Estimation of potential evapotranspiration from extraterrestrial radiation, air temperature and humidity to assess future climate change effects on the vegetation of the Northern Great Plains, USA

The potential evapotranspiration (PET) that would occur with unlimited plant access to water is a central driver of simulated plant growth in many ecological models. PET is influenced by solar and long wave radiation, temperature, wind speed, and humidity, but it is often modeled as a function of temperature alone. This approach can cause biases in projections of future climate impacts in part because it confounds the effects of warming due to increased greenhouse gases with that which would be caused by increased radiation from the sun. We developed an algorithm for linking PET to extraterrestrial solar radiation (incoming top-of atmosphere solar radiation), as well as temperature and atmospheric water vapor pressure, and incorporated this algorithm into the dynamic global vegetation model MC1. We tested the new algorithm for the Northern Great Plains, USA, whose remaining grasslands are threatened by continuing woody encroachment. Both the new and the standard temperature-dependent MC1 algorithm adequately simulated current PET, as compared to the more rigorous PenPan model of Rotstayn et al. (2006). However, compared to the standard algorithm, the new algorithm projected a much more gradual increase in PET over the 21st century for three contrasting future climates. This difference led to lower simulated drought effects and hence greater woody encroachment with the new algorithm, illustrating the importance of more rigorous calculations of PET in ecological models dealing with climate change

Estimation of potential evapotranspiration from extraterrestrial radiation, air temperature and humidity to assess future climate change effects on the vegetation of the Northern Great Plains, USA

The potential evapotranspiration (PET) that would occur with unlimited plant access to water is a central driver of simulated plant growth in many ecological models. PET is influenced by solar and long wave radiation, temperature, wind speed, and humidity, but it is often modeled as a function of temperature alone. This approach can cause biases in projections of future climate impacts in part because it confounds the effects of warming due to increased greenhouse gases with that which would be caused by increased radiation from the sun. We developed an algorithm for linking PET to extraterrestrial solar radiation (incoming top-of atmosphere solar radiation), as well as temperature and atmospheric water vapor pressure, and incorporated this algorithm into the dynamic global vegetation model MC1. We tested the new algorithm for the Northern Great Plains, USA, whose remaining grasslands are threatened by continuing woody encroachment. Both the new and the standard temperature-dependent MC1 algorithm adequately simulated current PET, as compared to the more rigorous PenPan model of Rotstayn et al. (2006). However, compared to the standard algorithm, the new algorithm projected a much more gradual increase in PET over the 21st century for three contrasting future climates. This difference led to lower simulated drought effects and hence greater woody encroachment with the new algorithm, illustrating the importance of more rigorous calculations of PET in ecological models dealing with climate change

Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique

Introduction The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. We implemented a three-colour triage system in a rural district hospital with lay-staff workers conducting the first triage. Methods A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for ‘green’/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for ‘red’/urgent (IQR 2–40 min). Conclusion In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings

Estimation of potential evapotranspiration from extraterrestrial radiation, air temperature and humidity to assess future climate change effects on the vegetation of the Northern Great Plains, USA

The potential evapotranspiration (PET) that would occur with unlimited plant access to water is a central driver of simulated plant growth in many ecological models. PET is influenced by solar and longwave radiation, temperature, wind speed, and humidity, but it is often modeled as a function of temperature alone. This approach can cause biases in projections of future climate impacts in part because it confounds the effects of warming due to increased greenhouse gases with that which would be caused by increased radiation from the sun. We developed an algorithm for linking PET to extraterrestrial solar radiation (incoming top-of atmosphere solar radiation), as well as temperature and atmospheric water vapor pressure, and incorporated this algorithm into the dynamic global vegetation model MC1. We tested the new algorithm for the Northern Great Plains, USA, whose remaining grasslands are threatened by continuing woody encroachment. Both the new and the standard temperature-dependent MC1 algorithm adequately simulated current PET, as compared to the more rigorous PenPan model of Rotstayn et al. (2006). However, compared to the standard algorithm, the new algorithm projected a much more gradual increase in PET over the 21st century for three contrasting future climates. This difference led to lower simulated drought effects and hence greater woody encroachment with the new algorithm, illustrating the importance of more rigorous calculations of PET in ecological models dealing with climate change.Keywords: Potential evapotranspiration, Great Plains USA, Climate change, Vegetation dynamics, MC

Characterizing the double-sided cascade of care for adolescents living with HIV transitioning to adulthood across Southern Africa

INTRODUCTION: As adolescents and young people living with HIV (AYLH) age, they face a "transition cascade," a series of steps associated with transitions in their care as they become responsible for their own healthcare. In high-income countries, this usually includes transfer from predominantly paediatric/adolescent to adult clinics. In sub-Saharan Africa, paediatric HIV care is mostly provided in decentralized, non-specialist primary care clinics, where "transition" may not necessarily include transfer of care but entails becoming more autonomous for one's HIV care. Using different age thresholds as proxies for when "transition" to autonomy might occur, we evaluated pre- and post-transition outcomes among AYLH. METHODS: We included AYLH aged <16 years at enrolment, receiving antiretroviral therapy (ART) within International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) sites (2004 to 2017) with no history of transferring care. Using the ages of 16, 18, 20 and 22 years as proxies for "transition to autonomy," we compared the outcomes: no gap in care (≥2 clinic visits) and viral suppression (HIV-RNA <400 copies/mL) in the 12 months before and after each age threshold. Using log-binomial regression, we examined factors associated with no gap in care (retention) in the 12 months post-transition. RESULTS: A total of 5516 AYLH from 16 sites were included at "transition" age 16 (transition-16y), 3864 at 18 (transition-18y), 1463 at 20 (transition-20y) and 440 at 22 years (transition-22y). At transition-18y, in the 12 months pre- and post-transition, 83% versus 74% of AYLH had no gap in care (difference 9.3 (95% confidence interval (CI) 7.8 to 10.9)); while 65% versus 62% were virally suppressed (difference 2.7 (-1.0 to 6.5%)). The strongest predictor of being retained post-transition was having no gap in the preceding year, across all transition age thresholds (transition-16y: adjusted risk ratio (aRR) 1.72; 95% CI (1.60 to 1.86); transition-18y: aRR 1.76 (1.61 to 1.92); transition-20y: aRR 1.75 (1.53 to 2.01); transition-22y: aRR 1.47; (1.21 to 1.78)). CONCLUSIONS: AYLH with gaps in care need targeted support to prevent non-retention as they take on greater responsibility for their healthcare. Interventions to increase virologic suppression rates are necessary for all AYLH ageing to adulthood

Hepatitis B infection, viral load and resistance in HIV-infected patients in Mozambique and Zambia

BACKGROUND: Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa. METHODS: We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine ® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression. RESULTS: Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir. CONCLUSION: One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults

The TMI-2 accident evaluation program

The accident at the Three Mile Island Unit 2 (TMI-2) reactor, now 10 years old, remains as the United States&#x27; worst commercial nuclear reactor accident. Although the consequences of the accident were restricted primarily to the plant itself, the potential consequences of the accident, should it have progressed further, are large enough to warrant close scrutiny of all aspects of the event. TMI-2 accident research is being conducted by the US Department of Energy (DOE) to provide the basis for more accurate calculations of source terms for postulated severe accidents. Research objectives supporting this goal include developing a comprehensive and consistent understanding of the mechanisms that controlled the progression of core damage and subsequent fission product behavior during the TMI-2 accident, and applying that understanding to the resolution of important severe accident safety issues. Developing a best-estimate scenario of the core melt progression during the accident is the focal point of the research and involves analytical work to interpret and integrate: (1) data recorded during the accident from plant instrumentation, (2) the post-accident state of the core, (3) results of the examination of material from the damaged core, and (4) related severe-accident research results. This paper summarizes the TMI-2 Accident Evaluation Program that is being conducted for the USDOE and briefly describes the important results that have been achieved. The Program is divided into four parts: Sample Acquisition and Plant Examination, Accident Scenario, Standard Problem Exercise, and Information and Industry Coordination