Forest Response to Chronic Hurricane Disturbance in Coastal New England

Question: Hurricanes and cyclones cause a wide range of damage to coastal forests worldwide. Most of these storms are not catastrophic in ecological terms, but forest responses to storms of moderate intensities are poorly understood. In regions with a high frequency of moderate hurricanes, how does variation in disturbance intensity affect the magnitude of ecological responses? Location: Naushon Island, Massachusetts USA Methods: We use historical records and dendroecological methods to characterize establishment and growth of Fagus grandifolia, Quercus alba and Quercus velutina in response to seven non-catastrophic hurricanes of varying intensity and a major logging event, relative to baseline conditions, over the past ~ 150 years. Our aim was to document variation in the magnitude of responses to known disturbance events of varying intensity, and to determine whether tree growth after moderate hurricanes differs from growth during periods of no disturbance. Results: Forest harvesting in 1824-1827 had a strong impact on forest composition and growth. Since then, the study region has been characterized by little harvesting but frequent hurricanes. However, only one of the seven storms examined caused substantial increases in growth and new establishment for the dominant species; most moderate disturbances had minimal impacts on growth and regeneration dynamics. We also document highly variable responses among species to individual storms, including substantial growth decreases that may not be detected by standard analytical approaches. Conclusions: Our results caution against the use of simple metrics such as wind speed to predict forest response to specific hurricanes, and highlight the importance of individual disturbance events in controlling long-term forest dynamics, even in regions characterized by high disturbance frequency. Additionally, we show that standard approaches to reconstructing disturbance history based on increases in radial growth and pulses of tree establishment are likely to underestimate the frequency of moderate disturbances.Other Research Uni

Security and skills: the two key issues in health worker migration.

BACKGROUND: Migration of health workers from Africa continues to undermine the universal provision of quality health care. South Africa is an epicentre for migration--it exports more health workers to high-income countries than any other African country and imports health workers from its lower-income neighbours to fill the gap. Although an inter-governmental agreement in 2003 reduced the very high numbers migrating from South Africa to the United Kingdom, migration continues to other high-income English-speaking countries and few workers seem to return although the financial incentive to work abroad has lessened. A deeper understanding of reasons for migration from South Africa and post-migration experiences is therefore needed to underpin policy which is developed in order to improve retention within source countries and encourage return. METHODS: Semi-structured interviews were conducted with 16 South African doctors and nurses who had migrated to the United Kingdom. Interviews explored factors influencing the decision to migrate and post-migration experiences. RESULTS: Salary, career progression, and poor working conditions were not major push factors for migration. Many health workers reported that they had previously overcome these issues within the South African healthcare system by migrating to the private sector. Overwhelmingly, the major push factors were insecurity, high levels of crime, and racial tension. Although the wish to work and train in what was perceived to be a first-class care system was a pull factor to migrate to the United Kingdom, many were disappointed by the experience. Instead of obtaining new skills, many (particularly nurses) felt they had become 'de-skilled'. Many also felt that working conditions and opportunities for them in the UK National Health Service (NHS) compared unfavourably with the private sector in South Africa. CONCLUSIONS: Migration from South Africa seems unlikely to diminish until the major concerns over security, crime, and racial tensions are resolved. However, good working conditions in the private sector in South Africa provide an occupational incentive to return if security did improve. Potential migrants should be made more aware of the risks of losing skills while working abroad that might prejudice return. In addition, re-skilling initiatives should be encouraged

Comparing the Job Satisfaction and Intention to Leave of Different Categories of Health Workers in Tanzania, Malawi, and South Africa.

Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave. We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date

Editorial: The role of dispersal and transmission in structuring microbial communities

Microbial communities influence the systems they inhabit by driving ecosystem processes and promoting the health and fitness of plant and animals hosts. While an extensive body of work has documented variation in microbial community membership across hosts and systems, understanding the drivers of this variation remains a challenge. Much of the focus of these efforts has been on the characterization of host variation or the abiotic environment, and has overlooked the role of dispersal, i.e., the movement of organisms across space, and transmission, i.e., the movement of microbes among environments, hosts and between hosts and their environment

A Hypothetical Bottleneck in the Plant Microbiome

The plant microbiome may be bottlenecked at the level of endophytes of individual seeds. Strong defense of developing seeds is predicted by optimal defense theory, and we have experimentally demonstrated exclusionary interactions among endophytic microbes infecting individual seeds of Centaurea stoebe. Having found a single, PDA-culturable microbe per seed or none in an exploratory study with Centaurea stoebe, we completed a more extensive survey of an additional 98 plant species representing 39 families. We again found that individual, surface-sterilized seeds of all species hosted only one PDA-culturable bacterial or fungal endophyte per seed, or none. PDA-unculturables were not determined but we expect them to also be bottlenecked in individual seeds, as they too should be governed by exclusionary interactions. If the bottleneck were confirmed with high-throughput sequencing of individual seeds then it would make sense to further investigate the Primary Symbiont Hypothesis (PSH). This includes the prediction that primary symbionts (i.e., the winners of the exclusionary battles among seed endophytes) have strong effects on seedlings depending on symbiont identity

The National and International Implications of a Decade of Doctor Migration in the Irish Context

Background: Between 2000 and 2010, Ireland became increasingly dependent on foreign-trained doctors to staff its health system. An inability to train and retain sufficient doctors to meet demand is the primary reason for the dependence on foreign-trained doctors. By 2008 the proportion of foreign-trained doctors was the second highest in the OECD. This increased dependence on international medical migration has both national and international policy implications. Methods: Registration data were obtained from the Medical Council of Ireland (MCI) for a ten year period: 2000-2010. Data indicate country of qualification but not nationality. The total number of registrants and entrants (n) was determined for each year. Immigration data were also obtained on the number of work visas issued to doctors. Registration and visa data were then compared in order to estimate doctor migration to Ireland 2000-2010. Results: The proportion of foreign-trained doctors rose from 13.4% of all registered doctors in 2000 to 33.4% by 2010. The largest increase was in foreign-trained doctors from outside the EU, rising from 972 (7.4%) in 2000 to 4,740 (25.3%) of registered doctors in 2010. The biggest source country in 2000 was Pakistan. By 2010, South Africa had become the biggest source country. The number of foreign-trained doctors from other EU countries doubled from 780 in 2000 to 1,521 in 2010. Conclusions: Registration data are likely to over-estimate and visa data under-estimate the numbers of doctors actively working in Ireland. However, they serve to illustrate Ireland’s rapidly increasing and potentially unsustainable reliance on foreign-trained doctors; and to highlight the need for better data to measure migratory flows. Improved measurement of health worker migration is necessary both for national workforce planning and to fulfil the requirements of the WHO Global Code on the International Recruitment of Health Personnel

Perceived Sufficiency of Full-Field Digital Mammograms With and Without Irreversible Image Data Compression for Comparison with Next-Year Mammograms

Problems associated with the large file sizes of digital mammograms have impeded the integration of digital mammography with picture archiving and communications systems. Digital mammograms irreversibly compressed by the novel wavelet Access Over Network (AON) compression algorithm were compared with lossless-compressed digital mammograms in a blinded reader study to evaluate the perceived sufficiency of irreversibly compressed images for comparison with next-year mammograms. Fifteen radiologists compared the same 100 digital mammograms in three different comparison modes: lossless-compressed vs 20:1 irreversibly compressed images (mode 1), lossless-compressed vs 40:1 irreversibly compressed images (mode 2), and 20:1 irreversibly compressed images vs 40:1 irreversibly compressed images (mode 3). Compression levels were randomly assigned between monitors. For each mode, the less compressed of the two images was correctly identified no more frequently than would occur by chance if all images were identical in compression. Perceived sufficiency for comparison with next-year mammograms was achieved by 97.37% of the lossless-compressed images and 97.37% of the 20:1 irreversibly compressed images in mode 1, 97.67% of the lossless-compressed images and 97.67% of the 40:1 irreversibly compressed images in mode 2, and 99.33% of the 20:1 irreversibly compressed images and 99.19% of the 40:1 irreversibly compressed images in mode 3. In a random-effect analysis, the irreversibly compressed images were found to be noninferior to the lossless-compressed images. Digital mammograms irreversibly compressed by the wavelet AON compression algorithm were as frequently judged sufficient for comparison with next-year mammograms as lossless-compressed digital mammograms

Beauty in proofs: Kant on aesthetics in mathematics

It is a common thought that mathematics can be not only true but also beautiful, and many of the greatest mathematicians have attached central importance to the aesthetic merit of their theorems, proofs and theories. But how, exactly, should we conceive of the character of beauty in mathematics? In this paper I suggest that Kant's philosophy provides the resources for a compelling answer to this question. Focusing on §62 of the ‘Critique of Aesthetic Judgment’, I argue against the common view that Kant's aesthetics leaves no room for beauty in mathematics. More specifically, I show that on the Kantian account beauty in mathematics is a non-conceptual response felt in light of our own creative activities involved in the process of mathematical reasoning. The Kantian proposal I thus develop provides a promising alternative to Platonist accounts of beauty widespread among mathematicians. While on the Platonist conception the experience of mathematical beauty consists in an intellectual insight into the fundamental structures of the universe, according to the Kantian proposal the experience of beauty in mathematics is grounded in our felt awareness of the imaginative processes that lead to mathematical knowledge. The Kantian account I develop thus offers to elucidate the connection between aesthetic reflection, creative imagination and mathematical cognition

A multi-centre quality improvement project to reduce the incidence of obstetric anal sphincter injury (OASI): study protocol.

BACKGROUND: Third and fourth degree perineal tears, or obstetric anal sphincter injuries (OASI), sustained during childbirth can result in anal incontinence and psychosocial problems which require ongoing treatment. Within the English National Health System (NHS) reported rates of OASI have gradually increased. In response, a care bundle was developed incorporating four elements: 1) antenatal information to women, 2) manual perineal protection during all vaginal births, 3) episiotomy to be performed with a 60° mediolateral angle at crowning (when clinically indicated) and 4) perineal examination (including per rectum) after childbirth. Implementation of the OASI Care Bundle is aided by a skills development module and an awareness campaign. The project is a collaboration between two national professional bodies, an NHS hospital trust and an academic institution. METHODS: Implementation of the OASI Care Bundle will be evaluated using a stepped-wedge design. From January 2017 sixteen maternity units across England, Wales and Scotland will participate in the study over a 15-month period, with sequential roll-out of the intervention in four blocks (regions) of four units. The primary clinical outcome is OASI rate. Regression analysis will adjust for differences in organisational characteristics and obstetric risk factors in women who gave birth before and after implementation of the care bundle. Focus group discussions and in-depth interviews with clinicians will evaluate the feasibility of integrating the care bundle into routine practice. Interviews with women will explore the acceptability of the intervention. DISCUSSION: This protocol outlines the evaluation of our quality improvement project which aims to prevent OASI using a bundle of evidence-based interventions that are each widely used in practice. The OASI project aims to 1) standardise practice to prevent OASI in a way that is acceptable to clinicians and women and 2) identify the barriers and enablers associated with upscaling interventions within maternity units. If found to be effective, feasible and acceptable, the OASI Care Bundle will be shared with a range of audiences using the communication channels available to the professional bodies. TRIAL REGISTRATION: The OASI Project was retrospectively registered on the ISCTRN12143325 database date assigned 03/10/2017