Experiences and challenges of people living with multiple long-term conditions in managing their care in primary care settings in Kerala, India: A qualitative study.

BACKGROUND: Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. METHODS: We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. FINDINGS: Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. CONCLUSION: This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.

A review on transition metal oxides based photocatalysts for degradation of synthetic organic pollutants.

This review provides insight into the current research trend in transition metal oxides (TMOs)-based photocatalysis in removing the organic colouring matters from water. For easy understanding, the research progress has been presented in four generations according to the catalyst composition and mode of application, viz: single component TMOs (the first-generation), doped TMOs/binary TMOs/doped binary TMOs (the second-generation), inactive/active support-immobilized TMOs (the third-generation), and ternary/quaternary compositions (the fourth-generation). The first two generations represent suspended catalysts, the third generation is supported catalysts, and the fourth generation can be suspended or supported. The review provides an elaborated comparison between suspended and supported catalysts, their general/specific requirements, key factors controlling degradation, and the methodologies for performance evaluation. All the plausible fundamental and advanced dye degradation mechanisms involved in each generation of catalysts were demonstrated. The existing challenges in TMOs-based photocatalysis and how the researchers approach the hitch to resolve it effectively are discussed. Future research trends are also presented.

Tailoring of 1T Phase-Domain MoS2 Active Sites with Bridging S22-/Apical S2- Phase-Selective Precursor Modulation for Enriched HER Kinetics.

Molybdenum disulfide (MoS2) is a promising alternative electrocatalyst for hydrogen evolution reaction (HER) due to its relatively near zero hydrogen adsorption free energy (ΔGH = 0.08) and availability as a metallic (1T) phase. The superior catalytic activity of the 1T phase over 2H is owing to the availability of dense active sites, 107 fold higher conductivity, and greater hydrophilicity. However, in the synthesis of 1T-MoS2, a highly controlled proficient method is indispensable due to its metastable nature. Besides, phase enrichment is greatly sensitive to experimental parameters such as precursor, temperature, reaction time, and solvent. In the context of precursors, to date, no single precursor has been recognized as a selective precursor for the synthesis of 1T-MoS2. In this work, MoS2 with high content of 1T phase (79.4%) and excessive bridging S22-/apical S2- sites has been formulated from a single precursor, that is, ammonium tetrathiomolybdate ((NH4)2MoS4), ATTM). In HER, it displayed an inspired activity, that is, achieving 10 mA cm-2 current density, it requires just 248 mV overpotential with a minimal Tafel slope value (56 mV/dec). The maximum enrichment of the 1T phase, abundant accumulation of catalytically active bridging S22-/apical S2- sites, and the complete reduction of Mo+6 to Mo+4 (absence of Mo+6) are root causes for the outstanding activity of the synthesized 1T phase-domain MoS2. To the best of our knowledge for the very first time, here, we declare that the single source, that is, ATTM is an exclusive precursor for the selective synthesis of 1T-MoS2 with advantageous structural features. Moreover, this expedient precursor could be more pertinent for the industrial-scale preparation of 1T phase-domain MoS2 in near future.

CMIP5 wind speed comparison between satellite altimeter and reanalysis products for the Bay of Bengal.

A proper evaluation and performance assessment of climate model projections have received considerable attention during the recent past amongst the scientific community. Quality of wind datasets used for analysis is of paramount importance to meteorologists, oceanographers, and climatologist as an essential pre-requisite for modelling needs. This study examined the measured wind speeds obtained from satellite altimetry available from IFREMER/CERSAT, along with two atmospheric reanalysis products ECMWF ERA-Interim and NCEP-CFSR. The reanalysis products and altimeter data were compared with wind speed simulated from 33 different models under WCRP-CMIP5 project for the Bay of Bengal (BoB) region. Study investigated both historical and projections of CMIP5 data providing an opportunity to inter-compare the wind speeds resulting from various emission scenarios with Representative Concentration Pathways (RCPs) 2.6, 4.5, 6.0, and 8.5, respectively. The objective is to establish and find out a suitable emission scenario applicable to the BoB region. Temporal and spatial analyses of CMIP5 data infer variability in terms of correlation, bias, and root mean square error. For the historical runs (1991-2005) based on analysis of 29 CMIP5 models, it could be ascertained that the correlation coefficient in wind speed varied between 0.6 and 0.9 and with a bias ranging from - 1.6 to 4 ms-1. Similar analysis of the CMIP5 projections was carried out with 11 models for RCP 2.6, 29 models for RCP 4.5, 10 models for RCP 6.0, and 28 models for RCP 8.5. Basin-scale mean using altimeter and re-analysis products indicates that RCPs 2.6 and 6.0 showed less correlation with a higher bias for the study region. Analysis of historical model runs signifies that HadGEM2-ES, HadGEM2-AO, HadGEM2-CC, MIROC5, GISS-E2R, and CNRM-CM5 are the best performing models for the study domain. Findings from the study indicate that RCP 4.5 wind speed stands better for the Bay of Bengal region. In a broader perspective, due to various uncertainties involved in climate model outputs, it is imperative to perform a comprehensive analysis amongst multiple data sources to establish and identify the best quality data for scientific needs.

Exploration and evaluation of proton source-assisted photocatalyst for hydrogen generation.

The present paper reports about the superior performance of some amine-based proton sources in enhancing the photocatalytic efficiency of Fe2O3-TiO2 composite during a water-splitting reaction. The band gap of the Fe2O3-TiO2 catalyst is tuned to 2.3 eV by varying the Fe content. The heterojunctions generated in the photocatalyst facilitate effective charge carrier migration suppressing the electron-hole recombination rate. The enhanced photocatalytic activity of the catalyst is studied using an experimental setup comprising a solar simulator (AAA) and a hydrogen gas chromatograph. The effect of proton sources viz, aniline hydrogen chloride (AH), diethylamine hydrogen chloride (DAH) and triethylamine hydrogen chloride (TAH), on the photocatalytic performance of the catalyst is explored and studied in detail. These proton sources serve as electron donors that stimulate photogenerated electron-hole separation that results in high quantum efficiency of the Fe2O3-TiO2 photocatalyst. A very high hydrogen generation rate of 880 µmol h-1 is achieved with the DAH-assisted Fe2O3-TiO2, whereas it is just 323 µmol h-1 with the Fe2O3-TiO2 alone. The enhancement in the hydrogen generation rate is attributed to the high basic nature, distinct hole scavenging action, low electron-hole recombination rate and the swift interfacial charge - transfer process. The effect of other proton source-assisted catalysts are also discussed in detail.