Cap Reform and Nitrate Restrictions: Implications for Irish Grass Based Dairy Production Systems

The benefit of a systems approach to analysing production situations has long been recognised in agricultural research. The development and application of production-oriented dairy models offer tremendous capabilities for both encompassing the realities faced by producers while also considering the adaptation possibilities available to them in light of internal and external forces of change. This farm level dairy model represents one such approach. The objectives of the study were: (1) to develop a comprehensive farm-level model of Irish milk production systems and (2) to apply the model to identify optimal adaptation strategies of dairy farmers within the context of European policy reform. This paper examines the implications of both the Luxembourg Agreement and the imposition of the Nitrates Directive on Irish dairy systems

A framework for extension studies using real-world data to examine long-term safety and effectiveness

Understanding the long-term benefits and risks of treatments, devices, and vaccines is critically important for individual- and population-level healthcare decision-making. Extension studies, or \u27roll-over studies,\u27 are studies that allow for patients participating in a parent clinical trial to \u27roll-over\u27 into a subsequent related study to continue to observe and measure long-term safety, tolerability, and/or effectiveness. These designs are not new and are often used as an approach to satisfy regulatory post-approval safety requirements. However, designs using traditional clinical trial infrastructure can be expensive and burdensome to conduct, particularly, when following patients for many years post trial completion. Given the increasing availability and access of real-world data (RWD) sources, direct-to-patient technologies, and novel real-world study designs, there are more cost-efficient approaches to conducting extension studies while assessing important long-term outcomes. Here, we describe various fit-for-purpose design options for extension studies, discuss related methodological considerations, and provide scientific and operational guidance on practices when planning to conduct an extension study using RWD. This manuscript is endorsed by the International Society for Pharmacoepidemiology (ISPE)

Tracking the decline of weasels in North America

Small carnivores are of increasing conservation concern globally, including those formerly thought to be widespread and abundant. Three weasel species (Mustela nivalis, M. frenata, and M. erminea) are distributed across most of North America, yet several recent studies have reported difficulty detecting weasels within their historical range and several states have revised the status of weasels to that of species of conservation concern. To investigate the status and trends of weasels across the United States (US) and Canada, we analyzed four separate datasets: historical harvests, museum collections, citizen scientist observations (iNaturalist), and a recent US-wide trail camera survey. We observed 87–94% declines in weasel harvest across North America over the past 60 years. Declining trapper numbers and shifts in trapping practices likely partially explain the decline in harvest. Nonetheless, after accounting for trapper effort and pelt price, we still detected a significant decline in weasel harvest for 15 of 22 evaluated states and provinces. Comparisons of recent and historical museum and observational records suggest relatively consistent distributions for M. erminea, but a current range gap of \u3e1000 km between two distinct populations of M. nivalis. We observed a dramatic drop-off in M. frenata records since 2000 in portions of its central, Great Lakes, and southern distribution, despite extensive sampling effort. In 2019, systematic trail camera surveys at 1509 sites in 50 US states detected weasels at 14 sites, all of which were above 40o latitude. While none of these datasets are individually conclusive, they collectively support the hypothesis that weasel populations have declined in North America and highlight the need for improved methods for detecting and monitoring weasels. By identifying population declines for small carnivores that were formerly abundant across North America, our findings echo recent calls to expand investigations into the conservation need of small carnivores globally

Patterns of Use of Human Papillomavirus and Other Adolescent Vaccines in the United States

AbstractPurposeThe purpose of the study was to describe the patterns of use of universally recommended adolescent vaccines in the United States.MethodsWe identified 11-year-olds using the MarketScan insurance claims database (2009–2014). Human papillomavirus (HPV), tetanus-diphtheria-acellular pertussis (Tdap), and meningococcal (MenACWY) vaccination claims were identified using diagnosis and procedure codes. Generalized linear models estimated vaccination incidence rates and correlates of adolescent vaccination and timely vaccination.ResultsAmong 1,691,223 adolescents, receipt of Tdap (52.1%) and MenACWY (45.8%) vaccinations exceeded receipt of HPV vaccination (18.4%). While both sexes had similar Tdap and MenACWY vaccination proportions, girls received HPV vaccination more frequently than boys (21.9% vs. 15.1%). Adolescents received HPV vaccination later (mean age: 11.8 years) than Tdap or MenACWY vaccination (mean age: 11.2 years for both). Half of vaccinated adolescents received Tdap and MenACWY vaccination only; however, coadministration with HPV vaccine increased with birth cohort. Western adolescents had the highest incidence rates of HPV vaccination, and Southern adolescents had the lowest. Rural adolescents were less likely than urban adolescents to receive each vaccination except in the Northeast, where they were more likely to receive HPV vaccination (incidence rate ratio: 1.09, 95% confidence interval: 1.2005–1.13). Timely HPV vaccination was associated with female sex, urbanicity, Western residence, and later birth cohort.ConclusionsHPV vaccination occurred later than Tdap or MenACWY vaccination and was less frequent in boys and rural adolescents. Girls, Western and urban residents, and younger birth cohorts were more likely to receive timely HPV vaccination. Vaccine coadministration increased over time and may encourage timely and complete vaccination coverage

Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery

BACKGROUND: Accurate data on costs attributable to hospital-acquired infections are needed in order to determine their economic impact and the cost-benefit of potential preventive strategies. OBJECTIVE: Determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section using two different methods. DESIGN: Retrospective cohort. SETTING: Barnes-Jewish Hospital, a 1250-bed academic tertiary care hospital. PATIENTS: 1,605 women who underwent low transverse cesarean section from 7/1999 – 6/2001. METHODS: Attributable costs of SSI and EMM were determined by generalized least squares (GLS) and propensity score matched-pairs using administrative claims data to define underlying comorbidities and procedures. For the matched-pairs analyses, uninfected control patients were matched to patients with SSI or with EMM based on their propensity to develop infection, and the median difference in costs calculated. RESULTS: The attributable total hospital cost of SSI calculated by GLS was $3,529 and by propensity score matched-pairs was$2,852. The attributable total hospital cost of EMM calculated by GLS was $3,956 and by propensity score matched-pairs was$3,842. The majority of excess costs were associated with room and board and pharmacy costs. CONCLUSIONS: The costs of SSI and EMM were lower than SSI costs reported after more extensive operations. The attributable costs of EMM calculated using the two methods were very similar, while the costs of SSI calculated using propensity score matched-pairs were lower than the costs calculated by GLS. The difference in costs determined by the two methods needs to be considered by investigators performing cost analyses of hospital-acquired infections