Burden of Typhoid and Paratyphoid Fever in India.

BACKGROUND: In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. METHODS: From 2017 through 2020, we conducted weekly surveillance for acute febrile illness and measured the incidence of typhoid fever (as confirmed on blood culture) in a prospective cohort of children between the ages of 6 months and 14 years at three urban sites and one rural site in India. At an additional urban site and five rural sites, we combined blood-culture testing of hospitalized patients who had a fever with survey data regarding health care use to estimate incidence in the community. RESULTS: A total of 24,062 children who were enrolled in four cohorts contributed 46,959 child-years of observation. Among these children, 299 culture-confirmed typhoid cases were recorded, with an incidence per 100,000 child-years of 576 to 1173 cases in urban sites and 35 in rural Pune. The estimated incidence of typhoid fever from hospital surveillance ranged from 12 to 1622 cases per 100,000 child-years among children between the ages of 6 months and 14 years and from 108 to 970 cases per 100,000 person-years among those who were 15 years of age or older. Salmonella enterica serovar Paratyphi was isolated from 33 children, for an overall incidence of 68 cases per 100,000 child-years after adjustment for age. CONCLUSIONS: The incidence of typhoid fever in urban India remains high, with generally lower estimates of incidence in most rural areas. (Funded by the Bill and Melinda Gates Foundation; NSSEFI Clinical Trials Registry of India number, CTRI/2017/09/009719; ISRCTN registry number, ISRCTN72938224.).

Modeling of Quasi-Static Floating-Gate Transistor Biosensors.

Floating-gate transistors (FGTs) are a promising class of electronic sensing architectures that separate the transduction elements from molecular sensing components, but the factors leading to optimum device design are unknown. We developed a model, generalizable to many different semiconductor/dielectric materials and channel dimensions, to predict the sensor response to changes in capacitance and/or charge at the sensing surface upon target binding or other changes in surface chemistry. The model predictions were compared to experimental data obtained using a floating-gate (extended gate) electrochemical transistor, a variant of the generic FGT architecture that facilitates low-voltage operation and rapid, simple fabrication using printing. Self-assembled monolayer (SAM) chemistry and quasi-statically measured resistor-loaded inverters were utilized to obtain experimentally either the capacitance signals (with alkylthiol SAMs) or charge signals (with acid-terminated SAMs) of the FGT. Experiments reveal that the model captures the inverter gain and charge signals over 3 orders of magnitude variation in the size of the sensing area and the capacitance signals over 2 orders of magnitude but deviates from experiments at lower capacitances of the sensing surface (<1 nF). To guide future device design, model predictions for a large range of sensing area capacitances and characteristic voltages are provided, enabling the calculation of the optimum sensing area size for maximum charge and capacitance sensitivity.

Microfluidic opportunities in printed electrolyte-gated transistor biosensors.

Printed electrolyte-gated transistors (EGTs) are an emerging biosensor platform that leverage the facile fabrication engendered by printed electronics with the low voltage operation enabled by ion gel dielectrics. The resulting label-free, nonoptical sensors have high gain and provide sensing operations that can be challenging for conventional chemical field effect transistor architectures. After providing an overview of EGT device fabrication and operation, we highlight opportunities for microfluidic enhancement of EGT sensor performance via multiplexing, sample preconcentration, and improved transport to the sensor surface.

Interfacial Charge Contributions to Chemical Sensing by Electrolyte-Gated Transistors with Floating Gates.

The floating gate, electrolyte-gated transistor (FGT) is a chemical sensing device utilizing a floating gate electrode to physically separate and electronically couple the active sensing area with the transistor. The FGT platform has yielded promising results for the detection of DNA and proteins, but questions remain regarding its fundamental operating mechanism. Using carboxylic acid-terminated self-assembled monolayers (SAMs) exposed to solutions of different pH, we create a charged surface and hence characterize the role that interfacial charge concentration plays relative to capacitance changes. The results agree with theoretical predictions from conventional double-layer theory, rationalizing nonlinear responses obtained at high analyte concentrations in previous work using the FGT architecture. Our study elucidates an important effect in the sensing mechanism of FGTs, expanding opportunities for the rational optimization of these devices for chemical and biochemical detection.

Safer injections, fewer infections: injection safety in rural north India.

BACKGROUND: Unsafe injection practices result in a substantial burden of preventable blood-borne viral disease (BBV). The reasons are complex and include structural, economic and socio-cultural factors. OBJECTIVE: To describe injection-related practices in two rural north Indian health settings including the contextual factor, highlight some of the challenges facing those endeavouring to translate injection safety policies into safe injection practice, and to identify appropriate intervention strategies. METHOD: Qualitative data collection (participant observation and in-depth interviews) in two rural north Indian hospitals with affiliated community-based programmes over a 4-month period. A total of 130 h of observation took place in a range of clinical areas characterized by frequent use of needles and other sharps, and 40 healthcare workers were interviewed. Field notes and interview transcripts were thematically analysed. RESULTS: Managers in these health settings were clearly endeavouring to promote injection safety by implementing the widespread use of disposable needles and syringes and attempting to address the difficult issue of safe healthcare waste management. However, some unsafe practices were still occurring: reuse of syringes (with and without sterilization) was relatively common, and use of multi-dose vials, blood sampling, sterilization and disinfection, and healthcare waste management were sub-optimal in some instances, placing both staff and patients at unnecessary risk of BBV infection. CONCLUSION: Strategies for promoting injection safety are necessary if the risk of nosocomial transmission of BBV diseases via unsafe injection practices in rural north India is to be minimized.