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We report a simple and rapid method for the synthesis of fluorescent gallium oxyhydroxide (GaOOH) nanoparticles from liquid Ga by a probe sonication method in the presence of H2O2 as an oxidant for potential biomedical applications.

Purpose: Sexual and gender minority (SGM) populations throughout Kenya as well as other sub-Saharan African countries face systemic discrimination and substantial human rights violations, yet scant...

Highlights • After implementing optimized model, we observed 34% reduction in supply chain costs. • Costs increased for Provincial store but decreased for Zones and health facilities. • Streamlined distribution practices supported cost reductions for transportation. • After implementing optimized model, costs increased in control Zones and facilities., Objective In 2017, an optimized immunization supply chain (iSC) model was implemented in Equateur Province, Democratic Republic of the Congo. The optimized model aimed to address iSC challenges and featured direct deliveries to service delivery points (SDPs), longer replenishment intervals and increased cold chain capacity. This assessment examines iSC costs before and 5 months after implementing the optimized model. Materials & Methods We used a nonexperimental pre-post study design to compare iSC costs before and after implementation. We applied an activity-based costing approach with a comparison arm to assess procurement, management, storage and transportation costs for three iSC tiers: Province (n = 1); Zone (n = 4) and SDP (n = 15). We included data from 3 treatment Zones and 11 treatment SDPs; 1 control Zone and 4 control SDPs. We used sample and population data to estimate iSC costs for the entirety of Equateur Province. Results In the period immediately before implementing the optimized model, estimated annual iSC costs were $974,237. Following implementation, estimated annual iSC costs were $642,627—a 34% ($331,610) reduction. This change in costs was influenced by a 43% ($180,313) reduction in SDP costs, a 67% ($198,092) reduction in Zonal costs and an 18% ($46,795) increase in Provincial costs. After implementing the optimized model, average iSC costs for treatment Zones was $6,895 (SD: $6,072); for the control Zone was $21,738; for treatment SDPs was $989 (SD: $969); and for control SDPs was $1,356 (SD: $1,062). Conclusions We observed an absolute reduction in iSC costs in treatment Zones while control Zone post-implementation iSC costs remained the same or increased. The greatest cost reductions were for storage and transport at Zones and SDPs. Although cost implications of this model must continue to be evaluated over time, these findings are promising and will inform decisions around project expansion.

We report a simple and rapid method for the synthesis of fluorescent gallium oxyhydroxide (GaOOH) nanoparticles from liquid Ga by a probe sonication method in the presence of H

A sizable portion of youth (ages 13–24) living with HIV in the United States have unsuppressed viral load. The AIDS Interventions (ATN) 152 study [evaluating the Triggered Escalating Real-Time Adherence (TERA) intervention] baseline data were examined to identify correlates of high viremia (>5000 copies/mL) and self-reported adherence, which can help in planning of differentiated services for viremic youth. Depression, HIV-stigma, and cannabis use were common in this sample of 87 youth. Almost half (48%) had high viremia, which associated with enacted stigma, moderate- to high-risk alcohol use, mental health diagnosis, and age ≥21. Self-reported adherence was related to viral load and associated with mental and physical health functioning, depression, social support, self-confident decision-making, total and internalized stigma, adherence motivation, and report of a missed a care visit in the past 6 months. Mental health emerged as a common correlate of viral load and adherence. Clinical Trial Registration number: NCT03292432.

Youth living with HIV (YLWH) in the US have low rates of viral suppression (VS). In a prospective randomized clinical trial (ATN152) that enrolled 89 YLWH on antiretroviral therapy (ART) with detectable viral load, we evaluated a 12 week triggered escalating real-time adherence (TERA) intervention with remote coaching, electronic dose monitoring (EDM), and outreach for missed/delayed doses compared to standard of care (SOC). Median [Q1, Q3] percent days with EDM opening was higher in TERA (72% (47%, 89%)) versus SOC (41% (21%, 59%); p 0.001) and incidence of numbers of 7 day gaps between openings were lower (TERA to SOC ratio: 0.40; 95% CI 0.30, 0.53; p 0.001). There were no differences in VS at week 12 (TERA 35%; 95% CI 21%, 51% versus SOC 36%; 95% CI 22%, 51%; p 0.99) or later time-points. The intervention improved adherence but not VS in heavily ART-experienced YLWH. Remote coaching more closely tailored to the unique dosing patterns and duration of need for youth struggling to reach VS warrants further investigation.

Room temperature liquid metals based on Ga can be used as a synthesis medium for the creation of metal oxide nanomaterials, however one thermodynamic limitation is that metals that are more easily oxidised than Ga are required to ensure their preferential formation. In this work we demonstrate a proof of principle approach whereby exposing the liquid metal alloyed with the required metal to acidic conditions circumvents preferential formation of Ga2O3 and allows for the formation of the required 2D transition metal oxide nanosheets. The synthesis procedure is straightforward in that it only requires bubbling oxygen gas through the liquid metal alloy into a solution of 10 mM HCl. We show that the formation of thin nanosheets of ca. 1 nm in thickness of CoO is possible. The material is characterised using transmission electron microscopy, atomic force microscopy, X-ray photoelectron and Raman spectroscopy. The electrocatalytic activity of the CoO nanosheets was investigated for the oxygen evolution reaction where the nanosheet thickness was found to be a factor influencing the activity. This proof of principle offers a route to the possible formation of many other 2D transition metal oxides from metals that are less readily oxidised than Ga by taking advantage of the interesting properties of room temperature liquid metals.

The renewable energy driven electrochemical conversion of nitrates to ammonia is emerging as a viable route for the creation of this hydrogen carrier. However, the creation of highly efficient electrocatalysts that show prolonged stability is an ongoing challenge. Here we show that room temperature liquid metal Galinstan can be used as an efficient and stable electrocatalyst for nitrate conversion to ammonia achieving rates of up to 2335 μg h

Uptake of pre-exposure prophylaxis (PrEP) has dramatically increased but remains well below the estimated number of individuals who could benefit from PrEP in the United States, and uptake remains limited among young men who have sex with men (YMSM) and MSM of color. Reasons for not adopting PrEP as a prevention strategy among those at elevated risk for HIV is an important area of inquiry that could advise efforts to better position PrEP as an active part of prevention programs. As part of a mixed methods study investigating experiences with repeat HIV testing, we identified main themes emerging from in-depth interview data pertaining to reasons why YMSM report not using PrEP, among YMSM with frequent access to HIV testing services. Themes from 14 in-depth interviews with predominantly Latino MSM for not using PrEP included perceived burden of daily dosing, feeling that risk was not high enough to warrant PrEP, and beliefs that PrEP would have severe adverse events affecting the kidneys and bones. Less prominent but noteworthy themes included stigma as a PrEP user, social or provider influence on decisions not to use PrEP, and preference for current prevention strategy. No differences in PrEP discourse were noted across those at different levels of HIV risk. Results suggest that efforts are needed to engage communities and individuals around PrEP-related education, facilitate risk evaluation, and reduce PrEP stigma. New formulations and nondaily regimens may also be of particular interest to YMSM who may perceive daily PrEP regimens as highly burdensome.

BACKGROUND: Microneedle patch (MNP) technology is designed to simplify the process of vaccine administration; however, depending on its characteristics, MNP technology may provide additional benefits beyond the point-of-use, particularly for vaccine supply chains. METHODS: Using the HERMES modeling software, we examined replacing four routine vaccines – Measles-containing vaccine (MCV), Tetanus toxoid (TT), Rotavirus (Rota) and Pentavalent (Penta) – with MNP versions in the routine vaccine supply chains of Benin, Bihar (India), and Mozambique. RESULTS: Replacing MCV with an MNP (5 cm(3)-per-dose, 2-month thermostability, current single-dose price-per-dose) improved MCV availability by 13%, 1% and 6% in Benin, Bihar and Mozambique, respectively, and total vaccine availability by 1% in Benin and Mozambique, while increasing the total cost per dose administered by $0.07 in Benin, $0.56 in Bihar and $0.11 in Mozambique. Replacing TT with an MNP improved TT and total vaccine availability (3% and

Author(s): Felner, Jennifer K; Mittal, Maria L; Hoenigl, Martin; Amico, K Rivet; Grelotti, David J; Eanes, Alex; Hess, Kristen; Crawford, Jessica; Smith, Laramie R | Abstract: IntroductionTo end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions.MethodsInterviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group.ResultsObjective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment.ConclusionsQuantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.

Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18–34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW, 24.9%), (2) cisgender sexual minority men (SMM, 63.8%), and (3) gender minority individuals (GMI, 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily, and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.

Government partnerships are essential for many health solutions to sustain impact at scale, particularly in low-resource settings where strengthening health systems is critical for Universal Health Coverage. Many non-governmental organizations (NGOs) and funders ultimately want solutions to be integrated into public health systems by transitioning solution ownership, management and/or operation to government. However, NGOs and their government partners have limited guidance on how to effectively determine when a solution is ready to transition in a way that will maintain impact long term. To address this need, VillageReach developed the Transition Readiness Assessment (TRA) based on our transition to government theoretical framework. The framework was developed to define both factors related to a solution, as well as external influences that affect a solution’s success. The framework identifies seven dimensions of solution readiness: the political, economic, and social context; solution design; resource availability; financial management; government strategy; government policy and regulations; and organizational management. The TRA measures those dimensions and assigns each one a readiness score. We developed the framework and TRA for VillageReach solutions, as well as to share with government partners and stakeholders. This Open Letter outlines the TRA development, details empirical examples from applying the tool on two VillageReach solutions, and presents recommendations based on our lessons learned. Stakeholders working to transition solutions to government can utilize both the TRA and our lessons.

The government of Cape Verde, an archipelagic Small Island Developing State (SIDS) off the coast of Senegal, has established a goal to achieve 100% of its electricity from renewable sources by 2025. Several islands in the archipelago have suitable wind and solar resources and nationally these compose about 25% of the electricity output. However, not all islands are equally endowed with these resources and the lack of grid connections among islands poses challenges for integrating additional variable energy generation. Integrating desalination and storage (pumped hydro or battery) could enable greater penetration of wind and solar energy. Ocean thermal energy conversion (OTEC) is an emerging technology that could be suitable for Cape Verde. Microgrids and self-generation could prove to be more cost effective than grid connections outside of the large cities. Achieving the 100% renewable energy goal would require a US$1 billion investment. Cape Verde has a variety of resources that can contribute to achieving its 100% renewable electricity goal but combining them in manageable and cost-effective way remains a challenge. The options, opportunities, and challenges encountered by Cape Verde are applicable to other countries, especially small island developing states and archipelagos around the world.

The creation of liquid metal alloys that are reacted with species in solution is a relatively new approach to the synthesis of functional nanomaterials. In this work we explore the liquid Ag–Ga system and its interaction with redox active species in aqueous solution in the areas of heterogeneous catalysis and charge transfer complex formation. It was found that when Ag is alloyed with Ga that solid microwires of Ag2Ga were formed over time with a width of ca. 1–1.5 µm of up to 160 µm in length. This Ga/Ag2Ga composite was then investigated for the discolouration of methylene blue dye in both the liquid and solid state where little difference in activity was found resulting in 40% discolouration after 30 min. However, if nitrogen gas was passed through the liquid form of the catalyst the conversion efficiency of the catalyst increased significantly up to 99% after 1 min and could be re-used for up to 10 cycles. In addition, the catalytic conversion of 4-nitrophenol to 4-aminophenol at the liquid Ga/Ag2Ga catalyst was significantly greater than liquid Ga and could be reused for up to 5 cycles. The interaction of liquid Ag–Ga with the well-known electron acceptor 7,7,8,8-tetracyanoquinodimethane (TCNQ) was also studied where it was found that a reaction only occurred immediately after mixing Ag microparticles with liquid Ga and before any Ag2Ga microwires were formed. The reaction conditions of bubbling nitrogen gas through the liquid Ag–Ga catalysts in an acetonitrile solution of TCNQ resulted in the time dependent formation of various morphologies of the semi-conducting charge transfer complex AgTCNQ. This work shows that alloying metals with Ga can result in the time dependent formation of a variety of materials under different reaction conditions when exposed to solution based redox active species.

A well-functioning supply chain is a critical component of the health system to ensure high-quality medicines and health products are available when and where they are needed. However, because supply chains are complex systems, strong, competent leaders are needed to drive continuous improvement efforts. This paper documents the learnings from a supply chain leadership intervention in the Democratic Republic of Congo (DRC), which aimed to build leadership capacity in a cross-tier group of central/provincial/district-level leaders. The intervention, called the Leadership in Supply Chain Initiative, used an experiential learning curriculum to train 19 ‘champions’ in Equateur Province, DRC. Based on self-assessments and key informant interviews, participants reported that the intervention increased their ability to lead change in the supply chain. In particular, participants and stakeholders noted that empowering district managers as leaders in the supply chain was important to improve supply chain performance, since they oversee service delivery points and are responsible for operationalising changes in the supply chain. Moreover, this intervention adds to evidence that leadership capacity is most effectively gained through experiential learning coupled with mentorship and coaching. Additional research is needed to determine the optimal duration of leadership building interventions and to better understand how supply chain leaders can be supported and mentored within the public health system.

The galvanic replacement reaction is a highly versatile approach for the creation of a variety of nanostructured materials. However, the majority of reports are limited to the replacement of metallic nanoparticles or metal surfaces. Here we extend this elegant approach and describe the galvanic replacement of the liquid metal alloy galinstan with Ag and Au. This is achieved at a macrosized droplet to create a liquid metal marble that comprises a liquid metal core and a solid metal shell, whereby the morphology of the outer shell is determined by the concentration of metallic ions used in the solution during the galvanic replacement process. In principle, this allows one to recover precious metal ions from solution in their metallic form, which are immobilized on the liquid metal and therefore easy to recover. The reaction is also undertaken at liquid metal microdroplets created via sonication to produce Ag- and Au-based galinstan nanorice particles. These materials are characterized with SEM, XRD, TEM, SAED, EDX, XPS, UV-visible spectroscopy, and open-circuit potential versus time experiments to understand the galvanic replacement process. Finally, the nanosized materials are investigated for their catalytic activity toward the reduction of methylene blue in the presence of sodium borohydride. This approach illustrates a new avenue of research for the galvanic replacement process and, in principle, could be applied to many more systems.

Background Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship. Objective The objective of this project was to develop a national consensus on pediatric CLP competencies to help guide training in this specialty. Methods An expert working group developed a list of candidate competences based on previously established educational outcomes for CLP (formerly Psychosomatic Medicine), child and adolescent psychiatry, and general psychiatry. A survey was distributed to members of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee to determine child and adolescent psychiatry fellowship educational needs on pediatric CLP services and generate consensus regarding pediatric CLP competencies. Results Most survey respondents were supportive of the need for a national consensus on core competencies for pediatric CLP. Consensus from a panel of experts in the field of pediatric CLP generated a list of proposed core competencies that track the Accreditation Council for Graduate Medical Education's six core competencies. Conclusions Consistent learning outcomes provide the foundation for further development of tools to support training in pediatric CLP. There is a need to develop further tools including outcome assessment instruments and self-directed learning materials that can be used to support lifelong learning.

Background Poor access to essential medicines is common in many low- and middle-income countries, partly due to an insufficient and inadequately trained workforce to manage the medicines supply chain. We conducted a prospective impact evaluation of the training and deployment of pharmacy assistants (PAs) to rural health centers in Malawi. Methods A quasi-experimental design was used to compare access to medicines in two districts where newly trained PAs were deployed to health centers (intervention) and two districts with no trained PAs at health centers (comparison). A baseline household survey and two annual post-intervention household surveys were conducted. We studied children under five years with a history of fever, cough and difficulty in breathing, and diarrhea in the previous two weeks. We collected data on access to antimalarials, antibiotics and oral rehydration salts (ORS) during the childrens’ symptomatic periods. We used difference-in-differences regression models to estimate the impact of PA training and deployment on access to medicines. Results We included 3974 children across the three rounds of annual surveys: 1840 (46%) in the districts with PAs deployed at health centers and 2096 (53%) in districts with no PAs deployed at health centers. Approximately 80% of children had a fever, nearly 30% had a cough, and 43% had diarrhea in the previous two weeks. In the first year of the program, the presence of a PA led to a significant 74% increase in the odds of access to any antimalarial, and a significant 49% increase in the odds of access to artemisinin combination therapies. This effect was restricted to the first year post-intervention. There was no effect of presence of a PA on access to antibiotics or ORS. Conclusion The training and deployment of pharmacy assistants to rural health centers in Malawi increased access to antimalarial medications over the first year, but the effect was attenuated over the second year. Pharmacy assistants training and deployment demonstrated no impact on access to antibiotics for pneumonia or oral rehydration salts for diarrhea.

Mobile SMS health messages had higher successful delivery and led to higher intended or actual behavior change among subscribers than voice messages. Providing multiple delivery modalities led to greater overall access., Objective: To determine the difference in delivery success of health messages delivered through pushed SMS, pushed voice messages sent to personal phones, and voice messages retrieved from a community phone (“retrieved voice messaging”), as well as the difference in quality of the user experience. Methods: We analyzed the project's electronic monitoring data between September 2011 and June 2013, including demographics, enrollment data, and messages sent and successfully delivered. We also collected and analyzed information from quarterly phone-based surveys with users to assess quality of the user experience, including acceptability, comprehension, new information learned, and reported behavior change. Results: More than half of subscribers enrolled in the retrieved voice messaging service while nearly one-third enrolled in the pushed SMS service and less than 10% in pushed voice messaging. Message delivery success was highest among pushed SMS subscribers and lowest among retrieved voice subscribers. Overall, 99% of survey respondents reported trusting messages they received, and about 75% of respondents recalled the last message they received and learned something new. Almost 75% of respondents reported that they had already changed or intended to change their behavior based on received messages. Intended or actual behavior change was significantly higher among pushed SMS enrollees than among pushed or retrieved voice messaging enrollees (P = .01). Conclusion: All message modalities led to high levels of satisfaction, comprehension, and new information learned. Due to lower cost, higher delivery success, and higher levels of intended or actual behavior change, SMS is the preferred delivery modality. However, the majority of users included in this study did not have access to a personal phone, and retrieved voice messages provided an opportunity to access a population that otherwise could not be served. Providing multiple methods by which users could access the service was crucial in extending reach beyond literate personal phone owners.

Background Internationally, non-urgent presentations are increasing the pressure on Emergency Department (ED) staff and resources. This systematic review aims to identify the impact of alternative emergency care pathways on ED presentations – specifically GP cooperatives and walk-in clinics. Methods Based on a structured PICO enquiry with either walk-in clinic or GP cooperative as the intervention, a search was made for peer-reviewed publications in English, between 2000 and 2014. Medline plus, OVID, PubMed, and Google Scholar were searched. The Critical Appraisal Skills Program (CASP) guidelines were used to assess study quality and data was extracted using an adapted JBI Qualitative Assessment and Review Instrument (QARI). Subsequent reporting followed the PRISMA guideline. Results Eleven high quality quantitative studies met the inclusion criteria. Walk-in clinics do have the potential to reduce non-urgent emergency department presentations, however evidence of this effect is low. GP cooperatives offer an alternative care stream for patients presenting to the ED and do significantly reduce local ED attendances. Community members need to be made aware of these options in order to make informed treatment choices. Conclusion GP cooperatives in particular do have the potential to reduce ED workload. Further research is required to uncover recent trends and patient outcomes for walk-in clinics and GP cooperatives.

Objective To determine whether women with low-grade serous ovarian cancer (LGSOC) have personal and family histories of breast and ovarian cancer that are less suggestive of Hereditary Breast and Ovarian Cancer (HBOC), as compared to women with high-grade serous ovarian cancer (HGSOC). Methods A single institution, case-control retrospective review of medical records was conducted. Personal demographics, personal cancer history, and family history of breast and ovarian cancer of women with LGSOC were collected and compared to controls with HGSOC, which is known to be associated with HBOC. Results 195 cases of LGSOC and 386 controls with HGSOC were included in the analysis. Women with LGSOC were significantly less likely to have a first- or second-degree relative with breast or ovarian cancer ( p =0.0016). Additionally, when the personal and family histories were quantified using the AMyriad BRC mutation prevalence tables, women with LGSOC had lower scores indicative of a less suggestive family history for HBOC ( p =0.027). Conclusions In this study, women with LGSOC had family histories that were less suggestive of HBOC compared to women with HGSOC, especially when the degree of relatedness of affected relatives was taken into account. By beginning to determine if LGSOC is part of the tumor spectrum seen in HBOC, this study is an important step towards refining hereditary cancer risk assessment for women with ovarian cancer.

Direct solar-to-hydrogen conversion can be achieved via photoelectrochemical water splitting, and is an attractive approach for the storage of sunlight as a chemical fuel.1 However, current technologies rely on expensive components such as the noble metal platinum electrocatalyst, making such devices economically inviable. Efforts have therefore recently been turned towards transition metal chalcogenides (TMCs) as potential electrocatalysts for the hydrogen evolution reaction (HER).2 MoS2, in particular, has been studied extensively, with subtle changes in the crystal structure proving to be a pivotal factor for tuning the catalytic activity. Naturally occurring bulk semiconducting 2H-MoS2, for example, is catalytically inert but can be turned via lithium intercalation into the nanostructured metastable and metallic 1T-MoS2 polymorph which is a highly efficient HER catalyst.3 However, the nanostructured material is thermodynamically unstable and thus displays the reverse transformation into the less active 2H-phase.4 This modest change in crystal structure has therefore sparked interest in the role polymorphic control plays in tuning catalytic activity. Herein, we exploit a solid state route to MoTe2 which allows for the interconversion between both semiconducting and metallic phases to be carried out in the bulk form. In this way, the effect of polymorphic control on catalytic activity can be accurately investigated without compromising the composition and/or morphology of the materials.5 In this work phase purity is essential; therefore powder X-Ray Diffraction and Raman Spectroscopy were used to confirm the absence of impurity phases which may have affected the activity of the catalysts. Likewise, particle morphology and composition were shown to be identical by SEM/EDX and ICP-OES, meaning the only factor affecting the electrochemical performance is the change in crystal structure. Determination of the overpotentials for proton reduction by linear sweep voltammetry proved that 1T’-MoTe2 is an active HER electrocatalyst, while 2H-MoTe2 is catalytically inert. This coupled with investigation of the reaction kinetics by Tafel analysis and electrochemical impedance spectroscopy led to the conclusion that the metallic 1T’-MoTe2 phase exhibits a superior catalytic performance to its semiconducting counterpart. Crucially, gas chromatography also confirmed that hydrogen was indeed produced with a full Faradaic efficiency, thus verifying that 1T’-MoTe2 is an efficient electrocatalyst for the hydrogen evolution reaction. Therefore, we deem polymorphic control a key factor in the development of future HER electrocatalysts. 1. Roger, I.; Shipman, M. A.; Symes, M. D. Nat. Rev. Chem. 2017, 1, 3. 2. Roger, I.; Moca, R.; Miras, H. N.; Crawford, K. G.; Moran, D. A. J.; Ganin, A. Y.; Symes, M. D. J. Mater. Chem. A 2017, 5 (4), 1472. 3. Voiry, D.; Salehi, M.; Silva, R.; Fujita, T.; Chen, M.; Asefa, T.; Shenoy, V. B.; Eda, G.; Chhowalla, M. Nano Lett. 2013, 13 (12), 6222. 4. Heising, J.; Kanatzidis, M. G. J. Am. Chem. Soc. 1999, 121 (50), 11720. 5. McGlynn, J. C.; Cascallana-Matías, I.; Fraser, J. P.; Roger, I.; Mcallister, J.; Miras, H.; Symes, M. D.; Ganin, A. Y. Energy Technol. 2017. Figure 1

The generation of ammonium hydrogen sulfate from ammonium sulfate is of current interest because of its potential as a process component of bio-based organic acid production from biomass. An organic acid, for example succinic acid, is a chemical product that is used in food, cosmetics, deicing applications, etc. and a potential key carbon building block for numerous other materials. Its production from biomass (corn, etc.) makes it a renewable chemical resource, and the regeneration process described here minimizes the use of additional acid and base value reagents and byproduct (low value salt) waste. In the present work ammonium hydrogen sulfate (acid) and ammonia (base) were regenerated from ammonium sulfate using a thermal cracking method. Raman spectroscopy was used for primary analysis of the ammonium hydrogen sulfate product formed to determine the optimal reaction rate (80 °C/min) and to study the role of ammonium pyrosulfate in this reaction.

Background Malawi, like many low-income countries, is facing a severe health worker shortage. A potential stop-gap solution to this crisis is improving the efficiency of health center operations. Given the lack of research on center efficiency in rural health centers in Malawi, we conducted a study to identify deficiencies in center organization and barriers to patient flow. Methods We performed a time-motion survey at a rural health center in Ntaja, Malawi over a period of 1 week. We used a standardized questionnaire to collect information on the amount of time a patient spent with each health worker, the number of center staff that attended to each patient, and the total time spent at the center. Additionally, at the end of the visit, we conducted an exit survey to collect demographic information and data on perception of quality of care with the center visit for all patients. Results A total of 1018 patients were seen over the five-day study. The average total time spent at the center by the patients was 123 min (2–366 min). Adults had an average total time spent at the center of 111 min (2–366 min) and children 134 min (7–365 min). Patient waiting time (PWT) was higher in the early morning hours ranging from 157 min (between 06:00 and 08:00) to 53 min (between 14:00 and 16:00). Health worker contact time (HCT) was higher for adults (2.3 min) than children (1.7 min). Shorter wait times were associated with higher perceptions of quality of service. Conclusion Despite shortages in health workers and funds, opportunities are available to increase efficiency in rural health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries can treat more patients and improve service quality. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2144-x) contains supplementary material, which is available to authorized users.

Background Access to essential medicines is core to saving lives and improving health outcomes of people worldwide, particularly in the low- and middle-income countries. Having a trained pharmacy workforce to manage the supply chain and safely dispense medicines is critical to ensuring timely access to quality pharmaceuticals and improving child health outcomes. Methods/Design This study measures the impact of an innovative pharmacy assistant training program in the low-income country of Malawi on access to medicines and health outcomes. We employ a cluster quasi-experimental design with pre-and post-samples and decision analytic modeling to examine access to and the use of medicines for malaria, pneumonia, and diarrhea for children less than 5 years of age. Two intervention districts, with newly trained and deployed pharmacy assistants, and two usual care comparison districts, matched on socio-economic, geographic, and health-care utilization indicators, were selected for the study. A baseline household survey was conducted in March 2014, prior to the deployment of pharmacy assistants to the intervention district health centers. Follow-up surveys are planned at 12- and 24-months post-deployment. In addition, interviews are planned with caregivers, and time-motion studies will be conducted with health-care providers at the health centers to estimate costs and resources use. Discussion This impact evaluation is designed to provide data on the effects of a novel pharmacy assistant program on pharmaceutical systems performance, and morbidity and mortality for the most common causes of death for children under five. The results of this study should contribute to policy decisions about whether and how to scale up the health systems strengthening workforce development program to have the greatest impact on the supply chain and health outcomes in Malawi.

Background: Malaria rapid diagnostic tests (RDTs) are particularly useful in low-resource settings where follow-through on traditional laboratory diagnosis is challenging or lacking. The availability of these tests depends on supply chain processes within the distribution system. In Mozambique, stock-outs of malaria RDTs are fairly common at health facilities. A longitudinal cross-sectional study was conducted to evaluate drivers of stock shortages in the Cabo Delgado province. Methods: Data were collected from purposively sampled health facilities, using monthly cross-sectional surveys between October 2011 and May 2012. Estimates of lost consumption (consumption not met due to stock-outs) served as the primary quantitative indicator of stock shortages. This is a better measure of the magnitude of stock-outs than binary indicators that only measure frequency of stock-outs at a given facility. Using a case study based methodology, distribution system characteristics were qualitatively analysed to examine causes of stock-outs at the provincial, district and health centre levels. Results: 15 health facilities were surveyed over 120 time points. Stock-out patterns varied by data source; average monthly proportions of 59%, 17% and 17% of health centres reported a stock-out on stock cards, laboratory and pharmacy forms, respectively. Estimates of lost consumption percentage were significantly high; ranging from 0% to 149%; with a weighted average of 78%. Each ten-unit increase in monthly-observed consumption was associated with a nine-unit increase in lost consumption percentage indicating that higher rates of stock-outs occurred at higher levels of observed consumption. Causes of stock-outs included inaccurate tracking of lost consumption, insufficient sophistication in inventory management and replenishment, and poor process compliance by facility workers, all arguably stemming from inadequate attention to the design and implementation of the distribution system. Conclusions: Substantially high levels of RDT stock-outs were found in Cabo Delgado. Study findings point to a supply chain with a commendable degree of sophistication. However, insufficient attention paid to system design and implementation resulted in deteriorating performance in areas of increased need. In such settings fast moving commodities like malaria RDTs can call attention to supply chain vulnerabilities, the findings from which can be used to address other slower moving health commodities.

We describe our experiences integrating ODK Scan into the community health worker (CHW) supply chain in Mozambique. ODK Scan is a mobile application that uses computer vision techniques to digitize data from paper forms. The application automatically classifies machine-readable data types, like bubbles and checkboxes, and assists users with the manual entry of handwritten text and numbers. We designed an intervention that uses paper forms in conjunction with ODK Scan to monitor CHW usage of essential health commodities, finding that the application is capable of providing supervisors and stakeholders with important information regarding health commodity availability in the field. Specifically, we (1) detail our experiences integrating ODK Scan into the health worker supply chain in Mozambique, with particular emphasis on the critical (and often under-reported) role of practitioners; (2) evaluate the impact of the technology at multiple levels of the information hierarchy, providing quantitative and qualitative data that exposes the benefits, challenges and limitations of the technology; and (3) share lessons learned and provide actionable guidance to researchers and practitioners interested in ODK Scan or other systems that bridge the gap between paper-based and digital data collection.

In low-resource settings in developing countries, most records are still captured and maintained using paper forms. Despite a recent proliferation of digital data collection systems, paper forms remain a trusted, low-cost and ubiquitous medium that will continue to be utilized in these communities for years to come. However, it can be challenging to aggregate, share, and analyze the data collected using paper forms. This paper presents mScan, a mobile smartphone application that uses computer vision to capture data from paper forms that use a multiple choice or bubble format. The initial mScan implementation targets the task of digitizing paper forms used to record vaccine statistics in rural health centers in Mozambique. We have evaluated the accuracy and performance of mScan under a variety of different environmental conditions, and our results show that mScan is a robust tool that is capable of accurately capturing and digitizing data from paper forms.

The evidence base to support the growing field of mHealth is relatively nascent, with most studies lacking the level of rigor needed to inform scale up of interventions. This paper investigates the impact of a maternal, newborn and child health (MNCH) mHealth project in Malawi, comparing the intention-to-treat (ITT) and the treatment on the treated (TOT) estimates, and discussing the implications for future evaluations. Services offered included a toll-free case management hotline and mobile messaging service for women and children. The evaluation methods included a quasi-experimental pre-test post-test design, consisting of cross-sectional household surveys. A total of 4,230 women were interviewed in the intervention area and 2,463 in the control site. While the intervention did not have any ITT effects of the MNCH outcomes studied, there were large TOT effects. Rigorous evaluation designs can be successfully applied to mHealth pilot projects, helping to understand what works and what does not.