Surface Characterisation of Atmospheric Pressure Plasma-Modified and -Coated Polymers

Atmospheric pressure plasma liquid deposition- APPLD, combines atmospheric pressure plasma with injection of atomised liquid from the delivery nozzle directly into the plasma. As such, the liquid within each droplet is protected from the plasma, and is carried intact to the surface, where it spreads and polymerises to form a conformal, high-value functional coating, which retains the properties of the original precursor molecule. The relationship between the chemistry of surfaces modified or deposited using this technique and the plasma deposition parameters has been investigated using a complementary suite of surface analytical techniques: contact angle analysis, X-ray photoelectron spectroscopy and atomic force microscopy. It has been shown that atmospheric pressure plasma (APP) can lead to the same level of oxidation as corona discharge. The APP has been shown to be less damaging to the substrate, and leads to a reduction in the formation of low molecular weight oxidised materials, despite the use of higher energy densities. A new methodology for curve-fitting of the XPS Si 2p and C 1s core levels of siloxane materials has been developed using siloxane standards. This method has been expanded to be used on siloxane coatings thinner than the depth of analysis of XPS. This enabled the chemistry of the coatings to be determined without the influence of the substrate. The chemistry of siloxane coatings deposited on poly(ethylene terephthalate) film have been related to the plasma parameters utilised during deposition. Up to 95% polymeric siloxane [(CH3)3SiO1/2 and (CH3)2SiO2/2] have been retained for deposition of poly(dimethylsiloxane) precursor. The use of a poly(hydrogenmethylsiloxane) precursor led to a more oxidised coating, with up to 25% siloxane in (CH3)SiO3/2 environment. The trends in deposition rate for PDMS and PHMS were also found to be different. Siloxane coatings durable to immersion in boiling water for 30 minutes have been achieved by plasma treatment of the substrate prior to deposition, and by plasma treatment of the coating following deposition. It is believed that improved grafting and enhanced crosslinking, respectively are the mechanisms behind this performance improvement

How well do Health Surveillance Assistants (HSAs) — Malawi’s cadre of community health workers — deliver integrated services?

HSAs are Malawi’s government-paid cadre of community health workers. Over the past decade, the HSAs’ portfolio of interventions has expanded in number and complexity to include maternal, newborn, and childhealth (MNCH) and family planning (FP).However, HSAs operate in an environment in which these community-based interventions are often implemented in a vertical and fragmented manner, resulting in gaps in the continuum of care and missed opportunities for integrated service delivery.Publisher PD

Surface Characterisation of Atmospheric Pressure Plasma-Modified and -Coated Polymers

Atmospheric pressure plasma liquid deposition- APPLD, combines atmospheric pressure plasma with injection of atomised liquid from the delivery nozzle directly into the plasma. As such, the liquid within each droplet is protected from the plasma, and is carried intact to the surface, where it spreads and polymerises to form a conformal, high-value functional coating, which retains the properties of the original precursor molecule. The relationship between the chemistry of surfaces modified or deposited using this technique and the plasma deposition parameters has been investigated using a complementary suite of surface analytical techniques: contact angle analysis, X-ray photoelectron spectroscopy and atomic force microscopy. It has been shown that atmospheric pressure plasma (APP) can lead to the same level of oxidation as corona discharge. The APP has been shown to be less damaging to the substrate, and leads to a reduction in the formation of low molecular weight oxidised materials, despite the use of higher energy densities. A new methodology for curve-fitting of the XPS Si 2p and C 1s core levels of siloxane materials has been developed using siloxane standards. This method has been expanded to be used on siloxane coatings thinner than the depth of analysis of XPS. This enabled the chemistry of the coatings to be determined without the influence of the substrate. The chemistry of siloxane coatings deposited on poly(ethylene terephthalate) film have been related to the plasma parameters utilised during deposition. Up to 95% polymeric siloxane [(CH3)3SiO1/2 and (CH3)2SiO2/2] have been retained for deposition of poly(dimethylsiloxane) precursor. The use of a poly(hydrogenmethylsiloxane) precursor led to a more oxidised coating, with up to 25% siloxane in (CH3)SiO3/2 environment. The trends in deposition rate for PDMS and PHMS were also found to be different. Siloxane coatings durable to immersion in boiling water for 30 minutes have been achieved by plasma treatment of the substrate prior to deposition, and by plasma treatment of the coating following deposition. It is believed that improved grafting and enhanced crosslinking, respectively are the mechanisms behind this performance improvement

Challenges in the management of HIV-infected malnourished children in Sub-Saharan Africa

Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.Publisher PDFPeer reviewe

Lost revenues in low income countries

This research estimates how much revenue six low income countries – of which five are in sub Saharan Africa - are losing unnecessarily from various potential revenue streams that could be used to fund public services. In recent years, increased attention has been paid to government revenues lost to tax evasion and to tax incentives given to corporations. However, few attempts have been made to estimate losses for a larger number of potential revenue streams. This task is critical given the massive under-funding of public services, and the extent of need, in Low Income Countries. Developing countries can lose revenue in a variety of ways. Here we estimate how much is being lost from the following sources: Corporate tax avoidance by multinational companies Providing tax incentives (for example, reductions or exemptions from the payment of corporate taxes) which constitute government ‘tax expenditure’ Not collecting taxes from a proportion of business activity in the informal sector Corruption in the national budget Debt interest payments to international creditors. The responsibility for these revenue losses lies partly with foreign and partly with domestic actors. Multinational companies are depriving governments of revenues by failing to pay fair taxes. Many companies also receive tax incentives, which reduces their tax payments to governments still further. Governments could themselves be doing much more to stop the leakage of revenues. They could do much more to tax parts of the currently informal sector, which often comprise businesses operating under the radar of the tax authorities but which should pay their fair share of taxes. They must also do more to prevent corruption in the budget, which means that a proportion of public money allocated to support public services is often simply lost in the system somewhere. Both foreign and domestic actors need to ensure that low income countries are also paying back a fair proportion of the debt interest they owe, but no more than that.Publisher PD

An analysis of the impact of minimum core human rights deprivation on under five mortality

This work was supported by the College of Medicine, University of Malawi and the Division of Infection and Global Health at the University of St Andrews, Scotland.Background Most deaths of children under the age of five observed between 1990 and 2010 were due to preventable causes. These causes included poor nutrition, lack of safe water and proper sanitation, lack of access to basic vaccines. Yet, the Universal Declaration of Human Rights (UDHR) protects these rights and the World Health Organisation recognises that the right to health includes the right to these determinants of health. However, the clause ‘progressive realisation’ in the Convention on Economic, Social and Cultural Rights (CESCR) has left a loophole, allowing deferment of access to basic human rights. In 1989 the concept of a minimum core of human rights was introduced to establish a minimum set of protections. Our objective is to study the effect of deprivation of these rights on the chances of children surviving until they are five years of age and thus enjoying their right to life. Method In order to gauge the effect of deprivation of human rights on health status, we employed regression analysis. Specifically, we regressed under-five mortality (U5M) on a set of measures of deprivation of minimum core rights while controlling for other known determinants of U5M. The measures of deprivation used are the proportion of the population deprived of; safe water, improved sanitation, primary education, access to basic vaccines and stunting (as a proxy for food). Results Deprivation of minimum core human rights is associated with increased under-five mortality. All else being equal, a one percentage point increase in the proportion of the population deprived of safe water leads to a 1.5 percentage point increase in under-five mortality rate, while a one percentage increase in the proportion of the population deprived of improved sanitation leads to a 1.3 percentage point increase in under-five mortality rate. A one percentage point increase in the proportion of the population which do not complete primary education and with no access to basic vaccines and leads to, respectively, a 0.6 and 0.3 percent increase in under-five mortality rate. Therefore, where there is reduced access to primary preventative health care services and education, under-five mortality increases. When the proportion of children who are stunted (as a proxy for lack of access to essential food) goes up by one percent, the rate of under-five mortality rises by 0.8 percent. Conclusions Deprivation of minimum core human rights reduces children’s chances of survival and enjoyment of their most fundamental right, the right to life. Therefore, we recommend that the essence approach to minimum core human rights should be adopted by the international community with immediate effect. In addition, since deprivation of these rights reduces chances of survival, these rights are better described as survival rights.Preprin

Tax and the right to health

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International corporate tax avoidance and domestic government health expenditure

Objective To compare estimated losses from international corporate tax avoidance in individual countries and domestic government health expenditure, with reference to the annual threshold of 86 United States dollars (US$) per capita required to achieve universal health coverage. Methods I obtained and compared estimates of international corporate tax avoidance and domestic government health expenditure for 2013. Findings Data were available for 100 countries: 24 low-, 28 lower-middle-, 21 upper-middle- and 27 high-income countries. Domestic government health expenditure was under US$ 86 per capita in all 24 low-income countries and in 24 of 28 lower-middle-income countries. International corporate tax lost per capita was higher than domestic government health expenditure in 19 low-income and 10 lower-middle-income countries. If the revenue lost to tax avoidance were recouped and allocated to the health sector, average annual government health expenditure could increase from US$8 to US$ 24 per capita in the low-income countries studied and from US$54 to US$ 91 per capita in the lower-middle-income countries. Conclusion Recouping losses due to international corporate tax avoidance and allocating them to the health sector would help low- and lower-middle-income countries achieve universal health coverage, a target of sustainable development goal (SDG) 3. Tackling tax avoidance requires cooperation between the governments of all countries, multinational corporations and investors, including private individuals. International cooperation to improve domestic resource mobilization is the focus of SDG target 17.1Publisher PDFPeer reviewe

Government revenue, quality of governance and child and maternal survival

Funding: Global Challenges Research Fund / Prof Sonia Buist Global Child Health Research Fund / Scottish Funding Council.This paper considers the effect of government revenue and the quality of governance on the under-five and maternal survival rates. A non-linear panel data study was undertaken using annual data for every country in the world. The study's broad conclusion is that while government resources, measured as total revenue received by a country's government, is essential, the quality of governance is even more critical in determining a good outcome for both mother and child.Publisher PDFPeer reviewe

Raltegravir-intensified initial antiretroviral therapy in advanced HIV disease in Africa : a randomised controlled trial

Funding: REALITY was funded by Joint Global Health Trials Scheme (JGHTS) of the UK Department for International Development (DFID), the Wellcome Trust, and Medical Research Council (MRC) (G1100693). Additional funding support was provided by the PENTA foundation and core support to the MRC Clinical Trials Unit at UCLBACKGROUND: In sub-Saharan Africa, individuals infected with HIV who are severely immunocompromised have high mortality (about 10%) shortly after starting antiretroviral therapy (ART). This group also has the greatest risk of morbidity and mortality associated with immune reconstitution inflammatory syndrome (IRIS), a paradoxical response to successful ART. Integrase inhibitors lead to significantly more rapid declines in HIV viral load (VL) than all other ART classes. We hypothesised that intensifying standard triple-drug ART with the integrase inhibitor, raltegravir, would reduce HIV VL faster and hence reduce early mortality, although this strategy could also risk more IRIS events. METHODS AND FINDINGS: In a 2×2×2 factorial open-label parallel-group trial, treatment-naive adults, adolescents, and children >5 years old infected with HIV, with cluster of differentiation 4 (CD4) 0.7) and despite significantly greater VL suppression with raltegravir-intensified ART at 4 weeks (343/836 [41.0%] versus 113/841 [13.4%] with standard ART, p < 0.001) and 12 weeks (567/789 [71.9%] versus 415/803 [51.7%] with standard ART, p < 0.001). Through 48 weeks, there was no evidence of differences in mortality (aHR = 0.98 [95% CI 0.76-1.28], p = 0.91); in serious (aHR = 0.99 [0.81-1.21], p = 0.88), grade-4 (aHR = 0.88 [0.71-1.09], p = 0.29), or ART-modifying (aHR = 0.90 [0.63-1.27], p = 0.54) adverse events (the latter occurring in 59 [6.5%] participants with raltegravir-intensified ART versus 66 [7.3%] with standard ART); in events judged compatible with IRIS (occurring in 89 [9.9%] participants with raltegravir-intensified ART versus 86 [9.5%] with standard ART, p = 0.79) or in hospitalisations (aHR = 0.94 [95% CI 0.76-1.17], p = 0.59). At 12 weeks, one and two raltegravir-intensified participants had predicted intermediate-level and high-level raltegravir resistance, respectively. At 48 weeks, the nucleoside reverse transcriptase inhibitor (NRTI) mutation K219E/Q (p = 0.004) and the non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations K101E/P (p = 0.03) and P225H (p = 0.007) were less common in virus from participants with raltegravir-intensified ART, with weak evidence of less intermediate- or high-level resistance to tenofovir (p = 0.06), abacavir (p = 0.08), and rilpivirine (p = 0.07). Limitations of the study include limited clinical, radiological, and/or microbiological information for some participants, reflecting available services at the centres, and lack of baseline genotypes. CONCLUSIONS: Although 12 weeks of raltegravir intensification was well tolerated and reduced HIV viraemia significantly faster than standard triple-drug ART during the time of greatest risk for early death, this strategy did not reduce mortality or clinical events in this group and is not warranted. There was no excess of IRIS-compatible events, suggesting that integrase inhibitors can be used safely as part of standard triple-drug first-line therapy in severely immunocompromised individuals.Publisher PDFPeer reviewe