Digital psychiatry in low-and-middle-income countries:New developments and the way forward

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

Development of low-and non-waste technologies in China

Water pollution is one of the most serious environmental problems in China. In order to reduce the discharge of waste water per RMB 1000 Yuan of the industrial output value, the author offered a proposal on the development of low-and non-waste technologies as follows: 1. Changing distribution and structures of industrial production; 2. Innovation in techniques and eliminating industrial wastewater in the process of manufacture; 3. Comprehensive utilization of wastes and wastewater; 4. Strengthening environmental management and supervision of industrial enterprises.

Lessons from the coronavirus disease 2019(COVID-19)pandemic response in China,Italy,and the U.S.:a guide for Africa and low-and middle-income countries

Africa can be"left behind"after other advanced continents recover from the coronavirus disease 2019(COVID-19)pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially adaptable,effective and innovative strategies from China,Italy,and the U.S.The purpose is to help African countries with weaker healthcare systems better respond to the COVID-19 pandemic.China,being the first to report COVID-19 infection swiftly swung into anti-epidemic actions by the use of innovative risk communication and epidemic containment strategies.Italy and U.S.,the next rapidly hit countries after China,however,experienced sustained infections and deaths due to delayed and ineffective response.Many African countries responded poorly to the COVID-19 pandemic as evidenced by the limited capacity for public health surveillance,poor leadership,low education and socioeconomic status,among others.Experience from China,Italy and U.S.suggests that a better response to the COVID-19 pandemic in Mrica needs a strong public health leadership,proactive strategies,innovative risk communication about the pandemic,massive tests and isolation,and scaling-up community engagement.Lastly,African countries must collaborate with other countries to facilitate real-time information and experience exchange with other countries to avoid being left behind.

Breast cancer awareness in reproductive women in the low-and middle-income countries:a scoping review

Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.

Modeling vaccination strategies with limited early COVID-19 vaccine access in low-and middle-income countries:A case study of Thailand

Low-and middle-income countries faced significant challenges in accessing COVID-19 vaccines during the early stages of the pandemic.In this study,we utilized an agestructured modeling approach to examine the implications of various vaccination strategies,vaccine prioritization,and vaccine rollout speeds in Thailand,an upper-middleincome country experiencing vaccine shortages during the early stages of the pandemic.The model directly compares the effectiveness of several vaccination strategies,including the heterologous vaccination where CoronaVac(CV)vaccine was administered as the first dose,followed by ChAdOx1 nCoV-19(AZ)vaccine as the second dose,under varying disease transmission dynamics.We found that the traditional AZ homologous vaccination was more effective than the CV homologous vaccination,regardless of disease transmission dynamics.However,combining CV and AZ vaccines via either parallel homologous or heterologous vaccinations was more effective than relying solely on AZ homologous vaccination.Additionally,prioritizing vaccination for the elderly aged 60 years and above was the most effective way to reduce mortality when community transmission is wellcontrolled.On the other hand,prioritizing workers aged 20e59 was most effective in lowering COVID-19 cases,irrespective of the transmission dynamics.Lastly,despite the vaccine prioritization strategy,rapid vaccine rollout speeds were crucial in reducing COVID-19 infections and deaths.These findings suggested that in low-and middle-income countries where early access to high-efficacy vaccines might be limited,obtaining any accessible vaccines as early as possible and using them in parallel with other higherefficacy vaccines might be a better strategy than waiting for and relying solely on higher-efficacy vaccines.

Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth:a scoping review on the impact of antenatal corticosteroids in low-and middle-income countries

Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at≤34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low-and middle-income countries.Methods Two reviewers independently searched four databases including MEDLINE(through PubMed),CINAHL,Embase,and Cochrane Libraries.We did not apply any language or date restrictions.All publications up to April 2020 were included in this search.Results The search yielded 71 articles,10 of which were included in this review(3 randomized controlled trials,7 observa-tional studies,36,773 neonates).The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome.However,a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.Conclusions Most of the studies in low-and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome.However,the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome.Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.

Universities as catalysts of social innovation in health systems in low-and middle-income countries: a multi-country case study

Background Social innovation(SI)in health holds potential to contribute to health systems strengthening and universal health coverage(UHC).The role of universities in SI has been well described in the context of high-income countries.An evidence gap exits on SI in healthcare delivery in the context of low-and middle-income countries(LMICs)as well as on the engagement of universities from these contexts.There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities.The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa,Asia and Latin America.The objectives were to describe the model,components and implementation process of the hubs;identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI.Methods A case study design was adopted to study the implementation process of a network of university hubs.Data from documentation,team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework.Results/discussion SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms,established to catalyse SI within the local health system through four core activities:research,community-building,storytelling and institutional embedding,and adhering to values of inclusion,assets,co-creation and hope.Hubs were implemented as informal structures,managed by a small core team,in existing department.Enablers of hub implementation and functioning were the availability of strong in-country social networks,legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages.Barriers encountered were internal institutional resistance,administrative challenges associated with university bureaucracy and annual funding cycles.Conclusions This case study shows the opportunity that reside within LMIC universities to act as eco-system enablers of SI in healthcare delivery in order to fill the evidence gap on SI and enhance cross-sectoral participation in support of achieving UHC.

Drug research and development opportunities in low-and middle-income countries:accelerating traditional medicine through systematic utilization and comprehensive synergy

Background:Though the utilization of traditional medicine has been proposed for modern drug research and development(R&D),limited research has discussed its feasible paths.In this commentary,we summarized key factors for new drug R&D under limited resources by reviewing China’s discovery of artemisinin,and raised suggestions to utilize traditional medicines in low-and middle-income countries(LMICs).Main text:We suggested that systematic utilization of traditional medicine,outstanding synergy of research units at all levels and timely information-sharing mechanism should be achieved to establish a comprehensive and efficient R&D system,especially under low-resource settings.In the case of artemisinin discovery,Chinese scientists integrated documented traditional medicine experiences and modern approaches to develop drug candidates timely.Due to limited R&D resources,China adopted a collaborative way,motivating nearly all domestic research units at different levels,to develop antimalarial products.Moreover,the excellent synergy among all units through efficient information-sharing mechanisms greatly avoided work repetition and accelerated the R&D process.Conclusion:Traditional medicines inspires drug discoveries in LMICs,while a comprehensive and efficient R&D system could accelerate its R&D process and save investment.The discovery of artemisinin in China gave a reliable pattern to promote sustainable development of traditional medicines and a good example to realize R&D of traditional medicine under low-resource settings.

Management of Preeclampsia in Low-and Middle-Income Countries:Lessons to Date,and Questions Arising,from the PRE-EMPT and Related Initiatives

Preeclampsia remains associated with an increased risk of maternal and perinatal morbidity and mortality,and the burden of that excess risk is largely borne by pregnant women and their families in low-and middle-income countries(LMICs).Therefore,the Bill&Melinda Gates Foundation funded the PREeclampsia–Eclampsia Monitoring,Prevention,and Treatment(PRE-EMPT)initiative to accelerate progress.From PRE-EMPT,and related activity,have come a number of impactful findings.First,there is increasing global support for broadening the definition of preeclampsia to include women with hypertension and either significant proteinuria or evidence of target organ damage or fetoplacental compromise(including evidence angiogenic imbalance).Second,using blood pressure(BP)data from the Community-Level Interventions for Preeclampsia trials in India,Mozambique,and Pakistan,acquired on validated-for-pregnancy,semi-automated,low-cost BP devices,there are now population-level,rather than facility-based,estimates for the burden of pregnancy hypertension(sub-categorized into preeclampsia(4%–6%),gestational hypertension(7%–12%),and chronic hypertension(0.3%–0.6%)).Third,there is an identified need to understand biological pathways that underlie the causation of preeclampsia in LMICs.Fourth,the Community-Level Interventions for Preeclampsia trials have shown that providing at least eight antenatal contacts,in this case using digital health-supported community health workers,cost-effectively reduces the burden of maternal(by 60%),fetal(60%),and neonatal(40%)mortality.Fifth,what is the utility and cost-effectiveness of routine proteinuria screening of normotensive pregnant women?Sixth,clinical risk factor-based prediction of preeclampsia remains most relevant for most women in LMICs;calcium replacement(≥1 g/day)and low-dose aspirin(100–175 mg/day)are the most useful directly preventative interventions.However,achieving sustainable development goals(SDGs)not directly related to health are more likely to reduce the global burden of preeclampsia and its consequences.Seventh,should a woman develop preeclampsia,personalized maternal time-of-disease risk estimates are available through the PIERS(Preeclampsia Integrated Estimate of RiSk)models,either with(fullPIERS)or without(miniPIERS)access to laboratory testing.Assessment of perinatal risks in LMICs is largely driven by gestational age;however,evidence of significant angiogenic imbalance may identify risk of intrauterine fetal death.Eighth,Control of Hypertension in Pregnancy Study trial data show that women with non-severe pregnancy hypertension(systolic BP 140–159 mmHg or diastolic BP(dBP)90–109 mmHg)should receive an antihypertensive medication for a target dBP of 85 mmHg.Ninth,for women with severe pregnancy hypertension(systolic BP≥160 mmHg or dBP≥110 mmHg),oral antihypertensive management with either nifedipine,labetalol,or,less so,methyldopa will lower BP into the non-severe hypertension range.Tenth,magnesium sulfate remains the sole agent of choice for preventing and treating eclamptic seizures.Eleventh,corticosteroids should be administered to women at risk of delivery<35+0 weeks’gestation.Twelfth,although delivery of the placenta initiates resolution of the maternal syndrome of preeclampsia,decisions to initiate delivery should be guided by gestational age and maternal and fetal status.Many women will experience significant postpartum deterioration;delivery should not be equated with“cure”.Thirteenth,whether the development of preeclampsia identifies women at increased risk for early-onset cardiovascular disease in LMICs must be determined.

Aero-Hydrodynamic Coupled Dynamic Characteristics of Semi-Submersible Floating Offshore Wind Turbines Under Inflow Turbulence

In this study,the frequency characteristics of the turbulent wind and the effects of wind-wave coupling on the low-and high-frequency responses of semi-submersible floating offshore wind turbines(FOWT)are investigated.Various wave load components,such as first-order wave loads,combined first-and second-order difference-frequency wave loads,combined first-and second-order sum-frequency wave loads,and first-and complete second-order wave loads are taken into consideration,while different turbulent environments are considered in aerodynamic loads.The com-parison is based on time histories and frequency spectra of platform motions and structural load responses and statistical values.The findings indicate that the second-order difference-frequency wave loads will significantly increase the natural frequency of low-frequency motion in the responses of the platform motion and structure load of the semi-submersible platform,which will cause structural fatigue damage.Under the action of turbulent wind,the influences of second-order wave loads on the platform motion and structural load response cannot be ignored,especially under extreme sea conditions.Therefore,in order to evaluate the dynamic responses of semi-submersible FOWT more accurately,the actual environment should be simulated more realistically.

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.

Cervical cancer screening in developing countries at a crossroad:Emerging technologies and policy choices

Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.

Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal

To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of m Health for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.

Management of neuroblastoma in limited-resource settings

BACKGROUND Neuroblastoma(NB)is a heterogeneous disease with variable outcomes among countries.Little is known about NB in low-and middle-income countries(LMICs).AIM The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries(HICs).METHODS PubMed,Global Health,Embase,SciELO,African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB,LMICs and outcomes.Only English language manuscripts and abstracts were included.A descriptive review was done,and tables illustrating the findings were constructed.RESULTS Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available.The disease characteristics varied among countries for the following variables:sex,age at presentation,MYCN amplification,stage and outcome.LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs.Implementation of evidence-based treatment protocols was still a barrier to care.Many socioeconomic variables also influenced the diagnosis,management and followup of patients with NB.CONCLUSION Patients presented at a later age with more advanced disease in LMICs.Management was limited by the lack of resources and genetic studies for improved NB classification.Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources.

Value of multi-quadrants biopsy:Pooled analysis of 11 population-based cervical cancer screening studies

Objective:The accuracy of colposcopy-guided biopsy is key to the success of colposcopic triage in cervical cancer screening programs.However,there is no widely adopted biopsy guideline up to date.Our study aimed to determine whether multi-quadrants biopsy improves the yield of cervical lesions.Methods:Eleven population-based cervical cancer screening studies were conducted in China.Cytology,highrisk human papillomavirus(hrHPV)testing and visual inspection were performed for primary screening.Females positive on one or more tests were referred for colposcopy and biopsy.The proportion of detected cervical intraepithelial neoplasia(CIN)2+and yields by quadrant lesion-targeted biopsy or 4-quadrant random biopsy were compared.Results:Among 4,923 females included,1,606 had quadrant lesion-targeted biopsy,and 3,317 had 4-quadrant random biopsy.The cumulative CIN2+yield increased from 0.10 for only one quadrant-targeted biopsy to 0.21,0.34,and 0.58 for at most two,three and four quadrants targeted biopsies.Among hrHPV positive females with high-grade squamous intraepithelial lesion(HSIL)+cytology,the cumulative CIN2+yield of a second targeted biopsy in another quadrant was significantly increased(P<0.05).Among hrHPV-negative females,the yield of 4-quadrant random biopsies was 0.005,and the yield by lesion-targeted biopsies was 0.017.For hrHPV positive females who had 4-quadrant random biopsy,the additional CIN2+yield for HSIL+,low-grade squamous intraepithelial lesion(LSIL)cytology,or abnormal visual inspection via acetic acid and Lugol’s iodine(VIA/VILI)were 0.46,0.11,0.14.Conclusions:A 4-quadrant random biopsy is recommended only for hrHPV positive females with HSIL cytology,and is acceptable if hrHPV positive with LSIL cytology or with abnormal VIA/VILI.Our findings add evidences for an objective and practical biopsy standard to guide colposcopy in cervical cancer screening programs in low-and middle-income countries.

Continuity of cancer care in the era of COVID-19 pandemic: Role of social media in low- and middle-income countries

A novel coronavirus(severe acute respiratory syndrome coronavirus 2)first detected in Wuhan,China,has spread rapidly since December 2019,causing more than 1.4 million confirmed infections and 15000 fatalities(as of April 9,2020).The outbreak was declared a pandemic by the World Health Organization on March 11,2020.Isolation,quarantine,social distancing,and community containment measures were rapidly implemented in China,which helped in containing the disease.However,other low-and middle-income countries lack such extensive infrastructural capacities and resources.Cancer patients are particularly at high risk of infection and mortality due to immunosuppression.Hence self-quarantine is recommended for them.Additionally,it is becoming impossible to maintain the continuity of care when cancer patients have to avoid physical visits.Social media applications,e.g.,Facebook and WhatsApp,can provide educational group program and psychosocial support to these patients while maintain social distancing.We have analyzed their use in this review article and how it could change the follow-up of cancer patients during this pandemic.

Can health technology assessments assist the global campaign against poverty?

Although a key tenant of the Sustainable Development Goals is to achieve universal health coverage,the global drug gap persists-cver a third of the global population lack access to essential medicines.Without access to affordable drugs,people have worse health outcomes,higher medical expenses,and productivity loss,pushing them into poverty.Health technology assessments(HTAs)offer an opportunity to decrease the global drug gap and increase access to essential medicines by overcoming barriers to medicine access.These barriers include drug procurement,drug affordability for payers and patients,a patienfs ability to obtain essential medicines,and health system capacity.Using HTAs can therefore close the global drug gap by increasing access to affordable essential medicines.In turn,people have better health outcomes,spend less money on medical care,and can have better productivity.Ultimately,use of HTAs can lift the population out of poverty and force fewer people into poverty by creating better health outcomes at affordable prices.

A Review of Sensorless Control Methods for AC Motor Drives

In recent years,the application of sensorless AC motor drives is expanding in areas ranging from industrial applications to household electrical appliances.As is well known,the advantages of sensorless motor drives include lower cost,increased reliability,reduced hardware complexity,better noise immunity,and less maintenance requirements.With the development of modern industrial automation,more advanced sensorless control strategies are needed to meet the requirements of applications.For sensorless motor drives at low-and zero-speed operation,inverter nonlinearities and motor parameter variation have significant impact on the stability of control system.Meanwhile,high observer’s bandwidth is required in high-speed region.This paper introduces the state of art of recent progress in sensorless AC motor drives.In addition,this paper presents the sensorless control strategies we investigated for practical industrial and household applications.Both advanced sensorless drives of induction motor(IM)and permanent magnet synchronous motor(PMSM)are presented in this paper.

Digital Social and Emotional Literacy Intervention for Vulnerable Children in Brazil:Participants’Experiences

Social emotional literacy(SEL)interventions are widely implemented through schools,with growing evidence for a range of positive child outcomes.Increasingly,such interventions are delivered on online platforms.To date,there is limited evidence about digital SEL interventions in low-and middle-income countries(LMIC).The aim of this study was to explore the perceptions and experiences of children,parents and facilitator of the potential value of addressing SEL via tailored digital intervention.The intervention was designed to help children,in Brazil,to cope during the first COVID-19 pandemic lockdown.The intervention was delivered via a digital platform to groups of three children for 45 min per week for nine.Thirteen children,nine parents and nine facilitators were interviewed following the completion of the intervention.The data was analysed through a codebook thematic approach,which led to three themes:empowerment,participatory aspects of the intervention and digital adaptation.Overall,children’s SEL development was reported to be supported during the COVID-19 pandemic,by the application of new skills outside the sessions.Children reported a number of empowering factors such as being heard and belonging.A range of useful participatory tools were identified including storytelling,games,drawings and videos.Blended SEL interventions involving both face-to-face and web-based facilitation could be developed within a tiered model of universal mental health promotion and targeted prevention.Access to online platforms would increase reach to large numbers of children in LMIC,especially in contexts of disadvantage.