configurations were assessed compared with no face shield (control), while grading trachomatous inflammation-follicular (TF). The second phase also included the assessment of impact of the configurations while performing trichiasis surgery using a training model. In phase 3, face shield ease of use was evaluated during routine surgical programmes. RESULTS: In phase 2, 124 trachoma graders and 28 trichiasis surgeons evaluated the 2 face shield configurations selected in phase 1. TF agreement was high (kappa=0.83 and 0.82) for both configurations compared with not wearing a face shield. Comfort was reported as good by 51% and 32% of graders using the two configurations. Trichiasis skill scores were similar for both configurations. CONCLUSION: The face shield configuration that includes a cut-out for mounting the 2.5× magnifying loupes does not appear to impact the ability or comfort of trachoma graders or trichiasis surgeons to carry out their work.

Disentangling physics and chemistry in AGB outflows: revealing degeneracies when adding complexity.

Observations of the outflows of asymptotic giant branch (AGB) stars continue to reveal their chemical and dynamical complexity. Spherical asymmetries, such as spirals and disks, are prevalent and thought to be caused by binary interaction with a (sub)stellar companion. Furthermore, high density outflows show evidence of dust-gas interactions. The classical chemical model of these outflows - a gas-phase only, spherically symmetric chemical kinetics model - is hence not appropriate for the majority of observed outflows. We have included several physical and chemical advancements step-by-step: a porous density distribution, dust-gas chemistry, and internal UV photons originating from a close-by stellar companion. Now, we combine these layers of complexity into the most chemically and physically advanced chemical kinetics model of AGB outflows to date. By varying over all model parameters, we obtain a holistic view of the outflow's composition and how it (inter)depends on the different complexities. A stellar companion has the largest influence, especially when combined with a porous outflow. We compile sets of gas-phase molecules that trace the importance of dust-gas chemistry and allow us to infer the presence of a companion and porosity of the outflow. This shows that our new chemical model can be used to infer physical and chemical properties of specific outflows, as long as a suitable range of molecules is observed.

Experimental and theoretical study of the low-temperature kinetics of the reaction of CN with CH2O and implications for interstellar environments.

Rate coefficients for the reaction of CN with CH2O were measured for the first time below room temperature in the range 32-103 K using a pulsed Laval nozzle apparatus together with the Pulsed Laser Photolysis-Laser-Induced Fluorescence technique. The rate coefficients exhibited a strong negative temperature dependence, reaching (4.62 ± 0.84) × 10-11 cm3 molecule-1 s-1 at 32 K, and no pressure dependence was observed at 70 K. The potential energy surface (PES) of the CN + CH2O reaction was calculated at the CCSD(T)/aug-cc-pVTZ//M06-2X/aug-cc-pVTZ level of theory, with the lowest energy channel to reaction characterized by the formation of a weakly-bound van der Waals complex, bound by 13.3 kJ mol-1, prior to two transition states with energies of -0.62 and 3.97 kJ mol-1, leading to the products HCN + HCO or HNC + HCO, respectively. For the formation of formyl cyanide, HCOCN, a large activation barrier of 32.9 kJ mol-1 was calculated. Reaction rate theory calculations were performed with the MESMER (Master Equation Solver for Multi Energy well Reactions) package on this PES to calculate rate coefficients. While this ab initio description provided good agreement with the low-temperature rate coefficients, it was not capable of describing the high-temperature experimental rate coefficients from the literature. However, increasing the energies and imaginary frequencies of both transition states allowed MESMER simulations of the rate coefficients to be in good agreement with data spanning 32-769 K. The mechanism for the reaction is the formation of a weakly-bound complex followed by quantum mechanical tunnelling through the small barrier to form HCN + HCO products. MESMER calculations showed that channel generating HNC is not important. MESMER simulated the rate coefficients from 4-1000 K which were used to recommend best-fit modified Arrhenius expressions for use in astrochemical modelling. The UMIST Rate12 (UDfa) model yielded no significant changes in the abundances of HCN, HNC, and HCO for a variety of environments upon inclusion of rate coefficients reported here. The main implication from this study is that the title reaction is not a primary formation route to the interstellar molecule formyl cyanide, HCOCN, as currently implemented in the KIDA astrochemical model.

Gas-phase formation of silicon monoxide via non-adiabatic reaction dynamics and its role as a building block of interstellar silicates.

Silicon monoxide (SiO) is classified as a key precursor and fundamental molecular building block to interstellar silicate nanoparticles, which play an essential role in the synthesis of molecular building blocks connected to the Origins of Life. In the cold interstellar medium, silicon monoxide is of critical importance in initiating a series of elementary chemical reactions leading to larger silicon oxides and eventually to silicates. To date, the fundamental formation mechanisms and chemical dynamics leading to gas phase silicon monoxide have remained largely elusive. Here, through a concerted effort between crossed molecular beam experiments and electronic structure calculations, it is revealed that instead of forming highly-stable silicon dioxide (SiO2), silicon monoxide can be formed via a barrierless, exoergic, single-collision event between ground state molecular oxygen and atomic silicon involving non-adiabatic reaction dynamics through various intersystem crossings. Our research affords persuasive evidence for a likely source of highly rovibrationally excited silicon monoxide in cold molecular clouds thus initiating the complex chain of exoergic reactions leading ultimately to a population of silicates at low temperatures in our Galaxy.

Nonadiabatic reaction dynamics to silicon monosulfide (SiS): A key molecular building block to sulfur-rich interstellar grains.

Sulfur- and silicon-containing molecules are omnipresent in interstellar and circumstellar environments, but their elementary formation mechanisms have been obscure. These routes are of vital significance in starting a chain of chemical reactions ultimately forming (organo) sulfur molecules-among them precursors to sulfur-bearing amino acids and grains. Here, we expose via laboratory experiments, computations, and astrochemical modeling that the silicon-sulfur chemistry can be initiated through the gas-phase reaction of atomic silicon with hydrogen sulfide leading to silicon monosulfide (SiS) via nonadiabatic reaction dynamics. The facile pathway to the simplest silicon and sulfur diatomic provides compelling evidence for the origin of silicon monosulfide in star-forming regions and aids our understanding of the nonadiabatic reaction dynamics, which control the outcome of the gas-phase formation in deep space, thus expanding our view about the life cycle of sulfur in the galaxy.

Chemical dynamics study on the gas-phase reaction of the D1-silylidyne radical (SiD; X2Π) with deuterium sulfide (D2S) and hydrogen sulfide (H2S).

The reactions of the D1-silylidyne radical (SiD; X2Π) with deuterium sulfide (D2S; X1A1) and hydrogen sulfide (H2S; X1A1) were conducted utilizing a crossed molecular beams machine under single collision conditions. The experimental work was carried out in conjunction with electronic structure calculations. The elementary reaction commences with a barrierless addition of the D1-silylidyne radical to one of the non-bonding electron pairs of the sulfur atom of hydrogen (deuterium) sulfide followed by possible bond rotation isomerization and multiple atomic hydrogen (deuterium) migrations. Unimolecular decomposition of the reaction intermediates lead eventually to the D1-thiosilaformyl radical (DSiS) (p1) and D2-silanethione (D2SiS) (p3) via molecular and atomic deuterium loss channels (SiD-D2S system) along with the D1-thiosilaformyl radical (DSiS) (p1) and D1-silanethione (HDSiS) (p3) through molecular and atomic hydrogen ejection (SiD-H2S system) via indirect scattering dynamics in barrierless and overall exoergic reactions. Our study provides a look into the complex dynamics of the silicon and sulfur chemistries involving multiple deuterium/hydrogen shifts and tight exit transition states, as well as insight into silicon- and sulfur-containing molecule formation pathways in deep space. Although neither of the non-deuterated species - the thiosilaformyl radical (HSiS) and silanethione (H2SiS) - have been observed in the interstellar medium (ISM) thus far, astrochemical models presented here predict relative abundances in the Orion Kleinmann-Low nebula to be sufficiently high enough for detection.

The Importance of Failure: How Doing Impact Surveys That Fail Saves Trachoma Programs Money.

Trachoma programs use annual antibiotic mass drug administration (MDA) in evaluation units (EUs) that generally encompass 100,000-250,000 people. After one, three, or five MDA rounds, programs undertake impact surveys. Where impact survey prevalence of trachomatous inflammation-follicular (TF) in 1- to 9-year-olds is ≥ 5%, ≥ 1 additional MDA rounds are recommended before resurvey. Impact survey costs, and the proportion of impact surveys returning TF prevalence ≥ 5% (the failure rate or, less pejoratively, the MDA continuation rate), therefore influence the cost of eliminating trachoma. We modeled, for illustrative EU sizes, the financial cost of undertaking MDA with and without conducting impact surveys. As an example, we retrospectively assessed how conducting impact surveys affected costs in the United Republic of Tanzania for 2017-2018. For EUs containing 100,000 people, the median (interquartile range) cost of continuing MDA without doing impact surveys is USD 28,957 (17,581-36,197) per EU per year, whereas continuing MDA solely where indicated by impact survey results costs USD 17,564 (12,158-21,694). If the mean EU population is 100,000, then continuing MDA without impact surveys becomes advantageous in financial cost terms only when the continuation rate exceeds 71%. For the United Republic of Tanzania in 2017-2018, doing impact surveys saved enough money to provide MDA for > 1,000,000 people. Although trachoma impact surveys have a nontrivial cost, they generally save money, providing EUs have > 50,000 inhabitants, the continuation rate is not excessive, and they generate reliable data. If all EUs pass their impact surveys, then we have waited too long to do them.

A chemical dynamics study on the gas phase formation of thioformaldehyde (H2CS) and its thiohydroxycarbene isomer (HCSH).

Complex organosulfur molecules are ubiquitous in interstellar molecular clouds, but their fundamental formation mechanisms have remained largely elusive. These processes are of critical importance in initiating a series of elementary chemical reactions, leading eventually to organosulfur molecules-among them potential precursors to iron-sulfide grains and to astrobiologically important molecules, such as the amino acid cysteine. Here, we reveal through laboratory experiments, electronic-structure theory, quasi-classical trajectory studies, and astrochemical modeling that the organosulfur chemistry can be initiated in star-forming regions via the elementary gas-phase reaction of methylidyne radicals with hydrogen sulfide, leading to thioformaldehyde (H2CS) and its thiohydroxycarbene isomer (HCSH). The facile route to two of the simplest organosulfur molecules via a single-collision event affords persuasive evidence for a likely source of organosulfur molecules in star-forming regions. These fundamental reaction mechanisms are valuable to facilitate an understanding of the origin and evolution of the molecular universe and, in particular, of sulfur in our Galaxy.

Quality Assurance and Quality Control in the Global Trachoma Mapping Project.

In collaboration with the health ministries that we serve and other partners, we set out to complete the multiple-country Global Trachoma Mapping Project. To maximize the accuracy and reliability of its outputs, we needed in-built, practical mechanisms for quality assurance and quality control. This article describes how those mechanisms were created and deployed. Using expert opinion, computer simulation, working groups, field trials, progressively accumulated in-project experience, and external evaluations, we developed 1) criteria for where and where not to undertake population-based prevalence surveys for trachoma; 2) three iterations of a standardized training and certification system for field teams; 3) a customized Android phone-based data collection app; 4) comprehensive support systems; and 5) a secure end-to-end pipeline for data upload, storage, cleaning by objective data managers, analysis, health ministry review and approval, and online display. We are now supporting peer-reviewed publication. Our experience shows that it is possible to quality control and quality assure prevalence surveys in such a way as to maximize comparability of prevalence estimates between countries and permit high-speed, high-fidelity data processing and storage, while protecting the interests of health ministries.

Directed gas phase formation of silicon dioxide and implications for the formation of interstellar silicates.

Interstellar silicates play a key role in star formation and in the origin of solar systems, but their synthetic routes have remained largely elusive so far. Here we demonstrate in a combined crossed molecular beam and computational study that silicon dioxide (SiO2) along with silicon monoxide (SiO) can be synthesized via the reaction of the silylidyne radical (SiH) with molecular oxygen (O2) under single collision conditions. This mechanism may provide a low-temperature path-in addition to high-temperature routes to silicon oxides in circumstellar envelopes-possibly enabling the formation and growth of silicates in the interstellar medium necessary to offset the fast silicate destruction.

A Population-Based Trachoma Prevalence Survey Covering Seven Districts of Sangha and Likouala Departments, Republic of the Congo.

PURPOSE: We set out to estimate the prevalence of trachoma and access to water and sanitation in seven suspected-trachoma-endemic districts of northern Congo, surveyed as a single evaluation unit. METHODS: From a complete list of rural villages in the seven districts, we systematically selected 22 with probability proportional to village size. In selected villages, we included all households where there were fewer than 25 in total, or used compact segment sampling to select a group of approximately 20 households by random draw. In each selected household, all consenting residents aged ≥1 year were examined by Global Trachoma Mapping Project-certified trachoma graders, and data collected on household-level access to water and sanitation. RESULTS: In November and December 2015, 466 households were visited in 22 villages, and 2081 (88%) of 2377 residents of those households were examined. No examined individual had trichiasis. The age-adjusted prevalence of the active trachoma sign trachomatous inflammation-follicular (TF) in 1-9-year-olds was 2.5% (95%CI 0.9-4.5%). Only 39% (95%CI 35-44%) of households had access to an improved source of drinking water. Only 10% (95%CI 7-13%) of households had access to an improved sanitation facility. CONCLUSION: Trachoma is not a public health problem in this part of Congo. Access to water and sanitation is inadequate.

The cost of mapping trachoma: Data from the Global Trachoma Mapping Project.

BACKGROUND: The Global Trachoma Mapping Project (GTMP) was implemented with the aim of completing the baseline map of trachoma globally. Over 2.6 million people were examined in 1,546 districts across 29 countries between December 2012 and January 2016. The aim of the analysis was to estimate the unit cost and to identify the key cost drivers of trachoma prevalence surveys conducted as part of GTMP. METHODOLOGY AND PRINCIPAL FINDINGS: In-country and global support costs were obtained using GTMP financial records. In-country expenditure was analysed for 1,164 districts across 17 countries. The mean survey cost was $13,113 per district [median: $11,675; IQR = $8,365-$14,618], $17,566 per evaluation unit [median: $15,839; IQR = $10,773-$19,915], $692 per cluster [median: $625; IQR = $452-$847] and $6.0 per person screened [median: $4.9; IQR = $3.7-$7.9]. Survey unit costs varied substantially across settings, and were driven by parameters such as geographic location, demographic characteristics, seasonal effects, and local operational constraints. Analysis by activities showed that fieldwork constituted the largest share of in-country survey costs (74%), followed by training of survey teams (11%). The main drivers of in-country survey costs were personnel (49%) and transportation (44%). Global support expenditure for all surveyed districts amounted to $5.1m, which included grant management, epidemiological support, and data stewardship. CONCLUSION: This study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date. The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities. Furthermore, the results of this study can also be used as a cost basis for other disease mapping programmes, where disease or context-specific survey cost data are not available.

TFOS DEWS II Tear Film Report.

The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership.

The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study.

PURPOSE: To complete the baseline trachoma map worldwide by conducting population-based surveys in an estimated 1238 suspected endemic districts of 34 countries. METHODS: A series of national and sub-national projects owned, managed and staffed by ministries of health, conduct house-to-house cluster random sample surveys in evaluation units, which generally correspond to "health district" size: populations of 100,000-250,000 people. In each evaluation unit, we invite all residents aged 1 year and older from h households in each of c clusters to be examined for clinical signs of trachoma, where h is the number of households that can be seen by 1 team in 1 day, and the product h × c is calculated to facilitate recruitment of 1019 children aged 1-9 years. In addition to individual-level demographic and clinical data, household-level water, sanitation and hygiene data are entered into the purpose-built LINKS application on Android smartphones, transmitted to the Cloud, and cleaned, analyzed and ministry-of-health-approved via a secure web-based portal. The main outcome measures are the evaluation unit-level prevalence of follicular trachoma in children aged 1-9 years, prevalence of trachomatous trichiasis in adults aged 15 + years, percentage of households using safe methods for disposal of human feces, and percentage of households with proximate access to water for personal hygiene purposes. RESULTS: In the first year of fieldwork, 347 field teams commenced work in 21 projects in 7 countries. CONCLUSION: With an approach that is innovative in design and scale, we aim to complete baseline mapping of trachoma throughout the world in 2015.