Site-level Data Research Articles

Internal validation of self-reported case numbers in hospital quality reports: preparing secondary data for health services research

BackgroundHealth services research often relies on secondary data, necessitating quality checks for completeness, validity, and potential errors before use. Various methods address implausible data, including data elimination, statistical estimation, or value substitution from the same or another dataset. This study presents an internal validation process of a secondary dataset used to investigate hospital compliance with minimum caseload requirements (MCR) in Germany. The secondary data source validated is the German Hospital Quality Reports (GHQR), an official dataset containing structured self-reported data from all hospitals in Germany.MethodsThis study conducted an internal cross-field validation of MCR-related data in GHQR from 2016 to 2021. The validation process checked the validity of reported MCR caseloads, including data availability and consistency, by comparing the stated MCR caseload with further variables in the GHQR. Subsequently, implausible MCR caseload values were corrected using the most plausible values given in the same GHQR. The study also analysed the error sources and used reimbursement-related Diagnosis Related Groups Statistic data to assess the validation outcomes.ResultsThe analysis focused on four MCR procedures. 11.8–27.7% of the total MCR caseload values in the GHQR appeared ambiguous, and 7.9–23.7% were corrected. The correction added 0.7–3.7% of cases not previously stated as MCR caseloads and added 1.5–26.1% of hospital sites as MCR performing hospitals not previously stated in the GHQR. The main error source was this non-reporting of MCR caseloads, especially by hospitals with low case numbers. The basic plausibility control implemented by the Federal Joint Committee since 2018 has improved the MCR-related data quality over time.ConclusionsThis study employed a comprehensive approach to dataset internal validation that encompassed: (1) hospital association level data, (2) hospital site level data and (3) medical department level data, (4) report data spanning six years, and (5) logical plausibility checks. To ensure data completeness, we selected the most plausible values without eliminating incomplete or implausible data. For future practice, we recommend a validation process when using GHQR as a data source for MCR-related research. Additionally, an adapted plausibility control could help to improve the quality of MCR documentation.

Enrolment patterns in a randomized controlled trial of probiotics in critically ill patients: a retrospective analysis of the PROSPECT trial

BackgroundUnderstanding site-related factors that influence enrolment within multicenter randomized controlled trials (RCT) may help reduce trial delays and cost over-runs and prevent early trial discontinuation. In this analysis of PROSPECT (Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial), we describe patient enrolment patterns and examine factors influencing site-based monthly enrolment.DesignRetrospective analysis of a multicenter RCT.MethodsThe PROSPECT multicenter RCT enrolled patients in the main trial from July 2015 to March 2019. We documented site characteristics and trial metrics including data from the methods center tracking documents, site-level data at trial initiation, screening logs submitted by research coordinators, and prospectively collected case report forms. In this retrospective analysis of trial data, we analyzed enrolment patterns across sites using negative binomial regression to explore the association between monthly enrolment rate accounting for number of ICU beds, site characteristics, and trial metrics.ResultsOverall, 41 sites enrolling 2365 patients in the PROSPECT main trial were analyzed. After accounting for number of beds in each ICU, site launch early in the trial was associated with higher monthly enrolment rates, but time to first enrolment and research coordinator experience was not. We observed considerable variability in the number of active screening months and enrolment rates across sites.ConclusionThese findings highlight the complexity of recruitment dynamics in critical care RCTs and emphasize the need for tailored approaches to trial planning and execution.Trial registrationPROSPECT (Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial): NCT02462590 (registered June 2, 2015).

Product differentiation in mineral commodities based on sustainability indicators: The case of copper mining

Metals are commonly characterized as commodities, as there are little to no differences across products. Despite this traditional view, there has been an increasing attempt to assess mineral production, including socioeconomic and environmental impacts, besides their financial performance. In this line, sustainability reports have been the fundamental tool to provide transparent and public information on these impacts, varying in quality and quantity across companies. Based on this premise, we analyze several indicators to assess the potential for differentiation in the copper mining industry. We consider mine site-level data on water withdrawal and greenhouse gas (GHG) emissions, publicly available from sustainability reports from companies operating in 20 countries representing almost 80% of global production. Socioeconomic and governance data is available nationally, which limits more detailed analysis in these aspects. Data gathering indicates that since 2017, copper companies have stabilized regarding the availability of data provided in sustainability reports.Results for copper mining show that water withdrawal is a leading indicator in terms of differentiation potential. Differentiation is higher when continental water is considered, creating a significant incentive for companies to invest in alternative water sources. Sustainability differentiation in copper mining disproportionately affects low-income countries when socioeconomic aspects are considered, mainly if governance measures are used. In this sense, high-income countries are more likely to support product differentiation based on responsible production standards.

Effect of indoor residual spraying on sandfly abundance and incidence of visceral leishmaniasis in India, 2016–22: an interrupted time-series analysis and modelling study

Efforts to eliminate visceral leishmaniasis in India mainly consist of early detection and treatment of cases and indoor residual spraying with insecticides to kill the phlebotomine sandfly Phlebotomus argentipes that transmits the causative Leishmania protozoa. In this modelling study, we aimed to estimate the effect of indoor residual spraying (IRS) on vector abundance and transmission of visceral leishmaniasis in India. In this time-series analysis and modelling study, we assessed the effect of IRS on vector abundance by using indoor vector-abundance data (from 2016 to 2022) and IRS quality-assurance data (from 2017-20) from 50 villages in eight endemic blocks in India where IRS was implemented programmatically. To assess a potential dose-response relation between insecticide concentrations and changes in sandfly abundance, we examined the correlation between site-level insecticide concentrations and the site-level data for monthly sandfly abundances. We used mathematical modelling to link vector data to visceral leishmaniasis case numbers from the national Kala-Azar Management Information System registry (2013-21), and to predict the effect of IRS on numbers of averted cases and deaths. IRS was estimated to reduce indoor sandfly abundance by 27% (95% CI 20-34). Concentrations of insecticides on walls were significantly-but weakly-associated with the degree of reduction in vector abundance, with a reduction of -0·0023 (95% CI -0·0040 to -0·0007) sandflies per mg/m2 insecticide (p=0·0057). Reported case numbers of visceral leishmaniasis were well explained by trends in vector abundance. Village-wide IRS in response to a newly detected case of visceral leishmaniasis was predicted to reduce disease incidence by 6-40% depending on the presumed reduction in vector abundance modelled. Indoor residual spraying has substantially reduced sandfly abundance in India, which has contributed to reductions in visceral leishmaniasis and related deaths. To prevent the re-emergence of visceral leishmaniasis as a public health problem, surveillance of transmission and sandfly abundance is warranted. Bill & Melinda Gates Foundation. For the Hindi translation of the abstract see Supplementary Materials section.

Design of unattended gas pumping station system based on multi-source data fusion

Abstract Aiming at the problems that some data has been built and distributed in different subsystems during the transformation of the unattended system of an underground gas pumping pump station in Shanxi Tiandi Wangpo Coal industry, such as low data sharing and comprehensive utilization rate due to data isolation, and weak linkage execution ability, a method combining site-level data fusion and platform-level data fusion is proposed. The advantages and disadvantages of the fusion method are analyzed, and the PLC program and WinCC program are written for the corresponding fusion method. The practical application of the underground gas pumping pump station shows that the system has strong fusion ability, which can meet the integration of extraction parameters, environmental parameters, electric parameters, pipeline parameters, working conditions parameters, and other data required by the unattended system, improve the data utilization rate of the unattended system, and realize the complex control functions of the gas pumping system such as one-key start-stop and one-key rotation vacuum pump. The use of data-driven execution instead of manual operation effectively reduces the duty personnel of the underground gas pumping station, provides a guarantee for the less manned or unmanned operation of the gas pumping pump station, reduces the unplanned downtime of the pumping system, improves the efficiency of gas pumping, and ensures the safety of coal mine production.

Accrual Quality Improvement Program for clinical trials.

The Early Phase Cancer Prevention Clinical Trials Program (Consortia), led by the Division of Cancer Prevention, National Cancer Institute, supports and conducts trials assessing safety, tolerability, and cancer preventive potential of a variety of interventions. Accrual to cancer prevention trials includes the recruitment of unaffected populations, posing unique challenges related to minimizing participant burden and risk, given the less evident or measurable benefits to individual participants. The Accrual Quality Improvement Program was developed to address these challenges and better understand the multiple determinants of accrual activity throughout the life of the trial. Through continuous monitoring of accrual data, Accrual Quality Improvement Program identifies positive and negative factors in real-time to optimize enrollment rates for ongoing and future trials. The Accrual Quality Improvement Program provides a web-based centralized infrastructure for collecting, analyzing, visualizing, and storing qualitative and quantitative participant-, site-, and study-level data. The Accrual Quality Improvement Program approaches cancer prevention clinical trial accrual as multi-factorial, recognizing protocol design, potential participants' characteristics, and individual site as well as study-wide implementation issues. The Accrual Quality Improvement Program was used across 39 Consortia trials from 2014 to 2022 to collect comprehensive trial information. The Accrual Quality Improvement Program captures data at the participant level, including number of charts reviewed, potential participants contacted and reasons why participants were not eligible for contact or did not consent to the trial or start intervention. The Accrual Quality Improvement Program also captures site-level (e.g. staffing issues) and study-level (e.g. when protocol amendments are made) data at each step of the recruitment/enrollment process, from potential participant identification to contact, consent, intervention, and study completion using a Recruitment Journal. Accrual Quality Improvement Program's functionality also includes tracking and visualization of a trial's cumulative accrual rate compared to the projected accrual rate, including a zone-based performance rating with corresponding quality improvement intervention recommendations. The challenges associated with recruitment and timely completion of early phase cancer prevention clinical trials necessitate a data collection program capable of continuous collection and quality improvement. The Accrual Quality Improvement Program collects cumulative data across National Cancer Institute, Division of Cancer Prevention early phase clinical trials, providing the opportunity for real-time review of participant-, site-, and study-level data and thereby enables responsive recruitment strategy and protocol modifications for improved recruitment rates to ongoing trials. Of note, Accrual Quality Improvement Program data collected from ongoing trials will inform future trials to optimize protocol design and maximize accrual efficiency.

The Value of Safety Training for Business-to-Business Firms

Business-to-business suppliers invest in safety training programs believing that such programs mitigate safety hazards, prevent workplace injuries, and create value for their customers. However, causal evidence of these effects is sparse. Study 1 uses site-level monthly data from a global oil field services company. Exploiting sharp discontinuities in safety training hours due to catastrophic accidents, the authors find that a 10% increase in safety training hours per capita decreases safety hazards per capita by 6.45%–9.57%. Study 2 measures the causal impact of business establishments’ safety training intensity on their workplace injuries: it leverages Local Law 196 requiring workers at construction establishments in New York City to complete at least ten hours of safety training. This legislation reduced injury rates at construction establishments in New York City by .54–.68 percentage points (a 15.56%–18.84% decrease) relative to their counterparts. Study 3, a stated-choice conjoint experiment of business-to-business procurement professionals, documents that the focal supplier's investment in safety training increases the probability of its proposal being selected by those professionals. Collectively, these findings validate the need for suppliers to invest in safety training as a risk-mitigation vehicle that has positive implications for business-to-business buying decisions.

Enhancing availability of services to control hypertension through a team-based care approach that includes pharmacists

BackgroundPrimary care physician (PCP) shortages are expected to increase. The Michigan Medicine Hypertension Pharmacists’ Program uses a team-based care (TBC) approach to redistribute some patient care responsibilities from PCPs to pharmacists for patients with diagnosed hypertension. ObjectiveThis evaluation analyzed whether the Michigan Medicine Hypertension Pharmacists’ Program increased the availability of hypertension management services and described facilitators that addressed barriers to program sustainability and replicability. MethodsWe conducted a retrospective observational study that used a mixed methods approach. We examined the availability of hypertension management services using the number of pharmacists’ referrals of patients to other services and the number of PCP appointments. We analyzed qualitative interviews with program staff and site-level quantitative data to examine the program’s impact on the availability of services, the impact of TBC that engaged pharmacists, and program barriers and facilitators. ResultsPatients who visited a pharmacist had fewer PCP visits over 3- and 6-month periods compared to a matched comparison group that did not see a pharmacist and were 1.35 times more likely to receive a referral to a specialist within a 3-month period. Support from leaders and physicians, shared electronic health record access, and financial backing emerged as leading factors for program sustainability and replicability. ConclusionAdding pharmacists to the care team reduced the number of PCP appointments per patient while increasing the availability of hypertension management services; this may in turn improve PCPs’ availability. Similar models may be sustainable and replicable by relying on organizational buy-in, accessible infrastructure, and financing.

Antibacterial and clinical effectiveness of a mouthwash with a novel active system of amine + zinc lactate + fluoride: a randomized controlled trial

ObjectivesTo support the daily oral hygiene of patients experiencing gum inflammation, a new mouthwash was developed containing an amine + zinc lactate + fluoride system. In vitro and clinical efficacy was assessed using traditional methods as well as using novel site-specific and subject-specific analyses of the clinical data.Materials and methodsThis mouthwash was evaluated in a 12-h biofilm regrowth assay against a negative control mouthwash and in a 6-month plaque and gingivitis clinical study as compared to a negative control mouthwash. Analyses of healthy versus inflamed sites, visible plaque versus non-visible plaque sites, as well as subject-level evaluations bring new perspectives to the overall performance of this mouthwash and its significance from a patient outcome perspective.ResultsStudies demonstrated that this new mouthwash provided long-term (12-h) antibacterial activity after single application in vitro and reduced clinically all plaque and gingivitis parameters after 3 months and 6 months of use when compared to the negative control mouthwash. Examination of site-level and subject-level data determined that this mouthwash significantly increased the number of healthy sites in the oral cavity and significantly improved the gum health of subjects in the study, as compared to the negative control mouthwash.ConclusionsIn vitro and clinical research has demonstrated the antibacterial and clinical benefits of this mouthwash containing an amine compound + zinc lactate + fluoride system.Clinical relevanceOur subject-specific and site-specific analyses provide the dental practitioner with tools that can be used to guide patients who suffer from gingivitis toward optimal product selection and use.Clinical trial registrationThe trial was registered at ClinicalTrials.gov (reference no. NCT05821712).

Trends and site-level variation of novel cardiovascular medication utilization among patients admitted for heart failure or coronary artery disease in the US Veterans Affairs System: 2017-2021

We assessed trends in novel cardiovascular medication utilization in US Veterans Affairs (VA) for angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA). We retrospectively identified cohorts from 114 VA hospitals with admission for prevalent 1) systolic heart failure (HF, N=82,375) or 2) coronary artery disease and diabetes (CAD+T2D, N=74,209). Site-level data for prevalent filled prescriptions were assessed at hospital admission, discharge, or within 6 months of discharge. Variability among sites was estimated with median odds ratios (mOR), and within-site Pearson correlations of utilization of each medication class were calculated. Site- and patient-level characteristics were compared by high-, mixed-, and low-utilizing sites. ARNI and SGTL2i use for HF increased from <5% to 20% and 21%, respectively, while SGTL2i or GLP-1 RA use for CAD+T2D increased from <5% to 30% from 2017 to 2021. Adjusted mOR and 95% confidence intervals for ARNI, SGTL2i for HF, and SGTL2i or GLP-1 RA for CAD+T2D were 1.73 (1.64-1.91), 1.72 (1.59-1.81), and 1.53 (1.45-1.62), respectively. Utilization of each medication class correlated poorly with use of other novel classes (Pearson <0.38 for all). Higher patient volume, number of beds, and hospital complexity correlated with high-utilizing sites. Utilization of novel medications has increased over time but remains suboptimal for US Veterans with HF and CAD+T2D, with substantial site-level heterogeneity despite a universal medication formulary and low out-of-pocket costs for patients. Future work should include further characterization of hospital- and clinician-level practice patterns to serve as targets to increase implementation.

Enrollment forecast for clinical trials at the portfolio planning phase based on site-level historical data.

An accurate forecast of a clinical trial enrollment timeline at the planning phase is of great importance to both corporate strategic planning and trial operational excellence. The naive approach often calculates an average enrollment rate from historical data and generates an inaccurate prediction based on a linear trend with the average rate. Under the traditional framework of a Poisson-Gamma model, site activation delays are often modeled with either fixed initiation time or a simple random distribution while incorporating the user-provided site planning information to achieve good forecast accuracy. However, such user-provided information is not available at the early portfolio planning stage. We present a novel statistical approach based on generalized linear mixed-effects models and the use of non-homogeneous Poisson processes through the Bayesian framework to model the country initiation, site activation, and subject enrollment sequentially in a systematic fashion. We validate the performance of our proposed enrollment modeling framework based on a set of 25 preselected studies from four therapeutic areas. Our modeling framework shows a substantial improvement in prediction accuracy in comparison to the traditional statistical approach. Furthermore, we show that our modeling and simulation approach calibrates the data variability appropriately and gives correct coverage rates for prediction intervals of various nominal levels. Finally, we demonstrate the use of our approach to generate the predicted enrollment curves through time with confidence bands overlaid.

Early sepsis in Australia and New Zealand: A point-prevalence study of haemodynamic resuscitation practices.

Optimal resuscitation of sepsis-induced hypotension is uncertain, particularly the role of restrictive fluid strategies, leading to variability in usual practice. The objective of this study is to understand resuscitation practices in patients presenting to ED with early sepsis. Design, participants and setting: Prospective, observational, multicentre, single-day, point-prevalence study enrolling adult patients present in 51 Australian and New Zealand ICUs at 10.00 hours, 8 June 2021. Site-level data on sepsis policies and patient-level demographic data, presence of sepsis and fluid and vasopressor administration in the first 24 h post-ED presentation. A total of 722 patients were enrolled. ED was the ICU admission source for 222 of 722 patients (31.2%) and 78 of 222 patients (35%) met the criteria for sepsis within 24 h of ED presentation. Median age of the sepsis cohort was 61 (48-72) years, 58% were male and respiratory infection was the commonest cause (53.8%). The sepsis cohort had a higher severity of illness than the non-sepsis cohort (144/222 patients) and chronic immunocompromise was more common. Of 78 sepsis patients, 55 (71%) received ≥1 fluid boluses with 500 and 1000 mL boluses equally common (both 49%). In the first 24 h, 2335 (1409-3125) mL (25.3 [13.2-42.9] mL/kg) was administered. Vasopressors were administered in 53 of 78 patients (68%) and for 25 patients (47%) administration was peripheral. ICU patients presenting to the ED with sepsis receive less fluids than current international recommendations and peripheral vasopressor administration is common. This finding supports the conduct of clinical trials evaluating optimal fluid dose and vasopressor timing for early sepsis-induced hypotension.

Clinical encounter heterogeneity and methods for resolving in networked EHR data: a study from N3C and RECOVER programs.

Clinical encounter data are heterogeneous and vary greatly from institution to institution. These problems of variance affect interpretability and usability of clinical encounter data for analysis. These problems are magnified when multisite electronic health record (EHR) data are networked together. This article presents a novel, generalizable method for resolving encounter heterogeneity for analysis by combining related atomic encounters into composite "macrovisits." Encounters were composed of data from 75 partner sites harmonized to a common data model as part of the NIH Researching COVID to Enhance Recovery Initiative, a project of the National Covid Cohort Collaborative. Summary statistics were computed for overall and site-level data to assess issues and identify modifications. Two algorithms were developed to refine atomic encounters into cleaner, analyzable longitudinal clinical visits. Atomic inpatient encounters data were found to be widely disparate between sites in terms of length-of-stay (LOS) and numbers of OMOP CDM measurements per encounter. After aggregating encounters to macrovisits, LOS and measurement variance decreased. A subsequent algorithm to identify hospitalized macrovisits further reduced data variability. Encounters are a complex and heterogeneous component of EHR data and native data issues are not addressed by existing methods. These types of complex and poorly studied issues contribute to the difficulty of deriving value from EHR data, and these types of foundational, large-scale explorations, and developments are necessary to realize the full potential of modern real-world data. This article presents method developments to manipulate and resolve EHR encounter data issues in a generalizable way as a foundation for future research and analysis.

Palaeosecular variation in Northern Patagonia recorded by 0–5 Ma Caviahue–Copahue lava flows

SUMMARY Palaeosecular variation (PSV) determinations and studies of the geometry of the Earth’s main magnetic field provide important information about the field evolution, and to constrain numerical geodynamo models. Palaeomagnetic directional data from lava flows over the last few million years is of particular interest because the regional and global tectonic effects are minimal. However, the distribution of this type of palaeomagnetic data is uneven where the Southern Hemisphere is the destitute side. Therefore, the better knowledge of the geomagnetic field behaviour depends on the increased availability of high-quality data, especially in the Southern Hemisphere. A PSV and the time-averaged field (TAF) study was then performed in 0–5 Ma lava flows from the Caviahue–Copahue Volcanic Complex located in Northern Patagonia, Argentina (37°0′S, 71°10′W). The magnetic mineralogy of lava flows was investigated through thermomagnetic susceptibility curves, isothermal remanent magnetization (IRM) acquisition curves, hysteresis loops and first-order reversal curves (FORCs). Samples are essentially comprised of titanomagnetite with different Ti contents and magnetic domain structures typical of vortex state particles. A total of 50 volcanic sites were sampled, which provided 42 reliable palaeomagnetic site-mean directions after alternating field and thermal demagnetization. From these 42 sites, 36 are of normal and 6 are of reversed polarity. The mean direction from normal (reversed) sites is D = 356.2°, I = −50.1°, α95 = 4.0° and N = 36 (D = 176.5°, I = 59.5°, α95 = 14.1° and N = 6). Using only site-level data with the precision parameter k ≥ 100, we obtain 26 palaeomagnetic sites for PSV and TAF investigations in the study region. The filtered data set has a mean direction (D = 354.4°, I = −53.2° and α95 = 5.1°) close to the expected direction for a geocentric axial dipole (GAD) field (IGAD = −57.3°). The palaeopole (Plat = 84.4°, Plon = 229.1° and A95 = 5.7°) coincides with the Earth’s spin axis within the 95 per cent confidence interval. Virtual geomagnetic pole scatter ($S_{B} = {15.8^{18.9}_{11.8}}^{\circ }$) and the inclination anomaly ($\Delta I = 4.1_{-1.0}^{{9.2}^{\circ }}$) are both consistent at the 95 per cent confidence level with recent PSV and TAF models, respectively. Our results support the presence of small non-dipole field contributions (&amp;lt;3 per cent) superimposed on the GAD term, as reported by South American studies at mid southern latitudes.

Detection of m6A from direct RNA sequencing using a multiple instance learning framework

RNA modifications such as m6A methylation form an additional layer of complexity in the transcriptome. Nanopore direct RNA sequencing can capture this information in the raw current signal for each RNA molecule, enabling the detection of RNA modifications using supervised machine learning. However, experimental approaches provide only site-level training data, whereas the modification status for each single RNA molecule is missing. Here we present m6Anet, a neural-network-based method that leverages the multiple instance learning framework to specifically handle missing read-level modification labels in site-level training data. m6Anet outperforms existing computational methods, shows similar accuracy as experimental approaches, and generalizes with high accuracy to different cell lines and species without retraining model parameters. In addition, we demonstrate that m6Anet captures the underlying read-level stoichiometry, which can be used to approximate differences in modification rates. Overall, m6Anet offers a tool to capture the transcriptome-wide identification and quantification of m6A from a single run of direct RNA sequencing.

EP06.01-006 Multidisciplinary Team during the COVID-19 Pandemic: The BE-PACIFIC Italian Observational Study Analysis

EP06.01-006 Multidisciplinary Team during the COVID-19 Pandemic: The BE-PACIFIC Italian Observational Study Analysis

Engaging youth for positive change: A mixed methods evaluation of site level program implementation & outcomes

This convergent, mixed-methods research presents a site-level assessment of a civic engagement program geared towards middle and high school students (i.e. young people). In Illinois, a majority of young adults (ages 18–29) report discussing sociopolitical issues with friends and family, mimicking national trends. Simultaneously, approximately one in four young people in Illinois physically voted in 2018 elections, and less than 10% reported contacting or visiting public officials. These discrepancies allude to the importance of empowering younger people to engage actively in civic and electoral discourse and processes as a means to improving their communities. Engaging Youth for Positive Change (EYPC) is one example of a civic engagement program for adolescents and young people in the United States. The curriculum guides middle and high school aged people through civic processes including adopting local ordinances by working with city councils or other governing bodies. Researchers collected site level data from EYPC implementation sites (N = 122) across Illinois and there were significant correlations between outcome scores and both number of activities implemented and implementation indices. This manuscript delineates site level aspects of EYPC in detail—including quantitative and qualitative findings from site-level analyses—and discusses implications regarding how EYPC and similar programs may promote civic engagement among youth and young adult populations.

Comparing satellites and vegetation indices for cover crop biomass estimation

• Adequate biomass is required for cover crops to provide significant ecological benefits. • Satellite imagery predicted field level cover crop biomass accurately. • Satellite imagery more accurately estimated biomass than handheld sensors. • At least one vegetation index for each satellite system accurately predicted biomass. • NDVI was not the best predictor of cover crop biomass for any satellite. Cost-share programs based on measures of participation rather than performance are available to farmers who plant cover crops. However, cover crops only provide significant ecological benefits like reduced nutrient loss when adequate biomass is established. The purpose of this study was to determine whether satellite imagery can effectively estimate cover crop biomass in fields with diverse species composition, and whether increased spatial resolution and satellite imaging frequency can increase biomass estimation accuracy. Aboveground biomass samples of 1 m 2 were collected for 86 sites within 26 agricultural fields containing unique cover crop species composition to assess biomass production. In-field sensors were used to measure normalized difference vegetation index (NDVI) and groundcover percentage. Three satellites (Landsat-8 [30 m resolution], Sentinel-2 [10 m resolution], and PlanetScope [3 m resolution]) were used to calculate eight vegetation indices (VIs) for comparison with cover crop biomass. Multiple linear regression, correlation coefficients, and root mean square error (RMSE) were used to perform hierarchical clustering to rank VIs calculated from each satellite for biomass estimation accuracy. Satellites predicted cover crop biomass at the field level very accurately (r 2 up to 0.79), demonstrating the potential of large-scale biomass estimation at relatively low cost compared to in-field sampling. All satellite-VI pairs estimated biomass more accurately than the in-field sensors. Performance of VIs varied by satellite, but each satellite had at least one VI that performed very well for both site-level and field-averaged data. When using PlanetScope or Landsat-8 imagery, the perpendicular vegetation index provided the most accurate cover crop biomass estimation on a per-site basis and ratio vegetation index performed best using Sentinel-2 imagery. PlanetScope was the only satellite to provide useable imagery for every site due to increased revisit period; however, its increased spatial resolution did not increase estimation accuracy overall compared to Landsat-8 or Sentinel-2.

A national HIV clinical mentorship program: Enabling Zambia to accelerate control of the HIV epidemic.

Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those diagnosed should be on ART, and 90% of those on ART should achieve viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018-September 2018 and the post-mentorship period was July 2019-September 2019. Review of key programmatic indicators from the pre and post-deployment periods revealed the proportion of people who had a positive HIV test result out of those tested increased from 4.2% to 6.8% (P <0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8% to 90.1% (p <0.001). Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.

Relating Country-Level Governance and Tree Cover Loss in Sub-Saharan African Protected Areas: Identifying Knowledge Gaps and a More Nuanced Perspective

‘Good governance’ is highlighted by many as being essential for improving protected area (PA) management and conservation outcomes, with a growing body of evidence based on site-level governance data. Yet how exactly governance at other levels supports or hinders successful PA implementation, and how this should be considered in conservation planning and practice, remains insufficiently understood. We conducted an exploratory analysis of the relationship between the quality of country-level governance and trends in tree cover loss within sub-Saharan African PAs. For the period 2008–2017, we correlated annual governance scores from the Ibrahim Index of African Governance (IIAG) with the annual rate of tree cover loss in the total terrestrial area of PAs in 33 forested sub-Saharan African countries. Overall governance was not correlated with tree cover loss in a simple model, but there was evidence that overall governance was positively correlated with tree cover loss in PAs when the interaction with environmental governance was included. The interaction indicated that the rate of tree cover loss decreased for a given level of overall governance as environmental governance increased. Human development was negatively correlated with forest loss. Thus, the relationship between country-level ‘good governance’ and conservation success is more complex than a direct and positive cause and effect. Yet, uncertainty remains about the many possible and likely confounding pathways: whilst the quality of overall governance may be mirrored at the site-level, it may also contribute to increased anthropogenic pressures on natural resources. Through this research we found significant limitations in data quality and availability both to evaluate the effectiveness of protection beyond tree cover, as well as less conventional governance aspects, such as environmental policy and regulation or site-level governance. With an expected increase in area-based protection and conservation financing in the coming decades, such data will be vital to monitor the effectiveness of our efforts and ensure financial accountability.