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An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.
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Ebolavirus/fisiologia , Epidemias , Instalações de Saúde , Doença pelo Vírus Ebola/epidemiologia , Atenção à Saúde , Serviços Médicos de Emergência , Pessoal de Saúde , Doença pelo Vírus Ebola/virologia , Humanos , Organizações , Serra Leoa/epidemiologiaRESUMO
Assembling two-dimensional van der Waals (vdW)-layered materials into heterostructures is an exciting development that sparked the discovery of rich correlated electronic phenomena. vdW heterostructures also offer possibilities for designer device applications in areas such as optoelectronics, valley- and spintronics, and quantum technology. However, realizing the full potential of these heterostructures requires interfaces with exceptionally low disorder which is challenging to engineer. Here, we show that thermal scanning probes can be used to create pristine interfaces in vdW heterostructures. Our approach is compatible at both the material- and device levels, and monolayer WS2 transistors show up to an order of magnitude improvement in electrical performance from this technique. We also demonstrate vdW heterostructures with low interface disorder enabling the electrical formation and control of quantum dots that can be tuned from macroscopic current flow to the single-electron tunneling regime.
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Corticosteroids are potent anti-inflammatory agents used as a mainstay of therapy in most of the rheumatologic disorders. Common side effects of pulse steroid therapy include hypertension, hyperglycemia, seizure, hypokalemia, and infection. We report a case of an 11-year-old girl with polyarticular Juvenile idiopathic arthritis who developed bradycardia following pulse methylprednisolone therapy. On day 2 of methylprednisolone infusion, she developed bradycardia with a heart rate between 50 and 60/min. ECG was suggestive of sinus bradycardia. There was no evidence of dyselectrolytemia (Na-141 mmol/l, K-3.54 mmol/l, Ca-8.72 mg/l) or sepsis. The patient did not receive methylprednisolone on day 3 and vitals continued to be monitored. Her heart rate improved after 12 hours. In the mid of infusion on day 4, again the patient had bradycardia with a heart rate of 50-60/minute. Since she was hemodynamically stable, we continued the infusion, and bradycardia resolved in the next 8 hours. On follow-up after 2 weeks, she had some improvement in joint symptoms and normal heart rate. As per Naranjo adverse drug reaction probability scale, the adverse reaction in our case was probable with a score of 8. Although bradycardia associated with pulse steroid therapy is benign and is usually reversible following cessation of therapy, a baseline heart rate, ECG, and electrolyte level are suggested before infusion as a cautionary measure to minimize serious adverse events.
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Nearly 45% of under 5 mortality is directly or indirectly linked to malnutrition. Infection adds to the increased mortality and morbidity in these groups. Vaccination is very important in these undernourished children protecting against life-threatening infections. The goal of vaccination is to produce long-term protection by generating memory cells and the generation of antibodies. Since malnutrition is a state of immunodeficiency, the immune response to vaccines in these children is a matter of concern. We did an exhaustive search to gather more recent studies and corroborated previous findings. Oral Polio Vaccine (OPV), Pneumococcal Polysaccharide Vaccine, Haemophilus influenza vaccine, rabies, and cholera vaccine showed normal response to immunization. Measles and rotavirus vaccines were found to elicit lower seroprotection and lower efficacy in undernourished children. Data regarding response to vaccination against BCG, DPwT, Hepatitis B, pneumococcal conjugate vaccine, and meningococcal vaccine was inconclusive. Although most of the studies show a normal immune response to different vaccines, excluding other confounding factors and effect modifiers had not been easy to interpret. However, with the advances in the understanding of vaccine physiology with newer immunological techniques, good-quality studies might explore the gray areas that remain untouched.
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OBJECTIVE: To study the prevalence of common dyslipidemia among overweight and obese children between 2-18 years in a tribal region. METHODS: This cross-sectional study was carried out in 151 overweight and obese children aged 2-18 years, who visited the pediatric outpatient department of a tertiary care hospital in Jharkhand between 1 August and 30 November, 2022. Dyslipidemia was defined as anyone of the following: a total cholesterol level of 240 mg/dL, a triglyceride level of 150 mg/dL, a low-density lipoprotein cholesterol level (LDL-C) of 140 mg/dL, a high-density lipoprotein cholesterol level (HDL-C) of 40 mg/dL, or the use of a lipid-lowering drug [8]. Overweight and obesity were defined as per World Health Organization criteria. RESULTS: The prevalence of dyslipidemia was 63.6%. The most common type of dyslipidemia was low HDL-C + high TG levels found in 32.5% (n=49) children. The most prevalent pattern of dyslipidemia in overweight children was low HDL-C (19, 32.3%); and in obese children low HDL-C and high TG levels (39, 42.3%). CONCLUSION: The prevalence rate of dyslipidemia was high among overweight and obese children in this region. There was a positive association between dyslipidemia and body mass index.
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Dislipidemias , Obesidade Infantil , Criança , Humanos , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Estudos Transversais , Triglicerídeos , Dislipidemias/epidemiologia , Prevalência , Hospitais , Colesterol , HDL-ColesterolRESUMO
Excitonic states trapped in harmonic moiré wells of twisted heterobilayers is an intriguing testbed for exploring many-body physics. However, the moiré potential is primarily governed by the twist angle, and its dynamic tuning remains a challenge. Here we demonstrate anharmonic tuning of moiré potential in a WS2/WSe2 heterobilayer through gate voltage and optical power. A gate voltage can result in a local in-plane perturbing field with odd parity around the high-symmetry points. This allows us to simultaneously observe the first (linear) and second (parabolic) order Stark shift for the ground state and first excited state, respectively, of the moiré trapped exciton - an effect opposite to conventional quantum-confined Stark shift. Depending on the degree of confinement, these excitons exhibit up to twenty-fold gate-tunability in the lifetime (100 to 5 ns). Also, exciton localization dependent dipolar repulsion leads to an optical power-induced blueshift of ~ 1 meV/µW - a five-fold enhancement over previous reports.
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Despite over a decade of intense research efforts, the full potential of two-dimensional transition-metal dichalcogenides continues to be limited by major challenges. The lack of compatible and scalable dielectric materials and integration techniques restrict device performances and their commercial applications. Conventional dielectric integration techniques for bulk semiconductors are difficult to adapt for atomically thin two-dimensional materials. This review provides a brief introduction into various common and emerging dielectric synthesis and integration techniques and discusses their applicability for 2D transition metal dichalcogenides. Dielectric integration for various applications is reviewed in subsequent sections including nanoelectronics, optoelectronics, flexible electronics, valleytronics, biosensing, quantum information processing, and quantum sensing. For each application, we introduce basic device working principles, discuss the specific dielectric requirements, review current progress, present key challenges, and offer insights into future prospects and opportunities.
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Malaria poses a major public health challenge in the Asia Pacific. Malaria Elimination Demonstration Project was conducted as a public-private partnership initiative in Mandla between State government, ICMR, and FDEC India. The project employed controls for efficient operational and management decisions. IEC campaigns found crucial in schools and communities. Capacity building of local workers emphasized for better diagnosis and treatment. SOCH mobile app launched for complete digitalization. Better supervision for Indoor Residual Sprays and optimized Long Lasting Insecticidal Nets distribution. Significant malaria cases reduction in Mandla. Insights from MEDP crucial for malaria elimination strategies in other endemic regions of the Asia Pacific.
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Inseticidas , Malária , Humanos , Ásia/epidemiologia , Índia , Malária/prevenção & controle , Malária/epidemiologia , Saúde PúblicaRESUMO
Two-dimensional (2D) semiconductors are promising channel materials for continued downscaling of complementary metal-oxide-semiconductor (CMOS) logic circuits. However, their full potential continues to be limited by a lack of scalable high-k dielectrics that can achieve atomically smooth interfaces, small equivalent oxide thicknesses (EOTs), excellent gate control, and low leakage currents. Here, large-area liquid-metal-printed ultrathin Ga2O3 dielectrics for 2D electronics and optoelectronics are reported. The atomically smooth Ga2O3/WS2 interfaces enabled by the conformal nature of liquid metal printing are directly visualized. Atomic layer deposition compatibility with high-k Ga2O3/HfO2 top-gate dielectric stacks on a chemical-vapor-deposition-grown monolayer WS2 is demonstrated, achieving EOTs of â¼1 nm and subthreshold swings down to 84.9 mV/dec. Gate leakage currents are well within requirements for ultrascaled low-power logic circuits. These results show that liquid-metal-printed oxides can bridge a crucial gap in dielectric integration of 2D materials for next-generation nanoelectronics.
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Cold atmospheric pressure plasma jet (CAPJ) has piqued the interest of researchers for various antimicrobial applications such as disinfection, wound decontamination, etc. In the current context, a deeper understanding of the correlation between CAPJ's intrinsic parameters, discharge characteristics, species composition, and antimicrobial activity is required for any successful application. This research evaluated the effect of intrinsic operational parameters such as voltage, frequency, gas flow rate, and operating gas on the reactive species composition of an in-house-developed CAPJ discharge along with the antimicrobial activity. It was observed that the identified excited atoms (Ar I, He I, N2, and O I), ions (Ar+, N2+, N+, H2O+, H3O+, etc.), radical reactive oxygen and nitrogen species (RONS) (OHâ¢), and nonradical RONS (O I, O+, OH+, NO+, O2+, O2-, NO2-, N2O2-, NO3-, N2O3-, etc.) might play a synergistic role in bacterial inactivation via oxidative and electrostatic stress. The variation in voltage, frequency, gas flow rate, and operating gas influenced the discharge chemistry, leading to variation in bacterial inactivation. The reactive species in the discharge responsible for such variation was evaluated extensively. This investigation into various operational parameters would aid in determining the most effective settings for a developed CAPJ to achieve high productivity.
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Strong Coulomb interactions in monolayer semiconductors allow them to host optically active large many-body states, such as the five-particle state, charged biexciton. Strong nonlinear light absorption by the charged biexciton under spectral resonance, coupled with its charged nature, makes it intriguing for nonlinear photodetectionâan area that is hitherto unexplored. Using the high built-in vertical electric field in an asymmetrically designed few-layer graphene encapsulated 1L-WS2 heterostructure, here we report a large, highly nonlinear photocurrent arising from the strong absorption by two charged biexciton species under zero external bias (self-powered mode). Time-resolved measurement reveals that the generated charged biexcitons transfer to the few-layer graphene in a time scale of sub-5 ps, indicating an ultrafast intrinsic limit of the photoresponse. By using single- and two-color photoluminescence excitation spectroscopy, we show that the two biexcitonic peaks originate from bright-dark and bright-bright exciton-trion combinations. Such innate nonlinearity in the photocurrent due to its biexcitonic origin, coupled with the ultrafast response due to swift interlayer charge transfer, exemplifies the promise of manipulating many-body effects in monolayers toward viable optoelectronic applications.
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In Asia Pacific, several nations that were part of the World Health Organization's initiative to eliminate malaria by 2020 or the E2020 Initiative reported being off-track. The COVID-19 pandemic further strained health systems and has the potential to stall the efforts and reverse earlier progress made towards the fight against malaria. These nations have since recommitted to eliminating malaria by 2025, in a renewed E2025 Initiative. This viewpoint presents efforts of the national malaria programs in Bhutan and Timor-Leste as they prepare for this new commitment. It includes insights on the approaches adapted by both countries that have helped them keep the spotlight on malaria whilst preventing large COVID-19 outbreaks. This viewpoint proposes key strategies that near-elimination countries can consider to sustain malaria interventions and realize their elimination goal. Of note, it calls for national strategic plans to consider a whole-of-government approach to ensure progress - which includes sustaining political commitment, systematically collaborating across borders, empowering communities and strengthening health systems particularly through surveillance and data management - that will benefit all existing and future infectious threats and pave the way for integrated response mechanisms across diseases.
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We report strong second-harmonic generation (SHG) from 2H polytype of multilayer Tin diselenide (SnSe2) for fundamental excitation close to the indirect band-edge in the absence of excitonic resonances. Comparison of SHG and Raman spectra from exfoliated SnSe2 flakes of different polytypes shows strong (negligible) SHG and Raman Eg mode at 109 cm-1 (119 cm-1), consistent with 2H (1T) polytypes. The difference between the A1g-Eg Raman peak positions is found to exhibit significant thickness dependent for the 1T form, which is found to be absent for the 2H form. The observed thickness dependence of SHG with rapid oscillations in signal strength for small changes in flake thickness are in good agreement with a nonlinear wave propagation model considering nonlinear polarization with alternating sign from each monolayer. The nonlinear optical susceptibility extracted from SHG signal comparison with standard quartz samples for 1040 nm excitation is found to be more than 4-times higher than that at 1550 nm. This enhanced nonlinear response at 1040 nm is attributed to the enhanced nonlinear optical response for fundamental excitation close to the indirect band-edge. We also study SHG from heterostructures of monolayer MoS2/multilayer SnSe2 which allows us to unambiguously compare the nonlinear optical response of SnSe2 with MoS2. We find the SHG signal and any interference effect in the overlap region to be dominated by the SnSe2 layer for the excitation wavelengths considered. The comparison of SHG from SnSe2 and MoS2 underscores that the choice of the 2D material for a particular nonlinear optical application is contextual on the wavelength range of interest and its optical properties at those wavelengths. The present works further highlights the usefulness of near band-edge enhancement of nonlinear processes in emerging 2D materials towards realizing useful nanophotonic devices.
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Introduction The study aims to evaluate the association between a deficiency of Vitamin D level with the duration of hospital stay, pediatric intensive care unit (PICU) stay, and ventilation; the pediatric risk of mortality (PRISM) score, and the rate of readmission. Materials and methods This prospective observational study was conducted from November 2014 to October 2015, and the study population consisted of children admitted to the pediatric intensive care unit (PICU) in a tertiary care hospital of Puducherry. After measuring vitamin D levels, children were allotted into three categories depending on their serum 25(OH)D levels as the sufficient group (25[OH]D level ≥ 30 ng/mL), insufficient group (25[OH]D level = 20 - 29.9 ng/mL), and deficient group (25[OH]D level < 20 ng/mL). Among these three groups, the duration of hospital stay, PICU stay, and ventilation; the PRISM score, and the rate of readmission were compared. Results A total of 522 patients were included in the study. Based on their 25(OH)D level, 222 patients (42.5%) were in the sufficient category, 153 patients (29.3%) were in the deficient category, and 147 patients (28.2%) were in the insufficient category. Vitamin D deficiency state is not statistically significantly associated with the duration of hospital stay (P = .84), duration of PICU stay (P = .69), duration of ventilation (P = .48), PRISM score (P = .63), and rate of readmission (P = .91). Conclusions Longer hospital stay, prolonged PICU stay, longer duration of ventilation, and higher PRISM III score were independent risk factors for higher mortality in the PICU. However, lower vitamin D levels are not statistically significant to predict mortality among the study population.
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Introduction This study aims to evaluate the prevalence of vitamin D deficiency and the correlation between serum 25-hydroxyvitamin D (25(OH)D) and mortality. Materials and methods A prospective observational study was conducted among 522 children admitted to the Pediatric Intensive Care Unit in the Pediatrics Department of the Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. After measuring vitamin D levels, children were assigned into three groups based on their serum 25(OH)D levels: a sufficient group (25(OH)D level ≥ 30 ng/mL), an insufficient group (25(OH)D level = 20-29.9 ng/mL), and a deficient group (25(OH)D level < 20 ng/mL). Each group was again divided into two sub-groups (survivors and non-survivors if death was the outcome), and then each sub-group was again divided into two groups (sepsis and all non-septic causes). Results were evaluated for an association with mortality. Results A majority (66.6%) of patients who died had low levels of 25(OH)D (deficient = 37.9%; insufficient = 28.7%). Mortality was higher in children with 25(OH)D deficiency (P = 0.03). In univariate analysis, 25(OH)D deficiency was strongly associated with sepsis in children according to our observation, with 51% from the deficient group, 38% from the insufficient group, and 27.5% from the sufficient group (P ≤ 0.01). Mortality is not associated with 25(OH)D deficiency or insufficiency in multilogistic regression analysis. A serum vitamin D level of 20 ng/mL can predict higher mortality, with a specificity of 62.1%. Conclusions Vitamin D supplementation may be recommended for PICU-admitted cases to decrease the risk of sepsis. This association can be explored more in the future among the community population for further recommendations.
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On the global health agenda, Universal Health Coverage has been displaced by the COVID-19 pandemic while disparities in COVID-19 outcomes have exposed stark gaps in quality, access, equity, and financial risk protection. These disparities highlight the importance of the core goals of Universal Health Coverage and the need for innovative approaches to working toward them. The newly codified concept of "Networks of Care" offers a promising option for implementation. The articles in this special issue present the Networks of Care lexicon and framework and demonstrate the development of leadership, responsibility, intra- and inter-facility cooperation, and dynamic cycles of quality improvement. These elements are associated with better access to services and better health outcomes, the ultimate goals of Universal Health Coverage. Increases in poverty, food insecurity, and deleterious impact on the status of women secondary to the COVID-19 pandemic add urgency to Universal Health Coverage, while the economic impact of pandemic mitigation may reduce availability of resources for years to come. The need for Universal Health Coverage and efficiency and flexibility in health spending, including the ability to contract directly, has become even more important. Countries where Universal Health Coverage efforts have yet to carry through to provision of good quality, accessible and equitable service delivery could potentially benefit from concurrent Networks of Care implementation. Documentation of Networks of Care in the context of Universal Health Coverage should be prioritized to understand how Networks of Care can be used to help realize the goals of Universal Health Coverage around the world.
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COVID-19 , Assistência Integral à Saúde/organização & administração , Saúde Global , Reforma dos Serviços de Saúde , Equidade em Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , COVID-19/economia , COVID-19/epidemiologia , Equidade de Gênero , Gastos em Saúde , Financiamento da Assistência à Saúde , Humanos , Pandemias , SARS-CoV-2 , Cobertura Universal do Seguro de SaúdeRESUMO
The interface of transition-metal dichalcogenides (TMDCs) and high-k dielectric transition-metal oxides (TMOs) had triggered umpteen discourses because of the indubitable impact of TMOs in reducing the contact resistances and restraining the Fermi-level pinning for the metal-TMDC contacts. In the present work, we focus on the unresolved tumults of large-area TMDC/TMO interfaces, grown by adopting different techniques. Here, on a pulsed laser-deposited MoS2 thin film, a layer of TiO2 is grown by atomic layer deposition (ALD) and pulsed laser deposition (PLD). These two different techniques emanate the layer of TiO2 with different crystallinities, thicknesses, and interfacial morphologies, subsequently influencing the electronic and optical properties of the interfaces. Contrasting the earlier reports of n-type doping at the exfoliated MoS2/TiO2 interfaces, the large-area MoS2/anatase-TiO2 films had realized a p-type doping of the underneath MoS2, manifesting a boost in the extent of p-type doping with increasing thickness of TiO2, as emerged from the X-ray photoelectron spectra. Density functional analysis of the MoS2/anatase-TiO2 interfaces, with pristine and interfacial defect configurations, could correlate the interdependence of doping and the terminating atomic surface of TiO2 on MoS2. The optical properties of the interface, encompassing photoluminescence, transient absorption and z-scan two-photon absorption, indicate the presence of defect-induced localized midgap levels in MoS2/TiO2 (PLD) and a relatively defect-free interface in MoS2/TiO2 (ALD), corroborating nicely with the corresponding theoretical analysis. From the investigation of optical properties, we indicate that the MoS2/TiO2 (PLD) interface may act as a promising saturable absorber, having a significant nonlinear response for the sub-band-gap excitations. Moreover, the MoS2/TiO2 (PLD) interface had exemplified better phototransport properties. A potential application of MoS2/TiO2 (PLD) is demonstrated by the fabrication of a p-type phototransistor with the ionic-gel top gate. This endeavor to analyze and perceive the MoS2/TiO2 interface establishes the prospectives of large-area interfaces in the field of optics and optoelectronics.