The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data—medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York—were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%–0.096%), sCIR of 0.239% (0.134%–0.458%), and sCHR of 1.44% (0.83%–2.64%). Using self-reported ILI, we obtained estimates approximately 7–96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5–17 y. sCHR appears to be lowest in persons aged 5–17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn–winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0–4 and adults 18–64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed

Tree planting in organic soils does not result in net carbon sequestration on decadal timescales

Tree planting is increasingly being proposed as a strategy to combat climate change through carbon (C) sequestration in tree biomass. However, total ecosystem C storage that includes soil organic C (SOC) must be considered to determine whether planting trees for climate change mitigation results in increased C storage. We show that planting two native tree species (Betula pubescens and Pinus sylvestris ), of widespread Eurasian distribution, onto heather (Calluna vulgaris ) moorland with podzolic and peaty podzolic soils in Scotland, did not lead to an increase in net ecosystem C stock 12 or 39 years after planting. Plots with trees had greater soil respiration and lower SOC in organic soil horizons than heather control plots. The decline in SOC cancelled out the increment in C stocks in tree biomass on decadal timescales. At all four experimental sites sampled, there was no net gain in ecosystem C stocks 12–39 years after afforestation—indeed we found a net ecosystem C loss in one of four sites with deciduous B. pubescens stands; no net gain in ecosystem C at three sites planted with B. pubescens ; and no net gain at additional stands of P. sylvestris . We hypothesize that altered mycorrhizal communities and autotrophic C inputs have led to positive ‘priming’ of soil organic matter, resulting in SOC loss, constraining the benefits of tree planting for ecosystem C sequestration. The results are of direct relevance to current policies, which promote tree planting on the assumption that this will increase net ecosystem C storage and contribute to climate change mitigation. Ecosystem‐level biogeochemistry and C fluxes must be better quantified and understood before we can be assured that large‐scale tree planting in regions with considerable pre‐existing SOC stocks will have the intended policy and climate change mitigation outcomes

Routine activities and proactive police activity: a macro-scale analysis of police searches in London and New York City

This paper explored how city-level changes in routine activities were associated with changes in frequencies of police searches using six years of police records from the London Metropolitan Police Service and the New York City Police Department. Routine activities were operationalised through selecting events that potentially impacted on (a) the street population, (b) the frequency of crime or (c) the level of police activity. OLS regression results indicated that routine activity variables (e.g. day of the week, periods of high demand for police service) can explain a large proportion of the variance in search frequency throughout the year. A complex set of results emerged, revealing cross-national dissimilarities and the differential impact of certain activities (e.g. public holidays). Importantly, temporal frequencies in searches are not reducible to associations between searches and recorded street crime, nor changes in on-street population. Based on the routine activity approach, a theoretical police-action model is proposed

“Re-Culturing” Teacher Education: Inquiry, Evidence, and Action

Currently the press to make policy and practice decisions on the basis of evidence is being coupled with recognition that real change requires shifts in organizational culture. Consequently, there are now many efforts to “re-culture” organizations by making evidence central to decision making. In this article, the authors problematize the notion of a “culture of evidence” in teacher education. Then the article identifies four key aspects involved in efforts to create a culture of evidence at one institution over a five-year period: (1) development of a portfolio of studies about processes and outcomes; (2) recognition that teacher education always poses values questions as well as empirical questions; (3) an exploratory, open-ended approach to evidence construction; and, (4) multiple structures that institutionalize evidence collection and use locally and beyond. The authors suggests that building cultures of evidence has the potential to be transformative in teacher education, but only if challenges related to sustainability, complexity, and balance are addressed

Interactions between white-tailed deer density and the composition of forest understories in the northern United States

Forest understories across the northern United States (US) are a complex of tree seedlings, endemic forbs, herbs, shrubs, and introduced plant species within a forest structure defined by tree and forest floor attributes. The substantial increase in white-tailed deer (Odocoileus virginianus Zimmerman) populations over the past decades has resulted in heavy browse pressure in many of these forests. To gain an objective assessment of the role of deer in forested ecosystems, a region-wide forest inventory across the northern US was examined in concert with white-tailed deer density information compiled at broad scales. Results indicate that deer density may be an additional driver of tree seedling abundance when analyzed along with stand attributes such as above ground biomass, relative density, and stand age. Tree seedling abundance generally decreased as deer density increased above 5.8 deer km2 for all forest type groups with the exception of oak-dominated forests. Findings indicate that introduced plant species, of which 393 were recorded in this study, increased in areas with higher deer density. The abundance of white-tailed deer is just as important as forest stand and site attributes in the development of forest understories. Given the complexity of forest and land use dynamics across the northern US, this study provides directions for future research as more data linking forest-dependent wildlife and forest dynamics at regional and national scales become available

Long-term trends in submicron particle concentrations in a metropolitan area of the northeastern United States

Significant changes in emission sources have occurred in the northeastern United States over the past decade, due in part to the implementation of emissions standards, the introduction and addition of abatement technologies for road transport, changes in fuel sulfur content for road and non-road transport, as well as economic impacts of a major recession and differential fuel prices. These changes in emission scenarios likely affected the concentrations of airborne submicron particles. This study investigated the characteristics of 11–500 nm particle number concentrations and their size spectra in Rochester, NY during the past 15 years (2002 to 2016). The modal structure, diurnal, weekly and monthly patterns of particle number concentrations are analyzed. Long-term trends are quantified using seasonal-trend decomposition procedures based on “Loess”, Mann-Kendall regression with Theil-Sen slope and piecewise regression. Particle concentrations underwent significant (p < 0.05) downward trends. An annual decrease of −323 particles/cm3/y (−4.6%/y) was estimated for the total particle number concentration using Theil-Sen analysis. The trends were driven mainly by the decrease in particles in the 11–50 nm range (−181 particles/cm3/y; −4.7%/y). Slope changes were investigated annually and seasonally. Piecewise regression found different slopes for different portions of the overall period with the strongest declines between 2005 and 2011/2013, followed by small upward trends between 2013 and 2016 for most size bins, possibly representing increased vehicular traffic after the recovery from the 2008 recession

Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases.</p> <p>Methods</p> <p>Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan.</p> <p>Results</p> <p>Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ²= 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control.</p> <p>Conclusion</p> <p>TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.</p> <p>Please see related article: <url>http://www.biomedcentral.com/1741-7015/9/127</url></p

Introduction to and spread of COVID-19-like illness in care homes in Norfolk, UK

BACKGROUND: Residential care homes for the elderly are important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. METHODS: We undertook secondary analysis of 248 care homes in Norfolk, UK. The dataset counted nurses, care workers and non-care workers, their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) and residents (if any) with suspected COVID-19 in the period 6 April to 6 May 2020. Concurrent descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and sanitizer) were in the data. PPE access was categorized as (most to least) green, amber or red. We undertook two-stage modelling, first for suspected COVID-19 cases amongst residents and second relating any increases in case counts after introduction to staffing or PPE levels. RESULTS: Counts of non-care workers had strongest relationships (P < 0.05) to introduction of suspected SARS-CoV-2 to the homes. Higher staff levels and more severe PPE shortages were linked to higher case counts (P < 0.05) during the monitoring period. CONCLUSION: Managing aspects of staff interaction with residents and some working practices might reduce ingression to and spread of COVID-19-like illness within care homes

A randomised controlled trial of a patient based Diabetes recall and Management system: the DREAM trial: A study protocol [ISRCTN32042030]

BACKGROUND: Whilst there is broad agreement on what constitutes high quality health care for people with diabetes, there is little consensus on the most efficient way of delivering it. Structured recall systems can improve the quality of care but the systems evaluated to date have been of limited sophistication and the evaluations have been carried out in small numbers of relatively unrepresentative settings. Hartlepool, Easington and Stockton currently operate a computerised diabetes register which has to date produced improvements in the quality of care but performance has now plateaued leaving substantial scope for further improvement. This study will evaluate the effectiveness and efficiency of an area wide 'extended' system incorporating a full structured recall and management system, actively involving patients and including clinical management prompts to primary care clinicians based on locally-adapted evidence based guidelines. METHODS: The study design is a two-armed cluster randomised controlled trial of 61 practices incorporating evaluations of the effectiveness of the system, its economic impact and its impact on patient wellbeing and functioning