Extreme weather caused by concurrent cyclone, front and thunderstorm occurrences

This is the final version of the article. Available from Springer Nature via the DOI in this recordPhenomena such as cyclones, fronts and thunderstorms can cause extreme weather in various regions throughout the world. Although these phenomena have been examined in numerous studies, they have not all been systematically examined in combination with each other, including in relation to extreme precipitation and extreme winds throughout the world. Consequently, the combined influence of these phenomena represents a substantial gap in the current understanding of the causes of extreme weather events. Here we present a systematic analysis of cyclones, fronts and thunderstorms in combination with each other, as represented by seven different types of storm combinations. Our results highlight the storm combinations that most frequently cause extreme weather in various regions of the world. The highest risk of extreme precipitation and extreme wind speeds is found to be associated with a triple storm type characterized by concurrent cyclone, front and thunderstorm occurrences. Our findings reveal new insight on the relationships between cyclones, fronts and thunderstorms and clearly demonstrate the importance of concurrent phenomena in causing extreme weather.This project is supported through funding from the Australian Government’s National Environmental Science Programme (NESP)

Lightning prediction for Australia using multivariate analyses of large-scale atmospheric variables

Lightning is a natural hazard that can lead to the ignition of wildfires, disruption and damage to power and telecommunication infrastructures, human and livestock injuries and fatalities, and disruption to airport activities. This paper examines the ability of six statistical and machine-learning classification techniques to distinguish between non-lightning and lightning days at the coarse spatial and temporal scales of current general circulation models and reanalyses. The classification techniques considered were: a combination of principal component analysis and logistic regression; classification and regression trees; random forests; linear discriminant analysis; quadratic discriminant analysis; and logistic regression. Lightning flash count observations at six locations across Australia for the period 2004 to 2013 were used, together with atmospheric variables from the ERA-Interim reanalysis. Ten-fold cross validation was used to evaluate classification performance. It was found that logistic regression was superior to the other classifiers considered, and that its prediction skill is much better than climatology. The sets of atmospheric variables included in the final logistic regression models were primarily composed of spatial mean measures of instability and lifting potential, and atmospheric water content. However, the memberships of these sets varied between climatic zones

Classification of Australian Thunderstorms using Multivariate Analyses of Large-Scale Atmospheric Variables

Lightning accompanied by inconsequential rainfall (i.e., “dry” lightning) is the primary natural ignition source for wildfires globally. This paper presents a machine-learning and statistical-classification analysis of dry and “wet” thunderstorm days in relation to associated atmospheric conditions. The study is based on daily data for lightning-flash count and precipitation from ground-based sensors and gauges and a comprehensive set of atmospheric variables that are based on ERA-Interim for the period from 2004 to 2013 at six locations in Australia. These locations represent a wide range of climatic zones (temperate, subtropical, and tropical). Quadratic surface representations and low-dimensional summary statistics were used to characterize the main features of the atmospheric fields. Four prediction skill scores were considered, and 10-fold cross validation was used to evaluate the performance of each classifier. The results were compared with those obtained by adopting the approach used in an earlier study for the U.S. Pacific Northwest. It was found that both approaches have prediction skill when tested against independent data, that mean atmospheric field quantities proved to be the most influential variables in determining dry-lightning activity, and that no single classifier or set of atmospheric variables proved to be consistently superior to its counterpart for the six sites examined here

Estimating trends and seasonality in Australian monthly lightning flash counts

We present the results of a statistical analysis of lightning characteristics in mainland Australia for the period from approximately 1988 to 2012, based on monthly lightning flash count (LFC) series obtained from a network of 19 Comité Internationale des Grands Réseaux Electriques, 500 Hz peak transmission filter circuit sensors. The temporal structures of the series are examined in terms of detecting and characterizing seasonal cycles, long-term trends, and changes in seasonality over time. A generalized additive modeling approach is used to ensure that the estimated structures are determined by the data, rather than by the constraints of any assumed mathematical form for the trends and seasonal cycle. Results indicate strong seasonality at all sites, the presence of long-term trends at 16 sites, and interactions between trend and seasonality (corresponding to changes in seasonality over time) at 13 sites. The most systematic change corresponds to a progressive deepening of the seasonal cycle (i.e., an ongoing decline in winter lightning flash counts) and is most noticeable across southern Australia (south of 30°S). These results are consistent with previous analyses that have detected decreasing atmospheric instability during the austral winter since the mid-1970s. This is associated with increasing mean sea level pressure and declining rainfall

Designing and Evaluating Interventions to Halt the Transmission of Tuberculosis.

To reduce the incidence of tuberculosis, it is insufficient to simply understand the dynamics of tuberculosis transmission. Rather, we must design and rigorously evaluate interventions to halt transmission, prioritizing those interventions most likely to achieve population-level impact. Synergy in reducing tuberculosis transmission may be attainable by combining interventions that shrink the reservoir of latent Mycobacterium tuberculosis infection (preventive therapy), shorten the time between disease onset and treatment initiation (case finding and diagnosis), and prevent transmission in key settings, such as the built environment (infection control). In evaluating efficacy and estimating population-level impact, cluster-randomized trials and mechanistic models play particularly prominent roles. Historical and contemporary evidence suggests that effective public health interventions can halt tuberculosis transmission, but an evidence-based approach based on knowledge of local epidemiology is necessary for success. We provide a roadmap for designing, evaluating, and modeling interventions to interrupt the process of transmission that fuels a diverse array of tuberculosis epidemics worldwide

The contributions of fronts, lows and thunderstorms to southern Australian rainfall

This is the final version. Available from the publisher via the DOI in this record.The correction to this article is available in ORE at http://hdl.handle.net/10871/126081A systematic analysis of the main weather types influencing southern Australian rainfall is presented for the period 1979–2015. This incorporates two multi-method datasets of cold fronts and low pressure systems, which indicate the more robust fronts and lows as distinguished from the weaker and less impactful events that are often indicated only by a single method. The front and low pressure system datasets are then combined with a dataset of environmental conditions associated with thunderstorms, as well as datasets of warm fronts and high pressure systems. The results demonstrate that these weather types collectively account for about 86% of days and more than 98% of rainfall in Australia south of 25° S. We also show how the key rain-bearing weather systems vary throughout the year and for different regions, with the co-occurrence of simultaneous lows, fronts and thunderstorm conditions particularly important during the spring and summer months in southeast Australia

Challenges with scale-up of GeneXpert MTB/RIF® in Uganda: a health systems perspective.

BACKGROUND: Many high burden countries are scaling-up GeneXpert® MTB/RIF (Xpert) testing for tuberculosis (TB) using a hub-and-spoke model. However, the effect of scale up on reducing TB has been limited. We sought to characterize variation in implementation of referral-based Xpert TB testing across Uganda, and to identify health system factors that may enhance or prevent high-quality implementation of Xpert testing services. METHODS: We conducted a cross-sectional study triangulating quantitative and qualitative data sources at 23 community health centers linked to one of 15 Xpert testing sites between November 2016 and May 2017 to assess health systems infrastructure for hub-and-spoke Xpert testing. Data sources included a standardized site assessment survey, routine TB notification data, and field notes from site visits. RESULTS: Challenges with Xpert implementation occurred at every step of the diagnostic evaluation process, leading to low overall uptake of testing. Of 2192 patients eligible for TB testing, only 574 (26%) who initiated testing were referred for Xpert testing. Of those, 54 (9.4%) were Xpert confirmed positive just under half initiated treatment within 14 days (n = 25, 46%). Gaps in required infrastructure at 23 community health centers to support the hub-and-spoke system included lack of refrigeration (n = 14, 61%) for sputum testing and lack of telephone/mobile communication (n = 21, 91%). Motorcycle riders responsible for transporting sputum to Xpert sites operated variable with trips once, twice, or three times a week at 10 (43%), nine (39%) and four (17%) health centers, respectively. Staff recorded Xpert results in the TB laboratory register at only one health center and called patients with positive results at only two health centers. Of the 15 Xpert testing sites, five (33%) had at least one non-functioning module. The median number of tests per day was 3.57 (IQR 2.06-4.54), and 10 (67%) sites had error/invalid rates > 5%. CONCLUSIONS: Although Xpert devices are now widely distributed throughout Uganda, health system factors across the continuum from test referral to results reporting and treatment initiation preclude effective implementation of Xpert testing for patients presenting to peripheral health centers. Support for scale up of innovative technologies should include support for communication, coordination and health systems integration

Spectral quantification of nonlinear behaviour of the nearshore seabed and correlations with potential forcings at Duck, N.C., U.S.A

Local bathymetric quasi-periodic patterns of oscillation are identified from monthly profile surveys taken at two shore-perpendicular transects at the USACE field research facility in Duck, North Carolina, USA, spanning 24.5 years and covering the swash and surf zones. The chosen transects are the two furthest (north and south) from the pier located at the study site. Research at Duck has traditionally focused on one or more of these transects as the effects of the pier are least at these locations. The patterns are identified using singular spectrum analysis (SSA). Possible correlations with potential forcing mechanisms are discussed by 1) doing an SSA with same parameter settings to independently identify the quasi-periodic cycles embedded within three potentially linked sequences: monthly wave heights (MWH), monthly mean water levels (MWL) and the large scale atmospheric index known as the North Atlantic Oscillation (NAO) and 2) comparing the patterns within MWH, MWL and NAO to the local bathymetric patterns. The results agree well with previous patterns identified using wavelets and confirm the highly nonstationary behaviour of beach levels at Duck; the discussion of potential correlations with hydrodynamic and atmospheric phenomena is a new contribution. The study is then extended to all measured bathymetric profiles, covering an area of 1100m (alongshore) by 440m (cross-shore), to 1) analyse linear correlations between the bathymetry and the potential forcings using multivariate empirical orthogonal functions (MEOF) and linear correlation analysis and 2) identify which collective quasi-periodic bathymetric patterns are correlated with those within MWH, MWL or NAO, based on a (nonlinear) multichannel singular spectrum analysis (MSSA). (...continued in submitted paper)Comment: 50 pages, 3 tables, 8 figure

Study protocol: a cluster randomized trial to evaluate the effectiveness and implementation of onsite GeneXpert testing at community health centers in Uganda (XPEL-TB).

BACKGROUND: Delays in diagnosis and treatment of tuberculosis (TB) remain common in high-burden countries. To improve case detection, substantial investments have been made to scale-up Xpert MTB/RIF (Xpert), a cartridge-based nucleic acid amplification test that can detect TB within 2 hours, as a replacement for sputum smear microscopy. However, the optimal strategy for implementation of Xpert testing remains unclear. METHODS: The Xpert Performance Evaluation for Linkage to Tuberculosis Care (XPEL-TB) trial uses an ultra-pragmatic, hybrid type II effectiveness-implementation design to assess the effectiveness and implementation of a streamlined strategy for delivery of Xpert testing in real-world settings. Twenty health centers with TB microscopy units were selected to participate in the trial, with ten health centers randomized to the intervention strategy (onsite molecular testing using GeneXpert Edge, process redesign to facilitate same-day TB diagnosis and treatment, and performance feedback) or routine care (onsite sputum smear microscopy plus referral of sputum samples to Xpert testing sites). The primary outcome is the number of patients with microbiologically confirmed TB who were initiated on treatment within 14 days of presentation to the health center, which reflects successful completion of the TB diagnostic evaluation process. Secondary outcomes include health outcomes (6-month vital status), as well as measures of the reach, adoption, and implementation of the intervention strategy. DISCUSSION: The design elements and implementation approach for the XPEL-TB trial were intentionally selected to minimize disruptions to routine care procedures, with the goal of limiting their influence on key primary and secondary outcomes. Trial findings may result in increased support and funding for rapid, onsite molecular testing as the standard-of-care for all patients being evaluated for TB. TRIAL REGISTRATION: US National Institutes of Health's ClinicalTrials.gov, NCT03044158. Registered 06 February 2017. Pan African Clinical Trials Registry, PACTR201610001763265. Registered 03 September 2016

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed