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This chapter investigates the feasibility of large-scale centralized renewable generation and residential solar photovoltaic electricity (PV) in addressing Zambia’s electricity deficit, caused by droughts which are in turn attributable to climate disturbances and the nation’s rapidly increasing electricity demand. Specifically, it was found that centralized solar generation when optimally located could produce generation/cost ratios as low as $0.042/kWh, comparable with existing hydro generation cost ratios of $0.02-$0.03/kWh. For the decentralized generation scenarios, which analyzed the potential of on-grid and off-grid solar PV generation in Lusaka, Zambia’s capital, it was observed that a fully decentralized approach is not economically feasible, as electricity would be 6 to 12 times as costly as the existing rate. A series of hybrid scenarios, with varying combinations of centralized and decentralized generation, were also analyzed, with the 70 percent centralized, 30 percent decentralized scenario being found to best address Zambia’s electricity shortage. This approach would both provide affordable power and enable quicker implementation, greater consumer autonomy, easier planning, and diversified sources of funding. It would also enhance Zambia’s ability to become a continental leader in renewable energy.
A series of farming experiments was conducted between 2013 and 2017 in Range Creek Canyon, Utah, to better understand the opportunities and constraints faced by prehistoric farmers in the Southwest. The experiments were designed to collect data on the optimal amount of supplemental water that should be applied to maize fields given the costs in labor and benefits in greater yield. We investigate expected variation in water management strategies using an optimal irrigation model (OIM). The model makes clear that the payoff for farming is best understood as a continuum of relative success and that irrigation is one activity (probably of many) that may improve farming efficiency as well as increase harvest yields. The optimal harvest will always be less than the maximum harvest when there are significant operating costs associated with irrigation. Estimating the costs and benefits of irrigation in a specific area allows for an assessment of whether irrigation is expected, and if so, how much effort should be devoted to water management. A local dendroclimatological study is used to provide the prehistoric context for the Fremont who occupied Range Creek Canyon, and irrigation is expected even in periods of greater precipitation.
The aim of this study is to enrich public health emergency management (PHEM) curricula and increase the workforce readiness of graduates through the implementation of an innovative curriculum structure centered around simulation and the creation of authentic learning experiences into a mastery-based Disaster Preparedness graduate certificate program launched in 2016 at the Colorado School of Public Health. Learners progress through a sequence of increasingly complex discussion and operations-based exercises designed to align with training methodologies used by future employers in the disaster response field, covering PHEM fundamentals and domestic and international disaster preparedness and response. Preliminary feedback is overwhelmingly positive, equating the experience to securing an internship. Embedding simulation-based exercises and authentic learning environments into graduate curricula exposes learners to diverse disaster scenarios, provides occasion for practicing critical thinking and dynamic problem solving, increases familiarity with anticipated emergency situations, and builds the confidence necessary for exercising judgment in a real-world situation. This novel curriculum should serve as a model for graduate programs wishing to enrich traditional training tactics using a typical school of public health support and alignment with community resources. (Disaster Med Public Health Preparedness. 2019;13:777–781)
High-temperature X-ray diffraction techniques were employed to study the condensation reactions which occur when sodium orthophosphates are heated to 380°C. Crystalline Na4P2O7 and an amorphous phase were formed first from an equimolar mixture of Na2HPO4·NaH2PO4 and Na2HPO4 at temperatures above 150°C. Further heating resulted in the formation of Na5P3O10-I (high-temperature form) at the expense of the crystalline Na4P4O7 and amorphous phase. Crystalline Na5P3O10-II (low-temperature form) appears after Na5P3O10-I.
Conditions which affect the yield of crystalline Na4P2O7 and amorphous phase as intermediates and their effect on the yield of Na5P3O10 are also presented.
To determine the acceptability, internal consistency and test–retest reliability of self-efficacy, motivation and knowledge scales relating to pre-school children’s nutrition, oral health and physical activity.
An online questionnaire was completed twice with an interval of 7–11d.
Online questionnaires were sent to participants via email from nursery managers. The parent questionnaire was also available on the parenting website www.netmums.com.
Eighty-two parents and sixty-nine nursery staff from Bristol, UK who had and worked with 2–4-year-olds, respectively.
Response rates were 86·3 and 86·0 % and missing data 15·9 and 14·5 % for the second administration of the parent and nursery staff questionnaires, respectively. Weighted κ coefficients for individual items mostly fell under the ‘moderate’ agreement category for the parental (75·0 %) and nursery staff (55·8 %) items. All self-efficacy and motivation scales had acceptable levels of internal consistency (Cronbach’s α coefficients>0·7). The intraclass correlation coefficients for the self-efficacy, motivation and knowledge scales ranged between 0·48 and 0·82. Paired t tests found an increase between test and retest knowledge scores for the Nutrition Motivation (t=−2·91, df=81, P=0·00) and Knowledge (t=−3·22, df=81, P=0·00) scales in the parent questionnaire.
Our findings demonstrate that the items and scales show good acceptability, internal consistency and test–retest reliability.
Bentonite clay is often included as a buffer, backfill and/or sealing material in designs for deep geological repositories for radioactive wastes. It is expected that bentonite materials may undergo some mineralogical alteration as they interact with in situ groundwaters over long timescales on the order of thousands to millions of years. Long-term modelling of these materials is therefore important in order to demonstrate confidence that the engineered designs will continue to perform as required over their intended lifetimes (required assessment timescales can be up to 1 million years). The key geochemical processes that must be considered in such modelling are mineral dissolution and precipitation and cation exchange. These processes are expected to occur simultaneously and so modelling of their coupled effects and their rates (kinetics) is necessary. Illustrative reactive-transport models of the geochemical alteration of montmorillonite (the primary mineral in bentonite exhibiting cation exchange) are presented which demonstrate that one possible approach to fully coupling cation exchange and clay mineral dissolution kinetics, referred to here as the ‘all-component coupling’ approach, may lead to unrealistic behaviour due to feedback that may occur in the formulation. This feedback can be avoided if a ‘common-component’ conceptual model for the dissolution of exchanger end members is adopted, where only the saturation of the exchanger ‘structural unit’ is considered when evaluating the potential for dissolution of the mineral. Such considerations have been proposed historically in stability analyses for montmorillonite, but have not been explored widely in the modelling literature.
Effective communication skills are essential for all healthcare professionals. Specialist teaching on communicating with people with intellectual disabilities is often lacking, resulting in poorer healthcare and worse outcomes than in the general population. Working with professionally trained actors with intellectual disabilities, we developed an interprofessional workshop that sought to provide authentic communication skills training to enable healthcare students from various disciplines to communicate effectively with patients of all abilities. In a survey, students reported that they found the workshops rewarding and confidence-building, and that they learnt more about the roles of their interprofessional colleagues.
Measles is a target for elimination in all six WHO regions by 2020, and over the last decade, there has been considerable progress towards this goal. Surveillance is recognised as a cornerstone of elimination programmes, allowing early identification of outbreaks, thus enabling control and preventing re-emergence. Fever–rash surveillance is increasingly available across WHO regions, and this symptom-based reporting is broadly used for measles surveillance. However, as measles control increases, symptom-based cases are increasingly likely to reflect infection with other diseases with similar symptoms such as rubella, which affects the same populations, and can have a similar seasonality. The WHO recommends that cases from suspected measles outbreaks be laboratory-confirmed, to identify ‘true’ cases, corresponding to measles IgM titres exceeding a threshold indicative of infection. Although serological testing for IgM has been integrated into the fever–rash surveillance systems in many countries, the logistics of sending in every suspected case are often beyond the health system's capacity. We show how age data from serologically confirmed cases can be leveraged to infer the status of non-tested samples, thus strengthening the information we can extract from symptom-based surveillance. Applying an age-specific confirmation model to data from three countries with divergent epidemiology across Africa, we identify the proportion of cases that need to be serologically tested to achieve target levels of accuracy in estimated infected numbers and discuss how this varies depending on the epidemiological context. Our analysis provides an approach to refining estimates of incidence leveraging all available data, which has the potential to improve allocation of resources, and thus contribute to rapid and efficient control of outbreaks.
Although measles incidence has reached historic lows in many parts of the world, the disease still causes substantial morbidity globally. Even where control programs have succeeded in driving measles locally extinct, unless vaccination coverage is maintained at extremely high levels, susceptible numbers may increase sufficiently to spark large outbreaks. Human mobility will drive potentially infectious contacts and interact with the landscape of susceptibility to determine the pattern of measles outbreaks. These interactions have proved difficult to characterise empirically. We explore the degree to which new sources of data combined with existing public health data can be used to evaluate the landscape of immunity and the role of spatial movement for measles introductions by retrospectively evaluating our ability to predict measles outbreaks in vaccinated populations. Using inferred spatial patterns of accumulation of susceptible individuals and travel data, we predicted the timing of epidemics in each district of Pakistan during a large measles outbreak in 2012–2013 with over 30 000 reported cases. We combined these data with mobility data extracted from over 40 million mobile phone subscribers during the same time frame in the country to quantify the role of connectivity in the spread of measles. We investigate how different approaches could contribute to targeting vaccination efforts to reach districts before outbreaks started. While some prediction was possible, accuracy was low and we discuss key uncertainties linked to existing data streams that impede such inference and detail what data might be necessary to robustly infer timing of epidemics.
Glioblastomas are the most frequent and aggressive primary brain tumor in adults and despite recent therapeutic advances, they are resistant to treatment. Increasing malignancy of gliomas correlates with an increase in cellularity and a poorly organized tumor vasculature, leading to insufficient blood supply, hypoxic areas, and ultimately to the formation of necrosis. Hypoxia induces direct or indirect changes in the biology of solid tumor and their microenvironment through the activation of HIF transcription factors, leading to increased aggressiveness and tumor resistance to therapy. Not much is known about the epigenetic alterations induced by hypoxia and how they could alter tumor biology. In the present study, we have utilized PIMO as a specific marker of hypoxia in glioblastoma patients, treated with PIMO preoperatively. We have estimated PIMO positivity in each tumor (5-45%) and determined that it positively correlates with the hypoxia marker CA IX (r=0.57). In addition, 10 surgical PIMO cases were dissociated, immune labeled using PIMO antibody, followed by DNA isolation and methylation profiling. Our analysis of differentially top 4000 differentially methylated probes suggests that PIMO-positive (hypoxic) cells are differentially methylated compared to the PIMO-negative cells and these changes are associated with genes involved in hypoxic cellular response. We will validate these findings in additional glioblastoma cases and assess the mechanism of these epigenetic alterations in vitro in glioma stem cell culture conditions and upon exposure of the cells hypoxic conditions.
Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.
Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and management of neonatal seizures. However, it is labour-intensive. We aimed to establish consistency in monitoring of newborns utilising NICU nurses. Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues. Guidelines, checklists and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. We compared 100 infants with moderate to severe HIE before and after the training program. Results: 192 cvEEGs were performed. Of the 100 infants compared; time to initiate brain monitoring decreased by average of 31.5 hours, in electrographic seizure detection increased(20% compared to 34% a), seizure clinical misdiagnosis decreased (65% compared to 36% ), and Anti-Seizure burden decreased. Conclusions: Training experienced NICU nurses to set-up, start and monitor cvEEG can decrease the time to initiate cvEEG which may lead to better seizure diagnosis and management.
Introduction: Hypertensive disorders of pregnancy (HDP), including preeclampsia, can develop or worsen in the early postpartum period, often following discharge from hospital, resulting in severe preventable maternal morbidity and mortality. Due to a lack of routine early out-patient follow-up, many women with postpartum HDP present to the emergency department (ED) with severe hypertension or symptoms of preeclampsia (e.g., headache). In the ED, postpartum HDP can be difficult for clinicians to recognize (due to vague presenting symptom) and manage (due to lower blood pressure targets and concern of medication safety). ED clinicians recognized a need for timely recognition and effective treatments for postpartum HDP in the ED to improve maternal outcomes. As such, as part of a multi-step quality improvement initiative, an interdisciplinary team developed and implemented a postpartum HDP management protocol (consisting of nursing and physician protocols and an electronic order set embedded in the electronic medical record). The aims of this specific project were to assess: 1) the use of this clinical management protocol in the ED; and 2) its impacts on clinical care. Methods: This quality improvement project used electronic medical records to identify: 1) ED visits for postpartum HDP for postpartum women ages 20-50; 2) utilization of the postpartum HDP order set; and 3) clinical care outcomes (consultation and admission). Patient population characteristics and clinical care measures were summarized with descriptive statistics and compared using a before and after design. Changes in the utilization of the protocol were assessed using run charts. Results: 540 women with postpartum HDP were seen in the four Calgary EDs in the 16-month period following protocol implementation compared with 335 women in the preceding 12 months. The protocol was used in 46% of these 540 women, and increased over the 16 month follow-up period. We found an increase in the frequency of consultation of specialists (47% to 52%) and admissions (26% to 29%) amongst these women after protocol implementation. Conclusion: This initial assessment demonstrated good uptake of a postpartum HDP management protocol including referral for consultation and admission to hospital for blood pressure management. Future steps include evaluation of the impacts of this management protocol on important patient outcomes.
After decades of effort, the solar magnetic cycle is exceptionally well characterized, but it remains poorly understood. Pioneering work at the Mount Wilson Observatory demonstrated that other Sun-like stars also show regular activity cycles, and identified two distinct relationships between the rotation rate and the length of the cycle. The solar cycle appears to be an outlier, falling between the two stellar relationships, potentially threatening the very foundation of the solar-stellar connection. Recent discoveries emerging from NASA’s Kepler space telescope have started to shed light on this perplexing result, suggesting that the Sun’s rotation rate and magnetic field are currently in a transitional phase that occurs in all middle-aged stars. We have recently identified the manifestation of this magnetic transition in the best available data on stellar cycles. These observations suggest that the solar cycle is currently growing longer on stellar evolutionary timescales, and that the global dynamo may shut down entirely sometime in the next 0.8-2.4 Gyr. Future tests of this hypothesis will come from ground-based activity monitoring of Kepler targets that span the magnetic transition, and from asteroseismology with the TESS mission to determine precise masses and ages for bright stars with known cycles.