May Measurement Month 2017: An analysis of blood pressure screening results in Nepal - South Asia

Hypertension is the leading risk factor of mortality in Nepal accounting for ∼33 000 deaths in 2016. However, more than 50% of the hypertensive patients are unaware of their status. We participated in the May Measurement Month 2017 (MMM17) project initiated worldwide by the International Society of Hypertension to raise the awareness on the importance of blood pressure (BP) screening. In this paper, we discuss the screening results of MMM17 in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017 following the standard MMM protocol. Data were collected from 18 screening sites in 7 districts covering 5 provinces. Screenings were conducted either in health facilities, public places, or participants' homes. Trained volunteers with health science background and female community health volunteers were mobilized to take part in the screening. A total of 5972 individuals were screened and of 5968 participants, for whom a mean of the 2nd and 3rd readings was available, 1456 (24.4%) participants had hypertension; 908 (16.8%) of those not receiving treatment were hypertensive; and 248 (45.2%) of those being treated had uncontrolled BP. MMM17 is the first nationwide BP screening campaign undertaken in Nepal. Given the suboptimal treatment and control rates identified in the study, there is a strong imperative to scale up hypertension prevention, screening, and management programmes. These results suggest that opportunistic screening can identify significant numbers with hypertension. Mobilization of existing volunteer networks and support of community stakeholders, would be necessary to improve the overall impact and sustainability of future screening programmes

Polar opposites? NGOs, left parties and the fight for social change in Nepal

In the early 1990s, when NGOs were rising to prominence as an ostensible force for social change in Nepal, the Maoists were also beginning to organise, and denounced NGOs as agents of imperialism. The Maoists came to prominence by fighting a People’s War launched in 1996, with the intention of improving life for the poor peasant and working-class majority. But after a decade-long struggle, the Maoists became incorporated into the parliamentary system. While Nepal’s first democratic revolution in 1990 met formal, popular political demands, which were consolidated in a subsequent revolution in 2006 overthrowing the monarchy and bringing the People’s War to an end, there was little socio-economic progress for the vast majority. The argument advanced in this article is that this lack of progress relied on the interplay of two phenomena: an anti-Maoist alliance consisting of the international community, the domestic ruling elite and NGOs, and a fundamental ambiguity at the heart of the Maoists’ political theory

Effects of deposition time and post-deposition annealing on the physical and chemical properties of electrodeposited CdS thin films for solar cell application

CdS thin films were cathodically electrodeposited by means of a two-electrode deposition system for different durations. The films were characterised for their structural, optical, morphological and compositional properties using x-ray diffraction (XRD), spectrophotometry, scanning electron microscopy (SEM) and energy dispersive x-ray (EDX) respectively. The results obtained show that the physical and chemical properties of these films are significantly influenced by the deposition time and post-deposition annealing. This influence manifests more in the as-deposited materials than in the annealed ones. XRD results show that the crystallite sizes of the different films are in the range (9.4 – 65.8) nm and (16.4 – 66.0) nm in the as-deposited and annealed forms respectively. Optical measurements show that the absorption coefficients are in the range (2.7×104 – 6.7×104) cm-1 and (4.3×104 – 7.2×104) cm-1 respectively for as-deposited and annealed films. The refractive index is in the range (2.40 – 2.60) for as-deposited films and come to the value of 2.37 after annealing. The extinction coefficient varies in the range (0.1 – 0.3) in asdeposited films and becomes 0.1 in annealed films. The estimated energy bandgap of the films is in the range (2.48 – 2.50) eV for as-deposited films and becomes 2.42 eV for all annealed films. EDX results show that all the films are S-rich in chemical composition with fairly uniform Cd/S ratio after annealing. The results show that annealing improves the qualities of the films and deposition time can be used to control the film thickness. Keywords: Electrodeposition; two-electrode system; CdS; annealing; deposition time; thin-film

Electrodeposition and characterisation of CdS thin films using thiourea precursor for application in solar cells

CdS thin films have been successfully electrodeposited on glass/FTO substrates using acidic and aqueous solution of CdCl2.xH2O and thiourea (SC(NH2)2). The electrodeposition of CdS thin films were carried out potentiostatically using a 2-electrode system. The prepared films were characterised using X-ray diffraction (XRD), Raman spectroscopy, Scanning electron microscopy (SEM), Atomic force microscopy (AFM), Photoelectrochemical (PEC) cell measurements, Electrical resistivity measurements and UV-Vis spectrophotometry to study their structural, compositional, morphological, electrical and optical properties, respectively. The structural studies show that the as-deposited and annealed CdS layers are polycrystalline with hexagonal crystal structure and preferentially oriented along (200) planes. The optical studies indicate that the ED-CdS layers have direct bandgaps in the range (2.53-2.58) eV for the as-deposited and (2.42-2.48) eV after annealing at 400oC for 20 minutes in air. The morphological studies show the good coverage of the FTO surface by the CdS grains. The average grain sizes for the as-deposited and annealed layers were in the range (60-225) nm. These grains or clusters are made out of smaller nano crystallites with the sizes in the range ~(11-33) nm. The electrical resistivity shows reduction as thickness increases. The resistivity values for the as-deposited and annealed layers were in the range (0.82-4.92)×105 Ωcm. The optimum growth voltage for the CdS thin films was found to be at the cathodic potential of 797 mV with respect to the graphite anode. No visible precipitations of elemental S or CdS particles were observed in the deposition electrolyte showing a stable bath using thiourea during the growth

A concept for integrated care pathways for atopic dermatitis-A GA2 LEN ADCARE initiative

INTRODUCTION: The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. METHODS: The GA2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL2 EN ADCARE centres. RESULTS: The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. CONCLUSION: The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD

Spectropolarimetry of stars across the H-R diagram

The growing sample of magnetic stars shows a remarkable diversity in the properties of their magnetic fields. The overall goal of current studies is to understand the origin, evolution, and structure of stellar magnetic fields in stars of different mass at different evolutionary stages. In this chapter we discuss recent measurements together with the underlying assumptions in the interpretation of data and the requirements, both observational and theoretical, for obtaining a realistic overview of the role of magnetic fields in various types of stars.Comment: 23 pages, 3 figures, chapter 7 of "Astronomical Polarisation from the Infrared to Gamma Rays", published in Astrophysics and Space Science Library 46

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. // Methods: For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. // Findings: By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6–60·9) to 14·5 million (13·4–15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. // Interpretation: After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)