High Burden of Unrecognized Atrial Fibrillation in Rural India: An Innovative Community-Based Cross-Sectional Screening Program

BACKGROUND: Atrial fibrillation, the world\u27s most common arrhythmia, is a leading risk factor for stroke, a disease striking nearly 1.6 million Indians annually. Early detection and management of atrial fibrillation is a promising opportunity to prevent stroke but widespread screening programs in limited resource settings using conventional methods is difficult and costly. OBJECTIVE: The objective of this study is to screen people for atrial fibrillation in rural western India using a US Food and Drug Administration-approved single-lead electrocardiography device, Alivecor. METHODS: Residents from 6 villages in Anand District, Gujarat, India, comprised the base population. After obtaining informed consent, a team of trained research coordinators and community health workers enrolled a total of 354 participants aged 50 years and older and screened them at their residences using Alivecor for 2 minutes on 5 consecutive days over a period of 6 weeks beginning June, 2015. RESULTS: Almost two-thirds of study participants were 55 years or older, nearly half were female, one-third did not receive any formal education, and more than one-half were from households earning less than US $2 per day. Twelve participants screened positive for atrial fibrillation yielding a sample prevalence of 5.1% (95% CI 2.7-8.7). Only one participant had persistent atrial fibrillation throughout all of the screenings, and 9 screened positive only once. CONCLUSIONS: Our study suggests a prevalence of atrial fibrillation in this Indian region (5.1%) that is markedly higher than has been previously reported in India and similar to the prevalence estimates reported in studies of persons from North America and Europe. Historically low reported burden of atrial fibrillation among individuals from low and middle-income countries may be due to a lack of routine screening. Mobile technologies may help overcome resource limitations for atrial fibrillation screening in underserved and low-resource settings

RAHI-SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program

BACKGROUND: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. PROGRAM DESCRIPTION: Research and Advocacy for Health in India (RAHI, or pathfinder in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or partnership in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI-SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI-SATHI\u27s trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. CONCLUSION: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program

Water supply in hard rock coastal regions : The effect of heterogeneity and kinematic porosity

Water resources in hard rock terrain are difficult to characterize due to heterogeneity and anisotropy in the fracture network, low porosities and limited recharge volumes available during the summer season. Three methods were developed and evaluated in order to assist in water supply planning. A groundwater resources potential index was estimated using multivariate statistics, where physical and geological variables were classified using Analysis of Variance and Fisher's Least Significant Difference tests according to their effect on hydraulic properties. Principal component analysis was used to assign weights to the different classed variables. Classes and weights were used to produce an index referred to as groundwater resources potential (GRP), which correlated significantly with well data. Nearly 80% of the wells with less than median specific capacity values also had GRP values at those locations of zero or lower. Non-stationary variance was observed in specific capacity sub-samples taken from the Geological Survey of Sweden's well archive, despite homogeneous geology and topography. Spatial statistical analyses showed that spatial correlations were weak in well archive samples, implying that regional approximations based on sparse point data are highly error prone. Kinematic porosity estimated using superficial fracture measurements correlated significantly with well archive data. However, low correlation coefficients indicated that well data is likely not a suitable method for predicting water supply characteristics. This approach is an efficient method which shows promise in preliminary estimations of groundwater storage in heterogenic terrains. A groundwater balance model which describes seasonal groundwater storage changes was created in order to better approximate the groundwater situation often found in Swedish urbanized and semi-urbanized hard rock terrains. The model was based on a water budget approach at the pixel scale, and allows for approximation of well extraction which is not uniformly distributed in space. The model showed that in specific regions groundwater extraction may lead to severe decreases in groundwater level, where these impacts may not otherwise be expected. Dry season modelling with 10% increased evapotranspiration showed that in several areas groundwater reservoir depletion may be influenced by more than 50%.QC 20140331</p

Groundwater resources in hard rock coastal terrains : Insights into heterogeneity and spatial variability

Challenges regarding water security in hard rock coastal regions with limited soil cover are: a seasonal absence of recharge during times of peak residency, heterogeneity and variability of the fracture network, close proximity to saline water sources and spatially inconsistent storage and extraction. In areas where it is not feasible to connect residents to municipal water systems, a better understanding of the resilience of reservoirs is needed. The purpose of this study is to investigate and describe the spatial nature of hydraulic data in these types of terrains and present several novel GIS-based groundwater tools with the intent of increasing local water security and aiding in sustainable water resources management. Methods used in this study include groundwater balance modelling and conceptual groundwater storage modelling, as well as a combination of parametric and non-parametric statistical methods such as ANOVA, PCA, correlation and semivariogram analyses. Specific capacity estimates from the Geological Survey of Sweden’s well archive grouped by age or rock type showed very little autocorrelation and in assumed homogeneous geological regions showed statistically significant differences when arbitrarily grouped along a lineament. Estimates of kinematic porosity based on surface fracture data were found have statistically significant correlations with the well data. A GIS-based multivariate prediction tool for assessing Groundwater Resources Potential (GRP) was found to have statistically significant correlations with well data. The GRP method was then combined with a conceptual groundwater storage model and was subsequently found to have statistically significant correlations with chloride concentrations in well quality tests. The storage model was found to have a spatially-dependent sensitivity, meaning that different assumptions within the model had varying effects on the model depending on the geological settings. Incorporating the storage model into a spatial groundwater balance model was then compared with groundwater level time series data over a period of two years, where it was found to have a good explanative capacity and RMSE values of the storage ratio (0.06 to 0.34). Additionally, a soil depth model was developed, tested and found to produce promising results in regions with frequent rock outcrops, where up to 86% of estimates were within 2 m of actual soil depths. Conclusions from this study illustrate the need for a spatial approach to groundwater resources in these types of terrains, and demonstrate a strong potential of several new tools for quantity, capacity and vulnerability estimates to increase water security in a changing climate.Utmaningar för grundvattenförsörjning i kustnära områden med litet jordtäcke inkluderar begränsad grundvattenbildning under sommarsäsongen när behoven av vatten är som störst, heterogenitet i vattenflöde, närhet till saltvattenkällor samt heterogen lagring och uttag. I områden där det inte är möjligt att ansluta boende till kommunala VA-system behövs en bättre förståelse av magasinens uthållighet för att tillgodose vattenbehoven under nuvarande och ändrade klimatförhållanden. Syftet med forskningen har varit att undersöka det rumsliga beteendet hos hydraulisk data och att öka kunskapen om grundvattnets sårbarhet i kustnära områden med kristallin berggrund och tunna jordlager samt att utveckla verktyg för att beräkna vattenuttag och användning i dylika områden. Projekten har bedrivits med hjälp av GIS-verktyg, parametriska och icke-parametriska statistiska metoder såsom ANOVA, PCA, variogramsanalyser och korrelationsanalyser, samt modellering med grundvattenbalanser och grundvattenlagring. Brunnsdata från borrade brunnar, grupperade efter ålder och berggrundstyp visade på svag rumslig korrelation. I områden med en antagen geologisk homogenitet hittades statistiskt signifikanta skillnader i brunnkapacitetsdata vid slumpmässig gruppering längs ett lineament. Uppskattningar av kinematisk porositet baserad på ytliga sprickmätningar har visat statistiskt signifikanta korrelationer med brunnskapacitet. Ett multivariat prediktionsverktyg (GRP) för bedömning av områden med god utvinningskapacitet har utvecklats och visade statistiskt signifikanta korrelationer med kapaciteten från existerande brunnar. GRP-metoden kombinerades sedan med en konceptuell grundvattenmagasinsmodell som visade statistiskt signifikanta korrelationer med kloridhalter tagna från ett brunnskemiarkiv. Magasinsmodellen visade sig ha en rumsligt beroende känslighet, vilket innebar att olika antaganden inom modellen, bland annat avseende geologiska egenskaper i terrängen, hade varierande effekt på modellresultaten. En grundvattenbalansmodell har också utvecklats i GIS och jämförts med verkliga tidserier av grundvattennivå över en tvåårsperiod, med RMSE-värden varierande mellan 0,06 till 0,34. Som hjälp för att beräkna magasineringen i jordlager har en jorddjupsmodell utvecklats och testats vilken visade god överensstämmelse med existerande borrhål i områden med kristallint berg och stor berghällfrekvens. Slutsatserna från dessa studier ger stöd till behovet av att ta hänsyn till det rumsliga förhållandet hos grundvattenresurserna i områden med kristallin berggrund och visar hur den rumsliga variationen kan beskrivas. Ökad kunskap om den rumsliga variationen kan ge möjlighet att utveckla förbättrade uppskattningar av grundvattenresurserna vilket i sin tur kan leda till bättre användning av befintliga vattenresurser. Dessutom har ett flertal nya verktyg utvecklats för potentiella beräkningar av kvantitet, kapacitet och sårbarhetsanalyser för grundvattenresurserna vilka kan användas för att analysera vattensäkerheten vid olika klimat- och markanvändningsscenarier.QC 20190830</p

Groundwater resources in hard rock coastal terrains : Insights into heterogeneity and spatial variability

Challenges regarding water security in hard rock coastal regions with limited soil cover are: a seasonal absence of recharge during times of peak residency, heterogeneity and variability of the fracture network, close proximity to saline water sources and spatially inconsistent storage and extraction. In areas where it is not feasible to connect residents to municipal water systems, a better understanding of the resilience of reservoirs is needed. The purpose of this study is to investigate and describe the spatial nature of hydraulic data in these types of terrains and present several novel GIS-based groundwater tools with the intent of increasing local water security and aiding in sustainable water resources management. Methods used in this study include groundwater balance modelling and conceptual groundwater storage modelling, as well as a combination of parametric and non-parametric statistical methods such as ANOVA, PCA, correlation and semivariogram analyses. Specific capacity estimates from the Geological Survey of Sweden’s well archive grouped by age or rock type showed very little autocorrelation and in assumed homogeneous geological regions showed statistically significant differences when arbitrarily grouped along a lineament. Estimates of kinematic porosity based on surface fracture data were found have statistically significant correlations with the well data. A GIS-based multivariate prediction tool for assessing Groundwater Resources Potential (GRP) was found to have statistically significant correlations with well data. The GRP method was then combined with a conceptual groundwater storage model and was subsequently found to have statistically significant correlations with chloride concentrations in well quality tests. The storage model was found to have a spatially-dependent sensitivity, meaning that different assumptions within the model had varying effects on the model depending on the geological settings. Incorporating the storage model into a spatial groundwater balance model was then compared with groundwater level time series data over a period of two years, where it was found to have a good explanative capacity and RMSE values of the storage ratio (0.06 to 0.34). Additionally, a soil depth model was developed, tested and found to produce promising results in regions with frequent rock outcrops, where up to 86% of estimates were within 2 m of actual soil depths. Conclusions from this study illustrate the need for a spatial approach to groundwater resources in these types of terrains, and demonstrate a strong potential of several new tools for quantity, capacity and vulnerability estimates to increase water security in a changing climate.Utmaningar för grundvattenförsörjning i kustnära områden med litet jordtäcke inkluderar begränsad grundvattenbildning under sommarsäsongen när behoven av vatten är som störst, heterogenitet i vattenflöde, närhet till saltvattenkällor samt heterogen lagring och uttag. I områden där det inte är möjligt att ansluta boende till kommunala VA-system behövs en bättre förståelse av magasinens uthållighet för att tillgodose vattenbehoven under nuvarande och ändrade klimatförhållanden. Syftet med forskningen har varit att undersöka det rumsliga beteendet hos hydraulisk data och att öka kunskapen om grundvattnets sårbarhet i kustnära områden med kristallin berggrund och tunna jordlager samt att utveckla verktyg för att beräkna vattenuttag och användning i dylika områden. Projekten har bedrivits med hjälp av GIS-verktyg, parametriska och icke-parametriska statistiska metoder såsom ANOVA, PCA, variogramsanalyser och korrelationsanalyser, samt modellering med grundvattenbalanser och grundvattenlagring. Brunnsdata från borrade brunnar, grupperade efter ålder och berggrundstyp visade på svag rumslig korrelation. I områden med en antagen geologisk homogenitet hittades statistiskt signifikanta skillnader i brunnkapacitetsdata vid slumpmässig gruppering längs ett lineament. Uppskattningar av kinematisk porositet baserad på ytliga sprickmätningar har visat statistiskt signifikanta korrelationer med brunnskapacitet. Ett multivariat prediktionsverktyg (GRP) för bedömning av områden med god utvinningskapacitet har utvecklats och visade statistiskt signifikanta korrelationer med kapaciteten från existerande brunnar. GRP-metoden kombinerades sedan med en konceptuell grundvattenmagasinsmodell som visade statistiskt signifikanta korrelationer med kloridhalter tagna från ett brunnskemiarkiv. Magasinsmodellen visade sig ha en rumsligt beroende känslighet, vilket innebar att olika antaganden inom modellen, bland annat avseende geologiska egenskaper i terrängen, hade varierande effekt på modellresultaten. En grundvattenbalansmodell har också utvecklats i GIS och jämförts med verkliga tidserier av grundvattennivå över en tvåårsperiod, med RMSE-värden varierande mellan 0,06 till 0,34. Som hjälp för att beräkna magasineringen i jordlager har en jorddjupsmodell utvecklats och testats vilken visade god överensstämmelse med existerande borrhål i områden med kristallint berg och stor berghällfrekvens. Slutsatserna från dessa studier ger stöd till behovet av att ta hänsyn till det rumsliga förhållandet hos grundvattenresurserna i områden med kristallin berggrund och visar hur den rumsliga variationen kan beskrivas. Ökad kunskap om den rumsliga variationen kan ge möjlighet att utveckla förbättrade uppskattningar av grundvattenresurserna vilket i sin tur kan leda till bättre användning av befintliga vattenresurser. Dessutom har ett flertal nya verktyg utvecklats för potentiella beräkningar av kvantitet, kapacitet och sårbarhetsanalyser för grundvattenresurserna vilka kan användas för att analysera vattensäkerheten vid olika klimat- och markanvändningsscenarier.QC 20190830</p

Impact on Soil and Groundwater from Road Maintenance and Traffic: Initial Study of the E18 Highway.

The investigation of environmental impacts of 16 different contaminants originating from the E18 Highway (17 000 AADT) were carried out over the first six months of the highway‘s operational life. Investigative methods used include electrical resistivity surveying, water chemistry analyses, soil analyses, distribution modelling and transportation modelling. The investigation shows conclusively a year round infiltration due to melting of the snowpack from road salt, and a strong preferential anthropogenic pathway due to in-creased hydraulic conductivities of the road building materials relative to the natural soils. The resistivity surveys show values well below the expected values for the highway materials, indicating increased ionic content of the unsaturated zone. Time lapse resistivity modelling shows a clear downwards spreading of contamination from the roadway to subsurface distances greater than 5 m. Elevated concentrations of nearly every contaminant relative to baseline values were observed, with many concentrations of metals in the snow pack averaging values in excess of Swedish EPA groundwater limitations. Distribution modelling demonstrated a potential offset of peak values from the road surface due to ploughing and splash transport processes, but otherwise conformed to established distribution patterns. One dimensional transport modelling demonstrated the importance of adsorption and other retentive factors to the migration of contaminants to the water table, and provided an estimate for potential long term contaminant concentrations