Laser-Induced Color Marking of Titanium Alloy

A Nd:YAG nanosecond laser was utilized in the laser color marking of  titanium alloy substrates. It was focused on how several laser parameters, such as pumping current, delay between the effective vector step, laser line spacing, Q-switch frequency and focal plane offset, affected the resulting colors, and the influence of the resulting colors on the substrate. Firstly, single-factor experiments were carried out. Then the dark blue square pattern and two samples were analyzed using an environmental scanning electron microscope (ESEM) and X-ray diffractometer (XRD) respectively. Results clearly showed that the Nd:YAG nanosecond laser can induce multiple colors on titanium alloy substrates and all the five parameters had an effect on the resulting colors significantly. The dark blue square pattern didn’t induce internal stresses within the substrate material, so  the influence of the resulting colors on the substrate is negligible

Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level

Background A 2007 study published in The Lancet estimated that approximately 219 million children aged younger than 5 years were exposed to stunting or extreme poverty in 2004. We updated the 2004 estimates with the use of improved data and methods and generated estimates for 2010. Methods We used country-level prevalence of stunting in children younger than 5 years based on the 2006 Growth Standards proposed by WHO and poverty ratios from the World Bank to estimate children who were either stunted or lived in extreme poverty for 141 low-income and middle-income countries in 2004 and 2010. To avoid counting the same children twice, we excluded children jointly exposed to stunting and extreme poverty from children living in extreme poverty. To examine the robustness of estimates, we also used moderate poverty measures. Findings The 2007 study underestimated children at risk of poor development. The estimated number of children exposed to the two risk factors in low-income and middle-income countries decreased from 279·1 million (95% CI 250·4 million–307·4 million) in 2004 to 249·4 million (209·3 million–292·6 million) in 2010; prevalence of children at risk fell from 51% (95% CI 46–56) to 43% (36–51). The decline occurred in all income groups and regions with south Asia experiencing the largest drop. Sub-Saharan Africa had the highest prevalence in both years. These fi ndings were robust to variations in poverty measures. Interpretation Progress has been made in reducing the number of children exposed to stunting or poverty between 2004 and 2010, but this is still not enough. Scaling up of eff ective interventions targeting the most vulnerable children is urgently needed

Strengthening Primary Health Care Through Community Health Workers: Investment Case And Financing Recommendations

A report released this week at the Third International Conference on Financing for Development found that there is a strong case for investing in Community Health Worker (CHW) programs as part of integrated health systems. The report was released by leaders from the Federal Democratic Republic of Ethiopia, the Republic of Liberia, the U.N. Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, Partners in Health, the Clinton Foundation, the African Leaders Malaria Alliance, and the MDG Health Alliance. The authors encourage domestic governments, international financers, bilateral and multilateral donors, and the broader global health community to finance and support the scale up of CHW programs as part of community-based primary health care through a set of specific recommendations. The authors participated in the crafting of the report and its recommendations as part of a distinguished panel chaired by Ray Chambers, the UN Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, and Prime Minister Hailemariam Dessalegn, President of the Federal Democratic Republic of Ethiopia

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

Background: Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods: Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings: Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions: These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities

A Systematic Review of Reported Cost for Smear and Culture Tests during Multidrug-Resistant Tuberculosis Treatment

Background: In 2011, World Health Organization revised its recommendation for microbiological monitoring during treatment for multidrug-resistant tuberculosis (MDR-TB) by increasing the frequency of culture examination from quarterly to monthly after culture conversion. Implementing the recommendation requires substantial additional investment in laboratory infrastructure. The objective of this review is to provide cost evidence that is needed for national TB programs to budget for optimal monitoring strategies. Methods and Findings: We conducted the first systematic literature review on unit cost estimates of three monitoring strategies: 1) smear only; 2) culture only; 3) combined smear and culture. 26 peer-reviewed studies were selected by searching 10 databases in English and Chinese for literature published between 1995 and 2012. Cost estimates were converted into 2010 constant USD and international dollars. We assessed the quality of the estimates using a matrix with five essential elements and provided a cost projection for the combined smear and culture tests where the data were available. The 26 studies reported the cost estimates in 16 predominantly high- or middle-income countries from 1993 to 2009. The estimated unit cost for smear, culture, and combined tests ranges from $0.26 to$10.50, $1.63 to$62.01, and $26.73 to$39.57, respectively. The ratio of culture to smear costs varies from 1.35 to 11.98. The wide range of estimates is likely attributable to using different laboratory methods in different regions and years and differing practices in collecting and reporting cost data. Most studies did not report information critical for generalizing their conclusions. Conclusion: The paucity and low quality of unit cost estimates for TB monitoring in resource-poor settings impose technical challenges in predicting the resources needed for strengthening microbiological monitoring. To improve the validity and comparability of the cost data, we strongly advocate the data collection, estimation, and reporting follow protocols proposed by WHO

Global development assistance for early childhood care and education in 134 low- and middle-income countries, 2007-2021

Providing quality early childhood care and education (ECCE) is widely recognized as a fundamental strategy for lifelong individual and societal benefits. However, the expansion of ECCE in low- and middle-income countries (LMICs) is impeded by limited financial resources. Little is known about the levels and trends of global development assistance (DA) allocated to ECCE in LMICs between 2007 and 2021. We extracted data from the Creditor Reporting System (CRS) on aid projects in 134 LMICs from 2007 to 2021. Using keyword-searching and funding-allocation methods, we generated two estimates of ECCE aid: one for DA primarily focused on ECCE, and another for DA both primarily and partially focused on ECCE as well as DA not explicitly targeting ECCE but benefiting ECCE. We analyzed the patterns and time trends of ECCE aid by donors, recipients, CRS sectors, implementing agencies, and aid-flow types. We calculated ECCE aid as a percentage of educational aid at both annual and aggregative levels, comparing it to UNICEF’s recommended allocation of at least 10% of educational aid to the ECCE sector in LMICs. Additionally, we explored the alignment of aid with addressing children’s learning losses during global crises by examining ECCE aid to projects involving COVID-19 prevention and mitigation, along with ECCE aid to conflict-affected countries. From 2007 to 2021, primary ECCE-focused DA amounted to US dollars 3,646 million, accounting for 1.7% of the total US dollars 213,279 million allocated to education. The World Bank led all donors with US dollars 1,944 million in ECCE aid (53.3%). Low-income countries consistently received less ECCE aid per child before 2016, then started to catch up, but subsequently experienced a decrease from US dollars 0.8 (2020) to US dollars 0.6 (2021). In contrast, lower-middle-income and upper-middle-income countries saw an increase from US dollars 0.4 (2020) to US dollars 0.6 (2021) and from US dollars 1.0 (2020) to US dollars 1.3 (2021), respectively. ECCE aid to projects with COVID-19 activities declined from US dollars 50 million in 2020 to US dollars 37 million in 2021, representing 11.4% and 6.6% of annual ECCE aid. Over 15 years, conflict-affected countries received an average of US dollars 0.3 per child, only a quarter of the aid received by non-conflict-affected countries (US dollars 1.2 per child). Although ECCE aid increased significantly between 2007 and 2021, its share of total educational aid remained small and fell far short of the recommended minimum of 10%. Our recommendations include increasing the share of ECCE aid in total educational aid, raising aid to low-income and conflict-affected countries, and investing more in preparing ECCE programs for future global crises

Decisions to use antibiotics for upper respiratory tract infections across China: a large-scale cross-sectional survey among university students.

OBJECTIVES: To investigate the decision-making process of Chinese university students with respect to antibiotic use for upper respiratory tract infections (URTIs). DESIGN: A cross-sectional questionnaire study. SETTING: The participants recruited from six universities across all Chinese regions from September to November 2015. PARTICIPANTS: A total of 2834 university students sampled across six Chinese regions who self-reported experiencing symptoms of URTI within the past month completed the survey. OUTCOME MEASURES: The prevalence of decisions for treatment and antibiotic use for URTIs as well as knowledge about antibiotic use were measured by a self-administrated questionnaire. Using regular and multinomial logistic regression a nd adapted health belief model, we identified and measured a number of variables as potential risk factors for antibiotic misuse behaviours in order to explain and predict people's treatment decisions and antibiotic use including knowledge, perceptions, access to antibiotics and cues to action. RESULTS: Of the 2834 university students who self-diagnosed a URTI, 947 (33.4%) self-reported having taken antibiotics; among them, 462 (48.8%) used non-prescription antibiotics, which came principally from left-over prescriptions (29.0%) and over-the-counter purchases at retail pharmacies (67.3%). One in four who sought care pressured their doctors for antibiotics; all received them. Those who perceived greater severity of the disease, had access to antibiotics, perceived benefits of using antibiotics (for the common cold: adjusted OR (aOR)=2.55, 95% CI 1.93 to 3.38 or as anti-inflammatory drugs: aOR=1.35, 95% CI 1.12 to 1.63), and were cued to action (eg, seeing presence of fever: aOR=2.05, 95% CI 1.62 to 2.60 or self-diagnosing their current infection as severe: aOR=1.86, 95% CI 1.41 to 2.45), keeping antibiotics at home (aOR=2.27, 95% CI 1.83 to 2.81) and access to over-the-counter antibiotics (aOR=2.00, 95% CI 1.63 to 2.45), were more likely to misuse antibiotics. CONCLUSIONS: Misconceptions of antibiotic efficacy and easy access to antibiotics-with or without a prescription-were associated with antibiotic misuse among Chinese university students, which calls for context-appropriate multifaceted interventions in order to effectively reduce antibiotic misuse

Tracking Rural Health Facility Financial Data in Resource-Limited Settings: A Case Study from Rwanda

Chunling Lu and colleagues describe a project for tracking health center financial data in two rural districts of Rwanda, which could be adapted for other low- or middle-income countries. Please see later in the article for the Editors' Summar

Assessing household financial burdens for preprimary education and associated socioeconomic inequalities: a case study in China

Background: Providing young children with universal access to preprimary education (PPE) is considered a powerful tool for human capital development and eliminating the intergenerational transmission of poverty. To remove household financial barrier for achieving universal PPE, this study proposed a measure to identify households incurring ‘heavy financial burdens from paying for PPE’ (HBPPE) and conducted a case study in China. Methods: Using nationally representative data in 2019, we estimated the percentage of households with HBPPE (spent 7% or more of their total annual expenditure) and associated socioeconomic inequalities. We also applied a three-level logit regression model to investigate the factors associated with the probabilities of households incurring HBPPE. Results: Half of the sampled households spent 7% or more of their expenditures on PPE. Households in the lowest wealth quintile (54%) or households with children attending private PPE (55%) had higher percentages of HBPPE than households in other wealth quintiles (eg, 51% in the highest wealth quintile) or households with children attending public kindergartens (41%). Logit regression analysis shows that the poorest households and households with children attending private kindergarten were more likely to incur HBPPE than their counterparts. Conclusion: To ensuring universal access to PPE in China, future policy should consider increasing the enrolment of children from low-income families in public kindergartens and increasing governmental investments in low-income households by subsidising children attending PPE