Nurturing Care Interventions for Realizing the Development Potential of Every Child: From Pilot to Scale Up in Maharashtra.

The WHO-UNICEF nurturing care framework (NCF) for early childhood development provides a roadmap for action, focusing on pregnancy and the first three years of life. It emphasizes the need to invest in capacity building and empowerment of service providers, families and communities to create a conducive environment that promotes child development. We describe our experience of implementing nurturing care interventions, beginning with a pilot project in Maharashtra covering a population of 10000 to and scaling it up to a model called Aarambh (the beginning), catering to a population of 1,500,000. Opportunities available within the existing services across multiple sectors were used; Integrated Child Development Services (ICDS) scheme, the health sector, and others. It utilized multiple approaches for promoting NCF within families; home visits by frontline workers (FLWs), mothers' meetings, growth monitoring and promotion sessions, and community-based events as key opportunities. Joint training for FLWs, establishing supervisors of FLWs as their trainers, and an interactive training curriculum were critical elements identified for the success of the model. An environment of appreciation for the FLWs and their supervisors helped build their confidence and helped them own the interventions.

Additive manufacturing of cellulose-based materials with continuous, multidirectional stiffness gradients.

Functionally graded materials (FGMs) enable applications in fields such as biomedicine and architecture, but their fabrication suffers from shortcomings in gradient continuity, interfacial bonding, and directional freedom. In addition, most commercial design software fail to incorporate property gradient data, hindering explorations of the design space of FGMs. Here, we leveraged a combined approach of materials engineering and digital processing to enable extrusion-based multimaterial additive manufacturing of cellulose-based tunable viscoelastic materials with continuous, high-contrast, and multidirectional stiffness gradients. A method to engineer sets of cellulose-based materials with similar compositions, yet distinct mechanical and rheological properties, was established. In parallel, a digital workflow was developed to embed gradient information into design models with integrated fabrication path planning. The payoff of integrating these physical and digital tools is the ability to achieve the same stiffness gradient in multiple ways, opening design possibilities previously limited by the rigid coupling of material and geometry.

ß Decay of

The interpretation of observations of cooling neutron star crusts in quasipersistent x-ray transients is affected by predictions of the strength of neutrino cooling via crust Urca processes. The strength of crust Urca neutrino cooling depends sensitively on the electron-capture and ß-decay ground-state-to-ground-state transition strengths of neutron-rich rare isotopes. Nuclei with a mass number of A=61 are predicted to be among the most abundant in accreted crusts, and the last remaining experimentally undetermined ground-state-to-ground-state transition strength was the ß decay of ^{61}V. This Letter reports the first experimental determination of this transition strength, a ground-state branching of 8.1_{-3.1}^{+4.0}%, corresponding to a log ft value of 5.5_{-0.2}^{+0.2}. This result was achieved through the measurement of the ß-delayed γ rays using the total absorption spectrometer SuN and the measurement of the ß-delayed neutron branch using the neutron long counter system NERO at the National Superconducting Cyclotron Laboratory at Michigan State University. This method helps to mitigate the impact of the pandemonium effect in extremely neutron-rich nuclei on experimental results. The result implies that A=61 nuclei do not provide the strongest cooling in accreted neutron star crusts as expected by some predictions, but that their cooling is still larger compared to most other mass numbers. Only nuclei with mass numbers 31, 33, and 55 are predicted to be cooling more strongly. However, the theoretical predictions for the transition strengths of these nuclei are not consistently accurate enough to draw conclusions on crust cooling. With the experimental approach developed in this work, all relevant transitions are within reach to be studied in the future.

Strained epitaxial interfaces of metal (Pd, Pt, Au) overlayers on nonpolar CdS ([Formula: see text]) surfaces from first-principles.

The depositions of (1 1 1) and (1 0 0) overlayers of Pd, Pt and Au on the CdS (1 0 [Formula: see text] 0) surface are studied within epitaxial mismatches of 6%-7%, using spin-polarized density functional theory. For both compressively strained and tensile-strained interfaces, the (1 0 0) overlayers were found to be thermodynamically more stable owing to better interfacial matching, and higher surface uncoordination resulting in higher reactivity. Pt(1 1 1) exhibits slip dislocations even for five-atomic-layer thick Pt slabs. Along with the leading metal-S interaction, the interfacial charge transfers indicate a weak metal-Cd interaction which decreases in strength in the order Pd > Pt ∼ Au. For the same substrate area, the accumulation of electronic charge for Pt overlayers is ∼1.5-2 times larger than that of Pd and Au. The n-type Schottky barriers of Au overlayers with the minimum mismatch are within 0.1 eV of the predictions of Schottky-Mott rule, indicating a relatively ideal, scantily reactive interface structure. This is in clear contrast to the Pt epitaxial overlayers which deviate by 0.6-0.8 eV.

Validating the MUAC (Mid-upper arm circumference) Cut-off for Detection of Severe Acute Malnutrition in Children Aged 6-59 Months in Rural Maharashtra.

OBJECTIVE: To review the Mid-upper arm circumference (MUAC) cut-off currently being used to identify Severe Acute Malnutrition (SAM) as currently defined using Weight-for-Height. METHODS: Cross-sectional study conducted in 24 villages of a Primary Health Centre in Wardha district of Maharashtra among 2650 children between the ages of 6 to 59 months. RESULTS: For identifying SAM, sensitivity of MUAC was 23.5% and specificity was 99.7% for cut-off <11.5 cm. Using Youden index, best Mid-upper arm circumference cut-off point to identify SAM was <13 cm with sensitivity of 74.5% and specificity of 92.7%. Using Receiver operating characteristics curve, best MUAC cut-off point was 12.8 cm with 74.5% sensitivity and 92.7% specificity. Area under curve was 0.88 (95%CI: 0.85-0.91). CONCLUSION: The current MUAC cut-off of <11.5 cm for detecting SAM needs to be increased to ensure that children, who need referral for management of malnutrition, are not missed.

Intermetallic Differences at CdS-Metal (Ni, Pd, Pt, and Au) Interfaces: From Single-Atom to Subnanometer Metal Clusters.

Metal co-catalysts tipped at a photocatalyst surface form a crucial component in the nanoheterostructures designed for the photocatalytic hydrogen evolution reaction. To examine the intermetallic differences and size effects at these interfaces, we use spin-polarized density functional theory to study single-atom, 13-atom, and 55-atom cluster depositions of Ni, Pd, Pt, and Au on the CdS(101̅0) surface. For the single metal atoms, the ground-state configuration was the same site for all of the elements. Analysis of the metal-CdS bonding and of the charge transfers revealed a Ni-Cd bonding complex leading to depletion of electronic charge at the Ni single atom and at deposited Ni clusters, in contrast to charge accumulation observed for the other three metals Pd, Pt, and Au. For scaling up sizes of the metal deposition, six subnanometer cluster types were selected over a wide range of cluster's effective coordination number, and their interfaces were differentiated by charge redistributions, structure and adhesion energies, highest occupied molecular orbital-lowest occupied molecular orbital (HOMO-LUMO) gaps, and Schottky barrier heights. Although all considered clusters are semiconducting in the gas phase, 9 out of 28 clusters became (semi)metallic after deposition on the CdS semiconductor surface. Intermetallic differences and common trends are discussed.

Adsorption Study of a Water Molecule on Vacancy-Defected Nonpolar CdS Surfaces.

A detailed understanding of the water-semiconductor interface is of major importance for elucidating the molecular interactions at the photocatalyst's surface. Here, we studied the effect of vacancy defects on the adsorption of a water molecule on the (101̅0) and (112̅0) CdS surfaces, using spin-polarized density functional theory. We observed that the local spin polarization did not persist for most of the cationic vacancies on the surfaces, unlike in bulk, owing to surface reconstructions caused by displaced S atoms. This result suggests that cationic vacancies on these surfaces may not be the leading cause of the experimentally observed magnetism in CdS nanostructures. The surface vacancies are predominantly nonmagnetic except for one case, where a magnetic cationic vacancy is relatively stable due to constraints posed by the (101̅0) surface geometry. At this particular magnetic defect site, we found a very strong interaction with the H2O molecule leading to a case of chemisorption, where the local spin polarization vanishes concurrently. At the same defect site, adsorption of an O2 molecule was also simulated, and the results were found to be consistent with experimental electron paramagnetic resonance findings for powdered CdS. The anion vacancies on these surfaces were always found to be nonmagnetic and did not affect the water adsorption at these surfaces.

Esophageal histoplasmosis in a renal allograft recipient.

Histoplasmosis is a progressive granulomatous disease caused by the intracellular dimorphic fungus Histoplasma capsulatum. We report a rare case of esophageal histoplasmosis in a renal allograft recipient. A 55-year-old male who received a live, unrelated renal allograft 20 years ago presented with complaints of recurrent fever for ten to 12 months, weight loss over six months, progressive dysphagia more for solids for five to six months and joint pain and swelling involving the bilateral metacarpo-phalangeal and proximal interphalangeal joints. Biopsy from the esophageal ulcers revealed dense inflammation infiltrated with lymphocytes and macrophages with clusters of strongly positive intracellular fungal spores with a clear area or "halo-like" zone suggestive of Histoplasma capsulatum invasion. The patient was treated with intravenous liposomal amphotericin B for ten days and later switched over to oral itraconazole. Repeated endoscopy revealed significant improvement of the lesions.

Use of the ThinPrep Imaging System for internal quality control of cervical cytology.

OBJECTIVE: To audit the use of the ThinPrep Imaging System (TIS) for internal quality control (IQC) in the place of rapid review (RR), and to compare its performance with routine primary screening. METHOD: During 9 months, 16 462 ThinPrep slides were processed by TIS. Slides were initially reviewed using the TIS review scope, as recommended by the manufacturer: 22 fields of view were observed and, if considered abnormal, a full microscopic review was conducted using the review scope. Different biomedical scientists (BMSs), working on each procedure in rotation, performed batches of TIS-assisted quality control and routine primary screening independently on unmarked slides. Any slides with abnormalities detected by either method were referred to a consultant pathologist or advanced BMS practitioner for a final report. TIS results were compared with both previous records of RR and routine primary screening carried out on the same slides. We used the UK terminology in which 'dyskaryosis' is equivalent to squamous intraepithelial lesion (SIL) and borderline to atypical (including squamous and glandular cells). RESULTS: TIS preview detected significantly more high-grade dyskaryosis compared with RR during the previous 4 years: 2.0-4.2 compared with 0.1-1.8 detected per 1000 slides (P = 0.0001). TIS and routine screening were equivalent in sensitivity and specificity for the final cytology result, but BMSs were significantly more likely to classify slides as dyskaryotic rather than borderline when using TIS compared with routine screening. Referrals for potentially high-grade abnormalities detected by TIS-assisted IQC alone found 28 biopsies of at least cervical intraepithelial neoplasia grade 2 (CIN2+), whereas 15 CIN2+ biopsies were found on routine screening but missed using TIS. There was no significant change in the rates of inadequate tests, high- or low-grade cytological abnormalities, or positive predictive value for CIN2+ when TIS was in use. CONCLUSIONS: Screening with TIS was more sensitive than RR for IQC, providing a rescreening method equivalent to routine primary screening in overall accuracy.

Biochemical and reproductive effects of gestational/lactational exposure to lead and cadmium with respect to testicular steroidogenesis, antioxidant system, endogenous sex steroid and cauda-epididymal functions.

This study investigated the effects of gestational and lactational exposure to lead and cadmium on testicular steroidogenesis, antioxidant system and male accessory gland functions in F1 generation rats to understand the biochemical mechanisms involved in endocrine disruptions. Pregnant rats were subcutaneously administered with 0.05 mg kg(-1) body wt\ day(-1) of sodium acetate (control), lead acetate, cadmium acetate and (lead acetate + cadmium acetate) throughout the gestational-lactational period, and all animals from each of the experimental groups were sacrificed by decapitation on post-natal day 56 for performing various biochemical assays. We observed significant reduction in the activities of testicular key steroidogenic enzymes and serum testosterone concentration along with significant depletion in cholesterol, ascorbic acid and reduced glutathione contents in all the metal-treated groups. Reductions in the activities of catalase and superoxide dismutase with concomitant increase in the levels of thiobarbituric acid reactive substance were observed in experimental groups. Both sperm contents and sperm motility patterns were significantly altered in all the metal-treated groups, suggesting the direct/indirect spermotoxic effects of lead and cadmium. The inhibitory effects of lead, cadmium and combined exposure on testicular steroidogenesis machinery, along with the male accessory gland functions, are indicative of multiple targets of lead and cadmium to disrupt male reproductive functions.

Time-of-flight mass measurements for nuclear processes in neutron star crusts.

We present results from time-of-flight nuclear mass measurements at the National Superconducting Cyclotron Laboratory that are relevant for neutron star crust models. The masses of 16 neutron-rich nuclei in the scandium-nickel range were determined simultaneously, with the masses of (61)V, (63)Cr, (66)Mn, and (74)Ni measured for the first time with mass excesses of -30.510(890) MeV, -35.280(650) MeV, -36.900(790) MeV, and -49.210(990) MeV, respectively. With these results the locations of the dominant electron capture heat sources in the outer crust of accreting neutron stars that exhibit super bursts are now experimentally constrained. We find the experimental Q value for the (66)Fe→(66)Mn electron capture to be 2.1 MeV (2.6σ) smaller than predicted, resulting in the transition occurring significantly closer to the neutron star surface.

Tube sigmoidostomy: a valuable alternative to sigmoidopexy for sigmoid volvulus.

OBJECTIVE: To compare the effectiveness of tube sigmoidostomy and sigmoidopexy as effective treatment options for patients with acute uncomplicated sigmoid volvulus. METHODS: The records of 72 patients with acute uncomplicated sigmoid volvulus with obstruction who were treated by tube sigmoidostomy (Group I: n=32) and sigmoidopexy (Group II: n=40) were reviewed retrospectively. Follow-up period was 22 months (range: 6-51 months). RESULTS: Results show significant improvement in postoperative tachycardia, respiratory distress and urine output in Group I patients as compared to those in Group II. Most of the clinical parameters of Group I patients normalized by day 3, while it took up to 7 days in Group II patients. Intraabdominal hypertension caused by persistent colonic dilatation after sigmoidopexy was found to be an important determinant of postoperative morbidity. As compared to tube sigmoidostomy, the sigmoidopexy group had delayed recovery, more chances of abdominal fascial dehiscence, and longer hospital stay, as well as more prolonged abdominal discomfort, constipation, and recurrent volvulus rates during follow-up. CONCLUSION: Tube sigmoidostomy provides both fixation and decompression of the redundant sigmoid colon in the postoperative period while allowing time to recover from massive dilatation and edema caused by prolonged volvulus. Compared with sigmoidopexy for the treatment of uncomplicated sigmoid volvulus, tube sigmoidostomy leads to lesser rates of morbidity and recurrence. Thus, it can be considered as a definitive alternative treatment option for uncomplicated sigmoid volvulus.

An evaluation of ROME Camp: forgotten innovation in medical education.

BACKGROUND AND OBJECTIVES: Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, India's first rural medical institute, has been implementing its community-based public health teaching with the aim of building a physician workforce for the rural poor. For the past four decades, the MGIMS has organized and run the Re-orientation of Medical Education (ROME) camp for final year medical undergraduates at one of the rural centres of the department of Community Medicine. The objectives of the present study were to learn students' perceptions of the value and effectiveness of various components of the ROME camp and learn the factors they perceive facilitate and inhibit learning. METHODS: A mixed-method research design of quantitative (survey) and qualitative (force field analysis) methods was used. The study participants were all 61 of the final year medical undergraduates participating in the ROME camp in 2008. The quantitative data was analyzed using SPSS software package and summative content analysis of the qualitative data was undertaken. RESULTS: Students were generally very positive about all aspects of the camp and its component parts. The greatest consensus (88.9%, on a 0 to 100% scale) was for the contribution to student learning of the visit to the Primary health centre and Sub-centre, as offering direct exposure and interaction with the village-level service providers. There was poorer consensus for students' involvement with the field-based clinics, as this was felt by some not to contribute significantly to their understanding of socio-economic and environmental factors related to cases (78.8%) and their ability to diagnose health problems in resource poor settings (76.5%). The major strength of the camp was felt to be its exposure visits and hands-on experiences in surveys and interaction with village-level health care providers. Students reported poor interactions with teachers in some educational sessions, including the field-based clinics and classes on theories of national health programs. CONCLUSIONS: The curriculum of the ROME camp was generally well regarded by students, but based on their views it should emphasize interactive theory sessions. The ROME scheme can be revitalized in all medical colleges as it is an effective practical approach for teaching public health principles and practice to medical students.