Evaluation Of The Ltbi Cascade Of Care At The Winchester Chest Clinic

Background: Latent tuberculosis infections affect around two billion people world-wide. In order to effectively control and reduce TB incidence, latent TB cases must be identified and treated. The latent TB cascade of care involves screening, diagnosis, evaluation, prescription of a treatment regimen, and completion of treatment. Existing studies have identified low rates of LTBI treatment completion among patients in diverse settings. Objective: The aim of this study was to assess certain steps in the cascade of care among the LTBI-positive patients referred to the Winchester Chest Clinic in order to determine where patients were lost to follow up and potential inequities in care between patient groups. Methods: This was a retrospective cohort study performed through medical chart data review for LTBI-positive Winchester patients. The presence of a chest x-ray, medication prescription, at least one follow-up appointment and at least four follow-up appointments were used to assess patient completion of the evaluation and treatment stages of care. Multivariate models were created using demographic variables classifying gender, race, ethnicity and age as the independent variables, and the outcome variables as the dependent variable. Results: Female patients had lower odds of being prescribed medications and completing at least one follow-up appointment than did their male counterparts (OR 0.4 and OR 0.3, respectively). Non-Hispanic or Latino patients were more likely than Hispanic or Latino patients to be prescribed TB medications or complete at least one follow-up appointment (OR 1.6 and OR 1.8, respectively). Black patients were also less likely to complete a follow-up appointment than non-black patients (OR 0.5), and Asian patients were less likely to be prescribed medications than non-Asian patients (OR 0.5)

Comparing self-identified and census-defined neighborhoods among adolescents using GPS and accelerometer

Background: Numerous definitions of neighborhood exist, yet few studies have considered youth’s perceptions of neighborhood boundaries. This study compared youth-identified neighborhood (YIN) boundaries to census-defined neighborhood (CDN) boundaries, and determined how the amount of time spent and moderate-to-vigorous physical activity (MVPA) levels compared within both boundary types. Methods: Adolescents aged 11–14 years were asked to identify their neighborhood boundaries using a map. Objective location and physical activity data collected using Global Positioning System (GPS) devices and accelerometers were used to calculate the amount of time spent and MVPA within youth-identified and census-defined neighborhood boundaries. Paired bivariate analyses compared mean area (meters squared), percent of total time, daily MVPA (minutes), time density (minutes/m2) and MVPA density (minutes/m2) for both boundary types. Results: Youth-identified neighborhoods (1,821,705 m2) and census-defined neighborhoods (1,277,181 m2) were not significantly different in area, p = 0.30. However, subjects spent more time in youth-identified neighborhoods (80.3%) than census-defined neighborhoods (58.4%), p < 0.0001, and engaged in more daily MVPA within youth-identified neighborhoods (14.7 minutes) than census-defined neighborhoods (9.5 minutes), p < 0.0001. After adjusting for boundary area, MVPA density (minutes of MVPA per squared meter of area) remained significantly greater for youth-identified neighborhoods (2.4 × 10-4 minutes/m2) than census-defined neighborhoods (1.4 × 10-4 minutes/m2), p = 0.02. Conclusions: Adolescents perceive their neighborhoods to be similar in size to census-defined neighborhoods. However, youth-identified neighborhoods better capture the locations in which adolescents spend time and engage in physical activity. Asking adolescents to identify their neighborhood boundaries is a feasible and valuable method for identifying the spaces that adolescents are exposed to and use to be physically active

Pathways to Social-Ecological Viability for Mangrove Dependent Small-Scale Fisheries in the Bangladesh Sundarbans

It is well described in the literature that mangrove-dependent small-scale fisheries (MDSSF) are increasingly vulnerable to drivers of change. However, the survivability of many MDSSF communities indicates that there are strategies in place to cope and adapt to drivers of change. It is poorly understood what adaptive responses are used to achieve viability, and how the transition from vulnerability to viability can be mobilized. Given that it is not conceivable to eliminate the uncertainty associated with the vulnerabilities that MDSSF experience, it is important to understand how viability can be achieved. In congruence with a transformative phenomenological research approach, this study will address viability in mangrove-dependent small-scale fisheries (MDSSF) using a social-ecological systems (SES) framework, with a broad goal of describing social-ecological viability in MDSSF and identifying pathways through which this can be achieved from the perspectives of the research participants. SES is an important framework for understanding the nature and dynamics of viability in MDSSF, and more specifically how it is rooted in interactions between social, political, institutional and ecological factors of a complex, multilevel system. Two objectives guide this research: (1) to describe the magnitude and impacts of drivers of change and vulnerabilities and (2) to understand key response strategies and conceivable pathways to achieve viability in MDSSF. The study methods include three in-depth, qualitative case studies consisting of household surveys and a focus group discussion in the Bangladesh Sundarbans Forest. Key findings include identification of five components that contribute to social-ecological viability. Results support that bottom-up strategies rooted in the perspectives and knowledge of local resource users are critical for developing a management approach for mangrove fisheries that supports the long-term viability of dependent small-scale fishing communities. At a regional level, this research provides information to develop local and specific strategies towards building social-ecological viability in the case study locations. At a global level, this study will be applied to the I-ADApT Framework and contribute to the Vulnerability to Viability Global Partnership database, providing a case for comparison of mangrove-dependent small-scale fishery viability which can be used in developing policy and management recommendations

Waterproofing 3D-Printed Parts

Team Operation: Watertight has been given the task to design a technique for printing or a post process application for treating fused deposition modeled parts to become impermeable to water. The final design report shows the progress made over the past academic year in order to create this process. In the fall, the team brainstormed many possible solutions and was able to narrow them down with the support of our sponsors, accompanied by a lot of research. This research consisted of many literature searches and patent searches to ensure there was not a process already designed for this application. Last semester, four concepts were selected and tested: resin injection, resin vacuum in filtration, XTC-3D, and Gelcoat. Each concept was applied to 3D printed ABS parts and then submerged in water. The change in mass after submersion for varying lengths of time allowed for the evaluation of each process. From the results seen, XTC-3D and resin injection proved to be the most promising out of the four. With this knowledge, the two methods were combined and tested in the Spring semester. They were not only tested by submergence, but pressure and strength tests were done as well. The original goal for the pressure test was to create a vessel to withstand 100 psi. With the methods applied, this goal was surpassed by 200 psi. The strength test was completed to see the effects of each method on the structural integrity of the 3D printed part

Partnership work between Public Health and Health Psychology: introduction to a novel training programme

Background: Public health services implement individual, community and population level interventions to change health behaviours, improve healthy life expectancy and reduce health inequalities. Understanding and changing health behaviour is complex. Integrating behaviour change theory and evidence into interventions has the potential to improve services. Methods: Health Psychologists apply evidence and theories aimed at understanding and changing health behaviour. A Scottish programme is piloting the training of Health Psychologists within NHS contexts to address prominent public health challenges. Results: This article outlines the details of this novel programme. Two projects are examined to illustrate the potential of partnership working between public health and health psychology. Conclusion: In order to develop and improve behaviour change interventions and services, public health planners may want to consider developing and using the knowledge and skills of Health Psychologists. Supporting such training within public health contexts is a promising avenue to build critical NHS internal mass to tackle the major public health challenges ahead

Harvesting Intensity and Aridity Are More Important Than Climate Change in Affecting Future Carbon Stocks of Douglas-Fir Forests

Improved forest management may offer climate mitigation needed to hold warming to below 2°C. However, uncertainties persist about the effects of harvesting intensity on forest carbon sequestration, especially when considering interactions with regional climate and climate change. Here, we investigated the combined effects of harvesting intensity, climatic aridity, and climate change on carbon stocks in Douglas-fir [Pseudotsuga menziesii Mirb. (Franco)] stands. We used the Carbon Budget Model of the Canadian Forest Sector to simulate the harvest and regrowth of seven Douglas-fir stand types covering a 900 km-long climate gradient across British Columbia, Canada. In particular, we simulated stand growth under three regimes (+17%, −17% and historical growth increment) and used three temperature regimes [historical, representative concentration pathways (RCP) 2.6 and RCP 8.5]. Increasing harvesting intensity led to significant losses in total ecosystem carbon stocks 50 years post-harvest. Specifically, forests that underwent clearcutting were projected to stock about 36% less carbon by 2,069 than forests that were left untouched. Belowground carbon stocks 50 years into the future were less sensitive to harvesting intensity than aboveground carbon stocks and carbon losses were greater in arid interior Douglas-fir forests than in humid, more productive forests. In addition, growth multipliers and decay due to the RCP’s had little effect on total ecosystem carbon, but aboveground carbon declined by 7% (95% confidence interval [−10.98, −1.81]) in the high emissions (RCP8.5) scenario. We call attention to the implementation of low intensity harvesting systems to preserve aboveground forest carbon stocks until we have a more complete understanding of the impacts of climate change on British Columbia’s forests

Harvest intensity effects on carbon stocks and biodiversity are dependent on regional climate in Douglas-fir forests of British Columbia

Temperate forests provide crucial ecosystems services as living sinks for atmospheric carbon (C) and repositories of biodiversity. Applying harvesting at intensities that minimize losses offers one means for mitigating global change. However, little is known of overstory retention levels that best conserve ecosystem services in different regional climates, and likewise as climate changes. To quantify the effect of harvest intensity on C stocks and biodiversity, we compared five harvesting intensities (clearcutting,seedtree retention, 30% patch retention, 60% patch retention, and uncut controls) across a climatic aridity gradient that ranged from humid to semi-arid in the Douglas-fir (Pseudostuga menziesii) forests of British Columbia. We found that increased harvesting intensity reduced total ecosystem, aboveground, and live tree C stocks one year post-harvest, and the magnitude of these losses were negatively correlated with climatic aridity. In humid forests, total ecosystem C ranged from 50% loss following clearcut harvest, to 30% loss following large patch retention harvest. In arid forests this range was 60% to 8% loss, respectively. Where lower retention harvests are sought, the small patch retention treatment protected both C stocks and biodiversity in the arid forests, whereas the seedtree method performed as well or better in the humid forests. Belowground C stocks declined by an average of 29% after harvesting, with almost all of the loss from the forest floor and none from the mineral soil. Of the secondary pools, standing and coarse deadwood declined in all harvesting treatments regardless of cutting intensity or aridity, while C stocks in fine fuels and stumps increased. The understory plant C pool declined across all harvesting intensities in the humid forests, but increased in arid forests. Shannon’s diversity and richness of tree and bryoid species declined with harvesting intensity, where tree species losses were greatest in the humid forests and bryoid losses greatest in arid forests. Shrub and herb species were unaffected. This study showed that the highest retention level was best at reducing losses in C stocks and biodiversity, and clearcutting the poorest, and while partial retention of canopy trees can reduce losses in these ecosystem services, outcomes will vary with climatic aridity

Asia-Pacific ICEMR: Understanding Malaria Transmission to Accelerate Malaria Elimination in the Asia Pacific Region

Gaining an in-depth understanding of malaria transmission requires integrated, multifaceted research approaches. The Asia-Pacific International Center of Excellence in Malaria Research (ICEMR) is applying specifically developed molecular and immunological assays, in-depth entomological assessments, and advanced statistical and mathematical modeling approaches to a rich series of longitudinal cohort and cross-sectional studies in Papua New Guinea and Cambodia. This is revealing both the essential contribution of forest-based transmission and the particular challenges posed by Plasmodium vivax to malaria elimination in Cambodia. In Papua New Guinea, these studies document the complex host–vector–parasite interactions that are underlying both the stunning reductions in malaria burden from 2006 to 2014 and the significant resurgence in transmission in 2016 to 2018. Here we describe the novel analytical, surveillance, molecular, and immunological tools that are being applied in our ongoing Asia-Pacific ICEMR research program