A Cu/CuO/porous carbon nanofiber/TiO2 (Cu/CuO/PCNF/TiO2) composite uniformly covered with TiO2 nanoparticles was synthesized by electrospinning and a simple hydrothermal technique. The synthesized ...composite exhibits a unique morphology and excellent supercapacitive performance, including both electric double layer and pseudo-capacitance behavior. Electrochemical measurements were performed by cyclic voltammetry, galvanostatic charge–discharge and electrochemical impedance spectroscopy. The highest specific capacitance value of 530 F g−1 at a current density of 1.5 A g−1 was obtained for the Cu/CuO/PCNF/TiO2 composite electrode in a three-electrode configuration. The solid-state hybrid supercapacitor (SSHSC) fabricated based on this composite exhibits a high specific capacitance value of 330 F g−1 at a current density of 1 A g−1 with 78.8% capacitance retention for up to 10,000 cycles. At the same time, a high energy density of 45.83 Wh kg−1 at a power density of 1.27 kW kg−1 was also realized. The developed electrode material provides new insight into ways to enhance the electrochemical properties of solid-state supercapacitors, based on the synergistic effect of porous carbon nanofibers, metal and metal oxide nanoparticles, which together open up new opportunities for energy storage and conversion applications.
Minority ethnic groups have been disproportionately affected by the COVID-19 pandemic. While the exact reasons for this remain unclear, they are likely due to a complex interplay of factors rather ...than a single cause. Reducing these inequalities requires a greater understanding of the causes. Research to date, however, has been hampered by a lack of theoretical understanding of the meaning of ‘ethnicity’ (or race) and the potential pathways leading to inequalities. In particular, quantitative analyses have often adjusted away the pathways through which inequalities actually arise (ie, mediators for the effect of interest), leading to the effects of social processes, and particularly structural racism, becoming hidden. In this paper, we describe a framework for understanding the pathways that have generated ethnic (and racial) inequalities in COVID-19. We suggest that differences in health outcomes due to the pandemic could arise through six pathways: (1) differential exposure to the virus; (2) differential vulnerability to infection/disease; (3) differential health consequences of the disease; (4) differential social consequences of the disease; (5) differential effectiveness of pandemic control measures and (6) differential adverse consequences of control measures. Current research provides only a partial understanding of some of these pathways. Future research and action will require a clearer understanding of the multiple dimensions of ethnicity and an appreciation of the complex interplay of social and biological pathways through which ethnic inequalities arise. Our framework highlights the gaps in the current evidence and pathways that need further investigation in research that aims to address these inequalities.
The success of a government's COVID-19 control strategy relies on public trust and broad acceptance of response measures. We investigated public perceptions of the UK government's COVID-19 response, ...focusing on the relationship between trust and perceived transparency, during the first wave (April 2020) of the COVID-19 pandemic in the United Kingdom.
Anonymous survey data were collected (2020-04-06 to 2020-04-22) from 9,322 respondents, aged 20+ using an online questionnaire shared primarily through Facebook. We took an embedded-mixed-methods approach to data analysis. Missing data were imputed via multiple imputation. Binomial & multinomial logistic regression were used to detect associations between demographic characteristics and perceptions or opinions of the UK government's response to COVID-19. Structural topic modelling (STM), qualitative thematic coding of sub-sets of responses were then used to perform a thematic analysis of topics that were of interest to key demographic groups.
Most respondents (95.1%) supported government enforcement of behaviour change. While 52.1% of respondents thought the government was making good decisions, differences were apparent across demographic groups, for example respondents from Scotland had lower odds of responding positively than respondents in London. Higher educational levels saw decreasing odds of having a positive opinion of the government response and decreasing household income associated with decreasing positive opinion. Of respondents who thought the government was not making good decisions 60% believed the economy was being prioritised over people and their health. Positive views on government decision-making were associated with positive views on government transparency about the COVID-19 response. Qualitative analysis about perceptions of government transparency highlighted five key themes: (1) the justification of opacity due to the condition of crisis, (2) generalised mistrust of politics, (3) concerns about the role of scientific evidence, (4) quality of government communication and (5) questions about political decision-making processes.
Our study suggests that trust is not homogenous across communities, and that generalised mistrust, concerns about the transparent use and communication of evidence and insights into decision-making processes can affect perceptions of the government's pandemic response. We recommend targeted community engagement, tailored to the experiences of different groups and a new focus on accountability and openness around how decisions are made in the response to the UK COVID-19 pandemic.
As the new school year begins in the United States, school districts will be tasked with providing in-person teaching while keeping children and school staff safe, an increasingly difficult goal in ...the presence of the COVID-19 delta variant. We aim to provide updated interpretations of past and newly published studies to assist in assessing risk in schools, and to add additional perspectives on addressing the social determinants of learning and on the role of race and other social factors. We advocate for the continued implementation of risk mitigation strategies in schools, including mandatory mask policies, improved ventilation, and convenient access to vaccinations for those eligible, as recommended by the CDC, and to use this opportunity to make long-term improvements to our schools as a matter of urgency.
Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is ...the most common form of care-seeking. The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria (mRDTs) in registered drug shops in Uganda, with the aim to increase appropriate treatment of malaria with artemisinin-based combination therapy (ACT) in patients seeking treatment for fever in drug shops.
A cluster-randomized trial of introducing mRDTs in registered drug shops was implemented in 20 geographical clusters of drug shops in Mukono district, central Uganda. Ten clusters were randomly allocated to the intervention (diagnostic confirmation of malaria by mRDT followed by ACT) and ten clusters to the control arm (presumptive treatment of fevers with ACT). Treatment decisions by providers were validated by microscopy on a reference blood slide collected at the time of consultation. The primary outcome was the proportion of febrile patients receiving appropriate treatment with ACT defined as: malaria patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving ACT or rectal artesunate, and patients with no malaria parasites not given ACT.
A total of 15,517 eligible patients (8672 intervention and 6845 control) received treatment for fever between January-December 2011. The proportion of febrile patients who received appropriate ACT treatment was 72·9% versus 33·7% in the control arm; a difference of 36·1% (95% CI: 21·3 - 50·9), p<0·001. The majority of patients with fever in the intervention arm accepted to purchase an mRDT (97·8%), of whom 58·5% tested mRDT-positive. Drug shop vendors adhered to the mRDT results, reducing over-treatment of malaria by 72·6% (95% CI: 46·7- 98·4), p<0·001) compared to drug shop vendors using presumptive diagnosis (control arm).
Diagnostic testing with mRDTs compared to presumptive treatment of fevers implemented in registered drug shops substantially improved appropriate treatment of malaria with ACT.
ClinicalTrials.gov NCT01194557.
Many patients with malaria-like symptoms seek treatment in private medicine retail outlets (PMR) that distribute malaria medicines but do not traditionally provide diagnostic services, potentially ...leading to overtreatment with antimalarial drugs. To achieve universal access to prompt parasite-based diagnosis, many malaria-endemic countries are considering scaling up malaria rapid diagnostic tests (RDTs) in these outlets, an intervention that may require legislative changes and major investments in supporting programs and infrastructures. This review identifies studies that introduced malaria RDTs in PMRs and examines study outcomes and success factors to inform scale up decisions.
Published and unpublished studies that introduced malaria RDTs in PMRs were systematically identified and reviewed. Literature published before November 2016 was searched in six electronic databases, and unpublished studies were identified through personal contacts and stakeholder meetings. Outcomes were extracted from publications or provided by principal investigators.
Six published and six unpublished studies were found. Most studies took place in sub-Saharan Africa and were small-scale pilots of RDT introduction in drug shops or pharmacies. None of the studies assessed large-scale implementation in PMRs. RDT uptake varied widely from 8%-100%. Provision of artemisinin-based combination therapy (ACT) for patients testing positive ranged from 30%-99%, and was more than 85% in five studies. Of those testing negative, provision of antimalarials varied from 2%-83% and was less than 20% in eight studies. Longer provider training, lower RDT retail prices and frequent supervision appeared to have a positive effect on RDT uptake and provider adherence to test results. Performance of RDTs by PMR vendors was generally good, but disposal of medical waste and referral of patients to public facilities were common challenges.
Expanding services of PMRs to include malaria diagnostic services may hold great promise to improve malaria case management and curb overtreatment with antimalarials. However, doing so will require careful planning, investment and additional research to develop and sustain effective training, supervision, waste-management, referral and surveillance programs beyond the public sector.
Private sector drug shops are an important source of malaria treatment in Africa, yet diagnosis without parasitological testing is common among these providers. Accurate rapid diagnostic tests for ...malaria (mRDTs) require limited training and present an opportunity to increase access to correct diagnosis. The present study was a cost-effectiveness analysis of the introduction of mRDTs in Ugandan drug shops.
Drug shop vendors were trained to perform and sell subsidised mRDTs and artemisinin-based combination therapies (ACTs) in the intervention arm while vendors offered ACTs following presumptive diagnosis of malaria in the control arm. The effect on the proportion of customers with fever 'appropriately treated of malaria with ACT' was captured during a randomised trial in drug shops in Mukono District, Uganda. Health sector costs included: training of drug shop vendors, community sensitisation, supervision and provision of mRDTs and ACTs to drug shops. Household costs of treatment-seeking were captured in a representative sample of drug shop customers.
The introduction of mRDTs in drug shops was associated with a large improvement of diagnosis and treatment of malaria, resulting in low incremental costs for the health sector at US$0.55 per patient appropriately treated of malaria. High expenditure on non-ACT drugs by households contributed to higher incremental societal costs of US$3.83. Sensitivity analysis showed that mRDTs would become less cost-effective compared to presumptive diagnosis with increasing malaria prevalence and lower adherence to negative mRDT results.
mRDTs in drug shops improved the targeting of ACTs to malaria patients and are likely to be considered cost-effective compared to presumptive diagnosis, although the increased costs borne by households when the test result is negative are a concern.
Objective. Inflammatory arthritis in childhood is variable in terms of both presentation and outcome. This analysis describes disease activity in children with juvenile idiopathic arthritis (JIA) ...during the first year following presentation to a paediatric rheumatologist and identifies predictors of moderate to severe disability defined using a Childhood HAQ (CHAQ) score ⩾0.75 at 1 year. Methods. The Childhood Arthritis Prospective Study recruits children <16 years with new inflammatory arthritis persisting for ⩾2 weeks from five UK tertiary referral centres. Demographics, disease features, joint count, CHAQ, physician's global assessment, parent's general evaluation of well-being (PGE), ESR and treatment, are collected at first presentation, 6 months and then yearly. Independent predictors of CHAQ ⩾0.75 at 1 year in children diagnosed with JIA were identified using multivariable logistic regression models. Results. Seven hundred and forty children with JIA were included; median age at presentation 7.6 years, 64% girls. During the first year, 85% received NSAIDs, 70% IA corticosteroids, 47% MTX and 27% systemic steroids (oral or i.v.). Median presenting CHAQ score was 0.63 and decreased to 0.25 at 1 year; 32% had CHAQ ⩾0.75 at 1 year. The strongest predictor of CHAQ ⩾0.75 at 1 year was CHAQ ⩾0.75 at presentation (odds ratio 3.92; 95% CI 2.17, 7.09). Additional predictors included female gender and higher PGE Conclusion. Although CHAQ score improved in most children, the strongest predictor of persistent disability at 1 year was moderate to severe disability at first presentation. Follow-up beyond 1 year will assess whether CHAQ at presentation will continue to be a predictor of future poor outcome.
Objective
To compare the impact of malaria rapid diagnostic tests (mRDTs), used by community health workers (CHWs), on the proportion of children <5 years of age receiving appropriately targeted ...treatment with artemisinin‐based combination therapy (ACT), vs. presumptive treatment.
Methods
Cluster‐randomized trials were conducted in two contrasting areas of moderate‐to‐high and low malaria transmission in rural Uganda. Each trial examined the effectiveness of mRDTs in the management of malaria and targeting of ACTs by CHWs comparing two diagnostic approaches: (i) presumptive clinical diagnosis of malaria control arm and (ii) confirmatory diagnosis with mRDTs followed by ACT treatment for positive patients intervention arm, with village as the unit of randomisation. Treatment decisions by CHWs were validated by microscopy on a reference blood slide collected at the time of consultation, to compare the proportion of children <5 years receiving appropriately targeted ACT treatment, defined as patients with microscopically‐confirmed presence of parasites in a peripheral blood smear receiving artemether‐lumefantrine or rectal artesunate, and patients with no malaria parasites not given ACT.
Results
In the moderate‐to‐high transmission area, ACT treatment was appropriately targeted in 79.3% (520/656) of children seen by CHWs using mRDTs to diagnose malaria, vs. 30.8% (215/699) of children seen by CHWs using presumptive diagnosis (P < 0.001). In the low transmission area, 90.1% (363/403) children seen by CHWs using mRDTs received appropriately targeted ACT treatment vs. 7.8% (64/817) seen by CHWs using presumptive diagnosis (P < 0.001). Low mRDT sensitivity in children with low‐density parasitaemia (<200 parasites/μl) was identified as a potential concern.
Conclusion
When equipped with mRDTs, ACT treatments delivered by CHWs are more accurately targeted to children with malaria parasites. mRDT use could play an important role in reducing overdiagnosis of malaria and improving fever case management within iCCM, in both moderate‐to‐high and low transmission areas. Nonetheless, missed treatments due to the low sensitivity of current mRDTs in patients with low parasite density are a concern. For community‐based treatment in areas of low transmission and/or non‐immune populations, presumptive treatment of all fevers as malaria may be advisable, until more sensitive diagnostic assays, suitable for routine use by CHWs in remote settings, become available.
Objectif
Comparer l'impact des tests de diagnostic rapide (TDR) du paludisme, utilisés par les agents de santé communautaires (ASC), sur la proportion d'enfants <5 ans qui reçoivent un traitement de combinaison à base d'artémisinine (ACT) ciblé de manière appropriée pour le traitement présomptif.
Méthodes
Des essais randomisés en grappes ont été menés dans deux zones rurales contrastées de transmission modérée à élevée et de transmission faible du paludisme en Ouganda. Chaque essai a examiné l'efficacité des TDR dans la prise en charge du paludisme et le ciblage de l'ACT par les ASC en comparant deux approches diagnostiques: (1) le diagnostic présomptif clinique du paludisme bras témoin et (2) le diagnostic de confirmation avec les TDR suivi d'un traitement ACT pour les patients positifs bras d'intervention; avec le village comme unité de randomisation. Les décisions de traitement par les ASC ont été validées par la microscopie sur un frottis de sang de référence recueilli au moment de la consultation, pour comparer la proportion d'enfants <5 ans qui reçoivent un traitement ACT ciblé de façon appropriée, défini comme les patients avec une présence de parasites confirmée microscopiquement dans un frottis de sang périphérique, recevant un ACT ou de l'artésunate par voie rectale, et les patients sans parasites du paludisme qui ne reçoivent pas d'ACT.
Résultats
Dans la zone de transmission modérée à élevée, le traitement ACT a été ciblé de manière appropriée chez 79,3% (520/656) des enfants vus par les ASC en utilisant les TDR pour diagnostiquer le paludisme, contre 30,8% (215/699) des enfants vus par les ASC en utilisant du diagnostic présomptif (P < 0,001). Dans la zone de transmission faible, 90,1% (363/403) des enfants vus par les ASC utilisant les TDR ont reçu de manière appropriée le traitement ciblé ACT contre 7,8% (64/817) des enfants vus par les ASC en utilisant le diagnostic présomptif (P < 0,001). Une sensibilité faible pour les TDR chez les enfants avec une faible densité de parasitémie (<200 parasites/μl) a été identifiée comme un problème potentiel.
Conclusion
Lorsqu’équipés de TDR, les traitements ACT délivrés par les ASC sont ciblés avec plus de précision aux enfants avec des parasites du paludisme. L'utilisation des TDR pourrait jouer un rôle important dans la réduction du surdiagnostic du paludisme et dans l'amélioration de la prise en charge des cas de fièvres au sein de la prise en charge intégrée communautaire des cas, à la fois dans les deux zones de transmission modérée à élevée et faible. Néanmoins, les traitements manqués en raison de la faible sensibilité des TDR actuels chez les patients présentant une densité parasitaire faible restent une préoccupation. Pour le traitement à base communautaire dans les zones de faible transmission et/ou à populations non immunes, le traitement présomptif de toutes les fièvres comme étant le paludisme peut être conseillé, jusqu’à ce que des tests de diagnostic plus sensibles, convenant à une utilisation de routine par les ASC dans des régions éloignées, deviennent disponibles.
Objetivo
Comparar el impacto de las pruebas de diagnóstico rápido de malaria (PDRms) utilizadas por trabajadores sanitarios comunitarios (TSC) sobre la proporción de niños <5 años que recibieron adecuadamente la terapia de combinación basada en la artemisinina (TCA), comparado con tratamiento presuntivo.
Métodos
Se realizaron ensayos aleatorizados en conglomerados en dos áreas rurales contrastables, con intensidades de transmisión de malaria moderadamente‐alta y baja de Uganda. Cada ensayo examinó la efectividad de PDRms en el manejo de la malaria y la elección de TCA por TSC comparando dos metodologías diagnósticas: (1) diagnóstico clínico presuntivo de malaria brazo control y (2) diagnóstico confirmatorio con PDRms seguido por tratamiento con TCA para pacientes positivos brazo de intervención; con el poblado como unidad de aleatorización. Las decisiones sobre el tratamiento por los TSCs se validaron mediante microscopía de extensiones de sangre de referencia recogidas en el momento de la consulta, para comparar la proporción de niños <5 años recibiendo un TCA adecuadamente elegido, (definidos como pacientes con confirmación microscópica de presencia de parásitos en una extensión de sangre periférica y recibiendo tratamiento con TCA o artesunato rectal), y aquellos sin parásitos de malaria que no recibieron TCA.
Resultados
En el área de transmisión moderadamente‐alta, el tratamiento con TCA estaba apropiadamente elegido para un 79.3% (520/656) de los niños visitados por los TSCs utilizando PDRms para diagnosticar la malaria, vs. 30.8% (215/699) de los niños visitados por TSCs y utilizando diagnóstico presuntivo (P < 0.001). En el área de baja transmisión, 90.1% (363/403) de los niños visitados por TSCs utilizando PDRms recibieron un tratamiento con TCA elegido apropiadamente vs. 7.8% (64/817) de los visitados por TSCs utilizando un diagnóstico presuntivo (P < 0.001). Se identificó como una preocupación potencial la baja sensibilidad a las PDRms en niños con una parasitemia de baja intensidad.
Conclusión
Con el uso de PDRms, los tratamientos con TCA entregados por TSCs son más precisos en niños con parásitos de malaria. Los PDRms podrían jugar un papel importante para reducir el sobre diagnóstico de malaria y mejorar el manejo de casos de fiebre dentro del iCCM, tanto en áreas de transmisión moderada‐a‐alta como de baja transmisión. Sin embargo, los tratamientos perdidos en pacientes con una baja densidad de parásitos, debido a la baja sensibilidad de los PDRms actualmente disponibles, son preocupantes. Para tratamientos basados en la comunidad en áreas de baja intensidad de transmisión y/o poblaciones no inmunes, el tratamiento presuntivo como malaria de todas las fiebres sería recomendable hasta que haya disponibilidad de pruebas diagnósticas más sensibles, y adecuadas para un uso rutinario por TSCs en emplazamientos remotos.
•A composite-type hybrid supercapacitor based on SWCNTs/TiO2 nanocomposite is fabricated.•High specific capacitance of 144 F g−1 at a current density of 2 A g−1 is achieved.•An outstanding prolonged ...cycle life of 95 % upto 50 k cycles is demonstrated.•Energy density of 20 Wh kg−1 at a power density of 2.1 kW kg−1 is obtained.
Development of long cycle life hybrid supercapacitors without compromising with specific energy is a real challenge because of volume expansion, which causes electrode material degradation in due course of time. Herein, an advanced electrode material based on high mechanically as well chemically stable titanium dioxide (TiO2) nanoparticles and single-walled carbon nanotubes (SWCNTs) i.e. (SWCNTs/TiO2 nanocomposite), is developed for composite-type hybrid supercapacitors. A simple and cost-effective hydrothermal technique is utilized for preparing SWCNTs/TiO2 nanocomposite. Meanwhile, a quasi-solid-state composite-type symmetric hybrid supercapacitor based on SWCNTs/TiO2 nanocomposite as electrodes and PVA/H2SO4 as gel electrolyte with voltage window 1 V is fabricated. As a result, high capacitance of 144 F g−1, specific energy of 20 Wh kg−1 and remarkable cycling life of 95 % upto 50 k cycles are delivered. This work indicates that the hybrid electrochemical behaviour of SWCNTs/TiO2 nanocomposite improves the overall supercapacitive performance and offers a promising route to develop the high performance hybrid supercapacitor.
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