Prevalence, Incidence, and Reversal Pattern of Childhood Stunting From Birth to Age 2 Years in Ethiopia.

Importance: Although there has been a reduction in stunting (low-height-for-age and low-length-for-age), a proxy of malnutrition, the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to increase awareness and resources to improve the potential for recovery. Objective: To estimate the prevalence, incidence, and reversal of stunting among children aged 0 to 24 months. Design, Setting, and Participants: This population-based cohort study of the Birhan Maternal and Child Health cohort in North Shewa Zone, Amhara, Ethiopia, was conducted between December 2018 and November 2020. Eligible participants included children aged 0 to 24 months who were enrolled during the study period and had their length measured at least once. Data analysis occurred from Month Year to Month Year. Main Outcomes and Measures: The primary outcome of this study was stunting, defined as length-for-age z score (LAZ) at least 2 SDs below the mean. Z scores were also used to determine the prevalence, incidence, and reversal of stunting at each key time point. Growth velocity was determined in centimeters per month between key time points and compared with global World Health Organization (WHO) standards for the same time periods. Heterogeneity was addressed by excluding outliers in sensitivity analyses using modeled growth trajectories for each child. Results: A total of 4354 children were enrolled, out of which 3674 (84.4%; 1786 [48.7%] female) had their length measured at least once and were included in this study. The median population-level length was consistently below WHO growth standards from birth to 2 years of age. The observed prevalence of stunting was highest by 2 years of age at 57.4% (95% CI, 54.8%-9 60.0%). Incidence of stunting increased over time and reached 51.0% (95% CI, 45.3%-56.6%) between ages 12 and 24 months. Reversal was 63.5% (95% CI, 54.8%-71.4%) by age 6 months and 45.2% (95% CI, 36.0%-54.8%) by age 2 years. Growth velocity point estimate differences were slowest compared with WHO standards during the neonatal period (-1.4 cm/month for girls and -1.6 cm/month for boys). There was substantial heterogeneity in anthropometric measurements. Conclusions and Relevance: The evidence from this cohort study highlights a chronically malnourished population with much of the burden associated with growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia, needs to be addressed.

Mitigation of Chemical Reporting Liabilities through Systematic Modernization of Chemical Hazard and Safety Data Management Systems.

In the United States alone, approximately 2 billion tons of hazardous material products are manufactured each year for both household and industrial applications and contribute to thousands of worker chemical exposures with as many as 50,000 deaths from prolonged exposure each year. The potential hazards and impacts of these chemicals for human health and the environment are primarily communicated to the public through Safety Data Sheets (SDSs) from the chemical vendors or distributors. These documents provide a standardized approach for how and what information is provided to product users to assist them with assessment of precautionary measures, hazard mitigation, emergency response or cleanup procedures, and environmental, health, and safety (EHS) management. Despite the criticality for hazard communication (HAZCOM) precision, legacy SDS management and industry business practices leave the overall ability to effectively manage chemicals vulnerable to significant liability through a lack of full constituent disclosure, injection of data quality errors through various handling of SDS information and manual data entry, and the lack of direct SDS-to-product association. Chemical spills and accidents often require individuals to look for the appropriate SDS on a local computer, online, or in workplace binders; each of which results in information returned that is often found to be outdated or incorrect. Workplace HAZCOM violations remain among the top citations during EHS inspections by regulatory agencies. More important, however, is the lack of precise association of SDS to hazardous products that can occur through chemical management lifecycles. Incorrect SDSs can yield significant liability, as subsequent environmental and occupational health analyses and reporting are based upon incorrect and, in some cases, entirely different chemical formulations. This paper focuses on the need for a paradigm shift in our chemical management systems and how a standardized management system and various recent technological advances can be incorporated into Environmental Management System operations to reduce or eliminate these liabilities. The following advancements can be used to enhance the lifecycle management of workplace chemicals, reduce potential exposure and spill risks, reduce workplace hazards, and increase the efficiency and accuracy of environmental reporting through a more streamlined systems approach. EHS system enhancement applications discussed in this paper include the following: the need for a centralized universal SDS repository with full chemical disclosure of all product constituents and a nationally adopted machine language SDS standard. The use of artificial intelligence/machine learning in environmental systems and how they can be used as a medium to transition toward an automated standard by reverse-engineering and partitioning SDS components into machine-encoded text that can be validated and uploaded to a centralized repository. Algorithmic and meta-algorithmic approaches to SDS requirement and data validation, hazard characteristic code calculations, and determination of potentially less hazardous substitutions. Application of Natural Language Processing methods for real-time updates from scientific journals, regulatory agencies, and other reputable sources to produce "living" SDSs capable of informing users of relevant regulatory updates, news, and research. Embedded SDSs or SDS links in product barcodes with QR code reader technology to retrieve precise SDSs for each product in emergency situations. Use of advanced QR codes embedding authentication layers, authenticity verification, and alerts of potential product or inventory problems or discrepancies. Benefits of radio frequency identification technology in providing accurate SDS associations while also minimizing manual tracking of hazardous material and hazardous waste containers and monitoring for expired shelf life, incompatible storage, temperature sensitivities, and other inventory concerns.

Duration of viral shedding and culture positivity with postvaccination SARS-CoV-2 delta variant infections.

Isolation guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are largely derived from data collected prior to the emergence of the delta variant. We followed a cohort of ambulatory patients with postvaccination breakthrough SARS-CoV-2 infections with longitudinal collection of nasal swabs for SARS-CoV-2 viral load quantification, whole-genome sequencing, and viral culture. All delta variant infections in our cohort were symptomatic, compared with 64% of non-delta variant infections. Symptomatic delta variant breakthrough infections were characterized by higher initial viral load, longer duration of virologic shedding by PCR, greater likelihood of replication-competent virus at early stages of infection, and longer duration of culturable virus compared with non-delta variants. The duration of time since vaccination was also correlated with both duration of PCR positivity and duration of detection of replication-competent virus. Nonetheless, no individuals with symptomatic delta variant infections had replication-competent virus by day 10 after symptom onset or 24 hours after resolution of symptoms. These data support US CDC isolation guidelines as of November 2021, which recommend isolation for 10 days or until symptom resolution and reinforce the importance of prompt testing and isolation among symptomatic individuals with delta breakthrough infections. Additional data are needed to evaluate these relationships among asymptomatic and more severe delta variant breakthrough infections.