A protocol for the development of a validated scale of household water insecurity in the United States: HWISE-USA

Background New metrics of household water insecurity have been validated for low- to middle-income countries, but it is unclear how these measurements apply to the experiences of people living in high-income countries. This project aims to develop and validate a novel metric for household water insecurity experiences in the United States (HWISE-USA) using a cross-sectional design and data from the Southwest, Midwest, and Western regions. Methods We outline the protocol for the development and validation of a novel household water insecurity scale for the United States to address this scientific need, including the following key steps: (1) item development through literature and theory; (2) pre-testing of items and expert review; (3) scale development and item reduction; and (4) scale validation. To assess the performance of the HWISE-USA scale, we will follow the same scale development analytics on a separate, quasi-nationally-representative U.S. sample. The scale will be generated from household survey data collected from communities at risk of water insecurity throughout the United States. Discussion We explain how a novel metric of water insecurity experiences for households in the United States has important implications for resource allocation, structural interventions, public health and infrastructure planning, and reductions in inequalities

Swallowing abnormalities in HIV infected children : an important cause of morbidity

Publication of this article was funded by the Stellenbosch University Open Access Fund.The original publication is available at http://www.biomedcentral.com/bmcpediatrBackground: Swallowing disorders, well recognised in adults, contribute to HIV-infection morbidity. Little data however is available for HIV-infected children. The purpose of this study is to describe swallowing disorders in a group of HIV-infected children in Africa after the introduction of combined anti-retroviral therapy. Methods: We describe 25 HIV-infected children referred for possible swallowing disorders. Clinical and videofluoroscopic assessment of swallowing (VFSS), HIV stage, and respiratory and neurological examination were recorded. Results: Median age was 8 months (range 2.8-92) and 15 (60%) were male. Fifteen (60%) were referred for recurrent respiratory complaints, 4 (16%) for poor growth, 4 (16%) for poor feeding and 2 (8%) patients for respiratory complaints and either poor growth or feeding. Twenty patients (80%) had clinical evidence of swallowing abnormalities: 11 (44%) in the oral phase, 4 (16%) in the pharyngeal phase, and 5 (25%) in both the oral and pharyngeal phases. Thirteen patients had a videofluoroscopic assessment of which 6 (46%) where abnormal. Abnormalities were detected in the oral phase in 2, in the pharyngeal phase in 3, and in the oral and pharyngeal phase in 1; all of these patients also had evidence of respiratory involvement. Abnormal swallowing occurred in 85% of children with central nervous system disease. CNS disease was due to HIV encephalopathy (8) and miscellaneous central nervous system diseases (5). Three of 4 (75%) patients with thrush had an abnormal oral phase on assessment. No abnormalities of the oesophagus were found. Conclusions: This report highlights the importance of swallowing disorders in HIV infected children. Most patients have functional rather than structural or mucosal abnormalities. VFSS makes an important contribution to the diagnosis and management of these patients.Stellenbosch University Open Access FundPublishers' versio

Gene-environment and gene-gene interactions of specific MTHFR, MTR and CBS gene variants in relation to homocysteine in a black South Africans

The methylenetetrahydrofolate reductase (MTHFR), cystathione-β-synthase (CBS) and methionine synthase (MTR) genes interact with each other and the environment. These interactions could influence homocysteine (Hcy) and diseases contingent thereon. We determined single nucleotide polymorphisms (SNPs) within these genes, their relationships and interactions with total Hcy concentrations within black South Africans to address the increased prevalence of diseases associated with Hcy. The MTHFR 677 TT and MTR 2756 AA genotypes were associated with higher Hcy concentrations (16.6 and 10.1 μmol/L; p b 0.05) compared to subjects harboring the MTHFR 677 CT/CC and the MTR 2756 AG genotypes (10.5, 9.7 and 9.5 μmol/L, respectively). The investigated CBS genotypes did not influence Hcy.We demonstrated interactions between the area of residence and the CBS T833C/844ins68 genotypes (p = 0.005) so that when harboring the wildtype allele, rural subjects had significantly higher Hcy than their urban counterparts, but when hosting the variant allele the environment made no difference to Hcy. Between the CBS T833C/844ins68 or G9276A and MTHFR C677T genotypes, there were two-way interactions (p = 0.003 and = 0.004, respectively), with regard to Hcy. Subjects harboring the MTHFR 677 TT genotype in combination with the CBS 833 TT/homozygous 844 non-insert or the MTHFR 677 TT genotype in combination with the CBS 9276 GA/GG displayed higher Hcy concentrations. Therefore, some of the investigated genotypes affected Hcy; residential area changed the way in which the CBS T833C/844ins68 SNPs influenced Hcy concentrations highlighting the importance of environmental factors; and gene–gene interactions allude to epistatic effectsSANPAD (South Africa- Netherlands Research Programme on Alternatives in Development), South African National Research Foundation (NRF),North-West University (NWU), Population Health Research Institute (PHRI), Medical Research Council (MRC) and the NorthWest Province Health Departmen

Evolutionary and Holistic Assessment of Green-Grey Infrastructure for CSO Reduction

Recent research suggests future alterations in rainfall patterns due to climate variability, affecting public safety and health in urban areas. Urban growth, one of the main drivers of change in the current century, will also affect these conditions. Traditional drainage approaches using grey infrastructure offer low adaptation to an uncertain future. New methodologies of stormwater management focus on decentralized approaches in a long-term planning framework, including the use of Green Infrastructure (GI). This work presents a novel methodology to select, evaluate, and place different green-grey practices (or measures) for retrofitting urban drainage systems. The methodology uses a hydrodynamic model and multi-objective optimization to design solutions at a watershed level. The method proposed in this study was applied in a highly urbanized watershed to evaluate the effect of these measures on Combined Sewer Overflows (CSO) quantity. This approach produced promising results and may become a useful tool for planning and decision making of drainage systems

Public support for renewables

The extent to which renewables gain public support and are able to attract adequate private or public investment is key to their further uptake. Although individuals and some groups have expressed concerns about specific renewable energy projects, opinion polls indicate strong public support for the growth of renewables. Governments have sought to improve public participation, strengthen regulatory control and share economic benefits with host communities to further build citizen support for renewable energy projects