Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries.

Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D 1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations

Impacts of Coastal Acidification on the Pacific Northwest Shellfish Industry and Adaptation Strategies Implemented in Response

In 2007, the US west coast shellfish industry began to feel the effects of unprecedented levels of larval mortality in commercial hatcheries producing the Pacific oyster Crassostrea gigas. Subsequently, researchers at Whiskey Creek Shellfish Hatchery, working with academic and government scientists, showed a high correlation between aragonite saturation state (Ω[subscript]arag) of inflowing seawater and survival of larval groups, clearly linking increased CO₂ to hatchery failures. This work led the Pacific Coast Shellfish Growers Association (PCSGA) to instrument shellfish hatcheries and coastal waters, establishing a monitoring network in collaboration with university researchers and the US Integrated Ocean Observing System. Analytical developments, such as the ability to monitor Ω[subscript]arag in real time, have greatly improved the industry’s understanding of carbonate chemistry and its variability and informed the development of commercial-scale water treatment systems. These treatment systems have generally proven effective, resulting in billions of additional oyster larvae supplied to Pacific Northwest oyster growers. However, significant challenges remain, and a multifaceted approach, including selective breeding of oyster stocks, expansion of hatchery capacity, continued monitoring of coastal water chemistry, and improved understanding of biological responses will all be essential to the survival of the US west coast shellfish industry

Core Principles of the California Current Acidification Network: Linking Chemistry, Physics, and Ecological Effects

Numerous monitoring efforts are underway to improve understanding of ocean acidification and its impacts on coastal environments, but there is a need to develop a coordinated approach that facilitates spatial and temporal comparisons of drivers and responses on a regional scale. Toward that goal, the California Current Acidification Network (C-CAN) held a series of workshops to develop a set of core principles for facilitating integration of ocean acidification monitoring efforts on the US West Coast. The recommended core principles include: (1) monitoring measurements should facilitate determination of aragonite saturation state (Ω[subscript]arag) as the common currency of comparison, allowing a complete description of the inorganic carbon system; (2) maximum uncertainty of ±0.2 in the calculation of Ω[subscript]arag is required to adequately link changes in ocean chemistry to changes in ecosystem function; (3) inclusion of a variety of monitoring platforms and levels of effort in the network will insure collection of high-frequency temporal data at fixed locations as well as spatial mapping across locations; (4) physical and chemical oceanographic monitoring should be linked with biological monitoring; and (5) the monitoring network should share data and make it accessible to a broad audience

Design, development and testing of a low-cost electric powered wheelchair for India

Purpose. To design and develop an appropriate, low-cost electric powered wheelchair EPW for the Indian subcontinent. Method. We performed the following multi-phase design process: 1 Conceptual design; 2 System design, Prototype I fabrication, focus group testing with Indian stakeholders n 29; 3 System re-design, Prototype II fabrication and user trials with US n 5 and Indian n 25 subjects. Results. 1 Preliminary investigations revealed that a conventional EPW design was infeasible due to the high component cost. Instead, we constrained our design to incorporate a single drive motor and manual steering, with the option of upgrading to power steering where economically feasible. 2 The first prototype was fabricated out of easily available, low-cost materials. Focus group testing demonstrated feasibility of the design and revealed differences between stakeholder groups. 3 Prototype II incorporated feedback from the first focus group and a needs assessment. US subjects provided valuable design advice prior to the India trials. Indian subjects travelled further in the SIMPL-EPW than their own manual wheelchair MWC. Depending on spinal injury level, Indian subjects found the entire tetraplegia or outdoor portion paraplegia of the obstacle course significantly less challenging in the SIMPL-EPW compared with their own MWC. Conclusions. We demonstrated a useful and successful multi-phase design approach for developing assistive technology for developing regions. © 2009 Informa UK Ltd All rights reserved

Relationship between wheelchair durability and wheelchair type and years of test

Objective. To investigate the relationship between the durability of wheelchairs according to American National Standard for Wheechairs/ Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/RESNA) Wheelchair Standards and wheelchair type as well as year of test. Design. A retrospective study design with a sample of 246 wheelchairs that were tested in accordance with the ANSI/RESNA standards from 1992 to 2008 including four types of wheelchairs: manual wheelchair (MWC), electrical powered wheelchair (EPW), scooters and pushrim-activated power-assisted wheelchair (PAPAW). Unconditional binary logic regression analysis was chosen to evaluate the relationship between test results and test year as well as wheelchair type. Setting. Rehabilitation Engineering Research Center. Main Outcome Measures:Wheelchair durability test result (fatigue test: pass or fail) Results. There was no significant correlation between the year when tested and equivalent cycles. A significant relation was found between test results and wheelchair type (Wald score=10.845, degree of freedom=3, p=0.013) with scooters having a significantly higher pass ratio than MWC (OR=15.629, 95% CI=2.026-120.579). EPW also had significantly higher pass ratio than MWC (OR=1.953, 95% CI=1.049-3.636). No significant difference on pass ratio was found between PAPAW and MWC. Conclusions. No significant improvements in wheelchair test results during the time frame from 1992 to 2008 were discovered. Wheelchair standard tests should be conducted to assure minimum quality of the wheelchairs and for improving the design of wheelchairs. Although the ANSI/RESNA wheelchair durability test procedures have remained consistent, it does not appear that the introduction of new materials, designs and the availability of test data have improved wheelchair fatigue life. © 2010 Informa UK Ltd