A Call to Action: Person-Centered Care Aligned with Reproductive Justice for Incarcerated Pregnant People with Substance Use Disorder

Although research has proven that jails and prisons are ineffective in preventing or reducing substance use among pregnant people, the USA continues to rely heavily on the criminal legal system as its intervention. Pregnant people with an opioid use disorder are more likely to experience incarceration than pregnant people without an opioid use disorder. In some states, pregnant people are transported from jail to prison through the process of safekeeping in order to receive physical or mental health care that the jail does not provide, despite conviction status. When pregnant and postpartum safekeepers with an opioid use disorder experience incarceration, they face barriers related to continuity of physical and behavioral health care, have limited access to maternal-infant attaching opportunities at delivery, and are at risk for an opioid-related overdose upon release. This commentary describes clinical care challenges that impact the reproductive health needs of pregnant safekeepers with an opioid use disorder and offers solution-focused innovations to reduce harm. Such solutions include uninterrupted optimal dosing of medication and integrated prenatal clinics, specialized substance use disorder treatment, and opportunities to integrate lactation programs and perinatal dyadic-focused services

Contracting Agile Developments for Mission Critical Systems in the Public Sector

Although Agile is a well established software development paradigm, major concerns arise when it comes to contracting issues between a software consumer and a software producer. How to contractualize the Agile production of software, especially for security & mission critical organizations, which typically outsource software projects, has been a major concern since the beginning of the \u201cAgile Era.\u201d In literature, little has been done, from a foundational point of view regarding the formalization of such contracts. Indeed, when the development is outsourced, the management of the contractual life is non\u2013trivial. This happens because the interests of the two parties are typically not aligned. In these situations, software houses strive for the minimization of the effort, while the customer commonly expects high quality artifacts. This structural asymmetry can hardly be overcome with traditional \u201cWaterfall\u201d contracts. In this work, we propose a foundational approach to the Law & Economics of Agile contracts. Moreover, we explore the key elements of the Italian procurement law and outline a suitable solution to merge some basic legal constraints with Agile requirements. Finally, a case study is presented, describing how Agile contracting has been concretely implemented in the Italian Defense Acquisition Process. This work is intended to be a framework for Agile contracts for the Italian public sector of critical systems, according to the new contractual law (Codice degli Appalti)

Public Benefits of Undeveloped Lands on Urban Outskirts: Non-Market Valuation Studies and their Role in Land Use Plans

Over the past three decades, the economics profession has developed methods for estimating the public benefits of green spaces, providing an opportunity to incorporate such information into land-use planning. While federal regulations routinely require such estimates for major regulations, the extent to which they are used in local land use plans is not clear. This paper reviews the literature on public values for lands on urban outskirts, not just to survey their methods or empirical findings, but to evaluate the role they have played--or have the potential to play-- in actual land use plans. Based on interviews with authors and representatives of funding agencies and local land trusts, it appears that academic work has had a mixed reception in the policy world. Reasons for this include a lack of interest in making academic work accessible to policy makers, emphasizing revealed preference methods which are inconsistent with policy priorities related to nonuse values, and emphasis on benefit-cost analyses. Nevertheless, there are examples of success stories that illustrate how such information can play a vital role in the design of conservation policies. Working Paper 07-2

Characterization of Indoor Extremely Low Frequency and Low Frequency Electromagnetic Fields in the INMA-Granada Cohort

Objective: To characterize the exposure to electric fields and magnetic fields of non-ionizing radiation in the electromagnetic spectrum (15 Hz to 100 kHz) in the dwellings of children from the Spanish Environment and Childhood-“INMA” population-based birth cohort. Methodology: The study sample was drawn from the INMA-Granada cohort. Out of 300 boys participating in the 9–10 year follow-up, 123 families agreed to the exposure assessment at home and completed a specific ad hoc questionnaire gathering information on sources of non-ionizing radiation electric and magnetic fields inside the homes and on patterns of use. Long-term indoor measurements were carried out in the living room and bedroom. Results: Survey data showed a low exposure in the children's homes according to reference levels of the International Commission on Non-Ionizing Radiation Protection but with large differences among homes in mean and maximum values. Daytime electrostatic and magnetic fields were below the quantification limit in 78.6% (92 dwellings) and 92.3% (108 dwellings) of houses, with an arithmetic mean value (± standard deviation) of 7.31±9.32 V/m and 162.30±91.16 nT, respectively. Mean magnetic field values were 1.6 lower during the night than the day. Nocturnal electrostatic values were not measured. Exposure levels were influenced by the area of residence (higher values in urban/semi-urban versus rural areas), type of dwelling, age of dwelling, floor of the dwelling, and season. Conclusion: Given the greater sensitivity to extremely low-frequency electromagnetic fields of children and following the precautionary principle, preventive measures are warranted to reduce their exposure.This work was supported by the Spanish Ministry of Health (CIBERESP and FIS PI11/0610) and the Andalusia Regional Government, Council of Innovation, Science and Enterprise (Excellence Project P09-CTS-5488) and Council of Health (SAS PI-0675-2010)

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood. Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF education and practice among Kenyan mothers who delivered infants during the COVID-19 pandemic. We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya. While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers’ access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employment and food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social support and food insecurity limit EBF practices for mothers in this context

Transmission patterns of smallpox: systematic review of natural outbreaks in Europe and North America since World War II

BACKGROUND: Because smallpox (variola major) may be used as a biological weapon, we reviewed outbreaks in post-World War II Europe and North America in order to understand smallpox transmission patterns. METHODS: A systematic review was used to identify papers from the National Library of Medicine, Embase, Biosis, Cochrane Library, Defense Technical Information Center, WorldCat, and reference lists of included publications. Two authors reviewed selected papers for smallpox outbreaks. RESULTS: 51 relevant outbreaks were identified from 1,389 publications. The median for the effective first generation reproduction rate (initial R) was 2 (range 0–38). The majority outbreaks were small (less than 5 cases) and contained within one generation. Outbreaks with few hospitalized patients had low initial R values (median of 1) and were prolonged if not initially recognized (median of 3 generations); outbreaks with mostly hospitalized patients had higher initial R values (median 12) and were shorter (median of 3 generations). Index cases with an atypical presentation of smallpox were less likely to have been diagnosed with smallpox; outbreaks in which the index case was not correctly diagnosed were larger (median of 27.5 cases) and longer (median of 3 generations) compared to outbreaks in which the index case was correctly diagnosed (median of 3 cases and 1 generation). CONCLUSION: Patterns of spread during Smallpox outbreaks varied with circumstances, but early detection and implementation of control measures is a most important influence on the magnitude of outbreaks. The majority of outbreaks studied in Europe and North America were controlled within a few generations if detected early

Episodic Occurrence of Favourable Weather Constrains Recovery of a Cold Desert Shrubland After Fire

Key to the long-term resilience of dryland ecosystems is the recovery of foundation plant species following disturbance. In ecosystems with high interannual weather variability, understanding the influence of short-term environmental conditions on establishment of foundation species is essential for identifying vulnerable landscapes and developing restoration strategies. We asked how annual environmental conditions affect post-fire establishment of Artemisia tridentata, a shrub species that dominates landscapes across much of the western United States, and evaluated the influence of episodic establishment on population recovery. We collected A. tridentata stem samples from 33 plots in 12 prescribed fire sites that burned 8–11 years before sampling. We determined individual establishment years using annual growth rings. We measured seasonal soil environmental conditions at the study sites and asked if these conditions predicted annual establishment density. We then evaluated whether establishment patterns could be predicted by site-level climate or dominant subspecies. Finally, we tested the effect of the magnitude and frequency of post-fire establishment episodes on long-term population recovery. Annual post-fire recruitment of A. tridentata was driven by the episodic availability of spring soil moisture. Annual establishment was highest with wetter spring soils (relative influence [RI] = 19.4%) and later seasonal dry-down (RI = 11.8%) in the year of establishment. Establishment density declined greatly 4 to 5 years after fire (RI = 17.1%). Post-fire establishment patterns were poorly predicted by site-level mean climate (marginal R2 ≤ 0.18) and dominant subspecies (marginal R2 ≤ 0.43). Population recovery reflected the magnitude, but not the frequency, of early post-fire establishment pulses. Post-fire A. tridentata density and cover (measured 8–11 years after fire) were more strongly related to the magnitude of the largest establishment pulse than to establishment frequency, suggesting that population recovery may occur with a single favourable establishment year. Synthesis and applications. This study demonstrates the importance of episodic periods of favourable weather for long-term plant population recovery following disturbance. Management strategies that increase opportunities for seed availability to coincide with favourable weather conditions, such as retaining unburned patches or repeated seeding treatments, can improve restoration outcomes in high-priority areas