Emergency Department as an epidemiological observatory of Human Mobility: the experience of the Moroccan population

We conducted a retrospective study of the accesses to the Emergency Department registered from January 2000 to December 2014 in 5 major hospitals in the Metropolitan Area of Rome. We extrapolated data relating to patients of Moroccan origin from about 5 million total accesses, so we compared with Italians data which, in the same period, came to ED. The Moroccan population is distinguished by a larger number of diagnoses belonging to the ICD-9 code of Infectious Diseases and, more precisely, to Respiratory Infectious Diseases. There are also no differences in the assignment of such diagnoses to Moroccans with Italian citizenship, and this led to think that this could play an important role in the use of the ED and moreover that enrollment to the National Health Service may reduce its inappropriate use. Regarding to Degenerative Disorders, the result of our analysis is quite emblematic, showing that the accesses to the ED is due to Cardiovascular Diseases: 6.33% of Italians' accesses against 1.81% of Moroccans and 2.36% of Moroccans with Italian citizenship. The main explanation for this difference is, obviously, due to the age of the population: about 60% of Moroccans who accessed to ED was less than 40 years old. It is interesting how, in the field of ​​Cardiovascular Diseases, Moroccans have a lower percentage of diagnosis compared to Italians for acute diseases and a greater percentage of diagnoses for chronic diseases, suggesting once again that accesses to ED for migrants often is due to the inability to use the general services of the National Health Service. In conclusion, from the point of view of the Emergency Department, Migration Medicine still has Infectious Diseases as the main reason for access. Degenerative Disorders remain a prerogative of the Italians, but we could certainly assume that the Moroccan population would develop at some point with the aging

Modeling Perennial Bioenergy Crops in the E3SM Land Model (ELMv2)

Perennial bioenergy crops are increasingly important for the production of ethanol and other renewable fuels, and as part of an agricultural system that alters the climate through its impact on biogeophysical and biogeochemical properties of the terrestrial ecosystem. Few Earth System Models (ESMs) represent such crops, however. In this study, we expand the Energy Exascale Earth System Land Model to include perennial bioenergy crops with a high potential for mitigating climate change. We focus on high-productivity miscanthus and switchgrass, estimating various parameters associated with their different growth stages and performing a global sensitivity analysis to identify and optimize these parameters. The sensitivity analysis identifies five parameters associated with phenology, carbon/nitrogen allocation, stomatal conductance, and maintenance respiration as the most sensitive parameters for carbon and energy fluxes. We calibrated and validated the model against observations and found that the model closely captures the observed seasonality and the magnitude of carbon fluxes. The validated model represents the latent heat flux fairly well, but sensible heat flux for miscanthus is not well captured. Finally, we validated the model against observed leaf area index (LAI) and harvest amount and found modeled LAI captured observed seasonality, although the model underestimates LAI and harvest amount. This work provides a foundation for future ESM analyses of the interactions between perennial bioenergy crops and carbon, water, and energy dynamics in the larger Earth system, and sets the stage for studying the impact of future biofuel expansion on climate and terrestrial systems

Predicting outcomes in pediatric Crohn's disease for management optimization: systematic review and consensus statements from the pediatric inflammatory bowel disease–ahead program

Background & Aims: A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. Methods: A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. Results: Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. Conclusions: These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk

Predicting outcomes in pediatric ulcerative colitis for management optimization: systematic review and consensus statements from the pediatric inflammatory bowel disease–ahead program

Background & Aims: A better understanding of prognostic factors in ulcerative colitis (UC) could improve patient management and reduce complications. We aimed to identify evidence-based predictors for outcomes in pediatric UC, which may be used to optimize treatment algorithms. Methods: Potential outcomes worthy of prediction in UC were determined by surveying 202 experts in pediatric UC. A systematic review of the literature, with selected meta-analysis, was performed to identify studies that investigated predictors for these outcomes. Multiple national and international meetings were held to reach consensus on evidence-based statements. Results: Consensus was reached on 31 statements regarding predictors of colectomy, acute severe colitis (ASC), chronically active pediatric UC, cancer and mortality. At diagnosis, disease extent (6 studies, N = 627; P =.035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n = 318; P <.001), hemoglobin, hematocrit, and albumin may predict colectomy. In addition, family history of UC (2 studies, n = 557; P =.0004), extraintestinal manifestations (4 studies, n = 526; P =.048), and disease extension over time may predict colectomy, whereas primary sclerosing cholangitis (PSC) may be protective. Acute severe colitis may be predicted by disease severity at onset and hypoalbuminemia. Higher Pediatric Ulcerative Colitis Activity Index score and C-reactive protein on days 3 and 5 of hospital admission predict failure of intravenous steroids. Risk factors for malignancy included concomitant diagnosis of primary sclerosing cholangitis, longstanding colitis (>10 years), male sex, and younger age at diagnosis. Conclusions: These evidence-based consensus statements offer predictions to be considered for a personalized medicine approach in treating pediatric UC

Realized ecological forecast through an interactive Ecological Platform for Assimilating Data (EcoPAD, v1.0) into models

Predicting future changes in ecosystem services is not only highly desirable but is also becoming feasible as several forces (e.g., available big data, developed data assimilation (DA) techniques, and advanced cyber-infrastructure) are converging to transform ecological research into quantitative forecasting. To realize ecological forecasting, we have developed an Ecological Platform for Assimilating Data (EcoPAD, v1.0) into models. EcoPAD (v1.0) is a web-based software system that automates data transfer and processing from sensor networks to ecological forecasting through data management, model simulation, data assimilation, forecasting, and visualization. It facilitates interactive data–model integration from which the model is recursively improved through updated data while data are systematically refined under the guidance of model. EcoPAD (v1.0) relies on data from observations, process-oriented models, DA techniques, and the web-based workflow. We applied EcoPAD (v1.0) to the Spruce and Peatland Responses Under Climatic and Environmental change (SPRUCE) experiment in northern Minnesota. The EcoPAD-SPRUCE realizes fully automated data transfer, feeds meteorological data to drive model simulations, assimilates both manually measured and automated sensor data into the Terrestrial ECOsystem (TECO) model, and recursively forecasts the responses of various biophysical and biogeochemical processes to five temperature and two CO2 treatments in near-real time (weekly). Forecasting with EcoPAD-SPRUCE has revealed that mismatches in forecasting carbon pool dynamics are more related to model (e.g., model structure, parameter, and initial value) than forcing variables, opposite to forecasting flux variables. EcoPAD-SPRUCE quantified acclimations of methane production in response to warming treatments through shifted posterior distributions of the CH4:CO2 ratio and the temperature sensitivity (Q10) of methane production towards lower values. Different case studies indicated that realistic forecasting of carbon dynamics relies on appropriate model structure, correct parameterization, and accurate external forcing. Moreover, EcoPAD-SPRUCE stimulated active feedbacks between experimenters and modelers to identify model components to be improved and additional measurements to be taken. It has become an interactive model–experiment (ModEx) system and opens a novel avenue for interactive dialogue between modelers and experimenters. Altogether, EcoPAD (v1.0) acts to integrate multiple sources of information and knowledge to best inform ecological forecasting.</p

Ten-year trends in overweight and obesity in the adult Portuguese population, 1995 to 2005

There is little information regarding the trends in body mass index (BMI) and obesity in the overall Portuguese population, namely if these trends are similar according to educational level. In this study, we assessed the trends in the prevalence of overweight and obesity in the Portuguese population, overall and by educational level. Cross-sectional national health interview surveys conducted in 1995-6 (n = 38,504), 1998-9 (n = 38,688) and 2005-6 (n = 25,348). Data were derived from the population and housing census of 1991 and two geographically-based strata were defined. The sampling unit was the house, and all subjects living in the sampling unit were surveyed. Height and weight were self-reported; the effects of gender, age group and educational level were also assessed by self-reported structured questionnaires. Bivariate comparisons were performed using Chi-square or analysis of variance (ANOVA). Trends in BMI levels were assessed by linear regression analysis, while trends in the prevalence of obesity were assessed by logistic regression. Mean (±standard deviation) BMI increased from 25.2 ± 4.0 in 1995-6 to 25.7 ± 4.5 kg/m² in 2005-6. Prevalence of overweight remained stable (36.1% in 1995-6 and 36.4% in 2005) while prevalence of obesity increased (11.5% in 1995-6 and 15.1% in 2005-6). Similar findings were observed according to age group. Mean age-adjusted BMI increase (expressed in kg/m²/year and 95% confidence interval) was 0.073 (0.062, 0.084), 0.016 (0.000, 0.031) and 0.073 (0.049, 0.098) in men with primary, secondary and university levels, respectively; the corresponding values in women were 0.085 (0.073, 0.097), 0.052 (0.035, 0.069) and 0.062 (0.038, 0.084). Relative to 1995-6, obesity rates increased by 48%, 41% and 59% in men and by 40%, 75% and 177% in women with primary, secondary and university levels, respectively. The corresponding values for overweight were 6%, 1% and 23% in men and 5%, 7% and 65% in women. Between 1995 and 2005, obesity increased while overweight remained stable in the adult Portuguese population. Although higher rates were found among lesser educated subjects, the strong increase in BMI and obesity levels in highly educated subjects is of concern

2016 International Land Model Benchmarking (ILAMB) Workshop Report

As earth system models (ESMs) become increasingly complex, there is a growing need for comprehensive and multi-faceted evaluation of model projections. To advance understanding of terrestrial biogeochemical processes and their interactions with hydrology and climate under conditions of increasing atmospheric carbon dioxide, new analysis methods are required that use observations to constrain model predictions, inform model development, and identify needed measurements and field experiments. Better representations of biogeochemistryclimate feedbacks and ecosystem processes in these models are essential for reducing the acknowledged substantial uncertainties in 21st century climate change projections

Climate control of terrestrial carbon exchange across biomes and continents

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