Global Health Challenges: Why the Four S's Are Not Enough.

A well-known tenant of global health is the need for the four-S's to be successful in providing care in any context; Staff, Stuff, Space and Systems. Advanced thoracoscopy is slow to gain traction in low- and middle-income countries (LMICs). To our knowledge, no pediatric advanced thoracoscopy had been attempted previously in either LMIC. Therefore, we report the challenges associated with the adoption of the first advanced thoracoscopic procedures in two LMIC hospitals by a visiting surgeon. To further identify aspects of care in promoting the introduction of advanced thoracoscopy, we added a fifth S as an additional category-Socialization. A key to accomplishing goals for the patients as a visiting surgeon, particularly when introducing an advanced procedure, is acceptance into the culture of a hospital. Despite facing significant obstacles in caring for complex thoracic pathology with heavy reliance on disposable and reusable instrumentation provided through donation and limitations in staff such as access to neonatologists and pediatric surgeons, many obstacles have been overcome. In this perspective article, we show that a "fifth S" is also integral-having local surgeons and anesthesiologists eager to learn with acceptance of the visiting surgeon's expertise opens a path towards attempting advanced procedures in limited-resource settings.

A Layer 3→5 Circuit in Auditory Cortex That Contributes to Pre-pulse Inhibition of the Acoustic Startle Response.

While connectivity within sensory cortical circuits has been studied extensively, how these connections contribute to perception and behavior is not well understood. Here we tested the role of a circuit between layers 3 and 5 of auditory cortex in sound detection. We measured sound detection using a common variant of pre-pulse inhibition of the acoustic startle response, in which a silent gap in background noise acts as a cue that attenuates startle. We used the Nr5a-Cre driver line, which we found drove expression in the auditory cortex restricted predominantly to layer 3. Photoactivation of these cells evoked short-latency, highly reliable spiking in downstream layer 5 neurons, and attenuated startle responses similarly to gaps in noise. Photosuppression of these cells did not affect behavioral gap detection. Our data provide the first demonstration that direct activation of auditory cortical neurons is sufficient to attenuate the acoustic startle response, similar to the detection of a sound.

Nonuniform Composition Profiles in Amorphous Multimetal Oxide Thin Films Deposited from Aqueous Solution.

Metal oxide thin films are ubiquitous in technological applications. Often, multiple metal components are used to achieve desired film properties for specific functions. Solution deposition offers an attractive route for producing these multimetal oxides because it allows for careful control of film composition through the manipulation of precursor stoichiometry. Although it has been generally assumed that homogeneous precursor solutions yield homogeneous thin films, we recently reported evidence of nonuniform electron density profiles in aqueous-deposited films. Herein, we show that nonuniform electron densities in lanthanum zirconium oxide (LZO) thin films are the result of inhomogeneous distributions of metal components. Specifically, La aggregates at the film surface, whereas Zr is relatively evenly distributed throughout single-layer films. This inhomogeneous metal distribution persists in stacked multilayer films, resulting in La-rich interfaces between the sequentially deposited layers. Testing of metal-insulator-semiconductor devices fabricated from single and multilayer LZO films shows that multilayer films have higher dielectric constants, indicating that La-rich interfaces in multilayer films do not detrimentally impact film properties. We attribute the enhanced dielectric properties of multilayer films to greater condensation and densification relative to single-layer films, and these results suggest that multilayer films may be preferred for device applications despite the presence of layering artifacts.