Impediments in Energy Efficient Building Retrofitting: With Special Reference to Public University Buildings in Sri Lanka

In a world where sustainability and energy conservation have taken center stage, the building sector, which happens to be the largest consumer of energy, finds itself at a critical crossroads. As sustainability and energy reduction become increasingly important, building retrofitting is recognized as a viable and sustainable solution. Retrofitting involves integrating new features and technology into existing buildings to enhance their efficiency. Despite the acknowledged need for building retrofitting, there is relatively low concern within the public sector, including university buildings. Various barriers hinder the adoption, implementation, and operation of energy-efficient retrofits in public university buildings in Sri Lanka. This study aimed to investigate these impediments. Qualitative methods were employed, and five professionals, including three architects and two institutional hierarchical heads in Finance and Legal Units, were interviewed. Data analysis was conducted using content analysis. The findings highlighted financial, procurement, energy assessment, technical, and legal aspects as barriers to energy-efficient retrofitting in public university buildings. Among these, technical barriers emerged as the predominant impeding category. Therefore, the authors recommend future studies to focus on in-depth examinations of technical barriers and their impacts on building retrofitting. Authors suggested several policy level implications as well

A content analysis of district level health data in Uttar Pradesh, India

The study aimed to conduct a content analysis of the different types of public health data maintained by the Health Department, the Department of Women and Child Development, and the private for profit and not for profit health sectors and the links that exist between them in terms of data sharing. Method: In two districts, Sitapur and Unnao, an IDEAS/PHFI study team visited district, sub-district and village level health facilities (public and private) as well as NRHM programme management units, and Women and Child Development offices. The team collected all available forms and interviewed facility staff and programme managers to understand the types of data collected, their flow and data sharing. Case studies of three not-for-profit non-governmental organisations were developed to understand how they maintain and share data with the public health system. Findings: The public health system collects a large volume of health data; Data exist for all of WHO’s health system building blocks, but it is unevenly distributed. There are fewer data on contextual information, e.g. village infrastructure and demographic profile, compared to service delivery; There is little formal or institutional routine data sharing between the public and private health sectors, and between the health department and other related departments such as Women and Child Development

Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy.

Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting. Five cases of mediastinal lymphadenopathy are presented here in which lymph node anthracosis was identified as the primary diagnosis using EBUS-TBNA. They were female, non-smokers presenting with non-specific symptoms, who retrospectively reported cooking over wood fires. Four were from South Asia. Three were investigated by F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and increased signal was identified in the anthracotic nodes sampled. With expansion of PET/CT and EBUS-TBNA services it is likely that primary nodal anthracosis will be encountered more frequently and should be considered in the differential diagnosis of those with PET/CT positive lymphadenopathy. It may mimic pathologies including tuberculosis and malignancy, thus accurate sampling and follow-up are essential

Characterization of Telehealth Use in Veterans with Spinal Cord Injuries and Disorders

BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic functions, and secondary complications. Telehealth has the capacity to substantially transform healthcare delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here, we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project SETTING: Veterans Health Administration (VHA) facilities. Participants: 15,028 Veterans living with SCI/D whom received services from the VHA SCI/D System of Care. Intervention: Not applicable Outcome Measures: Frequency and characteristics associated with VHA telehealth utilization. Results: Of the 15,028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans over the age of 65 had lower odds (OR = 0.88, p \u3c 0.05, CI: 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, p \u3c 0.01, CI: 1.09-1.52), living in rural areas (OR =1.16, p \u3c 0.01, CI: 1.05-1.28), living greater distances away from the VHA (p \u3c 0.01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR=1.46, p \u3c 0.001, CI: 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. Conclusion: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population

Interferon-gamma release assay (IGRA) conversion, reversion and implications for the diagnosis of latent tuberculosis infection using a multimodality approach: a retrospective, observational study within a central London TB centre

Introduction and Objectives Accurate diagnosis & management of latent tuberculosis infection (LTBI) among TB contacts is critical for both the health of infected individuals and prevention of disease transmission. Interferon gamma release assays (IGRAs) measure T cell release of interferon-gamma following stimulation by antigens not confounded by the BCG vaccination. The current NICE guidelines recommend their use following a positive TST. In addition some centres have moved to a single step IGRA test for LTBI. Our institution adopts a triple investigation approach comprising a chest radiograph (CXR), TST and IGRA on presentation followed by a rescreen if the TST & IGRA are discordant or if pulmonary contacts are screened prior to 6 weeks. The aim of our study was to evaluate the prevalence of IGRA conversion and reversion in rescreened asymptomatic TB contacts that attended our centre. Methods This was a retrospective, observational study carried out at a central London teaching hospital. The study population comprised 593 consecutive, adult TB contacts screened between 1 January 2008 and 31 December 2010. Data were collected through retrospective review of chest radiographs, TST & IGRA tests. Results Of 498 asymptomatic TB contacts screened, 460 had both an initial TST and IGRA performed (Abstract P13 figure 1). 81 (17.7%) contacts had discordant TST & IGRA results. 52 (64%) of these discordant cases had a positive TST & Negative IGRA; these patients would have been discharged under NICE guidelines however, our rescreen revealed 9 (17%) positive 2nd IGRAs that is, conversion. Three of these patients were under 35 and would therefore by eligible for chemoprophylaxis. Twenty-nine (36%) of the discordant cases had a negative TST and positive IGRA however, 8 (28%) of these IGRAs reverted to negative. It is important to note that if following a single-step IGRA screening protocol (ie, without a rescreen) these cases may have been commenced on chemoprophylaxis unnecessarily (four of these reversion cases were under the age of 35). Conclusions Our results show that adoption of either a sequential TST + ve/IGRA approach or single IGRA approach can result in a significant number of false negative LTBI diagnoses due to IGRA conversion. Conversely, we have also shown that an IGRA rescreen because of discordant TST/IGRA tests can improve LTBI diagnostic specificity and therefore reduce unnecessary chemoprophylaxis due to the effect of reversion

Informed Decisions for Actions in Maternal and Newborn Health 2010–17 Report What works, why and how in maternal and newborn health

IDEAS is a measurement, learning and evaluation project based at the London School of Hygiene & Tropical Medicine (LSHTM). The project aims to find out “what works, why, and how” for maternal and newborn health in three low-resource settings in Nigeria, India, and Ethiopia. The IDEAS team includes 20 research and professional support staff, living in Abuja, Addis Ababa, London, and New Delhi, who have been working since 2010 with the Bill & Melinda Gates Foundation (the foundation) and with the foundation’s implementation partners