Occupational Heat Stress in the Floriculture Industry of Ethiopia: Health Risks and Productivity Losses

Background: The Ethiopian flower industry is growing fast with successful diversification of export products under greenhouse structures. Higher temperatures in the greenhouses pose a serious threat to the health of workers and add to the risk of occupational heat stress. Excessive heat in workplace settings also reduces work capacity and labour productivity. This study aims to investigate the level of heat exposure, and workers’ and managers’ perceptions and behavioural responses towards extreme heat exposure in a warming climate. Methods: We used the Wet Bulb Globe Temperature (WBGT) measured in representative greenhouses to capture the heat exposure during hotter and cooler seasons following ISO 7243 (generally risk of heat stress occurs when WBGT exceeds 26°C). A comparative cross-sectional study design with a stratified sampling method was used to assess occupational heat stress and workers’ perceptions of the impact of heat on their health and productivity in six different floriculture greenhouses in Ethiopia representing three different agro-ecologies and products. A questionnaire survey was conducted (30 managers/supervisors and 305 workers;76.1% female) to capture perceptions on heat exposures, symptoms of potential health impacts, productivity losses and coping mechanisms. Results: Heat exposure varied across different agroecologies, product types and greenhouse materials with a median WBGT Index of 25.5°C and a range from 18.1°C to 31.5°C. The impact of heat stress also varied across different employment sectors and geographical regions. Overall, workers in cut-flower greenhouses are exposed to higher than recommended WBGT Index (26°C) for 3 - 6 working hours daily. 65% of the managers reported that heat stress has a significant impact on the workers’ labour productivity, but do not have guidance about working in hot conditions. Workers reported more heat-related health issues and reduced productivity, especially in the mid-altitude greenhouses. About 50% of the workers reported that heat exposure decreased work productivity during hot hours. Sweating, exhaustion, heat-rashes, dehydration, crumps, nausea and headache were self-reported health issues. Labour productivity losses ranged from no loss to 19.5% in the mid- and low-altitudes. Conclusions and Recommendations: Excessive workplace heat in the greenhouses is both an occupational health hazard and detrimental to productivity in the floriculture industry. However, the level of understanding and actions on the ground regarding occupational heat stress are low. The code of conduct in place now does not consider the occupational heat stress issues. Multiple actions (engineering, management, training and policy-related recommendations) have to be implemented by Ethiopian Horticultural Producers and Exporters Association (EHPEA) and farm owners to mitigate heat stress and loss of productivity. Designing and implementing these heat prevention strategies and incorporating them into the code of conduct is in the interests of both employers and employees.

Pregnant Women’s Perceptions of Patient-Provider Communication for Health Behavior Change during Pregnancy

Aim: The primary aim of the project was to conduct focus groups with pregnant women to examine their perceptions on patient and health care provider (HCP) communication during prenatal visits pertaining to health behavioral change. In particular, to determine what types of communication facilitate or prevent patient engagement and adherence to certain health behaviors related to smoking cessation, engagement in physical activity, healthy eating and healthy weight gain, and stress management. Methods: Participants were recruited from the obstetric and midwifery clinics at the University of Colorado Hospital. Twenty-four pregnant, English-speaking women between the ages of 18 and 46 years old, the majority of which had full health insurance coverage, participated in one of three focus groups that were conducted. The transcripts were coded for themes and patterns. Results identified numerous current practices of HCPs, facilitators and barriers in care, and patient recommendations related to effective patient-provider communication. Results: Overall many women received basic information about most health behaviors (i.e. healthy eating, physical activity, and smoking cessation) with the exception of stress management from their HCPs via their introductory information packet. However, typically there was no follow-up beyond receipt of the packet. As a result, women sought information online from numerous sources. Unfortunately, this information often conflicted with HCP provided information, as did the information provided from multiple HCPs in group care settings. A major facilitator of behavioral change pertained to building trust and rapport as it directly enhanced the perceived quality of patient-provider communication on prenatal health behaviors. Across all behaviors, women voiced the need for available resources that were credible and referenced by their HCPs. Conclusions: These findings provide a better understanding of what facilitates and prevents women from engaging in healthy behaviors during their pregnancy, in addition to improving patient and provider communication.

Antenatal physical activity counseling among healthcare providers

Objective: Pregnant women often report a lack of knowledge concerning the safety of exercising during pregnancy. Healthcare providers play an integral role in providing pregnant women with the necessary knowledge to promote antenatal physical activity. Thus, the objective of this study was to assess healthcare providers’ beliefs, attitudes, knowledge and practices related to antenatal physical activity counseling. Study Design: 188 Providers (i.e. obstetricians, midwives, and family medicine physicians) completed a 39 closed-item survey. Characteristics among healthcare providers’ physical activity counseling practices as well as belief, attitudes and knowledge were explored. Results: The majority of all providers agreed that physical activity during pregnancy will result in numerous improved health outcomes for mother and baby. Approximately half of the providers (48%, n = 89) were not familiar with the current national guides recommending that women free of obstetric complications should engage in at least 150 minutes of exercise per week. Only 43% of providers believed their patients followed the advice they are given about physical activity. Over half of the providers reported that they provide in-office physical activity counseling, and FMs provide individualized counseling less often than OBs and CNMs (i.e. 33%, 60%, and 65%, respectively;p = 0.0014). Importantly, 17% (n = 31) of providers reported that they never received professional training in antenatal physical activity counseling and of those that did receive training, 69% (n = 107) claimed their training was “fair” or “poor”. Conclusion: Findings from the pre- sent study demonstrate a need for further continuing education opportunities on the current national guide- lines on antenatal physical activity.

A Mindfulness-Based Cognitive Therapy (MBCT) Intervention to Improve Resilience and Mitigate Symptoms of Burnout Syndrome in Critical Care Nurses: Results of a Randomized Trial

Objective: Critical care nurses work in a challenging intensive care (ICU) environment that results in work-related psychological distress. Our objective was to pilot an in-person or virtual mindfulness-based cognitive therapy (MBCT) program enhanced resilience and a similarly designed attention control group. Methods: We randomized ICU nurses with symptoms of burnout syndrome and decreased resilience to an MBCT program or a similarly formatted book club control. Our primary outcome was change in resilience as measured by the Connor-Davidson Resilience Scale (CD-RISC). Results: One-hundred one nurses completed study-related procedures. Overall, 70% had baseline symptoms of anxiety and 26% had symptoms of depression. For the in-person cohorts, there was no statistical difference between intervention and control groups regarding the total number of sessions attended (3.85 days ± 1.4 versus 3.75 days ± 0.15;p = 0.64). Using the Client/Patient Satisfaction Questionnaire-8 (CSQ-8), satisfaction scores were higher in the intervention group for weeks two through four of the program: p = 0.03, 0.0003, 0.007 respectively. There was no difference in the change in CD-RISC scores between the two groups (mean difference: treatment = 5.0, control = 7.0;p = 0.30). The online intervention cohort had greater improvements in the change of their median emotional exhaustion burnout scores when compared to the in-person intervention cohorts (-5 [-8 to -1.5] vs. 2 [-5 to 8], p = 0.049). Conclusions: We developed a feasible and acceptable in-person and online MBCT-ICU intervention that did not increase resilience scores in ICU nurses when compared to an attention control group. These results could help guide the proper design of larger trials to determine the efficacy of other resilience interventions.

Stable Isotope Sourcing Using Sampling

Stable isotope mixing models are used to estimate proportional contributions of sources to a mixture, such as in the analysis of animal diets, plant nutrient use, geochemistry, pollution, and forensics. We describe an algorithm implemented as SISUS software for providing a user-specified number of probabilistic exact solutions derived quickly from the extended mixing model. Our method outperforms IsoSource [1], a deterministic algorithm for providing approximate solutions to represent the solution polytope. Our method is an approximate Bayesian large sample procedure. SISUS software is freely available at StatAcumen.com/sisus and as an R package at cran.r-project.org/web/packages/sisus.

Association between axial length and toric intraocular lens rotation according to an online toric back-calculator

AIM: To assess the relationship between axial length(AL) and intraocular lens(IOL) rotation among eyes receiving a toric IOL and subsequently entered into an online toric back-calculator database.METHODS: Retrospective analysis of data collected online via astigmatismfix.com, a freely available online toric back-calculator where surgeons enter pre-and postoperative information to help manage residual postoperative astigmatism.Included records were deemed valid with entry of AL and IOL orientation between January 2017 and March 2019.Rotation was determined by a difference of ≥5° between pre-operative intended IOL orientation and actual post-operative IOL orientation.Frequency and magnitude of rotation are presented with means and associated standard deviation(SD).Linear regression models of this association are presented.RESULTS: Records of 6752 eyes were included in the analysis, of which 74.8% were determined to have a rotated IOL.The magnitude of rotation increased with each millimeter(mm) increase in AL with a mean rotation of 13.3°(SD: 12.8°) for eyes with AL 20-20.9 mm and a maximum mean rotation of 30.6°(SD: 30.3°) among eyes with AL 29-29.9 mm.General linear modeling demonstrated a significant association(P<0.0001) with a parameter estimate of 1.19(standard error: 0.159) and R;of 0.0083.CONCLUSION: Analysis from an online database indicates that toric IOLs inserted into eyes with longer AL are more likely to rotate and to rotate more degrees from the target axis.The findings from this study are clinically relevant for surgeons implanting toric IOLs.

Antenatal physical activity: Investigating the effects on postpartum depression

Engaging in regular moderate-intensity physical activity has been demonstrated as a successful treatment modality for both major and minor depression and as effective as pharmacologic treatments. However, less is known about the use of antenatal physical activity as a preventive modality for depression during the perinatal period. The objective of the present study was to determine if there is an association between antenatal physical activity and PPD. A cross-sectional study using the 2007-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) data from Colorado and North Carolina (N = 6026) was conducted. PRAMS self-reported data are from a large randomized sample collected by the CDC that assesses maternal demographic, socio-economic, and prepregnancy and perinatal behaviors. Multivariable logistic regression was used to examine the relationship between antenatal sedentary behavior and PPD. Upon adjusting for maternal age, education, race, marital status, parity, stress, smoking, drinking, and prenatal care utilization, women who did not engage in antenatal physical activity were 1.34 times more likely to screen positive for PPD than women who exercised 5 or more days per week [OR 1.34;95% CI: (1.04, 1.74);p = 0.03]. These findings suggest that not engaging in antenatal exercise may be associated with an increase risk of PPD. Further research is warranted to better understand the effects of antenatal sedentary behavior on PPD and the potential use of physical activity as a preventive modality for PPD.

Using Virtual Reality to Promote Physical Activity

The purpose of this research is to develop an immersive virtual fitness center as an intervention to promote physical activity and examine its impacts on users’ exercise plans and exercise behaviors. The virtual reality (VR)-based intervention includes three main features: enabling the users to control their avatar, personalizing the avatar to look the same as the user, and visualizing the positive consequences of exercising. We conducted an experiment to randomly assign participants to two treatment groups: experiencing either the self or another person losing weight because of exercising in the virtual environment. The findings demonstrated that the self-avatar group exercised more in the voluntary section than the other-avatar group. However, participants in the self-avatar condition perceived a lower level of sense of presence compared to participants in the other-avatar condition. Compared to people in the control condition who watched and followed the exercise from a workout video, those who exercised in the virtual fitness center, regardless of whether the avatar was based on the self’s image or another person’s image, planned to spend more time on exercising in the following week. Theoretical and practical implications for using VR technology to promote health-related behavioral change, and why personalization decreases perceived sense of presence in the virtual environment are discussed.

Promoting higher-valent pediatric combination vaccines in China: challenges and recommendations for action

Many countries have adopted higher-valent pediatric combination vaccines to simplify vaccination schedules and minimize health expenditures and social costs.However,China is conservative in the use of pediatric combina-tion vaccines.By reviewing and synthesizing quantitative and qualitative data,in this commentary we identify gaps and challenges to combination vaccine use and make recommendations for promoting use of higher-valent pediatric combination vaccines in China.Challenges are in four dimensions:(1)legislation and regulation,(2)immunization schedule design,(3)vaccine awareness and price,and(4)research and development capacity.To optimize the use of combination vaccines to reduce vaccine-preventable disease burden,we make recommendations that address key challenges:(1)develop policies and regulations to strengthen enforcement of the Vaccine Administration Law and remove regulatory hurdles that hinder combination vaccine research and development,(2)establish an evi-dence-informed policy-making mechanism for combination vaccines,(3)resolve immunization schedule conflicts between monovalent and combination vaccines,and(4)implement effective interventions to increase vaccine awareness and reduce price.

Impact of a nationwide training program for neonatal resuscitation in China

Background Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program （NRP） on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants. Methods The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces. Results Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110 659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10 000 from 2003 to 2008, and the incidence of Apgar 〈7 at 1 minute decreased from 6.3% to 2.9%. Conclusions The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.

Incidence and consequences of varicella in children treated for cancer in Guatemala

Background:Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children,despite treatment with antiviral agents.Universal varicella vaccine programs have significantly decreased this risk in many highincome countries,but in most low-income and middleincome countries,the burden of varicella in children treated for malignancy is poorly defi ned.Methods:We retrospectively reviewed records of children at the National Unit of Pediatric Oncology(UNOP)in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity,mortality,treatment interruption,and cost.Results:Fifty-nine cases of varicella were identified.Incidence was 23.4 cases per 1000 person-years(p-y).66.1%of cases occurred in children with leukemia(median age 5.2 years;interquantile range 3.4-7 years)and 41.0%of these occurred during maintenance therapy.Source of exposure was identified for 14/59(23.7%)children.Most were hospitalized(71.2%)and given intravenous acyclovir(64.4%).Eight(13.6%)children required critical care,and two(3.4%)died from disseminated varicella with multiorgan failure.Chemotherapy was delayed or omitted due to varicella in 50%.No signifi cant differences in outcomes based on nutritional and immunologic status were detected.The minimum average cost of treatment per episode was 598.75 USD.Conclusions:Varicella is a significant problem in children treated for cancer in Guatemala,where effective post-exposure prophylaxis is limited.In the absence of universal varicella vaccination,strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden.

Mechanism-driven strategies for prevention of rheumatoid arthritis

In seropositive rheumatoid arthritis(RA),the onset of clinically apparent inflammatory arthritis(IA)is typically preceded by a prolonged period of autoimmunity manifest by the presence of circulating autoantibodies that can include antibodies to citrullinated protein antigens(ACPA)and rheumatoid factor.This period before clinical IA can be designated preclinical RA in those individuals who have progressed to a clinical diagnosis of RA,and an“at‐risk”status in those who have not developed IA but exhibit predictive biomarkers of future clinical RA.With the goal of developing RA prevention strategies,studies have characterized immune phenotypes of preclinical RA/at-risk states.From these studies,a model has emerged wherein mucosal inflammation and dysbiosis may lead first to local autoantibody production,which should normally be transient,but instead is followed by a systemic spread of the autoimmunity as manifested by serum autoantibody elevations,ultimately driving the development of clinically identified joint inflammation.This model can be envisioned as the progression of disease development through serial“checkpoints”that in principle should constrain or resolve autoimmunity;however,instead,the checkpoints“fail”and clinical RA develops.Herein we review the immune processes that are likely to be present at each step and the potential therapeutic strategies that could be envisioned to delay,diminish,halt,or even reverse the progression to clinical RA.Notably,these prevention strategies could utilize existing therapies approved for clinical RA,therapies approved for other diseases that target relevant pathways in the preclinical/at-risk state,or approaches that target novel pathways.

On the use of kernel machines for Mendelian randomization

Background： Properly adjusting for unmeasured confounders is critical for health studies in order to achieve valid testing and estimation of the exposure＇s causal effect on outcomes. The instrumental variable （IV） method has long been used in econometrics to estimate causal effects while accommodating the effect of unmeasured confounders. Mendefian randomization （MR）, which uses genetic variants as the instrumental variables, is an application of the instrumental variable method to biomedical research fields, and has become popular in recent years. One often-used estimator of causal effects for instrumental variables and Mendelian randomization is the two-stage least square estimator （TSLS）. The validity of TSLS relies on the accurate prediction of exposure based on IVs in its first stage. Results： In this note, we propose to model the link between exposure and genetic IVs using the least-squares kernel machine （LSKM）. Some simulation studies are used to evaluate the feasibility of LSKM in TSLS setting. Conclusions： Our results show that LSKM based on genotype score or genotype can be used effectively in TSLS. It may provide higher power when the association between exposure and genetic IVs is nonlinear.

Hands-on Workshops as An Efective Means of Learning Advanced Technologies Including Genomics,Proteomics and Bioinformatics

Genomics and proteomics have emerged as key technologies in biomedical research, resulting in a surge of interest in training by investigators keen to incorporate these technologies into their research. At least two types of training can be envisioned in order to produce meaningful results, quality publications and successful grant applications： （1） immediate short-term training workshops and （2） long-term graduate education or visiting scientist programs. We aimed to fill the former need by providing a comprehensive hands-on training course in genomics, proteomics and informatics in a coherent, experimentally-based framework. This was accomplished through a National Heart, Lung, and Blood Institute （NHLBI）-sponsored 10-day Genomics and Proteomics Hands-on Workshop held at National Jewish Health （NJH） and the University of Colorado School of Medicine （UCD）. The course content included comprehensive lectures and laboratories in mass spectrometry and genomics technologies, extensive hands-on experience with instrumentation and software, video demonstrations, optional workshops, online sessions, invited keynote speakers, and local and national guest faculty. Here we describe the detailed curriculum and present the results of short- and long-term evaluations from course attendees. Our educational program consis- tently received positive reviews from participants and had a substantial impact on grant writing and review, manuscript submissions and publications.

El Nio and the Kppen–Geiger Classification: A Prototype Concept and Methodology for Mapping Impacts in Central America and the Circum-Caribbean

The aim of this pilot study conducted by the consortium for capacity building was to develop a prototype concept and methodology for the classification and visualization of the geographic impacts of El Nio on annual climates and seasonality. Our study is based on the Kppen–Geiger climate classification scheme for a set of selected countries affected by strong El Nios in Latin America. By identifying and visualizing the annual and seasonal changes in regional, national, or subnational climate regimes that generally accompany an El Nio event,this research proposes an efficient way to detect and describe climate shifts and variability across time and space. Such knowledge provides a support tool for risk analysis and can potentially enhance government efforts of climate risk management, including disaster risk reduction activities that prevent, mitigate, and improve coping responses to El Nio-related hydrometeorological threats.Details of the conceptual approach and methodology to classifying and mapping El Nio's impacts are described and explained using the Central American and circumCaribbean region as a case study. The potential applications for disaster risk reduction as well as its limitations and future work are also discussed.

Renal-function change after transjugular intra-hepatic portosystemic shunt placement and its relationship with survival:a single-center experience

Background:The effect of transjugular intra-hepatic portosystemic shunt(TIPS)placement on renal function and the correlation of post-TIPS Cr with mortality remain unclear.This study aimed to assess the effect of TIPS placement on renal function and to examine the relationship between post-TIPS Cr and mortality risk.Methods:A total of 593 patients who underwent de novo TIPS placement between 2004 and 2017 at a single institution were included in the study.The pre-TIPS Cr level(T0;within 7 days before TIPS placement)and post-TIPS Cr levels,at 1–2 days(T1),5–12 days(T2),and 15–40 days(T3),were collected.Predictors of Cr change after TIPS placement and the 1-year mortality rate were analysed using multivariable linear-regression and Cox proportional-hazards models,respectively.Results:Overall,21.4%of patients(n=127)had elevated baseline Cr(≤1.5 mg/dL;mean,2.5161.49 mg/dL)and 78.6%(n=466)had normal baseline Cr(<1.5 mg/dL;mean,0.9260.26 mg/dL).Patients with elevated pre-TIPS Cr demonstrated a decrease in post-TIPS Cr(difference,-0.60 mg/dL),whereas patients with normal baseline Cr exhibited no change(difference,<0.01 mg/dL).The 30-day,90-day,and 1-year mortality rates were 13%,20%,and 32%,respectively.Variceal bleeding as a TIPS-placement indication(hazard ratio=1.731;P=0.036),higher T0 Cr(hazard ratio=1.834;P=0.012),and higher T3 Cr(hazard ratio=3.524;P<0.001)were associated with higher 1-year mortality risk.Conclusion:TIPS placement improved renal function in patients with baseline renal dysfunction and the post-TIPS Cr level was a strong predictor of 1-year mortality risk.

2010年1月至2015年3月美国因缺氧和吸入烃类气体/蒸气引起的石油天然气开采工人急性死亡调查

2013年,1名来自旧金山加州大学的职业医师向美国疾病预防控制中心（CDC）国家职业安全与卫生研究院（National Institute for Occupational Safety and Health,NIOSH）和职业安全与健康管理局（Occupational Safety and Health Administration,OSHA）报告美国西部2名石油天然气开采工人的死亡病例,引起死亡的原因可能是由于工人打开油气储罐的舱门时,暴露在烃类气体/蒸气（hydrocarbon gases and vapors,HGVs）中且合并缺氧。