Handcuffing the Vote: Diluting Minority Voting Power Through Prison Gerrymandering and Felon Disenfranchisement

For the purposes of legislative redistricting, Texas counts prison populations at the address of the prison in which they are incarcerated at the time of the census, rather than their home prior to incarceration—regardless of whether the prisoners themselves maintain a residence in their home communities and intend to return home after incarceration. This deprives those home communities of full representation in the redistricting process. Combined with Texas’s felon disenfranchisement laws, this also results in arbitrarily bolstering the representational power of some Texans on the backs of other Texans who themselves are unable to vote. All of this takes place against the backdrop of a long history of unconstitutional racial discrimination by the State of Texas and a broken criminal justice system. Some states have taken proactive policy measures to remedy the systemic problem of prison gerrymandering, and changing societal values might pave the way for new legal challenges to combat these injustices

Acute Resistance Exercise Influences Bioelectrical Impedance Analysis Segmental Fat Mass Estimates

Bioelectrical impedance analysis (BIA) is an attractive tool for routine assessment of human body composition. However, there is also concern regarding how some variables, particularly exercise, may affect its measurements and therefore limit the conditions under which this technology can provide useful body composition data. PURPOSE: The purpose of this study was to determine if acute, localized resistance exercise (RE) compromises the validity of BIA segmental fat mass (FM) estimates. METHODS: In a crossover design, 32 healthy, resistance trained adults (18 F, 14 M; age: 23.4 ± 2.3 y; height: 172.4 ± 8.7 cm; body mass: 74.9 ± 15.3 kg; body fat: 25.6 ± 8.4%) completed three conditions in a randomized order: lower-body resistance exercise (L), upper-body resistance exercise (U), and rest (R). The RE protocol included a warm-up consisting of 2 sets of 12-15 repetitions of 3 upper-body exercises (U), or 3 lower-body exercises (L), followed by 5 sets of 10 repetitions per exercise, with 1-minute rest intervals. The R condition involved no exercise. BIA (InBody 770) was completed immediately pre- and post-exercise and at 15-, 30-, and 60-minutes post-exercise. The effects of the acute RE session on BIA estimates of total and segmental FM were analyzed using linear mixed-effects models with condition and time specified as within-subject factors and a random intercept for participant. In all models, the reference groups were R for condition and the pre-exercise time point for time. RESULTS: Condition by time interactions were observed for total and segmental FM. Examination of model coefficients indicated that most condition by time interactions were attributable to differences in the U condition across time relative to the reference group (i.e., R condition at baseline). In relation to the reference group, mean decreases of 0.75 to 1.25 kg for total FM, 0.38 to 0.58 kg for trunk FM, 0.27 to 0.47 kg for leg FM, and 0.15 to 0.22 kg for arm FM were observed in the U condition (p≤0.001 for all). In contrast, no changes across time were observed in the L condition. CONCLUSION: These findings suggest that an acute bout of localized RE influences BIA total and segmental FM estimates to an extent that can compromise accurate interpretation of the results. These data corroborate the need for a period of rest from physical activity, particularly upper body RE, prior to BIA body composition assessment

Incidence and risk factors of neonatal infections in a rural Bangladeshi population: a community-based prospective study

Background: Infections cause about one fifth of the estimated 2.7 million annual neonatal deaths worldwide. Population-based data on burden and risk factors of neonatal infections are lacking in developing countries, which are required for the appropriate design of effective preventive and therapeutic interventions in resource-poor settings. Methods: We used data from a community-based cluster-randomized trial conducted to evaluate the impact of two umbilical cord cleansing regimens with chlorhexidine solution on neonatal mortality and morbidity in a rural area of Sylhet District in Bangladesh. Newborns were assessed four times in the first 9 days of life by trained community health workers (CHWs) using a WHO IMCI-like clinical algorithm. Cumulative incidence of the first episode of infections in the first 9 days of life was estimated using survival analysis technique accounting for survival bias and competing risk of death before the occurrence of infection. A multivariable generalized estimating equation log-binomial regression model was used to identify factors independently associated with infections. Results: Between 2007 and 2009, 30,267 newborns who received at least one postnatal assessment visit by a CHW within the first 9 days of life were included in this study. Cumulative incidence of infections in the first 9 days of life was 14.5% (95% CI 14.1\u201314.9%). Significant risk factors included previous child death in the family [RR 1.10 (95% CI 1.02\u20131.19)]; overcrowding [RR 1.14 (95% CI 1.04\u20131.25)]; home delivery [RR 1.86 (95% CI 1.58\u20132.19)]; unclean cord care [RR 1.15 (95% CI 1.03\u20131.28)]; multiple births [RR 1.34 (95% CI 1.15\u20131.56)]; low birth weight [reference: 65 2500 g, RR (95% CI) for < 1500, 1500\u20131999, and 2000\u20132499 g were 4.69 (4.01\u20135.48), 2.15 (1.92\u20132.42), and 1.15 (1.07\u20131.25) respectively]; and birth asphyxia [RR 1.65 (1.51\u20131.81)]. Higher pregnancy order lowered the risk of infections in the study population [compared to first pregnancy, RR (95% CI) for second, third, and 65 fourth pregnancy babies were 0.93 (0.85\u20131.02), 0.88 (0.79\u20130.97), and 0.79 (0.71\u20130.87), respectively]. Conclusion: Neonatal infections and associated deaths can be reduced by identifying and following up high-risk mothers and newborns and promoting facility delivery and clean cord care in resource-poor countries like Bangladesh where the burden of clinically ascertained neonatal infections is high. Further research is needed to measure the burden of infections in the entire neonatal period, particularly in the second fortnight and its association with essential newborn care. Trial registration: NCT00434408. Registered February 9, 2007

Pneumococcal Conjugate Vaccine impact assessment in Bangladesh [version 1; referees: 1 approved, 2 approved with reservations]

The study examines the impact of the introduction of 10-valent Pneumococcal Conjugate Vaccine (PCV10) into Bangladesh’s national vaccine program. PCV10 is administered to children under 1 year-old; the scheduled ages of administration are at 6, 10, and 18 weeks. The study is conducted in ~770,000 population containing ~90,000 <5 children in Sylhet, Bangladesh and has five objectives: 1) To collect data on community-based pre-PCV incidence rates of invasive pneumococcal diseases (IPD) in 0-59 month-old children in Sylhet, Bangladesh; 2) To evaluate the effectiveness of PCV10 introduction on Vaccine Type (VT) IPD in 3-59 month-old children using an incident case-control study design. Secondary aims include measuring the effects of PCV10 introduction on all IPD in 3-59 month-old children using case-control study design, and quantifying the emergence of Non Vaccine Type IPD; 3) To evaluate the effectiveness of PCV10 introduction on chest radiograph-confirmed pneumonia in children 3-35 months old using incident case-control study design. We will estimate the incidence trend of clinical and radiologically-confirmed pneumonia in 3-35 month-old children in the study area before and after introduction of PCV10; 4) To determine the feasibility and utility of lung ultrasound for the diagnosis of pediatric pneumonia in a large sample of children in a resource-limited setting. We will also evaluate the effectiveness of PCV10 introduction on ultrasound-confirmed pneumonia in 3-35 month-old children using an incident case-control design and to examine the incidence trend of ultrasound-confirmed pneumonia in 3-35 month-old children in the study area before and after PCV10 introduction; and 5) To determine the direct and indirect effects of vaccination status on nasopharyngeal colonization on VT pneumococci among children with pneumonia.  This paper presents the methodology. The study will allow us to conduct a comprehensive and robust assessment of the impact of national introduction of PCV10 on pneumococcal disease in Bangladesh

Incidence and risk factors of neonatal infections in a rural Bangladeshi population: a community-based prospective study

BACKGROUND: Infections cause about one fifth of the estimated 2.7 million annual neonatal deaths worldwide. Population-based data on burden and risk factors of neonatal infections are lacking in developing countries, which are required for the appropriate design of effective preventive and therapeutic interventions in resource-poor settings. METHODS: We used data from a community-based cluster-randomized trial conducted to evaluate the impact of two umbilical cord cleansing regimens with chlorhexidine solution on neonatal mortality and morbidity in a rural area of Sylhet District in Bangladesh. Newborns were assessed four times in the first 9 days of life by trained community health workers (CHWs) using a WHO IMCI-like clinical algorithm. Cumulative incidence of the first episode of infections in the first 9 days of life was estimated using survival analysis technique accounting for survival bias and competing risk of death before the occurrence of infection. A multivariable generalized estimating equation log-binomial regression model was used to identify factors independently associated with infections. RESULTS: Between 2007 and 2009, 30,267 newborns who received at least one postnatal assessment visit by a CHW within the first 9 days of life were included in this study. Cumulative incidence of infections in the first 9 days of life was 14.5% (95% CI 14.1–14.9%). Significant risk factors included previous child death in the family [RR 1.10 (95% CI 1.02–1.19)]; overcrowding [RR 1.14 (95% CI 1.04–1.25)]; home delivery [RR 1.86 (95% CI 1.58–2.19)]; unclean cord care [RR 1.15 (95% CI 1.03–1.28)]; multiple births [RR 1.34 (95% CI 1.15–1.56)]; low birth weight [reference: ≥ 2500 g, RR (95% CI) for &lt; 1500, 1500–1999, and 2000–2499 g were 4.69 (4.01–5.48), 2.15 (1.92–2.42), and 1.15 (1.07–1.25) respectively]; and birth asphyxia [RR 1.65 (1.51–1.81)]. Higher pregnancy order lowered the risk of infections in the study population [compared to first pregnancy, RR (95% CI) for second, third, and ≥ fourth pregnancy babies were 0.93 (0.85–1.02), 0.88 (0.79–0.97), and 0.79 (0.71–0.87), respectively]. CONCLUSION: Neonatal infections and associated deaths can be reduced by identifying and following up high-risk mothers and newborns and promoting facility delivery and clean cord care in resource-poor countries like Bangladesh where the burden of clinically ascertained neonatal infections is high. Further research is needed to measure the burden of infections in the entire neonatal period, particularly in the second fortnight and its association with essential newborn care. TRIAL REGISTRATION: NCT00434408. Registered February 9, 2007

Incidence and risk factors of neonatal infections in a rural Bangladeshi population: a community-based prospective study

Abstract Background Infections cause about one fifth of the estimated 2.7 million annual neonatal deaths worldwide. Population-based data on burden and risk factors of neonatal infections are lacking in developing countries, which are required for the appropriate design of effective preventive and therapeutic interventions in resource-poor settings. Methods We used data from a community-based cluster-randomized trial conducted to evaluate the impact of two umbilical cord cleansing regimens with chlorhexidine solution on neonatal mortality and morbidity in a rural area of Sylhet District in Bangladesh. Newborns were assessed four times in the first 9 days of life by trained community health workers (CHWs) using a WHO IMCI-like clinical algorithm. Cumulative incidence of the first episode of infections in the first 9 days of life was estimated using survival analysis technique accounting for survival bias and competing risk of death before the occurrence of infection. A multivariable generalized estimating equation log-binomial regression model was used to identify factors independently associated with infections. Results Between 2007 and 2009, 30,267 newborns who received at least one postnatal assessment visit by a CHW within the first 9 days of life were included in this study. Cumulative incidence of infections in the first 9 days of life was 14.5% (95% CI 14.1–14.9%). Significant risk factors included previous child death in the family [RR 1.10 (95% CI 1.02–1.19)]; overcrowding [RR 1.14 (95% CI 1.04–1.25)]; home delivery [RR 1.86 (95% CI 1.58–2.19)]; unclean cord care [RR 1.15 (95% CI 1.03–1.28)]; multiple births [RR 1.34 (95% CI 1.15–1.56)]; low birth weight [reference: ≥ 2500 g, RR (95% CI) for < 1500, 1500–1999, and 2000–2499 g were 4.69 (4.01–5.48), 2.15 (1.92–2.42), and 1.15 (1.07–1.25) respectively]; and birth asphyxia [RR 1.65 (1.51–1.81)]. Higher pregnancy order lowered the risk of infections in the study population [compared to first pregnancy, RR (95% CI) for second, third, and ≥ fourth pregnancy babies were 0.93 (0.85–1.02), 0.88 (0.79–0.97), and 0.79 (0.71–0.87), respectively]. Conclusion Neonatal infections and associated deaths can be reduced by identifying and following up high-risk mothers and newborns and promoting facility delivery and clean cord care in resource-poor countries like Bangladesh where the burden of clinically ascertained neonatal infections is high. Further research is needed to measure the burden of infections in the entire neonatal period, particularly in the second fortnight and its association with essential newborn care. Trial registration NCT00434408. Registered February 9, 2007