Cost-effectiveness of an ambulance-based referral system for emergency obstetrical and neonatal care in rural Ethiopia

Background: To estimate the cost-effectiveness of an ambulance-based referral system an dedicated to emergency obstetrics and neonatal care (EmONC) in remote sub-Saharan settings. Methods: In this prospective study performed in Oromiya Region (Ethiopia), all obstetrical cases referred to the hospital with the ambulance were consecutively evaluated during a three-months period. The health professionals who managed the referred cases were requested to identify those that could be considered as undoubtedly effective. Pre and post-referral costs included those required to run the ambulance service and the additional costs necessary for the assistance in the hospital. Local life expectancy tables were used to calculate the number of year saved. Results: A total of 111 ambulance referrals were recorded. The ambulance was undoubtedly effective for 9 women and 4 newborns, corresponding to 336 years saved. The total cost of the intervention was 8299 US dollars. The cost per year life saved was 24.7 US dollars which is below the benchmarks of 150 and 30 US dollars that define attractive and very attractive interventions. Sensitivity analyses on the rate of effective referrals, on the costs of the ambulance and on the discount rate confirmed the robustness of the result. Conclusions: An ambulance-based referral system for EmONC in remote sub-Saharan areas appears highly cost-effective

State of the climate in 2018

In 2018, the dominant greenhouse gases released into Earth’s atmosphere—carbon dioxide, methane, and nitrous oxide—continued their increase. The annual global average carbon dioxide concentration at Earth’s surface was 407.4 ± 0.1 ppm, the highest in the modern instrumental record and in ice core records dating back 800 000 years. Combined, greenhouse gases and several halogenated gases contribute just over 3 W m−2 to radiative forcing and represent a nearly 43% increase since 1990. Carbon dioxide is responsible for about 65% of this radiative forcing. With a weak La Niña in early 2018 transitioning to a weak El Niño by the year’s end, the global surface (land and ocean) temperature was the fourth highest on record, with only 2015 through 2017 being warmer. Several European countries reported record high annual temperatures. There were also more high, and fewer low, temperature extremes than in nearly all of the 68-year extremes record. Madagascar recorded a record daily temperature of 40.5°C in Morondava in March, while South Korea set its record high of 41.0°C in August in Hongcheon. Nawabshah, Pakistan, recorded its highest temperature of 50.2°C, which may be a new daily world record for April. Globally, the annual lower troposphere temperature was third to seventh highest, depending on the dataset analyzed. The lower stratospheric temperature was approximately fifth lowest. The 2018 Arctic land surface temperature was 1.2°C above the 1981–2010 average, tying for third highest in the 118-year record, following 2016 and 2017. June’s Arctic snow cover extent was almost half of what it was 35 years ago. Across Greenland, however, regional summer temperatures were generally below or near average. Additionally, a satellite survey of 47 glaciers in Greenland indicated a net increase in area for the first time since records began in 1999. Increasing permafrost temperatures were reported at most observation sites in the Arctic, with the overall increase of 0.1°–0.2°C between 2017 and 2018 being comparable to the highest rate of warming ever observed in the region. On 17 March, Arctic sea ice extent marked the second smallest annual maximum in the 38-year record, larger than only 2017. The minimum extent in 2018 was reached on 19 September and again on 23 September, tying 2008 and 2010 for the sixth lowest extent on record. The 23 September date tied 1997 as the latest sea ice minimum date on record. First-year ice now dominates the ice cover, comprising 77% of the March 2018 ice pack compared to 55% during the 1980s. Because thinner, younger ice is more vulnerable to melting out in summer, this shift in sea ice age has contributed to the decreasing trend in minimum ice extent. Regionally, Bering Sea ice extent was at record lows for almost the entire 2017/18 ice season. For the Antarctic continent as a whole, 2018 was warmer than average. On the highest points of the Antarctic Plateau, the automatic weather station Relay (74°S) broke or tied six monthly temperature records throughout the year, with August breaking its record by nearly 8°C. However, cool conditions in the western Bellingshausen Sea and Amundsen Sea sector contributed to a low melt season overall for 2017/18. High SSTs contributed to low summer sea ice extent in the Ross and Weddell Seas in 2018, underpinning the second lowest Antarctic summer minimum sea ice extent on record. Despite conducive conditions for its formation, the ozone hole at its maximum extent in September was near the 2000–18 mean, likely due to an ongoing slow decline in stratospheric chlorine monoxide concentration. Across the oceans, globally averaged SST decreased slightly since the record El Niño year of 2016 but was still far above the climatological mean. On average, SST is increasing at a rate of 0.10° ± 0.01°C decade−1 since 1950. The warming appeared largest in the tropical Indian Ocean and smallest in the North Pacific. The deeper ocean continues to warm year after year. For the seventh consecutive year, global annual mean sea level became the highest in the 26-year record, rising to 81 mm above the 1993 average. As anticipated in a warming climate, the hydrological cycle over the ocean is accelerating: dry regions are becoming drier and wet regions rainier. Closer to the equator, 95 named tropical storms were observed during 2018, well above the 1981–2010 average of 82. Eleven tropical cyclones reached Saffir–Simpson scale Category 5 intensity. North Atlantic Major Hurricane Michael’s landfall intensity of 140 kt was the fourth strongest for any continental U.S. hurricane landfall in the 168-year record. Michael caused more than 30 fatalities and $25 billion (U.S. dollars) in damages. In the western North Pacific, Super Typhoon Mangkhut led to 160 fatalities and$6 billion (U.S. dollars) in damages across the Philippines, Hong Kong, Macau, mainland China, Guam, and the Northern Mariana Islands. Tropical Storm Son-Tinh was responsible for 170 fatalities in Vietnam and Laos. Nearly all the islands of Micronesia experienced at least moderate impacts from various tropical cyclones. Across land, many areas around the globe received copious precipitation, notable at different time scales. Rodrigues and Réunion Island near southern Africa each reported their third wettest year on record. In Hawaii, 1262 mm precipitation at Waipā Gardens (Kauai) on 14–15 April set a new U.S. record for 24-h precipitation. In Brazil, the city of Belo Horizonte received nearly 75 mm of rain in just 20 minutes, nearly half its monthly average. Globally, fire activity during 2018 was the lowest since the start of the record in 1997, with a combined burned area of about 500 million hectares. This reinforced the long-term downward trend in fire emissions driven by changes in land use in frequently burning savannas. However, wildfires burned 3.5 million hectares across the United States, well above the 2000–10 average of 2.7 million hectares. Combined, U.S. wildfire damages for the 2017 and 2018 wildfire seasons exceeded $40 billion (U.S. dollars)

Gender Inequalities in Remote Settings : Analysis of 105,025 Medical Records of a Rural Hospital in Ethiopia (2005-2015)

Gender inequalities in Sub-Saharan Africa are deemed relevant but data to support this view are scanty. Retrospective analysis of a large dataset of 105,025 patients admitted to an Ethiopian rural private, non-for-profit hospital over a 11\ua0years period (2005-2015). Since 2001, the hospital and the local community are involved in a long-term, comprehensive and externally-supported health care intervention. The total number of admissions was higher for females (61.9% of the total) mainly because of the high frequency of admissions for obstetrics conditions. The total male-to-female ratio (M:F) was 0.6. Except for malaria, men had more admissions for the other leading causes, with the highest M:F being found for injuries (2.7) and musculoskeletal diseases (1.7). Overall, excluding admissions for pregnancy-related issues, the M:F was 1.4. The frequency of admissions changed with age and gender. Female admissions prevailed in the reproductive age period (from 15 to 44\ua0years of age) while males admissions prevailed in the younger and older age groups. The case fatality rate was higher for men (M:F\u2009=\u20092.0). The total M:F and the M:F excluding pregnancy-related admissions did not change during the study period. Gender inequalities do exist in rural remote setting but tend to affect women differently during their lifespan. Even if gender inequalities generally favor males, the substantial proportion of admissions for pregnancy-related situations is encouraging

Biocarburants en Europe Developpements, applications, perspectives 1994-2004, Tours (France), 9-11 mai 1994

SIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : RP 400 (1939) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Etude du fonctionnement d'une pile a combustible

SIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : RP 400 (1958) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Influence des caracteristiques du bois sur le collage haute frequence

SIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : RP 400 (1792) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Feasibility of the 4 per 1000 aspirational target for soil carbon: A case study for France

International audienceIncreasing soil organic carbon (SOC) stocks is a promising way to mitigate the increase in atmospheric CO2 concentration. Based on a simple ratio between CO2 anthropogenic emissions and SOC stocks worldwide, it has been suggested that a 0.4% (4 per 1000) yearly increase in SOC stocks could compensate for current anthropogenic CO2 emissions. Here, we used a reverse RothC modelling approach to estimate the amount of C inputs to soils required to sustain current SOC stocks and to increase them by 4 parts per thousand per year over a period of 30 years. We assessed the feasibility of this aspirational target first by comparing the required C input with net primary productivity (NPP) flowing to the soil, and second by considering the SOC saturation concept. Calculations were performed for mainland France, at a 1 km grid cell resolution. Results showed that a 30%-40% increase in C inputs to soil would be needed to obtain a 4 parts per thousand increase per year over a 30-year period. 88.4% of cropland areas were considered unsaturated in terms of mineral-associated SOC, but characterized by a below target C balance, that is, less NPP available than required to reach the 4 parts per thousand aspirational target. Conversely, 90.4% of unimproved grasslands were characterized by an above target C balance, that is, enough NPP to reach the 4 parts per thousand objective, but 59.1% were also saturated. The situation of improved grasslands and forests was more evenly distributed among the four categories (saturated vs. unsaturated and above vs below target C balance). Future data from soil monitoring networks should enable to validate these results. Overall, our results suggest that, for mainland France, priorities should be (1) to increase NPP returns in cropland soils that are unsaturated and have a below target carbon balance and (2) to preserve SOC stocks in other land uses