Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children

Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children of developing countries. In a randomized, placebo-controlled trial, we assessed the effectiveness and efficacy of giving 3 Recommended Daily Allowances of elemental zinc to 6- to 35-month-old children with acute diarrhea. Methods: Seventeen hundred ninety-two cases of acute diarrhea in Nepalese children were randomized to 4 study groups. Three groups were blinded and the children supplemented daily by field workers with placebo syrup, zinc syrup, or zinc syrup and a massive dose of vitamin A at enrollment. The fourth group was open and the caretaker gave the children zinc syrup daily. Day-wise information on morbidity was obtained by household visits every fifth day. Results: The relative hazards for termination of diarrhea were 26% (95% confidence interval [CI]: 8%, 46%), 21% (95% CI: 4%, 38%), and 19% (95% CI: 2%, 40%) higher in the zinc, zinc-vitamin A, and zinc-caretaker groups, respectively, than in the placebo group. The relative risks of prolonged diarrhea (duration >7 days) in these groups were 0.57 (95% CI: 0.38, 0.86), 0.53 (95% CI: 0.35, 0.81), and 0.55 (0.37, 0.84); zinc accordingly reduced the risk of prolonged diarrhea with 43% to 47%. Five percent and 5.1% of all syrup administrations were followed by regurgitation in the zinc and zinc-vitamin A group, respectively, whereas this occurred after only 1.3% of placebo administrations. Vomiting during diarrhea was also more common in children receiving zinc. Conclusions: Three Recommended Daily Allowances of zinc given daily by caretakers or by field workers substantially reduced the duration of diarrhea. The effect of zinc was not dependent on or enhanced by concomitant vitamin A administration

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Role of broad spectrum antibiotics in chest infections in infants.

50 patients with chest infections admitted in the Kanti Childrens Hospital were studied to assess the effectiveness of the broad spectrum antibiotics in altering the course of the disease. These infants were graded to assess the daily improvement in their conditions and were followed up to 7 days. Altogether 12 patients were grouped in grade 2 and 38 were grouped in grade 1. There were no change in the condition of these patients up to the fifth day of admision inspite of the costly drugs used. These findings confirm that routine use of antibiotics in chest infections in infants without secondary complications does not alter the prognosis. Moreover it increases the economic burden to family whose daily income can hardly afford nutretious diet

AN APPROACH TO A CHILD (1 WEEK TO 36 MONTHS) WITH FEVER

Nearly seventy percent of all children between the ages of one week and two-years-ofage are brought to Kanti Children’s Hospital for some type of febrile episode. And 50% of these visits are for temperatures greater than or equal to 39 degrees celsius. These children may have significant bacterial infection. In 35% of these children there’s no definable source for the fever on clinical examination. So the child that don’t have identifiable sources could be either bacteremic, meningitis or could have a bone or joint infection in evolution. Simple clinical observation to differentiate a well looking infant from a toxic infant helps to differentiate children who needs admisson or out patient follow-up. Key Words: Fever, young infant, antibiotics, management

The first record of European free-tailed bat, Tadarida teniotis Rafinesque, 1814, and note on probable elevational movement from Nepal

Out of the four Molossidae species from South Asia, the distribution of the European free-tailed bat, T. teniotis is most poorly known. This species has been occasionally reported from Afghanistan, Bangladesh, Bhutan, and India; however, no records exist in Nepal. Here we report the first record of T. teniotis from Nepal and comment on its possible elevational movement in the Himalaya. Active acoustic surveys were conducted in the Kali Gandaki canyon during autumn and winter seasons at two elevational zones, 800–1200 m and 2100–2500 m, in three habitat types (forest, agricultural land, and human settlements). Echolocation calls of T. teniotis were easily distinguished by their low frequency, shallow frequency modulation, and long duration. During autumn, the activity was recorded only at 2100 to 2500 m and varied significantly from winter activity, while T. teniotis was observed at both elevational zones during winter. The result confirms the presence of T. teniotis from Nepal. Based on our observations of differential activity at different elevation zones in two seasons, we recommend more intensive studies to confirm seasonal migration and to understand seasonal demographics along the Kali Gandaki landscape and in the entire Himalayan range at large

Ultrathin, Flexible Organic–Inorganic Hybrid Solar Cells Based on Silicon Nanowires and PEDOT:PSS

Recently, free-standing, ultrathin, single-crystal silicon (c-Si) membranes have attracted considerable attention as a suitable material for low-cost, mechanically flexible electronics. In this paper, we report a promising ultrathin, flexible, hybrid solar cell based on silicon nanowire (SiNW) arrays and poly­(3,4-ethylenedioxythiophene):poly­(styrenesulfonate) (PEDOT:PSS). The free-standing, ultrathin c-Si membranes of different thicknesses were produced by KOH etching of double-side-polished silicon wafers for various etching times. The processed free-standing silicon membranes were observed to be mechanically flexible, and in spite of their relatively small thickness, the samples tolerated the different steps of solar cell fabrication, including surface nanotexturization, spin-casting, dielectric film deposition, and metallization. However, in terms of the optical performance, ultrathin c-Si membranes suffer from noticeable transmission losses, especially in the long-wavelength region. We describe the experimental performance of a promising light-trapping scheme in the aforementioned ultrathin c-Si membranes of thicknesses as small as 5.7 μm employing front-surface random SiNW texturization in combination with a back-surface distribution of silver (Ag) nanoparticles (NPs). We report the enhancement of both the short-circuit current density (<i>J</i>_SC) and the open-circuit voltage (<i>V</i>_OC) that has been achieved in the described devices. Such enhancement is attributable to the plasmonic backscattering effect of the back-surface Ag NPs, which led to an overall 10% increase in the power conversion efficiency (PCE) of the devices compared to similar structures without Ag NPs. A PCE in excess of 6.62% has been achieved in the described devices having a c-Si membrane of thickness 8.6 μm. The described device technology could prove crucial in achieving an efficient, low-cost, mechanically flexible photovoltaic device in the near future

Plasmonic Effects of Au/Ag Bimetallic Multispiked Nanoparticles for Photovoltaic Applications

In recent years, there has been considerable interest in the use of plasmons, that is, free electron oscillations in conductors, to boost the performance of both organic and inorganic thin film solar cells. This has been driven by the possibility of employing thin active layers in solar cells in order to reduce materials costs, and is enabled by significant advances in fabrication technology. The ability of surface plasmons in metallic nanostructures to guide and confine light in the nanometer scale has opened up new design possibilities for solar cell devices. Here, we report the synthesis and characterization of highly monodisperse, reasonably stable, multipode Au/Ag bimetallic nanostructures using an inorganic additive as a ligand for photovoltaic applications. A promising surface enhanced Raman scattering (SERS) effect has been observed for the synthesized bimetallic Au/Ag multispiked nanoparticles, which compare favorably well with their Au and Ag spherical nanoparticle counterparts. The synthesized plasmonic nanostructures were incorporated on the rear surface of an ultrathin planar c-silicon/organic polymer hybrid solar cell, and the overall effect on photovoltaic performance was investigated. A promising enhancement in solar cell performance parameters, including both the open circuit voltage (<i>V</i>_OC) and short circuit current density (<i>J</i>_SC), has been observed by employing the aforementioned bimetallic multispiked nanoparticles on the rear surface of solar cell devices. A power conversion efficiency (PCE) value as high as 7.70% has been measured in a hybrid device with Au/Ag multispiked nanoparticles on the rear surface of an ultrathin, crystalline silicon (c-Si) membrane (∼12 μm). This value compares well to the measured PCE value of 6.72% for a similar device without nanoparticles. The experimental observations support the hope for a sizable PCE increase, due to plasmon effects, in thin-film, c-Si solar cells in the near future

High Efficiency Hybrid Silicon Nanopillar–Polymer Solar Cells

Recently, inorganic/organic hybrid solar cells have been considered as a viable alternative for low-cost photovoltaic devices because the Schottky junction between inorganic and organic materials can be formed employing low temperature processing methods. We present an efficient hybrid solar cell based on highly ordered silicon nanopillars (SiNPs) and poly­(3,4-ethylene-dioxythiophene):polystyrenesulfonate (PEDOT:PSS). The proposed device is formed by spin coating the organic polymer PEDOT:PSS on a SiNP array fabricated using metal assisted electroless chemical etching process. The characteristics of the hybrid solar cells are investigated as a function of SiNP height. A maximum power conversion efficiency (PCE) of 9.65% has been achieved for an optimized SiNP array hybrid solar cell with nanopillar height of 400 nm, despite the absence of a back surface field enhancement. The effect of an ultrathin atomic layer deposition (ALD), grown aluminum oxide (Al₂O₃), as a passivation layer (recombination barrier) has also been studied for the enhanced electrical performance of the device. With the inclusion of the ultrathin ALD deposited Al₂O₃ between the SiNP array textured surface and the PEDOT:PSS layer, the PCE of the fabricated device was observed to increase to 10.56%, which is ∼10% greater than the corresponding device without the Al₂O₃ layer. The device described herein is considered to be promising toward the realization of a low-cost, high-efficiency inorganic/organic hybrid solar cell