Abstract Context Precise and accurate estimates of animal numbers are often essential for population and epidemiological models, as well as for guidance for population management and conservation. This is particularly true for threatened species in landscapes facing multiple threats. Estimates can be derived by different methods, but the question remains as to whether these estimates are comparable. Aims We compared three methods to estimate population numbers, namely, distance sampling, mark–recapture analysis, and home-range overlap analysis, for a population of the iconic threatened species, the koala (Phascolarctos cinereus). This population occupies a heavily fragmented forest and woodland habitat on the Liverpool Plains, north-western New South Wales, Australia, on a mosaic of agricultural and mining lands. Key resultsAll three methods produced similar estimates, with overlapping confidence intervals. Distance sampling required less expertise and time and had less impact on animals, but also had less precision; however, future estimates using the method could be improved by increasing both the number and expertise of the observers. ConclusionsWhen less intrusive methods are preferred, or fewer specialised practitioners are available, we recommend distance sampling to obtain reliable estimates of koala numbers. Although its precision is lower with a low number of sightings, it does produce estimates of numbers similar to those from the other methods. However, combining multiple methods can be useful when other material (genetic, health and demographic) is also needed, or when decisions based on estimates are for high-profile threatened species requiring greater confidence. We recommend that all estimates of population numbers, and their precision or variation, be recorded and reported so that future studies can use them as prior information, increasing the precision of future surveys through Bayesian analyses.
Buildings account for over 40% of the world's energy consumption and are therefore a key contributor to a country's energy as well as carbon budget. Understanding how buildings use energy is critical to understanding how related policies may impact energy use. Data enables decision making, and good quality data arms consumers with the tools to compare their energy performance to their peers, allowing them to differentiate their buildings in the real estate market on the basis of their energy footprint. Good quality data are also essential for policy makers to prioritize their energy saving strategies and track implementation. The United States' Commercial Building Energy Consumption Survey (CBECS) is an example of a successful data framework that is highly useful for governmental and nongovernmental initiatives related to benchmarking energy forecasting, rating systems and metrics, and more. The Bureau of Energy Efficiency (BEE) in India developed the Energy Conservation Building Code (ECBC) and launched the Star Labeling program for a few energy-intensive building segments as a significant first step. However, a data driven policy framework for systematically targeting energy efficiency in both new construction and existing buildings has largely been missing. There is no quantifiable mechanism currently in place to track the impact of code adoption through regular reporting/survey of energy consumption in the commercial building stock. In this paper we present findings from our study that explored use cases and approaches for establishing a commercial buildings data framework for India.
Buildings account for over 40% of the world's energy consumption and are therefore a key contributor to a country's energy as well as carbon budget. Understanding how buildings use energy is critical to understanding how related policies may impact energy use. Data enables decision making, and good quality data arms consumers with the tools to compare their energy performance to their peers, allowing them to differentiate their buildings in the real estate market on the basis of their energy footprint. Good quality data are also essential for policy makers to prioritize their energy saving strategies and track implementation. The United States' Commercial Building Energy Consumption Survey (CBECS) is an example of a successful data framework that is highly useful for governmental and nongovernmental initiatives related to benchmarking energy forecasting, rating systems and metrics, and more. The Bureau of Energy Efficiency (BEE) in India developed the Energy Conservation Building Code (ECBC) and launched the Star Labeling program for a few energy-intensive building segments as a significant first step. However, a data driven policy framework for systematically targeting energy efficiency in both new construction and existing buildings has largely been missing. There is no quantifiable mechanism currently in place to track the impact of code adoption through regular reporting/survey of energy consumption in the commercial building stock. In this paper we present findings from our study that explored use cases and approaches for establishing a commercial buildings data framework for India.
Buildings account for over 40% of the world's energy consumption and are therefore a key contributor to a country's energy as well as carbon budget. Understanding how buildings use energy is critical to understanding how related policies may impact energy use. Data enables decision making, and good quality data arms consumers with the tools to compare their energy performance to their peers, allowing them to differentiate their buildings in the real estate market on the basis of their energy footprint. Good quality data are also essential for policy makers to prioritize their energy saving strategies and track implementation. The United States' Commercial Building Energy Consumption Survey (CBECS) is an example of a successful data framework that is highly useful for governmental and nongovernmental initiatives related to benchmarking energy forecasting, rating systems and metrics, and more. The Bureau of Energy Efficiency (BEE) in India developed the Energy Conservation Building Code (ECBC) and launched the Star Labeling program for a few energy-intensive building segments as a significant first step. However, a data driven policy framework for systematically targeting energy efficiency in both new construction and existing buildings has largely been missing. There is no quantifiable mechanism currently in place to track the impact of code adoption through regular reporting/survey of energy consumption in the commercial building stock. In this paper we present findings from our study that explored use cases and approaches for establishing a commercial buildings data framework for India.
Background-Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction (MI) patients with cognitive impairment. Methods and Results-Patients >= 65 years old with MI in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2015 and December 2016 were categorized by presence and degree of chart-documented cognitive impairment. We evaluated whether cognitive impairment was associated with all-cause in-hospital mortality after adjusting for known prognosticators. Among 43 812 ST-segment-elevation myocardial infarction (STEMI) patients, 3.9% had mild and 2.0% had moderate/severe cognitive impairment; among 90 904 non-ST-segment-elevation myocardial infarction (NSTEMI patients, 5.7% had mild and 2.6% had moderate/severe cognitive impairment. A statistically significant but numerically small difference in the use of primary percutaneous coronary intervention was observed between patients with STEMI with and without cognitive impairment (none, 92.1% versus mild, 92.8% versus moderate/severe, 90.4%; P=0.03); use of fibrinolysis was lower among patients with cognitive impairment (none, 40.9% versus mild, 27.4% versus moderate/severe, 24.2%; P<0.001). Compared with NSTEMI patients without cognitive impairment, rates of angiography, percutaneous coronary intervention, and coronary artery bypass grafting were significantly lower among patients with NSTEMI with mild (41%, 45%, and 70% lower, respectively) and moderate/severe cognitive impairment (71%, 74%, and 93% lower, respectively). After adjustment, compared with no cognitive impairment, presence of moderate/severe (STEW: odds ratio, 2.2, 95% CI, 1.8-2.7; NSTEMI: odds ratio, 1.7, 95% CI, 1.4-2.0) and mild cognitive impairment (STEMI: OR, 1.3, 95% CI, 1.1-1.5; NSTEMI: odds ratio, 1.3, 95% CI, 1.2-1.5) was associated with higher in-hospital mortality. Conclusions-Patients with NSTEMI with cognitive impairment are substantially less likely to receive invasive cardiac care, while patients with STEMI with cognitive impairment receive similar primary percutaneous coronary intervention but less fibrinolysis. Presence and degree of cognitive impairment was independently associated with increased in-hospital mortality. Approaching clinical decision making for older patients with MI with cognitive impairment requires further study. ; American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR); National Institute on AgingUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Aging (NIA) [K23 AG052463]; National Heart, Lung, and Blood InstituteUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01HL126911, R01HL137734, R01HL137794, R01HL136660, U54HL143541]; National Center for Complementary and Integrative Health; Heart and Stroke National New Investigator/Ontario Clinician Scientist Award; Government of Ontario Early Researcher AwardMinistry of Research and Innovation, Ontario; Peter Munk Cardiac Centre, University Health Network; Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of TorontoUniversity of Toronto; Women's College Research InstituteUniversity of Toronto; Department of Medicine, Women's College Hospital; Department of Medicine ; Open access journal ; This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
Background Transthyretin amyloidosis (also known as ATTR amyloidosis) is a systemic, life-threatening disease characterized by transthyretin (TTR) fibril deposition in organs and tissue. A definitive diagnosis of ATTR amyloidosis is often a challenge, in large part because of its heterogeneous presentation. Although ATTR amyloidosis was previously considered untreatable, disease-modifying therapies for the treatment of this disease have recently become available. This article aims to raise awareness of the initial symptoms of ATTR amyloidosis among general practitioners to facilitate identification of a patient with suspicious signs and symptoms. Methods These consensus recommendations for the suspicion and diagnosis of ATTR amyloidosis were developed through a series of development and review cycles by an international working group comprising key amyloidosis specialists. This working group met to discuss the barriers to early and accurate diagnosis of ATTR amyloidosis and develop a consensus recommendation through a thorough search of the literature performed using PubMed Central. Results The cardiac and peripheral nervous systems are most frequently involved in ATTR amyloidosis; however, many patients often also experience gastrointestinal and other systemic manifestations. Given the multisystemic nature of symptoms, ATTR amyloidosis is often misdiagnosed as a more common disorder, leading to significant delays in the initiation of treatment. Although histologic evaluation has been the gold standard to confirm ATTR amyloidosis, a range of tools are available that can facilitate early and accurate diagnosis. Of importance, genetic testing should be considered early in the evaluation of a patient with unexplained peripheral neuropathy. Conclusions A diagnostic algorithm based on initial red flag symptoms and manifestations of cardiac or neurologic involvement will facilitate identification by the general practitioner of a patient with clinically suspicious symptoms, enabling subsequent referral of the patient to a multidisciplinary specialized medical center.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.