Strategies to improve enrollment in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): examining high coverage states and leveraging successful COVID-19 pandemic adjustments.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an essential program in the USA providing food benefits and nutritional and breast-feeding support to low-income pregnant or postpartum women, infants and children at nutritional risk. Despite similarities amongst federal regulations shared across WIC programs at the state level, important differences in the operations, policies and technologies between states exist. Nationally, nearly half of women, infants and children who were eligible to receive WIC benefits in 2018 were not participating in the program. In this paper, we evaluate common practices exhibited by states with the highest and lowest WIC coverage rates to identify strategies that may improve enrollment and retention rates in regions with low WIC coverage rates. We use WIC as a case study for identifying strategies that can be broadly applied to improve utilisation of similar food assistance programs globally, particularly those benefiting low-income women and children. The four strategies discussed here include utilising data to check adjunctive eligibility and reach eligible non-participants, increasing public awareness of WIC through outreach and referral efforts, implementing a centralised smartphone app and linking personal electronic benefits and streamlining the use of technologies for online applications, participant portals and remote communication. In most states, the COVID-19 pandemic and the federal waivers issued in response have offered the opportunity to promptly implement some of these strategies, particularly with regard to remote communication capabilities. With proper resources and implementation, these strategies can improve utilisation of WIC and similar programs globally.

Long-term monitoring of cardiorespiratory patterns in drug-resistant epilepsy.

OBJECTIVE: Sudden unexplained death in epilepsy (SUDEP) during inpatient electroencephalography (EEG) monitoring has been a rare but potentially preventable event, with associated cardiopulmonary markers. To date, no systematic evaluation of alarm settings for a continuous pulse oximeter (SpO2 ) has been performed. In addition, evaluation of the interrelationship between the ictal and interictal states for cardiopulmonary measures has not been reported. METHODS: Patients with epilepsy were monitored using video-EEG, SpO2 , and electrocardiography (ECG). Alarm thresholds were tested systematically, balancing the number of false alarms with true seizure detections. Additional cardiopulmonary patterns were explored using automated ECG analysis software. RESULTS: One hundred ninety-three seizures (32 generalized) were evaluated from 45 patients (7,104 h recorded). Alarm thresholds of 80-86% SpO2 detected 63-73% of all generalized convulsions and 20-28% of all focal seizures (81-94% of generalized and 25-36% of focal seizures when considering only evaluable data). These same thresholds resulted in 25-146 min between false alarms. The sequential probability of ictal SpO2 revealed a potential common seizure termination pathway of desaturation. A statistical model of corrected QT intervals (QTc), heart rate (HR), and SpO2 revealed close cardiopulmonary coupling ictally. Joint probability maps of QTc and SpO2 demonstrated that many patients had baseline dysfunction in either cardiac, pulmonary, or both domains, and that ictally there was dissociation-some patients exhibited further dysfunction in one or both domains. SIGNIFICANCE: Optimal selection of continuous pulse oximetry thresholds involves a tradeoff between seizure detection accuracy and false alarm frequency. Alarming at 86% for patients that tend to have fewer false alarms and at 80% for those who have more, would likely result in a reasonable tradeoff. The cardiopulmonary findings may lead to SUDEP biomarkers and early seizure termination therapies.

Interdependence of social-ecological-technological systems in Phoenix, Arizona: consequences of an extreme precipitation event.

Complex adaptive systems - such as critical infrastructures (CI) - are defined by their vast, multi-level interactions and emergent behaviors, but this elaborate web of interactions often conceals relationships. For instance, CI is often reduced to technological components, ignoring that social and ecological components are also embedded, leading to unintentional consequences from disturbance events. Analysis of CI as social-ecological-technological systems (SETS) can support integrated decision-making and increase infrastructure's capacity for resilience to climate change. We assess the impacts of an extreme precipitation event in Phoenix, AZ to identify pathways of disruption and feedback loops across SETS as presented in an illustrative causal loop diagram, developed through semi-structured interviews with researchers and practitioners and cross-validated with a literature review. The causal loop diagram consists of 19 components resulting in hundreds of feedback loops and cascading failures, with surface runoff, infiltration, and water bodies as well as power, water, and transportation infrastructures appearing to have critical roles in maintaining system services. We found that pathways of disruptions highlight potential weak spots within the system that could benefit from climate adaptation, and feedback loops may serve as potential tools to divert failure at the root cause. This method of convergence research shows potential as a useful tool to illustrate a broader perspective of urban systems and address the increasing complexity and uncertainty of the Anthropocene. Supplementary Information: The online version contains supplementary material available at 10.1186/s43065-023-00085-6.