Time for global scale-up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved

Next Steps for Human-Computer Integration

Human-Computer Integration (HInt) is an emerging paradigm in which computational and human systems are closely interwoven. Integrating computers with the human body is not new. however, we believe that with rapid technological advancements, increasing real-world deployments, and growing ethical and societal implications, it is critical to identify an agenda for future research. We present a set of challenges for HInt research, formulated over the course of a five-day workshop consisting of 29 experts who have designed, deployed and studied HInt systems. This agenda aims to guide researchers in a structured way towards a more coordinated and conscientious future of human-computer integration

Characteristics of an Advective Marine Heatwave in the Middle Atlantic Bight in Early 2017

There has been wide interest in Marine Heatwaves and their ecological consequences in recent years. Most analyses have focused on remotely sensed sea surface temperature data due to the temporal and spatial coverage it provides in order to establish the presence and duration of Heatwaves. Using hydrographic data from a variety of sources, we show that an advective Marine Heatwave was initiated by an event in late December of 2016 south of New England, with temperature anomalies measuring up to 6°C and salinity anomalies exceeding 1 PSU. Similar features were observed off of New Jersey in February 2017, and are associated with the Shelfbreak Front migrating from its normal position to mid-shelf or further onshore. Shelf water of 34 PSU was observed just north of Cape Hatteras at the 30 m isobath and across the continental shelf in late April 2017. These observations reveal that the 2017 Marine Heatwave was associated with a strong positive salinity anomaly, that its total duration was approximately 4 months, and its advective path extended roughly 850 km along the length of the continental shelf in the Middle Atlantic Bight. The southward advective velocity implied by the arrival north of Cape Hatteras is consistent with previous estimates of alongshelf velocity for the region. The origin of this Marine Heatwave is likely related to cross-shelf advection driven by the presence of a Warm Core Ring adjacent to the shelfbreak south of New England

Estimating the predictability of an oceanic time series using linear and nonlinear methods

Author Posting. © American Geophysical Union, 2004. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 109 (2004): C08002, doi:10.1029/2003JC002148.This study establishes a series of tests to examine the relative utility of nonlinear time series analysis for oceanic data. The performance of linear autoregressive models and nonlinear delay coordinate embedding methods are compared for three numerical and two observational data sets. The two observational data sets are (1) an hourly near-bottom pressure time series from the South Atlantic Bight and (2) an hourly current-meter time series from the Middle Atlantic Bight (MAB). The nonlinear methods give significantly better predictions than the linear methods when the underlying dynamics have low dimensionality. When the dimensionality is high, the utility of nonlinear methods is limited by the length and quality of the time series. On the application side we mainly focus on the MAB data set. We find that the slope velocities are much less predictable than shelf velocities. Predictability on the slope after several hours is no better than the statistical mean. On the other hand, significant predictability of shelf velocities can be obtained for up to at least 12 hours.This research was supported by Office of Naval Research grants N00014-01-1-0260, N00014-92-J-1481, and N10014-99-1-0258

Entry, Exit, and the Determinants of Market Structure

This paper estimates a dynamic, structural model of entry and exit in an oligopolistic industry and uses it to quantify the determinants of market structure and long-run firm values for two U.S. service industries, dentists and chiropractors. Entry costs faced by potential entrants, fixed costs faced by incumbent producers, and the toughness of short-run price competition are all found to be important determinants of long-run firm values, firm turnover, and market structure. Estimates for the dentist industry allow the entry cost to differ for geographic markets that were designated as Health Professional Shortage Areas and in which entry was subsidized. The estimated mean entry cost is 11 percent lower in these markets. Using simulations, we compare entry-cost versus fixed-cost subsidies and find that entry-cost subsidies are less expensive per additional firm

The handling of urinary incontinence in Danish general practices after distribution of guidelines and voiding diary reimbursement: an observational study

BACKGROUND: Though urinary incontinence (UI) is a bothersome condition for the individual patient, the patients tend not to inform their physician about UI and the physician tend not to ask the patient. Recently different initiatives have been established in Danish general practices to improve the management of UI. The aim of this study was to identify the handling of urinary incontinence (UI) in Danish general practices after distribution of clinical guidelines and reimbursement for using a UI diary. METHODS: In October 2001, a questionnaire was sent to 243 general practitioners (GPs) in Frederiksborg County following distribution of clinical guidelines in July 1999 (UI in general practice) and September 2001 (UI in female, geriatric, or neurological patients). A policy for a small reimbursement to GPs for use of a fluid intake/voiding diary in the assessment of UI in general practice was implemented in October 2001. Information concerning monthly reimbursement for using a voiding diary, prescribed drugs (presumably used for treating UI), UI consultations in outpatient clinics, and patient reimbursement for pads was obtained from the National Health Service County Registry. RESULTS: Of the 132 (54%) GPs who replied, 87% had read the guidelines distributed 2 years before, but only 47% used them daily. The majority (69%) of the responding GPs had read and appreciated 1–3 other UI guidelines distributed before the study took place. Eighty-three percent of the responding GPs sometimes or often actively asked their patients about UI, and 92% sometimes or often included a voiding diary in the UI assessment. The available registry data concerning voiding diary reimbursement, prescribed UI drugs, UI consultations in outpatient clinics, and patient reimbursement for pads were insufficient or too variable to determine significant trends. CONCLUSION: GPs management of UI in a Danish county may be reasonable, but low response rate to the questionnaire and insufficient registry data made it difficult to evaluate the impact of different UI initiatives

Palaeoecological data indicates land-use changes across Europe linked to spatial heterogeneity in mortality during the Black Death pandemic

Historical accounts of the mortality outcomes of the Black Death plague pandemic are variable across Europe, with much higher death tolls suggested in some areas than others. Here the authors use a 'big data palaeoecology' approach to show that land use change following the pandemic was spatially variable across Europe, confirming heterogeneous responses with empirical data.The Black Death (1347-1352 ce) is the most renowned pandemic in human history, believed by many to have killed half of Europe's population. However, despite advances in ancient DNA research that conclusively identified the pandemic's causative agent (bacterium Yersinia pestis), our knowledge of the Black Death remains limited, based primarily on qualitative remarks in medieval written sources available for some areas of Western Europe. Here, we remedy this situation by applying a pioneering new approach, 'big data palaeoecology', which, starting from palynological data, evaluates the scale of the Black Death's mortality on a regional scale across Europe. We collected pollen data on landscape change from 261 radiocarbon-dated coring sites (lakes and wetlands) located across 19 modern-day European countries. We used two independent methods of analysis to evaluate whether the changes we see in the landscape at the time of the Black Death agree with the hypothesis that a large portion of the population, upwards of half, died within a few years in the 21 historical regions we studied. While we can confirm that the Black Death had a devastating impact in some regions, we found that it had negligible or no impact in others. These inter-regional differences in the Black Death's mortality across Europe demonstrate the significance of cultural, ecological, economic, societal and climatic factors that mediated the dissemination and impact of the disease. The complex interplay of these factors, along with the historical ecology of plague, should be a focus of future research on historical pandemics

Marriage, Sex, and Hydrocele: An Ethnographic Study on the Effect of Filarial Hydrocele on Conjugal Life and Marriageability from Orissa, India

Lymphatic filariasis, the second leading cause of permanent and long-term disability, affects 120 million people globally. Hydrocele, an accumulation of fluid in the scrotum that causes it to swell, is one of the chronic manifestations of LF among men and there are about 27 million men with hydrocele worldwide. We conducted ethnographic interviews and discussions with patients, women whose husbands have hydrocele, and the general public in a rural community of eastern India. The study describes how hydrocele impacts patients' sexual and marital life. It reveals the most worrisome effect of hydrocele for patients and their wives due to the inability to have a satisfactory sexual life. Patients expressed their incapacity during sexual intercourse. A majority of hydrocele patients' wives reported that their married life became burdened and couples were not living happily. This study also highlights the impact on marriageability, and some women expressed that a hydrocele patient is the “last choice”. In some cases, the patients were persuaded by their wives to remove hydrocele by surgery (hydrocelectomy). Hence, access to hydrocelectomy has to be strengthened under the Global Programme to Eliminate Lymphatic Filariasis, which is operational in several endemic areas in the world. Also, this activity may be integrated with primary healthcare services and interventions of other neglected tropical diseases