Factors influencing operationalization of Integrated Disease Surveillance in Malawi.

OBJECTIVES: Malawi's disease surveillance system is built on several different data sources and systems and is informed by the Integrated Diseases Surveillance and Response (IDSR) strategy. This study was carried out as part of a larger multicountry study to identify context-specific factors, which influence the operationalization of integrated disease surveillance. STUDY DESIGN AND METHODS: A total of six focus group discussions were conducted with 43 relevant personnel at the primary and secondary healthcare levels in two districts (Lilongwe and Dowa) and at the national level. The discussions were analyzed and sorted into predefined categories based on the domains of the International Association of Public Health conceptual framework. RESULTS: We found ongoing efforts to enhance integrated disease surveillance operationalization, including the establishment of the Public Health Institute of Malawi for coordination, digitalizing the surveillance system through One Health Surveillance Platform, and improving communication among rapid response teams using WhatsApp. The adoption of World Health Organization's third edition IDSR technical guidelines was also underway. Nonetheless, there were major implementation barriers such as parallel and uncoordinated surveillance systems, priority conditions that cannot be diagnosed at the point of reporting, lack of case definitions and diagnostic codes for priority conditions, reporting forms with unexplained acronyms, illegible data sources, unstable electronic data transfers, inadequate supervision and training, poor enforcement of reporting from private health facilities, high reporting burden, and lack of and feedback to those reporting. CONCLUSIONS: The results fit well into the predefined categories used. The study reveals basic problems with the operationalization, tools, and reporting forms used for IDSR. These findings may have implications for practice and policy in Malawi and other countries where IDSR is the national strategy for surveillance.

The state of integrated disease surveillance in seven countries: a synthesis report.

OBJECTIVES: Integrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. STUDY DESIGN: Synthesis of qualitative studies undertaken in seven countries. METHODS: Thirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. RESULTS: None of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. CONCLUSIONS: A plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose.

Optical manipulation of Rashba-split 2-dimensional electron gas.

In spintronics, the two main approaches to actively control the electrons' spin involve static magnetic or electric fields. An alternative avenue relies on the use of optical fields to generate spin currents, which can bolster spin-device performance, allowing for faster and more efficient logic. To date, research has mainly focused on the optical injection of spin currents through the photogalvanic effect, and little is known about the direct optical control of the intrinsic spin-splitting. To explore the optical manipulation of a material's spin properties, we consider the Rashba effect. Using time- and angle-resolved photoemission spectroscopy (TR-ARPES), we demonstrate that an optical excitation can tune the Rashba-induced spin splitting of a two-dimensional electron gas at the surface of Bi2Se3. We establish that light-induced photovoltage and charge carrier redistribution - which in concert modulate the Rashba spin-orbit coupling strength on a sub-picosecond timescale - can offer an unprecedented platform for achieving optically-driven spin logic devices.

Solvothermal flow synthesis of zinc phosphate pigment.

Synthesis of phase pure hopeite pigment through a solvothermal flow method is reported here for the first time. The products show two-step dehydration behaviour from thermogravimetric analysis (TGA), and a higher degree of purity and homogeniety than commercial zinc phosphate pigment. By increasing the reaction temperature stepwise from room temperature to 350 °C it was possible to decrease the size of the individual crystallite sheets and to tune their packing into larger assemblies. The conversion of reactants to product proved to be significantly higher at increased temperature with a measured yield of 98.7% at 250 °C versus 85.4% at room temperature. The synthesis route demonstrated here is environmentally sustainable, increases cost-efficiency through minimization of waste, and is compatible with a scale-up strategy.

Interfacial superconductivity in a bi-collinear antiferromagnetically ordered FeTe monolayer on a topological insulator.

The discovery of high-temperature superconductivity in Fe-based compounds triggered numerous investigations on the interplay between superconductivity and magnetism, and on the enhancement of transition temperatures through interface effects. It is widely believed that the emergence of optimal superconductivity is intimately linked to the suppression of long-range antiferromagnetic (AFM) order, although the exact microscopic picture remains elusive because of the lack of atomically resolved data. Here we present spin-polarized scanning tunnelling spectroscopy of ultrathin FeTe1-xSex (x=0, 0.5) films on bulk topological insulators. Surprisingly, we find an energy gap at the Fermi level, indicating superconducting correlations up to Tc∼6 K for one unit cell FeTe grown on Bi2Te3, in contrast to the non-superconducting bulk FeTe. The gap spatially coexists with bi-collinear AFM order. This finding opens perspectives for theoretical studies of competing orders in Fe-based superconductors and for experimental investigations of exotic phases in superconducting layers on topological insulators.

Core-shell nanoparticles by silica coating of metal oxides in a dual-stage hydrothermal flow reactor.

γ-Fe2O3@SiO2, TiO2@SiO2, and α-Fe2O3@SiO2 core-shell nanoparticles were synthesized by a surfactant-free hydrothermal method in a continuous flow dual-stage reactor. Uniform silica shells of 2 nm thickness were obtained when grown on γ-Fe2O3 and TiO2 nanoparticles while thicker and more irregular shells were deposited on α-Fe2O3 due to low pH.

Atomic and electronic structure transformations in SnS2 at high pressures: a joint single crystal X-ray diffraction and DFT study.

The layered semiconductor SnS2 spurs much interest for both intercalation and optoelectronic applications. Despite the wealth of research in the field of metal dichalcogenides, the structure-property relationship of this compound remains unclear. Here we present a thorough study combining single-crystal X-ray diffraction and DFT calculations on SnS2 in the pressure range 0 < p < 20 GPa. The anisotropic compression of the unit cell is clearly linked to the van der Waals interactions between the S-Sn-S sandwich layers, as the compression mainly affects the interlayer distance. This compression behavior is coincidal with the compression of other well-known layered compounds (graphite and boron nitride) but differs significantly from the compression of other MS2 compounds, making it clear that SnS2 presents a unique and interesting case in the field of metal dichalcogenides. The compression leads to a significant increase in S···S interlayer interaction which in turn results in a change in the electronic structure, documented through DFT band structure calculations. The calculated narrowing of the band gap is supported by a significant, reversible color change of the single crystal. At 20 GPa, the size of the band gap has decreased from 2.15 to 0.88 eV, and band gap closure is predicted to occur at 33 GPa.

High-pressure single crystal X-ray diffraction study of the linear metal chain compound Co3(dpa)4Br2·CH2Cl2.

The crystal structure of the linear metal chain compound Co3(dpa)4Br2·CH2Cl2 (1) has been investigated up to a pressure of 13.6(2) GPa in a diamond anvil cell (DAC) using single crystal X-ray diffraction. The structure remains orthorhombic as the unit cell volume is reduced by 30% at 12.8 GPa. At 13.6(2) GPa the diffraction pattern is of very poor quality and not even reliable unit cell parameters can be determined. Peak broadening resulting from non-hydrostatic conditions was avoided by annealing the loaded DAC prior to data collection, allowing reliable structural models to be refined up to a pressure of 11.8(2) GPa. On increasing pressure, the disordered CH2Cl2 crystal solvent molecule gradually becomes redistributed from one site to another. Hirshfeld surface analysis suggests that the redistribution is a result of repulsive HH interactions. Pressure also affects the molecular geometry, in particular the Co-Co and Co-Br bond lengths which decrease by 4% and 12%, respectively, at 11.8(2) GPa.

The suprasacral parallel shift vs lumbar plexus blockade with ultrasound guidance in healthy volunteers--a randomised controlled trial.

Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the lumbar plexus and the lumbosacral trunk with ultrasound-guided blockade of the lumbar plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal lumbar plexus nerves compared with a lumbar plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included in a randomised crossover trial comparing the new suprasacral with a lumbar plexus block. The primary outcome was sensory dermatome anaesthesia of L2-S1. Secondary outcomes were peri-neural analgesic spread estimated with magnetic resonance imaging, sensory blockade of dermatomes L2-S3, motor blockade, volunteer discomfort, arterial blood pressure change, block performance time, lidocaine pharmacokinetics and complications. Only one volunteer in the suprasacral group had sensory blockade of all dermatomes L2-S1. Epidural spread was verified by magnetic resonance imaging in seven of the 34 trials (two suprasacral and five lumbar plexus blocks). Success rates of the sensory and motor blockade were 88-100% for the major lumbar plexus nerves with the suprasacral technique, and 59-88% with the lumbar plexus block (p > 0.05). Success rate of motor blockade was 50% for the lumbosacral trunk with the suprasacral technique and zero with the lumbar plexus block (p < 0.05). Both techniques are effective for blockade of the terminal nerves of the lumbar plexus. The suprasacral parallel shift technique is 50% effective for blockade of the lumbosacral trunk.

Controllable magnetic doping of the surface state of a topological insulator.

A combined experimental and theoretical study of doping individual Fe atoms into Bi(2)Se(3) is presented. It is shown through a scanning tunneling microscopy study that single Fe atoms initially located at hollow sites on top of the surface (adatoms) can be incorporated into subsurface layers by thermally activated diffusion. Angle-resolved photoemission spectroscopy in combination with ab initio calculations suggest that the doping behavior changes from electron donation for the Fe adatom to neutral or electron acceptance for Fe incorporated into substitutional Bi sites. According to first principles calculations within density functional theory, these Fe substitutional impurities retain a large magnetic moment, thus presenting an alternative scheme for magnetically doping the topological surface state. For both types of Fe doping, we see no indication of a gap at the Dirac point.

In-plane magnetic anisotropy of Fe atoms on Bi2Se3(111).

The robustness of the gapless topological surface state hosted by a 3D topological insulator against perturbations of magnetic origin has been the focus of recent investigations. We present a comprehensive study of the magnetic properties of Fe impurities on the prototypical 3D topological insulator Bi(2)Se(3) using local low-temperature scanning tunneling spectroscopy and integral x-ray magnetic circular dichroism techniques. Single Fe adatoms on the Bi(2)Se(3) surface, in the coverage range ≈ 1% of a monolayer, are heavily relaxed into the surface and exhibit a magnetic easy axis within the surface plane, contrary to what was assumed in recent investigations on the supposed opening of a gap. Using ab initio approaches, we demonstrate that an in-plane easy axis arises from the combination of the crystal field and dynamic hybridization effects.

Estimating influenza-related sick leave in Norway: was work absenteeism higher during the 2009 A(H1N1) pandemic compared to seasonal epidemics?

The impact of influenza on work absenteeism is poorly documented. We used data from the national registry and Norway Post AS (>14,000 employees) to explore sickness absence patterns from 2005/06 through 2009/10 in Norway. Annually, an estimated 2.868% (mean 95% confidence interval (CI): 2.405-4.820%) of the working population obtained sick leave for influenza, of whom 0.915% (mean 95% CI: 0.453-1.590%) had diagnoses for other respiratory illnesses with influenza as underlying cause. In the 2009/10 pandemic season, the absence rate increased 1.5-fold, mainly due to a 73% increase in influenza-diagnosed sick leaves. At Norway Post AS, absence related to seasonal influenza accounted for 0.351% (mean 95% CI: 0.126-0.704%) of total person-days annually (excluding parental care absence), of which 32-43% were estimated to be self-certified. Medically certified sick leave increased 1.3-fold in the pandemic season to 0.458% (95% CI: 0.176-0.856), while self-certified sick leave remained at a level typical for seasonal influenza. We found a significant four-fold increase in work loss to care for sick children, 0.048% (95% CI: 0.031-0.070%) of person-days, compared with 0.012% (95% CI: 0.004-0.028%) in 2008/09. In conclusion, GP-certified and parental care work absence were higher in the pandemic season. More studies are needed to quantify the burden of self-certified sick leave.

Meticillin-resistant Staphylococcus aureus in Norway, a low-incidence country, 2006-2010.

BACKGROUND: Antibiotic resistance is a global public health threat. Norway has managed to keep the incidence of resistant bacteria at a low level in both the healthcare system and the community. Reporting of both individual cases and meticillin-resistant Staphylococcus aureus (MRSA) outbreaks is mandatory. All isolates are genotyped. AIM: To describe the epidemiology of MRSA in Norway and to analyse how MRSA is spreading in a low-incidence country. METHODS: All cases of laboratory-confirmed MRSA colonisation and infection reported in Norway from 2006 to 2010 were subject to epidemiological analysis. FINDINGS: A total of 3620 cases of MRSA were found. Around one-third of the cases were imported, one-third acquired in the Norwegian healthcare system and one-third acquired in the community. Twelve percent of the cases were linked to known outbreaks. The total incidence of infected and colonized patients is slowly increasing. The numbers of severe infections remain stable at around 20 cases annually and the proportion of MRSA cases associated with healthcare has decreased. CONCLUSION: MRSA is still rare in the Norwegian population and the strategic objective of preventing MRSA from becoming a permanent part of the bacterial flora in hospitals and nursing homes has so far been met.

Large tunable Rashba spin splitting of a two-dimensional electron gas in Bi2Se3.

We report a Rashba spin splitting of a two-dimensional electron gas in the topological insulator Bi(2)Se(3) from angle-resolved photoemission spectroscopy. We further demonstrate its electrostatic control, and show that spin splittings can be achieved which are at least an order-of-magnitude larger than in other semiconductors. Together these results show promise for the miniaturization of spintronic devices to the nanoscale and their operation at room temperature.

Experimental and theoretical charge density studies at subatomic resolution.

Analysis of accurate experimental and theoretical structure factors of diamond and silicon reveals that the contraction of the core shell due to covalent bond formation causes significant perturbations of the total charge density that cannot be ignored in precise charge density studies. We outline that the nature and origin of core contraction/expansion and core polarization phenomena can be analyzed by experimental studies employing an extended Hansen-Coppens multipolar model. Omission or insufficient treatment of these subatomic charge density phenomena might yield erroneous thermal displacement parameters and high residual densities in multipolar refinements. Our detailed studies therefore suggest that the refinement of contraction/expansion and population parameters of all atomic shells is essential to the precise reconstruction of electron density distributions by a multipolar model. Furthermore, our results imply that also the polarization of the inner shells needs to be adopted, especially in cases where second row or even heavier elements are involved in covalent bonding. These theoretical studies are supported by direct multipolar refinements of X-ray powder diffraction data of diamond obtained from a third-generation synchrotron-radiation source (SPring-8, BL02B2).

Adenosine sensitization after angiotensin II stimulation in afferent arterioles from normal rats does not occur during two-kidney, one-clip hypertension.

AIMS: G protein-coupled receptors such as the AT(1a) R are frequently subject to desensitization, extensively studied in cell culture but to small extent in hypertensive models. Recently, angiotensin II (ANG II)-induced desensitization was shown to last 10 min in isolated afferent arterioles (AAs), suggesting impact on ANG II vasoactivity. In the present study, we explored ANG II desensitization and effects of adenosine (Ado) in AAs from two-kidney, one-clip (2K1C) hypertensive rats. Our main hypothesis was that Ado affects ANG II contractility differently in 2K1C, because of persistently elevated levels of ANG II. METHODS: Afferent arterioles were isolated with the agarose-infusion/enzyme-treatment technique from normotensive and 2K1C hypertensive rats, and stimulated with ANG II (10(-7) M) at baseline and re-stimulated after 20 or 40 min, with or without Ado (2.5 × 10(-5) M) in the vessel bath. RESULTS: Afferent arterioles from normotensive rats re-stimulated with ANG II after 20 min displayed a blunted contraction (Δ12.8 ± 4.3%, P < 0.05), which disappeared when AAs were stimulated after 40 min (Δ2.7 ± 2.3%, NS), indicating that desensitization lasted for 30 ± 10 min. Ado augmented ANG II contractions after 20 min, but not after 40 min, suggesting that only de-sensitized vessels were affected. Similar experiments in AAs from the clipped and non-clipped kidneys revealed no desensitization when re-stimulated with ANG II after 20 and 40 min, and contractions were unaffected by Ado. CONCLUSIONS: Reduced duration of desensitization in AAs from 2K1C may cause vessels to be sensitized longer and increase vasoconstriction. The present study demonstrates that Ado does not augment ANG II-induced contractions in AAs from 2K1C as in normotensive rats, possibly because of a reduced period of desensitization.

Multi-temperature synchrotron PXRD and physical properties study of half-Heusler TiCoSb.

Phase pure samples of the half-Heusler material TiCoSb were synthesised and investigated. Multi-temperature synchrotron powder X-ray diffraction (PXRD) data measured between 90 and 1000 K in atmospheric air confirm the phase purity, but they also reveal a decomposition reaction starting at around 750 K. This affects the high temperature properties since TiCoSb is semiconducting, whereas CoSb is metallic. Between 90 K and 300 K the linear thermal expansion coefficient is estimated to be 10.5 × 10(-6) K(-1), while it is 8.49 10(-6) K(-1) between 550 K and 1000 K. A fit of a Debye model to the Atomic Displacement Parameters obtained from Rietveld refinement of the PXRD data gives a Debye temperature of 395(4) K. The heat capacity was measured between 2 K and 300 K and a Debye temperature of 375(5) K was obtained from modelling of the data. Coming from low temperatures the electrical resistivity shows a metallic to semiconducting transition at 113 K. A relatively high Seebeck coefficient of ∼-250 µV K(-1) was found at 400 K, but the substantial thermal conductivity (∼10 W mK(-1) at 400 K) leads to a moderate thermoelectric figure of merit of 0.025 at 400 K.

Multipole electron-density modelling of synchrotron powder diffraction data: the case of diamond.

Accurate structure factors are extracted from synchrotron powder diffraction data measured on crystalline diamond based on a novel multipole model division of overlapping reflection intensities. The approach limits the spherical-atom bias in structure factors extracted from overlapping powder data using conventional spherical-atom Rietveld refinement. The structure factors are subsequently used for multipole electron-density modelling, and both the structure factors and the derived density are compared with results from ab initio theoretical calculations. Overall, excellent agreement is obtained between experiment and theory, and the study therefore demonstrates that synchrotron powder diffraction can indeed provide accurate structure-factor values based on data measured in minutes with limited sample preparation. Thus, potential systematic errors such as extinction and twinning commonly encountered in single-crystal studies of small-unit-cell inorganic structures can be overcome with synchrotron powder diffraction. It is shown that the standard Hansen-Coppens multipole model is not flexible enough to fit the static theoretical structure factors, whereas fitting of thermally smeared structure factors has much lower residuals. If thermally smeared structure factors (experimental or theoretical) are fitted with a slightly wrong radial model (s(2)p(2) instead of sp(3)) the radial scaling parameters (kappa' parameters) are found to be inadequate and the ;error' is absorbed into the atomic displacement parameter. This directly exposes a correlation between electron density and thermal parameters even for a light atom such as carbon, and it also underlines that in organic systems proper deconvolution of thermal motion is important for obtaining correct static electron densities.