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AIM: To design a health system model for scaling-up Kangaroo mother care (KMC) and assess its impact on the population-level coverage and quality of KMC in Uttar Pradesh, India. METHODS: We co-developed the model with mothers and health system stakeholders using human-centred design over multiple cycles of implementation, learning and data-driven refinement. Infants with birthweight <2000 g in the study district were prospectively followed to assess the 'effective coverage' of KMC. Effective coverage referred to the proportion of eligible infants receiving ≥8 h of daily skin-to-skin contact and exclusive breastfeeding. RESULTS: High delivery load facilities were equipped with a KMC Lounge to ensure comfort, respectful care of mothers and high-quality KMC over prolonged periods. Systems to ensure weighing at birth, referral of infants with birthweight <2000 g to KMC facilities, initiation of KMC for all stable low birthweight infants, improving quality of care within KMC facilities and supporting families to continue KMC at home post discharge, were integrated into existing services. KMC was initiated in 93.3% of eligible infants with effective coverage of 52.7% and 64.8% at discharge and 7 days post discharge, respectively. CONCLUSION: The model addressed critical barriers to KMC implementation and adoption, contributing to its scale-up across the state.
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Método Madre-Canguro , Recién Nacido , Lactante , Femenino , Niño , Humanos , Peso al Nacer , Mortalidad Infantil , Cuidados Posteriores , Alta del Paciente , IndiaRESUMEN
This study investigates the role of single-step silica nanofluids as additives to increase CO2 absorption in polymeric solutions for proposed oilfield applications. Using pressure decay approach, the study investigates the applicability of single-step silica nanofluids for CO2 absorption in a high pressure-high temperature (HPHT) cell. Various parameters like nanoparticle size (30-120 nm) and concentration (0.1-1 wt%) were investigated to ascertain the absorption performance of the nanofluids and optimization their application in subsurface applications as carrier fluids for CO2. The solutions under observation (deionized water and silica nanofluids) were pressurized under the desired pressure and temperature inside a stirring pot and the decline in pressure was continuously noted. To comprehensively cover the near-reservoir field conditions, the CO2 absorption was investigated in the pressure range of 5-10 MPa and at temperatures of 30-90 °C. While increasing the nanoparticle concentration (from 0.1 to 1 wt%) increased the CO2 absorption (evident by the sharper decline in pressure), increasing the nanoparticle size reduced the absorption capacity of the nanofluids as a lesser volume of decline in pressure was noted. Furthermore, increasing the temperature of the experimental investigation caused a major reduction (12-19%) in the pressure decay. However, it was also observed that higher pressure (> 7.5 MPa) was detrimental for CO2 absorption (due to its supercritical nature). Adding salt (sodium chloride, NaCl) was found to massively lower (up to 33%) while adding surfactant (sodium dodecyl sulfate, SDS) slightly increased the amount of CO2 absorption (in presence of salinity). Based on the observations of this study, the use of single-step silica nanofluids as CO2 carrier fluids is recommended for oilfield conditions where salinity is less than 4 wt%.
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Dióxido de Carbono , Nanopartículas , Dióxido de Silicio , Difusión , TensoactivosRESUMEN
BACKGROUND: Newborn oil massage is a widespread practice. Vigorous massage with potentially harmful products and forced removal of vernix may disrupt skin barrier integrity. Hospitalized, very-preterm infants treated with sunflower seed oil (SSO) have demonstrated improved growth but community-based data on growth and health outcomes are lacking. OBJECTIVES: We aimed to test whether SSO therapy enhances neonatal growth and reduces morbidity at the population level. METHODS: We conducted an open-label, controlled trial in rural Uttar Pradesh, India, randomly allocating 276 village clusters equally to comparison (usual care) and intervention comprised of promotion of improved massage practices exclusively with SSO, using intention-to-treat and per-protocol mixed-effects regression analysis. RESULTS: We enrolled 13,478 and 13,109 newborn infants in demographically similar intervention and comparison arms, respectively. Adherence to exclusive SSO increased from 22.6% of intervention infants enrolled in the first study quartile to 37.2% in the last quartile. Intervention infants gained significantly more weight, by 0.94 g · kg-1 · d-1 (95% CI: 0.07, 1.82 g · kg-1 · d-1, P = 0.03), than comparison infants by intention-to-treat analysis. Restricted cubic spline regression revealed the largest benefits in weight gain (2-4 g · kg-1 · d-1) occurred in infants weighing <2000 g at birth. Weight gain in intervention infants was higher by 1.31 g · kg-1 · d-1 (95% CI: 0.17, 2.46 g · kg-1 · d-1; P = 0.02) by per-protocol analysis. Morbidities were similar by intention-to-treat analysis but in per-protocol analysis rates of hospitalization and of any illness were reduced by 36% (OR: 0.64; 95% CI: 0.44, 0.94; P = 0.02) and 44% (OR: 0.56; 95% CI: 0.40, 0.77; P < 0.001), respectively, in treated infants. CONCLUSIONS: SSO therapy improved neonatal growth, and reduced morbidities when applied exclusively, across the facility-community continuum of care at the population level. Further research is needed to improve demand for recommended therapy inside hospital as well as in community settings, and to confirm these results in other settings.This trial was registered at www.isrctn.com as ISRCTN38965585 and http://ctri.nic.in as CTRI/2014/12/005282.
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Emolientes , Recien Nacido Prematuro , Humanos , India/epidemiología , Lactante , Recién Nacido , Recién Nacido de muy Bajo Peso , Morbilidad , Aceite de GirasolRESUMEN
Modern oil reservoirs exhibit high macro-scale heterogeneity, i.e., presence of shales and clays, which complicate the implementation of conventional enhanced oil recovery (EOR) practices. Hence, there is a need to investigate new class of EOR methods which not only improve recovery of oil from reservoir but also reduce formation damage. Thus, in this study, synthetic smart brines of varying salinity were formulated to investigate carbon utilization in shaly-sandstone for oil recovery and sequestration applications. To prepare shaly-sandstone samples, shale content in sand varied between 0 and 25 wt%. The addition of shale reduced porosity and permeability of sand-packs, and porosity ~ 25 and permeability < 10 md were measured for a combination of 75% sand + 25% shale which were originally 38% and 692 md for 100% sand + 0% shale. The oil recovery experiments were performed at temperature ≈ 40 °C and ambient pressure. The impact of shale content was insignificant on CO2-based oil recovery resulting its value remained nearly constant (5-7%). Smart saline water (SSW) solutions were prepared through the dilution of formation water (FW) of typical oilfield salinity and used these SSW solutions in investigating shale swelling and interfacial tension with CO2. Compared to other SSW solutions, SSW-2 (1 part FW/9 part water: 1/10th of FW) demonstrated superior control on mitigating shale swelling (by 67%) and reduce interfacial tension (by 30%) when compared to FW. Moreover, it helped to mobilize higher amount of oil (50% OOIP) from sand-pack (80% sand + 20% shale) in which conventional water flood failed to perform, indicating its viability for EOR from heterogeneous reservoir. In addition, SSW solutions promoted use of carbonated (CO2-enriched) water injection for oil recovery from sandstone exhibiting high shale content of 20% as over 5-8% higher oil recovery was obtained compared to conventional water flooding. Comparative performance of water flooding, salinity water-alternating CO2 flooding and carbonated smart water injection in heterogeneous sandstone.
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Dióxido de Carbono , Inundaciones , Dióxido de Carbono/análisis , Minerales , Yacimiento de Petróleo y Gas , ArenaRESUMEN
OBJECTIVES: Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. DESIGN: This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. PARTICIPANTS: 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. MAIN OUTCOME MEASURES: The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. RESULTS: Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%-86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%-65% of infants in all sites, except Oromia (38%) and Karnataka (36%). CONCLUSIONS: This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers' conviction that KMC is the standard of care, women's and families' acceptance of KMC, and changes in infrastructure, policy, skills and practice. TRIAL REGISTRATION NUMBERS: ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.
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Método Madre-Canguro , Cuidados Posteriores , Etiopía , Femenino , Humanos , India , Recién Nacido , Alta del PacienteRESUMEN
BACKGROUND: Hospitalized preterm infants with compromised skin barrier function treated topically with sunflower seed oil (SSO) have shown reductions in sepsis and neonatal mortality rate (NMR). Mustard oil and products commonly used in high-mortality settings may possibly harm skin barrier integrity and enhance risk of infection and mortality in newborn infants. We hypothesized that SSO therapy may reduce NMR in such settings. METHODS AND FINDINGS: This was a population-based, cluster randomized, controlled trial in 276 clusters in rural Uttar Pradesh, India. All newborn infants identified through population-based surveillance in the study clusters within 7 days of delivery were enrolled from November 2014 to October 2016. Exclusive, 3 times daily, gentle applications of 10 ml of SSO to newborn infants by families throughout the neonatal period were recommended in intervention clusters (n = 138 clusters); infants in comparison clusters (n = 138 clusters) received usual care, such as massage practice typically with mustard oil. Primary analysis was by intention-to-treat with NMR and post-24-hour NMR as the primary outcomes. Secondary analysis included per-protocol analysis and subgroup analyses for NMR. Regression analysis was adjusted for caste, first-visit weight, delivery attendant, gravidity, maternal age, maternal education, sex of the infant, and multiple births. We enrolled 13,478 (52.2% male, mean weight: 2,575.0 grams ± standard deviation [SD] 521.0) and 13,109 (52.0% male, mean weight: 2,607.0 grams ± SD 509.0) newborn infants in the intervention and comparison clusters, respectively. We found no overall difference in NMR in the intervention versus the comparison clusters [adjusted odds ratio (aOR) 0.96, 95% confidence interval (CI) 0.84 to 1.11, p = 0.61]. Acceptance of SSO in the intervention arm was high at 89.3%, but adherence to exclusive applications of SSO was 30.4%. Per-protocol analysis showed a significant 58% (95% CI 42% to 69%, p < 0.01) reduction in mortality among infants in the intervention group who were treated exclusively with SSO as intended versus infants in the comparison group who received exclusive applications of mustard oil. A significant 52% (95% CI 12% to 74%, p = 0.02) reduction in NMR was observed in the subgroup of infants weighing ≤1,500 g (n = 589); there were no statistically significant differences in other prespecified subgroup comparisons by low birth weight (LBW), birthplace, and wealth. No severe adverse events (SAEs) were attributable to the intervention. The study was limited by inability to mask allocation to study workers or participants and by measurement of emollient use based on caregiver responses and not actual observation. CONCLUSIONS: In this trial, we observed that promotion of SSO therapy universally for all newborn infants was not effective in reducing NMR. However, this result may not necessarily establish equivalence between SSO and mustard oil massage in light of our secondary findings. Mortality reduction in the subgroup of infants ≤1,500 g was consistent with previous hospital-based efficacy studies, potentially extending the applicability of emollient therapy in very low-birth-weight (VLBW) infants along the facility-community continuum. Further research is recommended to develop and evaluate therapeutic regimens and continuum of care delivery strategies for emollient therapy for newborn infants at highest risk of compromised skin barrier function. TRIAL REGISTRATION: ISRCTN Registry ISRCTN38965585 and Clinical Trials Registry-India (CTRI/2014/12/005282) with WHO UTN # U1111-1158-4665.
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Emolientes/uso terapéutico , Mortalidad Infantil , Aceite de Girasol/uso terapéutico , Administración Tópica , Adulto , Análisis por Conglomerados , Femenino , Humanos , India/epidemiología , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Masaje , Planta de la Mostaza , Aceites de Plantas/uso terapéutico , Crema para la Piel/uso terapéutico , Factores Socioeconómicos , Aceite de Girasol/administración & dosificaciónRESUMEN
Previous studies have shown insufficient dispersion and thermal stability of nanofluids for high-temperature carbon capture and storage applications. Compared to the other NPs, TiO2 nanofluids exhibit superior stability due to their high zeta potential. In previous studies, TiO2 nanofluids have shown superior performance in heat transfer and cooling applications along with importing the stability of other nanofluids like SiO2 in form of nanocomposites. Therefore, in this study, a nanofluid formulation consisting of titania nanofluid in a base solution of ethylene glycol (EG) with different co-stabilizers such as surfactants was synthesized for better dispersion stability, enhanced electrical, and rheological properties especially for the use in high-temperature industrial applications which include carbon capture and storage along with enhanced oil recovery. The formulated nanofluid was investigated for stability using dynamic light scattering (DLS) study and electrical conductivity. Additionally, the formulated nanofluid was also examined for thermal stability at high temperatures using an electrical conductivity study followed by rheological measurements at 30 and 90 °C. At a high temperature, the shear-thinning behavior of EG was found highly affected by shear rate; however, this deformation was controlled using TiO2 nanoparticles (NPs). Furthermore, the role of surfactant was also investigated on dispersion stability, electrical conductivity followed by viscosity results, and it was found that the nanofluid is superior in presence of anionic surfactant sodium dodecyl sulfate (SDS) as compared to nonionic surfactant Triton X-100 (TX-100). The inclusion of ionic surfactant provides a charged layer of micelles surrounding the core of a NP and it produced additional surface potential. Consequently, it increases the repulsive force between two adjacent NPs and renders a greater stability to nanofluid while nonionic surfactant allowed monomers to adsorb on the surface of NP via hydrophobic interaction and enhances the short-range interparticle repulsion, to stabilize nanofluid. This makes titania nanofluid suitable for widespread high-temperature applications where conventional nanofluids face limitations. Finally, the application of the synthesized titania nanofluids was explored for the capture and transport of CO2 where the inclusion of the anionic surfactant was found to increase the CO2 capturing ability of titania nanofluids by 140-220% (over the conventional nanofluid) while also showing superior retention at both investigated temperatures. Thus, the study promotes the role of novel surfactant-treated titania nanofluids for carbon removal and storage and recommends their applications involving carbonated fluid injection (CFI) to carbon utilization in oilfield applications.
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Nanopartículas , Tensoactivos , Carbono , Reología , Dióxido de SilicioRESUMEN
INTRODUCTION: Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. METHODS AND ANALYSIS: This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: 'pre-KMC facility'-to maximise the number of newborns getting to a facility that provides KMC; 'KMC facility'-for initiation and maintenance of KMC; and 'post-KMC facility'-for continuation of KMC at home. Stable infants with birth weight<2000 g and born in the catchment population of the study KMC facilities would form the eligible population. The primary outcome will be coverage of KMC in the preceding 24 hours and will be measured at discharge from the KMC facility and 7 days after hospital discharge. ETHICS AND DISSEMINATION: Ethics approval was obtained in all the project sites, and centrally by the Research Ethics Review Committee at the WHO. Results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and global level dissemination. STUDY STATUS: WHO approved protocol: V.4-12 May 2016-Protocol ID: ERC 2716. Study implementation beginning: April 2017. Study end: expected March 2019. TRIAL REGISTRATION NUMBER: Community Empowerment Laboratory, Uttar Pradesh, India (ISRCTN12286667); St John's National Academy of Health Sciences, Bangalore, India and Karnataka Health Promotion Trust, Bangalore, India (CTRI/2017/07/008988); Society for Applied Studies, Delhi (NCT03098069); Oromia, Ethiopia (NCT03419416); Amhara, SNNPR and Tigray, Ethiopia (NCT03506698).