Actual neighborhood-level crime predicts body mass index z-score changes in a multi-racial/ethnic sample of children

Longitudinal studies are warranted to clarify the influence crime has on health outcomes in children especially children representing multiple racial/ethnic backgrounds. To address this need, the current study examined whether neighborhood-level crime predicted changes in body mass index z (BMIz) scores in 373 White (W), 627 African American (AA), 1020 Hispanic (H), and 88 Asian (A), five to ten year-old boys and girls living in urban neighborhoods. Heights and weights were assessed at baseline (2012) and three-years later and used to calculate BMIz scores. Characteristics of zip codes where students lived during the three-year period were obtained at baseline from various sources. The Crime Risk Index (CRI) for each zip code was calculated using actual crime statistics. Multiple linear regression analyses were conducted to examine associations between baseline CRI and follow-up BMIz scores while controlling for other variables including BMIz at baseline. The CRI and BMIz scores differed significantly by race/ethnicity with the highest values for both noted in H. Regression analyses indicated that the CRI accounted for a significant percentage of the variance in follow-up BMIz scores in the overall sample. When race/ethnicity was considered, the CRI predicted follow-up BMIz scores only in W children. The CRI was not significantly associated with BMIz scores in the other races/ethnicities. The impact actual, neighborhood-level crime has on BMI in children is complex. Based on the existing evidence, considering actual crime as a primary target in obesity prevention would be premature especially in racial/ethnicity minority children living in urban areas

Gynecologic Oncologist Views Influencing Referral to Outpatient Specialty Palliative Care

Early specialty palliative care is underutilized for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists’ views influence outpatient specialty palliative care referral to help inform strategies for improvement

Agricultural practices drive elevated rates of topsoil decline across Kenya, but terracing and reduced tillage can reverse this

As agricultural land area increases to feed an expanding global population, soil erosion will likely accelerate, generating unsustainable losses of soil and nutrients. This is critical for Kenya where cropland expansion and nutrient loading from runoff and erosion is contributing to eutrophication of freshwater ecosystems and desertification. We used the Revised Universal Soil Loss Equation (RUSLE) to predict soil erosion rates under present land cover and potential natural vegetation nationally across Kenya. Simulating natural vegetation conditions allows the degree to which erosion rates are elevated under current land use practices to be determined. This methodology exploits new digital soil maps and two vegetation cover maps to model topsoil (top 20 cm) erosion rates, lifespans (the mass of topsoil divided by erosion rate), and lateral nutrient fluxes (nutrient concentration times erosion rate) under both scenarios. We estimated the mean soil erosion rate under current land cover at ~5.5 t ha−1 yr−1, ~3 times the rate estimated for natural vegetation cover (~1.8 t ha−1 yr−1), and equivalent to ~320 Mt yr−1 of topsoil lost nationwide. Under present erosion rates, ~8.8 Mt, ~315 Kt, and ~ 110 Kt of soil organic carbon, nitrogen and phosphorous are lost from soil every year, respectively. Further, 5.3 % of topsoils (~3.1 Mha), including at >25 % of croplands, have short lifespans (<100 years). Additional scenarios were tested that assume combinations of terracing and reduced tillage practices were adopted on croplands to mitigate erosion. Establishing bench terraces with zoned tillage could reduce soil losses by ≥75 %; up to 87.1 t ha−1 yr−1. These reductions are comparable to converting croplands to natural vegetation, demonstrating most agricultural soils can be conserved successfully. Extensive long-term monitoring of croplands with terraces and reduced tillage established is required to verify the efficacy of these agricultural support practices as indicated by our modelling

Continental aridification and the vanishing of Australia\u27s megalakes

The nature of the Australian climate at about the time of rapid megafaunal extinctions and humans arriving in Australia is poorly understood and is an important element in the contentious debate as to whether humans or climate caused the extinctions. Here we present a new paleoshoreline chronology that extends over the past 100 k.y. for Lake Mega-Frome, the coalescence of Lakes Frome, Blanche, Callabonna and Gregory, in the southern latitudes of central Australia. We show that Lake Mega-Frome was connected for the last time to adjacent Lake Eyre at 50-47 ka, forming the largest remaining interconnected system of paleolakes on the Australian continent. The final disconnection and a progressive drop in the level of Lake Mega-Frome represents a major climate shift to aridification that coincided with the arrival of humans and the demise of the megafauna. The supply of moisture to the Australian continent at various times in the Quaternary has commonly been ascribed to an enhanced monsoon. This study, in combination with other paleoclimate data, provides reliable evidence for periods of enhanced tropical and enhanced Southern Ocean sources of water filling these lakes at different times during the last full glacial cycle. © 2011 Geological Society of America

Community deworming alleviates geohelminth-induced immune hyporesponsiveness

In cross-sectional studies, chronic helminth infections have been associated with immunological hyporesponsiveness that can affect responses to unrelated antigens. To study the immunological effects of deworming, we conducted a cluster-randomized, double-blind, placebo-controlled trial in Indonesia and assigned 954 households to receive albendazole or placebo once every 3 mo for 2 y. Helminth-specific and nonspecific whole-blood cytokine responses were assessed in 1,059 subjects of all ages, whereas phenotyping of regulatory molecules was undertaken in 121 school-aged children. All measurements were performed before and at 9 and 21 mo after initiation of treatment. Anthelmintic treatment resulted in significant increases in proinflammatory cytokine responses to Plasmodium falciparum-infected red blood cells (PfRBCs) and mitogen, with the largest effect on TNF responses to PfRBCs at 9 mo—estimate [95% confidence interval], 0.37 [0.21–0.53], P value over time (Ptime) < 0.0001. Although the frequency of regulatory T cells did not change after treatment, there was a significant decline in the expression of the inhibitory molecule cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) on CD4+ T cells of albendazole-treated individuals, –0.060 [–0.107 to –0.013] and –0.057 [–0.105 to –0.008] at 9 and 21 mo, respectively; Ptime = 0.017. This trial shows the capacity of helminths to up-regulate inhibitory molecules and to suppress proinflammatory immune responses in humans. This could help to explain the inferior immunological responses to vaccines and lower prevalence of inflammatory diseases in low- compared with high-income countries

The quantification of the extent of flooding on selected major Afrotropical lakes to guide management implications

The extent of flooding in vulnerable inland and lacustrine systems can demonstrate the coverage and the magnitude of such phenomenon for policy enhancement. This study examined the extent of flooding due to rising water levels in selected Afrotropical lakes to guide interventions that would sustain the livelihoods of communities affected. The years that were most prone to flooding (2010 and 2020) were used as a baseline in the extraction of changes in spatial extent and area of lacustrine shoreline, and rainfall and satellite altimetry data, using geospatial and remote sensing technologies. The extent of flooding was strongly but insignificantly related (R2 = 0.63; p = 0.07) to the sizes of the studied lakes and the amount of rainfall. Lakes with the smallest surface areas such as Baringo and Naivasha showed the greatest increase in flooding of 52.63% and 42.62%, respectively. Larger lakes such as Lakes Victoria (1.05%), Turkana (3.77%), and Tanganyika (0.07%) had the lowest increases in areal extent. Furthermore, the topography of the lakes studied further determined the residence time and the extent of flooding, such that lakes such as Edward (−0.09%) and Rukwa (−3.25%) receded during the period when other lakes were flooding. The information and data presented here provides the most up-to-date quantification of flooding to support adaptation strategies for inland lake systems and guide policy implementation

Beyond the limits of clinical governance? The case of mental health in English primary care

Background: Little research attention has been given to attempts to implement organisational initiatives to improve quality of care for mental health care, where there is a high level of indeterminacy and clinical judgements are often contestable. This paper explores recent efforts made at an organisational level in England to improve the quality of primary care for people with mental health problems through the new institutional processes of 'clinical governance'. Methods: Framework analysis, based on the Normalisation Process Model (NPM), of attempts over a five year period to develop clinical governance for primary mental health services in Primary Care Trusts (PCTs). The data come from a longitudinal qualitative multiple case-study approach in a purposive sample of 12 PCTs, chosen to reflect a maximum variety of organisational contexts for mental health care provision. Results: The constant change within the English NHS provided a difficult context in which to attempt to implement 'clinical governance' or, indeed, to reconstruct primary mental health care. In the absence of clear evidence or direct guidance about what 'primary mental health care' should be, and a lack of actors with the power or skills to set about realising it, the actors in 'clinical governance' had little shared knowledge or understanding of their role in improving the quality of mental health care. There was a lack of ownership of 'mental health' as an integral, normalised part of primary care. Conclusion: Despite some achievements in regard to monitoring and standardisation of prescribing practice, mental health care in primary care seems to have so far largely eluded the gaze of 'clinical governance'. Clinical governance in English primary mental health care has not yet become normalised. We make some policy recommendations which we consider would assist in the process normalisation and suggest other contexts to which our findings might apply

Do early warning indicators consistently predict nonlinear change in long-term ecological data?

1. Anthropogenic pressures, including climate change, are causing nonlinear changes in ecosystems globally. The development of reliable early warning indicators (EWIs) to predict these changes is vital for the adaptive management of ecosystems and the protection of biodiversity, natural capital and ecosystem services. Increased variance and autocorrelation are potential early warning indicators and can be readily estimated from ecological time series. Here, we undertook a comprehensive test of the consistency between early warning indicators and nonlinear abundance change across species, trophic levels and ecosystem types. 2. We tested whether long-term abundance time series of 55 taxa (126 data sets) across multiple trophic levels in marine and freshwater ecosystems showed (i) significant nonlinear change in abundance ‘turning points’ and (ii) significant increases in variance and autocorrelation (‘early warning indicators’). For each data set, we then quantified the prevalence of three cases: true positives (early warning indicators and associated turning point), false negatives (turning point but no associated early warning indicators) and false positives (early warning indicators but no turning point). 3. True positives were rare, representing only 9% (16 of 170) of cases using variance, and 13% (19 of 152) of cases using autocorrelation. False positives were more prevalent than false negatives (53% vs. 38% for variance; 47% vs. 40% for autocorrelation). False results were found in every decade and across all trophic levels and ecosystems. 4. Time series that contained true positives were uncommon (8% for variance; 6% for autocorrelation), with all but one time series also containing false classifications. Coherence between the types of early warning indicators was generally low with 43% of time series categorized differently based on variance compared to autocorrelation. 5. Synthesis and applications. Conservation management requires effective early warnings of ecosystem change using readily available data, and variance and autocorrelation in abundance data have been suggested as candidates. However, our study shows that they consistently fail to predict nonlinear change. For early warning indicators to be effective tools for preventative management of ecosystem change, we recommend that multivariate approaches of a suite of potential indicators are adopted, incorporating analyses of anthropogenic drivers and process-based understanding