Digital child health: opportunities and obstacles. A joint statement of European Academy of Paediatrics and European Confederation of Primary Care Paediatricians.

The advancement of technology and the increasing digitisation of healthcare systems have opened new opportunities to transform the delivery of child health services. The importance of interoperable electronic health data in enhancing healthcare systems and improving child health care is evident. Interoperability ensures seamless data exchange and communication among healthcare entities, providers, institutions, household and systems. Using standardised data formats, coding systems, and terminologies is crucial in achieving interoperability and overcoming the barriers of different systems, formats, and locations. Paediatricians and other child health stakeholders can effectively address data structure, coding, and terminology inconsistencies by promoting interoperability and improving data quality and accuracy of children and youth, according to guidelines of the World Health Organisation. Thus, ensure comprehensive health assessments and screenings for children, including timely follow-up and communication of results. And implement effective vaccination schedules and strategies, ensuring timely administration of vaccines and prompt response to any concerns or adverse events. Developmental milestones can be continuously monitored. This can improve care coordination, enhance decision-making, and optimise health outcomes for children. In conclusion, using interoperable electronic child health data holds great promise in advancing international child healthcare systems and enhancing the child's care and well-being. By promoting standardised data exchange, interoperability enables timely health assessments, accurate vaccination schedules, continuous monitoring of developmental milestones, coordination of care, and collaboration among child healthcare professionals and the individual or their caregiver. Embracing interoperability is essential for creating a person-centric and data-driven healthcare ecosystem where the potential of digitalisation and innovation can be fully realized.

Discovery of Discrete Stages in the Oxidation of exo-Tetrahydrodicyclopentadiene (C10H16) Droplets Doped with Titanium-Aluminum-Boron Reactive Mixed-Metal Nanopowder.

Titanium (Ti), aluminum (Al), and boron (B) reactive mixed-metal nanopowders (Ti-Al-B RMNPs) represent attractive additives to hydrocarbon fuels such as exo-tetrahydrodicyclopentadiene (C10H16; JP-10) enhancing the limited volumetric energy densities of traditional hydrocarbons, but fundamental mechanisms and combustion stages in the oxidation have been obscure. This understanding is of vital significance in the development of next-generation propulsion systems and energy-generation technologies. Here, we expose distinct oxidation stages of single droplets of JP-10 doped with Ti-Al-B-RMNP exploiting innovative ultrasonic levitator technology coupled with time-resolved spectroscopic (UV-vis) and imaging diagnostics (optical and infrared). Two spatially and temporally distinct stages of combustion define a glow flame stage in which JP-10 and nanoparticles combust via a homogeneous gas phase (Al) and heterogeneous gas-surface oxidation (Ti, B) and a slower diffusion flame stage associated with the oxidation of JP-10. These findings enable the development of next-generation RMNP fuel additives with superior payload delivery capabilities.

Combined Spectroscopic and Computational Investigation on the Oxidation of exo-Tetrahydrodicyclopentadiene (JP-10; C10H16) Doped with Titanium-Aluminum-Boron Reactive Metal Nanopowder.

We report the results on the combustion of single, levitated droplets of exo-tetrahydrodicyclopentadiene (JP-10) doped with titanium-aluminum-boron (Ti-Al-B) reactive metal nanopowders (RMNPs) in an oxygen (60%)-argon (40%) atmosphere by exploiting an ultrasonic levitator with droplets ignited by a carbon dioxide laser. Ultraviolet-visible (UV-vis) emission spectroscopy revealed the presence of gas-phase aluminum (Al) and titanium (Ti) atoms. These atoms can be oxidized in the gas phase by molecular oxygen to form spectroscopically detected aluminum monoxide (AlO) and titanium monoxide (TiO) transients. Analysis of the optical ignition videos supports that the nanoparticles are ignited before JP-10. The detection of boron monoxide (BO) further proposes an active surface chemistry through the oxidation of the RMNPs and the release of at least BO into the gas phase. The oxidation of gas-phase BO by molecular oxygen to boron dioxide (BO2) plus atomic oxygen might operate in the gas phase, although the involvement of surface oxidation processes of RMNPs to BO2 cannot be discounted. The UV-vis emission spectra also revealed the key reactive intermediates (OH, CH, C2, and HCO) of the oxidation of JP-10. Electronic structure calculations reveal that the presence of reactive radicals has a profound impact on the oxidation of JP-10. Although titanium monoxide (TiO) reacts to produce titanium dioxide (TiO2), it does not engage in an active JP-10 chemistry as all abstraction pathways are endoergic by more than 217 kJ mol-1. This is similar for atomic aluminum and titanium, whose hydrogen abstraction reactions from JP-10 were revealed to be endoergic by at least 77 kJ mol-1. Therefore, aluminum and titanium react preferentially with molecular oxygen to produce their monoxides. However, the formation of BO, AlO, and BO2 supplies a pool of highly reactive radicals, which can abstract hydrogen from JP-10 via transition states ranging from only 1 to 5 kJ mol-1 above the separated reactants, forming JP-10 radicals along with the hydrogen abstraction products (boron hydride oxide, aluminum monohydroxide, and metaboric acid) in the overall exoergic reactions. These abstraction barriers are well below the barriers of abstractions for ground-state atomic oxygen and molecular oxygen. In this sense, gas-phase BO, AlO, and BO2 catalyze the oxidation of gas-phase JP-10 via hydrogen abstraction, forming highly reactive JP-10 radicals. Overall, the addition of RMNPs to JP-10 not only provides a higher energy density fuel but is also expected to lead to shorter ignition delays compared to pure JP-10 due to the highly reactive pool of radicals (BO, AlO, and BO2) formed in the initial stage of the oxidation process.

Different Outcomes of "Silent Hypoxia" in Patients with COVID-19 Pneumonia: A Case Series and Literature Review.

COVID-19 has been declared a pandemic since March 2020 and it has been responsible for millions of deaths worldwide. The SARS-CoV-2 causes a spectrum of diseases mainly affecting the respiratory system. It can also complicate other systems causing thromboembolic phenomena and myocardial ischaemia. An entity of hypoxia has been described in these patients which show no clinical signs and symptoms of respiratory distress despite being extremely hypoxic. This is called silent or happy hypoxia. The exact mechanism for this is not known. We report 4 cases which had similar presentations of silent hypoxia but had different course of illness and different outcomes. All 4 patients did not show any signs of respiratory distress, but had oxygen saturation less than 82%. 3 of them needed intensive care unit support for oxygen therapy and subsequently needed noninvasive ventilation. Only one required invasive ventilation. The fourth patient did not require intensive care support. The patient who required invasive ventilation succumbed due to severe COVID pneumonia whereas the other 3 patients were discharged from the hospital. Silent hypoxemia can go undetected in COVID-19 patients particularly in the time of a pandemic. This case series highlights the importance of meticulous clinical examination including oxygen saturation measurements in suspected or confirmed patients with COVID-19. The course of illness can be different in different populations, and this needs further clinical evidence.

Catalytic Effects of Zeolite Socony Mobil-5 (ZSM-5) on the Oxidation of Acoustically Levitated exo-Tetrahydrodicyclopentadiene (JP-10) Droplets.

Jet propulsion 10 (JP-10) droplets with and without aluminum nanoparticles in conjunction with HZSM-5 zeolite and surfactants were ultrasonically levitated, and their oxidation processes were explored to identify how the oxidation process of JP-10 is catalytically affected by the HZSM-5 zeolites and how the surfactant and Al NPs in the system impacted the key experimental parameters of the ignition such as ignition delay time, burn rate, and the maximum temperatures. Singly levitated droplets were ignited using a carbon dioxide laser under an oxygen-argon atmosphere. Pure JP-10 droplets and JP-10 droplets with silicon dioxide of an identical size distribution as the zeolite HZSM-5 did not ignite in strong contrast to HZSM-5-doped droplets. Acidic sites were found to be critical in the ignition of the JP-10. With the addition of the surfactant, the characteristic features of the JP-10 ignition were improved, so the ignition delay time of the zeolite-JP-10 samples were decreased by 2-3 ms and the burn rates were increased by 1.3 to 1.6 × 105 K s-1. The addition of Al NPs increased the maximum temperatures during the combustion of the systems by 300-400 K. Intermediates and end products of the JP-10 oxidation over HZSM-5 were characterized by UV-vis emission and Fourier-transform infrared transmission spectroscopies, revealing key reactive intermediates (OH, CH, C2, O2, and HCO) along with the H2O molecules in highly excited rovibrational states. Overall, this work revealed that acetic sites in HZSM-5 are critical in the catalytic ignition of JP-10 droplets with the addition of the surfactant and Al NPs, enhancing the oxidation process of JP-10 over HZSM-5 zeolites.

Temperature Dependence in the NEXAFS Spectra of n-Alkanes.

The near edge X-ray absorption fine structure (NEXAFS) spectra of orthorhombic single crystals of n-octacosane ( n-C28H58), recorded at room temperature (298 K) and at cryogenic temperatures (93 K), show distinct differences. The characteristic carbon 1s → σ*C-H band in the NEXAFS spectrum of n-C28H58 is broader and has a lower-energy onset in its room temperature spectrum than in its NEXAFS spectrum recorded at cryogenic temperatures. Density functional theory simulations show that nuclear motion and molecular disorder contribute to the observed spectral broadness and are the origin of the low-energy onset of the C-H band in the room temperature spectrum.

Systematic Investigation of π-π Interactions in Near-Edge X-ray Fine Structure (NEXAFS) Spectroscopy of Paracyclophanes.

NEXAFS spectroscopy has potential for study of packing and order in organic materials but only if intermolecular effects are understood. This work studies how π-π interactions between adjacent unsaturated groups affect their NEXAFS spectra, with a broader goal of building a general understanding of the role of intermolecular effects in NEXAFS spectroscopy. These effects are examined using paracyclophane (PCP) molecules, in which the benzene-benzene separation distance is controlled by varying the length of the alkyl groups separating the benzene rings. NEXAFS spectroscopy and density functional theory (DFT) simulations are used to examine spectroscopic changes related to the strength of these π-π interactions. A characteristic red shift is observed as adjacent benzene rings get closer together. This shift is attributed to Coulombic and orbital interactions between the adjacent benzene rings, mediated through overlapping π/π* orbitals.

Leptospirosis outbreak in Sri Lanka in 2008: lessons for assessing the global burden of disease.

Global leptospirosis disease burden estimates are hampered by the lack of scientifically sound data from countries with probable high endemicity and limited diagnostic capacities. We describe the seroepidemiologic and clinical characteristics of the leptospirosis outbreak in 2008 in Sri Lanka. Definitive/presumptive case definitions proposed by the World Health Organization Leptospirosis Epidemiology Reference Group were used for case confirmation. Of the 404 possible cases, 155 were confirmed to have leptospirosis. Highest titers of patient seum samples reacted with serovars Pyrogenes (28.7%), Hardjo (18.8%), Javanica (11.5%), and Hebdomadis (11.5%). Sequencing of the 16S ribosomal DNA gene identified six infections: five with Leptospira interrogans and one with L. weilli. In this patient population, acute renal failure was the main complication (14.8%), followed by myocarditis (7.1%) and heart failure (3.9%). The case-fatality rate was 1.3%. This report strengthens the urgent need for increasing laboratory diagnostic capabilities to determine the causes of epidemic and endemic infectious diseases in Sri Lanka, a finding relevant to other tropical regions.

Do People Know Adequately about Leptospirosis? A Knowledge Assessment Survey in Post-outbreak Situation in Sri Lanka.

OBJECTIVES: Sri Lanka experienced the worst ever outbreak of leptospirosis in 2008. One major determinant of control and prevention of communicable diseases is public awareness on the disease. The purpose of the present study was to determine the awareness on leptospirosis among public Sri Lanka. METHODS: A national household survey was carried out as a part of research methodology training of first year medical undergraduates in Rajarata Medical School. Each student visited 10 households surrounding his/her house to complete the interviewer administered questionnaire. The questionnaire was based on the factsheet published by the Epidemiology Unit for public health. RESULTS: Altogether 602 participants from 14 districts participated in the study. Of them 93.7% were aware of rat as a reservoir animal, but only 3% were aware of the role of cattle and buffalo. Contact with infected water as a mode of transmission was reported by 57.9% of the population. Only 30.8% of the subjects were aware of that the infection can go through skin breeches. Farming as a risk activity was reported by 63.5% of the patients, but knowledge on other exposure activities were less than 20%. Paddy field work and cleaning garbage were correctly identified as risk occupations by 89.7% and 27.6% of the sample, respectively. Respondents were aware of fever (86%), malaise (30.8%), headache (29.6%) and muscle tenderness (28.8%) as main clinical features of the disease. Most of them (73.7%) knew leptospirosis as a lethal condition and 39.5% were aware of chemoprophylaxis. CONCLUSIONS: Although there is not adequate information on MDD prevalence in some areas of Iran, the overall current prevalence of MDD in the country is high and females are at the greater risk of disease.