Three decades of inequality in neonatal and early childhood mortality in singleton births in Scotland

BACKGROUND: Socioeconomic inequality in child mortality highlights opportunities for policies to reduce child deaths. METHODS: We used singleton birth, death and maternity records from Scotland, 1981-2011, to examine mortality rate differences by age across deprivation quintiles over time. We measured the difference between the most and least deprived quintiles (Q5-Q1) and the slope index of inequality (SII) across all quintiles-measures of the absolute deprivation gap, providing an indication of the public health impact. RESULTS: Q5-Q1 remained relatively constant from 1990 onwards for early neonates, widened in the mid-2000s for late neonates, increased in the 1990 s then decreased in the 2000 s in the post-neonates and declined over time in early childhood. The trend over time in SII showed no significant change for early neonates (P = 0.440), significant decrease for post-neonates (P = 0.010) and early childhood (P = 0.043), and significant increase for late neonates (P = 0.011). CONCLUSIONS: Over three decades, the absolute deprivation gap in mortality widened in late neonates but stabilized or declined at other ages. This may reflect improved survival beyond the early neonatal period of babies with conditions related to socioeconomic inequality such as prematurity. Monitoring birth cohort data could enhance understanding of this vulnerable group

Introduction to the special column: Communication, cooperation, and cognition in predators

Communication is the glue that holds societies together, and many of the benefits that social species gain from living in groups rely on intra-group communication. We might expect that highly social species with more to communicate about will have more complex communication systems and more complex cognitive abilities. Social carnivores are one such group, as they often engage in a number of complex cooperative social behaviors, such as coordinating movement through space while maintaining social cohesion. Cooperative hunting also introduces challenges not present in other collaborative activities, most notably attention to the dynamic behavior of other individuals, whether hunter or prey. We suggest an integrative framework linking the tripartite behavioral complex: communication, cooperation and cognition, and linking multiple interactions between these three elements of behavior, and also the external environment, both physical and social. This special issue emerged from a symposium at a scientific meeting, Behaviour 2015 in Cairns, Australia, and draws together insights into the relationship between communication, cooperation, and cognition from studies of multiple species of cooperative predators. All the studies in this issue raise questions that are relevant for understanding the nature and evolution of complex cognition and cooperation, but also address real-world questions of conservation and management

A Case Study of Cross-Jurisdiction Resource Sharing: The Merger of Two Tuberculosis Clinics in East Tennessee.

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the Tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected improvements of economies of scale such as a reduction in overall staff time. Mechanisms found beneficial in coping with the merger, such as face-to-face meetings between coworkers and management of the different jurisdictions were identified at interview. The clinic merger was associated with a balance of efficiency changes, problems and advantages, and this balance is likely to change as new working arrangements become more routine

The Effects of the State of Tennessee Immunization Policy Change of 2011 - 2012 on Vaccination Uptake in East Tennessee

In the United States, funding for the purchase of vaccines depend on annual Congressional allocations. These allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2012, the loss of funds allocated from the American Recovery and Reinvestment Act required action by states to ensure appropriate use of remaining funds. In Tennessee, the response was a policy change that redefined the population who would receive immunizations at health departments

The Effects of the Changes in Section 317 Rules for Administration of Federally Purchased Vaccines

Section 317 of the Public Health Services Act is a federal program that provides funds for the purchase of vaccines. These annual Congressional allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2013, Section 317 rules redefined the population eligible for immunization with Section 317 purchased vaccines. In Tennessee, the response was a policy change that redefined the population who would receive immunizations at health departments

Acoustic localisation of wildlife with low-cost equipment: Lower sensitivity, but no loss of precision

Abstract Context Synchronised acoustic recorders can be used as a non-invasive tool to detect and localise sounds of interest, including vocal wildlife and anthropogenic sounds. Due to the high cost of commercial synchronised recorders, acoustic localisation has typically been restricted to small or well funded surveys. Recently, low-cost acoustic recorders have been developed, but until now their efficacy has not been compared with higher specification recorders. Aims The present study aimed to compare the efficacy of a newly developed low-cost recorder, the Conservation at Range through Audio Classification and Localisation (CARACAL), with an established, high-end recorder, the Wildlife Acoustics Song Meter (SM). Methods Four recorders of each type were deployed in a paired set-up across five nights in Wisconsin, USA. The recordings allowed for manual identification of domestic dog (Canis familiaris), grey wolf (Canis lupus), coyote (Canis latrans) and barred owl (Strix varia) calls, and then the ability of each recorder type to detect and localise the vocalising animals was compared. Key results The CARACALs were less sensitive, detecting only 47.5% of wolf, 55% of coyote, 65% of barred owl and 82.5% of dog vocalisations detected by the paired SMs. However, when the same vocalisations were detected on both recorders, localisation was comparable, with no significant difference in the precision or maximum detection ranges. Conclusions Low-cost recording equipment can be used effectively for acoustic localisation of both wild and domestic animals. However, the lower sensitivity of the CARACALs means that a denser network of these recorders would be needed to achieve the same efficacy as the SMs. Deploying a greater number of cheaper recorders increases the labour time in the field and the quantity of data to process and store. Thus, there is a trade-off between cost and time to be considered. Implications The ability to use low-cost recorders for acoustic localisation provides new avenues for tracking, managing and researching a wide range of wildlife species. Presently, CARACALs are more suited to monitoring species that have small home ranges and high amplitude vocalisations, and for when a large time investment for in situ equipment checks and data processing is feasible.Christine Stevens Wildlife Award from the Animal Welfare Institut

Visual classification of feral cat Felis silvestris catus vocalizations

Cat vocal behavior, in particular, the vocal and social behavior of feral cats, is poorly understood, as are the differences between feral and fully domestic cats. The relationship between feral cat social and vocal behavior is important because of the markedly different ecology of feral and domestic cats, and enhanced comprehension of the repertoire and potential information content of feral cat calls can provide both better understanding of the domestication and socialization process, and improved welfare for feral cats undergoing adoption. Previous studies have used conflicting classification schemes for cat vocalizations, often relying on onomatopoeic or popular descriptions of call types (e.g., “miow”). We studied the vocalizations of 13 unaltered domestic cats that complied with our behavioral definition used to distinguish feral cats from domestic. A total of 71 acoustic units were extracted and visually analyzed for the construction of a hierarchical classification of vocal sounds, based on acoustic properties. We identified 3 major categories (tonal, pulse, and broadband) that further breakdown into 8 subcategories, and show a high degree of reliability when sounds are classified blindly by independent observers (Fleiss’ Kappa $K$ = 0.863). Due to the limited behavioral contexts in this study, additional subcategories of cat vocalizations may be identified in the future, but our hierarchical classification system allows for the addition of new categories and new subcategories as they are described. This study shows that cat vocalizations are diverse and complex, and provides an objective and reliable classification system that can be used in future studies

Evaluating a computer aid for assessing stomach symptoms (ECASS): study protocol for a randomised controlled trial

Background: For most cancers, only a minority of patients have symptoms meeting the National Institute for Health and Clinical Excellence guidance for urgent referral. For gastro-oesophageal cancers, the ‘alarm’ symptoms of dysphagia and weight loss are reported by only 32 and 8 % of patients, respectively, and their presence correlates with advanced-stage disease. Electronic clinical decision-support tools that integrate with clinical computer systems have been developed for general practice, although uncertainty remains concerning their effectiveness. The objectives of this trial are to optimise the intervention and establish the acceptability of both the intervention and randomisation, confirm the suitability and selection of outcome measures, finalise the design for the phase III definitive trial, and obtain preliminary estimates of the intervention effect. Methods/design: This is a two-arm, multi-centre, cluster-randomised, controlled phase II trial design, which will extend over a 16-month period, across 60 general practices within the North East and North Cumbria and the Eastern Local Clinical Research Network areas. Practices will be randomised to receive either the intervention (the electronic clinical decision-support tool) or to act as a control (usual care). From these practices, we will recruit 3000 adults who meet the trial eligibility criteria and present to their GP with symptoms suggestive of gastro-oesophageal cancer. The main measures are the process data, which include the practitioner outcomes, service outcomes, diagnostic intervals, health economic outcomes, and patient outcomes. One-on-one interviews in a sub-sample of 30 patient-GP dyads will be undertaken to understand the impact of the use or non-use of the electronic clinical decision-support tool in the consultation. A further 10–15 GPs will be interviewed to identify and gain an understanding of the facilitators and constraints influencing implementation of the electronic clinical decision-support tool in practice. Discussion: We aim to generate new knowledge on the process measures regarding the use of electronic clinical decision-support tools in primary care in general and to inform a subsequent definitive phase III trial. Preliminary data on the impact of the support tool on resource utilisation and health care costs will also be collected. Trial registration: ISRCTN Registry, ISRCTN12595588

A global model of malaria climate sensitivity: Comparing malaria response to historic climate data based on simulation and officially reported malaria incidence

Background: The role of the Anopheles vector in malaria transmission and the effect of climate on Anopheles populations are well established. Models of the impact of climate change on the global malaria burden now have access to high-resolution climate data, but malaria surveillance data tends to be less precise, making model calibration problematic. Measurement of malaria response to fluctuations in climate variables offers a way to address these difficulties. Given the demonstrated sensitivity of malaria transmission to vector capacity, this work tests response functions to fluctuations in land surface temperature and precipitation. Methods. This study of regional sensitivity of malaria incidence to year-to-year climate variations used an extended Macdonald Ross compartmental disease model (to compute malaria incidence) built on top of a global Anopheles vector capacity model (based on 10years of satellite climate data). The predicted incidence was compared with estimates from the World Health Organization and the Malaria Atlas. The models and denominator data used are freely available through the Eclipse Foundations Spatiotemporal Epidemiological Modeller (STEM). Results: Although the absolute scale factor relating reported malaria to absolute incidence is uncertain, there is a positive correlation between predicted and reported year-to-year variation in malaria burden with an averaged root mean square (RMS) error of 25% comparing normalized incidence across 86 countries. Based on this, the proposed measure of sensitivity of malaria to variations in climate variables indicates locations where malaria is most likely to increase or decrease in response to specific climate factors. Bootstrapping measures the increased uncertainty in predicting malaria sensitivity when reporting is restricted to national level and an annual basis. Results indicate a potential 20x improvement in accuracy if data were available at the level ISO 3166-2 national subdivisions and with monthly time sampling. Conclusions: The high spatial resolution possible with state-of-the-art numerical models can identify regions most likely to require intervention due to climate changes. Higher-resolution surveillance data can provide a better understanding of how climate fluctuations affect malaria incidence and improve predictions. An open-source modelling framework, such as STEM, can be a valuable tool for the scientific community and provide a collaborative platform for developing such models