Safe Delivery application with facilitation increases knowledge and confidence of obstetric and neonatal care among frontline health workers in India.

Background: Digital learning tools have proliferated among healthcare workers in India. Evidence of their effectiveness is however minimal. We sought to examine the impact of the Safe Delivery App (SDA) on knowledge and confidence among frontline health workers (HW) in India. We also studied whether facilitation to address technical challenges enhanced self-learning. Methods: Staff nurses and nurse-midwives from 30 facilities in two states were divided into control and intervention groups through randomization. Knowledge and confidence were assessed at baseline and after 6 months. Three rounds of facilitation addressing technical challenges in downloading and usage along with reminders about the next phase of learning were conducted in the intervention group. A user satisfaction scale along with qualitative interviews was conducted in the intervention group at the endline along with qualitative interviews on facilitation. Results: The knowledge and confidence of the healthcare workers significantly increased from the baseline to endline by 4 percentage points (P < 0.001). The participants who received facilitation had a higher mean score difference in knowledge and confidence compared to those who did not receive facilitation (P < 0.001). The participants were highly satisfied with the app and video was the most-watched feature. They reported a positive experience of the facilitation process. Conclusion: The effectiveness and acceptability of the SDA indicate the applicability of mHealth learning tools at the primary healthcare level. In a time of rapid digitalization of training, facilitation or supportive supervision needs further focus while on-ground digital training could be invested in to overcome digital illiteracy among healthcare workers.

mHealth learning tool for skilled birth attendants: scaling the Safe Delivery App in India.

BACKGROUND: One of the main drivers of maternal and newborn mortality and morbidity in India is a lack of quality of care in health facilities. Inadequate competencies of health workers, insufficient quality of training and infrastructure, and the financial challenges of providing training across the country impede quality care provision. To this end, the Government of India began exploring cost-effective tech and IT-based solutions to support existing quality improvement (QI) initiatives. METHOD: We describe the process and approach of scaling the Safe Delivery App (hereafter referred to as the App) throughout India. The App is an mHealth learning tool for equipping health workers in managing obstetric and neonatal emergencies by placing evidence-based, and up-to-date clinical guidelines in their hands through their mobile devices. The use of the App was supported by the Ministry of Health and the Department of Health at the state level. Both parties were actively involved in the roll-out of the App and had a clear vision of how the App can complement existing structures/systems/programmes. RESULTS: The App was successfully integrated and implemented in various government-led QI initiatives. Approximately 20 000 healthcare workers (HCWs) have been trained on the App and selected clinical topics since its launch, and between 2018 and 2021 over 86 000 HCWs across all states and union territories used the App. Moreover, project-specific data show a significant increase in the knowledge level of users of the App. CONCLUSION: Scaling such a tool within existing programmes is not a linear process. In India, the approach, government buy-in and flexibility of implementation modalities led to the successful roll-out of the App. We have demonstrated that an mHealth tool can be used to support the growing desire of governments to use tech in support existing QI initiatives and supporting the improvement of quality of care provided.

Limitations of the equivalent neutral polymer assumption for theories describing nanochannel-confined DNA.

The prevailing theories describing DNA confinement in a nanochannel are predicated on the assumption that wall-DNA electrostatic interactions are sufficiently short-ranged such that the problem can be mapped to an equivalent neutral polymer confined by hard walls with an appropriately reduced effective channel size. To determine when this hypothesis is valid, we leveraged a recently reported experimental data set for the fractional extension of DNA molecules in a 250-nm-wide poly(dimethyl siloxane) (PDMS) nanochannel with buffer ionic strengths between 0.075 and 48 mM. Evaluating these data in the context of the weakly correlated telegraph model of DNA confinement reveals that, at ionic strengths greater than 0.3 mM, the average fractional extension of the DNA molecules agree with theoretical predictions with a mean absolute error of 0.04. In contrast, experiments at ionic strengths below 0.3 mM produce average fractional extensions that are systematically smaller than the theoretical predictions with a larger mean absolute error of 0.15. The deviations between experiment and theory display a correlation coefficient of 0.82 with the decay length for the DNA-wall electrostatics, linking the deviations with a breakdown in approximating the DNA with an equivalent neutral polymer.

Extension distribution for DNA confined in a nanochannel near the Odijk regime.

DNA confinement in a nanochannel typically is understood via mapping to the confinement of an equivalent neutral polymer by hard walls. This model has proven to be effective for confinement in relatively large channels where hairpin formation is frequent. An analysis of existing experimental data for Escherichia coli DNA extension in channels smaller than the persistence length, combined with an additional dataset for λ-DNA confined in a 34 nm wide channel, reveals a breakdown in this approach as the channel size approaches the Odijk regime of strong confinement. In particular, the predicted extension distribution obtained from the asymptotic solution to the weakly correlated telegraph model for a confined wormlike chain deviates significantly from the experimental distribution obtained for DNA confinement in the 34 nm channel, and the discrepancy cannot be resolved by treating the alignment fluctuations or the effective channel size as fitting parameters. We posit that the DNA-wall electrostatic interactions, which are sensible throughout a significant fraction of the channel cross section in the Odijk regime, are the source of the disagreement between theory and experiment. Dimensional analysis of the wormlike chain propagator in channel confinement reveals the importance of a dimensionless parameter, reflecting the magnitude of the DNA-wall electrostatic interactions relative to thermal energy, which has not been considered explicitly in the prevailing theories for DNA confinement in a nanochannel.

Simulations corroborate telegraph model predictions for the extension distributions of nanochannel confined DNA.

Hairpins in the conformation of DNA confined in nanochannels close to their persistence length cause the distribution of their fractional extensions to be heavily left skewed. A recent theory rationalizes these skewed distributions using a correlated telegraph process, which can be solved exactly in the asymptotic limit of small but frequent hairpin formation. Pruned-enriched Rosenbluth method simulations of the fractional extension distribution for a channel-confined wormlike chain confirm the predictions of the telegraph model. Remarkably, the asymptotic result of the telegraph model remains robust well outside the asymptotic limit. As a result, the approximations in the theory required to map it to the polymer model and solve it in the asymptotic limit are not the source of discrepancies between the predictions of the telegraph model and experimental distributions of the extensions of DNA during genome mapping. The agreement between theory and simulations motivates future work to determine the source of the remaining discrepancies between the predictions of the telegraph model and experimental distributions of the extensions of DNA in nanochannels used for genome mapping.

Measuring the wall depletion length of nanoconfined DNA.

Efforts to study the polymer physics of DNA confined in nanochannels have been stymied by a lack of consensus regarding its wall depletion length. We have measured this quantity in 38 nm wide, square silicon dioxide nanochannels for five different ionic strengths between 15 mM and 75 mM. Experiments used the Bionano Genomics Irys platform for massively parallel data acquisition, attenuating the effect of the sequence-dependent persistence length and finite-length effects by using nick-labeled E. coli genomic DNA with contour length separations of at least 30 µm (88 325 base pairs) between nick pairs. Over 5 × 106 measurements of the fractional extension were obtained from 39 291 labeled DNA molecules. Analyzing the stretching via Odijk's theory for a strongly confined wormlike chain yielded a linear relationship between the depletion length and the Debye length. This simple linear fit to the experimental data exhibits the same qualitative trend as previously defined analytical models for the depletion length but now quantitatively captures the experimental data.

Evaluation of Blob Theory for the Diffusion of DNA in Nanochannels.

We have measured the diffusivity of λ-DNA molecules in approximately square nanochannels with effective sizes ranging from 117 nm to 260 nm at moderate ionic strength. The experimental results do not agree with the non-draining scaling predicted by blob theory. Rather, the data are consistent with the predictions of previous simulations of the Kirkwood diffusivity of a discrete wormlike chain model, without the need for any fitting parameters.

Effect of Surface Wettability on Crack Dynamics and Morphology of Colloidal Films.

The effect of surface wettability on the dynamics of crack formation and their characteristics are examined during the drying of aqueous colloidal droplets (1 µL volume) containing nanoparticles (53 nm mean particle diameter, 1 w/w %). Thin colloidal films, formed during drying, rupture as a result of the evaporation-induced capillary pressure and exhibit microscopic cracks. The crack initiation and propagation velocity as well as the number of cracks are experimentally evaluated for substrates of varying wettability and correlated to their wetting nature. Atomic force and scanning electron microscopy are used to examine the region in the proximity of the crack including the particle arrangements near the fracture zone. The altered substrate-particle Derjaguin-Landau-Verwey-Overbeek (DLVO) interactions, as a consequence of the changed wettability, are theoretically evaluated and found to be consistent with the experimental observations. The resistance of the film to cracking is found to depend significantly on the substrate surface energy and quantified by the critical stress intensity factor, evaluated by analyzing images obtained from confocal microscopy. The results indicate the possibility of controlling crack dynamics and morphology by tuning the substrate wettability.