Playlab: Telling Stories with Technology (workshop summary)

This one-day workshop explores how playful interaction can be used to develop technologies for public spaces and create temporal experiences

Population Dynamics of Long-tailed Ducks Breeding on the Yukon-Kuskokwim Delta, Alaska

Population estimates for long-tailed ducks in North America have declined by nearly 50% over the past 30 years. Life history and population dynamics of this species are difficult to ascertain, because the birds nest at low densities across a broad range of habitat types. Between 1991 and 2004, we collected information on productivity and survival of long-tailed ducks at three locations on the Yukon-Kuskokwim Delta. Clutch size averaged 7.1 eggs, and nesting success averaged 30%. Duckling survival to 30 days old averaged 10% but was highly variable among years, ranging from 0% to 25%. Apparent annual survival of adult females based on mark-recapture of nesting females was estimated at 74%. We combined these estimates of survival and productivity into a matrix-based population model, which predicted an annual population decline of 19%. Elasticities indicated that population growth rate (?) was most sensitive to changes in adult female survival. Further, the relatively high sensitivity of ? to duckling survival suggests that low duckling survival may be a bottleneck to productivity in some years. These data represent the first attempt to synthesize a population model for this species. Although our analyses were hampered by the small sample sizes inherent in studying a dispersed nesting species, our model provides a basis for management actions and can be enhanced as additional data become available.Les estimations de populations d’hareldes kakawis en Amérique du Nord ont chuté de près de 50 pour cent ces 30 dernières années. Le cycle biologique et la dynamique des populations de cette espèce sont difficiles à établir car ces oiseaux nichent moyennant de faibles densités dans une vaste gamme d’habitats. De 1991 à 2004, nous avons recueilli des données sur la productivité et la survie des hareldes kakawis à trois emplacements du delta Yukon-Kuskokwim. Les couvées atteignaient 7,1 oeufs en moyenne, tandis que le succès de reproduction s’établissait généralement à 30 pour cent. En moyenne, 10 pour cent des jeunes canards survivaient jusqu’à l’âge de 30 jours, mais ce taux variait beaucoup d’une année à l’autre, allant de 0 pour cent à 25 pour cent. Annuellement, d’après la méthode par marquage et recapture des femelles nidificatrices, la survie apparente des femelles adultes était évaluée à 74 pour cent. Nous avons combiné ces estimations de survie et de productivité dans un modèle de population matriciel, ce qui a permis de prédire un déclin de population annuel de 19 pour cent. Selon les élasticités, le taux de croissance de la population (?) était plus sensible aux changements dans le cas de la survie des femelles adultes. Par ailleurs, la sensibilité relativement élevée du ? par rapport à la survie des jeunes canards laisse croire que le faible taux de survie des jeunes canards pourrait présenter une embûche en matière de productivité d’ici quelques années. Ces données représentent la première tentative de synthèse d’un modèle de population pour cette espèce. Bien que nos analyses aient été gênées par la petite taille des échantillons inhérente à l’étude d’espèces de nidification dispersées, notre modèle fournit un fondement permettant d’aboutir à des mesures de gestion en plus de présenter la possibilité d’être amélioré au fur et à mesure que des données supplémentaires sont disponibles

An outbreak investigation of paediatric severe acute respiratory infections requiring admission to intensive care units - Fiji, May 2016

Introduction Influenza-associated severe acute respiratory infections (SARI) are a major contributor to global morbidity and mortality. In response to a cluster of SARI cases and deaths in pregnant women, with two deceased cases testing positive for influenza A(H1N1)pdm09, an investigation was initiated to determine whether there was an increase of paediatric SARI cases admitted to divisional hospital intensive care units in Fiji in may 2016 compared to May 2013-2015. Methods Retrospective case finding was conducted at the paediatric intensive care units (PICUs) in Fiji's three divisional hospitals. Data were collected from 1 January 2013 to 26 May 2016. Cases were identified using a list of clinical diagnoses compatible with SARI. Results A total of 632 cases of paediatric SARI with complete details were identified. The median age of cases was 6 months (Interquartile range: 2-14 months). Children aged less than 5 years had a higher rate of paediatric SARI requiring admission to a divisional hospital PICU in May 2016 compared to May 2013-2015 (Incidence rate ratio: 1.7 [95% CI: 1.1-2.6]). This increase was not observed in children aged 5-14 years. The case-fatality ratio was not significantly different in 2016 compared to previous years. Conclusion The investigation enabled targeted public health response measures, including enhanced SARI surveillance at divisional hospitals and an emergency influenza vaccination campaign in the Northern Division

Barriers and enablers experienced by health care workers in swabbing for COVID-19 in Papua New Guinea: A multi-methods cross-sectional study.

OBJECTIVE: We aimed to identify the barriers and enablers that Health Care Workers (HCWs) in Papua New Guinea experienced in swabbing for COVID-19. METHODS: We conducted a cross-sectional multi-methods study: a qualitative scoping exercise and a telephone survey. The target population was COVID-19-trained HCWs from all provinces of Papua New Guinea. A descriptive analysis of survey responses was conducted alongside a rapid qualitative analysis of interviews and open-ended survey questions. RESULTS: Four thematic areas were identified: human resources, logistics, HCW attitudes and community attitudes. The survey response rate was 70.3% (407/579). Commonly reported barriers to COVID-19 swabbing were insufficient staff trained (74.0%, n = 301), inadequate staffing in general (64.9%, n = 264), insufficient supply of personal protective equipment (60.9%, n = 248) and no cold chain to store swabs (57.5%, n = 234). Commonly reported enablers to swabbing were community awareness and risk communication (80.8%, n = 329), consistent and sufficient supplies of personal protective equipment (67.8%, n = 276), increased surge workforce (63.9%, n = 260) and having a fridge to store swabs (59.7%, n = 243). CONCLUSIONS: A comprehensive community and HCW engagement strategy combined with innovations to improve the supply chain are needed to increase COVID-19 swabbing in Papua New Guinea to reach national testing targets. Investments in increasing numbers of frontline workforce, consistent supplies of PPE, swabs, transport medium, cold boxes and ability to make ice packs, in addtion to establishing regular tranport of specimens from the facility to the testing site will strengthen the supply chain. Innovations are needed to address these issues

Perinatal outcomes after in-utero exposure to beta-blockers in women with heart disease:Data from the ESC EORP registry of pregnancy and cardiac disease (ROPAC)

Background: Beta-blockers are commonly used drugs during pregnancy, especially in women with heart disease, and are regarded as relatively safe although evidence is sparse. Differences between beta-blockers are not well-studied. Methods: In the Registry of Pregnancy And Cardiac disease (ROPAC, n = 5739), a prospective global registry of pregnancies in women with structural heart disease, perinatal outcomes (small for gestational age (SGA), birth weight, neonatal congenital heart disease (nCHD) and perinatal mortality) were compared between women with and without beta-blocker exposure, and between different beta-blockers. Multivariable regression analysis was used for the effect of beta-blockers on birth weight, SGA and nCHD (after adjustment for maternal and perinatal confounders). Results: Beta-blockers were used in 875 (15.2%) ROPAC pregnancies, with metoprolol (n = 323, 37%) and bisoprolol (n = 261, 30%) being the most frequent. Women with beta-blocker exposure had more SGA infants (15.3% vs 9.3%, p &lt; 0.001) and nCHD (4.7% vs 2.7%, p = 0.001). Perinatal mortality rates were not different (1.4% vs 1.9%, p = 0.272). The adjusted mean difference in birth weight was −177 g (−5.8%), the adjusted OR for SGA was 1.7 (95% CI 1.3–2.1) and for nCHD 2.3 (1.6–3.5). With metoprolol as reference, labetalol (0.2, 0.1–0.4) was the least likely to cause SGA, and atenolol (2.3, 1.1–4.9) the most. Conclusions: In women with heart disease an association was found between maternal beta-blocker use and perinatal outcomes. Labetalol seems to be associated with the lowest risk of developing SGA, while atenolol should be avoided.</p

Home-based cardiac rehabilitation: A review

Cardiac rehabilitation has positive effects on mortality, morbidity, quality of life and many cardiac risk factors. Cardiac rehabilitation is usually delivered within a hospital or 'centre' setting, however, home-based programmes may offer greater accessibility and choice to patients. While there have been fewer studies of home-based cardiac rehabilitation, the available data suggest that it is acceptable, safe and effective and has comparable results to hospital-based programmes. Furthermore, home-based cardiac rehabilitation results in longer-lasting maintenance of physical activity levels in patients compared with hospital programmes. It has the potential to be more cost-effective for patients who cannot easily access their local hospital or centre. Home-based cardiac rehabilitation may be particularly useful in patients in a remote or rural setting. Despite the options available and the evidence based benefits, the uptake of cardiac rehabilitation remains low. It is the responsibility of all cardiac health-care workers to ensure that the uptake of cardiac rehabilitation improves

Evaluation of the early warning, alert and response system after Cyclone Winston, Fiji, 2016

To assess the performance of an early warning, alert and response system (EWARS) developed by the World Health Organization (WHO) – EWARS in a Box – that was used to detect and control disease outbreaks after Cyclone Winston caused destruction in Fiji on 20 February 2016

Restraint and Social Isolation Stressors Differentially Regulate Adaptive Immunity and Tumor Angiogenesis in a Breast Cancer Mouse Model

The ability of stress to induce immune suppression is widely recognized, but the mechanisms underlying the effects of stress on the adaptive immune system during tumor progression are not completely understood. To study the effect of stress on the immune system in vivo, we used a preclinical immunocompetent mouse model bearing 4T1 mammary adenocarcinoma cells. Mice were randomized into 4 groups, including social isolation (SI), acute restraint stress (aRRS), chronic restraint stress (cRRS), or no stress (NS). We found that SI significantly decreased the number of tumor-bearing mice still alive at the end of protocol (28 days), compared to NS mice. Although we did not detect significant changes in primary tumor volume, we observed a significant increase in the endothelial marker CD31 in primary tumors of SI mice and in lung metastases in SI and RRS mice. Survival decline in SI mice was associated with significant decreases in splenic CD8 cells and in activated T cells. From a mechanistic standpoint, RRS increased expression of FOXP3, CXCL-10, and granzyme B in mouse tumors, and the effects were reversed by propranolol. Our data demonstrate that various forms of stress differentially impact adaptive immunity and tumor angiogenesis, and negatively impact survival.</jats:p

Association between Class III Obesity (BMI of 40–59 kg/m2) and Mortality: A Pooled Analysis of 20 Prospective Studies

Background: The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity. Methods and Findings: In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19–83 y at baseline, classified as obese class III (BMI 40.0–59.9 kg/m2) compared with those classified as normal weight (BMI 18.5–24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976–2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40–44.9, 45–49.9, 50–54.9, and 55–59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7–7.3), 8.9 (95% CI: 7.4–10.4), 9.8 (95% CI: 7.4–12.2), and 13.7 (95% CI: 10.5–16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report. Conclusions: Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight. Please see later in the article for the Editors' Summar