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Quality and uptake of antenatal and postnatal care in Haiti

Background: Despite improvement, maternal mortality in Haiti remains high at 359/100,000 live births. Improving access to high quality antenatal and postnatal care has been shown to reduce maternal mortality and improve newborn outcomes. Little is known regarding the quality and uptake of antenatal and postnatal care among Haitian women. Methods: Exit interviews were conducted with all pregnant and postpartum women seeking care from large health facilities (n = 10) in the Nord and Nord-Est department and communes of St. Marc, Verrettes, and Petite Rivière in Haiti over the study period (March-April 2015; 3–4 days/facility). Standard questions related to demographics, previous pregnancies, current pregnancy, and services/satisfaction during the visit were asked. Total number of antenatal visits were abstracted from charts of recently delivered women (n = 1141). Provider knowledge assessments were completed by antenatal and postnatal care providers (n = 39). Frequencies were calculated for descriptive variables and multivariable logistic regression was used to explore predictors of receiving 5 out of 10 counseling messages among pregnant women. Results: Among 894 pregnant women seeking antenatal care, most reported receiving standard clinical service components during their visit (97% were weighed, 80% had fetal heart tones checked), however fewer reported receiving recommended counseling messages (44% counselled on danger signs, 33% on postpartum family planning). Far fewer women were seeking postnatal care (n = 63) and similar service patterns were reported. Forty-three percent of pregnant women report receiving at least 5 out of 10 counseling messages. Pregnant women on a repeat visit and women with greater educational attainment had greater odds of reporting having received 5 out of 10 counseling messages (2nd visit: adjusted odds ratio [aOR] =1.70, 95% confidence interval [CI]: 1.09–2.66; 5+ visit: aOR = 5.44, 95% CI: 2.91–10.16; elementary school certificate: aOR = 2.06, 95% CI: 1.17–3.63; finished secondary school or more aOR = 1.97, 95% CI = 1.05–3.02). Chart reviews indicate 27% of women completed a single antenatal visit and 36% completed the recommended 4 visits. Conclusions: Antenatal and postnatal care uptake in Haiti is sub-optimal. Despite frequent reports of provision of standard service components, counseling messages are low. Consistent provision of standardized counseling messages with regular provider trainings is recommended to improve quality and uptake of care in Haiti.

59 BASIC BIOLOGICAL SCIENCES↗

Policy, Permit, Perform: Using City Benchmarking Data and Building Construction Permit History to Identify Energy Performance Improvements

The City of Portland (City) and Multnomah County 2015 Climate Action Plan targets a 40 percent reduction in carbon emissions below 1990 levels by 2030. To reach this goal, the plan includes a key objective to reduce the total energy use of existing buildings by 25 percent. Buildings are responsible for one-half of carbon emissions in Portland, Oregon, U.S., and improving their performance is critical to achieving the City’s climate goals. As part of its climate action planning, the City passed an ordinance on April 22, 2015, requiring commercial buildings 20,000 ft2 and larger to benchmark and disclose annual energy performance metrics through ENERGY STAR® Portfolio Manager® (ESPM), including greenhouse gas emissions, building energy use intensity (EUI) and ENERGY STAR scores. Twenty-five cities in the U.S. have adopted similar policies requiring energy benchmarking. These policies are generating a treasure trove of data about the drivers of building performance, but practitioners are only beginning to link benchmarking data to other datasets to produce actionable insight into improving building performance. In 2016, the City received a financial assistance award from the U.S. Department of Energy (DOE) through the Cities Leading through Energy Analysis and Planning project (Award Number DE-0007737). Portland’s project evaluated the application of the DOE Building Energy Asset Score Tool and rating system developed by Pacific Northwest National Laboratory (PNNL) to commercial buildings that report to the City. The City used building construction permit history to develop Asset Scores for a set of office buildings that reported energy performance for 2015 – the first year the City mandated energy benchmarking and reporting for commercial buildings 50,000 ft2 and larger. The primary project objective was to link energy benchmarking data and commercial building permit data to analyze commercial buildings systems that present the best, specific opportunities to improve energy performance. Integrating these datasets from two City departments, the Bureau of Development Services and the Bureau of Planning and Sustainability, could expand Portland’s use of analytics to inform climate policy decisions and strategic targeting of financial incentives for building owners and managers who are best positioned to improve the performance of their buildings. The project began with the commercial benchmarking data received for 340 commercial buildings that submitted calendar year 2015 energy reports. The City retained Research Into Action and Energy 350 (RIA team) to evaluate this self-reported benchmarking data. Based on a survey of 53 building managers, the RIA team found that most respondents used the City’s compliance tools, including a How-to Guide and Help Desk, and found access to utility data to be straightforward. However, almost one-third of the respondents encountered challenges when estimating the gross floor area (GFA), and some experienced confusion regarding the input of property use types and details into ESPM. Based on the RIA team’s recommendations, the City refined its How-to Guide, created online answers to frequently asked questions, and hosted office hour sessions to help building managers accurately characterize their building’s physical characteristics and operations in ESPM. Concurrently with the RIA team’s evaluation, the City worked with PNNL to estimate DOE Asset Score Preview (Preview) scores for 181 of the 340 commercial buildings that submitted ESPM reports to the City. Asset Score Tool is a web-based tool developed by PNNL for DOE to evaluate and rate the as-built energy efficiency of a building. Asset Score Tool’s full analysis capability runs a detailed energy model based on building geometry, age, envelope, lighting and mechanical systems using standard operating assumptions to give the building a score, similar to a miles per gallon rating for a car. Preview, a simplified deployment of the full Asset Score Tool, provides a preliminary score range using only seven data points, six of which are readily available in the ESPM benchmarking data. Analysis of the combined Preview scores and the operational ESPM scores identified buildings with a high potential for energy improvements through either retro-commissioning and retuning of existing operations or capital investments into building systems. The City contracted Whole Building Solutions (WBS) to mine building permit history and develop full Asset Scores for a subset of 26 office buildings that were eligible for both ENERGY STAR scores and Asset Scores. WBS researched permits and building plans to identify mechanical, lighting and envelope systems and other building characteristics necessary to complete Asset Scores. This historical data was recorded using the web-based Asset Score Tool, which evaluates the as designed energy efficiency of existing buildings. Much of this City information was available online after 2010; however, WBS had to search through microfiche files and the City’s database to obtain permit and plan history prior to 2010. Although building geometry, mechanical system type and basic envelope information was consistently identifiable, WBS found permit data gaps that prevented complete and accurate Asset Scores for most of the office buildings. If the City decides to develop Asset Scores based on building permit information in the future, WBS recommended requiring lighting plans, control diagrams and as-built drawings that reflect how the buildings are actually constructed. In addition, WBS recommended uploading plans and permits from microfiche storage into a more comprehensive, searchable database consistent with the City’s current online permit information. To identify the actual lighting types, WBS and City staff conducted site visits of all 26 office buildings. As part of managing the flow of ESPM and Asset Score data for the project, Earth Advantage, a sub-recipient of the Cities-LEAP award, created a DOE Standard Energy Efficiency Data (SEED) (USDOE 2018) instance for the City and used Asset Score’s Application Programming Interface (API) (Asset Score 2018) capabilities to develop two new features in the SEED Platform™: (1) automated Asset Score Preview ranges calculated based on benchmarking data and the City’s estimate of number of building floors; and (2) storage of full Asset Score information. Leveraging the construction permit history and site visit information for the 26 office buildings, The Cadmus Group (Cadmus) analyzed benchmarking data and Asset Score information to identify opportunities and drivers to improve performance. Correlation and regression analysis of the combined dataset was completed to determine whether building operations or specific systems – mechanical, lighting or envelope – present the best opportunities to improve energy performance. The central outcome of this project was Cadmus’ detailed analysis of the richer dataset that was created by combining the City of Portland’s commercial building permit activity and building-specific energy performance information based on metrics from ESPM and Asset Score Tool. Some of their findings collaborate with well-known facts, such as buildings with less efficient lighting systems are good targets for efficiency improvements through lighting upgrades. This analysis also helped identify that individual heating, ventilation, and air conditioning (HVAC) equipment efficiency does not necessarily correlate with building performance. However, overall HVAC system performance, as measured with the Total System Performance Ratio (TSPR) metric, is a better indicator of building performance (Goel et al. 2014). As a metric, TSPR considers whole system performance that includes equipment efficiency and system controls, such as resets for static pressure and chilled water setpoints, which can be more effective and financially feasible options for improving building performance. Given the high cost associated with envelope retrofits, opportunities to upgrade envelope insulation are likely to be limited. However, buildings with single-pane and non-thermal break windows are good candidates for window replacements, such as upgrading to double-pane windows with thermal breaks. This research project determined that developing Asset Scores based on site visits is preferable to mining City building permit data. In addition, the use of benchmarking data to develop Asset Score Preview Scores is recommended as a first step in engaging building managers to develop full Asset Scores. Asset Score Tool outputs can help building managers quickly identify opportunities for improvement and then work with the utility incentive administrator and energy service providers to develop their retrofit plan. Where full Asset Scores are available, analysis using a quadrant matrix with ENERGY STAR scores is recommended to identify buildings that present the best opportunities for operational-behavioral improvements versus ones with opportunities for upgrades to physical building systems. This workflow and the tools will help cities, utility incentive administrators, building portfolio managers and energy service providers develop energy programs and strategies for screening and analysis of buildings with the greatest energy savings potential. This report describes the project approach and research results to inform future coordination of ESPM and Asset Score data, including the use of benchmarking data to generate Preview scores. Given better awareness of energy performance, building managers can make more informed decisions to reduce energy consumption and carbon emissions. With cities, states and jurisdictions adopting benchmarking and auditing ordinances, there are substantial amounts of data submitted to cities that could be used to inform investments in energy efficiency.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

ESI-MS Identification of the Cationic Phosphine-Ligated Gold Clusters Au1-Au22: Insight into the Gold-Ligand Ratio and Abundance of Larger Clusters

Triphenylphosphine (PPh3)-ligated gold clusters offer promising potential applications due to their relative ease of synthesis and usefulness in forming advanced cluster architectures. While previous studies reported cationic PPh3-ligated gold clusters with core sizes of Au1 - Au4, Au6 - Au11, and Au¬13 - Au14, there has not been definitive identification by mass spectrometry of larger clusters in the Au12 - Au25¬ range. Herein, we survey a polydisperse solution of cationic PPh3-ligated gold clusters using high mass-resolution (M/?M = 60,000) electrospray ionization mass spectrometry (ESI-MS). To improve the sensitivity and mass resolution of larger clusters for unambiguous identification, we increased the number of scan averages and reduced the range of mass collection windows to 200 m/z, thereby mitigating potential mass and ion abundance bias resulting from smaller “building block” gold clusters and other solution components present in higher abundance. In addition to the previously reported clusters, we identified several new species including Au5(PPh3)5+, Au12(PPh3)9HCl2+, Au15(PPh3)9Cl2+, Au16(PPh3)10Cl22+, Au17(PPh3)113+, Au18(PPh3)102+, Au19(PPh3)10Cl2+, Au20(PPh3)12H33+, Au21(PPh3)10Cl2+, and Au22(PPh3)10Cl22+, indicating that a full range of clusters between Au1 - Au22 may be observed in a single polydisperse solution. Considering all of the observed clusters, our findings provide evidence that the “magic number” icosahedral Au13 may be the transition point in cluster growth between smaller clusters, exhibiting a 1:1 gold-to-ligand ratio, and larger clusters, wherein subsequent gold atoms are added to the core without an equal number of accompanying ligands. Our method demonstrates that reducing the range of m/z collection windows and increasing the number of scan averages can improve instrument sensitivity for cationic gold clusters and enable a more complete survey of polydisperse solutions, thereby providing new insights to guide and validate the results of other characterization methods and theoretical calculations. This work was supported by the US Department of Energy (DOE), Office of Science, Office of Basic Energy Sciences, Division of Chemical Sciences, Geosciences, and Biosciences. MH acknowledges support from the DOE Science Undergraduate Laboratory Internship (SULI) program. HH acknowledges support from the DOE Office of Workforce Development for Teachers and Scientist (WDTS) under the Visiting Faculty Program (VFP). This work was performed using EMSL, a national scientific user facility sponsored by the DOE's Office of Biological and Environmental Research and located at Pacific Northwest National Laboratory (PNNL). PNNL is a multiprogram national laboratory operated for DOE by Battelle.

Hewitt, Michael↗

Incentivizing Cold-Climate Efficiency in Juneau (Final Report)

This is the final technical report for the DOE EERE BTO project Incentivizing Cold-Climate Efficiency in Juneau. The project implemented a community energy campaign to deploy heat pumps and efficiency for residents of Juneau, in Southeast Alaska. The project helped Juneau make progress towards its renewable energy goal of reaching 80% renewable energy for space heating by 2045. The Incentivizing Cold-Climate Efficiency in Juneau (ICE-Juneau) project began in 2020 and concluded three years later in 2023. During that time, a group of implementation partners and a research advisory team instituted a beneficial electrification campaign to promote energy savings and carbon reduction in residences of Juneau, Alaska. The campaign, Thermalize Juneau, focused on the installation of single head ductless mini-split heat pumps along with other efficiency upgrades. Thermalize Juneau was the first campaign of its kind in Alaska. After several months of planning, registration opened to the public in early 2021, and over the course of six months 164 participants enrolled. Campaign staff provided education to homeowners on heat pumps and efficiency, and each participant received a one-on-one heat pump assessment using a custom Microsoft Excel-based calculator that estimated energy savings for their residence based on building characteristics and past utility bills. Participants could also obtain a free energy audit from one of the two local energy auditors to further inform their decision. A heat pump installer, electrician, and builder were selected via a competitive RFP process. Participants who felt ready to install a heat pump or other efficiency upgrades received a site visit and custom quote from each of these contractors free of charge, and if they still felt energy upgrades were right for them, could move forward with an individual contract. Participants received a $400 heat pump installation rebate, offered by the installer if 40 heat pump installations occurred through the campaign. Overall, the campaign facilitated 75 heat pump installations (including participants that went with another contractor or heat pump model) and 30 efficiency upgrades (including participants that went with another builder or did DIY upgrades). The campaign created 3 new jobs as the heat pump installer hired an administrative assistant and two apprentices over the course of the campaign. It also helped Juneau work toward achieving its renewable energy goal of 80% renewable energy for space heating by 2045 by upgrading houses from fuel oil to heat pumps powered by the hydropower electric grid. Researchers conducted four surveys to inform Thermalize Juneau and future energy campaigns. The first surveyed existing and prospective heat pump owners in Juneau to identify barriers the campaign could address and inform recruitment efforts. Entry and exit surveys provided information on participant demographics, goals, outcomes, and suggestions for improving future campaigns. And a final survey of community members who had not participated in Thermalize Juneau gave insight on ways future campaigns could include a greater diversity of participants so they could realize similar benefits. Researchers also used pre-campaign energy modeling to predict energy savings, which was then compared to the savings estimated through aggregation of heat pump assessments and energy audits, and later to actual energy savings of 10 participants who installed a heat pump and were able to provide complete energy use data sets. In addition to energy savings, and to assist the electric utility in future planning efforts, researchers analyzed the overall change in electric use across participants with energy data and heat pump installations. They also completed a life cycle cost analysis, showing positive net present values for those displacing a fuel oil appliance, and a more mixed case for those switching from electric baseboard. This project proved the feasibility of energy campaigns, with a goal of beneficial electrification, in cold, remote locations. The Thermalize Juneau team compiled a Guidebook to Thermalize Campaigns, available online. In addition to documenting what occurred in Alaska’s first thermalize campaign, it provides tips and resources for other communities wishing to implement a similar program.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

t -channel dark matter models – a whitepaper

This report, summarising work achieved in the context of the LHC Dark Matter Working Group, investigates the phenomenology of t -channel dark matter models, spanning minimal setups with a single dark matter candidate and mediator to more complex constructions closer to UV-complete models. For each considered class of models, we examine collider, cosmological and astrophysical implications. In addition, we explore scenarios with either promptly decaying or long-lived particles, as well as featuring diverse dark matter production mechanisms in the early universe. By providing a unified analysis framework, numerical tools and guidelines, this work aims to support future experimental and theoretical efforts in exploring t -channel dark matter models at colliders and in cosmology.

Arina, Chiara [Universite Catholique de Louvain, L↗