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Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal's commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets.

BackgroundTraditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning.MethodsThe intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted.ResultsLecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site.ConclusionWe demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.

The study aims at synthesizing a simple, cost-effective, selective, and sensitive colorimetric sensor based on chlorophyll-coated silver nanoparticles (Chl-AgNPs) using microwave-assisted method for the determination of Cr(VI) ions in an aqueous medium. The characterization reveals that synthesized nanoparticles are 20–30 nm in size and spherical in shape. The presence of methyl, carboxyl, aldehyde, and ketone groups on the surface of Chl-AgNPs results in the formation of size controlled, well dispersed, and stable silver nanoparticles. The prepared nano-colloidal solution has been used for selective and sensitive determination of Cr(VI) in water samples. The addition of single drop of Chl-AgNPs solution immediately changes the color of water samples containing Cr(VI) to red displaying good sensitivity from 10 to 100 µM and high selectivity even in the presence of other metal ions. The ultraviolet–visible spectra show that in the presence of Cr(VI), the localized surface plasmon resonance (LSPR) band of Chl-AgNPs at 410 nm shifts to 470 nm with a new peak at 357 nm. Furthermore, the absorbance of the LSPR band decreases and the absorbance at 357 nm increases linearly with the concentration of Cr(VI). The functional groups on the surface of nanoparticles bind Cr(VI) on the surface leading to agglomeration and alterations in interparticle distance that are observed as changes in the color and LSPR profile. The limits of detection and quantification for Cr(VI) ions were determined to be 0.62 µM and 1.88 µM, respectively. [ABSTRACT FROM AUTHOR]

Plums are nutraceutically rich and have health-promoting properties. To produce high-quality fruits, it is important to monitor them at harvest. This study illustrates the potential of nondestructive laser-induced fluorescence and confocal micro Raman spectroscopy for monitoring the ripening of plums. The fluorescence profile indicates that as fruit ripens, the intensity of the fluorescence of chlorophyll at 685 and 730 nm decreases with increase in the intensity ratio (F685/F730) of these bands. These observations reveal that as fruit ripens, there is a gradual loss of chlorophyll. In order to get further insight into pigment dynamics, the Raman spectra of the fruit were analyzed. The Raman spectra of pre and post-ripe stages of fruits show that as the fruit ripens, there is a prominent increase in the intensity of anthocyanin bands accompanied by subsequent decrease in the intensity of the carotenoid bands. The spectral analysis reveals that the ripening is associated with a decrease in the chlorophyll and carotenoid content with subsequent increase in anthocyanins. The results of this study highlight the utility of laser-induced fluorescence and confocal micro-Raman spectroscopy for the rapid, sensitive, and nondestructive monitoring of plum ripening. [ABSTRACT FROM AUTHOR]

The present study demonstrates the potential of confocal micro Raman spectroscopy together with data mining approaches such as principal component analysis and hierarchical cluster analysis for the nondestructive monitoring of pigment changes during the ripening of sweet cherries. The exocarp of young, premature, mature, pre-ripe, ripe, and post-ripe stages was analyzed using a 532 nm laser as the excitation source. The analysis of the spectral profile shows that scattering features of the carotenoids, anthocyanins, and other flavonoids can be used for interpreting the events taking place during ripening of the cherries and serve as a maturity and ripening index. The intensities of carotenoids bands decrease with a subsequent increase in the anthocyanin bands in the ripe fruit spectra in comparison to that of mature and pre-ripe stages. The results of the principal component analysis and hierarchical cluster analysis show that the complexity of the spectra is resolved by these approaches facilitating easy interpretation. The obtained results demonstrate the potential of confocal micro Raman spectroscopy with principal component and hierarchical cluster analysis for monitoring the ripening and determining quality attributes of the cherries nondestructively, rapidly, and sensitively. The results and spectral features are useful in conceptualizing fully automated instruments for cherry characterization and postharvest quality control. [ABSTRACT FROM AUTHOR]