Intentional injury against children in Sub-Saharan Africa: A tertiary trauma centre experience

Background Intentional injuries are the result of violence. This is an important public health issue, particularly in children, and is an unaddressed problem in sub-Saharan Africa. This study sought to describe the characteristics of intentional injury, particularly physical abuse, in children presenting to our tertiary trauma centre in Lilongwe, Malawi and how they compare to children with unintentional injuries. Methods A retrospective analysis of children (<18 years old) with traumatic injuries presenting to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2009 to 2013 was performed. Children with intentional and unintentional injuries were compared with bivariate analysis and multivariate logistic regression modelling. Results 67,672 patients with traumatic injuries presented to KCH of which 24,365 were children. 1976 (8.1%) patients presented with intentional injury. Intentional injury patients had a higher mean age (11.1 ± 5.0 vs. 7.1 ± 4.6, p < 0.001), a greater male preponderance (72.5 vs. 63.6%, p < 0.001), were more often injured at night (38.3 vs. 20.7%, p < 0.001), and alcohol was more often involved (7.8 vs. 1.0%, p < 0.001). Multivariate logistic regression modelling showed that increasing age, male gender, and nighttime or urban setting for injury were associated with increased odds of intentional injury. Soft tissue injuries were more common in intentional injury patients (80.5 vs. 45.4%, p < 0.001) and fist punches were the most common weapon (25.6%). Most patients were discharged in both groups (89.2 vs 80.9%, p < 0.001) and overall mortality was lower for intentional injury patients (0.9 vs. 1.2%, p = 0.001). Head injury was the most common cause of death (43.8 vs. 32.2%, p < 0.001) in both groups. Conclusions Sub-Saharan African tertiary hospitals are uniquely positioned to play a pivotal role in the identification, clinical management, and alleviation of intentional injuries to children by facilitating access to social services and through prevention efforts

Medicaid Expenditures on Psychotropic Medications for Children in the Child Welfare System

Abstract Objective: Children in the child welfare system are the most expensive child population to insure for their mental health needs. The objective of this article is to estimate the amount of Medicaid expenditures incurred from the purchase of psychotropic drugs ? the primary drivers of mental health expenditures ? for these children. Methods: We linked a subsample of children interviewed in the first nationally representative survey of children coming into contact with U.S. child welfare agencies, the National Survey of Child and Adolescent Well-Being (NSCAW), to their Medicaid claims files obtained from the Medicaid Analytic Extract. Our data consist of children living in 14 states, and Medicaid claims for 4 years, adjusted to 2010 dollars. We compared expenditures on psychotropic medications in the NSCAW sample to a propensity score-matched comparison sample obtained from Medicaid files. Results: Children surveyed in NSCAW had over thrice the odds of any psychotropic drug use than the comparison sample. Each maltreated child increased Medicaid expenditures by between $237 and$840 per year, relative to comparison children also receiving medications. Increased expenditures on antidepressants and amphetamine-like stimulants were the primary drivers of these increased expenditures. On average, an African American child in NSCAW received $399 less expenditure than a white child, controlling for behavioral problems and other child and regional characteristics. Children scoring in the clinical range of the Child Behavior Checklist received, on average,$853 increased expenditure on psychotropic drugs. Conclusion: Each child with child welfare involvement is likely to incur upwards of $1482 in psychotropic medication expenditures throughout his or her enrollment in Medicaid. Medicaid agencies should focus their cost-containment strategies on antidepressants and amphetamine-type stimulants, and expand use of instruments such as the Child Behavior Checklist to identify high-cost children. Both of these strategies can assist Medicaid agencies to better predict and plan for these expenditures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98497/1/cap%2E2011%2E0135.pd

Smoke consequences of new wildfire regimes driven by climate change

Smoke from wildfires has adverse biological and social consequences, and various lines of evidence suggest that smoke from wildfires in the future may be more intense and widespread, demanding that methods be developed to address its effects on people, ecosystems, and the atmosphere. In this paper, we present the essential ingredients of a modeling system for projecting smoke consequences in a rapidly warming climate that is expected to change wildfire regimes significantly. We describe each component of the system, offer suggestions for the elements of a modeling agenda, and provide some general guidelines for making choices among potential components. We address a prospective audience of researchers whom we expect to be fluent already in building some or many of these components, so we neither prescribe nor advocate particular models or software. Instead, our intent is to highlight fruitful ways of thinking about the task as a whole and its components, while providing substantial, if not exhaustive, documentation from the primary literature as reference. This paper provides a guide to the complexities of smoke modeling under climate change, and a research agenda for developing a modeling system that is equal to the task while being feasible with current resources

Neurocognition and quality of life after reinitiating antiretroviral therapy in children randomized to planned treatment interruption

Objective: Understanding the effects of antiretroviral treatment (ART) interruption on neurocognition and quality of life (QoL) are important for managing unplanned interruptions and planned interruptions in HIV cure research. Design: Children previously randomized to continuous (continuous ART, n=41) vs. planned treatment interruption (PTI, n=47) in the Pediatric European Network for Treatment of AIDS (PENTA) 11 study were enrolled. At study end, PTI children resumed ART. At 1 and 2 years following study end, children were assessed by the coding, symbol search and digit span subtests of Wechsler Intelligence Scale for Children (6-16 years old) or Wechsler Adult Intelligence Scale ( 6517 years old) and by Pediatrics QoL questionnaires for physical and psychological QoL. Transformed scaled scores for neurocognition and mean standardized scores for QoL were compared between arms by t-test and Mann-Whitney U test, respectively. Scores indicating clinical concern were compared (&lt;7 for neurocognition and &lt;70 for QoL tests). Results: Characteristics were similar between arms with a median age of 12.6 years, CD4 + of 830 cells/\u3bcl and HIV RNA of 1.7 log 10 copies/ml. The median cumulative ART exposure was 9.6 in continuous ART vs. 7.7 years in PTI (P=0.02). PTI children had a median of 12 months off ART and had resumed ART for 25.2 months at time of first assessment. Neurocognitive scores were similar between arms for all tests. Physical and psychological QoL scores were no different. About 40% had low neurocognitive and QoL scores indicating clinical concern. Conclusion: No differences in information processing speed, sustained attention, short-term memory and QoL functioning were observed between children previously randomized to continuous ART vs. PTI in the PENTA 11 trial

Development and recent progress on ammonia synthesis catalysts for Haber–Bosch process

Due to its essential use as a fertilizer, ammonia synthesis from nitrogen and hydrogen is considered to be one of the most important chemical processes of the last 100 years. Since then, an enormous amount of work has been undertaken to investigate and develop effective catalysts for this process. Although the catalytic synthesis of ammonia has been extensively studied in the last century, many new catalysts are still currently being developed to reduce the operating temperature and pressure of the process and to improve the conversion of reactants to ammonia. New catalysts for the Haber–Bosch process are the key to achieving green ammonia production in the foreseeable future. Herein, the history of ammonia synthesis catalyst development is briefly described as well as recent progress in catalyst development with the aim of building an overview of the current state of ammonia synthesis catalysts for the Haber–Bosch process. The new emerging ammonia synthesis catalysts, including electride, hydride, amide, perovskite oxide hydride/oxynitride hydride, nitride, and oxide promoted metals such as Fe, Co, and Ni, are promising alternatives to the conventional fused‐Fe and promoted‐Ru catalysts for existing ammonia synthesis plants and future distributed green ammonia synthesis based on the Haber–Bosch process

A Place Based Approach to Net Zero. A report by the Net Zero Infrastructure Industry Coalition

This report was produced as part of the work programme of the Net-Zero Infrastructure Industry Coalition, formed in 2019 in response to the UK government’s 2050 net- zero greenhouse gas (GHG) emissions commitment. Our launch report, ‘Building a net-zero economy: planning and practical action to transition our economic infrastructure for a net-zero future’ is available at mottmac.com. Coalition members include Mott MacDonald, Skanska, the UK Collaboratorium for Research on Infrastructure & Cities, UK Green Building Council, Anglian Water, Transport for London, Engie, Pinsent Masons, KPMG, Energy Systems Catapult, Carbon Trust and Leeds City Council. The aim of our coalition is to harness our collective expertise to support the delivery of UK net-zero. Our belief is that net-zero must become an industry-wide mission that transcends traditional business relationships to become a fundamental part of the way we all work, much like health and safety has over recent decades. Our vision is that the UK’s engineering and infrastructure sectors rapidly mobilise to meet the net-zero challenge

Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study

Mold and other allergen exposures exacerbate asthma symptoms in sensitized individuals. We evaluated allergen concentrations, skin test sensitivities, and asthma morbidity for 182 children, aged 4–12 years, with moderate to severe asthma, enrolled 18 months after Katrina, from the city of New Orleans and the surrounding parishes that were impacted by the storm, into the Head-off Environmental Asthma in Louisiana (HEAL) observational study. Dust (indoor) and air (indoor and outdoor) samples were collected at baseline of 6 and 12 months. Dust samples were evaluated for dust mite, cockroach, mouse, and Alternaria by immunoassay. Air samples were evaluated for airborne mold spore concentrations. Overall, 89% of the children tested positive to ≥1 indoor allergen, with allergen-specific sensitivities ranging from 18% to 67%. Allergen concentration was associated with skin sensitivity for 1 of 10 environmental triggers analyzed (cat). Asthma symptom days did not differ with skin test sensitivity, and surprisingly, increased symptoms were observed in children whose baseline indoor airborne mold concentrations were below median levels. This association was not observed in follow-up assessments. The lack of relationship among allergen levels (including mold), sensitivities, and asthma symptoms points to the complexity of attempting to assess these associations during rapidly changing social and environmental conditions

Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study

Mold and other allergen exposures exacerbate asthma symptoms in sensitized individuals. We evaluated allergen concentrations, skin test sensitivities, and asthma morbidity for 182 children, aged 4-12 years, with moderate to severe asthma, enrolled 18 months after Katrina, from the city of New Orleans and the surrounding parishes that were impacted by the storm, into the Head-off Environmental Asthma in Louisiana (HEAL) observational study. Dust (indoor) and air (indoor and outdoor) samples were collected at baseline of 6 and 12 months. Dust samples were evaluated for dust mite, cockroach, mouse, and Alternaria by immunoassay. Air samples were evaluated for airborne mold spore concentrations. Overall, 89% of the children tested positive to ≥1 indoor allergen, with allergen-specific sensitivities ranging from 18% to 67%. Allergen concentration was associated with skin sensitivity for 1 of 10 environmental triggers analyzed (cat). Asthma symptom days did not differ with skin test sensitivity, and surprisingly, increased symptoms were observed in children whose baseline indoor airborne mold concentrations were below median levels. This association was not observed in follow-up assessments. The lack of relationship among allergen levels (including mold), sensitivities, and asthma symptoms points to the complexity of attempting to assess these associations during rapidly changing social and environmental conditions