| 1. |
- Sbarra, AN, et al.
(author)
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Mapping routine measles vaccination in low- and middle-income countries
- 2021
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In: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 589:7842, s. 415-
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Journal article (peer-reviewed)abstract
- The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.
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| 2. |
- Graetz, N, et al.
(author)
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Mapping disparities in education across low- and middle-income countries
- 2020
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In: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 577:77907789, s. 235-238
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Journal article (peer-reviewed)abstract
- Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12–14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.
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| 3. |
- Ding, X., et al.
(author)
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A study of the cutting performance of poly-crystalline oxygen free copper with single crystalline diamond micro-tools
- 2012
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In: Precision engineering. - : Elsevier BV. - 0141-6359 .- 1873-2372. ; 36:1, s. 141-152
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Journal article (peer-reviewed)abstract
- A study was carried out to investigate the crystallographic effects on the performance of cutting poly-crystalline oxygen free copper C10200 (OFC) with single crystalline diamond (SCD) micro-tools. At both large cutting depth and cross-feed rate, as the micro-tool traversed a grain with a crystallographic orientation less favorable for a stable machining process, the work material in front of the rake face was found to be severely deformed. This may lead to a reduced shear angle, thick chip, striation at the back of the chip, high cutting forces, degraded machined surface and the possibility of burr formation. The results showed minimal variations in the machined surface integrity and cutting forces compared to cut amorphous NiP plating with micro-tools. For a high cutting depth, burrs were also observed due to material deformation and pile-up occurring at the groove edges since the localized stress probably built up in front of the rake face. Cutting strategies were demonstrated to improve the performance of cutting OFC with micro-tools and to generate high aspect ratio micro-pillar arrays.
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| 4. |
- Ghassemali, E., et al.
(author)
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Investigation of microstructure and hardness in microfoming of pure copper pins
- 2010
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In: Key Engineering Materials. - 1013-9826 .- 1662-9795. ; 447-448, s. 381-385
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Journal article (peer-reviewed)abstract
- Microforming is defined as the process of production of metallic micro-parts with sub-millimeter dimension. There is as strong interaction between the scale of the microstructure and the size of the part affecting material flow, the so-called "size effect" in microforming processes. Conventional forming rules cannot be directly applied to the micro-scale forming. To better understand the implications for part geometry and properties, further investigation of the material flow related events is necessary. The aim of this work is to investigate microstructural evolution of pure copper during a micro-extrusion process - for production of micro-pins with diameters varying from 300 to 800Όm - by means of optical microscope (OM). Qualitative strain gradient distribution could be observed by those pictures. The results showed that change of micro-pins diameter and die angle affect the microstructure and strain distribution of the final product remarkably, that affect the mechanical properties of the pin formed. Furthermore, microhardness results were consistent with the microstructural observations. © (2010) Trans Tech Publications.
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| 5. |
- Goi, K. L. S., et al.
(author)
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Elastic modulus of sintered porous Ti-Si-Zr, using activation by Ti-Si mechanically alloyed powder and TiH2 powder
- 2008
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In: Materials Science & Engineering. - : Elsevier BV. - 0921-5093 .- 1873-4936. ; 475:1-2, s. 45-51
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Journal article (peer-reviewed)abstract
- A novel biomaterial based on Ti-Si-Zr was developed using the sintering process with a composition targeting at a bulk modulus in the same range as that of human bone, i.e. 10-30 GPa. Control of porosity should also be possible to allow for the promotion osseointegration. The sintering procedure involves the use of mechanically alloyed Ti-Si-powder, and TiH2, to promote bonding, but not consolidation. The effect of porosity on the bulk modulus using compression testing is investigated. The influence of sintering temperature, heating rate, and amount and size of the TiH2-activator on porosity are also investigated. The achievable bulk modulus was in the range of 20-55 GPa at porosity levels ranging from 16% to 54%. Porosity had a profound influence on the bulk modulus, and the choice of appropriate processing conditions enables the creation of an engineered porosity and bulk modulus primarily by varying the sintering temperature and the size of the TiH2-powder particles. © 2007.
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| 6. |
- Green, Dido, et al.
(author)
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Sensory Processing Difficulties in Opsoclonus-Myoclonus Syndrome
- 2016
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In: Journal of Child Neurology. - : Sage Publications. - 0883-0738 .- 1708-8283. ; 31:8, s. 965-970
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Journal article (peer-reviewed)abstract
- Opsoclonus-myoclonus syndrome is a rare but serious neurological condition resulting in loss of control of eye movements, often accompanied by difficulties in posture and movement control with reports of sensory sensitivities potentially impacting on behavior. This pilot study characterizes the presence of atypical sensory behaviors in opsoclonus-myoclonus syndrome through questionnaire survey of a cohort of families. The Short Sensory Profile, Vineland Adaptive Behavior Scale, and Developmental Behaviour Checklist were distributed to 30 families; 16 were returned anonymously. Atypical sensory behaviors were identified in a large proportion (62.5%). Children reported as being more anxious showed greater sensitivity to auditory stimuli, U(14) 11, P =.026. This is consistent with recent recognition of more extensive disease neurocognitive effects in Opsoclonus-myoclonus syndrome. Further research is needed to increase understanding of the complex pathology of this disease and to provide indicators for sensory and behavioral as well as pharmacological interventions.
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| 7. |
- Lim, Esther Li Ping, et al.
(author)
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An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes
- 2023
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In: International Journal of Integrated Care. - : Ubiquity Press. - 1568-4156. ; 23:4
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Journal article (peer-reviewed)abstract
- Introduction: The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners’ PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of “caring about the service user as a whole person” and the “sharing of power, control and information”. Methods: A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points – before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time. Results: A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to “care” than to “share power” with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3). Conclusion: Training as a specific intervention, appeared to have potential to increase health practitioners’ person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.
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| 8. |
- Lim, E. L. P., et al.
(author)
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How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore : a realist evaluation
- 2022
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:12
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Journal article (peer-reviewed)abstract
- OBJECTIVES: The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore. DESIGN: An organisational case study using a realist evaluation approach drawing on Greenhalgh et al (2004)'s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities. SETTING: SingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore. PARTICIPANTS: Policy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis. RESULTS: Singapore's ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together. CONCLUSIONS: The enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN's success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide.
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