Smoke-Free Policy in Vermont Public Housing Authorities

Introduction. Millions of adults and children living in public housing face exposure to second hand smoke from adjacent apartments. These tenants are less able to escape smoke exposure by moving, and Housing Authorities are beginning to implement smoke-free policies. We assessed the status of smoke-free policy in Vermont public housing, and explored the experience of tenants and managers in Burlington who recently implemented such a policy.https://scholarworks.uvm.edu/comphp_gallery/1080/thumbnail.jp

Singleton preterm births in Korle bu teaching hospital, Accra, Ghana – origins and outcomes

Objective: To determine the singleton preterm birth rate, the relative proportions of the clinical categories of preterm births and to compare the outcomes in these categories. Setting: Department of Obstetrics & Gynaecol-ogy, Korle Bu Teaching Hospital. Participants: Preterm births from 1st July to 31st December 2003. Results: Out of a total of 4731 singleton births 440 were preterm, giving a preterm birth rate of 9.3%. One hundred and eighty-five (42%, [95% Confidence Interval (CI) 37.4%, 46.8%]) preterm births followed spontaneous onset of preterm la-bour (group A), 82 (18.6%, [95% CI 15.2%, 22.7%]) followed preterm premature rupture of membranes, PPROM (group B) and 173 (39.3%, [95% CI 34.8%, 44.1%]) were medically indicated (group C). The commonest indication for delivery in group C was severe pre-eclampsia/eclampsia. Although there was no significant difference in the mean gestational ages at delivery between the groups, babies in group C had significantly lower birth weights. No differences in sex ratios, still-birth rates, or incidence of low Apgar scores were found. Babies in group C were significantly more likely to be admitted to the neonatal intensive care unit (NICU) and had a significantly higher perina-tal death rate. Survivors of NICU admission among group C babies spent significantly longer periods in hospital before discharge.Conclusion: Outcomes of preterm births in Korle Bu Teaching Hospital are less favourable among indicated preterm births than among spontaneous or PPROM-related preterm births. A detailed study of the causes of neonatal morbidity and mortality is suggested to determine any differences between the three groups

Count every newborn; a measurement improvement roadmap for coverage data.

BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks

Discrete element modelling of scaled railway ballast under triaxial conditions

The aim of this study is to demonstrate the use of tetrahedral clumps to model scaled railway ballast using the discrete element method (DEM). In experimental triaxial tests, the peak friction angles for scaled ballast are less sensitive to the confining pressure when compared to full-sized ballast. This is presumed to be due to the size effect on particle strength, whereby smaller particles are statistically stronger and exhibit less abrasion. To investigate this in DEM, the ballast is modelled using clumps with breakable asperities to produce the correct volumetric deformation. The effects of the quantity and properties of these asperities are investigated, and it is shown that the strength affects the macroscopic shear strength at both high and low confining pressures, while the effects of the number of asperities diminishes with increasing confining pressure due to asperity breakage. It is also shown that changing the number of asperities only affects the peak friction angle but not the ultimate friction angle by comparing the angles of repose of samples with different numbers of asperities

Smartphone colorimetry using ambient subtraction: Application to neonatal jaundice screening in Ghana

A smartphone app to screen for neonatal jaundice has a large potential impact in reducing neonatal death and disability. Our app, neoSCB, uses a colour measurement of the sclera to make a screening decision. Although there are numerous benefits of a smartphone-based approach, smartphone colour measurement that is accurate and repeatable is a challenge. Using data from a clinical setting in Ghana, we compare sclera colour measurement using an ambient subtraction method to sclera colour measurement using a standard colour card method, and find they are comparable provided the subtracted signal-to-noise ratio (SSNR) is sufficient. Calculating a screening decision metric via the colour card method gave 100% sensitivity and 69% specificity (n=87), while applying the ambient subtraction method gave 100% sensitivity and 78% specificity (SSNR>3.5; n=50)

Tillage systems and soils in the semi-arid tropics

Even though conservation tillage may be ideal for the semi-arid tropics (SAT) in view of results from studies and tillage practices in the U.S.A. and Australia, studies conducted in semi-arid regions of Africa appear to support the use of conventional tillage systems. Some of the reasons for this apparent discrepancy are because of the physical properties of the soils in semi-arid Africa, particularly the Sahelian zones where the soils are sandy, have high bulk densities and therefore low total porosities and form crusts upon wetting and drying. Consequently, no-till or reduced tillage systems that do not have the soil surface covered by residue in irder to prevent formation of crust as a result of raindrop impact, tend to lose water through runoff in a region where water economy is essential. Also, because these soils have inherently high bulk densities, conventional tillage systems appear to be suitable since they increase the macropores, reduce both bulk density and strength and thus ensure prolific root distribution and the resultant exploration of water and nutrients at greater soil depths. Notwithstanding, it seems that since most of the SAT soils are structurally unstable, further conventional tillage even though it has ephemeral advantages, may in the long term be exacerbating the problems of structural instability and their deleterious effect on water and soil conservation and therefore on crop production. We suggest that at this stage soil tillage research in the semi-arid regions of Africa and Asia should re-examine some of the concepts of conservation tillage in relation to soil physical properties and processes in order to obtain a tillage system that ensures high crop yields without destruction of the soil resource

Feasibility of smartphone colorimetry of the face as an anaemia screening tool for infants and young children in Ghana

Background Anaemia affects approximately a quarter of the global population. When anaemia occurs during childhood, it can increase susceptibility to infectious diseases and impair cognitive development. This research uses smartphone-based colorimetry to develop a non-invasive technique for screening for anaemia in a previously understudied population of infants and young children in Ghana. Methods We propose a colorimetric algorithm for screening for anaemia which uses a novel combination of three regions of interest: the lower eyelid (palpebral conjunctiva), the sclera, and the mucosal membrane adjacent to the lower lip. These regions are chosen to have minimal skin pigmentation occluding the blood chromaticity. As part of the algorithm development, different methods were compared for (1) accounting for varying ambient lighting, and (2) choosing a chromaticity metric for each region of interest. In comparison to some prior work, no specialist hardware (such as a colour reference card) is required for image acquisition. Results Sixty-two patients under 4 years of age were recruited as a convenience clinical sample in Korle Bu Teaching Hospital, Ghana. Forty-three of these had quality images for all regions of interest. Using a naïve Bayes classifier, this method was capable of screening for anaemia (<11.0g/dL haemoglobin concentration) vs healthy blood haemoglobin concentration (≥11.0g/dL) with a sensitivity of 92.9% (95% CI 66.1% to 99.8%), a specificity of 89.7% (72.7% to 97.8%) when acting on unseen data, using only an affordable smartphone and no additional hardware. Conclusion These results add to the body of evidence suggesting that smartphone colorimetry is likely to be a useful tool for making anaemia screening more widely available. However, there remains no consensus on the optimal method for image preprocessing or feature extraction, especially across diverse patient populations

Measuring soil processes in agricultural research

Soil and crop management strategies (e.g., tillage, bunding, cropping intensity, and crop sequencing) are location- and season-specific in the way they affect soil processes and resource utilization by crops. Research findings on these effects therefore need to be modeled if they are to be extrapolated to other locations wi th similar soils and climatic conditions. This manual presents practical methods for assessing management effects on such soil processes as water infiltration and erosion by water, and on water, air, and nutrient use by crops. It covers the basic elements of soil physical characterization, and deals principally with the role of soil structure on water infiltration and percolation, heat flow, aeration, and the mobility of roots and soil microorganisms. The authors discuss the agronomic and engineering practices that affect soil processes; and the effects of such strategies as contour cultivation, organic and inorganic amendments, watershed management, and soil surface manipulations are emphasized