Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia.

Introduction The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact. Methods A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders' perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis. Results The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases. Conclusions Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening

Reproductive health for refugees by refugees in Guinea III: maternal health

BACKGROUND: Maternal mortality can be particularly high in conflict and chronic emergency settings, partly due to inaccessible maternal care. This paper examines associations of refugee-led health education, formal education, age, and parity on maternal knowledge, attitudes, and practices among reproductive-age women in refugee camps in Guinea. METHODS: Data comes from a 1999 cross-sectional survey of 444 female refugees in 23 camps. Associations of reported maternal health outcomes with exposure to health education (exposed versus unexposed), formal education (none versus some), age (adolescent versus adult), or parity (nulliparous, parous, grand multiparous), were analysed using logistic regression. RESULTS: No significant differences were found in maternal knowledge or attitudes. Virtually all respondents said pregnant women should attend antenatal care and knew the importance of tetanus vaccination. Most recognised abdominal pain (75%) and headaches (24%) as maternal danger signs and recommended facility attendance for danger signs. Most had last delivered at a facility (67%), mainly for safety reasons (99%). Higher odds of facility delivery were found for those exposed to RHG health education (adjusted odds ratio 2.03, 95%CI 1.23-3.01), formally educated (adjusted OR 1.93, 95%CI 1.05-3.92), or grand multipara (adjusted OR 2.13, 95%CI 1.21-3.75). Main reasons for delivering at home were distance to a facility (94%) and privacy (55%). CONCLUSIONS: Refugee-led maternal health education appeared to increase facility delivery for these refugee women. Improved knowledge of danger signs and the importance of skilled birth attendance, while vital, may be less important in chronic emergency settings than improving facility access where quality of care is acceptable

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Accuracy of small diameter sheathed thermocouples for the core flow test loop

This report summarizes the research and development on 0.5-mm-diameter, compacted, metal sheathed thermocouples. The objectives of this research effort have been: to identify and analyze the sources of temperature measurement errors in the use of 0.5-mm-diameter sheathed thermocouples to measure the surface temperature of the cladding of fuel-rod simulators in the Core Flow Test Loop (CFTL) at ORNL; to devise methods for reducing or correcting for these temperature measurement errors; to estimate the overall temperature measurement uncertainties; and to recommend modifications in the manufacture, installation, or materials used to minimize temperature measurement uncertainties in the CFTL experiments

Quantitative SIMS analysis of decalibrated Chromel versus Alumel thermocouples using indexed sensitivity factors

Secondary ion mass spectrometry (SIMS) is used to determine the failure mode responsible for the large decalibrations observed in sheathed, MgO-insulated Chromel versus Alumel, compacted thermocouple assemblies, exposed to temperatures above 1100/sup 0/C. Thermocouples sheathed in Inconel-600 and type 304 stainless steel were studied in this work. Quantified SIMS data showed that the observed decalibrations were due to significant alterations that took place in the Chromel and Alumel thermoelements. The amount of alteration was different for each thermocouple and was influenced by the particular sheath material used in the thermocouple construction

Engineering Evaluation of Proposed Alternative Salt Transfer Method for the Molten Salt Reactor Experiement for the Oak Ridge National Laboratory

This evaluation was performed by Pro2Serve in accordance with the Technical Specification for an Engineering Evaluation of the Proposed Alternative Salt Transfer Method for the Molten Salt Reactor Experiment at the Oak Ridge National Laboratory (BJC 2009b). The evaluators reviewed the Engineering Evaluation Work Plan for Molten Salt Reactor Experiment Residual Salt Removal, Oak Ridge National Laboratory, Oak Ridge, Tennessee (DOE 2008). The Work Plan (DOE 2008) involves installing a salt transfer probe and new drain line into the Fuel Drain Tanks and Fuel Flush Tank and connecting them to the new salt transfer line at the drain tank cell shield. The probe is to be inserted through the tank ball valve and the molten salt to the bottom of the tank. The tank would then be pressurized through the Reactive Gas Removal System to force the salt into the salt canisters. The Evaluation Team reviewed the work plan, interviewed site personnel, reviewed numerous documents on the Molten Salt Reactor (Sects. 7 and 8), and inspected the probes planned to be used for the transfer. Based on several concerns identified during this review, the team recommends not proceeding with the salt transfer via the proposed alternate salt transfer method. The major concerns identified during this evaluation are: (1) Structural integrity of the tanks - The main concern is with the corrosion that occurred during the fluorination phase of the uranium removal process. This may also apply to the salt transfer line for the Fuel Flush Tank. Corrosion Associated with Fluorination in the Oak Ridge National Laboratory Fluoride Volatility Process (Litman 1961) shows that this problem is significant. (2) Continued generation of Fluorine - Although the generation of Fluorine will be at a lower rate than experienced before the uranium removal, it will continue to be generated. This needs to be taken into consideration regardless of what actions are taken with the salt. (3) More than one phase of material - There are likely multiple phases of material in the salt (metal or compound), either suspended through the salt matrix, layered in the bottom of the tank, or both. These phases may contribute to plugging during any planned transfer. There is not enough data to know for sure. (4) Probe heat trace - The alternate transfer method does not include heat tracing of the bottom of the probe. There is a concern that this may cool the salt and other phases of materials present enough to block the flow of salt. (5) Stress-corrosion cracking - Additionally, there is a concern regarding moisture that may have been introduced into the tanks. Due to time constraints, this concern was not validated. However, if moisture was introduced into the tanks and not removed during heating the tanks before HF and F2 sparging, there would be an additional concern regarding the potential for stress-corrosion cracking of the tank walls

A review of vacuum insulation research and development in the Building Materials Group of the Oak Ridge National Laboratory

This report is a summary of the development work on flat-vacuum insulation performed by the Building Materials Group (BMG) in the Metals and Ceramics Division of the Oak Ridge National Laboratory (ORNL) during the last two years. A historical review of the technology of vacuum insulation is presented, and the role that ORNL played in this development is documented. The ORNL work in vacuum insulation has been concentrated in Powder-filled Evacuated Panels (PEPs) that have a thermal resistivity over 2.5 times that of insulating foams and seven times that of many batt-type insulations, such as fiberglass. Experimental results of substituting PEPs for chlorofluorocarbon (CFC) foal insulation in Igloo Corporation ice coolers are summarized. This work demonstrated that one-dimensional (1D) heat flow models overestimated the increase in thermal insulation of a foam/PEP-composite insulation, but three-dimensional (3D) models provided by a finite-difference, heat-transfer code (HEATING-7) accurately predicted the resistance of the composites. Edges and corners of the ice coolers were shown to cause the errors in the 1D models as well as shunting of the heat through the foam and around the PEPs. The area of coverage of a PEP in a foam/PEP composite is established as an important parameter in maximizing the resistance of such composites. 50 refs., 27 figs,. 22 tabs

A review of vacuum insulation research and development in the Building Materials Group of the Oak Ridge National Laboratory

This report is a summary of the development work on flat-vacuum insulation performed by the Building Materials Group (BMG) in the Metals and Ceramics Division of the Oak Ridge National Laboratory (ORNL) during the last two years. A historical review of the technology of vacuum insulation is presented, and the role that ORNL played in this development is documented. The ORNL work in vacuum insulation has been concentrated in Powder-filled Evacuated Panels (PEPs) that have a thermal resistivity over 2.5 times that of insulating foams and seven times that of many batt-type insulations, such as fiberglass. Experimental results of substituting PEPs for chlorofluorocarbon (CFC) foal insulation in Igloo Corporation ice coolers are summarized. This work demonstrated that one-dimensional (1D) heat flow models overestimated the increase in thermal insulation of a foam/PEP-composite insulation, but three-dimensional (3D) models provided by a finite-difference, heat-transfer code (HEATING-7) accurately predicted the resistance of the composites. Edges and corners of the ice coolers were shown to cause the errors in the 1D models as well as shunting of the heat through the foam and around the PEPs. The area of coverage of a PEP in a foam/PEP composite is established as an important parameter in maximizing the resistance of such composites. 50 refs., 27 figs,. 22 tabs