Average Annual Use Research Articles

Procedural skills workshops for primary care physicians in Israel: a comprehensive analysis

BackgroundSome of the most common complaints addressed by primary care physicians (PCPs) require manual procedures, such as lacerations repair, abscesses drainage, ingrown toenails removal, dry needling for myofascial pain syndrome, and Epley maneuver for treating benign paroxysmal positional vertigo (BPPV). The aim of this study was to describe the procedural skills workshops program for PCPs implemented in Maccabi Healthcare Services and to investigate how many PCPs have participated and used the skills since the program’s inception in 2017.MethodsIn this observational study, we followed all participants in courses from 2017 to 2021. We extracted all procedures performed during these years by PCPs who learned the skill in MHS.ResultsDuring the study period, 620 PCPs participated in workshops for dry needling, soft-tissue and joint injections, BPPV treatment, minor surgical procedures, and spirometry. Most procedures performed were dry needling (average annual number 3,537) and minor surgical procedures (average annual number 361). The average annual use per physician was highest for dry needling (annual average use per physician who used the learned skill was 50.9), followed by soft tissue and joint injections (16.8), minor surgical procedures (14.8), and BPPV treatment (7.5).Conclusionprocedural skills workshops may expand PCPs’ therapeutic arsenal, thus empowering PCPs and providing more comprehensive care for patients. Some manual skills, such as dry needling, soft tissue injections, and the Epley maneuver, were more likely to be used by participants than other skills, such as spirometry and soft tissue injections.

Factors associated with receipt of medication for opioid use disorder among pregnant individuals entering treatment programs in the U.S.

BackgroundOpioid use disorder (OUD) among pregnant individuals in the U.S. has been on the rise, and carries significant health risks if left untreated. Despite the effectiveness of medication for opioid use disorder (MOUD), rates of treatment utilization remain low, and access varies by state. This study seeks to expand on what is known about the utilization of MOUD by estimating annual percentages of MOUD use among treatment admissions among pregnant individuals across all 50 states and U.S. regions. The study also examines how pregnant people experiencing OUD are referred to substance use treatment programs to better understand which referral sources are most effective at linking them to MOUD. MethodsThis study estimated MOUD utilization among pregnant admissions over a 9-year period, identifying trends in the use of this treatment, using national and state level data from the Treatment Episode Dataset-Admissions (TEDS-A). The sample were pregnant females who admitted to treatment with opioids as a primary substance use problem, in all 50 states, from 2010 to 2018. The study examined the referral pathways through which pregnant individuals enter treatment, identifying variations in how they are linked with MOUD. A binary logistic regression was conducted to estimate significant sociodemographic characteristics and referral sources associated with MOUD receipt in treatment. ResultsAmong admissions who reported both pregnancy and OUD across nine years (n= 84,492), the average percentage of MOUD use was 50.8%. Average annual MOUD use was highest in the Northeast region (63.42%), and lowest in the South (34.01%). Maine had the highest MOUD use, for an average of 81.99% across all years. Pregnant individuals who were self-referred to treatment comprised the largest percentage of admissions leading to MOUD use (62.1%), and those referred by the criminal justice system or other legal entity resulted in the lowest MOUD use across years (23.6%). Binary logistic regression results found that race, education, employment status, and referral source were significantly associated with MOUD receipt in 2018; specifically, individuals with a higher education, those were unemployed, and those who were referred to treatment by another substance use or healthcare provider or from the criminal or legal system, were significantly less likely to receive MOUD. ConclusionThis study estimated that an average of approximately half of admissions who were pregnant with OUD received MOUD as part of their treatment plans, and identified regional and state trends which can be further investigated to understand factors contributing to these geographical variations in MOUD access. Also notable were findings pertaining to low MOUD receipt among those referred from criminal or legal entities, warranting further investigation. These findings can lead to a better understanding of which referral sources to treatment can act as effective pathways to MOUD, and best practices to link pregnant individuals with evidence-based care.

The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model.

To estimate the impact on clinical outcomes and healthcare resource use from recommending that patients with 1-2 low-risk adenomas (LRAs) return to routine fecal immunochemical test (FIT) screening instead of surveillance colonoscopy, from a Canadian provincial healthcare system perspective. The OncoSim-Colorectal microsimulation model simulated average-risk individuals eligible for FIT-based colorectal cancer (CRC) screening in Alberta, Canada. We simulated two surveillance strategies that applied to individuals with 1-2 LRAs (<10 mm) removed as part of the average risk CRC screening program: (a) Surveillance colonoscopy (status quo) and (b) return to FIT screening (new strategy); both at 5 years after polypectomy. A 75 ng/mL FIT positivity threshold was used in the base case. The simulations projected average annual CRC outcomes and healthcare resource use from 2023 to 2042. We conducted alternative scenarios and sensitivity analyses on key variables. Returning to FIT screening (versus surveillance colonoscopy) after polypectomy was projected to have minimal impact on long-term CRC incidence and deaths (not statistically significant). There was a projected decrease of one (4%) major bleeding event and seven (5%) perforation events per year. There was a projected increase of 4800 (1.5%) FIT screens, decrease of 3900 (5.1%) colonoscopies, and a decrease of $3.4 million (1.2%) in total healthcare costs per year, on average. The annual colonoscopies averted and healthcare cost savings increased over time. Results were similar in the alternative scenarios and sensitivity analyses. Returning to FIT screening would have similar clinical outcomes as surveillance colonoscopy but could reduce colonoscopy demand and healthcare costs.

Social comparisons and groundwater use: Evidence from Colorado and Kansas

AbstractIn the United States, agriculture is responsible for the majority of consumptive water use. To reduce consumptive use in water scarce regions, policymakers have implemented a number of costly interventions. These interventions range from land retirement to subsidies that encourage the adoption of efficient irrigation technologies. In nonagricultural contexts, costly policy interventions have been complemented by low‐cost interventions inspired by behavioral economics. Whether these behavioral interventions are effective in the context of commercial farming is not well understood. In a preregistered, randomized field intervention, we estimate the impact of social (peer) comparisons on agricultural groundwater users in Colorado and Kansas. More than three thousand irrigators were randomized to receive either an annual peer comparison or no comparison. The peer comparison contrasted each irrigator's groundwater use to the distribution of use by neighboring irrigators. The comparison intervention reduced average annual groundwater use by 4.05% [95% CI (−5.87%, − 2.21%)], resulting in an aggregate reduction of more than 21,000 acre‐feet per year at a cost less than $1.31 per acre‐foot conserved. The estimated treatment effect was larger among irrigators with lower pre‐intervention water use. In the 3‐year experiment, we observed no evidence that the treatment effect substantially attenuated over time. We did, however, detect within‐irrigator spillovers in the treatment group: groundwater use also declined among wells that were not included in the peer comparisons (peer comparisons included a maximum of three wells). The results imply that social comparisons can be a cost‐effective tool, alongside other policy interventions, aimed at reducing agricultural water use.

Quantification of water erosion using empirical models RUSLE and EPM in the Rheraya basin in the High Atlas of Marrakech

Soil loss caused by water erosion constitutes a major issue that generate environmental and other several problems. The objective of this work is to quantify and assess the risk of erosion in the region of the Rheraya basin3 and to estimate the rate of soil loss and to characterize the main criteria involved in the evolution of water erosion in the basin. The study revealed that the combined presence of streams, crossing easily eroded surfaces, slopes, as well as anthropogenic action, aggravated the phenomenon. The empirical RUSLE4 and EPM5 models combined with GIS and remote sensing6 were adopted to characterize this rate in the region. The RUSLE model evaluated the rate of soil loss produced by sheet erosion, based on the aggressiveness of the rain, soil erodibility, the vegetation cover, the length and the inclination of the slope as well as the anti-erosion practices in the basin. The "EPM" model estimated the rate of erosion and soil losses caused by water erosion in general. It is based on the mapping and the combination of six parameters which are: average temperature, average annual precipitation, slope, erosion state, land use and soil resistance to erosion. Results showed that the erosion rate using Rusle model varies between 0 and 188 t/ha/year with an average annual soil loss of 46, 85 t/ha/year. The results of the application of the EPM model showed that the average annual of soil loss is 103 t/ha/y with values extending between 0 and 200 t/ha/y. These results exposed that the areas upstream represent a very high risk of erosion, so they can surely aid to manage and reduce soil erosion in the High Atlas mountains.

A Synthesis of Surface Water Quality in Awash Basin, Ethiopia

Developing countries like Ethiopia are grabbling with rapid population growth, urbanization, agricultural intensification, and climate change which put intense pressure on the availability and quality of water resources. The surface water quality degradation is exacerbating due to increasing urbanization and agricultural activities. The average annual fertilizer use in Ethiopia increased from 132,522 metric tons (mt) in 1996 to 858,825 mt in 2015. Pesticide use also increases significantly from 3,327.7 mt/y in 2006 to 4,211.5 mt/y in 2010. The Awash river is one of the most affected rivers by intensified irrigation schemes, industrial, and urbanization pollution. The Awash river and its tributaries are used for domestic, irrigation, industrial, and recreational purposes. However, as per Canadian water quality indices for the drinking and irrigation water quality, the upper Awash basin scored 34.79, and 46.39, respectively, in the poor and marginal categories; whereas the middle/lower basin indicated 32.25 and 62.78 in poor and marginal ranges, respectively. Dissolved phosphorous in the headwater tributaries is about 0.51 mg/l which is beyond the threshold (0.15 mg/l). The surface water quality impairment is severe in the upper Awash basin where more than 90% of Addis Ababa's industries discharge their waste into nearby waterways without treatment; about 30% of the population lacks access to a liquid waste disposal and treatment facility; only 16% of the population is connected to sewage system, and 25% of the total waste generated enters freshwater systems without treatment. Many studies on surface water quality are reviewed and many of them are inconclusive for a number of reasons. For example, no comprehensive surface water quality research, lack of detailed combined spatial and temporal surface water quality data, and analysis to show the overall picture of the basin are a few of them. Despite the existence of the policy and legal tools, enforcement is lacking. Improving the ecological health of rivers necessitates policy revision as well as increased knowledge and engagement among implementers.

Influence of Long-term Nonaspirin NSAID Use on Risk of Frailty in Men ≥60 Years: The Physicians' Health Study.

Inflammation is a central pathway leading to frailty but whether commonly used nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can prevent frailty is unknown. Prospective cohort study of male physicians ≥60 who participated in the Physicians' Health Study. Annual questionnaires collected data on NSAID use, lifestyle, and morbidity. Average annual NSAID use was categorized as 0 days/year, 1-12 days/year, 13-60 days/year, and >60 days/year. Frailty was assessed using a validated 33-item frailty index. Propensity score inverse probability of treatment weighting was used to address confounding by indication and logistic regression models estimated odds ratios (ORs) of prevalent frailty according to nonaspirin NSAID use. A total of 12 101 male physicians were included (mean age 70 ± 7 years, mean follow-up 11 years). Reported NSAID use was 0 days/year for 2 234, 1-12 days/year for 5 812, 13-60 days/year for 2 833, and >60 days/year for 1 222 participants. A total of 2 413 participants (20%) were frail. Higher self-reported NSAID use was associated with greater alcohol use, smoking, arthritis, hypertension, and heart disease, while less NSAID use was associated with coumadin use and prior bleeding. After propensity score adjustment, all characteristics were balanced. ORs (95% confidence intervals) of prevalent frailty were 0.90 (0.80-1.02), 1.02 (0.89-1.17), and 1.26 (1.07-1.49) for average NSAID use of 1-12 days/year, 13-60 days/year, and >60 days/year, compared to 0 days/year (p-trend < .001). Long-term use of NSAIDs at high frequency is associated with increased risk of frailty among older men. Additional study is needed to understand the role of anti-inflammatory medication in older adults and its implication for overall health.

Failure of Orthopaedic Residents to Voluntarily Participate in a Laboratory Skills Training.

Arthroscopy simulation is increasingly used in orthopaedic residency training. The implementation of a curriculum to accommodate these new training tools is a point of interest. We assessed the use of a high-fidelity arthroscopy simulator in a strictly voluntary curriculum to gauge resident interest and educational return. Fifty-eight months of simulator use data were collected from a single institution to analyze trends in resident use. Comparable data from two additional residency programs were analyzed as well, for comparison. Orthopaedic residents were surveyed to gauge interest in continued simulation training. Average annual simulator use at the study institution was 27.7 hours (standard deviation = 26.8 hours). Orthopaedic residents spent an average of 1.7 hours practicing on the simulation trainer during the observation period. A total of 21% of residents met or exceeded a minimum of 3 hours of simulation time required for skill improvement defined by literature. Most (86%) of the residents agreed that the simulator in use should become a mandated component of a junior resident training. Although surgical simulation has a role in orthopaedic training, voluntary simulator use is sporadic, resulting in many residents not receiving the full educational benefits of such training. Implementation of a mandated simulation training curriculum is desired by residents and could improve the educational return of surgical simulators in residency training.

Impact of stroke center certification on rt-PA thrombolysis after acute ischemic stroke in South China from 2015 to 2020.

In China, stroke center certification was launched in 2015, but little is known about its impact on intravenous thrombolysis. This study aimed to evaluate the effects of stroke center certification on the use of intravenous thrombolysis during a five-year period in South China. We retrospectively collected data regarding the use of recombinant tissue plasminogen activator (rt-PA) in 21 cities of Guangdong from 2015 to 2020. The annual thrombolysis rate was defined as the number of patients who underwent intravenous rt-PA therapy divided by the number of those who had acute ischemic stroke within the same year. The density of stroke centers was calculated as the number of stroke centers divided by the corresponding residents. Spearman's correlation analysis was used to determine the correlations between the annual thrombolysis rates and the number/density of stroke centers. Paired t-test was used to compare differences in growth in annual thrombolysis rates before and after having stroke centers. From 2015 to 2020, the annual rt-PA thrombolysis rates of Guangdong increased from 1.4% to 7.2%, which was accompanied by an increase in the number of stroke centers from 0 to 82 and density of stroke centers from 0.00 to 0.71 per million population. The average annual rt-PA use in stroke centers was higher than that in non-stroke centers from 2016 to 2020 (all P < 0.05). There was a positive correlation of annual thrombolysis rates with the number of stroke centers (r = 1.00, P = 0.0028) and with the density of stroke centers in the 21 cities from 2018 to 2020 (all P < 0.05). The growth in annual thrombolysis rates significantly accelerated at the city-level after having stroke centers (1.55%/y vs. 0.77%/y, P < 0.001). Stroke center certification may partially drive the increased use of rt-PA thrombolysis. Stroke center certification should be continually promoted to facilitate access to intravenous thrombolysis for patients with acute ischemic stroke.

Analysis of the Offering and Resale Prices on the Second-Hand Skidders Market

Skidders, as self-propelled machines designed to transport trees or parts of trees by trailing or dragging it from the woods to a landing area, are still extensively used as the main wood extraction equipment in most of the Europe and worldwide. The high price of new machines (and even higher for CTL technology) makes the second-hand skidder market very interesting and appealing, especially for small forest owners and forestry contractors. So, this paper reports on a survey of used skidders available for purchase on the European market. Up-to-date empirical data was gathered by the analysis of the offerings on the main online marketplaces, i.e., specialized websites. The study included skidder make and model, variation in their age, annual usage and resale prices. The survey identified a total of 163 second-hand skidders and the results pointed out the prevalence of small-size machines (&lt;110 kW), the average annual use (after excluding 1 year old machines from calculation) of 863 hours per year and the average re-sale price of about 65,000 EUR. Skidders are most commonly re-sold at an age of 16 years and the calculated price models show that skidder age is a stronger predictor of their value, i.e., resale price, than the total machine working hours. In the concluding section, paper also includes some reflections on possible future trends and perspectives of skidding technology in forestry.

Overuse or underuse? Use of healthcare services among irregular migrants in a north-eastern Spanish region

BackgroundThere is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare utilization between irregular migrants, documented migrants, and Spanish nationals in a Spanish autonomous community.MethodsThis retrospective, observational study included the total adult population of Aragon, Spain: 930,131 Spanish nationals; 123,432 documented migrants; and 17,152 irregular migrants. Healthcare utilization data were compared between irregular migrants, documented migrants and Spanish nationals for the year 2011. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.ResultsThe average annual use of healthcare services was lower for irregular migrants than for documented migrants and Spanish nationals at all levels of care analyzed: primary care (0.5 vs 4 vs 6.7 visits); specialized care (0.2 vs 1.8 vs 2.9 visits); planned hospital admissions (0.3 vs 2 vs 4.23 per 100 individuals), unplanned hospital admissions (0.5 vs 3.5 vs 5.2 per 100 individuals), and emergency room visits (0.4 vs 2.8 vs 2.8 per 10 individuals). The average annual prescription drug expenditure was also lower for irregular migrants (€9) than for documented migrants (€77) and Spanish nationals (€367). These differences were only partially attenuated after adjusting for age, sex, and morbidity burden.ConclusionsUnder conditions of equal access, healthcare utilization is much lower among irregular migrants than Spanish nationals (and lower than that of documented migrants), regardless of country of origin or length of stay in Spain.

Long-Term Aspirin Use and Self-Reported Walking Speed in Older Men: The Physicians' Health Study.

Mobility limitation is a component of frailty that shares a bidirectional relationship with cardiovascular disease (CVD). Data are limited on the role of established CVD prevention therapies, such as aspirin, for prevention of frailty and mobility limitation. Examine the association between long-term aspirin use and walking speed. Prospective cohort of 14,315 men who participated in the Physicians' Health Study I, a completed randomized controlled trial of aspirin (1982-1988), with extended post-trial follow-up. Annual questionnaires collected data on aspirin use, lifestyle and other factors. Average annual aspirin use was categorized for each participant: ≤60 days/year and >60 days/year. Mobility was defined according to self-reported walking pace, categorized as: don't walk regularly (reference), easy/casual <2mph, normal ≥2-2.9mph, or brisk/very brisk ≥3mph. Propensity scoring balanced covariates between aspirin categories. Multinomial logistic regression models estimated odds of being in each self-reported walking category. Mean age was 70±8 years; mean aspirin use 11 years. There were 2,056 (14.3%) participants who reported aspirin use ≤60 days/year. Aspirin use >60 days/year was associated with drinking alcohol, smoking, hypertension, heart disease and stroke, while ≤60 days/year was associated with anticoagulation use and bleeding history. In all, 13% reported not walking regularly, 12% walked <2 mph, 44% walked ≥2-2.9 mph, and 31% walked ≥3 mph. After propensity score adjustment, regular aspirin use was associated with a faster walking speed. Odds ratios (95% confidence intervals) were 1.16 (0.97 to 1.39), 1.24 (1.08 to 1.43), and 1.40 (1.21 to 1.63) for <2 mph, ≥2-2.9 mph and ≥3 mph, respectively, compared to not walking regularly (p-trend<0.001). In this cohort of older men, long-term aspirin use is associated with a greater probability of faster walking speed later in life.

Comparison of RUSLE and MMF Soil Loss Models and Evaluation of Catchment Scale Best Management Practices for a Mountainous Watershed in India

Soil erosion from arable lands removes the top fertile soil layer (comprised of humus/organic matter) and therefore requires fertilizer application which affects the overall sustainability. Hence, determination of soil erosion from arable lands is crucial to planning conservation measures. A modeling approach is a suitable alternative to estimate soil loss in ungauged catchments. Soil erosion primarily depends on soil texture, structure, infiltration, topography, land uses, and other erosive forces like water and wind. By analyzing these parameters, coupled with geospatial tools, models can estimate storm wise and annual average soil losses. In this study, a hilly watershed called Nongpoh was considered with the objective of prioritizing critical erosion hazard areas within the micro-catchment based on average annual soil loss and land use and land cover and making appropriate management plans for the prioritized areas. Two soil erosion models namely Revised Universal Soil Loss Equation (RUSLE) and Modified Morgan–Morgan–Finney (MMF) models were used to estimate soil loss with the input parameters extracted from satellite information and automatic weather stations. The RUSLE and MMF models showed similar results in estimating soil loss, except the MMF model estimated 7.74% less soil loss than the RUSLE model from the watershed. The results also indicated that the study area is under severe erosion class, whereas agricultural land, open forest area, and scrubland were prioritized most erosion prone areas within the watershed. Based on prioritization, best management plans were developed at catchment scale for reducing soil loss. These findings and the methodology employed can be widely used in mountainous to hilly watersheds around the world for identifying best management practices (BMP).

Investigation of Attitudes and Behaviors Related to Rational Drug Use in Adana Province Havutlu District

Introduction: Rational drug use is a process involving healthcare providers, legislators and the whole society. Here, we aimed to investigate the attitudes and behaviors related to 'Rational Drug Use' in Havutlu district of Adana province. Materials and Methods: In our study, we conducted a questionnaire consisting of 28 questions about the sociodemographic characteristics and the attitudes and behaviors related to "Rational Drug Use" we implemented. The sample size is 358. We also acquire the necessary statutory authorizations and approval of the ethics committee. The type of study is cross-sectional. In analysis, frequency analysis and chi-square test were used with SPSS version 19.0. Results: Average of 4.1±2.6 box medicine was left unused. 26% of the participants stated that they offered medication to their relatives, and the use of herbal medicines been found as 15.9%. 87.7% of the participants stated that the medication was overturned after the expiry date and 3.4% would continue to use it. The average annual antibiotic use of the participants was found to be 2.3±1.4. 59.8% of those who took antibiotic treatment stated that they terminated the treatment voluntarily without ending the treatment period. In order to be found at home, the prescription for medication seems to be significantly higher in women with a level of income below 1,000 TL (p=0.02) and with chronic disease (p <0.001). The presence of chronic illness appears to be associated with both herbal medication use (p <0.001) and home medication (p=0.008). Conclusion: When attitudes and behaviors related to rational drug use are examined, it is concluded that some variables have an influence and that inappropriate use is common throughout the society.

Energy Audit and Management of a Tannery Company: A Case Study of Kano State

Energy audit is considered as one of the comprehensive methods in checking the energy usage and wastage in facilities/buildings. This paper presents the results of the energy audit conducted to investigate the energy consumption pattern of tannery company from its record of fuel expenditure and electricity bills for a period of 5 years (2012 - 2016). Also, the use of energy models system, Energy Quick Energy Simulation Tool (eQUEST) to evaluate the consumption of the energy end users and performance of the company. Results shows peak electricity demand during the hot months from April to August due to high cooling or significant Air condition requirement. 2.37% of electricity consumed was contributed by the burning of AGO in the diesel power generators showing very less contribution over that of National grid 97.63%. The annual average consumption demand of electricity and diesel (kWh equivalent) of the company were 118960.72 kWh and 2881.17 kWh respectively. The energy modeling and simulation results shows that the sum total of the total monthly energy consumption by the end users is 138164 kWh representing the total average value of the annual energy use in air-conditioning (space cooling) was 27%, ventilation fan 2%, factory machineries 39%, heat rejection is 4%, pump and auxiliary is 2% and area lighting 26%. Also, the total monthly peak demand by space cooling was 22372.2 kWh, ventilation fan 1376 kWh, factory machineries 14294kWh heat rejection is 4461 kWh, pump and auxiliary is 1343 kWh and area light 11023 kWh respectively having a sum total monthly peak demand by the end users to be 44969.2 kWh. This represent energy use in air-conditioning (space cooling) was 41%, ventilation fan 3%, 26% factory machineries, heat rejection is 8%, pump and auxiliary is 2% and 20% area light of the annual peak demand. The Energy Used Index (average annual electricity use per tones of leather) was found to be 717.38kWh/tones of leather/Annum.

Electricity analysis for energy management in neighbourhoods: Case study of a large housing cooperative in Norway

As a basis for energy management in apartment blocks, this paper characterises electricity use in a Norwegian housing cooperative with 1,058 apartments. In 2018, the average specific electricity delivery to apartments and common areas is 56.7 kWh/m2 or 2,301 kWh per resident, in addition to heat delivery from district heating. Average annual electricity use in the apartments is 4,362 kWh and average maximum hourly load is 3.2 kWh/h. The electricity coincidence factor is 0.323. The study suggests a potential for shifting electricity loads in time on a neighbourhood level, where especially EV charging can be utilized as a flexible load.

Prediction Success of Machine Learning Methods for Flash Flood Susceptibility Mapping in the Tafresh Watershed, Iran

Floods are some of the most destructive and catastrophic disasters worldwide. Development of management plans needs a deep understanding of the likelihood and magnitude of future flood events. The purpose of this research was to estimate flash flood susceptibility in the Tafresh watershed, Iran, using five machine learning methods, i.e., alternating decision tree (ADT), functional tree (FT), kernel logistic regression (KLR), multilayer perceptron (MLP), and quadratic discriminant analysis (QDA). A geospatial database including 320 historical flood events was constructed and eight geo-environmental variables—elevation, slope, slope aspect, distance from rivers, average annual rainfall, land use, soil type, and lithology—were used as flood influencing factors. Based on a variety of performance metrics, it is revealed that the ADT method was dominant over the other methods. The FT method was ranked as the second-best method, followed by the KLR, MLP, and QDA. Given a few differences between the goodness-of-fit and prediction success of the methods, we concluded that all these five machine-learning-based models are applicable for flood susceptibility mapping in other areas to protect societies from devastating floods.

Preliminary regional landslide susceptibility assessment using limited data

In this paper a heuristic approach for preliminary regional landslide susceptibility assessment using limited amount of data is presented. It is called arbitrary polynomial method and takes into account 5 landslide conditioning parameters: lithology, slope inclination, average annual rainfall, land use and maximum expected seismic intensity. According to the method, in the first stage, a gradation is performed for each of the carefully selected conditioning parameters by assigning so called rating points to the grid cells on which the region is divided. Values of the rating points vary from 0 to 3 and depend on the parameter’s character and importance for landslide development within the region of interest. A so called Total Landslide Susceptibility Rating (TLSR) model is obtained by summing the individual rating points of each parameter and dividing the region into five susceptibility zones according to Jenks natural breaks classification. Verification of the TLSR model is then performed by overlaying the landslide inventory map of the selected region over the prepared susceptibility map. The sensitivity of the model can be additionally tested by multiplying the conditioning parameter’s rating points by sensitivity coefficients. In this way, additional landslide susceptibility models are obtained, named Weighted Total Landslide Susceptibility Rating (WTLSR) models. As a practical example of the method, two TLSR models are presented here for the Polog region in Republic of Macedonia, for return periods of maximum expected seismic intensity for 100 and 500 years. With over 74% of mapped landslides falling in zones of high and very high susceptibility, the results are considered satisfactory for regional scale landslide modelling and are comparable with more advanced quantitative methods. Additional WTLSR models were prepared, and their correlation identified the best model. The presented approach is considered to be very convenient for conducting preliminary regional landslide susceptibility assessments with the ability to fine-tune the results. Due to its simplicity, it can be applied to additional landslide conditioning parameters other than the one presented in the paper, depending on the region of interest and available data sources. It is especially practical for use in developing countries, where various organizational, technical and economic constraints prevent application of more advanced data driven methods. Limitations and restrictions of the approach are also discussed.

CAUSES OF TRACTOR BREAKDOWNS AND REQUISITE SOLUTIONS A CASE STUDY OF SMALL TRACTOR USE IN RIAU PROVINCE, INDONESIA

A survey has been undertaken to look into the causes of tractor breakdowns on field operations and the main constraints associated with repair and maintenance, and to recommend a solution to the problems in Riau Province. The owners of sixty-two small tractors were interviewed, from three regencies chosen of the Province in 2003. As a result, the working capacity of the tractors was relatively high and the average annual use was relatively low compared to the national average. Most tractor operators did not have sufficient skill to operate tractors. The tractor breakdowns resulted from operators’ mistakes, fuel and oil defilement, rough field conditions, poor maintenance, intense use, and factory design. Inadequate repair shops, a lack of spare parts, and a shortage of mechanics in the local vicinity were the main factors curbing tractor repair. It was also found that inadequate finances led many farmers to ignore tractor maintenance. These suggest that tractor operators should be well trained and tractor-supporting facilities should be provided in rural areas. A mechanical extension officer and credit options should be made available for farmers.

How Much Do Mental Health and Substance Use/Addiction Affect Use of General Medical Services? Extent of Use, Reason for Use, and Associated Costs.

To measure service use and costs associated with health care for patients with mental health (MH) and substance use/addiction (SA) problems. A 5-year cross-sectional study (2007-2012) of administrative health care data was conducted (average annual sample size = 123,235 adults aged >18 years who had a valid Ontario health care number and used at least 1 service during the year; 55% female). We assessed average annual use of primary care, emergency departments and hospitals, and overall health care costs for patients identified as having MH only, SA only, co-occurring MH and SA problems (MH+SA), and no MH and/or SA (MH/SA) problems. Total visits/admissions and total non-MH/SA visits (i.e., excluding MH/SA visits) were regressed separately on MH, SA, and MH+SA cases compared to non-MH/SA cases using the 2011-2012 sample ( N = 123,331), controlling for age and sex. Compared to non-MH/SA patients, MH/SA patients were significantly ( P < 0.001) more likely to visit primary care physicians (1.82 times as many visits for MH-only patients, 4.24 for SA, and 5.59 for MH+SA), use emergency departments (odds, 1.53 [MH], 3.79 [SA], 5.94 [MH+SA]), and be hospitalized (odds, 1.59 [MH], 4.10 [SA], 7.82 [MH+SA]). MH/SA patients were also significantly more likely than non-MH/SA patients to have non-MH/SA-related visits and accounted for 20% of the sample but over 30% of health care costs. MH and SA are core issues for all health care settings. MH/SA patients use more services overall and for non-MH/SA issues, with especially high use and costs for MH+SA patients.