Editorial

Missed opportunities for circumcising boy

Temperature sensitivity of decomposition: Discrepancy between field and laboratory estimates is not due to sieving the soil

© 2020 The Authors Is persistent soil organic matter (SOM), characterised by an old age and long-turnover time, more or less sensitive to changes in temperature than fast-cycling, recent SOM? Largely due to our limited understanding of the mechanisms of SOM formation, this question remains controversial. Laboratory incubation studies, through sieving the soil, may create conditions in which substrate accessibility is modified. The recent recognition of SOM accessibility as a defining factor of SOM persistency calls into question conclusions from these studies. Previously, in a study using root exclusion plots of increasing age, we showed in the field that the temperature sensitivity of SOM decomposition decreased with increasing persistence of SOM (Moinet et al., 2020), in opposition to many laboratory incubation studies. Here we sampled soils from the same root exclusion plots and conducted a laboratory incubation experiment to test the hypotheses that (i) the relationship between temperature sensitivity and SOM persistence is inverted as compared to the field, and (ii) the discrepancy is due to sieving the soil. We showed that, in the laboratory, the relationship was indeed inverted, with the temperature sensitivity being higher for the old root exclusion plots. However, sieving the soil at 2 mm did not affect estimates of the temperature sensitivity of SOM decomposition, suggesting that discrepancies between field and laboratory estimates are unlikely to stem from artificially modified substrate accessibility due to sieving

Playing With a Stacked Deck: Why Was a Single Payer Plan Dealt Such Bad Cards?

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Amgus King in November, 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period of time. Commission members were mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations Reactions to the MHCRC report were invited from individuals who represent constituencies which often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. This second commentary provides perspectives from three practicing physicians in Maine

Phase-type survival trees and mixed distribution survival trees for clustering patients' hospital length of stay

Clinical investigators, health professionals and managers are often interested in developing criteria for clustering patients into clinically meaningful groups according to their expected length of stay. In this paper, we propose two novel types of survival trees; phase-type survival trees and mixed distribution survival trees, which extend previous work on exponential survival trees. The trees are used to cluster the patients with respect to length of stay where partitioning is based on covariates such as gender, age at the time of admission and primary diagnosis code. Likelihood ratio tests are used to determine optimal partitions. The approach is illustrated using nationwide data available from the English Hospital Episode Statistics (HES) database on stroke-related patients, aged 65 years and over, who were discharged from English hospitals over a 1-year period.peer-reviewe

Rapid, minimally invasive adult voluntary male circumcision: A randomised trial

Background. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate male circumcision scale- up, the World Health Organization is actively seeking circumcision techniques that are quicker, easier, and safer than open surgical methods. Objective. To compare conventional open surgical circumcision with suturing with a minimally invasive technique using the Gomco circumcision clamp plus tissue adhesive.Methods. We conducted a non-blinded randomised controlled trial comprising 200 male volunteers >18 years of age, seen at the outpatient university teaching clinic of the Catholic University of Mozambique. We compared two interventions – open surgical circumcision with suturing v. Gomco instrument plus tissue adhesive. Our primary outcome was intraoperative time and our secondary outcomes included: ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Gomco/tissue adhesive technique (mean 12.8 min v. 22.5 min; p<0.001). Adverse events were similar except that wound disruption was greater in the Gomco/tissue adhesive group, with no difference in wound healing at 4 weeks. Levels of satisfaction were high in both groups. The cosmetic result was superior in the Gomco/tissue adhesive group.Conclusions. This study has important implications for the scale-up of VMMC services. Removing the foreskin with the Gomco instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, is an easier technique to learn, and is potentially safer than open surgical VMMC. A disposable plastic, Gomco-like device should be produced and evaluated for use in resource-limited settings.

Bed Particle Displacements and Morphological Development in a Wandering Gravel-Bed River

Bed particles were tracked using passive integrated transponder tags in a wandering reach of the San Juan River, British Columbia, Canada, to assess particle movement around three major bars in the river. In-channel topographic changes were monitored through repeat LiDAR surveys during this period and used in concert with the tracer data set to assess the relationship between particle displacements and changes in channel morphology, specifically, the development and re-working of bars. This has direct implications for virtual velocity and morphologic based estimates of bedload flux, which rely on accurate estimates of the variability and magnitude of particle path lengths over time. Tracers were deployed in the river at three separate locations in the Fall of 2015, 2016, 2017, and 2018, with recovery surveys conducted during the summer low-flow season the year after tracer deployment and multiple mobilizing events. Tracers exhibited path length distributions reflective of both morphologic controls and year to year differences related to the annual flow regime. Annual tracer transport was restricted primarily to less than one riffle-pool-bar unit, even during years with a greater number of peak floods and duration of competent flow. Tracer deposition and burial was focused along bar margins, particularly at or downstream of the bar apex, reflecting the downstream migration and lateral bar accretion observed on Digital Elevation Models of difference. This highlights the fundamental importance of bar development and re-working underpinning bedload transport processes in bar-dominated channels