Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022

Breast cancer screening (BCS) and cervical cancer screening (CCS) are integral parts of initiatives to reduce the burden associated with these diseases. In this context, we aimed to determine factors associated with BCS and CCS uptake among Nepalese women aged 30 to 49 years using data from the Nepal Demographic Health Survey (NDHS) 2022. We performed a weighted analysis to account complex survey design of the NDHS 2022. We employed univariable and multivariable logistic regression to determine factors associated with the uptake of BCS and CCS and results were presented as crude odds ratio and adjusted odds ratio (AOR) along with 95% confidence interval (CI). The uptake of BCS and CCS among Nepalese women aged 30 to 49 years were 6.5% and 11.4% respectively. Women from Terai compared to mountain region (AOR = 0.54, 95%CI: 0.31, 0.93) and those engaged in agriculture compared to non-working (AOR = 0.59, 95%CI: 0.42, 0.82) women had lower odds of BCS uptake. Conversely, Dalit women compared to Brahmin/Chhetri (AOR = 2.08, 95%CI: 1.37, 3.16), and women with basic (AOR = 1.49, 95%CI: 1.04, 2.13), secondary (AOR = 1.96, 95%CI: 1.33, 2.88), and higher education (AOR = 2.80, 95% CI: 1.51, 5.19) compared to those with no education had higher odds of BCS uptake. Women from rural areas (AOR = 0.76, 95%CI: 0.61, 0.96), and those living in Bagmati (AOR = 2.16, 95% CI: 1.44, 3.23) and Gandaki (AOR = 2.09, 95%CI: 1.40, 3.14) provinces had higher odds of CCS uptake compared to their urban counterparts and those living in Koshi province, respectively. The odds of CCS increased with age (AOR = 1.06, 95%CI: 1.04, 1.08). Women with secondary education (AOR = 1.47, 95%CI: 1.06, 2.04) had higher odds of CCS uptake compared to those without education. Similarly, married women (AOR = 8.24, 95%CI: 1.03, 66.21), and those with health insurance (AOR = 1.41, 95%CI: 1.08, 1.83) had higher odds of CCS. In conclusion, the uptake of both BCS and CCS was relatively poor among Nepalese women indicating a need for targeted and tailored intervention to increase BCS and CCS uptake.

Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis

Background

Endoscopic ultrasound (EUS)-guided cystogastrostomy is the treatment of choice for managing symptomatic pancreatic fluid collections (PFC). However, studies on the number of stents for optimal drainage of PFCs are limited. Hence, the present study was conducted to compare the outcome of single versus two double-pigtail stents for endoscopic drainage of PFCs.

Methods

This is a single-center, retrospective analysis of patients undergoing endoscopic drainage of PFCs with minimal necrosis (pseudocyst or walled-off necrosis with <30% solid content) at a tertiary center in South India from October 2020 to October 2022. Post-procedure, patients were followed up for clinical improvement, and stents were removed after documentation of cyst size reduction on imaging.

Results

Sixty-three patients (82.5% males, median age: 34 years) fulfilling the selection criteria were included. For single stent placement (n = 47), stents of size 8.5 Fr or 10 Fr were used, while for placement of two stents (n = 16), 7 Fr stents were used. The technical success rate was 100%. Intraprocedural and early postprocedural adverse events (all mild to moderate) were comparable between the groups (17.0% with single stent vs. 25.0% with two stents, p = NS). Clinical success was achieved in 93.6% of patients, with no difference between both groups. Three patients in the single stent group required additional procedures. All patients underwent successful stent removal after a median follow-up of 14 weeks.

Conclusion

A single pigtail stent of 8.5 Fr or 10 Fr size for EUSguided cystogastrostomy provides efficacy and safety similar to that of two stents.

Children in All Policies (CAP) 2030 Citizen Science for Climate Change Resilience: a cross-sectional pilot study engaging adolescents to study climate hazards, biodiversity and nutrition in rural Nepal

Background

Young people will suffer most from climate change yet are rarely engaged in dialogue about it. Citizen science offers a method for collecting policy-relevant data, whilst promoting awareness and capacity building. We tested the feasibility and acceptability of engaging Nepalese adolescents in climate change and health-related citizen science.

Methods

We purposively selected 33 adolescents from two secondary schools in one remote and one relatively accessible district of Nepal. We contextualised existing apps and developed bespoke apps to survey climate hazards, waste and water management, local biodiversity, nutrition and sociodemographic information. We analysed and presented quantitative data using a descriptive analysis. We captured perceptions and learnings via focus group discussions and analysed qualitative data using thematic analysis. We shared findings with data collectors using tables, graphs, data dashboards and maps.

Results

Adolescents collected 1667 biodiversity observations, identified 72 climate-change related hazards, and mapped 644 geolocations. They recorded 286 weights, 248 heights and 340 dietary recalls. Adolescents enjoyed learning how to collect the data and interpret the findings and gained an appreciation of local biodiversity which engendered 'environmental stewardship'. Data highlighted the prevalence of failing crops and landslides, revealed both under- and over-nutrition and demonstrated that children consume more junk foods than adults. Adolescents learnt about the impacts of climate change and the importance of eating a diverse diet of locally grown foods. A lack of a pre-established sampling frame, multiple records of the same observation and spurious nutrition data entries by unsupervised adolescents limited data quality and utility. Lack of internet access severely impacted feasibility, especially of apps which provide online feedback.

Conclusions

Citizen science was largely acceptable, educational and empowering for adolescents, although not always feasible without internet access. Future projects could improve data quality and integrate youth leadership training to enable climate-change advocacy with local leaders.

Readiness of health facilities to provide services related to non-communicable diseases in Nepal: evidence from nationally representative Nepal Health Facility Survey 2021

OBJECTIVE

To assess the readiness of public and private health facilities (HFs) in delivering services related to non-communicable diseases (NCDs) in Nepal.

METHODS

We analysed data from nationally representative Nepal Health Facility Survey 2021 to determine the readiness of HFs for cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs) and mental health (MH)-related services using Service Availability and Readiness Assessment Manual of the WHO. Readiness score was measured as the average availability of tracer items in per cent, and HFs were considered 'ready' for NCDs management if they scored ≥70 (out of 100). We performed weighted univariate and multivariable logistic regression to determine the association of HFs readiness with province, type of HFs, ecological region, quality assurance activities, external supervision, client's opinion review and frequency of meetings in HFs.

RESULTS

The overall mean readiness score of HFs offering CRDs, CVDs, DM and MH-related services was 32.6, 38.0, 38.4 and 24.0, respectively. Guidelines and staff training domain had the lowest readiness score, whereas essential equipment and supplies domain had the highest readiness score for each of the NCD-related services. A total of 2.3%, 3.8%, 3.6% and 3.3% HFs were ready to deliver CRDs, CVDs, DM and MH-related services, respectively. HFs managed by local level were less likely to be ready to provide all NCD-related services compared with federal/provincial hospitals. HFs with external supervision were more likely to be ready to provide CRDs and DM-related services and HFs reviewing client's opinions were more likely to be ready to provide CRDs, CVDs and DM-related services.

CONCLUSION

Readiness of the HFs managed by local level to provide CVDs, DM, CRDs and MH-related services was relatively poor compared with federal/provincial hospitals. Prioritisation of policies to reduce the gaps in readiness and capacity strengthening of the local HFs is essential for improving their overall readiness to provide NCD-related services.

Contextual factors affecting the implementation of an anemia focused virtual counseling intervention for pregnant women in plains Nepal: a mixed methods process evaluation

BACKGROUND

Anemia is estimated to cause 115,000 maternal deaths each year. In Nepal, 46% of pregnant women have anemia. As part of an integrated anemia-prevention strategy, family engagement and counseling of pregnant women can increase compliance to iron folic acid tablets, but marginalized women often have lower access to these interventions. We implemented the VALID (Virtual antenatal intervention for improved diet and iron intake) randomized controlled trial to test a family-focused virtual counseling mHealth intervention designed to inclusively increase iron folic acid compliance in rural Nepal; here we report findings from our process evaluation research.

METHODS

We conducted semi structured interviews with 20 pregnant women who had received the intervention, eight husbands, seven mothers-in-laws and four health workers. We did four focus groups discussions with intervention implementers, 39 observations of counseling, and used routine monitoring data in our evaluation. We used inductive and deductive analysis of qualitative data, and descriptive statistics of monitoring data.

RESULTS

We were able to implement the intervention largely as planned and all participants liked the dialogical counseling approach and use of story-telling to trigger conversation. However, an unreliable and inaccessible mobile network impeded training families about how to use the mobile device, arrange the counseling time, and conduct the counseling. Women were not equally confident using mobile devices, and the need to frequently visit households to troubleshoot negated the virtual nature of the intervention for some. Women's lack of agency restricted both their ability to speak freely and their mobility, which meant that some women were unable to move to areas with better mobile reception. It was difficult for some women to schedule the counseling, as there were competing demands on their time. Family members were difficult to engage because they were often working outside the home; the small screen made it difficult to interact, and some women were uncomfortable speaking in front of family members.

CONCLUSIONS

It is important to understand gender norms, mobile access, and mobile literacy before implementing an mHealth intervention. The contextual barriers to implementation meant that we were not able to engage family members as much as we had hoped, and we were not able to minimize in-person contact with families. We recommend a flexible approach to mHealth interventions which can be responsive to local context and the situation of participants. Home visits may be more effective for those women who are most marginalized, lack confidence in using a mobile device, and where internet access is poor.

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.

Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID

INTRODUCTION

Despite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would increase compliance to IFA tablets during the COVID-19 pandemic compared with antenatal care (ANC alone.

METHODS AND ANALYSIS

This non-blinded individually randomised controlled trial in the plains of Nepal has two study arms: (1) control: routine ANC; and (2) 'Virtual' antenatal counselling plus routine ANC. Pregnant women are eligible to enrol if they are married, aged 13-49 years, able to respond to questions, 12-28 weeks' gestation, and plan to reside in Nepal for the next 5 weeks. The intervention comprises two virtual counselling sessions facilitated by auxiliary nurse midwives at least 2 weeks apart in mid-pregnancy. Virtual counselling uses a dialogical problem-solving approach with pregnant women and their families. We randomised 150 pregnant women to each arm, stratifying by primigravida/multigravida and IFA consumption at baseline, providing 80% power to detect a 15% absolute difference in primary outcome assuming 67% prevalence in control arm and 10% loss-to-follow-up. Outcomes are measured 49-70 days after enrolment, or up to delivery otherwise.

PRIMARY OUTCOME

consumption of IFA on at least 80% of the previous 14 days.

SECONDARY OUTCOMES

dietary diversity, consumption of intervention-promoted foods, practicing ways to enhance bioavailability and knowledge of iron-rich foods. Our mixed-methods process evaluation explores acceptability, fidelity, feasibility, coverage (equity and reach), sustainability and pathways to impact. We estimate costs and cost-effectiveness of the intervention from a provider perspective. Primary analysis is by intention-to-treat, using logistic regression.

ETHICS AND DISSEMINATION

We obtained ethical approval from Nepal Health Research Council (570/2021) and UCL ethics committee (14301/001). We will disseminate findings in peer-reviewed journal articles and by engaging policymakers in Nepal.

TRIAL REGISTRATION NUMBER

ISRCTN17842200.

Factors associated with access to sexual and reproductive health services among women with disabilities in Nepal

Aim

The aim of the study is to investigate the relationships between social determinants and disability status and access and use of sexual and reproductive health services among women with disabilities in Nepal.

Materials ad methods

This study used data on women with disability from the Multiple Indicator Cluster Survey (MICS) of 2019, in which 13,320 women and 290 women with disabilities were included for the analysis. We used bivariate analysis to compare the social determinants with disability status and multivariate logistic regression to determine the association between social determinants and access and use of sexual and reproductive health services among women with disabilities.

Findings

The findings showed, in comparison with non-disabled women, women with disabilities had low education, low economic status, low media exposure and low access to sexual and reproductive health. On provincial level, those from Madesh [AOR = 0.22 (95%CI:0.06, 0.76)] and Lumbini [AOR = 0.24 (95%CI:0.06,0.88)] had lower attitude to violence. The usage of family planning (FP) methods among women with disabilities in Karnali [AOR = 3.57 (95% CI: 1.42-13.22)] and Sudurpashchim [AOR = 1.05 (95% CI: 1.01-1.071)] was higher than those in Province 1. Women with disabilities with secondary education were more than nine times [AOR = 9.28(95%CI:2.67,32,26)] and primary education had more than three times [AOR = 3.59 (95%CI:1.07, 12.02)] of knowledge on HIV/AIDS compared to those of no education. The odds of being tested for HIV/AIDS among women with disabilities with secondary education was more than eight times [AOR = 8.8 (95% CI:2.23-34.6)] than those of no education.

Conclusion

This study provides noteworthy findings that women with disabilities have poor socioeconomic status, high-risk behavior, and low access to sexual and reproductive health services in Nepal. This study highlights the significance of actions needed to address sexual and reproductive health services in Nepal that unfairly impact women with disabilities.

Application of machine learning to predict transport modes from GPS, accelerometer, and heart rate data

BACKGROUND

There has been an increased focus on active transport, but the measurement of active transport is still difficult and error-prone. Sensor data have been used to predict active transport. While heart rate data have very rarely been considered before, this study used random forests (RF) to predict transport modes using Global Positioning System (GPS), accelerometer, and heart rate data and paid attention to methodological issues related to the prediction strategy and post-processing.

METHODS

The RECORD MultiSensor study collected GPS, accelerometer, and heart rate data over seven days from 126 participants living in the Ile-de-France region. RF models were built to predict transport modes for every minute (ground truth information on modes is from a GPS-based mobility survey), splitting observations between a Training dataset and a Test dataset at the participant level instead at the minute level. Moreover, several window sizes were tested for the post-processing moving average of the predicted transport mode.

RESULTS

The minute-level prediction rate of being on trips vs. at a visited location was 90%. Final prediction rates of transport modes ranged from 65% for public transport to 95% for biking. Using minute-level observations from the same participants in the Training and Test sets (as RF spontaneously does) upwardly biases prediction rates. The inclusion of heart rate data improved prediction rates only for biking. A 3 to 5-min bandwidth moving average was optimum for a posteriori homogenization.

CONCLUSION

Heart rate only very slightly contributed to better predictions for specific transport modes. Moreover, our study shows that Training and Test sets must be carefully defined in RF models and that post-processing with carefully chosen moving average windows can improve predictions.

Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women's groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal

BACKGROUND

Anaemia in pregnancy remains prevalent in Nepal and causes severe adverse health outcomes.

METHODS

This non-blinded cluster-randomised controlled trial in the plains of Nepal has two study arms: (1) Control: routine antenatal care (ANC); (2) Home visiting, iron supplementation, Participatory Learning and Action (PLA) groups, plus routine ANC. Participants, including women in 54 non-contiguous clusters (mean 2582; range 1299-4865 population) in Southern Kapilbastu district, are eligible if they consent to menstrual monitoring, are resident, married, aged 13-49 years and able to respond to questions. After 1-2 missed menses and a positive pregnancy test, consenting women < 20 weeks' gestation, who plan to reside locally for most of the pregnancy, enrol into trial follow-up. Interventions comprise two home-counselling visits (at 12-21 and 22-26 weeks' gestation) with iron folic acid (IFA) supplement dosage tailored to women's haemoglobin concentration, plus monthly PLA women's group meetings using a dialogical problem-solving approach to engage pregnant women and their families. Home visits and PLA meetings will be facilitated by auxiliary nurse midwives. The hypothesis is as follows: Haemoglobin of women at 30 ± 2 weeks' gestation is ≥ 0.4 g/dL higher in the intervention arm than in the control. A sample of 842 women (421 per arm, average 15.6 per cluster) will provide 88% power, assuming SD 1.2, ICC 0.09 and CV of cluster size 0.27. Outcomes are captured at 30 ± 2 weeks gestation. Primary outcome is haemoglobin concentration (g/dL). Secondary outcomes are as follows: anaemia prevalence (%), mid-upper arm circumference (cm), mean probability of micronutrient adequacy (MPA) and number of ANC visits at a health facility. Indicators to assess pathways to impact include number of IFA tablets consumed during pregnancy, intake of energy (kcal/day) and dietary iron (mg/day), a score of bioavailability-enhancing behaviours and recall of one nutrition knowledge indicator. Costs and cost-effectiveness of the intervention will be estimated from a provider perspective. Using constrained randomisation, we allocated clusters to study arms, ensuring similarity with respect to cluster size, ethnicity, religion and distance to a health facility. Analysis is by intention-to-treat at the individual level, using mixed-effects regression.

DISCUSSION

Findings will inform Nepal government policy on approaches to increase adherence to IFA, improve diets and reduce anaemia in pregnancy.

TRIAL REGISTRATION

ISRCTN 12272130 .

Structural correlation to ferroelectric order, non-Griffiths like phase and magnetocaloric effect in YbCrO4

We report a ferroelectric order around ∼99 K (T_FE), which is considerably above the long range ferrimagnetic order at 25 K (T_N). The value of saturation electric polarization is considerable as ∼570μC m^-2for a poling field of 5 kV cm^-1. The ferroelectric order is associated with a significant magnetoelectric coupling below ∼90 K. A weak signature ofT_FEis observed in the dielectric constant, which is associated with a linear magnetodielectric response at 18 K(<TN). A transition to a polar structure has been correlated with the occurrence of ferroelectric order. A non-Griffiths like phase is observed around ∼48 K, which is also linked with the structural distortion. A reasonable value of the magnetic entropy change of 5.07 J Kg^-1 K^-1is noted atT_Nfor a change in field of 50 kOe, which involves a strong magnetoelastic coupling. The results indicate considerable structural instabilities, which is linked with the observed multifunctional properties of YbCrO₄.

180 NURSING HOMES DURING THE COVID-19 PANDEMIC: A NARRATIVE REVIEW OF CHALLENGES AND RESPONSES

Background

COVID-19 has caused unprecedented challenges in nursing homes. In this narrative review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges.

Methods

The MeSH terms ‘Nursing homes’ and ‘COVID-19’ were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes.

Results

The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents’ well-being, and technological innovations.

Conclusion

COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.

Use of personal protective equipment among waste workers of Sisdol landfill site of Nepal

Introduction: Solid waste management is a major issue in Nepal with Kathmandu valley generating the highest amount of solid waste. After recovery, the solid waste generated in Kathmandu valley is transferred to the Sisdol landfill site. There are waste workers in Sisdol landfill site who sustain their livelihood by collecting recyclables from those wastes. Personal protective equipment (PPE) is necessary to protect the frontline waste workers against infection. In addition, the waste workers need to know the proper usage of PPE in order to protect themselves from contamination. This study aimed to assess the awareness and proper usage of PPE along with the challenges faced by the waste workers at Sisdol landfill site. Methods: A descriptive cross-sectional study was conducted to collect data from landfill waste workers of Sisdol located at Kakani Rural Municipality in Nuwakot district of Nepal. A convenience sampling method was used based on the availability of landfill waste workers on that day and their willingness to participate. The data was collected using the structured questionnaire and personal interview of available waste workers. Results: The study comprised of 65% female and 35% male waste workers. The highest percentage of waste workers belong to 27-37 age group occupying 43% of total respondents.  Around 92% waste workers had participated in any orientation/training or session related to PPE and its usage. About 60% landfill waste workers were found only using mask and gloves. Conclusion: There is small number of waste workers who wish to wear full set of PPE. Most of them only like to wear mask and gloves. The gender, age group and the education level of waste workers had no association with the usage of PPE during the work.

Significant magneto-elastic coupling at Griffiths-like phase boundaries in low dimensional oxides,ASb2O6(ANi and Mn)

The compounds, NiSb₂O₆(NSO) and MnSb₂O₆(MSO) attract the community for the quasi one-dimensional and layered structure composed of Ni²⁺and Mn²⁺, which orders antiferromagnetically atT_N= 6.7 and 12 K, respectively. Here, we report the Griffiths-like phase much aboveT_Nin the range of 37-85 K and 25-80 K for NSO and MSO, respectively. The dc magnetization results indicate the Griffiths-like phase, following the modified Curie-Weiss law. The magneto-capacitive responses for both the compounds show anomalies at the onset of the Griffiths-like phase. Intriguingly, the low temperature synchrotron diffraction results are conclusive for determining the singularities for both the compounds. Interplay between the low-dimensionality, magnetic frustration, and magneto-elastic coupling correlates the observed short range ordered state, which is suggested as a Griffiths-like phase, aboveT_Nfor both the compounds.

Interplay between positive magnetoresistance and thermoelectric properties by tuning carrier concentration in Sb2-x Sn x Te3 (x ⩽ 0.05) crystals

We report transport properties of Sb2-x Sn x Te3 (x ⩽ 0.05) single crystals, where the tuning of the charge carrier densities via Sn doping significantly improves the magnetoresistance (MR) and the thermoelectric (TE) properties. The MR increases significantly at 2 K for x = 0.01, which reduces considerably with further Sn doping at x = 0.05. The MR results below 90 K for x = 0.01 satisfy the semi-classical two-band approach of Kohler's rule, which does not satisfy the MR results for x = 0.05. At 300 K, the Seebeck coefficient (S) is positive and small for x = 0.01 and it changes the sign with the further increase in Sn doping at x = 0.05 at 300 K. The value of |S| is considerable with an enhancement of the thermoelectric power factor compared to the value for x = 0.01 at 300 K. Analysis of the Hall conductivity indicates the interplay between carrier mobilities and densities, leading to the tuning of MR and TE properties with Sn doping. These results demonstrate that the p-type Sb2Te3 becomes n-type with a suitable doping engineering.

Unveiling spin-glass transition and antiferromagnetic order by μSR studies in spin-chain Sm2BaNiO5

We report the zero-field and longitudinal field muon spin relaxation studies in a spin-chain compound Sm₂BaNiO₅. Two magnetic transitions, that have not been previously detected by the heat capacity and magnetization measurements, are confirmed at 46 and 9 K. The antiferromagnetic order is suggested at 46 K. Analysis of the muon spin polarization unveils the spin-glass transition at 9 K. Time-field scaling relation of the muon spin polarization verifies the spin-spin autocorrelation function following the cut-off power law, which is approximated by the Ogielski form, as employed numerically for characterizing the spin-glasses.

Coexisting exchange bias effect and ferroelectricity in geometrically frustrated ZnCr2O4

Concomitant occurrence of exchange bias effect and ferroelectric order is revealed in antiferromagnetic spinel ZnCr₂O₄. The exchange bias effect is observed below antiferromagnetic Neél temperature (T _N) with a reasonable value of exchange bias field ([Formula: see text] Oe at 2 K). Intriguingly, the [Formula: see text] ratio is found unusually high as  ∼2.2, where H _C is the coercivity. This indicates that large H _C is not always primary for obtaining large exchange bias effect. Ferroelectric order is observed at T _N, where non-centrosymmetric magnetic structure with [Formula: see text] space group associated with the magnetoelectric coupling correlates the ferroelectric order, proposing that, ZnCr₂O₄ is an improper multiferroic material. Rare occurrence of exchange bias effect and ferroelectric order in ZnCr₂O₄ attracts the community for fundamental interest and draws special attention in designing new materials for possible electric field control of exchange bias effect.

Observation of short range order driven large refrigerant capacity in chemically disordered single phase compound Dy2Ni0.87Si2.95

In this work, we report the successful synthesis of a new intermetallic compound Dy2Ni0.87Si2.95 forming in single phase only with a chemically disordered structure. The random distribution of Ni/Si and crystal defects create a variation in the local electronic environment between the magnetic Dy ions. In the presence of both disorder and competing exchange interactions driven magnetic frustration, originating due to c/a ∼ 1, the compound undergoes spin freezing behaviour below 5.6 K. In the non-equilibrium state below the spin freezing behaviour, the compound exhibits aging phenomena and magnetic memory effects. In the magnetically short-range ordered region, much above the freezing temperature, an unusual occurrence of considerable magnetic entropy change, -ΔSmaxM ∼ 21 J kg-1 K-1 with large cooling power RCP ∼ 531 J kg-1 and adiabatic temperature change, ΔTad ∼ 10 K for a field change of 70 kOe, is observed for this short range ordered cluster-glass compound without any magnetic hysteresis loss.

Chemical disorder driven reentrant spin cluster glass state formation and associated magnetocaloric properties of Nd2Ni0.94Si2.94

In this work, we report the synthesis of a new ternary intermetallic compound, Nd₂Ni_0.94Si_2.94, that forms in single phase only in a defect crystal structure. The compound exhibits an antiferromagnetic transition below 7.2 K (T_N) followed by a spin cluster freezing behaviour below 2.85 K (T_f), which makes the compound a reentrant spin cluster glass system. The detailed studies of dc and ac magnetization, heat capacity, non-equilibrium dynamical behaviour, viz., aging effect, temperature and field dependent magnetic relaxation and magnetic memory effect establish the compound to be a cluster-glass material below freezing temperature. The interplay between competing exchange coupling (c/a ≃ 1.04 ⇒ J_NN ≃ J_NNN) and chemical disorder driven variation in the electronic environment among the Nd ions has been argued to be responsible for such a metastable state formation. A considerable value of MCE parameters (-ΔS ∼ 11.4 J kg^-1 K^-1, RCP ∼ 160 J kg^-1 and ΔT_ad ∼ 5.2 K for a field change of 70 kOe) is obtained for this magnetically frustrated glassy compound.

Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery

BACKGROUND

Minimally invasive surgery is associated with several patient-related benefits, including reduced length of hospital stay and reduced blood loss. Robotic-assisted surgery offers many advantages when compared with standard laparoscopic procedures, including a stable three-dimensional binocular camera platform, motion smoothing and motion scaling, improved dexterity and ergonomics. There are limited data on the effectiveness of the dual-console DaVinci Xi platform for teaching resident surgeons. The goal of this study was to examine preliminary outcomes following the introduction of a dual-console robotic platform in our institution.

METHODS

A retrospective review of our prospectively maintained patient database was performed. The first ten dual-console resident-performed procedures in colorectal surgery were compared with matched cases performed on a single console by the trainer. Patient demographics, operative times and patient outcomes were compared.

RESULTS

Twenty patients were included in this study. There was no significant difference in console time (p = 0.46) or total operative time (p = 0.52) when residents and trainers were compared. Patient outcomes were equivalent, with no difference in length of stay, morbidity or mortality.

CONCLUSIONS

The DaVinci Xi dual-console platform is a safe and effective platform for training junior surgeons. The dual-console system has the potential to alter surgical training pathways.

Observation of ultrasharp metamagnetic jumps in polycrystalline Er2Cu2O5

The observation of ultrasharp metamagnetic jumps in the field variation of magnetization (M versus H) data for the highly insulating metal oxide Er₂Cu₂O₅ is investigated. The compound orders antiferromagnetically below about T _N1  =  28 K and shows conventional 'not-so-sharp' metamagnetism around 13 kOe on the field-increasing leg in the polycrystalline sample. The uniqueness of the ultrasharp jumps in Er₂Cu₂O₅ resides in the fact that they are only observed in the field-decreasing segment of the magnetization curve. We observe that the jumps are affected by the sweep rate of the magnetic field, similarly to several other systems that show such ultrasharp jumps. Er₂Cu₂O₅ shows a considerable amount of thermo-remanent magnetization when it is cooled in a field that is higher than the critical field of 13 kOe. Our analysis indicates that above 13 kOe the system remains phase separated, with the coexistence of antiferromagnetic and field-induced ferromagnetic-like phases. The jumps in the return leg occur because of the shear-dominated martensitic-like phase transition of the ferromagnetic-like phase to an antiferromagnetic phase, and interfacial strain plays a major role in the observed jumps.