What happens to the natural environment when rural communities join the global economy? a case study from Nepal

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As rubber plantations expand in the highlands of Southeast Asia, what happens to local farmers?

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Bad news: analysis of the quality of information on influenza prevention returned by Google in English and Italian

Information available to the public influences the approach of the population toward vaccination against influenza compared with other preventative approaches. In this study, we have analyzed the first 200 websites returned by searching Google on two topics (prevention of influenza and influenza vaccine), in English and Italian. For all the four searches above, websites were classified according to their typology (government, commercial, professional, portals, etc.) and for their trustworthiness as defined by the Journal of the American Medical Association (JAMA) score, which assesses whether they provide some basic elements of information quality (IQ): authorship, currency, disclosure, and references. The type of information described was also assessed to add another dimension of IQ. Websites on influenza prevention were classified according to the type of preventative approach mentioned (vaccine, lifestyle, hygiene, complementary medicine, etc.), whether the approaches were in agreement with evidence-based medicine (EBM) or not. Websites on influenza vaccination were classified as pro- or anti-vaccine, or neutral. The great majority of websites described EBM approaches to influenza prevention and had a pro-vaccine orientation. Government websites mainly pointed at EBM preventative approaches and had a pro-vaccine orientation, while there was a higher proportion of commercial websites among those which promote non-EBM approaches. Although the JAMA score was lower in commercial websites, it did not correlate with the preventative approaches suggested or the orientation toward vaccines. For each of the four search engine result pages (SERP), only one website displayed the health-of-the-net (HON) seal. In the SERP on vaccines, journalistic websites were the most abundant category and ranked higher than average in both languages. Analysis using natural language processing showed that journalistic websites were mostly reporting news about two specific topics (different in the two languages). While the ranking by Google favors EBM approaches and, in English, does not promote commercial websites, in both languages it gives a great advantage to news. Thus, the type of news published during the influenza season probably has a key importance in orienting the public opinion due to its high visibility. This raises important questions on the relationships between health IQ, trustworthiness, and newsworthiness

Forest, agriculture, and migration: contemplating the future of forestry and agriculture in the middle-hills of Nepal

Nepal has experienced rapid transitions in forest and agricultural practices over the last several decades. This study compares surveys of forest cover, land use, demographic and socioeconomic characteristics of six sites in Sindhu Kabhre and Palanchok Districts conducted in 1992 and 2017. We correlated these transformations with changes in forest cover as documented with remotely sensed images. We found that forest cover has increased tremendously; farmers are less reliant on forests and forest products, and occupational multiplicity, where households create a nexus of activities, some on farm and others elsewhere, may offer a stable situation for the future of these villages

The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care

Post-Burst Quasi-Periodic Oscillations from GRO J1744-28 and from the Rapid Burster

The repetitive X-ray bursts from the accretion-powered pulsar GRO J1744-28 show similarities to the type II X-ray bursts from the Rapid Burster. Several authors (notably Lewin et al.) have suggested that the bursts from GRO J1744-28 are type II bursts (which arise from the sudden release of gravitational potential energy). In this paper, we present another similarity between these sources. Rossi X-ray Timing Explorer observations of GRO J1744-28 show that at least 10 out of 94 bursts are followed by quasi-periodic oscillations (QPO) with frequencies of about 0.4 Hz. The period of the oscillations decreases over their 30--80 s lifetime, and they occur during a spectrally hard ``shoulder'' (or ``plateau'') which follows the burst. In one case the QPO show a modulation envelope which resembles simple beating between two narrow-band oscillations at 0.325 and 0.375 Hz. Using EXOSAT observations, Lubin et al. found QPO with frequencies of 0.039 to 0.056 Hz following 10 out of 95 type II bursts from the Rapid Burster. As in GRO J1744-28, the period of these oscillations decreased over their 100 s lifetime, and they occurred only during spectrally hard ``humps'' in the persistent emission. Even though the QPO frequencies differ by a factor of 10, we believe that this is further evidence that a similar accretion disk instability is responsible for the type II bursts from these two sources.Comment: 7 pages, LaTeX, 2 figures, to appear in the Astrophysical Journal Letter

Comparison of Economic Evaluation Methods Across Low-income, Middle-income and High-income Countries: What are the Differences and Why?

There are marked differences in methods used for undertaking economic evaluations across low-income, middle-income, and high-income countries. We outline the most apparent dissimilarities and reflect on their underlying reasons. We randomly sampled 50 studies from each of three country income groups from a comprehensive database of 2844 economic evaluations published between January 2012 and May 2014. Data were extracted on ten methodological areas: (i) availability of guidelines; (ii) research questions; (iii) perspective; (iv) cost data collection methods; (v) cost data analysis; (vi) outcome measures; (vii) modelling techniques; (viii) cost-effectiveness thresholds; (ix) uncertainty analysis; and (x) applicability. Comparisons were made across income groups and odds ratios calculated. Contextual heterogeneity rightly drives some of the differences identified. Other differences appear less warranted and may be attributed to variation in government health sector capacity, in health economics research capacity and in expectations of funders, journals and peer reviewers. By highlighting these differences, we seek to start a debate about the underlying reasons why they have occurred and to what extent the differences are conducive for methodological advancements. We suggest a number of specific areas in which researchers working in countries of differing environments could learn from one another