Facility Level Research Articles

Tractor Injuries in the Upper Midwestern United States: a retrospective analysis of four trauma centers

ABSTRACT Objectives The purpose of the present study was to characterize the incidence, injury characteristics, and outcomes of patients presented to four trauma facilities located in the upper Midwest with tractor-related agricultural injuries. Methods We performed a retrospective review of the facility level trauma registries of four trauma centers located in North Dakota, South Dakota, and Minnesota between January 1, 2010 and December 31, 2021. We characterized the incidence, severity and outcomes of traumatic tractor-related agricultural injuries for pediatric and adult patients. We described the nature of these injuries by severity, anatomical site, type, age, sex, and length of stay (LoS). Injury severity was evaluated using Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS). Results Findings indicated that farmers aged 65 and older experience polytraumatic, severe tractor-related agricultural injuries and fatalities. Of the 177 tractor patients analyzed, 40 patients were between the ages of 65 and 74 years and 45 patients were 75 and over. Male farmers aged 65 and older are injured year-round, many are discharged to skilled nursing facilities for additional care, are spending more time in the hospital, and have the highest rate of critical injuries out of all age groups. Moreover, the patients who died as a result of tractor-related agricultural injuries were men over 65 years. The most common tractor-related agricultural injuries include falls from tractors (n = 53), struck by object falling/propelled from tractor (n = 25), rollovers (n = 26), and runovers (n = 24). Falls from tractors accounted for 33% of all tractor-related upper extremity fractures, 36% of head injuries and 29% of chest injuries. Conclusion The findings from this study indicate that tractor-related agricultural injuries represent a significant problem in the upper Midwest. Older, male farm workers experience a higher incidence of tractor-related agricultural injuries, and all tractor-related fatalities occurred in individuals 65 years of age and older. These results underscore the need for further investigation into aging-related farm safety issues.

Filling the climate governance gap: Do corporate decarbonization initiatives matter as much as state and local government policy?

Companies and subnational governments are actively attempting to fill the greenhouse gas (GHG) mitigation gap left by weak national policy, but how effective are their efforts in reducing GHG emissions? This is the first study to disaggregate corporate GHG reporting from CDP (formerly Carbon Disclosure Project), down to the facility level to analyze the respective roles of corporate initiatives and subnational public policies in driving corporate decarbonization in the United States from 2010 to 2019. We find that although corporate decarbonization initiatives are associated with GHG reductions, the primary drivers of corporate facility decarbonization are state-level climate policies, in particular financial incentives for energy efficiency. Given that the same types of incentives are significantly expanded under the 2022 Inflation Reduction Act (IRA), our finding suggests that state and local government mobilization of new incentives will play a crucial role in achieving private sector decarbonization goals. Last, total emissions by CDP-disclosing corporations increased substantially over our sample period, meaning that expansion of subnational climate action and corporate initiatives may be vital to reduce overall U.S. corporate emissions.

Social Accountability in Health System Governance: A Scoping Review.

Social accountability is an important element in health system governance, which is necessary for health system reform and reaching Universal Health Coverage. Understanding the social accountability mechanism and tools will help policymakers to design policies according to the context. We aimed to explore the extent of the application of social accountability in health system governance, its results, challenges, and tools. We conducted a scoping review study, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping review. An inclusive search in bibliographic databases and search engines was done to identify peer review articles and grey literatures, published in English in the range of 2010 to 2021. Search terms were (social accountability), (public accountability), AND (health system). Thirty-one records met inclusion criteria from 286 potentially relevant sources, which included 25 peer-review articles and 6 grey literatures. Maternal and child health was the main health subject for social accountability interventions. We identified some social accountability tools to apply at the health facility and community levels. Social accountability has some benefits for the health system and for the community and some challenges to the implementation of social accountability were listed. Social accountability improves health system performance. It contains different tools and strategies applied at different levels of the health system. Successful social accountability initiatives that are strategic, multi-interventional, and context-specific can produce good results in health services and social domains.

Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury.

We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. Kinney AR, Brenner LA, Nance M, etal. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.

Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation

BackgroundGlobally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project’s impact.MethodsA pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to ‘standard’ state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine.DiscussionDefining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized ‘access to family planning’ based on a composite of beliefs about using services if needed.Trial registrationISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.

Policy, health facility and community implications of the findings of the study of illnesses in preterm (sip project): Summary recommendations from a dissemination workshop

The Study of Illness in Preterm (SIP) was designed in 2015 to identify the major causes of morbidity and mortality in preterm babies. Preterm complications are the commonest cause of neonatal mortality. The SIP study investigators in collaboration with Federal Ministry of Health-Ethiopia (FMOH) organized a dissemination workshop during the world prematurity day between Nov 17-18, 2021. 
 The objective of the SIP dissemination workshop was to conduct a policy dialogue with policy makers and program implementers to support policy and practice changes. Five publications that have immediate policy and practice implications were selected and discussed in a dissemination workshop. These were hypothermia, preterm nutrition, bacterial isolates and antimicrobial resistance (AMR), antenatal corticosteroid utilization and respiratory distress syndrome (RDS). 
 For each topic, the workshop assessed and documented the magnitude of the burden of disease, operationally feasible recommendations at policy, facility and community levels and potential implementation research ideas that could help facilitate rapid scale up of interventions.

Long-term continuous monitoring of methane emissions at an oil and gas facility using a multi-open-path laser dispersion spectrometer

A method for methane emissions monitoring at industrial facility level was developed based on a high precision multi-open-path laser dispersion spectrometer combined with Bayesian analysis algorithms using Monte Carlo Markov Chain (MCMC) inference. From the methane path-averaged concentrations spatially distributed over the facility under study, together with the wind vector, the analysis allows detection, localization and quantification of fugitive methane emissions. This paper describes the very first long term (3 months), continuous (24 h/7 days) deployment of this monitoring system at an operational gas processing and distribution facility. The continuous monitoring system, made of the combination of the open-path high-precision (<10 ppb) methane concentration analyser and the data analysis method, was evaluated with controlled releases of methane of about 5 kg/h for short periods of time (30–60 min). Quantification was successful, with actual emission rates lying well within the quoted uncertainty ranges. Source localisation was found to lack accuracy, with biases of 30–50 m in the direction of the line of sight of the spectrometer, due to the short duration of the controlled releases, the limited wind vector diversity, and complications from air flows around buildings not accounted for by the transport model. Using longer-term data from the deployment, the MCMC algorithm led to the identification of unexpected low intensity persistent sources (<1 kg/h) at the site. Localisation of persistent sources was mostly successful at equipment level (within ~20 m) as confirmed by a subsequent survey with an optical gas imaging (OGI) camera. Quantification of these individual sources was challenging owing to their low intensity, but a consistent estimate of the total methane emission from the facility could be derived using two different inference approaches. These results represent a stepping stone in the development of continuous monitoring systems for methane emissions, pivotal in driving greenhouse gas reduction from industrial facilities. The demonstrated continuous monitoring system gives promising performance in early detection of unexpected emissions and quantification of potentially time-varying emissions from an entire facility.

Beyond Hospital-Level Aggregated Data: A Methodology to Adapt Clinical Data From the Electronic Health Record for Nursing Unit-Level Research.

Studies of nurse staffing frequently use data aggregated at the hospital level that do not provide the appropriate context to inform unit-level decisions, such as nurse staffing. Describe a method to link patient data collected during the provision of routine care and recorded in the electronic health record (EHR) to the nursing units where care occurred in a national dataset. We identified all Veterans Health Administration acute care hospitalizations in the calendar year 2019 nationwide. We linked patient-level EHR and bar code medication administration data to nursing units using a crosswalk. We divided hospitalizations into segments based on the patient's time-stamped location (ward stays). We calculated the number of ward stays and medication administrations linked to a nursing unit and the unit-level and facility-level mean patient risk scores. We extracted data on 1117 nursing units, 3782 EHR patient locations associated with 1,137,391 ward stays, and 67,772 bar code medication administration locations associated with 147,686,996 medication administrations across 125 Veterans Health Administration facilities. We linked 89.46% of ward stays and 93.10% of medication administrations to a nursing unit. The average (standard deviation) unit-level patient severity across all facilities is 4.71 (1.52), versus 4.53 (0.88) at the facility level. Identification of units is indispensable for using EHR data to understand unit-level phenomena in nursing research and can provide the context-specific information needed by managers making frontline decisions about staffing.

The Risk Factors for Workplace Violence Against Nurses and the Prevention Strategies in Public Health Facilities in Anambra State

Aim: This study determined the risk factors of workplace violence against nurses and the prevention strategies in public health facilities in Anambra State. Method: A cross-sectional descriptive design was adopted in conducting the study among nurses working at public secondary and tertiary levels of care facilities in Anambra State. The multi-stage sampling technique was employed to select 5 facilities and a sample size of two hundred and ninety-two nurses. The research instrument was adapted from the WHO standardized questionnaire on workplace violence and the Statistical Software Package version 16.0 was employed for the data analysis. Results: The results revealed that the highest risk factor for the nurses’ experience of workplace violence was staff shortage followed by prolonged waiting time and reporting workplace violence is the highest preventive strategy for workplace violence. Conclusion: The menace of workplace violence against nurses will be curtailed by mitigating the risk factors and implementing preventive strategies.

Micro-environmental factors impact breathing zone exposures: A simulated petrochemical manufacturing facility task

This study investigates the impact of micro-environmental factors on worker breathing zone exposure levels in petrochemical facilities. A laboratory simulation study evaluated near-field exposure to methane for a typical maintenance task. Individual and combinations of micro-environmental factors significantly affected methane exposure. Airflow direction and speed were significant determinants of exposure concentration reduction. A side airflow direction at medium to high speed produced the lowest gas concentration in the breathing zone. Worker body orientation relative to the methane emission point was also a critical factor affecting gas concentration in the worker's breathing zone. The study provides insights into how variations in airflow and small changes in position impact near-field exposures for petrochemical tasks, guiding industrial hygiene professionals' training on qualitative exposure estimation and providing input for near-field exposure modeling to guide quantitative exposure and risk assessment.

Public Heterogeneous Preferences for Low-Dose Computed Tomography Lung Cancer Screening Service Delivery in Western China: A Discrete Choice Experiment.

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is an efficient method that can reduce lung cancer mortality in high-risk individuals. However, few studies have attempted to measure the preferences for LDCT LCS service delivery. This study aimed to generate quantitative information on the Chinese population's preferences for LDCT LCS service delivery. The general population aged 40 to 74 in the Sichuan province of China was invited to complete an online discrete choice experiment (DCE). The DCE required participants to answer 14 discrete choice questions comprising five attributes: facility levels, facility ownership, travel mode, travel time, and out-of-pocket cost. Choice data were analyzed using mixed logit and latent class logit (LCL) models. The study included 2529 respondents, with 746 (29.5%) identified as being at risk for lung cancer. Mixed logit model (MLM) analysis revealed that all five attributes significantly influenced respondents' choices. Facility levels had the highest relative importance (44.4%), followed by facility ownership (28.1%), while out-of-pocket cost had the lowest importance (6.4%). The at-risk group placed relatively more importance on price and facility ownership compared to the non-risk group. LCL model identified five distinct classes with varying preferences. This study revealed significant heterogeneity in preferences for LCS service attributes among the Chinese population, with facility level and facility ownership being the most important factors. The findings underscore the need for tailored strategies targeting different subgroup preferences to increase screening participation rates and improve early detection outcomes.

Short- and long-term impacts of the National Essential Medicines Policy on drug availability, price, and usage in a deprived rural county in southwestern China: an interrupted time series analysis across 8 years.

China's National Essential Medicines Policy (NEMP) has been implemented for over 15 years; yet empirical evidence on its long-term impacts is lacking, particularly in remote and rural regions. This study aims to assess the short-and long-term effects of NEMP on the drug availability, price, and usage in a deprived rural county in southwestern China. A quasi-experimental design was employed, featuring a single-group pre-and-post comparison. We gathered 74,436 procurement records spanning from 2009 to 2016 from the drug warehouses of local medical institutions. Pharmaceutical data were analyzed quarterly, considering various policy and therapeutic attributes. Fisher's Drug Price Index (DPI-F) was calibrated for the retail and wholesale prices of a consistent collection of 405 medications. We conducted interrupted time-series analysis to examine the immediate and enduring impacts of NEMP's initial (commencing in January 2011) and second (starting from December 2015) stages. After initiation of NEMP, the number of available essential medicines surged by 115 but subsequently faced a steady quarterly decline (-9.1) in township healthcare centers (THCs, primary care). Conversely, county hospitals (secondary care) initially saw a reduction of 40 in drug availability but later exhibited a steady increase (+4.2 per quarter) up to the second-stage NEMP. Regarding price, THCs encountered abrupt (-26.1%/-15.9% in retail/wholesale price) and sustained (-0.2%/-0.3% per quarter) price drops after NEMP. The immediate price change after NEMP in county hospitals were milder but significant in non-essential medicines, and long-term declines were also observed in all drugs. As for total sales, a significant long-term disparity emerged between THCs (+0.9% per quarter) and county hospitals (+3.3% per quarter). Following the second-stage NEMP, retail prices in county hospitals further decreased, although wholesale prices did not; however, following price upward trends were observed in both THCs and county hospitals. Lastly, the influences of NEMP varied across different therapeutical categories of medicines. NEMP has successfully regulated drug prices in primary and secondary healthcare facilities in remote and rural areas, both short-term and long-term. However, a remarkable disparity in medicine availability and utilization was observed between different levels of facilities over time. Continuous monitoring is essential, with increased attention needed on the uneven impacts of the policy on diverse drugs, facilities, regions, and demographics.

Provisioning Oral Health Care through Indian Public Health Standards, 2022

The Indian Public Health Standards (IPHS) were initially developed in 2007 to provide an effective and optimal level of quality health care in our country. IPHS was later revised in 2012, and more recently, in 2022. IPHS revised guidelines for 2022 take into account several new initiatives and programs, including Ayushman Bharat Health and Wellness Centers, the introduction of the National Urban Health Mission and Urban Primary Health Centers (polyclinics) in urban areas. These revised guidelines also make provision for the delivery of oral health services at each facility level. This review highlights the oral health-care services and delivery mechanisms mentioned in all the four volumes of IPHS revised guidelines 2022 under the headings of infrastructure, human resource, service provisions and essential drugs, diagnostics, and equipment required at all the levels of health care.

Development of a novel primate welfare assessment tool for research macaques.

Primates are important species for biomedical research and ensuring their good welfare is critical for research translatability and ethical responsibility. Systematic animal welfare assessments can support continuous programme improvements and build institutional awareness of areas requiring more attention. A multi-facility, collaborative project aimed to develop and implement a novel primate welfare assessment tool (PWAT) for use with research macaques. PWAT development involved: establishing an internal focus group of primate subject matter experts, identifying animal welfare categories and descriptors based on literature review, developing a preliminary tool, beta-testing the tool to ensure practicality and final consensus on descriptors, finalising the tool in a database with semi-automated data analysis, and delivering the tool to 13 sites across four countries. The tool uses input- and outcome-based measures from six categories: physical, behavioural, training, environmental, procedural, and culture of care. The final tool has 133 descriptors weighted based upon welfare impact, and is split into three forms for ease of use (room level, site level, and personnel interviews). The PWAT was trialled across facilities in March and September 2022 for benchmarking current macaque behavioural management programmes. The tool successfully distinguished strengths and challenges at the facility level and across sites. Following this benchmarking, the tool is being applied semi-annually to assess and monitor progress in behavioural management programmes. The development process of the PWAT demonstrates that evidence-based assessment tools can be developed through collaboration and consensus building, which are important for uptake and applicability, and ultimately for promoting global improvements in research macaque welfare.

Opening decision spaces: A case study on the opportunities and constraints in the public health sector of Mpumalanga Province, South Africa.

Decentralised and evidence-informed health systems rely on managers and practitioners at all levels having sufficient 'decision space' to make timely locally informed and relevant decisions. Our objectives were to understand decision spaces in terms of constraints and enablers and outline opportunities through which to expand them in an understudied rural context in South Africa. This study examined decision spaces within Mpumalanga Province, using data and insights generated through a participatory action research process with local communities and health system stakeholders since 2015, which was combined with published documents and research team participant observation to produce findings on three core domains at three levels of the health system. Although capacity for decision making exists in the system, accessing it is frequently made difficult due to a number of intervening factors. While lines of authority are generally well-defined, personal networks take on an important dimension in how stakeholders can act. This is expressed through a range of informal coping strategies built on local relationships. There are constraints in terms of limited formal external accountability to communities, and internal accountability which is weak in places for individuals and focused more on meeting performance targets set at higher levels and less on enabling effective local leadership. More generally, political and personal factors are clearly identified at higher levels of the system, whereas at sub-district and facility levels, the dominant theme was constrained capacity. By examining the balance of authority, accountability and capacity across multiple levels of the provincial health system, we are able to identify emergent decision space and areas for enlargement. Creating spaces to support more constructive relationships and dialogue across system levels emerges as important, as well as reinforcing horizontal networks to problem solve, and developing the capacity of link-agents such as community health workers to increase community accountability.

Assessment of Neonatal Mortality and Associated Hospital-Related Factors in Healthcare Facilities Within Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana.

Ghana's quest to reduce neonatal mortality, in hospital facilities and communities, continues to be a nightmare. The pursuit of achieving healthy lives and well-being for neonates as enshrined in Sustainable Development Goal three lingered in challenging hospital facilities and communities. Notwithstanding that, there have been increasing efforts in that direction. This study examines the contributing factors that hinder the fight against neonatal mortality in all hospital facilities in the Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana. The study utilized neonatal mortality data consisting of neonatal deaths, structural facility related variables, medical human resources, types of hospital facilities and natal care. The data was collected longitudinally from 2014 to 2019. These variables were analysed using the negative binomial hurdle regression (NBH) model to determine factors that contribute to this menace at the facility level. Cause-specific deaths were obtained to determine the leading causes of neonatal deaths within health facilities in the two municipal assemblies. The study established that the leading causes of neonatal mortality in these districts are birth asphyxia (46%), premature birth (33%), neonatal sepsis (11%) and neonatal jaundice (7%). The NBH showed that neonatal mortality in hospital facilities depend on the number of incubators, monitoring equipment, hand washing facilities, CPAPb machines, radiant warmers, physiotherapy machines, midwives, paediatric doctors and paediatric nurses in the hospital facility. Early management of neonatal sepsis, birth asphyxia, premature birth and neonatal infections is required to reduce neonatal deaths. The government and all stakeholders in the health sector should provide all hospital facilities with the essential equipment and the medical human resources necessary to eradicate the menace. This will make the realization of Sustainable Development Goal three, which calls for healthy lives and well-being for all, a reality.

CO2 concentration retrieval and emission rate estimation over Indian thermal power plants using radiative transfer approach and AVIRIS-NG data

Carbon dioxide (CO2) emissions from thermal power plants (TPPs) are regarded as the primary source of CO2 at the boundary-level atmosphere. The first step toward mitigating these emissions is to improve emission estimation methods at the facility level and establish a reliable emission reporting system. This study aims to establish a transparent and reliable methodology for detecting point source CO2 emissions from TPP and estimating the emission rate released from the stakes of TPP. A remote sensing method continuum interpolated band ratio (CIBR) has been utilized to detect and estimate CO2 emissions over Indian TPPs using Airborne Visible/InfraRed Imaging Spectrometer - Next Generation (AVIRIS-NG) data acquired by the ISRO-NASA joint campaign over India in 2015 and 2018. MODerate resolution atmospheric TRANsmission (MODTRAN) 5.3 radiative transfer (RT) model simulations were carried out for TPP sites to develop a CIBR algorithm for CO2 retrieval. Two AVIRIS-NG short-wave infrared (SWIR) bands were utilized for CO2 concentration retrieval, and the results from each band were compared based on their emission detection capabilities. Comparatively, SWIR-2 (1960–2120 nm) bands show higher sensitivity of CO2 than SWIR-1 (1560–1640 nm). Therefore, we utilize SWIR-2 results for the CO2 retrieval and emission rate estimation. Maximum CO2 emissions of 53.10, 46.36, 96.84, and 53.49 ppmv were detected at Maithon, Dhariwal, Udupi, and Parangipettai TPPs. The study includes one USA-based TPP to compare emission results for validation and test the method in diverse atmospheric conditions. In addition, we compared CO2 estimation results with AVIRIS-NG benchmark data. The simple band ratio method uses only three SWIR bands and operates with minimal computational facility, making it suitable for CO2 retrieval in hyperspectral data. Further, the integrated mass enhancement (IME) method has been used for emission rate estimation using CO2 concentration values from SWIR-2 retrieval results and wind speed at the sites. Yearly 5.96, 6.82, 2.29, and 3.52 Mt emissions were estimated for Maithon, Dhariwal, Udupi, and Parangipettai TPPs, respectively. The emission results have been validated by establishing a relationship between TPP's coal consumption and CO2 emissions. Further, estimated emission rates have been validated with former investigations and the CO2 baseline emission database of India's Central Electricity Authority (CEA) reports. Not having in-situ measurements and uncertainty in wind data may limit the study.

Service readiness for the management of non-communicable diseases in publicly financed facilities in Malawi: findings from the 2019 Harmonised Health Facility Assessment census survey

IntroductionNon-communicable diseases (NCDs) are rising in low-income and middle-income countries, including Malawi. To inform policy-makers and planners on the preparedness of the Malawian healthcare system to respond to NCDs, we...

Analysis and Monitoring of Indoor Radon Concentrations of 37 Kindergartens - Beijing Municipality, China, 2023.

Radon (222Rn or 222radon) is a radioactive gas emitted from building materials, foundations, and soil. Children are especially susceptible to radon exposure, underscoring the need to assess indoor radon levels in kindergartens. This study monitored radon concentrations in 37 Beijing kindergartens from June to October 2023. A random sample of 37 kindergartens was selected from 18 administrative districts in Beijing. The indoor radon concentration was measured using the solid track accumulation method, with radon detectors continuously monitored over a 3-month period. The mean indoor radon level in 37 kindergartens, observed at 252 monitoring points, was 84.3 Bq/m3, with values varying from 12.9 to 263.5 Bq/m3. About 20.2% of points showed radon levels between 100.0 and 200.0 Bq/m3, while 2.4% exceeded 200.0 Bq/m3. Notably, radon levels were significantly elevated on the ground floor compared to the upper floors. Indoor radon levels in 37 kindergartens remained below the national standard limit of 300.0 Bq/m3 for buildings (GB/T 16146-2015). Nonetheless, 18.9% of the kindergartens exceeded the 100.0 Bq/m3 limit set for new constructions. It is advised to improve radon monitoring in kindergartens and consider developing a national standard for maximum permissible radon levels in such facilities.

КОНЦЕПЦИЯ МОДЕЛИ МОРОЗНОГО ВОЗДЕЙСТВИЯ НА БЕТОН МОРСКИХ СООРУЖЕНИЙ

A conceptual approach is presented to predicting the durability of concrete under conditions of frost exposure and strong saturation based on the actual work of concrete in the structures of port facilities on the sea coast of the south of the island. Sakhalin. It is shown that the lack of methods for predicting concrete corrosion under frost exposure, despite the large amount of theoretical and experimental work on this topic, is due to the diversity and synergistic effect of factors that determine durability. It has been established that the multicyclic effect of sign-variable temperatures due to sea tides is not always the determining critical indicator of severity for the zone of variable level. Non-freezing water in the port waters and severe hydrometeorological conditions in the form of strong waves predetermine the icing of structures throughout the winter period. This factor in certain cases can be critical for concrete. Based on the results of the study of the state, properties and temperature-humidity regime of concrete in the structures of the zone of variable water level and the generally accepted theoretical principles of frost destruction of concrete, it is proposed to predict its service life in the zone of variable level of port facilities based on the concept of a two-stage process of frost corrosion. The possibility of predicting the durability of concrete based on scenario modeling of the process of development of the system of pore structure of the cement matrix, depending on its parameters by the beginning of frost exposure and the mechanism of freezing of concrete in structures, is shown.