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As you progress through the various stages of learning CSP (intimidation, frustration, elucidation, puzzlement, and finally smooth operation), the symmetries of the various functions come up over and over again. Exploiting symmetries can result in lower computational costs, quicker debugging, and easier mathematical development.
What exactly do we mean by 'symmetries of parameters?' I'm talking primarily about the evenness or oddness of the time-domain functions in the delay and cycle frequency variables and of the frequency-domain functions in the spectral frequency and cycle frequency variables. Or a generalized version of evenness/oddness, such as , where and are closely related functions. We have to consider the non-conjugate and conjugate functions separately, and we'll also consider both the auto and cross versions of the parameters. We'll look at higher-order cyclic moments and cumulants in a future post.
You can use this post as a resource for mathematical development because I present the symmetry equations. But also each symmetry result is illustrated using estimated parameters via the frequency smoothing method (FSM) of spectral correlation function estimation. The time-domain parameters are obtained from the inverse transforms of the FSM parameters. So you can also use this post as an extension of the second-order verification guide to ensure that your estimator works for a wide variety of input parameters.
The Non-Conjugate Cyclic Autocorrelation Function
Let's start our symmetry odyssey with arguably the simplest CSP function: the non-conjugate cyclic autocorrelation function. Recall that this function is equal to the conventional autocorrelation function when the cycle frequency is zero. The non-conjugate cyclic autocorrelation is defined by
where the notation denotes the infinite time average:
The symmetry in the lag parameter is determined by examining for negative ,
A little algebra yields
Note that (4a) also reveals the symmetry in the cycle frequency parameter, since it can be rearranged as
Let's illustrate our sequence of symmetry results using our old friend, the rectangular-pulse BPSK signal. It has ten samples per bit, or Hz, and a carrier frequency offset of Hz. The carrier frequency offset renders the signal complex valued, and we also add complex-valued white Gaussian noise. The power of the signal is unity and the power of the noise is . The true parameters for this signal are known: frequency domain and time domain.
First, let's take a look at the autocorrelation, which yields the symmetry relation (4) with ,
This implies that the real part and the magnitude are even functions of and the imaginary part is an odd function of . Figure 1 shows the estimated autocorrelation, confirming these even/odd predictions:
Moving on to the cycle frequency of , we obtain the estimates shown in Figure 2. The result in (4) implies that the real part of the CAF for at should be equal to the real part of the CAF for at (verify with ). It also implies that the imaginary part for and should be the negative of that for and (verify with ). So the equation and the estimates are consistent.
The Conjugate Cyclic Autocorrelation Function
A similar analysis applies to the conjugate cyclic autocorrelation function. Let's go through it. The function is defined by
Symmetry in follows easily
because we don't have any conjugations to deal with. This simple result implies that the real and imaginary parts (and the magnitude) are even functions of . This symmetry is validated using estimates in Figure 3.
The symmetry relation (7) tells us nothing about the symmetry in cycle frequency . So let's look at ,
But (10) is just the conjugated conjugate CAF for the conjugated signal ,
The symmetry relation (12) is validated by estimating the conjugate CAF of for and the conjugate CAF of for and plotting the results. Both functions should be even functions of , and they should be conjugates of each other. This is verified in Figure 4.
The Non-Conjugate Cyclic Cross Correlation Function
Let's stay with the time-domain parameters and introduce cross functions, starting with the non-conjugate cyclic cross correlation. The basic definition is
Consider the function ,
The relation (17) also contains the symmetry relation for cycle frequency and the symmetry in 'function order,' that is, the symmetry relating to switching the order of and in the integrand. The symmetry relation for the cross cyclic CAF is illustrated for in Figure 5, which shows the (conventional) cross correlation symmetry because . Here is the same rectangular-pulse BPSK signal as we've used in the previous illustrations, and is the same signal shifted by samples and subject to a different carrier phase and independent Gaussian noise. (Shift the noise-free signal making up to the right by samples to get the noise-free .) We therefore expect the cross correlation to peak at in the XY cross function and at in the YX version.
A more complicated example is shown in Figure 6, which features the cycle frequencies of .
The Conjugate Cyclic Cross Correlation Function
A similar analysis yields the symmetry relations for the conjugate cyclic cross correlation function,
The symmetry in is validated in Figure 7, whereas the symmetry in cycle frequency is validated in Figure 8.
The Non-Conjugate Spectral Correlation Function
The symmetry derivations and illustrations for the cyclic correlation functions were fun, yes, but let's move on to the important function: spectral correlation. First, our oldest and dearest friend, the non-conjugate spectral correlation function.
The SCF is the temporal correlation between the time-series obtained from two narrowband spectral components of a signal. The narrowband components can be obtained using a simple sliding Fourier transform,
Their idealized correlation is
where we first average over all time, and then let the bandwidth of the narrowband components approach zero. As we go along looking at the symmetry properties of the non-conjugate, conjugate, cross, and conjugate cross SCFs, we'll need an expression for the narrowband component of the conjugate of ,
Let's look at the spectral correlation for the conjugated signal,
So the non-conjugate SCF doesn't possess any symmetry in on its own, but if we include the conjugated-signal SCF, we obtain a sort of symmetry.
Symmetry in cycle frequency is a bit easier,
So the information in the non-conjugate SCFs for negative cycle frequencies is redundant with that for positive cycle frequencies. The two forms of symmetry for the non-conjugate SCF are illustrated in Figures 9-11.
The Conjugate Spectral Correlation Function
Using an analysis approach similar to that for the non-conjugate SCF, we obtain the symmetry relations for the conjugate SCF:
The conjugate SCF is even in , and has no cycle-frequency symmetry itself, but possesses a symmetry relation with the conjugate SCF for the conjugated signal. Figures 12-14 illustrate and validate the symmetries.
The Non-Conjugate Cross Spectral Correlation Function
The non-conjugate cross SCF is defined by
Using the same kinds of analysis as above, we obtain a symmetry relation for frequency of
and for cycle frequency of
Equation (36) also provides the symmetry in function order. So there is no symmetry in for the function itself, but there is between the function and the non-conjugate cross SCF for conjugated and . Similarly, there is no symmetry in for the function itself, but there is between (34) and the conjugated function-reversed version of (34) with negated cycle frequency.
The symmetries are illustrated in Figures 15 and 16.
The Conjugate Cross Spectral Correlation Function
If you can bear it, there is one more case. The conjugate cross spectral correlation function is defined by
The symmetry relations are actually relatively easy to derive here. For frequency and function order we have
and for cycle frequency we have
Once again, no simple symmetry involving just the function itself (that is, (37)); all symmetry relations depend on reversing the function order and/or involve the conjugate cross spectral correlation function for conjugated inputs. The relations (38) and (39) are illustrated and validated in Figures 17 and 18.
Symmetries for the Spectral Coherence Function
I can hear you saying, "Yeah, great, but what about the coherence function?" And to be honest, that makes me tired, as this has been a long post. But I'm here for you. The non-conjugate spectral coherence function, greatly useful in blind CSP, is defined by
The denominator of (40) is symmetric in : it is the same when is replaced by . But it is not symmetric in . Recall that the numerator is not symmetric in , but obeys the cycle-frequency symmetry
So we have for the non-conjugate coherence
For the conjugate coherence,
both numerator and denominator are symmetric in , but not in . So we have the symmetry
The cross coherences don't seem to possess much symmetry. I'll leave those as an exercise for the reader.
I think the main point for CSP practitioners is that the non-conjugate spectral correlation for is redundant with respect to that for . If you've estimated the non-conjugate SCF for , you've got all the non-conjugate information you need. On the other hand, you have to estimate the conjugate spectral correlation (or coherence) for the entire range of cycle frequency to ensure you find all the valid cycle frequencies.
Comments, corrections, suggestions, and compliments welcome below!


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The Quarterback (Doubleday, 2018)
John Feinstein
Buy: Amazon US
Buy: Amazon UK
As John Feinstein writes in The Quarterback, no position in any sport is as important to a team's success as this one. The quarterback relays the play in the huddle, reads the defense at the line of scrimmage to determine whether the play call should change, then has to execute the play after the snap. Without a strong QB, a team's chances of a playoff run in the NFL are slim.
Feinstein has written about basketball, tennis, golf and baseball but this is only his second book about the NFL, following 2005's Next Man Up. While that book chronicled a full season with the Baltimore Ravens, this time Feinstein tracks five QBs through the 2017 season. He follows Baltimore's Joe Flacco, Kansas City's Alex Smith, Tampa Bay's Ryan Fitzpatrick, Indianapolis's Andrew Luck and Washington's former QB, now senior vice president of player personnel, Doug Williams.
Though the 2017 season is the focus, Feinstein fills in each man's background. Smith and Fitzpatrick were the first and last quarterbacks taken in their draft – the former first overall and the latter going in the seventh round. Smith went to the 49ers and struggled with coaching discontinuity, while Fitzpatrick bounced around a few teams, doing well but not well enough to stick. Flacco, meanwhile, switched colleges, moving to Delaware before being drafted by the Ravens and ending up as a Super Bowl MVP.
Luck grew up in Germany, where his dad – a former NFL QB himself – worked in NFL Europe. Finally, Doug Williams talks about his struggles as a black quarterback, his rise to a Super Bowl win and his subsequent front office career.
It's a good mix of players. A younger QB would have been good, just as a contrast. The players Feinstein has chosen are all able to reflect on their experience and say something meaningful about it. Perhaps Feinstein thought a younger guy might not have had the perspective to add anything meaningful
It would also have been interesting to hear from an active black QB, since Williams's experiences as a player are all 30-plus years in the past.
What links the players Feinstein has chosen is that they are all thoughtful and articulate. Luck is candid about his injury struggles and how they affected his mental state, for example, while Smith discusses the failure of his time at San Francisco with a sense of perspective.
All five are engaging subjects and it's interesting to hear them discuss a season that is so fresh in the memory. As a Ravens fan, for example, I was surprised by how much Flacco added on how the 2017 season unfolded. He's still diplomatic, of course, and doesn't criticise his teammates but he goes into more detail than he typically does during interviews. The section on the 2018 NFL Draft, where Flacco watches the Ravens select his eventual replacement, Lamar Jackson, is especially interesting.
The book drags somewhat when Feinstein recounts games that don't feature any of his five players. These are usually games that affected the season but Feinstein spends too much time detailing what happened in the game or what was said afterwards. All this information is readily available online for anyone who wants it and just feels superfluous here.
It will be interesting to see how this book ages. Will it come to be seen as a time capsule of an unremarkable season or will the insights the QBs provide be worth returning to in 10 or 20 years? It's hard to say.
For now, though, there is plenty of interest – especially for casual fans who want a glimpse into what it's like to play the highest profile role in the NFL.
Photo: Keith Allison

subset: commoncrawl


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Dr Jason Harvey
- Position: Associate Professor of Geochemistry
- Areas of expertise: geochemistry; isotope geochemistry; cosmochemistry; meteorites; mantle; lithosphere; thermal ionisation mass spectrometry; method development
- Email: firstname.lastname@example.com
- Location: 8.132c School of Earth and Environment
- Website: Twitter | Googlescholar | ORCID
- 08/2020 onwards: Associate Professor of Geochemistry
- 10/2012 to 08/2020: Lecturer in Geochemistry
- 10/2012 to 01/2018: NERC Advanced Research Fellow, University of Leeds
- 2014: Visiting Investigator, Carnegie Institution Washington (Department of Terrestrial Magnetism), Washington DC, USA. 2013 onwards. Re-Os-Pb geochronology of mantle sulphides; investigating the scale of mantle heterogeneity
- 2013: Blaustein Visiting Professor, Stanford University, CA, USA. Awarded 2012. Mantle neodymium isotope heterogeneity: analytical resolution at the grain scale?
- 10/2010 to 10/2012: Research fellow in isotope geochemistry, University of Leeds
- 2009 to 2010: PDRA, The Centre for Earth, Planetary, Space and Astronomical Research (CEPSAR), The Open University
- 2008 to 2015: Associate lecturer (Earth Sciences), The Open University.
- 2007 to 2009: Visiting researcher / Sessional lecturer, School of Earth & Planetary Sciences, Birkbeck College, University of London
- 2006 to 2007: Thermal ionisation mass spectrometry specialist, Boston University, Boston, MA, USA
- Academic Integrity Lead: School of Earth & Environment
- Academic Lead: Thermal Ionisation Mass Spectrometry (TIMS) laboratory
- Leader: Rocks, Melts and Fluids research group
Research interests
My research focuses on chemical and isotopic heterogeneity in the mantle. In particular, I am interested in determining the magnitude and spatial distribution of such heterogeneities and determining the implications of these anomalous compositions in various tectonic settings. I use a variety of isotope systems to investigate these problems and collaborate with a number of research groups in Europe and the US. My current research interests are relatively diverse but have a common peridotite theme:
The Pb paradox and Os isotopic gap: the role of mantle sulphides as refractory domains. With Steve Shirey (Carnegie Institution, Washington) Jessica Warren (Stanford University), Janne Koorneeff (Vrije University)
The effects of melt depletion, metasomatism, and supergene weathering on S-Se-Te and PGE in pyroxenite xenoliths from Kilbourne Hole, NM. With Stephan König (University of Tübingen) and Lukáš Ackerman (Czech Academy of Research, Prague)
Controls on the high PGE content of primary spinel. With Camilla Watson, Lewis Whitely, Richard Walshaw (University of Leeds), Zhuyin Chu (State Key Laboratory for Lithosphere Evolution, Chinese Academy of Science), Samantha Hammond (Open University).
Nd isotope heterogeneity at the grain scale in the mantle. With Ethan Baxter (Boston College) Matt Jackson (University of California, Santa Barbara), Jessica Warren (University of Delaware)
The effects of melt depletion, metasomatism and supergene weathering on 3He/4He and trace element abundances in peridotite-hosted olivine. With David Graham (Oregon State University), Samantha Hammond (The Open University) and Cees-Jan de Hoog (University of Edinburgh)
The nature and extent of stable isotope (Ni, Mo, V, Cr) fractionation in mantle peridotites. With Yu- Hsuan Liang (Academia Sinica, Taiwan), Julie Prytulak (Durham University), Naomi Saunders (University of Oxford), Matthew Jerram (University of Oxford), Alex Halliday (Columbia University)
Trace element systematics of variably altered peridotite-hosted base metal sulphides. With Jessica Warren (University of Delaware) Munir Humayun (Florida State University), Richard Walshaw (University of Leeds)
What do pallasite meteorites tell us about processes deep in the interior of differentiated planet(essimal)s? With Maeve Quinlan-Murphy (University of Leeds), Andrew Walker (University of Leeds), Chris Davies (University of Leeds), Thomas Mueller (University of Leeds, Jon Mound (University of Leeds).
Unravelling Early Earth evolution: the onset of plate tectonics at Isua, SE Greenland. With Thomas Mueller (University of Leeds), Sandra Piazolo (University of Leeds), Alex Webb (University of Hong Long)
Improving the precision of measurements of Nd isotopes in foraminifera for paleo-oceanographic applications. With Frances Proctor (University of Leeds), Tracy Aze (University of Leeds)
Chemical and isotopic tracers of the transition between oceanic and continental sub-continental lithospheric mantle. With Elena Curtis (University of Leeds), Dan Morgan (University of Leeds), Matt Pankhurst (INVOLCAN)

Research projects

Any research projects I'm currently working on will be listed below. Our list of all research projects allows you to view and search the full list of projects in the faculty.

The origins of Scottish orogenic gold. With Shane Webb (University of Leeds), Taija Torvela (University of Leeds), Rob Chapman (University of Leeds)
- PhD, 'Messengers from the mantle...
- BSc Hons, Geology, Durham University
Professional memberships
- Treasurer: Mineralogical Society of GB and Ireland
- Member of the Geochemistry Society since 2004
- Elected Fellow of the Geologiocal Society of London 2005
- Fellow of The Mineralogical Society of Great Britain and Ireland since 2011
- Member of the European Association of Geochemists since 2015
Student education
- First year scientific tutorials (Module manager)
- Metamorphism and the rock cycle
- Second year scientific tutorials
- Mineralogy and Petrology
- Geological sciences projects
- High temperature processes
- Geophysics research seminars
Research groups and institutes
- Deep Earth
- Institute of Geophysics and Tectonics
- Rocks, Melts and Fluids
- Planetary Exploration


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BIOMATERIALS: Programmable syringe pump for biomolecules & structural studies
Cytochrome c (cyt c) solution was injected into the ternary lipid membranes with a programmable VIT-FIT syringe pump at sufficiently low speed to study the phase behaviour: 2014
Effect of cytochrome c on the phase behavior of charged multicomponent lipid membranes.
Pataraia, Salome, Yonggang Liu, Reinhard Lipowsky, and Rumiana Dimova. Biochimica et Biophysica Acta (BBA)-Biomembranes 1838, no. 8 (2014): 2036-2045.
Max Planck Institute of Colloids and Interfaces, Germany and Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, China.
Keywords: Giant vesicles, Phase diagram (Gibbs triangle), Egg sphingomyelin, DOPG, Cholesterol, Confocal microscopy
Abstract: We studied the effect of submicromolar concentrations of cytochrome c (cyt c) on the phase behavior of ternary lipid membranes composed of charged dioleoylphosphatidylglycerol, egg sphingomyelin and cholesterol. The protein was found to induce micron-sized domains in membranes belonging to the single-fluid-phase region of the protein-free ternary mixture and, as a result, to expand the region of coexistence of liquid ordered (Lo) and liquid disordered (Ld) phases. Direct observations on individual vesicles revealed that protein adsorption increases the area of Ld domains.
Feeding of fluid to the microfluidic flow cell by a syringe pump VIT-FIT to study the adhesion strength between nanoparticles and substrate: 2013
Feasibility and constraints of particle targeting using the antigen–antibody interaction.
Tokárová, Viola, Anna Pittermannová, Vlastimil Král, Pavlína Řezáčová, and František Štěpánek. Nanoscale 5, no. 23 (2013): 11490-11498.
Institute of Chemical Technology Prague, Czech Republic and Academy of Sciences of the Czech Republic.
Keywords: Microfluidic flow cell, Monoclonal antibodies, Silica nanoparticles, Flow cytometry, Drug delivery
Part of themed collection: Functional Nanoparticles for Biomedical Applications
Abstract: This work is concerned with the surface modification of fluorescent silica nanoparticles by a monoclonal antibody (M75) and the specific bioadhesion of such particles to surfaces containing the PG domain of carbonic anhydrase IX (CA IX), which is a trans-membrane protein specifically expressed on the surfaces of several tumor cell lines. The adhesion strength of antibody-bearing silica nanoparticles to antigen-bearing surfaces was investigated under laminar flow conditions in a microfluidic cell and compared to the adhesion of unmodified silica nanoparticles and nanoparticles coupled with an unspecific antibody.
Dosing of fluids with VIT-FIT syringe pumps for reliably assessment of protein structures under various conditions: 2011
Coupling of a microfluidic mixer to a Fourier-transform infrared spectrometer for protein-conformation studies.
Prim, Denis, Simon Crelier, and Jean-Manuel Segura. CHIMIA International Journal for Chemistry 65, no. 10 (2011): 815-816.
HES-SO Valais, Institute of Life Technologies, Sion, Switzerland.
Keywords: FTIR, Microfluidic, Protein Conformation, Protein Folding
Abstract: The biological properties of a protein critically depend on its conformation, which can vary as a result of changes in conditions such as pH or following the addition of various substances. Being able to reliably assess the quality of protein structures under various conditions is therefore of crucial importance. Infrared (IR) spectroscopy of the Amide I band of proteins is a powerful method for the determination of protein conformations and further allows the analysis of continuously flowing solutions of the target molecule.
Cryotrapping at a flow rate of 40 ml/min with VIT-FIT programmable syringe pump: 2008
Speziation mikrobiologisch alkylierter, leichtflüchtiger Selenverbindungen in Abhängigkeit der geochemischen Verfügbarkeit des Selens.
Peitzsch, Mirko. Doktor der Naturwissenschaften, Johannes-Gutenberg-Universität Mainz, Mainz (2008).
Fachbereich Chemie, Pharmazie und Geowissenschaften der Johannes-Gutenberg-Universität Mainz, Germany
Keywords: Biomethylierung, Selen, GC-ICP-MS, Speziation, Oberflächenkomplexierung, Goethit, DMSe, Sorption, Aminosäuren, volatil; biomethylation, selenium, GC-ICP-MS, speciation, surface complexation, goethite, DMSe, sorption, amino acids, volatile
Abstract: Selenium exists in different oxidation states (+6, +4, ±0, -2) in diverse environmental compartments. Different properties are related to these oxidation states, for example water solubility, which is closely correlated with the migration capability and the bioavailability.
In this study, the availability of inorganic selenium species was investigated in different laboratory experiments to get information on the mobility of these species. Hereby selenite adsorbed on goethite was incubated with a pure culture of active methylating fungus Alternaria alternata as well as with an enriched environmental mixed culture.
Furthermore, the reduced iron selenid mineral ferroselite was used to investigate its stability at different activities of the sulfate reducing bacterium Desulfovibrio gigas. With ongoing incubation time and a related reduction of sulfate an increase of volatile organoselenium compounds in the headspace of the cultures up to nanograms was observable. Along with this an increase in dissolved selenium and therefore a biological induced re-dissolution of selenium out of the mineral into the water phase has been observed.
It was possible to show in this study, that the activity of microorganisms has a significant impact on the stability of surface complexes of selenite as well as with mineral selenid species.
Programmable VIT-FIT syringe pump provided steady injection of the sample (2 mL/h) through the deposition cell without flow rate pulses to study the kinetics of β-lactoglobulin at a solid−liquid interface: 2007
Effects of temperature, pH, and salt concentration on β-lactoglobulin deposition kinetics studied by optical waveguide lightmode spectroscopy.
Kroslak, Marek, Jan Sefcik, and Massimo Morbidelli. Biomacromolecules 8, no. 3 (2007): 963-970.
ETH, Zurich and University of Strathclyde, Scotland.
Keywords: β-lactoglobulin, Denaturation, Thermal stability, OWLS
Abstract: Deposition kinetics of β-lactoglobulin at a solid−liquid interface was studied with optical waveguide lightmode spectroscopy (OWLS) over a range of temperatures between 61 and 83 °C. A new temperature-controlled cell for OWLS measurements allows fast, on-line monitoring of the deposit formation at elevated temperatures. Primary protein layers were deposited at 25 °C in order to precondition and stabilize the waveguide surface. Sustained deposition lasting from a few minutes (around 80 °C) to hours (below 70 °C) resulted in multilayer deposits up to several tens of nanometers thick. The measured deposition rates were strongly influenced by temperature, pH, and NaCl concentration.
Flow rate was held constant at 2 ml/h (corresponding to a residence time of about 30s in the deposition cell) by the programmable syringe pump VIT-FIT: 2006
Investigation of deposition and adsorption on solid-liquid interfaces through optical waveguide lightmode spectroscopy.
Kroslak, Marek. PhD diss., Slovak Technical University, 2006.
ETH, Zurich.
Keywords: Topochemistry, Molecular Dynamics, Molecular Mobility, Molecular Motility, Biomolecules, Biological Macromolecules, Biochemistry
Abstract: Deposition of dissolved or suspended material from liquids at solid surfaces is present in various applications occurring not only in chemical process technologies, but also in many food, biomedical, environmental and mineral processing industries. Control of deposition phenomena through appropriate design of surface properties has been subject of much interest in recent years. Read more


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NoFraud uses thousands of data points to protect online businesses against $32 billion in online global fraud loss. And it takes only 10 minutes to set up the software.
New York, NY – In late 2013, Shaya Posner, VP of Operations at an online electronics company, was frustrated. Sales were on track to reach over $10 million, but he was having trouble with an increase in fraudulent transactions that were eating away at profits. He calculated his fraud to be 2-3% of all transactions (over $250k).
Shaya looked at existing solutions on the market that could complement the basic fraud protection that his gateway offered. While there were several options to choose from, each had its downside: some were simply not effective, some required extensive manual review which did not save him as much money as he wanted due to increased personnel expenses, others offered insurance against fraudulent transactions but those would lead to an increase in false positives by blocking legitimate transactions, and all were extremely expensive.
Wanting an effective, affordable solution that required no merchant intervention at all, Shaya partnered with Isaac Gurary, a successful entrepreneur, and NoFraud was born. It is the first all-in-one fraud prevention system of its kind, a fraud eliminator that uses more than 1,000 data points to consider if a transaction is fraudulent or legitimate. The proprietary and dynamic technology and databases reduce fraudulent transactions to 0.01% and NoFraud uses Live Cardholder Verification when a transaction is in doubt. No merchant fraud expertise is needed, easing the merchants' headache and allowing them to focus on building their business, rather than constantly fighting off fraudsters. Integration is very simple; set-up takes only 10 minutes.
"I have always been on the forefront of battling fraud," says Ezzie Schaffran, former VP of Operations & Risk Management at Worthy.com, an Israeli startup focusing on the 30-billion-dollar high-end luxury goods resale market and Ice.com, and currently at Certified Watch Store. "NoFraud is by far the most revolutionary fraud prevention platform I have seen in a long time. Integration was quick and the results speak for themselves. I actually haven't had a single CNP fraudulent transaction since we started using NoFraud. This has allowed me to focus on growing my business instead of wasting resources trying to outmaneuver the fraudsters."
NoFraud is out of beta testing and is now live, working with merchants on fighting fraud. Due to the new 2016 EMV chip requirements for brick and mortar stores, online fraud is expected to encompass a larger share of all fraud; it currently stands at 45% of all card fraud. NoFraud has launched at a most opportune time.
NoFraud, based in New York, NY, provides e-commerce merchants with the #1 most effective eCommerce card-not-present fraud protection (CNP), virtually eliminating card-not-present (CNP) fraud, false positives, and chargebacks after 10 minutes of set up. See an immediate impact on your bottom line, without manual review or training. NoFraud is the price-performance leader, with no quotas, lengthy contracts, or start-up fees. NoFraud's team of industry experts constantly updates the system using the latest technology to meet emerging threats. It is the only commercially available service that contacts cardholders directly to verify purchases, ensuring that businesses don't deny legitimate customers. Visit www.nofraud.com for more information.
Media Contacts:
Shoshanah Posner
888-773-3669 x104


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11 Offbeat Holidays You Can Celebrate In February
Sure, Valentine's Day gets all the commercial airtime and drugstore aisle displays come February, but we've rounded up plenty of other quirky holidays to celebrate on the other 27 days.
1. February 7: Bubble Gum Day
Celebrated annually on the first Friday of February, Bubble Gum Day proclaims itself a "FUNdraising Holiday." The occasion, which was started in 2006 by children's book author Ruth Spiro, allows school children to chew gum—chastisement free—in exchange for 50 cents, which then gets donated to a charity of the school's choice. Since its inception, participation has spread to include libraries, children's museums, and even senior centers.
2. February 8: Laugh and Get Rich Day
It's not clear if the laughter is intended to result in vast fiscal gains or if the two activities are merely suggested as befitting one another with no causal relationship implied.
3. February 9: Man Day
The Sunday before Valentine's Day has been officially reserved as a time for the neglected men of the world to finally get some recognition.
4. February 11: Pro Sports Wives Day
And in continuing the trend of honoring beleaguered subsets of the population comes Pro Sports Wives Day, for the women who support the men who get paid millions to play a game. (There does not appear to be a Pro Sports Husbands Day, for what that's worth.)
5. February 13: Get A Different Name Day
On the 14th, the sentiment "a rose by any other name would smell as sweet" is all about the rose. The day before, however, is all about the other name. This is the annual opportunity for people burdened with silly or undesirable names to insist that they are addressed in some more pleasing way and expect their friends and colleagues to do so.
6. February 13: Madly in Love with Me Day
February 13 is also a great day to celebrate everything, name and otherwise, that you don't hate about yourself. Conspicuously placed on the calendar, this is a day that makes literal the idea that you must love yourself before you can love another.
7. February 18: Single-Tasking Day
A day to do one, and only one, thing at a time.
8. February 20: Hoodie-Hoo Day
This is one for those of you in the Northern Hemisphere. It's a low commitment holiday: All you have to do is go outside at exactly noon (local time) and yell "Hoodie-hoo." This, supposedly will chase off winter. And frankly, it's about time someone figured out how to do so.
9. February 22: World Sword Swallowers Day
While we're not saying practitioners of the ancient art shouldn't get their own holiday, it's not clear how this is any different from other days, when people who can swallow swords should do just that, and people who can't definitely should not.
10. February 23: Curling is Cool Day
Note: This isn't just Curling Day; this is Curling is Cool Day. This is not a day to make curling the punch line of jokes, but rather an opportunity to embrace the Olympic sport and find out what about it, other than the ice, is so cool.
11: February 28: National Tooth Fairy Day
Don't tell your kids that this is basically the same thing as Mother's Day and Father's Day.
For an even more exhaustive list of holidays, historical anniversaries and notable birthdays, check out Chase's Calendar of Events.
All images courtesy of ThinkStock


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Adam Legzdins: Leyton Orient sign Derby County goalkeeper
Last updated on .From the section Football
League One Leyton Orient have signed Derby County goalkeeper Adam Legzdins on a free transfer.
The 27-year-old has been with the Rams for three years, but did not feature for the Championship side last season.
Legzdins, who began his career as a trainee at Birmingham and has had spells at Crewe and Burton, has signed a two-year deal with the O's.
Orient boss Russell Slade had been looking for a senior keeper after Jamie Jones joined Preston last week.
Legzdins made 37 appearances in total during his three-year spell with Derby, but is now hoping to establish himself in east London.
"I spoke to the manager and the goalkeeper coach and it became very clear the ambition of the club is to build on last year," Legzdins told the club website.
"It was important for me to join a team where I would play and I wanted one that would be challenging at the right end of the table
"Last year was disappointing for me for various reasons and I played fewer games than I'd hoped but the year before I played 33 games in the Championship.
"That's my ambition; to play games. I don't want to be number two goalkeeper."


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Mark Lancaster in The Guardian:
At 8pm BST today in prairie land just outside Chicago, a feat that is unlikely to be repeated in my lifetime will occur for the last time: man-made collisions of high-energy protons and anti-protons.
The final collisions at Fermilab's Tevatron collider bring to an end an odyssey that began in Bob Wilson's (not the Arsenal goalkeeper's) mind as Elvis topped the charts with The Wonder of You; produced its first collisions to the accompaniment of Jennifer Rush warbling about The Power of Love; and discovered the top quark just as Celine Dion was advising the world to Think Twice.
The odyssey ends, 26 years after the first collisions, with the dual horror of the Higgs boson potentially being found to be a hoax and a bunch of teenagers who failed to win X Factor topping the charts. I don't know who is more upset: me, Elvis or Peter Higgs.
I have been working on the Collider Detector at Fermilab (CDF) experiment at the Tevatron since 1996 but I feel like a spring chicken. Many people have been working on the experiment since the early 1980s and a handful from a decade earlier, their allegiance lasting longing than most marriages. Indeed, several marriages have resulted from eyes meeting across a crowded CDF control room.
PhD students have become professors, hair has receded and trouser legs have narrowed, but the quest for new knowledge has stayed firm. CDF has been the source of more than 550 papers, more than any other single experiment in the physical sciences. This year alone, scientists have published 30 papers using its data.
More here. [Thanks to Farrukh Azfar, professor of physics at Oxford University and experimentalist for many, many year at Fermilab. As a bit of indulgence to nostalgia, the photo shows Farrukh, who is my friend from our undergraduate years together at Johns Hopkins University, showing me around at the CDF in July of 2004.]


text:
It's snowing right now as I type. Snowing as in, 'we predict 18-24 inches in a 36-hour period.' Some people are calling it the snowpocalypse, which I kind of like, because it sounds vaguely end-of-the-worldy, but mostly just silly and funny. And I've been kicking around the idea of a new giveaway.
BEHOLD, the giveaway has arrived. Last November I went to a Cherie Priest book-signing in Seattle (I took my Dad with me. He's a trooper). I got two copies of Boneshaker signed – one for myself, and one for my blog. That book has been faithfully sitting on the shelf ever since, and it needs a new owner.
In the early days of the Civil War, rumors of gold in the frozen Klondike brought hordes of newcomers to the Pacific Northwest. Anxious to compete, Russian prospectors commissioned inventor Leviticus Blue to create a great machine that could mine through Alaska's ice. Thus Dr. Blue's Incredible Bone-Shaking Drill Engine was born.
But on its first test run the Boneshaker went terribly awry, destroying several blocks of downtown Seattle and unearthing a subterranean vein of blight gas that turned anyone who breathed it into the living dead.
Now it is sixteen years later, and a wall has been built to enclose the devastated and toxic city. Just beyond it lives Blue's widow, Briar Wilkes. Life is hard with a ruined reputation and a teenaged boy to support, but she and Ezekiel are managing. That is, until Ezekiel undertakes a secret crusade to rewrite history.
His quest will take him under the wall and into a city teeming with ravenous undead, air pirates, criminal overlords, and heavily armed refugees. And only Briar can bring him out alive.
If you'd like to win your own copy of Boneshaker, this is your chance! I'll give away one (1) SIGNED book to a lucky entrant.
To enter:
Leave a comment on this post answering the question, "What event will trigger the apocalypse?" (i.e. flood, zombies, snow, asteroid, etc.)
Please include your email address or another method of contact. Giveaway is open internationally. Comments will close on February 19 at 11:59pm EST, and I will notify the randomly selected winner via email.
Good luck!


text:
- Research article
- Open Access
- Published:
Facility readiness in low and middle-income countries to address care of high risk/ small and sick newborns
Maternal Health, Neonatology and Perinatology volume 5, Article number: 10 (2019)
4761 Accesses
22 Citations
3 Altmetric
The successful promotion of facility births in low and middle-income countries has not always resulted in improved neonatal outcome. We evaluated key signal functions pertinent to Level II neonatal care to determine facility readiness to care for high risk/ small and sick newborns.
Facility readiness for care of high risk/ small and sick babies was determined through self-evaluation using a pre-designed checklist to determine key signal functions pertinent to Level II neonatal care in selected referral hospitals in Uganda (10), Indonesia (4) and India (2) with focus on the Sub-Saharan country with greater challenges.
Most facilities reported having continuous water supply, resources for hand hygiene and waste disposal. Delivery rooms had newborn corners for basic neonatal resuscitation, but few practiced proper reprocessing of resuscitation equipment. Birth weight records were not consistently maintained in the Ugandan hospitals. In facilities with records of birth weights, more than half (51.7%) of newborns admitted to the neonatal units weighed 2500 g or more. Neonatal mortality rates ranged from 1.5 to 22.5%. Evaluation of stillbirths and numbers of babies discharged against medical advice gave a more comprehensive idea of outcome. Kangaroo Mother Care was practiced to varying extents. Incubators were more common in Africa while radiant warmers were preferred in Indian hospitals. Tube feeding was practiced in all and cup feeding in most, with use of human milk at all sites. There were proportionately more certified pediatricians and nurses in Indonesia and India. There was considerable shortage of nursing staff, (worst nurse –bed ratio ranging from 1 to 15 in the day shift, and 1 to 30 at night). There was significant variability in facility readiness, as in data maintenance, availability of commodities such as linen, air -oxygen blenders and infusion pumps and of infection prevention practices.
Referral neonatal units in LMIC have challenges in meeting even the basic level II requirements, with significant variability in equipment, staffing and selected care practices. Facility readiness has to improve in concert with increased facility births of high risk newborns in order to have an impact on neonatal outcome, and on achieving Sustainable Development Goals 3.2.2.
Over the last two decades, births of newborn infants in health care facilities in low and middle-income countries (LMICs) have increased progressively, from 60% in 1990 to 75% between 2010 and 2015 [1]. However, this increase has not always been associated with improved outcomes [2, 3]. Tools for facility-based care have mainly addressed basic essential newborn care such as hand hygiene, other clean delivery practices, temperature maintenance, clean cord care, early and exclusive breastfeeding, identification of danger signs with appropriate care seeking, basic resuscitation, Kangaroo Mother Care (KMC) and early postnatal care [4, 5]. However, more comprehensive facility-based care of what are termed as 'small and sick babies' is addressed to a lesser extent, although recent revised recommendations for maternal and newborn care at the global level have begun to consider additional components [6].
In the authors' experiences, in facilities for "small and sick babies" in LMIC, the care, resources and outcomes can be highly variable, and challenges considerable. This article focuses on some of the key issues of extra or 'special' care for these newborns in what are called "Special Care Neonatal Units" or equivalent to level II care, in some countries [7, 8]. This constitutes the basic requirement for the care of small and sick babies and is essential in all hospitals in LMICS, at the level of district hospitals and above.
In this preliminary evaluation, neonatal units in referral hospitals in Uganda, Indonesia and India were studied for readiness to provide care for the newborn. The countries served as examples of LMIC countries with more focus on a Sub-Saharan African country (Uganda), where challenges are often greater, and additionally in South Asia (India) and South East Asia (Indonesia). The hospitals included government (public) and private not-for-profit facilities. These hospitals are considered to be referral hospitals, which accept small or sick babies born at home or in sub-district/peripheral health centers. A checklist-style excel table (Additional file 1: Table S1) was adapted from the American Academy of Pediatrics recommendations (2012) and the National Neonatology Forum of India by the authors (IN and JR) with emphasis on signal functions essential for care of small and sick babies [8, 9]. Key signal functions included provision of extra warmth for babies who did not receive continuous Kangaroo Mother Care (KMC) through incubators or radiant warmers, intravenous fluids, alternate methods of feeding including tube feeding, safe oxygen use, and respiratory support up to continuous positive airway pressure (CPAP). Other elements included types and numbers of health care workers, proportion related to bed strength, selected components of infection prevention, and availability of antibiotics. Items such as ventilators were not covered as the focus was on level II or intermediary care that could address the basic signal functions for the "small and sick newborns". The tool was pilot tested and appropriate changes incorporated. Information was self-reported by the authors for the period Jan 1 to Dec 31, 2017. Necessary clearances were obtained for collection of data and information. Data related to neonatal deaths and stillbirths were obtained from the facilty registers and from forms in which data was collected for district and national health information systems.
Sixteen hospitals were included: 10 facilities in Uganda (7 government/public and 3 private-not-for-profit, 1 tertiary, 2 regional and 7 district hospitals), 4 public facilities in Indonesia (2 tertiary, 1 regional and 1 district), and 2 tertiary regional hospitals in India (1 private not for profit and 1 public hospital). There was an ongoing study of district hospitals in India when this study was planned, and therefore we could not include district hospitals. We still included these two tertiary hospitals to document whether they had at least the components of level II/special care for the high risk/small and sick babies.
In all the hospitals, the high risk/ small and sick babies were cared for in what were locally termed as neonatal intensive care units. They were found to be so variable that in this study they are termed as "neonatal units" (NU). Information documented, however, related only to the signal functions and issues relevant to level II newborn care or special care neonatal units (SCNU).
Patient load and outcome
Table 1 presents the number of deliveries and admissions to the NUs along with outcomes. The annual numbers of live births ranged from 951 to 14,469. All hospitals had in- house deliveries, except one hospital in India (NU#16), that was a large children's hospital with only outborn admissions. All the hospitals except one (#2) reported having ambulances for transporting babies to other facilities where required, but were not used to pick up babies.
The total stillbirth (SB) rate ranged from 18 to 87/1000 total births (mean = 41/1000 total births) in the Ugandan hospitals, 9 to 73/1000 total births (mean = 47/1000 total births) in the Indonesian hospitals, and 16/1000 total births in the Indian hospital with deliveries. While the total numbers of SBs were available in all the hospitals where deliveries took place, data on intrapartum or fresh stillbirths were available only for the facilities in Uganda (range: 41.3–65.5.% of the total SBs; mean 53.2%) .
All hospitals maintained data on numbers of inborn and out-born babies except for 4 in Uganda (hospitals # 2, 4, 7 and 8 who just had data on the total number of admissions). A significant proportion of inborn babies were admitted to the NU, ranging from 5.1% to as high as 78.9% (#11 in Indonesia) of all live births. In hospitals with a high proportion of inborn admissions, the admissions also included infants admitted to "allow the mothers to rest". Data about birth weights of babies admitted to NU was consistently available only for 2 facilities (# 2 and #3) in Uganda. The proportion of babies admitted to the NU with a birth weight below 2500 g ranged from 24.4 to 73.7% (mean 48.3%).
In most of the hospitals studied, outborn babies were admitted to the NUs, but in 5 district hospitals in Uganda, such babies, especially those who were obviously sick, were sent to the pediatric ward and cared for either in separate cubicles or along with the older infants and children. Although data related to these babies were maintained with the other children, even at times disaggregated by age, the staff, when questioned, felt that there were potential risks of information on these out-born babies in the Pediatric ward not getting incorporated into data related to the newborn in the health information system.
The mortality rates of neonates admitted to the NU ranged from 1.5 to 22.5%, (Uganda- 2.8 to 22.5% and in Indonesia 4.4 to 12.7%.). In the two Indian facilities, the rates were 1.5% in # 15 that admitted both inborn and out-born babies and 17.5% in hospital # 16 that admitted only out-born babies.
Table 1 also shows data from 6 hospitals on the number of babies who were discharged against medical advice (DAMA). Two hospitals in Uganda reported rates of 20 and 2% of all admissions, two hospitals in Indonesia reported DAMA rates of 0.5 and 0.4%, and the two hospitals in India reported rates of 2.9 and 2.8%. Data regarding babies referred to other hospitals were not available, except in hospital # 13 in Indonesia, that referred 50 babies to another facility.
Table 2 shows staffing patterns in the NU, indexed to the bed strength. Staffing varied widely, with nurse –bed ratio ranging from 0.7 to 15 beds in the day shift, and 1 to 30 in the night shift. The hospitals with the least number of beds per nurse of 0.7 and 1 were in district hospitals in Uganda that catered to far fewer beds/babies.
Resuscitation at birth and safe oxygen availability
Each facility had a newborn baby corner in the delivery room where resuscitation of babies and basic essential newborn care could be provided. Skin-to skin contact soon after birth was practiced in all the facilities. Delayed clamping or milking of the cord was done regularly, except in 2 hospitals in Uganda (#1 and #2) and one in India (#15). All had self-inflating bags, 220–240 mL and masks, sizes 1 and 0. Four Ugandan hospitals (# 7–10) and the two Indian hospitals also had 500 mL self-inflating bags for term babies. In the delivery room, a common suction machine was used for both mother and baby in all the hospitals in Uganda and Indonesia; in India, suction equipment was separate for the mother and baby. While most of the hospitals confirmed the presence of low pressure (≤100 mmHg) suction machines, all the hospitals in Uganda could not provide information on suction pressure. Suction bulbs were the conventional rubber bulbs and were available in all the hospitals. Eight hospitals in Uganda had, additionally, the Laerdal 'penguin' suction device, which is translucent and can be opened for cleaning and disinfection/sterilization.
Oxygen was available in all the centers in the labor and delivery rooms as well as in the NU, either through oxygen cylinders and/or oxygen concentrators or piped in from a central oxygen supply source. None of the hospitals in Uganda had the capability to provide blended air and oxygen, while this was available in all the facilities in Indonesia and India. All hospitals, except for one hospital in Uganda, could provide CPAP. In Uganda, 5 facilities had 1 pulse oximeter each, all functional. All hospitals in India and Indonesia had pulse oximeters, between 18 to 50 in number. In two hospitals in Indonesia, 12 of 37 (32%) in #12 and 4 out of 18 (22%) in # 14 were not in working order.
Temperature maintenance and kangaroo mother care (KMC) (Table 3)
All hospitals except for 4 in Uganda provided separate caps/hats in the labor and delivery rooms and in the NUs.
KMC was practiced to some extent in all the hospitals, with mothers staying in the unit/hospital (all 10 in Uganda; 2 in Indonesia, and 2 in India). It was also practiced during the mothers' hospital visits in all except in Uganda.
Hospital # 15 in India also practiced "family centered care". Parents were allowed 24-h access to their babies, and mothers after discharge stayed in a room near the NU and were available to provide KMC and expressed breast milk. Once the babies were stable and/or about 1500 g, mothers were additionally involved in the care of their baby, such as baths and feeding.
NUs utilized both incubators and radiant warmers or open care systems (Table 3). Incubators were used more often than radiant warmers in Uganda, whereas in Indonesia, units had both incubators and radiant warmers. In India, there was a distinct preference for locally manufactured radiant warmers. Ninety-six per cent of radiant warmers and 82.6% of incubators in all the facilities studied were in functioning order.
Monitoring of the baby's temperature through the axillary route was primarily through use of shared digital thermometers that were stored dry and swabbed with alcohol between babies. Separate thermometers for each baby were available only in three hospitals in Indonesia, and in both the Indian hospitals.
Feeding and IV fluids
All the hospitals used expressed human milk for feeding the babies, but proportions of human milk and formula substitution were not available. Only one of these hospitals (in India, # 15) had a milk bank supporting the unit. Two hospitals in Uganda (#1 and # 6); all in Indonesia and one in India (#16) stored surplus expressed breast milk in refrigerators in the unit. Hospital # 15 in India had mothers near the unit as part of associated family centered care. All the facilities had resources to provide gavage feeding. Most, except for two in Indonesia (# 12 and # 13), also used cups for feeding small babies. In India, the local traditional "paladai" (a cup with a small open spout/trough) was used.
All facilities had resources to administer intravenous fluids when required. They reported use of single-use cannulas and intravenous infusion sets that were changed between 24 and 72 h. Three Ugandan hospitals (#1, #2, # 5), and all in Indonesia and India had infusion pumps. The remaining Ugandan hospitals used adult infusion sets and did not have infusion pumps, micro-burettes or flow regulators. Only three hospitals (in Indonesia, #12, #13 and # 14) had commercial premixed intravenous fluids. All other units mixed intravenous fluids, usually within the unit. In one unit in Indonesia (#11), the fluids were prepared in the pharmacy.
Prevention of infection (Table 4)
All hospitals, except for #8 in Uganda, reported having 24 h running water. All had liquid soap and sinks for hand washing with 13 having a sink in every room with babies. All except 5 in Uganda (# 4, #7–10) had alcohol-based hand-rubs; five (# 1–3, #5,6) had limited supplies, placing them only at selected sites, such as near incubators.
Routine cleaning of the floor with mopping was carried out daily in all the centers. All the hospitals had dedicated containers for 'sharps', waste receptacles with lids and plastic linings and incinerators.
Baby linen was supplied by the facility in 6 hospitals, while the 10 hospitals in Uganda requested mothers/families to bring the linen. In the 10 hospitals in Uganda, linen was washed by hand and dried on lines or on the ground in open air; in the remaining 6 (in Indonesia and India), it was machine washed and dried. In one hospital in Indonesia (#14) and one in India (#16), the linen was additionally autoclaved centrally.
Among the 15 facilities that used rubber suction bulbs (all in Uganda and Indonesia and 1, #15, in India), 8 in Uganda and 2 in Indonesia reused suction bulbs after merely washing them with soap and water. One hospital in Uganda (#6) dipped it in a chlorine based solution "jik", and washed it with soap and water. Only one hospital in India discarded them after every use. With the exception of 2 hospitals in Indonesia (#12 and 13), none of the facilities reprocessed the self-inflating bag and mask with full disassembly and reassembly after each use. One hospital in India reprocessed it in this manner once a day. In 13 facilities (all 10 in Uganda, #11 and #14, in Indonesia and #15 in India), health workers simply detached the mask and cleaned it with soap and water, a chlorine- based solution or alcohol.
Treatment of infection
Regarding antibiotics, Ampicillin/ Penicillin and Gentamicin were available in all NUs (Additional file 2: Table S2). In addition, hospitals had access to cephalosporins, vancomycin and carbapenems. A larger variety of antibiotics were available in the facilities in India and Indonesia. Antibiotics were generally available in multi-dose vials. In 2 facilities in Uganda (# 1 and # 6), one vial was reserved for one baby. In the others, they were shared between babies. One mL syringes, that are usually recommended for accurate dosing of small volumes in babies, were not available in 7 hospitals in Uganda.
Management of Jaundice and Blood Transfusions
Phototherapy units were available in all the hospitals. Most hospitals had resources for blood transfusion, except for two facilities in Uganda, and all except 8 hospitals in Uganda could carry out exchange transfusions.
Laboratory tests
All hospitals had resources to carry out blood group typing, blood glucose, and blood counts, and all but 7 facilities in Uganda (#4–10) could perform serum bilirubin levels, serum electrolytes and blood cultures.
This study highlights the variability of facility readiness for care of "small and sick babies" in referral hospitals in LMIC. Although the units were all locally referred to as "Neonatal Intensive Care Units" (NICU), they actually consisted of a mixture of special care (Level 2 or SCNU) and Intensive care (Level 3 - NICU) units. Even when viewed through the lens of the requirements of SCNU, many centers including "tertiary" centers had challenges.
Interestingly, we noted that in the NUs in the hospitals that had records of birth weights, 51.7% of the babies admitted weighed 2500 g or more. In the authors' experience, not all the normal weight term infants admitted to the NU are sick. Some just require extra observation and monitoring; for example, respiratory rates or blood sugar estimations, in the initial stages after which they are transferred out to the mothers in the post-natal wards. Some late preterm babies too may weigh more than 2500 g. We believe the term "high risk/small and sick babies" may be more appropriate than the conventional "small and sick babies", when dealing with newborns needing extra care, in LMIC. It is possible that the greater numbers of admissions were partly due to the high-risk nature of these pregnancies and because of limited monitoring capabilities for babies in the postnatal ward.
In 5 of 8 facilities with the data, more than a third of inborn babies were admitted to the neonatal units (Table 1). As noted earlier, some of these admissions were to provide "extra rest of the mothers". While this may be important, it adds to the workload of the already over-burdened staff in the NUs, results in overcrowding, needless use of formula feeds and potential risk of cross- infections.
Bed strength and human resources
Professional bodies, such as the American Academy of Pediatrics), the National Neonatology Forum of India), organizations such as UNICEF, India and Ministries of Health in some LMIC, such as the Ministry of Health and Family Welfare, India have developed recommendations on bed strength, spacing and staffing [8, 10,11,12]. Recommendations are often based on the number of deliveries and do not in general, consider out-born admissions, that add to the workload, both by numbers and also with acuity. As shown in Table 2, hospitals in Indonesia and India had higher bed strengths, but the numbers of neonatal beds were much lower in most of the Ugandan hospitals. Placing multiple babies in a cot is not uncommon in LMIC. This carries increased risk of infection and places an additional strain on the care providers.
In this study there was a higher proportion of Pediatricians and nurses in Indonesia and India than in Uganda, but even in these facilities, the nurse -patient ratio was inadequate. Shortage of nursing staff was a challenge with one nurse covering 15 to 30 babies in 3 of the hospitals in the night shift. In LMIC, due to inadequate skilled staff, task-shifting to or task-sharing with trained but less skilled staff or even family members for some of the non-specialized care may be essential until the countries can afford to provide adequate staff [13].
With increasing proportion of facility births and high mortality among preterm and low birth weight babies, there is growing need for focus on the special requirements of high-risk/small babies and those with problems. Thus, while the families, community health workers and midwives play important roles, there is an increasing need for Pediatricians/Neonatologists and Pediatric/neonatal nurses with special expertise and interest in newborn care. Shortage and maldistribution of suitable health care providers have also been highlighted as key issues in other studies on newborn care from India and Indonesia [14, 15].
We noted that although many hospitals had ambulances, they were not used for transporting babies from the birth place at home or the peripheral centers to the referral hospitals. When babies are brought into the referral centers, they are mostly accompanied by the mother and other family members, but have not had the benefit of stabilization before or during transport. Although skin to skin contact may provide some temperature support, without additional care during transport, some of these vulnerable babies may reach referral centers in moribund states. Mapping of suitable referral centers, appropriate dissemination of this information and use of mobile phones may assist in initial stabilization of babies with problems and better facilitate transport to the appropriate referral center. Ideally, the at- risk mothers and those with anticipated deliveries of small babies should be referred in a timely manner to suitable referral centers.
Maintenance of records and effective use and reporting of data
Data maintenance was a major challenge. For instance, in the Ugandan hospitals, birth weight was not available for all babies and gestational age was often not noted. While some of the information may be on individual case sheets, they were not consistently or correctly available in registers or in the consolidated facility records that fed into the country health information systems (HIS). Since "complications of prematurity" is widely recorded as the most common cause of neonatal mortality, this deficiency has serious implications. Accurate data is critical for the HIS, for internal review (such as perinatal/neonatal death audits), as well as for improving quality of care.
Neonatal mortality showed significant variations in the different facilities. Some of the smaller facilities with fewer admissions had a lower mortality probably due to fewer complicated cases and some sick babies being sent to the larger centers. Comparison of mortality rates across hospitals is difficult because of a variety of influencing factors. While quality of care is important, it is well known that the types of babies cared for also matter. For example, out-born admissions are often sicker and have higher mortality rates [16]. A more comprehensive assessment of neonatal mortality can be obtained by evaluating stillbirths, particularly, fresh/intrapartum stillbirths, since in some centers, certain neonatal deaths at birth may be recorded as stillbirths [17]. In some centers in Uganda, fresh stillbirth rates were reported to be as high as 65.5% of total stillbirths.
Mortality rates also may be under-reported where babies are discharged against medical advice (DAMA). DAMA accounted for 0.4 to 20% of admissions. The outcome of these babies is unknown but may be presumed to be poor, since a major factor in DAMA is the fact that the baby is so sick that the relatives feel that further care is futile. Other potential reasons for DAMA include non-affordability of care where payment is required, inadequate communication strategies and poor infrastructural support to relatives [18].
Additionally, data on neonatal deaths may be under-reported when out-born babies are admitted in the Pediatric wards and not in the NU. These are frequently babies who have suspected or frank infections and have a higher risk of dying. These deaths may not be included in the total facility newborn deaths, unless such deaths in the Pediatric wards get disaggregated according to age and these newborn deaths get consolidated with the deaths from the NU, a process that may be challenging.
Components for basic neonatal resuscitation
A newborn corner in the delivery room, and reusable self-inflating bags with masks were present in all the hospitals studied. Some facilities used a common suction machine for mothers and babies in the delivery room, which carries the potential risk of excessive negative pressure, leading to apnea and bradycardia in the baby if pressure is not adjusted appropriately with each use. Similarly, having larger, 500 mL. bags carry the risk of volume trauma, as even the normal weight term baby requires only 6–8 ml/kg of tidal volume for which the conventional newborn size bag (220–240 ml) is more than adequate [19]. Care providers need to be trained and supervised/mentored to achieve adequate mask seal and provide appropriate ventilation [20].
Safe use of oxygen
Many facilities in LMIC, as in the Ugandan hospitals in this study, depend on oxygen from cylinders or oxygen concentrators without blenders. The capability to provide appropriate concentrations of oxygen and consistent monitoring with pulse oximeters, are essential to reduce retinopathy of prematurity (ROP). India contributes to 10% of worldwide cases of blindness and visual impairment from ROP, highlighting the importance of safe oxygen use; prevention being far better than cure [21].
CPAP was available in almost all the centers. CPAP also requires the safe administration of oxygen, as only select equipment, such as the Pumani bubble CPAP, have the capability of in built regulation of oxygen concentration (Website-http://hadleighhealthtechnologies.com/pumani-bcpap/).
Kangaroo mother care (KMC)
The immediate and long-term advantages of KMC have been well documented [22]. All facilities practiced KMC to some extent, but implementation needs to be further strengthened and expanded. The value of mothers or female relations in the care of these babies has been documented earlier in LMIC as in India with beneficial effects and without necessarily causing increased infection. It can also help empower women resulting in earlier discharge and, subsequently, better care at home [23, 24] More recently, Family Centered Newborn Care (FCNC), a "client focused "practice to promote and support a partnership between the health care team and the family, with mothers/family members providing selected non-specialized care for babies is gaining increasing acceptance around the world. In a randomized controlled trial, the intervention reduced health care providers' workload and increased family members' competence in infant care at home. There was no difference in nosocomial infections between the groups, and it also promoted pre-discharge exclusive breastfeeding [25].
Extra support for temperature maintenance
Other methods of temperature support in this study included overhead radiant warmers or open care systems and incubators [26]. Overhead warmers, available in a number of varieties including more economical versions, allow ready access to the baby and, in general, are easier to clean and maintain. They are associated with increased insensible water loss, but this can be overcome to some extent with the administration of additional fluids, especially in the weight and gestational age groups that often constitute the priority in LMIC. Studies on associated morbidities including infections have been variable but the numbers evaluated have been small and have not shown any significant differences [27]. Temperature monitoring is important and axillary temperature is more commonly used, as was noted in this study, with less risk of trauma and cross infection [28]. Despite the fact that thermometers are low cost commodities, only 5 facilities used a separate thermometer for every baby.
Procurement and maintenance of essential commodities
All the facilities studied had equipment and supplies required for basic essential newborn care, including in the delivery room, and met some of the requirements for high risk and sick babies. Every Woman, Every Child (2012) through the UN Commission for Life Saving Commodities, identified four products for newborn care, namely, antenatal corticosteroids for preterm births, chlorhexidine for cord care, equipment for basic resuscitation and antibiotics for treatment of neonatal sepsis [29]. While this brought attention to therapies that were not universally available or utilized appropriately, it also tended in some cases to inadvertently promote a 'magic bullet' approach instead of more comprehensive components covered in this study [30]. Although this study showed that most of the equipment was functional, maintenance of equipment, particularly donated equipment, is often a challenge in many facilities in LMIC. Inadequacy of equipment and commodities has also been reported to be a significant problem in a number of facilities in India and Indonesia [14, 31].
Feeding of high risk and small babies
It was encouraging that in all facilities mothers provided breast milk. Expressed human milk especially from their own mothers, has considerable advantages for preterm and low birth weight babies [32]. Milk banks are costly to establish and operate, require stringent quality control, and are available to a limited extent in LMIC. In this study, only one hospital in India had a milk bank. However, all the hospitals had the capability to store extra expressed breast milk for short periods in the refrigerator.
Small and sick babies tolerating feeds may be unable to suck adequately and need additional support in the form of tube feeding and, subsequently through use of cups. In India, the "paladai", a traditional cup with an open spout or a "trough" like extension, is extensively used for feeding small babies and has distinct advantages over the conventional cup, with less spillage, and more ready acceptance by babies [33]. Challenges are also particularly high for achieving exclusive breastfeeding for babies who are separated from their mothers. Lactation consultants are not widely available in LMIC. It may be necessary to task-shift and train alternative workers to provide some basic lactation support for mothers in SCNU along with the nurses and physicians. Avoidance of bottles, not only for feeding but also for collection of human milk is beneficial as its presence sends a wrong message.
Management of jaundice
Neonatal jaundice is a major cause of morbidity in LMIC. Early detection at the community and facility levels, effective phototherapy with appropriate wavelength of light with monitoring of serum bilirubin levels can decrease the need for exchange transfusions. Innovative methods for early detection and management of jaundice are also essential [34, 35]. In countries with advanced health care systems, exchange transfusions have become uncommon due to earlier detection of jaundice and effective phototherapy. In contrast, exchange transfusions are far more common in LMIC. Hence, it is worth looking into ensuring that selected well-functioning SCNUs even at district levels have the resources and capabilities to manage jaundice effectively and perform exchange transfusions.
Prevention of infection
All hospitals in this study except one, reported having 24 h running water supply and resources for waste disposal including incinerators. Some of the essential elements of infection prevention include proper cleaning of surfaces, adequate supplies of clean linen, single use items, use of breast milk, safe administration of injections and intravenous fluids, and capability for identification of causative microbes along with susceptibility testing; areas in which there may be significant deficiencies in supplies and practices [36].
In most of the hospitals in Uganda, the family was expected to bring linen for their babies. The effectiveness of laundering procedures used in cleaning the linen was unclear. Hand washing linen and drying on lines or on the ground carry greater risks in contrast to machine washing and drying. It is essential that facilities supply clean linen kept ready for use.
We found that reprocessing resuscitation equipment was inadequate and inconsistent in the centers studied. Most used rubber suction bulbs, which cannot be opened to permit proper cleaning, and generally reused them after cleaning with just soap and water. Eight hospitals in Uganda had the translucent bulbs that could be opened. Except for two hospitals in Indonesia, there was minimal compliance with recommended reprocessing of resuscitation devices with disassembly, initial decontamination, proper cleaning with soap and water and high-level disinfection such as boiling or sterilization by autoclaving, followed by reassembly and safe storage [37]. These recommendations, however, can present significant challenges in being time-consuming and in having potential risks of losing small parts, resulting in poor compliance.
There may be a significant underestimation of infection relevant to newborn health in LMIC. The term "complications of prematurity" as a cause of death is likely to include infections in addition to conditions such to respiratory distress syndrome, apnea and intraventricular hemorrhage. Thus, the proportion of babies dying of infections is probably greater than what is generally portrayed, especially as diagnosis of infections poses challenges. A high incidence of neonatal sepsis has been reported in some hospitals [38]. When quality of care is poor, preterm babies may die more often due to initial problems such as birth asphyxia or breathing difficulties. However, as care improves and babies survive for longer periods, prevention of nosocomial infection assumes an even greater importance.
Treatment of infection
The facilities studied had access to a number of essential antibiotics, but it was not within the scope of this study to determine actual antibiotic usage. Antibiotic resistance has grown to the extent that options for appropriate alternatives are limited and may not always be available. Countries should establish national guidelines for antibiotic therapy based on their local distribution of organisms and antibiotic sensitivity patterns, with periodic review as required. Appropriate antibiotic stewardship with avoidance of needless administration is also essential to decrease antimicrobial resistance.
Intravenous fluid administration
Although all facilities had resources for administration of intravenous fluid therapy, most had to mix their fluids, with potential risk for infection. Additionally, most facilities in Uganda had only adult infusion sets, through which it is difficult to safely infuse the small volumes required by babies.
This study provides a snapshot of some of the resources in a limited number of referral facilities caring for high risk/ small and sick newborns. Variations may be even greater in facilities in LMIC. The data were self-reported, and basic components such as weight of babies and gestational age were not available for some centers. These are not only challenges but highlight the existing status in some centers, notably in Sub-Saharan Africa.
Additional elements to be considered
While the physical requirements related to at-risk, small and sick baby care are important, in this study we were unable to evaluate certain additional components noted below that can have further impact on neonatal mortality.
Improving quality of care (QoC)
WHO with partners has highlighted the importance of compassionate and good QoC at facility level [39]. In many LMIC, there is often a significant variation in the existing quality of care, with some hospitals providing excellent care but with many others having neither the required skills, supplies nor the motivation, resulting in poorer quality care including inadequate pain management [40].
Health system strengthening with links between facilities and communities
Facility care is also incomplete without health system strengthening. In addition, facility/ community links, supportive supervision of trained community health workers and participatory involvement of the community through multiple strategies is essential.
Prioritizing low hanging fruits
As funds will not always meet the demand, it is essential that decisions are taken involving key stake holders to prioritize the order and the extent to which the various components need to be implemented, keeping equity and costing in mind.
Too little, too late; too much, too soon
As has been noted in maternal care, there is always a risk of doing too little too late and too much too soon [41]. An example of the former is, despite promoting facility deliveries to improve outcome, emphasis in some areas has still focused only on "essential newborn care" and the preparation of facilities to go further to care for the at-risk and sick babies has been inadequate. At the same time, progressing too quickly to instituting intensive care including mechanical ventilation and related interventions, without having the basic resources and skills to ensure competent, compassionate, quality based special/level II care, with adequate infection prevention, may have undesired effects. In establishing appropriate care for the newborn in whom, among other issues, the brain is still developing, the well-known dictum "Do no harm" has a very special significance.
We show that referral NUs in LMIC have significant challenges in meeting some of the basic requirements of Level II / special care neonatal units. The high neonatal mortality was responsible for some countries not achieving Millennium Development Goals 4. It is likely that newborn health may still continue to be one of the most challenging components and even be an important deterrent to the achievement of Sustainable Development Goals 3.2.2, unless a concerted effort is made to provide comprehensive, high quality care for the newborn both at the facility and community levels.
Continuous positive airway pressure
Discharged against medical advice
Family centered newborn care
Health information system
Kangaroo mother care
Low and middle-income country/countries
Neonatal intensive care unit(s)
Neonatal unit(s)
Special care newborn unit(s)
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No funding was available for carrying out this project.
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Data sharing is not applicable to this article as data sets more than those noted in the tables were not analyzed in this study.
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Authors' information
IN and JR have experience in neonatal intensive care units in high and low and middle-income countries; IN has worked in addition in the area of global health with special relevance to maternal and newborn health and nutrition for over 20 years. JNS, being the Asst. Commissioner, Child Health, Ministry of Health has experience in major policy decisions related to in-country newborn and child care; and SL, RR, NT, CNK, VNK, PS have experience in facility-based care of the high-risk/small and sick newborns in LMIC and HYC experience in a high-income country and collected data.. PW, has been involved in facility based newborn care in Uganda and has special experience in assessing facility readiness. JJW, SD, DK, PM and EO collected and consolidated data.
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Ethical approval and consent to participate are not applicable as this manuscript does not report on or use individual human data or tissue.
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This is not applicable as the manuscript did not include individual human data or information.
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Additional files
Additional file 1:
Facility readiness data collection tool (level II newborn care). (XLSX 29 kb)
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Table S2. Antibiotic Availability. (DOCX 17 kb)
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Cite this article
Narayanan, I., Nsungwa-Sabiti, J., Lusyati, S. et al. Facility readiness in low and middle-income countries to address care of high risk/ small and sick newborns. matern health, neonatol and perinatol 5, 10 (2019). https://doi.org/10.1186/s40748-019-0105-9
DOI: https://doi.org/10.1186/s40748-019-0105-9
- Newborn
- Preterm babies
- Prematurity
- Low birthweight
- Facility-based care
- Special care newborn units
- Level II newborn care
- Equipment for newborn care
- Commodities for newborn care
- Low and middle-income countries
- Health policies


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Practices of so-called "conversion therapy", the latest Report by IESOGI
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Víctor Madrigal-Borloz, explores practices of so-called "conversion therapy" across the globe, including their impact on victims, their human rights implications and their connection with violence and discrimination based on SOGI, as well as measures adopted to prevent them and to penalize or prosecute those who perform them and remedies provided to victims.


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Canonical trumpets Ubuntu tablet's convergence features
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© 2016 Tech Xplore


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Leave the Baby Wildlife Alone
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