--Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India.

Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.

Perturbations to 27Al electric field gradients in nanocrystalline alpha-Al2O3 studied by high-resolution solid-state NMR.

(27)Al solid-state NMR has been employed to study the perturbations to (27)Al electric field gradients for the aluminum environments in nanocrystalline alpha-alumina. Triple quantum magic angle spinning experiments show that the octahedral aluminum coordination remains unchanged down to 12 nm, although severe perturbations to (27)Al electric field gradients are noticed at 28 nm and below. 3Q-MAS and SATRAS experimental data of nano alpha-alumina have been analyzed through extensive spectral simulations to probe (27)Al electric field gradients of aluminum in the grains and grain boundaries. While the aluminum in the grains has a unique field gradient tensor, the same octahedrally coordinated aluminum environments in the grain boundaries suffer a distribution of electric field gradients. This is evidenced by data analysis of both 3Q-MAS and SATRAS spectra. By invoking the Gaussian isotropic model, in which the (C(Q), eta(Q)) parameter space is discretely sampled by the Czjzek distribution, we have been able to analyze the (27)Al SATRAS spectra of nanocrystalline alpha-alumina samples having grain sizes of 52, 28, 20, and 12 nm. Good agreement between experimental and simulated spectra has led to the quantitative determination of grain and grain boundary components in these materials.

Selenium in human hair in relation to age, diet, pathological condition and serum levels.

Approximately 0.5 g of hair samples free from medicated shampoos, bleaches and dyes were collected from 115 subjects from the occipitonuchal region. Prior to the analyses, the samples were thoroughly washed and dried in a gravity convection oven until consistent weight was obtained. A 100-mg portion of the cut up and thoroughly mixed sample in duplicate was used for the analysis of selenium (Se) by a fluorometric technique. The results were treated statistically. The level varied from 0.55 in the elderly to 0.76 microgram/g of hair in adolescents. A decline of Se was noted in the groups of ages 16-40 yrs, the levels being 0.64 to 0.59 microgram/g of hair. From groups 41-60 yrs no increase was seen in the Se content, the lowest level noted was in group 61-70 yrs. These differences between groups were found to be statistically significant (P less than 0.05). No significant correlation was found between the Se content of hair and diet. The levels in hair and serum of patients with cardiovascular disease were significantly low (P less than 0.05), the levels being 0.49 microgram/g of hair and 0.10 microgram/ml of serum. It was also noted that there was no correlation between Se in hair and serum of the same individuals. Further work using larger samples is necessary to shed more light on these relationships.

Trace minerals, amino acids, and plasma proteins in adult men fed wheat diets.

In summary, the ingestion by adult men of an all-plant diet supplying 46 gm. protein per day, primarily as bread made from white wheat four, over a period of 74 days, resulted in positive balances for copper, iron, molybdenum, selenium, and zinc. Iron balances were significantly decreased by the isonitrogenous substitution of pinto beans or peanut butter for 20 percent of the nitrogen supplied by white bread. When pinto beans or white rice substituted for 20 percent of the nitrogen of white bread, the retention of molybdenum was lower and the retention of selenium was greater. Although the men were nitrogen balance and total plasma protein concentrations were normal, the ingestion of diets providing 46 gm. protein, from all-plant sources resulted in significantly lower plasma albumin, with corresponding elevations in alpha, beta and gamma globulins. However, the substitution of pinto beans for a portion of the white bread improved plasma albumin and alpha-globulin levels. Routine clinical data obtained on patients who previously consumed strictly vegetarian diets should include determinations of plasma albumin. The ability of the subjects to maintain nitrogen balance on protein intakes of 46 gm. per day from all-plant sources appeared to be correlated with decreases in the urinary excretion and plasma concentration of alpha-aminobutyric acid, a metabolite of methionine and threonine, suggesting conservation of methionine or re-utilization of this metabolite. The possible mechanism of this adaptation to minimal protein intake, or dietary protein from all-plant sources, is discussed.

Fertilization of ova in selenium/vitamin E-treated ewes maintained on two planes of nutrition.

Studies were conducted to evaluate uterine motility and fertility of ova in ewes either given or not given supplemental selenium/vitamin E (SSE or NSE, respectively). The ewes were maintained on either an adequate plane of nutrition (APN) or an inadequate plane of nutrition (IPN). In a fertility study, 60 ewes were allotted to four treatment groups, (15 ewes per group): SSE-APN, NSE-APN, SSE-IPN and NSE-IPN. A 2-ml injection, containing 10 mg of Se as selenite and 136 IU of vitamin E as alpha-tocopheryl acetate, was given IM to designated ewes (SSE) at 21-day intervals. NSE ewes were given injection of corn oil. After 150 days of SSE supplementation, ewes were checked for estrus, bred to rams and laparotomized approximately, 72 hr after the onset of estrus for determination of fertility of ova. The proportion of recovered ova that were fertilized was, for each treatment: SSE-APN (19 of 19), NSE-APN (17 of 22), SSE-IPN (five of 10) and NSE-IPN (six of 14). Fertility of ova was affected (P < .005) by plane of nutrition and tended to be affected (P < .1) by Se/vitamin E supplementation. Throughout the fertility study, ewes in the APN group maintained their body weight, while ewes in the IPN groups lost .075 kg/ewe/day. In a uterine contraction study, ewes in the SSE-APN and NSE-APN groups were laparotomized at the onset of estrus for quantitation of the directional pattern of uterine contractions. The number of total contractions for SSE-APN ewes and NSE-APN ewes during a 10-min interval was 42.7 +/- 3.5 and 33.2 +/- 2.6 (P < .05), respectively, and number of contractions moving toward the oviduct was 21.0 +/- 2.8 and 13.4 +/- 1.2 (P < .025), respectively. Se was greater (P < .001) in serum of SSE ewes than in serum of NSE ewes, while vitamin E was greater in serum of SSE-APN ewes than in that of both groups of NSE ewes.