Two-year Study Period Research Articles

Kinship and reproductive condition correlate with affiliation patterns in female southern Australian bottlenose dolphins

Social relationships in female mammals are usually determined by an interplay among genetic, endogenous, social and ecological factors that ultimately affect their lifetime reproductive success. However, few studies have attempted to control for, and integrate these factors, hampering our understanding of drivers underlying female sociality. Here, we used generalized affiliation indices, combined with social networks, reproductive condition, and genetic data to investigate drivers of associations in female southern Australian bottlenose dolphins. Our analysis is based on photo-identification and genetic data collected through systematic boat surveys over a two-year study period. Female dolphins formed preferred associations and social clusters which ranged from overlapping to discrete home ranges. Furthermore, matrilineal kinship and biparental relatedness, as well as reproductive condition, correlated with the strength of female affiliations. In addition, relatedness for both genetic markers was also higher within than between social clusters. The predictability of resources in their embayment environment, and the availability of same-sex relatives in the population, may have favoured the formation of social bonds between genetically related females and those in similar reproductive condition. This study highlights the importance of genetic, endogenous, social and ecological factors in determining female sociality in coastal dolphins.

Two-year evaluation of hydraulic properties of biochar-amended vegetated soil for application in landfill cover system

Landfill cover should ideally have a medium with high water retention ability and low hydraulic conductivity to prevent rainfall infiltrating into the hazardous waste layer. Even though biochar amended soil (BAS) is advocated as cover medium, the interactions between biochar and plant, as well as the effects of biochar aging and plant growth on soil hydraulic properties are still not clear. This study aims to investigate the effects of grass (Cynodon dactylon) growth in BAS on soil water retention and saturated hydraulic conductivity (ks) over a two-year period. Four ground conditions were tested, namely bare silty sand with and without biochar, vegetated silty sand with and without biochar. The biochar content was kept at 10% (v/v). During the first 6 months, soil water content corresponding to field capacity (FC) and permanent wilting point (PWP) in grassed soil increased by 17% and 27%, respectively. With biochar inclusion, 43% and 57% additional increases in FC and PWP respectively were observed. Moreover, ks in biochar-amended grassed soil decreased by 50%. Furthermore, grass growth from 6 to 24 months reduced FC by 32%, PWP by 40% but caused 20 times increase in ks of grassed soil. With the presence of biochar, FC and PWP decreased by only 6% and 8%, respectively, and ks increased by 200% due to the enhanced plant growth (specifically root growth) by biochar. After two years, ks of grassed soil with biochar was 16 times smaller than that without biochar. This study demonstrated the effectiveness of biochar in maintaining the enhanced soil water retention ability and reduced ks in vegetated soil over a two-year study period.

Cost-effectiveness of a canine visceral leishmaniasis control program in Brazil based on insecticide-impregnated collars.

INTRODUCTION: The use of insecticide-impregnated dog collars is a potentially useful tool for the control of visceral leishmaniasis. The objective of the present study was to perform a cost-effectiveness analysis of a program based on insecticide-impregnated collars compared to traditional visceral leishmaniasis control strategies used in Brazil. METHODS: A cost-effectiveness analysis was performed from the perspective of the Unified Health System, using data from the Visceral Leishmaniasis Control Program implemented in the municipality of Montes Claros, Minas Gerais. The direct costs of the three control strategies, which were 1) canine infection screening + sacrifice, 2) residual chemical control of the vector, and 3) insecticide-impregnated dog collars (Scalibor®), were evaluated over the two-year study period. RESULTS: The total cost of the program in the area subjected to the traditional control strategies (strategies 1 and 2; control area) was R$ 1,551,699.80, and in the area subjected to all three control strategies (intervention area), it was R$ 1,898,190.16. The collar program was considered highly cost-effective at preventing canine visceral leishmaniasis (incremental cost-effectiveness ratio of approximately R$ 578 per avoided dog sacrifice). CONCLUSIONS: These results provide support for the decision by the Brazilian Ministry of Health in 2019 to provide insecticide-impregnated collars for the control of canine visceral leishmaniasis in a pilot project.

Comparative life cycle assessment of unmanned aerial vehicles, internal combustion engine vehicles and battery electric vehicles for grocery delivery

Abstract Due to the emergence of online grocery shopping, grocery delivery services, and high-payload unmanned aerial vehicles (commonly referred to as drones) there is now more potential than ever for an unmanned aerial vehicle (UAV)-based grocery delivery service. This study explores multiple grocery delivery service models involving UAVs, internal combustion engine vehicles (ICEVs), and battery electric vehicles (BEVs). A cradle-to-grave analysis was completed for a suitable high-payload UAV. The analysis showed that the UAV use phase was dominant with respect to several relevant environmental impact categories. For the use phase comparison, the primary delivery service model included UAV operation during optimal weather conditions in tandem with ICEV operation during the remainder of the two-year study period. This delivery model was compared to two other reference models: 1) full-year ICEV operation and 2) full-year BEV operation. This study found that while UAVs have the potential to produce less environmental impacts, such as global warming potential, during the use phase compared to ICEVs, a fleet of ten UAVs consumes more energy per delivery-kilometer than a BEV in the use phase. This results in greater use phase environmental impacts associated with electricity generation. An economic cost comparison for the three different delivery models was also performed and found that high-payload UAVs are not yet an economically-feasible replacement for a long-range BEV in a grocery delivery application in terms of capital and fuel costs.

Influence of hydrologic and anthropogenic drivers on emerging organic contaminants in drinking water sources in the Susquehanna River Basin.

Occurrence of emerging organic contaminants (EOCs) in surface water bodies can cause adverse effects on non-target organisms. When surface waters are used as drinking water sources, temporal variability in EOC concentrations can potentially impact drinking water quality and human health. To better understand spatiotemporal variability of EOCs in drinking water sources in Central Pennsylvania, EOCs were evaluated in six drinking water sources during a two-year study period (April 2016-June 2018) in the Susquehanna River Basin (SRB). The study was conducted in two phases: Phase I was a spatially distributed sampling approach within the SRB focusing on seven human pharmaceuticals and Phase II was a temporally intensive sampling regime at a single site focusing on a broader range of EOCs. Concentration-discharge relationships were utilized to classify EOC transport dynamics and understand the extent to which hydrologic and anthropogenic factors, such as surface runoff and wastewater effluent, may contribute to EOC occurrence. Overall, EOCs were present at higher concentrations in colder seasons than warmer seasons. Thiamethoxam, a neonicotinoid insecticide, and caffeine exhibited accretion dynamics during high-flow periods, suggesting higher transport during surface runoff events. Human pharmaceuticals known to persist in wastewater effluent were inversely correlated with discharge, indicating dilution characteristics consistent with diminished wastewater signals during high-flow periods. Acetaminophen exhibited near-chemostatic transport dynamics, indicating nonpoint source inputs during high-flow periods. Risk calculations revealed that although EOCs posed medium-to-high risk to aquatic organisms, human health risk through fish consumption was low.

Ferric Carboxymaltose in the treatment of chemotherapy-induced anaemia: an effective, safe and cost- sparing alternative to blood transfusion

Anaemia is highly prevalent in cancer patients, adversely affects quality of life and impacts survival. The pathogenesis is multifactorial, with iron deficiency being a major and potentially treatable contributor. This study aimed to assess the effectiveness and economic impact of ferric carboxymaltose in chemotherapy-induced anaemia. This prospective cohort study between 2015–2016 of chemotherapy-treated patients for solid tumours, grade ≥2 anaemia and iron deficiency evaluated hematopoietic response four weeks after ferric carboxymaltose treatment. Transfusion rate of all cancer patients treated at our ambulatory unit during the two-year study period (2015–2016) was compared to a retrospective cohort (2013–2014) who received blood transfusion only. Between 2015–2016, 99 patients were included and treated with ferric carboxymaltose, the majority of whom (n = 81) had relative iron deficiency. Mean haemoglobin concentrations improved from 9.2 [6.7–10.8] g/dL to 10.6 [7.8–14.2] g/dL four weeks after treatment. A 26% reduction in the transfusion rate was observed from control retrospective to the prospective study group including ferric carboxymaltose treated patients [relative risk 0.74 (95% CI:0.66–0.83)]. The cost analysis showed a benefit for the use of ferric carboxymaltose in chemotherapy-induced anaemia. This study shows that ferric carboxymaltose is an effective, cost-saving support treatment, reducing the need for allogeneic transfusions saving blood units which are a limited resource.

Association between body mass index (BMI) percentile and asthma in children of 5–12 years old: A case–control study using electronic medical records in Primary Health Care Corporation, Qatar 2016–2017

ABSTRACT Background: Over the last several decades, obesity and asthma prevalence have risen among children. The increase in overweight and obesity has been associated with an increased risk of asthma in children. Most epidemiological studies have proposed that a high body mass index (BMI) at infancy and early childhood increases the risk of asthma in children. A recently adopted electronic recording system for health service encounters in Primary Health Care Corporation of Qatar has provided a convenient opportunity to assess the possible link between asthma and obesity in children aged 5–12 years. Objectives: To calculate the prevalence rate of overweight and obesity among asthmatic children aged 5–12 years using primary health care centers during 2016–2017. To measure the strength of the association between BMI and asthma in children aged 5–12 years after adjusting for age, gender, and nationality. Methodology: This was a case–control study on the electronic health records of children aged 5–12 years who visited one of the primary health care centers during the two-year study period (2016–2017). A total of 9889 children with a diagnosis of asthma and valid BMI measurements were included in the case group, and an identical number of children who visited the health care centers for other reasons and had valid BMI measurements were randomly enrolled in the control group. Results: The prevalence of obesity (BMI-for-age Z-score >2) was significantly higher among asthmatics (24.9%) compared with non-asthmatic controls (17.7%). Asthma significantly increased the risk of being obese by 41% in bivariate analysis. The calculated risk estimate for the association between asthma and obesity increased to 70% after adjusting for the confounding effect of age, gender, and nationality. Conclusions: The present observational study based on a large sample of 5 to 12-year-old children documented a strong association between asthma and obesity (BMI-for-age Z-score 2 or above). This positive association between asthma and high BMI was stronger among older children, females, and Qatari nationals.

Association of antipsychotic treatment switching in patients with schizophrenia, bipolar, and major depressive disorders

Aims: To evaluate the association of relapse and healthcare resource utilization in patients with schizophrenia (SZ), bipolar disorder (BD), or major depressive disorder (MDD) who switched antipsychotic medication versus those who did not.Materials and methods: Medicaid claims from six US states spanning six years were retrospectively analyzed for antipsychotic switching versus non-switching. For all patients with SZ, BD, or MDD, and for the subset of patients who also had ≥1 extrapyramidal symptoms (EPS) diagnosis at baseline, times to the following outcomes were analyzed: underlying disease relapse, other psychiatric relapse, all-cause emergency room (ER) visit, all-cause inpatient (IP) admission, and EPS diagnosis.Results: Switchers (N = 10,548) had a shorter time to disease relapse, other psychiatric relapse, IP admissions, ER visits, and EPS diagnosis (all, log-rank p < .001) than non-switchers (N = 31,644). Switchers reached the median for IP admission (21.50 months) vs non-switchers (not reached) and for ER visits (switchers, 9.07 months; non-switchers, 13.35 months). For disease relapse, other psychiatric relapse, and EPS diagnosis, <50% of patients had an event during the two-year study period. Subgroup analysis of those with ≥1 EPS diagnosis revealed similar associations.Limitations: Only association, not causation, may be inferred, and there may be differences between the patient groups in parameters not evaluated.Conclusions: These results show that disease and other psychiatric relapse, all-cause ER visits, IP admissions, and EPS diagnosis occurred earlier for patients who switched antipsychotics than for those who did not, suggesting that switching is associated with an increased risk of relapse in patients with SZ, BD, and MDD. This may be attributed to more-severely ill patients being less responsive than those with less-severe illness, which, in turn, may require more episodes of switching.

Nitrogen release and plant available nitrogen of composted and un-composted biosolids.

The nitrogen (N) release from composted and un-composted biosolids and plant available N (PAN) of the biosolids were quantified to evaluate if composting can contribute to stabilize biosolids N and reduce the nitrate ( ) leaching potential in biosolids-amended soil. Biosolids were composted at >55°C for 21days after mixing the biosolids with yard waste at 1:1 (w/w) ratio. In the N release study, we installed field lysimeters filled with soil (sand and clay) amended with composted and un-composted biosolids at two rates (30 and 150 dry Mg/ha) and measured the inorganic N in leachate after each rainfall and soil inorganic N monthly. The N released from composted biosolids during the two-year study period were lower (6% of organic N added for clay and 11% for sandy loam soil) as compared to un-composted biosolids (14% of organic N added for clay and 21% for sandy soils). Composted biosolids showed a lower N release rate constant k value of 0.0014 and 0.0027month-1 for clay and sandy soil, respectively, compared to corresponding values of 0.0035 and 0.0068month-1 for un-composted biosolids. We used greenhouse bioassay with corn (Zea mays), ryegrass (Lolium perenne), and Miscanthus (Miscanthus giganteus) as test plants grown for six months with reference to N chemical fertilizer ranging from 0, 75, 150 to 300kgN/ha to evaluate the PAN of the biosolids. Based on our study, plant growth was not affected by using either composted or un-composted biosolids but the PAN was lower in composted biosolids (4.0%-5.9%) than un-composted biosolids (11.4%-13.6%). Composting results in higher N-retention efficiency in biosolids and composted biosolids are a valuable source of N to support the plant growth with lower N released to the environment. Thus, the potential of N leaching would still be low in the situations where a high rate of biosolids needs to be applied for land reclamation or landscaping soil reconstruction. PRACTITIONER POINTS: Composting enhances N-retention efficiency in biosolids and composted biosolids are a valuable source of N to support the plant growth with lower N released to the environment. Potential of N leaching would still be low in the situations where a high rate of biosolids needs to be applied for land reclamation or landscaping soil reconstruction. N released from composted and un-composted biosolids can be adequately described by first-order kinetic model.

Food Policy Councils as Loci for Practising Food Democracy? Insights from the Case of Oldenburg, Germany

In the highly concentrated and consolidated 21st century food systems, a broad range of stakeholders are rarely involved in food-related decision-making processes. One innovative institutional response is the establishment of food policy councils (FPCs). These institutions are often initiated by civil society actors and seek to transform prevailing agro-industrial food systems. They aim to raise awareness for alternative practises of food consumption and production, and they try to shape food policies at different governance levels. FPCs have been acclaimed for their democratic potential in the past. This study uses the five key dimensions of food democracy identified by Hassanein (2008) to assess the ways in which FPCs might represent loci for practising food democracy. This is achieved by taking one of the first FPCs in Germany as an example. During a two-year study period (2016–2018), the emergence of the FPC Oldenburg was studied through participant observations, semi-structured interviews, and document analysis. Data analysis reveals examples of, as well as challenges related to, all five dimensions of food democracy. In addition, the in-depth analysis of the case also illustrates the importance of taking additional aspects into account, i.e., openness and transparency. Looking at an additional dimension of food democracy, which covers the “How?” of the deliberative process, might allow for a more nuanced analysis of the democratic potential of food initiatives in the future.

Juvenile thinning can effectively mitigate the effects of drought on tree growth and water consumption in a young Pinus contorta stand in the interior of British Columbia, Canada

Large-scale forest disturbances including mountain pine beetle infestation and forest fires have generated overstocked lodgepole pine stands in the interior of British Columbia. A critical need is to determine sustainable management strategies to ensure their healthy growth and provision of various ecological functions under increased drought risk due to climate change. In 2016, a field experiment was established to study the effects of juvenile thinning on carbon assimilation and water use at the both tree- and stand-scales in a 16-year old lodgepole pine stand from June to October in 2016 and 2017. This study located northeast of Penticton, British Columbia, included two thinning treatments (T1: 4500 stems per ha; and T2: 1100 stems per ha) and one control (C: 27,000 stems per ha), randomly assigned in three blocks. Sap flow and microclimatic variables were continuously monitered in one plot of each treatment in one block, while tree diameter at breast height were measured across the three blocks. The results showed that C had the lowest tree radial growth (0.14 mm2/d), sap flow velocity (64.61 g/cm2d), and highest stand transpiration (4.36 mm/d), while T2 had the highest tree radial growth (1.28 mm2/d), sap flow velocity (149.14 g/cm2d), and lowest stand transpiration (0.36 mm/d) over the two-year study period. Significant differences of tree radial growth and sap flow velocity between T1 and T2 only occurred under the drought condition (in the summer season of 2017), with T2 having a significant higher resistant index of sap flow velocity than C and T1, by taking advantage of the change in microclimatic conditions following intense thinning. At the stand-level, only the stand transpiration of T1 statistically decreased in the drought year. We conclude that the thinning plays a significant and positive role in maintaining tree growth and water consumption in the short term, and the more heavily thinning (T2) would be more effective to mitigate the drought effect in young overstocking lodgepole pine forests in terms of water consumption. These findings improve our understanding on how thinning can be used to manage ecological responses to forest practices in a changing climate.

Performance and conduct of supply chains for United States farmed oysters

Farmed oysters are one of the most valuable aquacultured products in the United States (U.S.), are highly perishable, and increasingly shipped live year-round. Supply chain actors must work together to bring refrigerated oysters to market quickly, while maintaining product value, safety and traceability information. In light of these demands, this study assesses the performance and conduct of supply chains for U.S. farmed oysters (Crassostrea virginica, C. gigas). Over the two-year study period, we conducted interviews with 56 businesses and tracked 125 oyster shipments from two major growing regions in the U.S. through six different types of supply chains. We hypothesized that direct and intermediated supply chains would perform differently in terms of time-to-market, product temperature in cold chains, compliance with temperature regulations, and modeled risks from Vibrio parahaemolyticus. Intermediated supply chains, by their definition have more connections than direct supply chains, and we found this introduces a longer time-to-market and a higher incidence of time and temperature abuse. However, these factors did not lead to greater modeled V. parahaemolyticus risks. Participants in both direct and intermediated supply chains were aware of the importance of traceability and felt uniformly positive about their ability to perform recalls. A common concern was the speed of government-imposed recalls, which can be declared by regulators after the affected live oysters are consumed. Members of these supply chains play different roles in maintaining the cold chain, possess different levels of information related to traceability, and describe different levels of trust with other supply chain actors. This paper contributes to a growing body of knowledge on supply chains for seafood and their critical, and sometimes overlooked, role in larger food systems.

Prognostic significance of faecal eosinophil granule proteins in inflammatory bowel disease

Background: Non-invasive markers for predicting relapse would be a useful tool for the management of patients with inflammatory bowel disease. Eosinophil granulocytes and their granule proteins eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) have previously been shown to reflect disease activity in Crohn’s disease and ulcerative colitis.Aim: To examine the capacity of faecal ECP and EDN to predict relapse in ulcerative colitis and Crohn's disease, and to compare these proteins with faecal calprotectin.Methods: Patients with Crohn's disease (n = 49) and ulcerative colitis (n = 55) were followed prospectively until relapse or end of the two-year study period. Faecal samples were obtained every third month. The predictive value of ECP and EDN was assessed in Cox regression models.Results: In ulcerative colitis, a doubled EDN or ECP concentration was associated with a 31% and 27% increased risk of relapse, respectively. EDN levels were increased both at relapse and three months prior. By contrast, in Crohn's disease, the concentration of EDN was higher among patients in remission than in those who relapsed. Correlations between faecal calprotectin, ECP and EDN were observed in both diseases.Conclusions: We demonstrate that the risk of relapse in ulcerative colitis can be predicted by consecutively measuring faecal EDN every third month, and suggest EDN as a complementary faecal marker to calprotectin to predict future relapse in ulcerative colitis. Our finding of higher EDN in Crohn’s disease-patients staying in remission than in those who relapsed indicates different functions of the protein in ulcerative colitis and Crohn’s disease.

Systematic review and meta-analysis of the association between childhood physical activity and age at menarche

Aim To systematically appraise and summarise published evidence on the association between childhood physical activity (PA) and subsequent age at menarche (AAM). Methods We searched PubMed (1990-2018) for studies that reported the relationship between childhood PA and AAM. We performed tabular synthesis of population-based studies and a random-effects meta-analysis of results of athlete/nonathlete studies. Results One randomised controlled trial was identified, in which an intervention to prevent obesity reduced the likelihood of menarche during the two-year study period (relative risk: 0.75, 95% CI: 0.66-0.87; n = 422 girls). One of five prospective cohort studies (total n = 4492) reported a significant association between self-reported PA duration and subsequent menarche timing. Four of five historical cohort studies (total n = 89 470) reported significant associations between recalled premenarcheal PA and later AAM. Meta-analysis across 12 athlete/nonathlete studies showed that menarche occurred 1.13 years later (95% CI: 0.80-1.47) in athletes compared to nonathletes. Conclusion These findings suggest that AAM is a behaviourally modifiable trait. However, the quality of reported population-based study evidence is low and estimation of the true relationship between childhood PA and AAM is likely confounded by concomitant changes in diet and lifestyle behaviours.

Boundary conditions for modeling the ground thermal profile near shallow culverts

Abstract Culverts create disturbance in the ground thermal regime in cold regions below pavement structures. The thermal disturbance caused by culverts may result in geotechnical problems such as permafrost degradation, frost heave, and differential settlement which impact road roughness and road safety. Thermal numerical modeling of shallow culverts below a pavement structure requires accurately defining boundary conditions for the road surface. This study evaluates five empirical pavement temperature methods used as the pavement surface boundary condition in a 2D numerical model that predicts the soil temperature below pavement surfaces over shallow culverts. The predicted soil temperatures from the numerical model are validated with two years of measured soil temperatures at five instrumented culvert sites. The predicted soil temperatures are evaluated through trend analysis and statistical F-test at 95% confidence. A pavement surface boundary condition obtained from each of the five pavement temperature methods is considered successful when the difference between the predicted and measured values pass the F-test for all seasons over the two-year study period. The results of the analysis show that three of the five pavement temperature methods passed the trend and F-test analysis. The three pavement temperature methods more accurately defines the boundary conditions for the road surface and are utilized in the numerical model to predicted frost penetration depth below the pavement surface and near the culvert openings. The findings from this study are expected to increase the accuracy of modeling the frost heave and the differential thaw settlement under pavement structure due to the influence of culverts.

Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study.

BackgroundIn order to reach the health-related Sustainable Development Goals (SDGs) by 2030, gains attained in access to primary healthcare must be matched by gains in the quality of services delivered. Despite the broad consensus around the need to address quality, studies on the impact of health system strengthening (HSS) have focused predominantly on measures of healthcare access. Here, we examine changes in the content of maternal and child care as a proxy for healthcare quality, to better evaluate the effectiveness of an HSS intervention in a rural district of Madagascar. The intervention aimed at improving system readiness at all levels of care (community health, primary health centers, district hospital) through facility renovations, staffing, equipment, and training, while removing logistical and financial barriers to medical care (e.g., ambulance network and user-fee exemptions).Methods and findingsWe carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women aged 15–49. We used a difference-in-differences (DiD) analysis to compare trends between the intervention group (i.e., people living inside the HSS catchment area) and the non-intervention comparison group (i.e., the rest of the district). In addition, we used health facility–based surveys, monitoring service availability and readiness, to assess changes in the operational capacities of facilities supported by the intervention. The cohort study included 657 and 411 children (mean age = 2 years) reported to be ill in the 2014 and 2016 surveys, respectively (27.8% and 23.8% in the intervention group for each survey), as well as 552 and 524 women (mean age = 28 years) reported to have a live birth within the previous two years in the 2014 and 2016 surveys, respectively (31.5% and 29.6% in the intervention group for each survey). Over the two-year study period, the proportion of people who reported seeking care at health facilities experienced a relative change of +51.2% (from 41.4% in 2014 to 62.5% in 2016) and −7.1% (from 30.0% to 27.9%) in the intervention and non-intervention groups, respectively, for sick-child care (DiD p-value = 0.01); +11.4% (from 78.3% to 87.2%), and +10.3% (from 67.3% to 74.2%) for antenatal care (p-value = 0.75); and +66.2% (from 23.1% to 38.3%) and +28.9% (from 13.9% to 17.9%) for perinatal care (p-value = 0.13). Most indicators of care content, including rates of medication prescription and diagnostic test administration, appeared to increase more in the intervention compared to in the non-intervention group for the three areas of care we assessed. The reported prescription rate for oral rehydration therapy among children with diarrhea changed by +68.5% (from 29.6% to 49.9%) and −23.2% (from 17.8% to 13.7%) in the intervention and non-intervention groups, respectively (p-value = 0.05). However, trends observed in the care content varied widely by indicator and did not always match the large apparent increases observed in care seeking behavior, particularly for antenatal care, reflecting important gaps in the provision of essential health services for individuals who sought care. The main limitation of this study is that the intervention catchment was not randomly allocated, and some demographic indicators were better for this group at baseline than for the rest of the district, which could have impacted the trends observed.ConclusionUsing a district-representative longitudinal cohort to assess the content of care delivered to the population, we found a substantial increase over the two-year study period in the prescription rate for ill children and in all World Health Organization (WHO)-recommended perinatal care outputs assessed in the intervention group, with more modest changes observed in the non-intervention group. Despite improvements associated with the HSS intervention, this study highlights the need for further quality improvement in certain areas of the district’s healthcare system. We show how content of care, measured through standard population-based surveys, can be used as a component of HSS impact evaluations, enabling healthcare leaders to track progress as well as identify and address specific gaps in the provision of services that extend beyond care access.

Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study

ObjectiveLarge loop excision of the transformation zone (LLETZ) conization has been associated with adverse obstetrical outcomes. In an approach to reduce the number of performed LLETZ procedures, we conducted this study to evaluate whether “diagnostic” LLETZ should still be performed, by analyzing their yield in terms of detection (and treatment) of real high-grade squamous intraepithelial lesion (HSIL). MethodsDuring a two-year study period, all patients who underwent a LLETZ procedure in our institution were retrospectively included. Study participants were divided into two groups according to LLETZ indication: a biopsy-proven HSIL group, and a non-biopsy-proven HSIL group. The results of the final histological examination were recorded, as well as excision margin status and specimen dimensions. ResultsDuring the two-year study period, 396 LLETZs were performed, 283 (71%) of which were indicated by biopsy-proven HSIL. In the non-biopsy-proven group, final histology showed 50 cases of HSIL (44%) and 4 cases of carcinoma (3.6%), versus respectively, in the biopsy-proven group, 221 (78%) HSIL and 28 (9.9%) carcinoma (p<0.001). Regarding margin status and specimen dimensions, no intergroup difference was observed between the two groups. ConclusionSo called “diagnostic” LLETZ allowed the detection of severe cervical lesions in almost half of cases, without increasing specimen dimensions in comparison with classical conization indications. Moreover, they also allowed an efficient treatment as showed by similar margins status. Our results therefore strengthen the idea that “diagnostic” LLETZ, when specific indications are respected, should not be overlooked as a major part of our therapeutic arsenal.

Ensemble model aggregation using a computationally lightweight machine-learning model to forecast ocean waves

This study investigated an approach to improve the accuracy of computationally lightweight surrogate models by updating forecasts based on historical accuracy relative to sparse observation data. Using a lightweight, ocean-wave forecasting model, we created a large number of model ensembles, with perturbed inputs, for a two-year study period. Forecasts were aggregated using a machine-learning algorithm that combined forecasts from multiple, independent models into a single "best-estimate" prediction of the true state. The framework was applied to a case-study site in Monterey Bay, California. A~learning-aggregation technique used historical observations and model forecasts to calculate a weight for each ensemble member. Weighted ensemble predictions were compared to measured wave conditions to evaluate performance against present state-of-the-art. Finally, we discussed how this framework, which integrates ensemble aggregations and surrogate models, can be used to improve forecasting systems and further enable scientific process studies.

Out-of-hospital cardiac arrests in a large metropolitan area: synergistic effect of exposure to air particulates and high temperature.

Air pollution and climate change are intrinsically linked to emerging hazards for global health. High air particulate matter (PM) levels may trigger out-of-hospital cardiac arrest (OHCA). High temperature could act synergistically with PM in determining OHCA. The aim of the present study was to investigate the effect of PM exposure alone, and in combination with temperature, on the risk of OHCA, in a large European metropolitan area with population >4 million. We evaluated the association between short-term PM exposure, temperature, and the risk of OHCA over a two-year study period, allowing us to investigate 5761 events using a time-stratified case-crossover design combined with a distributed lag non-linear model. Higher risk of OHCA was associated with short-term exposure to PM10. The strongest association was experienced three days before the cardiac event where the estimated change in risk was 1.70% (0.48-2.93%) per 10 µg/m3 of PM. The cumulative exposure risk over the lags 0-6 was 8.5% (0.0-17.9%). We observed a joint effect of PM and temperature in triggering cardiac arrests, with a maximum effect of 14.9% (10.0-20.0%) increase, for high levels of PM before the cardiac event, in the presence of high temperature. The present study helps to clarify the controversial role of PM as OHCA determinant. It also highlights the role of increased temperature as a key factor in triggering cardiac events. This evidence suggests that tackling both air pollution and climate change might have a relevant impact in terms of public health.

Contact with primary health care physicians before an acute hospitalisation

Objectives: To assess contacts with general practitioners (GPs), both regular GPs and out-of-hours GP services (OOH) during the year before an emergency hospital admission.Design: Longitudinal design with register-based information on somatic health care contacts and use of municipality health care services.Setting: Four municipalities in central Norway, 2012–2013.Subjects: Inhabitants aged 50 and older admitted to hospital for acute myocardial infarction, hip fracture, stroke, heart failure, or pneumonia.Main outcome measures: GP contact during the year and month before an emergency hospital admission.Results: Among 66,952 identified participants, 720 were admitted to hospital for acute myocardial infarction, 645 for hip fracture, 740 for stroke, 399 for heart failure, and 853 for pneumonia in the two-year study period. The majority of these acutely admitted patients had contact with general practitioners each month before the emergency hospital admission, especially contacts with a regular GP. A general increase in GP contact was observed towards the time of hospital admission, but development differed between the patient groups. Patients admitted with heart failure had the steepest increase of monthly GP contact. A sizable percentage did not contact the regular GP or OOH services the last month before admission, in particular men aged 50–64 admitted with myocardial infarction or stroke.Conclusion: The majority of patients acutely admitted to hospital for different common severe emergency diagnoses have been in contact with GPs during the month and year before the admission. This points towards general practitioners having an important role in these patients’ health care.KEY MESSAGESThere is scarce knowledge about primary health care contact before an emergency hospital admission.The percentage of patients with contacts differed between patient groups, and increased towards hospital admission for most diagnoses, particularly heart failure.More than 50% having monthly general practitioner contact before admission underscores the general practitioners’ role in these patients’ health care.Our results underscore the need to consider medical diagnosis when talking about the role of general practitioners in preventing emergency hospital admissions.