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Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.

Household air pollution (HAP) from cooking with solid fuels used during pregnancy has been associated with adverse pregnancy outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial that assessed the impact of a liquefied petroleum gas (LPG) stove and fuel intervention on health in Guatemala, India, Peru, and Rwanda. Here we investigated the effects of the LPG stove and fuel intervention on stillbirth, congenital anomalies and neonatal mortality and characterized exposure-response relationships between personal exposures to fine particulate matter (PM2.5), black carbon (BC) and carbon monoxide (CO) and these outcomes. Pregnant women (18 to

Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight. Here we evaluate the effects of a LPG stove and fuel intervention during pregnancy on spontaneous abortion, postpartum hemorrhage, hypertensive disorders of pregnancy, and maternal mortality compared to women who continued to use solid cooking fuels. Pregnant women (18-34 years of age; gestation confirmed by ultrasound at 9-19 weeks) were randomly assigned to an intervention (n = 1593) or control (n = 1607) arm. Intention-to-treat analyses compared outcomes between the two arms using log-binomial models. Among the 3195 pregnant women in the study, there were 10 spontaneous abortions (7 intervention, 3 control), 93 hypertensive disorders of pregnancy (47 intervention, 46 control), 11 post postpartum hemorrhage (5 intervention, 6 control) and 4 maternal deaths (3 intervention, 1 control). Compared to the control arm, the relative risk of spontaneous abortion among women randomized to the intervention was 2.32 (95% confidence interval (CI): 0.60, 8.96), hypertensive disorders of pregnancy 1.02 (95% CI: 0.68, 1.52), postpartum hemorrhage 0.83 (95% CI: 0.25, 2.71) and 2.98 (95% CI: 0.31, 28.66) for maternal mortality. In this study, we found that adverse maternal outcomes did not differ based on randomized stove type across four country research sites.

Phytoplankton subsidies from river inputs and wetland habitats can be important food sources for pelagic organisms in the Sacramento–San Joaquin Delta (Delta). However, while the Sacramento River is a key contributor of water to the Delta, providing 80% of the mean annual inflow, the river is only a minor source of phytoplankton to the system. The reason for low phytoplankton biomass in the Sacramento River is not well understood but appears to be associated with a 65-km stretch of the lower river where chlorophyll-a (Chl-a) concentrations can decline by as much as 90%. We conducted two surveys along the lower Sacramento River, in spring and fall of 2016, to investigate the relative contributions of different factors potentially driving this Chl-a decline. Our study evaluated the change in Chl-a concentrations as a result of dilution from tributaries, light availability, nutrient concentrations, nutrient uptake, phytoplankton productivity, zooplankton grazing, and clam grazing. Chl-a concentration decreased from 14 µg/L to 1.8 µg/L in the spring and from 4.0 µg/L to 1.2 µg/L in the fall. Dilutions from the Feather River and American River contributed 39% and 11% of Chl-a declines, respectively, during the spring. Average water depths roughly doubled downstream of the American River confluence, reducing water column light availability and lowering productivity. Zooplankton and clam grazing rates were generally low. Using a mass balance analysis, the measured variables explained 76% of the observed decline in Chl-a in the spring, suggesting additional losses from unidentified factors. We found that phytoplankton biomass is regulated by multiple potential factors in the lower Sacramento River, emphasizing the need for practitioners of restoration and management programs to evaluate multiple potential loss factors when attempting to enhance phytoplankton production in the Delta, or other large river systems.

This case considers the literacy leadership practices of Principal Howard at Pinecrest Academy Title I elementary school in the southeastern United States. An award-winning school, Pinecrest Academy serves over 500 students, 98% of whom are students of color. Through the lens of instructional leadership for literacy and culturally responsive school leadership for literacy, this case study examines how the principal used school improvement planning to (a) bolster the literacy outcomes of third-grade students of color, (b) form partnerships with the parents and families of third-grade students of color to increase literacy outcomes, and (c) reframe the literacy focus when external and internal factors threatened to derail the school's progress.

Women and children in rural regions of low-income countries are exposed to high levels of household air pollution (HAP) as they traditionally tend to household chores such as cooking with biomass fuels. Early life exposure to air pollution is associated with aeroallergen sensitization and developing allergic diseases at older ages. This prospective cohort study assigned HAP-reducing chimney stoves to 557 households in rural Guatemala at different ages of the study children. The children's air pollution exposure was measured using personal CO diffusion tubes. Allergic outcomes at 4-5 years old were assessed using skin prick tests and International Study of Asthma and Allergies in Childhood (ISAAC)-based questionnaires. Children assigned to improved stoves before 6 months old had the lowest HAP exposure compared to the other groups. Longer exposure to the unimproved stoves was associated with higher risks of maternal-reported allergic asthma (OR = 2.42, 95% CI: 1.11-5.48) and rhinitis symptoms (OR = 2.01, 95% CI: 1.13-3.58). No significant association was found for sensitization to common allergens such as dust mites and cockroaches based on skin prick tests. Reducing HAP by improving biomass burning conditions might be beneficial in preventing allergic diseases among children in rural low-income populations.

BackgroundHousehold air pollution from solid fuels is a leading risk factor for morbidity and mortality worldwide. Pregnant women's exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), two components of solid-fuel smoke, is associated with adverse birth outcomes. Even with improved solid-fuel stoves, exposure to PAHs and VOCs remains high. Therefore, cleaner cooking fuels need to be prioritized.ObjectiveWe aimed to quantify exposure reduction to PAHs and VOCs among pregnant women in rural Guatemala with a liquefied petroleum gas (LPG) stove intervention.Materials and methodsUrine from pregnant women (N = 50) was collected twice: at

Background: Household air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda. Aims: We conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households. Method: We conducted ethnographic research, including direct observation (n = 36), in-depth (n = 18), and semistructured (n = 6) interviews, and 24 focus group discussions (n = 96) to understand participants' experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households. Results: We identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages. Discussion: We created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.

BackgroundThree billion people use solid cooking fuels, and 4 million people die from household air pollution annually. Shifting households to clean fuels, like liquefied petroleum gas (LPG), may protect health only if stoves are consistently used. Few studies have used an implementation science framework to systematically assess "de-implementation" of traditional stoves, and none have done so with pregnant women who are more likely to adopt new behaviors. We evaluated an introduced LPG stove coupled with a phased behavioral intervention to encourage exclusive gas stove use among pregnant women in rural Guatemala.MethodsWe enrolled 50 women at

BackgroundBy 2030, the Sub-Saharan African region is projected to be the epicenter of the tobacco epidemic. While smoking prevalence is currently low among women ( 94%); however, specific knowledge of associated health-risks was limited. More than 96% perceived female tobacco use as socially unacceptable. At the same time, more than 70% were able to name potential benefits of using tobacco for both personal consumption and non-personal use. Respondents reported greater experimentation with khat versus tobacco and 73% reported that their religion significantly influenced their tobacco-related attitudes. Overall, there were higher reports of exposure to anti-tobacco (70%) versus pro-tobacco (49%) messaging, in the last 30 days.ConclusionsThe high level of awareness of health risks associated with tobacco use and SHS exposure and the high exposure to anti-tobacco messaging are community-level strengths that can proactively be built on to prevent the projected disease burden associated with tobacco. Findings have implications for the development of contextualized gender-specific tobacco control interventions, particularly in relation to the promotion of smoke-free homes.

Recruitment for successful health sciences research requires balancing efficiency, cost, accessibility, and reliability of available recruitment methods. Our case-control study used online recruitment methods, which broadened our reach to potential participants across the United States. However, this approach also exposed us to challenges associated with bot interference and fraudulent participation. This paper focuses on maintaining data integrity, specifically when utilizing online participant recruitment methods. Drawing from our experience, we propose The Swiss Cheese Model of Study Participant Fraud Prevention, adapted from Reason’s Swiss Cheese Model, and illustrate 10 prevention and verification measures that can be taken to minimize fraud in research studies that rely on online recruitment. We emphasize the importance of a layered approach, including carefully designed recruitment media and compensation protocols, vetting of participant eligibility, and data verification protocols to ensure the validity and reliability of research findings in the digital age. [ABSTRACT FROM AUTHOR]

A simple parent request unveiled a startling revelation: The principal of Bridgforth Elementary School segregated students by race. Her attempt to establish a culturally responsive framework was met with an Office of Civil Rights (OCR) complaint of racial discrimination. This case will examine the principal's rationale for creating the framework, the parental complaint, the school community response, and two evidence-based options for increasing student outcomes for African American students and other ethnic minorities. [ABSTRACT FROM AUTHOR]

Increasing numbers of young children are now routinely screened for developmental delays during well-child visits in primary care settings which support early identification of developmental delays. Unfortunately, research indicates that there is often a gap between the number of children who receive an abnormal screen and the number who successfully follow through with a referral for further evaluation. This article highlights how, with support from Colorado Project LAUNCH, care navigation services in South Adams County, Colorado, have evolved over the past 4 years to address these issues and successfully reduce the referral gap.

BackgroundCompetency-based education is essential to prepare future nurse scientists to compete in the world of data-driven science. Yet, few schools of nursing have developed core competencies that guide quantitative research instruction. We described development of new competency-based curriculum in quantitative research for doctor of philosophy (PhD) nursing students.MethodWe assessed quantitative research methods curricula from among top National Institutes of Health-ranked research-intensive Schools of Nursing. At the University of California, San Francisco School of Nursing, we administered a survey to PhD students and alumni, and interviewed program faculty about current quantitative courses and perceived needs. A committee of PhD faculty framed competencies.ResultsCore competencies for quantitative methods training were developed. Faculty modified courses to align with core competencies. This allowed an outcome-based approach to design, implement, and evaluate coursework.ConclusionThis effort at generating core quantitative research skills competencies could be useful for other nursing schools interested in redesigning PhD training programs. [J Nurs Educ. 2018;57(8):483-488.].