ALBERT

Description: Background High-flow nasal cannula (HFNC) oxygen is a non-invasive ventilation system that was introduced as an alternative to CPAP (continuous positive airway pressure), with a marked increase in its use in pediatric care settings. This study aimed to evaluate the cost-effectiveness of early use of HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. Methods A decision tree model was used to estimate the cost-effectiveness of HFNC compared with oxygen by nasal cannula (control strategy) in an infant with bronchiolitis in the emergency setting. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Results The QALYs per patient calculated in the base-case model were 0.9141 (95% CI 0.913–0.915) in the HFNC and 0.9105 (95% CI 0.910–0.911) in control group. The cost per patient was US$368 (95% CI US$ 323–411) in HFNC and US$441 (95% CI US$ 384–498) per patient in the control group. Conclusions HFNC was cost-effective HFNC compared to oxygen by nasal cannula in an infant with bronchiolitis in the emergency setting. The use of this technology in emergency settings will allow a more efficient use of resources, especially in low-resource countries with high prevalence of bronchiolitis .

Description: Background Soil organic carbon (SOC) affects essential biological, biochemical, and physical soil functions such as nutrient cycling, water retention, water distribution, and soil structure stability. The Andean páramo known as such a high carbon and water storage capacity ecosystem is a complex, heterogeneous and remote ecosystem complicating field studies to collect SOC data. Here, we propose a multi-predictor remote quantification of SOC using Random Forest Regression to map SOC stock in the herbaceous páramo of the Chimborazo province, Ecuador. Results Spectral indices derived from the Landsat-8 (L8) sensors, OLI and TIRS, topographic, geological, soil taxonomy and climate variables were used in combination with 500 in situ SOC sampling data for training and calibrating a suitable predictive SOC model. The final predictive model selected uses nine predictors with a RMSE of 1.72% and a R2 of 0.82 for SOC expressed in weight %, a RMSE of 25.8 Mg/ha and a R2 of 0.77 for the model in units of Mg/ha. Satellite-derived indices such as VARIG, SLP, NDVI, NDWI, SAVI, EVI2, WDRVI, NDSI, NDMI, NBR and NBR2 were not found to be strong SOC predictors. Relevant predictors instead were in order of importance: geological unit, soil taxonomy, precipitation, elevation, orientation, slope length and steepness (LS Factor), Bare Soil Index (BI), average annual temperature and TOA Brightness Temperature. Conclusions Variables such as the BI index derived from satellite images and the LS factor from the DEM increase the SOC mapping accuracy. The mapping results show that over 57% of the study area contains high concentrations of SOC, between 150 and 205 Mg/ha, positioning the herbaceous páramo as an ecosystem of global importance. The results obtained with this study can be used to extent the SOC mapping in the whole herbaceous ecosystem of Ecuador offering an efficient and accurate methodology without the need for intensive in situ sampling.

Description: Background During the COVID-19 pandemic, health care systems are under extreme pressure. This study analyzed health care resource use (HCRU) and costs in patients admitted to the hospital for COVID-19 and aimed to estimate the one-year direct medical cost of the disease in Turkey. Methods This retrospective cohort study was conducted between March and July 2020 in a tertiary hospital (n = 1056) in Istanbul. Patient demographics, clinical and treatment characteristics at admission, comorbidities, disease severity, and costs from a payer perspective were evaluated using the microcosting method. The results include LOS, hospital costs, and univariate and generalized linear models to investigate influencing factors. The data were extrapolated to provide a country-level estimate. Results The mean length of stay was 9.1 days (SD 6.9). The mean length of stay was 8.0 days (4.7) for patients hospitalized in wards versus 14.8 days (SD 12.0) for patients hospitalized in the ICU. In univariate analysis, several factors, including O2 therapy (+ 3.7 days), high CRP 〉 41.8 mg/L (+ 3.8 days), and elevated ferritin (+ 3.5), were found to be associated with a longer LOS (p 

Description: Background British Columbia’s (BC) extensive forest resources provide climate change mitigation opportunities that are available to few other jurisdictions. However, as a consequence of the Mountain Pine Beetle outbreak and large-scale wildfires, BC is anticipating reduced roundwood harvest for the next decades. Progress towards more climatically efficient utilization of forest resources is needed. This research quantitatively compared the greenhouse gas emission consequences of nine harvested wood products trade and consumption strategies. Inward-focused strategies use wood products within Canada to achieve emission reduction objectives, while outward-focused strategies encourage exports of wood products. Results In the business-as-usual baseline scenario, average emissions arising from BC-originated harvested wood products between 2016 and 2050 were 40 MtCO2e yr−1. The estimated theoretical boundaries were 11 MtCO2e yr−1 and 54 MtCO2e yr−1, under the scenarios of using all harvests for either construction purposes or biofuel production, respectively. Due to the constrained domestic market size, inward-focused scenarios that were based on population and market capacity achieved 0.3–10% emission reductions compared to the baseline. The international markets were larger, however the emissions varied substantially between 68% reduction and 25% increase depending on wood products’ end uses. Conclusions Future bioeconomy strategies can have a substantial impact on emissions. This analysis revealed that from a carbon storage and emission perspective, it was better to consume BC’s harvests within Canada and only export those products that would be used for long-lived construction applications, provided that construction market access beyond the US was available. However, restricting export of wood products destined for short-lived uses such as pulp and wood pellets would have significant economic and social impacts. On the other hand, inward-focused strategies had a small but politically and environmentally meaningful contribution to BC’s climate action plan. This study also revealed the conflicts between a demand-driven bioeconomy and targeted environmental outcomes. A hierarchical incentive system that could co-exist with other market drivers may help achieve emission reduction goals, but this would require a better quantitative understanding of wood products’ substitution effects. While the analyses were conducted for BC, other regions that are net exporters of wood products may face similar issues.

Description: Background Economic research on hospital palliative care faces major challenges. Observational studies using routine data encounter difficulties because treatment timing is not under investigator control and unobserved patient complexity is endemic. An individual’s predicted LOS at admission offers potential advantages in this context. Methods We conducted a retrospective cohort study on adults admitted to a large cancer center in the United States between 2009 and 2015. We defined a derivation sample to estimate predicted LOS using baseline factors (N = 16,425) and an analytic sample for our primary analyses (N = 2674) based on diagnosis of a terminal illness and high risk of hospital mortality. We modelled our treatment variable according to the timing of first palliative care interaction as a function of predicted LOS, and we employed predicted LOS as an additional covariate in regression as a proxy for complexity alongside diagnosis and comorbidity index. We evaluated models based on predictive accuracy in and out of sample, on Akaike and Bayesian Information Criteria, and precision of treatment effect estimate. Results Our approach using an additional covariate yielded major improvement in model accuracy: R2 increased from 0.14 to 0.23, and model performance also improved on predictive accuracy and information criteria. Treatment effect estimates and conclusions were unaffected. Our approach with respect to treatment variable yielded no substantial improvements in model performance, but post hoc analyses show an association between treatment effect estimate and estimated LOS at baseline. Conclusion Allocation of scarce palliative care capacity and value-based reimbursement models should take into consideration when and for whom the intervention has the largest impact on treatment choices. An individual’s predicted LOS at baseline is useful in this context for accurately predicting costs, and potentially has further benefits in modelling treatment effects.

Description: Background Demand-side barriers to health care are as important as supply-side factors in deterring patients from obtaining effective treatment during COVID-19. Developing countries, including Togo, have focused on reducing the risk of health care utilization during this period by ensuring basic health care services as an important policy to improve health outcomes and meet international obligations to make health services accessible. Methods The data used to cover all 44 districts in the six (6) health regions of Togo, are from a national home survey. They are collected from July 8th to 17th, 2020. In each district chief town, a minimum of thirty (30) households were included by a systematic two-stage random draw (neighborhood and then home). Based on these data, the multinomial regression model was used to identify risk factors for the request for health care services during COVID-19. Results A total of 1946 (with a response rate of 98.3%) participants were addressed in the study. The finding on households with age above 60 years indicated that the relative risk ratio (RRR = 23.97; 95% CI = 0.93; 615.38) allowed them to practice self-medication in lieu of modern healthcare facilities. The multinomial model revealed that the relative risk ratio of pre-COVID-19 activities (RRR = 4.87; 95% CI = 1.018; 23.38) permits households to rely on their self-medication choice and (RRR = 3.14; 95% CI = 0.91; 0.83) prefer public health facilities. Given that the head of the households (RRR = 0.19; 95% CI = 0.017, 2.11) is educated, he prefers the choice of private health centers during COVID-19 pandemic to public health facilities. Conclusion This study has demonstrated that the majority (30.49%) of patients sought health care. The analysis shows that the loss of employment, activities before COVID-19 in households and areas not infected by the pandemics allow them to ask for health care (self-medication and public hospitals) despite the COVID-19 impacts. However, higher education and age determine a different choice of health care delivery by households. Thus, policy makers need to cast special emphasis on social policies to address home health shocks.

Description: Background Nearly 19 million people across OECD countries are living with dementia, and millions of family caregivers are affected by the disease. The costs of informal care are estimated to represent 40–75% of the total dementia cost exceeding formal care time and medical costs. Objective To conduct a systematic review to evaluate the methodological quality and factors associated with high informal care hours per month that increase societal costs, and to identify what type of interventions may alleviate the entire burden of informal and formal caregiving. Methods The systematic review was registered at PROSPERO (15.12.2020). A search in Medline, Embase, PsycINFO, and web of science for observational studies, cost-effectiveness, and cost of illness (COI) analyses on resource utilization in dementia (RUD) was conducted on 1 December 2020. Our inclusion criteria included a requirement that studies had to use the original RUD, RUD-FOCA or RUD lite in terms of hours or days per month, and costs as primary or secondary outcome, OECD countries, within the last 20 years and a sample population comprising persons with dementia (PwD) ≥65 years and their caregivers. We followed the PRISMA, GRADE, PICO guidelines and Drummond criteria to assess the methodology and quality of the studies. Results Of 307 studies, 26 cross-sectional and 3 longitudinal cohort studies were included in the analyses. Two studies had a randomized controlled trial (RCT) design. The methods and cost categories in each study varied widely. Disease severity, caregiver factors, and behavioural and psychological symptoms of dementia (BPSD) were associated with high informal care hours and societal cost. One RCT found no effect of a non-pharmacological intervention on informal care hours, yet another RCT found a cost-effective impact of an in-home respite care programme reducing informal care burden and costs. Conclusion The divergent use of the RUD components within included studies encourage more harmonized analyses. There are only two RCTs on RUD, one of which shows a significant treatment effect. Larger sample sizes and longer follow-up periods are required in future RCTs with dedicated focus on cost-enhancing and resource intensive factors such as disease severity and BPSD. Novel interventions must diversify between caregiver and PwD groups. PROSPERO registration CRD42021226388.

Description: Background Given the large bamboo resource base with considerable potential to act as an important carbon sink, Ethiopia has included bamboo in the national Reducing Emissions from Deforestation and Forest Degradation and enhancing forest carbon stocks (REDD+) and Clean Development Mechanisms (CDM) programs. However, little is known about the carbon stock and sequestration potential of bamboo forests. As a result, this research was conducted to quantify the carbon sequestration and storage capacity of Oxytenanthera abyssinica forests in the Lower Beles River Basin, northwestern Ethiopia. To this end, a total of 54 circular plots, each measuring 100 m2 with a radius of 5.64 m, were established to conduct the inventory in Assitsa and Eddida bamboo forests, the typical bamboo sites in Lower Beles River Basin. Biomass accumulation of bamboo was estimated using an allometric equation based on diameter at breast height (DBH) and age. Soil samples were taken from two different soil depths (0–15 and 15–30 cm) to determine soil organic carbon. Results Results indicate that the mean biomass of the bamboo forests in the study area accounted for about 177.1 $$pm$$ ±  3.1 Mg ha−1. The mean biomass carbon and soil organic carbon stock of the bamboo forests were 83.2 $$pm$$ ±  1.5 Mg C ha−1 and 70 $$pm$$ ±  1.7 Mg C ha−1, respectively. Therefore, the mean carbon stock of the O. abyssinica bamboo forests was 152.5 $$pm$$ ±  2.5 Mg C ha−1 to 559.8 $$pm$$ ±  9.0 ton CO2 ha−1. Conclusion This study highlights the importance of assessing bamboo’s carbon stock and sequestration potential for enhancing its role in climate change mitigation and sustainable resource management. The O. abyssinica bamboo forests of the study area have significant carbon stock and sequestration potential. Therefore, sustainable management of these crucial vegetation resources will enhance their role in providing ecosystem services, including climate change mitigation.

Description: Background Closed basins occupy 21% of the world’s land area and can substantially affect global carbon budgets. Conventional understanding suggests that the terminal areas of closed basins collect water and carbon from throughout the entire basin, and changes in lake organic carbon sinks are indicative of basin-wide organic carbon storages. However, this hypothesis lacks regional and global validation. Here, we first validate the depositional process of organic carbon in a typical closed-basin region of northwest China using organic geochemical proxies of both soil and lake sediments. Then we estimate the organic carbon sinks and human impacts in extant closed-basin lakes since the Last Glacial Maximum (LGM). Results Results show that 80.56 Pg organic carbon is stored in extant closed-basin lakes mainly found in the northern mid-latitudes. Carbon accumulation rates vary from 17.54 g C m−2 yr−1 during modern times, 6.36 g C m−2 yr−1 during the mid-Holocene and 2.25 g C m−2 yr−1 during the LGM. Then, we evaluated the influence by human activities during the late Holocene (in the past three thousand years). The ratio of human impacts on lake organic carbon storage in above closed basins is estimated to be 22.79%, and human-induced soil organic carbon emissions in the past three thousand years amounted to 207 Pg. Conclusions While the magnitude of carbon storage is not comparable to those in peatland, vegetation and soil, lake organic carbon sinks from closed basins are significant to long-term terrestrial carbon budget and contain information of climate change and human impact from the whole basins. These observations improve our understanding of carbon sinks in closed basins at various time scales, and provide a basis for the future mitigation policies to global climate change.

Description: Background We investigated the spatio-temporal dynamics of soil carbon dioxide (CO2)- and soil methane (CH4)-flux during biological soil crust (BSCs) deposition in a sand-binding area in the eastern Chinese Hobq Desert. The trends in soil organic carbon (C) content and density were analyzed during this process. The sampling sites comprised a mobile dune (control) and those with algal, lichen, and moss crust-fixed sands. The desert soil CO2- and CH4-flux, temperature, and water content were measured from May to October in 2017 and 2018. Simultaneously, organic C content and density were measured and analyzed by stratification. Results The spatio-temporal variation in desert soil CO2-flux was apparent. The average CO2- fluxes in the control, algal, lichen, and moss sites were 1.67, 2.61, 5.83, and 6.84 mmol m−2 h−1, respectively, during the growing season, and the average CH4-fluxes in the four sites were − 1.13, − 1.67, − 3.66, and − 3.77 µmol m−2 h−1, respectively. Soil temperature was significantly positively correlated with CO2-flux but could not influence CH4 absorption, and C flux had minimal correlation with soil water content. The soil total organic C density at all sites was significantly different and decreased as follows: moss 〉 lichen 〉 algal 〉 control; moreover, it decreased with soil depth at all sites. The accumulation of desert soil organic C could enhance soil C emissions. Conclusion In a semi-arid desert, artificial planting could promote sand fixation and BSCs succession; therefore, increasing the C storage capacity of desert soils and decreasing soil C emissions could alter the C cycle pattern in desert ecosystems. Soil temperature is the major factor controlling desert soil CO2 flux and vegetation restoration, and BSCs development could alter the response patterns of C emissions to moisture conditions in desert soils. The results provide a scientific basis for studying the C cycle in desert ecosystems.