Spatial Microsimulation for Regional Analysis of Marine Related Employment

This paper presents a modelling framework that facilitates marine policy impact assessment at a scale that is below the national level. The spatial microsimulation approach provides a regional level of analysis not generally possible when dealing with ocean economy statistics that are often even difficult to compile at a national level and offers a powerful modelling tool for maritime spatial planning. The spatial microsimulation model is used to profile the spatial distribution of marine related employment in Ireland. It is then used to carry out a micro-level regional assessment of the impact of the Covid-19 pandemic restrictions on the distribution of employment in the Irish ocean economy. The results demonstrate that many of those made unemployed in the ocean economy during the first lock down were outside the main urban centers, particularly in the case of marine tourism and leisure and the marine natural resource based industries. The paper argues that the use of such spatial microsimulation approaches can facilitate a more evidence based policy response to an economic shock, such as the Covid-19 pandemic, in terms of industry and regional specific supports and can also inform more effective marine spatial planning

Impact Assessment Modelling for the Ocean Economy: A Review of Developments

With increasing attention being paid to the role of marine related activity in promoting sustainable economic growth as well as development in coastal areas, it is important to be able to model the impact of policy decisions in this area in an ex-ante fashion. This paper provides an overview of an Economic, Social, Spatial and Environmental (ESSE) framework developed for impact assessment of ocean related industries. The modelling approach is applied to the ocean economy of Ireland and combines proven methodologies, namely input-output modelling and microsimulation, in order to assess multi-dimensional impacts. The capabilities of the ESSE modelling framework are highlighted using policy development examples from marine renewable energy, aquaculture and fisheries

How have advances in CT dosimetry software impacted estimates of CT radiation dose and cancer incidence? A comparison of CT dosimetry software: Implications for past and future research

Objective: Organ radiation dose from a CT scan, calculated by CT dosimetry software, can be combined with cancer risk data to estimate cancer incidence resulting from CT exposure. We aim to determine to what extent the use of improved anatomical representation of the adult human body “phantom” in CT dosimetry software impacts estimates of radiation dose and cancer incidence, to inform comparison of past and future research. Methods: We collected 20 adult cases for each of three CT protocols (abdomen/pelvis, chest and head) from each of five public hospitals (random sample) (January-April inclusive 2010) and three private clinics (self-report). Organ equivalent and effective dose were calculated using both ImPACT (mathematical phantom) and NCICT (voxelised phantom) software. Bland- Altman plots demonstrate agreement and Passing-Bablok regression reports systematic, proportional or random differences between results. We modelled the estimated lifetime attributable risk of cancer from a single exposure for each protocol, using age-sex specific risk-coefficients from the Biologic Effects of Ionizing Radiation VII report. Results: For the majority of organs used in epidemiological studies of cancer incidence, the NCICT software (voxelised) provided higher dose estimates. Across the lifespan NCICT resulted in cancer estimates 2.9%-6.6% and 14.8%-16.3% higher in males and females (abdomen/pelvis) and 7.6%-19.7% and 12.9%-26.5% higher in males and females respectively (chest protocol). For the head protocol overall cancer estimates were lower for NCICT, but with greatest disparity, \u3e30% at times. Conclusion: When the results of previous studies estimating CT dose and cancer incidence are compared to more recent, or future, studies the dosimetry software must be considered. Any change in radiation dose or cancer risk may be attributable to the software and phantom used, rather than—or in addition to—changes in scanning practice. Studies using dosimetry software to estimate radiation dose should describe software comprehensively to facilitate comparison with past and future research

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Increasing use of CT requested by emergency department physicians in tertiary hospitals in Western Australia 2003-2015: An analysis of linked administrative data

Objective: This study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms. Design: An observational cross-sectional study over study period from 2003 to 2015. Setting: Linked administrative health service data at individual level from WA. Participants: A total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this study Main outcome measure: Number of CT scans requested by tertiary ED physicians in an ED presentation. Methods: Poisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas. Results: Over the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians. Conclusions: Noticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally

Factors driving CT utilisation in tertiary hospitals: A decomposition analysis using linked administrative data in Western Australia

Objectives: While CT scanning plays a significant role in healthcare, its increasing use has raised concerns about inappropriate use. This study investigated factors driving the changing use of CT among people admitted to tertiary hospitals in Western Australia (WA). Design and setting: A repeated cross-sectional study of CT use in WA in 2003–2005 and 2013–2015 using linked administrative heath data at the individual patient level. Participants: A total of 2 375 787 tertiary hospital admissions of people aged 18 years or older. Main outcome measure: Rate of CT scanning per 1000 hospital admissions. Methods: A multivariable decomposition model was used to quantify the contribution of changes in patient characteristics and changes in the probability of having a CT over the study period. Results: The rate of CT scanning increased by 112 CT scans per 1000 admissions over the study period. Changes in the distribution of the observed patient characteristics were accounted for 62.7% of the growth in CT use. However, among unplanned admissions, changes in the distribution of patient characteristics only explained 17% of the growth in CT use, the remainder being explained by changes in the probability of having a CT scan. While the relative probability of having a CT scan generally increased over time across most observed characteristics, it reduced in young adults (−2.8%), people living in the rural/remote areas (−0.8%) and people transferred from secondary hospitals (−0.8%). Conclusions: Our study highlights potential improvements in practice towards reducing medical radiation exposure in certain high risk population. Since changes in the relative probability of having a CT scan (representing changes in scope) rather than changes in the distribution of the patient characteristics (representing changes in need) explained a major proportion of the growth in CT use, this warrants more in-depth investigations in clinical practices to better inform health policies promoting appropriate use of diagnostic imaging tests

Use of CT, ED presentation and hospitalisations 12 months before and after a diagnosis of cancer in Western Australia: A population-based retrospective cohort study

Objective: To examine the use of CT, emergency department (ED)-presentation and hospitalisation and in 12 months before and after a diagnosis of cancer. Design: Population-based retrospective cohort study. Setting: West Australian linked administrative records at individual level. Participants: 104 009 adults newly diagnosed with cancer in 2004–2014. Main outcome measures: CT use, ED presentations, hospitalisations. Results: As compared with the rates in the 12th month before diagnosis, the rate of CT scans started to increase from 2 months before diagnosis with an increase in both ED presentations and hospitalisation from 1 month before the diagnosis. These rates peaked in the month of diagnosis for CT scans (477 (95% CI 471 to 482) per 1000 patients), and for hospitalisations (910 (95% CI 902 to 919) per 1000 patients), and the month prior to diagnosis for ED (181 (95% CI 178 to 184) per 1000 patients) then rapidly reduced after diagnosis but remained high for the next 12 months. While the patterns of the health services used were similar between 2004 and 2014, the rate of the health services used during after diagnosis was higher in 2014 versus 2004 except for CT use in patients with lymphohaematopoietic cancer with a significant reduction. Conclusion: Our results showed an increase in demand for health services from 2 months before diagnosis of cancer. Increasing use of health services during and post cancer diagnosis may warrant further investigation to identify factors driving this change

Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia

Purpose Whilst computed tomography (CT) imaging has been a vital component of injury management, its increasing use has raised concern regarding ionising radiation exposure. This study aims to identify latent classes (underlying patterns) of CT use over a 3-year period following the incidence of injury and factors predicting the observed patterns. Method A retrospective observational cohort study was conducted in 21,544 individuals aged 18 + years presenting to emergency departments (ED) of four tertiary public hospitals with new injury in Western Australia. Mixture modelling approach was used to identify latent classes of CT use over a 3-year period post injury. Results Amongst injured people with at least one CT scan, three latent classes of CT use were identified including a: temporarily high CT use (46.4%); consistently high CT use (2.6%); and low CT use class (51.1%). Being 65 + years or older, having 3 + comorbidities, history with 3 + hospitalisations and history of CT use before injury were associated with consistently high use of CT. Injury to the head, neck, thorax or abdomen, being admitted to hospital after the injury and arriving to ED by ambulance were predictors for the temporarily high use class. Living in areas of higher socio-economic disadvantage was a unique factor associated with the low CT use class. Conclusions Instead of assuming a single pattern of CT use for all patients with injury, the advanced latent class modelling approach has provided more nuanced understanding of the underlying patterns of CT use that may be useful for developing targeted interventions