The inclusion of diagnostics in national health insurance schemes in Cambodia, India, Indonesia, Nepal, Pakistan, Philippines and Viet Nam.

The Lancet Commission on Diagnostics highlighted a huge gap in access to diagnostic testing even for basic tests, particularly at the primary care level, and emphasised the need for countries to include diagnostics as part of their universal health coverage benefits packages. Despite the poor state of diagnostic-related services in low-income and middle-income countries (LMICs), little is known about the extent to which diagnostics are included in the health benefit packages. We conducted an analysis of seven Asian LMICs-Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Viet Nam-to understand this issue. We conducted a targeted review of relevant literature and applied a health financing framework to analyse the benefit packages available in each government-sponsored scheme. We found considerable heterogeneity in country approaches to diagnostics. Of the seven countries, only India has developed a national essential diagnostics list. No country presented a clear policy rationale on the inclusion of diagnostics in their scheme and the level of detail on the specific diagnostics which are covered under the schemes was also generally lacking. Government-sponsored insurance expansion in the eligible populations has reduced the out-of-pocket health payment burden in many of the countries but overall, there is a lack of access, availability and affordability for diagnostic-related services.

The role of exercise and hypoxia on glucose transport and regulation.

Muscle glucose transport activity increases with an acute bout of exercise, a process that is accomplished by the translocation of glucose transporters to the plasma membrane. This process remains intact in the skeletal muscle of individuals with insulin resistance and type 2 diabetes mellitus (T2DM). Exercise training is, therefore, an important cornerstone in the management of individuals with T2DM. However, the acute systemic glucose responses to carbohydrate ingestion are often augmented during the early recovery period from exercise, despite increased glucose uptake into skeletal muscle. Accordingly, the first aim of this review is to summarize the knowledge associated with insulin action and glucose uptake in skeletal muscle and apply these to explain the disparate responses between systemic and localized glucose responses post-exercise. Herein, the importance of muscle glycogen depletion and the key glucoregulatory hormones will be discussed. Glucose uptake can also be stimulated independently by hypoxia; therefore, hypoxic training presents as an emerging method for enhancing the effects of exercise on glucose regulation. Thus, the second aim of this review is to discuss the potential for systemic hypoxia to enhance the effects of exercise on glucose regulation.

The role of the private sector in delivering essential packages of health services: lessons from country experiences.

Many countries are adopting essential packages of health services (EPHS) to implement universal health coverage (UHC), which are mostly financed and delivered by the public sector, while the potential role of the private health sector (PHS) remains untapped. Currently, many low-income and lower middle-income countries (LLMICs) have devised EPHS; however, guidance on translating these packages into quality, accessible and affordable services is limited. This paper explores the role of PHS in achieving UHC, identifies key concerns and presents the experience of the Diseases Control Priorities 3 Country Translation project in Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar. There are key challenges to engagement of the PHS, which include the complexity and heterogeneity of private providers, their operation in isolation of the health system, limitations of population coverage and equity when left to PHS's own choices, and higher overall cost of care for privately delivered services. Irrespective of the strategies employed to involve the PHS in delivering EPHS, it is necessary to identify private providers in terms of their characteristics and contribution, and their response to regulatory tools and incentives. Strategies for regulating private providers include better statutory control to prevent unlicensed practice, self-regulation by professional bodies to maintain standards of practice and accreditation of large private hospitals and chains. Potentially, purchasing delivery of essential services by engaging private providers can be an effective 'regulatory approach' to modify provider behaviour. Despite existing experience, more research is needed to better explore and operationalise the role of PHS in implementing EPHS in LLMICs.

New Type of Catalyst for Efficient Aerobic Oxidative Desulfurization Based On Tungsten Carbide Synthesized by the Microwave Method.

Herein, we present a new type of high-performance catalyst for aerobic oxidation of organosulfur compounds based on tungsten carbide. The synthesis of tungsten carbide was performed via microwave irradiation of the precursors, which makes it possible to obtain a catalyst in just 15 min. The synthesized catalyst was investigated by a variety of physicochemical methods: X-ray diffraction, X-ray photoelectron spectroscopy, Raman spectroscopy, electron microscopy, and N2 adsorption/desorption. It was shown that active centers containing tungsten in the transition oxidation state (+4) play a key role in the activation of oxygen. The main factors influencing the conversion of dibenzothiophene (DBT) were investigated. It should be noted that 100% conversion of DBT can be achieved under relatively mild conditions: 120 °C, 3 h, 6 bar, and 0.5% wt catalyst. The catalyst retained its activity for at least six oxidation/regeneration cycles. The simplicity and speed of synthesis of the proposed catalyst in combination with its high activity and stability open broad prospects for its further use both for oxidative desulfurization and for other reactions of aerobic oxidation of organic substrates.

Double Heterotopic Pregnancies with Live Intrauterine Pregnancy after Ovarian Stimulation.

Heterotopic pregnancies, although rare in natural conceptions, have increased in incidence with use of assisted reproductive techniques (ART). Double heterotopic pregnancy in addition to an intrauterine pregnancy is exceedingly rare. In this case, we present a patient who underwent ovulation induction and intrauterine insemination (IUI) and was found on ultrasound to have a live heterotopic pregnancy. Intraoperatively, both fallopian tubes were grossly swollen and engorged. Bilateral salpingectomy was performed. Pathology identified gestational products in both fallopian tubes consistent with a double heterotopic pregnancy. Postoperatively, the intrauterine pregnancy resulted in a live birth. Although double heterotopic pregnancy and an intrauterine pregnancy is exceedingly rare, this case emphasizes the importance of routinely inspecting the contralateral fallopian tube at the time of surgery for an ectopic pregnancy, particularly in patients undergoing ovulation induction.

A microfluidic platform for functional testing of cancer drugs on intact tumor slices.

Present approaches to assess cancer treatments are often inaccurate, costly, and/or cumbersome. Functional testing platforms that use live tumor cells are a promising tool both for drug development and for identifying the optimal therapy for a given patient, i.e. precision oncology. However, current methods that utilize patient-derived cells from dissociated tissue typically lack the microenvironment of the tumor tissue and/or cannot inform on a timescale rapid enough to guide decisions for patient-specific therapy. We have developed a microfluidic platform that allows for multiplexed drug testing of intact tumor slices cultured on a porous membrane. The device is digitally-manufactured in a biocompatible thermoplastic by laser-cutting and solvent bonding. Here we describe the fabrication process in detail, we characterize the fluidic performance of the device, and demonstrate on-device drug-response testing with tumor slices from xenografts and from a patient colorectal tumor.

Pyrene-phenylglycinol linked reversible ratiometric fluorescent chemosensor for the detection of aluminium in nanomolar range and its bio-imaging.

Pyrene-phenylglycinol tangled ratiometric sensor (R)-1 was developed for the detection of Al3+ ion over other metal ions. Ratiometric behaviour of (R)-1 for Al3+ ion explained through monomer emission and excimer quenching leads to avoiding the π-π interactions of bis-pyrene rings. Pull-push to push-pull binding mechanism is successfully explained by DFT and sensing of Al3+-ions demonstrated in living cells. The LOD of (R)-1 for Al3+ downs to nanomolar concentrations which is lower than the allowed concentration of drinking water set by the (World Health Organization) WHO.

Adsorption of arsenic using chitosan magnetic graphene oxide nanocomposite.

Chitosan-magnetic-graphene oxide (CMGO) nanocomposite was prepared for arsenic adsorption. The nanocomposite was characterized through BET, FTIR, FESEM, EDX, and VSM analyses. These characterizations confirmed the formation of CMGO nanocomposites with high specific surface area (152.38 m2/g) and excellent saturation magnetization (49.30 emu/g). Batch adsorption experiments were conducted to evaluate the performance of the nanocomposite in the adsorption of arsenic from aqueous solution. The effects of operational parameters, adsorption kinetic, equilibrium isotherm and thermodynamics were evaluated. The removal efficiency of arsenic increased with increasing adsorbent dosage and contact time. However, the effect of pH followed a different pattern, with the removal efficiency increasing from acidic to neutral pH, and then decreasing at alkaline conditions. The highest adsorption capacity (45 mg/g) and removal efficiency (61%) were obtained at pH 7.3. The adsorption kinetic followed a pseudo-second-order kinetic model. The analysis of adsorption isotherm shows that the adsorption data fitted well to Langmuir isotherm model, indicating a homogeneous process. Thermodynamic analysis shows that the adsorption of As(III) is exothermic and spontaneous. The superparamagnetic properties of the nanocomposite enabled the separation and recovery of the nanoparticles using an external magnetic field. Thus, the developed nanocomposite has a potential for arsenic remediation.

Synthesis and characterization of magnetic graphene oxide for arsenic removal from aqueous solution.

A magnetic graphene oxide (MGO) was developed for the adsorption of As(III) from aqueous solution. The characteristics of MGO were investigated using Fourier-transform infrared (FTIR), X-ray diffraction and field emission scanning electron microscope-E/energy-dispersive X-ray analyses. Batch adsorption experiments were designed using central composite design, and the effects of adsorbent dosage, pH, contact time and concentration of As(III) were investigated. The MGO showed an excellent performance, removing up to 99.95% of As(III) under the following condition: initial As(III) concentration = 100 mg/L, pH = 7, adsorbent dosage = 0.3 g/L and contact time = 77 min. MGO dosage and initial pH were the most significant parameters influencing the process performance. FTIR analysis of the used adsorbent confirms the adsorption of As(III) through complexation between surface functional groups of the MGO and the oxyanions of As(III). The adsorbent maintained a significant level of performance even after four cycles of adsorption. Thus, the developed MGO has the potential to be used for the abatement of arsenic pollution.

Whole-Genome Resequencing of Red Junglefowl and Indigenous Village Chicken Reveal New Insights on the Genome Dynamics of the Species.

The red junglefowl Gallus gallus is the main progenitor of domestic chicken, the commonest livestock species, outnumbering humans by an approximate ratio of six to one. The genetic control for production traits have been well studied in commercial chicken, but the selection pressures underlying unique adaptation and production to local environments remain largely unknown in indigenous village chicken. Likewise, the genome regions under positive selection in the wild red junglefowl remain untapped. Here, using the pool heterozygosity approach, we analyzed indigenous village chicken populations from Ethiopia, Saudi Arabia, and Sri Lanka, alongside six red junglefowl, for signatures of positive selection across the autosomes. Two red junglefowl candidate selected regions were shared with all domestic chicken populations. Four candidates sweep regions, unique to and shared among all indigenous domestic chicken, were detected. Only one region includes annotated genes (TSHR and GTF2A1). Candidate regions that were unique to each domestic chicken population with functions relating to adaptation to temperature gradient, production, reproduction and immunity were identified. Our results provide new insights on the consequence of the selection pressures that followed domestication on the genome landscape of the domestic village chicken.

A review of the applications of organo-functionalized magnetic graphene oxide nanocomposites for heavy metal adsorption.

Graphene-based adsorbents have attracted wide interests as effective adsorbents for heavy metals removal from the environment. Due to their excellent electrical, mechanical, optical and transport properties, graphene and its derivatives such as graphene oxide (GO) have found various applications. However, in many applications, surface modification is necessary as pristine graphene/GO may be ineffective in some specific applications such as adsorption of heavy metal ions. Consequently, the modification of graphene/GO using various metals and non-metals is an ongoing research effort in the carbon-material realm. The use of organic materials represents an economical and environmentally friendly approach in modifying GO for environmental applications such as heavy metal adsorption. This review discusses the applications of organo-functionalized GO composites for the adsorption of heavy metals. The aspects reviewed include the commonly used organic materials for modifying GO, the performance of the modified composites in heavy metals adsorption, effects of operational parameters, adsorption mechanisms and kinetic, as well as the stability of the adsorbents. Despite the significant research efforts on GO modification, many aspects such as the interaction between the functional groups and the heavy metal ions, and the quantitative effect of the functional groups are yet to be fully understood. The review, therefore, offers some perspectives on the future research needs.

An NGO-Implemented Community-Clinic Health Worker Approach to Providing Long-Term Care for Hypertension in a Remote Region of Southern India.

Poor blood pressure control results in tremendous morbidity and mortality in India where the leading cause of death among adults is from coronary heart disease. Despite having little formal education, community health workers (CHWs) are integral to successful public health interventions in India and other low- and middle-income countries that have a shortage of trained health professionals. Training CHWs to screen for and manage chronic hypertension, with support from trained clinicians, offers an excellent opportunity for effecting systemwide change in hypertension-related burden of disease. In this article, we describe the development of a program that trained CHWs between 2014 and 2015 in the tribal region of the Sittilingi Valley in southern India, to identify hypertensive patients in the community, refer them for diagnosis and initial management in a physician-staffed clinic, and provide them with sustained lifestyle interventions and medications over multiple visits. We found that after 2 years, the CHWs had screened 7,176 people over age 18 for hypertension, 1,184 (16.5%) of whom were screened as hypertensive. Of the 1,184 patients screened as hypertensive, 898 (75.8%) had achieved blood pressure control, defined as a systolic blood pressure less than 140 and a diastolic blood pressure less than 90 sustained over 3 consecutive visits. While all of the 24 trained CHWs reported confidence in checking blood pressure with a manual blood pressure cuff, 4 of the 24 CHWs reported occasional difficulty documenting blood pressure values because they were unable to write numbers properly. They compensated by asking other CHWs or members of their community to help with documentation. Our experience and findings suggest that a CHW blood pressure screening system linked to a central clinic can be a promising avenue for improving hypertension control rates in low- and middle-income countries.

Electrocoagulation treatment of raw landfill leachate using iron-based electrodes: Effects of process parameters and optimization.

The main problem of landfill leachate is its diverse composition comprising many persistent organic pollutants which must be removed before being discharge into the environment. This study investigated the treatment of raw landfill leachate using electrocoagulation process. An electrocoagulation system was designed with iron as both the anode and cathode. The effects of inter-electrode distance, initial pH and electrolyte concentration on colour and COD removals were investigated. All these factors were found to have significant effects on the colour removal. On the other hand, electrolyte concentration was the most significant parameter affecting the COD removal. Numerical optimization was also conducted to obtain the optimum process performance. Under optimum conditions (initial pH: 7.73, inter-electrode distance: 1.16 cm, and electrolyte concentration (NaCl): 2.00 g/L), the process could remove up to 82.7% colour and 45.1% COD. The process can be applied as a pre-treatment for raw leachates before applying other appropriate treatment technologies.

Effects of mild hypoxia in aviation on mood and complex cognition.

Thirty six volunteer air force personnel were sequentially exposed in a randomized balanced order in a hypobaric chamber to 30 min of baseline (sea level) and mild hypoxia induced by a specified altitude (sea level, 8000 ft and 12,000 ft), followed immediately by breathing 100% oxygen from an oro-nasal mask. Mood and complex cognition were assessed. Analysis of variance indicated that mood (fatigue and vigour) remained the same at 8000 ft but fatigue was increased (p = 0.001) and vigour reduced (p = 0.035) at 12,000 ft and was restored by supplementary oxygen. Complex cognition was not significantly altered by the test conditions. The results of this study do not support prior evidence that mild hypoxia equivalent to either 8000 or 12,000 ft, impairs complex cognition, but suggests that some aspects of mood may be affected at 12,000 ft and can be restored by breathing 100% oxygen.

Genome-wide analysis reveals the extent of EAV-HP integration in domestic chicken.

BACKGROUND: EAV-HP is an ancient retrovirus pre-dating Gallus speciation, which continues to circulate in modern chicken populations, and led to the emergence of avian leukosis virus subgroup J causing significant economic losses to the poultry industry. We mapped EAV-HP integration sites in Ethiopian village chickens, a Silkie, Taiwan Country chicken, red junglefowl Gallus gallus and several inbred experimental lines using whole-genome sequence data. RESULTS: An average of 75.22 ± 9.52 integration sites per bird were identified, which collectively group into 279 intervals of which 5 % are common to 90 % of the genomes analysed and are suggestive of pre-domestication integration events. More than a third of intervals are specific to individual genomes, supporting active circulation of EAV-HP in modern chickens. Interval density is correlated with chromosome length (P < 2.31(-6)), and 27 % of intervals are located within 5 kb of a transcript. Functional annotation clustering of genes reveals enrichment for immune-related functions (P < 0.05). CONCLUSIONS: Our results illustrate a non-random distribution of EAV-HP in the genome, emphasising the importance it may have played in the adaptation of the species, and provide a platform from which to extend investigations on the co-evolutionary significance of endogenous retroviral genera with their hosts.

Epiphyas postvittana (Lepidoptera: Tortricidae)-Botrytis cinerea (Helotiales: Sclerotiniaceae)-Vitis vinifera (Vitales: Vitaceae) Interaction: The Role of B. cinerea on the Development of E. postvittana in Synthetic Nutritional Media.

Epiphyas postvittana (Walker) (light-brown apple moth) is a polyphagous herbivore of economic significance, which also feeds on Vitis vinifera L. The E. postvittana-V. vinifera interacting system also involves the participation of the fungus Botrytis cinerea Persoon ex Fries. We have been exploring the relationship among E. postvittana-V. vinifera-B. cinerea over the past two years. In this article, we report the preference and performance of the larvae of E. postvittana raised solely on a synthetic diet incorporated with the mycelial material of B. cinerea (Diet B). To characterize the effect of fungus on the development of E. postvittana, another synthetic diet was prepared that included the lyophilized leaf material of V. vinifera (Diet C). When raised on Diets B and C, a decrease in the duration of larval development and an increase in the survival and fecundity rate of E. postvittana occurred. Diet B influenced the pupal mass, but a significant increase occurred when the larvae were fed on Diet C. The larval emergence rate was the greatest in E. postvittana raised on Diet B, followed by those on Diet C. The F(2) generation of the larvae reared on Diet B showed similar effects as F(1) on the life-history performance of the larvae. Diet B enhanced the life-history performance of E. postvittana, although the larvae of E. postvittana showed little preference to Diet B. The greater fertility rate of E. postvittana reared on Diet B suggests the importance of sterols as shown in Lobesia botrana (Denis & Schiffermüller) (Lepidoptera: Tortricidae) and in a few Myrmicinae (Hymenoptera: Formicidae), which serve as precursors to different ecdysteroids that regulate many critical processes through embryonic development.

Quantitative nanoscale electrostatics of viruses.

Electrostatics is one of the fundamental driving forces of the interaction between biomolecules in solution. In particular, the recognition events between viruses and host cells are dominated by both specific and non-specific interactions and the electric charge of viral particles determines the electrostatic force component of the latter. Here we probe the charge of individual viruses in liquid milieu by measuring the electrostatic force between a viral particle and the Atomic Force Microscope tip. The force spectroscopy data of co-adsorbed ϕ29 bacteriophage proheads and mature virions, adenovirus and minute virus of mice capsids is utilized for obtaining the corresponding density of charge for each virus. The systematic differences of the density of charge between the viral particles are consistent with the theoretical predictions obtained from X-ray structural data. Our results show that the density of charge is a distinguishing characteristic of each virus, depending crucially on the nature of the viral capsid and the presence/absence of the genetic material.

A Comparison of Teaching Modalities and Fidelity of Simulation Levels in Teaching Resuscitation Scenarios.

INTRODUCTION: The purpose of our study was to examine the ability of novices to learn selected aspects of Advanced Cardiac Life Support (ACLS) in training conditions that did not incorporate simulation compared to those that contained low- and high-fidelity simulation activities. We sought to determine at what level additional educational opportunities and simulation fidelity become superfluous with respect to learning outcomes. METHODS: Totally 39 medical students and physician assistant students were randomly assigned to 4 training conditions: control (lecture only), video-based didactic instruction, low-, and high-fidelity simulation activities. Participants were assessed using a baseline written pretest of ACLS knowledge. Following this, all participants received a lecture outlining ACLS science and algorithm interpretation. Participants were then trained in specific aspects of ACLS according to their assigned instructional condition. After training, each participant was assessed via a Megacode performance examination and a written posttest. RESULTS: All groups performed significantly better on the written posttest compared with the pretest (p < 0.001); however, no groups outperformed any other groups. On the Megacode performance test, the video-based, low-, and high-fidelity groups performed significantly better than the control group (p = 0.028, p < 0.001, p = 0.019). Equivalence testing revealed that the high-fidelity simulation condition was statistically equivalent to the video-based and low-fidelity simulation conditions. CONCLUSION: Video-based and simulation-based training is associated with better learning outcomes when compared with traditional didactic lectures only. Video-based, low-fidelity, and high-fidelity simulation training yield equivalent outcomes, which may indicate that high-fidelity simulation is superfluous for the novice trainee.