Warm Chain Research Articles

On-Board Hydrogen Production: Warm Plasma Chain Catalysis

Here we demonstrate an advanced on-board hydrogen production by warm plasma chain catalysis for fuel-cell electric vehicles (FCEVs) with high specific productivity and transient operation. Methanol, air and steam reactants as two specific feeds are fed into the reactor without soot formation and catalyst sintering. Oxidative pyrolysis reaction (OPR) by plasma, steam reforming (SR), and pyrolysis at high temperature, and SR and water gas shift (WGS) at medium temperature over catalysts occur subsequently for the coupled process. The heat with OPR is efficiently utilized by the subsequent endothermic reactions. Hydrogen selectivity of 99% (59 vol.%, 4.1 SLM) with methanol conversion of 92% is achieved. A fascinating match of energy efficiency of 91% (of methanol to hydrogen) and the atomic hydrogen generation of 88% is stressed. It can be attributed to the chain catalysis of (oxidative) pyrolysis and WGS in sequence (as well as SR), which is initiated by warm plasma.

Sociocultural factors affecting uptake of home-based neonatal thermal care practices in Africa: A qualitative review.

Neonatal hypothermia is a major contributor to neonatal mortality in sub-Saharan Africa, often as a comorbidity of severe infections, preterm births or asphyxia. Simple, cost-effective thermal care practices (TCPs) immediately at birth and in the post-natal period are recommended in the World Health Organization 'warm chain'. Current practices are suboptimal in the home in low-resource settings, where approximately half of neonatal deaths occur. Several databases (PubMed, OVID SP, Web of Science, The Cochrane Library and Google Scholar) were searched for original research on home-based TCPs. Seventeen articles were identified, and the results were analysed using a 'thermal care behavioural model'. This review of the qualitative literature on home-based practices across Africa illuminates the sociocultural factors affecting the uptake of recommended practices and strategies for behaviour change. Findings from the review confirm that potentially harmful cultural norms and traditions influence the sequence of TCPs in different contexts across Africa. Furthermore, caregiver factors and contextual barriers or facilitating factors to TCPs and behaviour change exist. Hypothermia and home-based TCPs are areas for further research. Thermal care behaviour change interventions tailored to the sociocultural context are necessary to improve neonatal outcomes in Africa.

An optimisation model for purchase, production and distribution in fish supply chain – a case study

This paper presents an optimisation model for spawn purchase, fish culturing production process and harvested fish distribution in a fish supply chain. Due to the complexity and variety of real-world fish supply chains, the model is built based on a case study for a real trout fish farm to illustrate the methodology on how to incorporate influential factors from both warm chain and cold chain. Warm chain mainly considers the biological factors while fish is alive and cold chain mainly considers the economic factors after fish is ready for harvest, harvested, and processed. The model seeks to improve the trout farm production planning to help decision-making on spawn purchase quantity, the best time to harvest fish, and the farming periods. In addition, the model adopts a customer classification method in distribution planning that is able to prioritise the delivery of fresh fish to the most profitable customers. A mixed integer linear programming (MILP) model was developed to maximise the total profit. The experimental results demonstrate that farmers’ total profit can be increased after applying the proposed optimisation strategy, compared to the traditional farming strategy.

Prevention and Management of Neonatal Hypothermia in Rural Zambia

BackgroundNeonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia.Methods and FindingsWe conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns.ConclusionsUnderstanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices.

Neonatal hypothermia and associated risk factors at baby friendly hospital in babol, iran.

Background:Thermal care is an important element of Baby Friendly Hospital.Aim:The objective of this study was to determine the prevalence of neonatal hypothermia and associated risk factors in healthy full term newborns at a Baby Friendly Hospital.Subjects and Methods:A cross-sectional, descriptive study was conducted on consecutively healthy full term neonates recruited during a 1 year. Temperatures were recorded immediately after birth and at the age of 1, 2 and 4 h after birth in order to estimate the prevalence of neonatal hypothermia, defined as axillary temperature less than 36.0°C. The data were collected using an especially questionnaire; data of history of abortion, parity, mode of vaginal delivery, gestational age, birth weight, newborn temperatures, time of the first skin-to-skin contact, time of first breast feeding, first wrapping and first visiting by the pediatrician. Association between neonatal hypothermia and risk factors was determined using logistic regression.Results:Axillary temperature showed 41.2%, 47.5%, 46.4% and 37.2% of the a consecutive number of 522 healthy full term neonates were moderately hypothermia immediately after birth, at 1 h, 2 h and 4 h respectively. Spontaneous labor and warming room were associated with decreased risk of hypothermia. A persistently high prevalence of neonatal hypothermia was shown within the first 4 h of vaginal birth. All analyses were carried out using the SPSS version 17.0 (Chicago IL, USA). Test of the associations were done, stepwise multiple logistic regressions. Odds ratios (ORs) were assessed using maximum likelihood and associated 95% confidence intervals were computed. A P ≤ 0.05 was considered to be statistically significantConclusion:The findings of this study indicated that a high prevalence of neonatal hypothermia was identified among healthy full term newborn in a Baby Friendly Hospital Initiative. Therefore, it is necessary to emphasize on the development “warm chain” in preventing neonatal hypothermia in Baby Friendly Hospital.

Microbial characteristics of food preparations in Benevento province

The aim of this preliminary study was to determine the microbiological quality of pastry products and gastronomic preparations served in food service establishments in Benevento province, Southern Italy. A total of 125 samples were collected from food service establishments. Parameters investigated were: aerobic plate counts (APCs), total Coliform bacteria counts, beta-glucuronidase-positive Escherichia (E.) coli counts, Enterobacteriaceae counts, coagulase-positive Staphylococci counts, isolation of Salmonella spp., Bacillus (B.) cereus counts, and isolation of Listeria (L.) monocytogenes. The microbiological quality was good, with absence of the pathogens L. monocytogenes and Salmonella spp. and extremely rare presence of E. coli. The fresh pastry and the uncooked gastronomy products were the most contaminated groups; also, cooked cold-served gastronomy products were susceptible to microbiological risk, as a result of the inadequate reheating and the interruption of the warm chain. On the contrary, dried pastry and cooked warm-served gastronomy products showed an excellent hygienic profile. In fact, the amount of compliant samples was 74.4%.

An Exploratory Study on Factors of Hypothermia in Neonates with Special Reference to Nursing Practice at Capital Govt. Hospital, Bhubaneswar, Odisha

Hypothermia in neonates is a very common problem occur in labour room, during resuscitation, during transport, and during nursing admission of neonates. As the present trend of health care delivery system emphasizes more on primitive and preventive aspects of health, it is felt that the occurrence of hypothermia in neonate should be checked by early detection and then maintaining warm chain from place of delivery to the place of transport. Also nurses must assume the responsibility in providing standard of nursing care to prevent hypothermia in neonates and research studies must be carried out by the nurses to help in the formation of these standards. Therefore keeping this issue in view, the researcher has undertaken an explorative study on factors of hypothermia with special reference to nursing care practice in Capital Govt. Hospital, Bhubaneswar, Odisha. A descriptive approach and non-experimental design was used to describe the phenomena under study.30 no of cases were selected by using purposive sampling method. The result reveals that among the hypothermic babies 50% were cold stress, 40% moderate hypothermia, and 10% were sever hypothermia. The predisposing factors were found as defective transport(24%), improper delivery room care(22%), LBW(22% and prematurity (20%), other illness(12%).The associated morbidity were prematurity(72%), septicemia (48%), birth asphyxia (38%), and pneumonia(16%) and no morbid condition was found in 18% of cases. In the area of nursing action observed in management of hypothermia was maintenance of airway (84%), maintaining normal body temperature (86%), prevention of respiratory distress (66.66%) and (88%) providing general care, prevention of infection (78%), 14% restriction of visitors were possible. Hence the study suggests that more emphasis should be given on nursing action for prevention of secondary infection, precaution of safety and health teaching to minimize the morbidity and mortality caused due to hypothermia in neonates.

Neonatal hypothermia in sub-Saharan Africa: A review

Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization's recommendation of maintenance of warm chain in newborn care, hypothermia continues to be a common neonatal condition which has remained under-recognized, under-documented, and poorly-managed. This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase, Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia,' 'Cold stress in newborn' 'thermal care of the newborn,' 'neonatal thermogenesis,' 'neonatal cold injury,' among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns.

Neonatal hypothermia in low resource settings: a review

Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed. This review aims to provide a thorough patho-physio-epidemiological discussion of neonatal hypothermia applied to local risk factors within the developing country context with particular emphasis on prevention, recognition and management. All available published literature on neonatal hypothermia relevant to resource poor settings were reviewed. Studies from the developing country settings were primarily reviewed for epidemiology, domiciliary risk factors as well as potential interventions for thermal care. Functional integrity and efficiency of biological systems is critically dependent on an optimal and very narrow range of core body temperature. Risk factors for neonatal hypothermia differ markedly within low resource settings. A combination of physiological, behavioral and environmental factors universally put all newborns, irrespective of birth weight, at risk of hypothermia. The knowledge deficit along the continuum from health providers to primary care givers has sustained the silent epidemic of hypothermia. The challenges of recognition, understanding of local risk factors and communication have meant a lack of informed thermal care for newborns. Simple, feasible interventions exist, but need to be applied, based on local risk factors that disrupt the warm chain. Further research is needed to document local risk factors, develop better techniques for recognition, evaluation of thermal care within essential newborn care and communication strategies for program effectiveness.

Point-of-admission hypothermia among high-risk Nigerian newborns

BackgroundFacilities which manage high-risk babies should frequently assess the burden of hypothermia and strive to reduce the incidence.ObjectiveTo determine the incidence and outcome of point-of-admission hypothermia among hospitalized babies.MethodsThe axillary temperatures of consecutive admissions into a Nigerian Newborn Unit were recorded. Temperature <36.5°C defined hypothermia. The biodata and outcome of these babies were studied.ResultsOf 150 babies aged 0 to 648 hours, 93 had hypothermia with an incidence of 62%. Mild and moderate hypothermia accounted for 47.3% and 52.7% respectively. The incidence of hypothermia was highest (72.4%) among babies aged less than 24 hours. It was also higher among out-born babies compared to in-born babies (64.4% vs 58.3%). Preterm babies had significantly higher incidence of hypothermia (82.5%) compared with 54.5% of term babies (RR = 1.51; CI = 1.21 – 1.89). The incidence of hypothermia was also highest (93.3%) among very-low-birth-weight babies.The Case-Fatality-Rate was significantly higher among hypothermic babies (37.6% vs 16.7%; RR = 2.26, CI = 1.14 – 4.48) and among out-born hypothermic babies (50% vs 17.1%; RR = 0.34, CI = 0.16 – 0.74). CFR was highest among hypothermic babies with severe respiratory distress, sepsis, preterm birth and asphyxia.ConclusionThe high incidence and poor outcome of hypothermia among high-risk babies is important. The use of the 'warm chain' and skin-to-skin contact between mother and her infant into routine delivery services in health facilities and at home may be useful.

Prevalence and risk factors for hypothermia on admission in Nigerian babies &lt;72 h of age

Hypothermia is a major contributor to early neonatal deaths especially in the developing world. Factors which predispose babies to hypothermia need to be identified for intervention purposes. To determine the prevalence and risk factors for neonatal hypothermia at admission in the first 72 h of life. Babies hospitalized within the first 72 h of life in a Nigerian Neonatal Unit were surveyed. Data collected included age, sex, weight, place of delivery, history of breastfeeding, recent bath, oil cleansing of the skin and presence of asphyxia. Babies with skin (axillary) temperature <36.5 degrees C were considered hypothermic. Of the 111 babies, 75 (67.6%) were hypothermic. The prevalence of hypothermia was high among babies aged <6 h (80.6%), preterm infants (88.9%), low-birth-weight babies (89.1%), babies with birth asphyxia (76.3%), babies without recent oiling of the skin (90.6%) and babies who had not been breastfed (79.2%). Using logistic regression, significant risk factors for early neonatal hypothermia at admission included low-birth-weight (P=0.000) and lack of breastfeeding (P=0.028). Most of the identified risk factors are preventable. The warm chain should be strictly applied in-hospital and be taught to mothers and community health workers.

Postnatal hypothermia and cold stress among newborn infants in Nepal monitored by continuous ambulatory recording.

To describe the pattern of hypothermia and cold stress after delivery among a normal neonatal population in Nepal; to provide practical advice for improving thermal care in a resource limited maternity hospital. The principal government funded maternity hospital in Kathmandu, Nepal, with an annual delivery rate of 15,000 (constituting 40% of all Kathmandu Valley deliveries), severe resource limitations (annual budget Pounds 250,000), and a cold winter climate provided the setting. Thirty five healthy term neonates not requiring special care were enrolled for study within 90 minutes of birth. Continuous ambulatory temperature monitoring, using microthermistor skin probes for forehead and axilla, a flexible rectal probe, and a black ball probe placed next to the infant for ambient temperature, was carried out. All probes were connected to a compact battery powered Squirrel Memory Logger, giving a temperature reading to 0.2 degree C at five minute intervals for 24 hours. Severity and duration of hypothermia, using cutoff values of core temperature less than 36 degrees C, 34 degrees C, and 32 degrees C; and cold stress, using cutoff values of skin-core (forehead-axilla) temperature difference greater than 3 degrees C and 4 degrees C were the main outcome measures. Twenty four hour mean ambient temperatures were generally lower than the WHO recommended level of 25 degrees C (median 22.3 degrees C, range 15.1-27.5 degrees C). Postnatal hypothermia was prolonged, with axillary core temperatures only reaching 36 degrees C after a mean of 6.4 hours (range 0-21.1; SD 4.6). There was persistent and increasing cold stress over the first 24 hours with the core-skin (axillary-forehead) temperature gap exceeding 3 degrees C for more than half of the first 24 hours. Continuous ambulatory recording identifies weak links in the "warm chain" for neonates. The severity and duration of thermal problems was greater than expected even in a hospital setting where some of the WHO recommendations had already been implemented.

Reduction in neonatal mortality with simple interventions.

At the neonatal intensive care unit of the Institute of Child Health Grant Medical College in Bombay India the main features are: 1) provision of warmth through inexpensive room heaters; 2) mothers milk as a sole source of nutrition; 3) mothers participation in the care of a baby; and 4) minimum handling and minimum interventions. Supportive aspects of this care include: 1) establishment of warm chain starting from labor room; 2) aggressive stabilization of a nursery admission; 3) establishment of perinatal audit sessions; 4) developing management schedules for common problems like respiratory distress and asphyxia; 5) teaching and training of staff nurses at neonatal unit as well as at labor ward; and 6) utilization of postnatal care ward as an intermediate care unit. The features were arrived at because of compulsions of circumstances such as broken incubators limited medical supply budgets to buy infant formula and shortage of trained nurses. The results of these changes are seen in the reduction of neonatal deaths for very low birth weight babies (from 84.6% dying using conventional methods from jan. 1-mar. 9 1987 to 50% mortality from Mar. 10-June. 20 1987 under the new set-up). Follow-up of discharged babies showed that the post-neonatal mortality in this high-risk group was for the general population in the city of Bombay. An important reason may be that few mothers had given up breastfeeding when surveyed at 1 year. The qualitative follow-up also revealed that the quality of survival is comparable with that under conventional care. With the declining trend in mortality the difference is reduced from approximately 25 years to about 10 years in various weight categories when compared with England and Wales. More importantly this kind of neonatal care can be made available outside of teaching institutions at an affordable cost The total yearly expenditure of the unit was Rs 326 830 (about US$40000). Capital cost was Rs 186 830 (About US$23350) and the running cost for each year was Rs 140 000 (about US$16650). Appendices give detailed instructions for the routine care and for managing respiratory distress. (Authors modified)