Differences in the prevalence of ankylosing spondylitis in primary and secondary care : only one-third of patients are managed in rheumatology

Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Disclosure statement: G.T.J. and G.J.M. have received research funding from Pfizer and AbbVie. L.E.D. conducted the analysis while funded by an Medical Research Council PhD studentship

Analytical method for designing dispersion-managed fiber systems

Peer reviewed

Hot dog vendor

General note: Title and date provided by Bettye Lane.

The Effects of Organic Matter Amendments and Migratory Waterfowl on Greenhouse Gas and Nutrient Dynamics in Managed Coastal Plain Wetlands

Wetland ecosystems provide many valuable ecosystem services, including carbon (C) storage and improvement of water quality. Yet, restored and managed wetlands are not frequently evaluated for their capacity to function in order to deliver on these values. Specific restoration or management practices designed to meet one set of criteria may yield unrecognized biogeochemical costs or co-benefits. The goal of this dissertation is to improve scientific understanding of how wetland restoration practices and waterfowl habitat management affect critical wetland biogeochemical processes related to greenhouse gas emissions and nutrient cycling. I met this goal through field and laboratory research experiments in which I tested for relationships between management factors and the biogeochemical responses of wetland soil, water, plants and trace gas emissions. Specifically, I quantified: (1) the effect of organic matter amendments on the carbon balance of a restored wetland; (2) the effectiveness of two static chamber designs in measuring methane (CH4) emissions from wetlands; (3) the impact of waterfowl herbivory on the oxygen-sensitive processes of methane emission and coupled nitrification-denitrification; and (4) nitrogen (N) exports caused by prescribed draw down of a waterfowl impoundment.

The potency of CH4 emissions from wetlands raises the concern that widespread restoration and/or creation of freshwater wetlands may present a radiative forcing hazard. Yet data on greenhouse gas emissions from restored wetlands are sparse and there has been little investigation into the greenhouse gas effects of amending wetland soils with organic matter, a recent practice used to improve function of mitigation wetlands in the Eastern United States. I measured trace gas emissions across an organic matter gradient at a restored wetland in the coastal plain of Virginia to test the hypothesis that added C substrate would increase the emission of CH4. I found soils heavily loaded with organic matter emitted significantly more carbon dioxide than those that have received little or no organic matter. CH4 emissions from the wetland were low compared to reference wetlands and contrary to my hypothesis, showed no relationship with the loading rate of added organic matter or total soil C. The addition of moderate amounts of organic matter (< 11.2 kg m-2) to the wetland did not greatly increase greenhouse gas emissions, while the addition of high amounts produced additional carbon dioxide, but not CH4.

I found that the static chambers I used for sampling CH4 in wetlands were highly sensitive to soil disturbance. Temporary compression around chambers during sampling inflated the initial chamber CH4 headspace concentration and/or lead to generation of nonlinear, unreliable flux estimates that had to be discarded. I tested an often-used rubber-gasket sealed static chamber against a water-filled-gutter seal chamber I designed that could be set up and sampled from a distance of 2 m with a remote rod sampling system to reduce soil disturbance. Compared to the conventional design, the remotely-sampled static chambers reduced the chance of detecting inflated initial CH4 concentrations from 66 to 6%, and nearly doubled the proportion of robust linear regressions from 45 to 86%. The new system I developed allows for more accurate and reliable CH4 sampling without costly boardwalk construction.

I explored the relationship between CH4 emissions and aquatic herbivores, which are recognized for imposing top-down control on the structure of wetland ecosystems. The biogeochemical consequences of herbivore-driven disruption of plant growth, and in turn, mediated oxygen transport into wetland sediments, were not previously known. Two growing seasons of herbivore exclusion experiments in a major waterfowl overwintering wetland in the Southeastern U.S. demonstrate that waterfowl herbivory had a strong impact on the oxygen-sensitive processes of CH4 emission and nitrification. Denudation by herbivorous birds increased cumulative CH4 flux by 233% (a mean of 63 g CH4 m-2 y-1) and inhibited coupled nitrification-denitrification, as indicated by nitrate availability and emissions of nitrous oxide. The recognition that large populations of aquatic herbivores may influence the capacity for wetlands to emit greenhouse gases and cycle nitrogen is particularly salient in the context of climate change and nutrient pollution mitigation goals. For example, our results suggest that annual emissions of 23 Gg of CH4 y-1 from ~55,000 ha of publicly owned waterfowl impoundments in the Southeastern U.S. could be tripled by overgrazing.

Hydrologically controlled moist-soil impoundment wetlands provide critical habitat for high densities of migratory bird populations, thus their potential to export nitrogen (N) to downstream waters may contribute to the eutrophication of aquatic ecosystems. To investigate the relative importance of N export from these built and managed habitats, I conducted a field study at an impoundment wetland that drains into hypereutrophic Lake Mattamuskeet. I found that prescribed hydrologic drawdowns of the impoundment exported roughly the same amount of N (14 to 22 kg ha-1) as adjacent fertilized agricultural fields (16 to 31 kg ha-1), and contributed approximately one-fifth of total N load (~45 Mg N y-1) to Lake Mattamuskeet. Ironically, the prescribed drawdown regime, designed to maximize waterfowl production in impoundments, may be exacerbating the degradation of habitat quality in the downstream lake. Few studies of wetland N dynamics have targeted impoundments managed to provide wildlife habitat, but a similar phenomenon may occur in some of the 36,000 ha of similarly-managed moist-soil impoundments on National Wildlife Refuges in the southeastern U.S. I suggest early drawdown as a potential method to mitigate impoundment N pollution and estimate it could reduce N export from our study impoundment by more than 70%.

In this dissertation research I found direct relationships between wetland restoration and impoundment management practices, and biogeochemical responses of greenhouse gas emission and nutrient cycling. Elevated soil C at a restored wetland increased CO2 losses even ten years after the organic matter was originally added and intensive herbivory impact on emergent aquatic vegetation resulted in a ~230% increase in CH4 emissions and impaired N cycling and removal. These findings have important implications for the basic understanding of the biogeochemical functioning of wetlands and practical importance for wetland restoration and impoundment management in the face of pressure to mitigate the environmental challenges of global warming and aquatic eutrophication.

Essays in Empirical Operations Management: Bayesian Learning of Service Quality and Structural Estimation of Complementary Product Pricing and Inventory Management

This dissertation contributes to the rapidly growing empirical research area in the field of operations management. It contains two essays, tackling two different sets of operations management questions which are motivated by and built on field data sets from two very different industries --- air cargo logistics and retailing.

The first essay, based on the data set obtained from a world leading third-party logistics company, develops a novel and general Bayesian hierarchical learning framework for estimating customers' spillover learning, that is, customers' learning about the quality of a service (or product) from their previous experiences with similar yet not identical services. We then apply our model to the data set to study how customers' experiences from shipping on a particular route affect their future decisions about shipping not only on that route, but also on other routes serviced by the same logistics company. We find that customers indeed borrow experiences from similar but different services to update their quality beliefs that determine future purchase decisions. Also, service quality beliefs have a significant impact on their future purchasing decisions. Moreover, customers are risk averse; they are averse to not only experience variability but also belief uncertainty (i.e., customer's uncertainty about their beliefs). Finally, belief uncertainty affects customers' utilities more compared to experience variability.

The second essay is based on a data set obtained from a large Chinese supermarket chain, which contains sales as well as both wholesale and retail prices of un-packaged perishable vegetables. Recognizing the special characteristics of this particularly product category, we develop a structural estimation model in a discrete-continuous choice model framework. Building on this framework, we then study an optimization model for joint pricing and inventory management strategies of multiple products, which aims at improving the company's profit from direct sales and at the same time reducing food waste and thus improving social welfare.

Collectively, the studies in this dissertation provide useful modeling ideas, decision tools, insights, and guidance for firms to utilize vast sales and operations data to devise more effective business strategies.

R-script modified VS-Lite model

Drought is a key factor affecting forest ecosystem processes at different spatio-temporal scales. For accurately modeling tree functioning ? and thus for producing reliable simulations of forest dynamics ? the consideration of the variability in the timing and extent of drought effects on tree growth is essential, particularly in strongly seasonal climates such as in the Mediterranean area. Yet, most dynamic vegetation models (DVMs) do not include this intra-annual variability of drought effects on tree growth. We present a novel approach for linking tree-ring data to drought simulations in DVMs. A modified forward model of tree-ring width (VS-Lite) was used to estimate seasonal- and site-specific growth responses to drought of Scots pine (Pinus sylvestris L.), which were subsequently implemented in the DVM ForClim. Ring-width data from sixteen sites along a moisture gradient from Central Spain to the Swiss Alps, including the dry inner Alpine valleys, were used to calibrate the forward ring-width model, and inventory data from managed Scots pine stands were used to evaluate ForClim performance. The modified VS-Lite accurately estimated the year-to-year variability in ring-width indices and produced realistic intra-annual growth responses to soil drought, showing a stronger relationship between growth and drought in spring than in the other seasons and thus capturing the strategy of Scots pine to cope with drought. The ForClim version including seasonal variability in growth responses to drought showed improved predictions of stand basal area and stem number, indicating the need to consider intra-annual differences in climate-growth relationships in DVMs when simulating forest dynamics. Forward modeling of ring-width growth may be a powerful tool to calibrate growth functions in DVMs that aim to simulate forest properties in across multiple environments at large spatial scales.

Inventory of SINOPS project data sets

During the SINOPS project, an optimal state of the art simulation of the marine silicon cycle is attempted employing a biogeochemical ocean general circulation model (BOGCM) through three particular time steps relevant for global (paleo-) climate. In order to tune the model optimally, results of the simulations are compared to a comprehensive data set of 'real' observations. SINOPS' scientific data management ensures that data structure becomes homogeneous throughout the project. Practical work routine comprises systematic progress from data acquisition, through preparation, processing, quality check and archiving, up to the presentation of data to the scientific community. Meta-information and analytical data are mapped by an n-dimensional catalogue in order to itemize the analytical value and to serve as an unambiguous identifier. In practice, data management is carried out by means of the online-accessible information system PANGAEA, which offers a tool set comprising a data warehouse, Graphical Information System (GIS), 2-D plot, cross-section plot, etc. and whose multidimensional data model promotes scientific data mining. Besides scientific and technical aspects, this alliance between scientific project team and data management crew serves to integrate the participants and allows them to gain mutual respect and appreciation.

Constructing the Vulvar Pain Assessment Questionnaire Inventory

The goals of this program of research were to examine the link between self-reported vulvar pain and clinical diagnoses, and to create a user-friendly assessment tool to aid in that process. These goals were undertaken through a series of four empirical studies (Chapters 2-6): one archival study, two online studies, and one study conducted in a Women’s Health clinic. In Chapter 2, the link between self-report and clinical diagnosis was confirmed by extracting data from multiple studies conducted in the Sexual Health Research Laboratory over the course of several years. We demonstrated the accuracy of diagnosis based on multiple factors, and explored the varied gynecological presentation of different diagnostic groups. Chapter 3 was based on an online study designed to create the Vulvar Pain Assessment Questionnaire (VPAQ) inventory. Following the construct validation approach, a large pool of potential items was created to capture a broad selection of vulvar pain symptoms. Nearly 300 participants completed the entire item pool, and a series of factor analyses were utilized to narrow down the items and create scales/subscales. Relationships were computed among subscales and validated scales to establish convergent and discriminant validity. Chapters 4 and 5 were conducted in the Department of Obstetrics & Gynecology at Oregon Health & Science University. The brief screening version of the VPAQ was employed with patients of the Program in Vulvar Health at the Center for Women’s Health. The accuracy and usefulness of the VPAQscreen was determined from the perspective of patients as well as their health care providers, and the treatment-seeking experiences of patients was explored. Finally, a second online study was conducted to confirm the factor structure, internal consistency, and test-retest reliability of the VPAQ inventory. The results presented in these chapters confirm the link between targeted questions and accurate diagnoses, and provide a guideline that is useful and accessible for providers and patients.

Alteration mineralogy and pathfinder element inventory of the McArthur River unconformity-related uranium deposit, Canada

The chemical compositions, modal mineralogy, and textural variability of interstitial minerals in sandstones of the Athabasca Group strata in the vicinity of the McArthur River unconformity-related uranium deposit were characterized using a combination of short wave infrared spectroscopy (SWIR), lithogeochemistry, scanning electron microscopy (SEM), electron probe microanalysis (EPMA) and laser ablation mass spectrometry (LA-ICP-MS) to determine the residence sites of pathfinder trace elements. The importance of integrating in-situ mineral chemistry with whole-rock analyses resides in the possibility to establish the mineralogical and paragenetic context of geochemical signatures in defining the footprint of the deposit. Located in the Athabasca Basin, Saskatchewan, Canada, the deposit is situated below ~550 m of quartz arenitic sandstones that are strongly silicified between depths of approximately 200-400 m. The silicified layer exhibits significant control on the distribution of alteration minerals, and appears to have restricted both the primary and secondary dispersion of pathfinder trace elements, which include U, radiogenic Pb isotopes, V, Ni, Co, Cu, Mo, As, Zn, and REEs. Diagenetic background sandstones contain assemblages of illite, dickite, aluminum-phosphate-sulfate (APS) minerals, apatite, and Fe-Ti oxide minerals. Altered sandstones contain assemblages of Al-Mg chlorite (sudoite), alkali-deficient dravite, APS minerals, kaolinite, illite, and oxide minerals. Throughout the sandstones, APS minerals account for the majority of the Sr and LREE concentrations, whereas late pre-ore chlorite, containing up to 0.1 wt.% Ni, accounts for the majority of Ni concentrations. Cobalt, Cu, Mo, and Zn occur predominantly in cryptic sub-micron sulfide and sulfarsenide inclusions in clay mineral aggregates and in association with paragenetically-late Fe-Ti oxides. Uranium occurs predominantly in cryptic micro-inclusions associated with pyrite in late-stage quartz overgrowths, and with paragenetically late Fe-Ti oxide micro-inclusions in kaolinite. Additionally, up to 0.2 wt.% U is cryptically distributed in post-ore Fe-oxide veins. Early diagenetic apatite, monazite and apatite inclusions in detrital quartz, and detrital zircon also contribute significant U and HREE to samples analyzed with an aggressive leach such as Aqua Regia. Detailed LA-ICP-MS chemical mapping of interstitial assemblages, detrital grains, and cements provides new insights into the distribution and inventory of pathfinder elements in the footprint of the McArthur River uranium deposit.

Noble States Managed by Women. Doña Teresa de Saavedra y Zúñiga, Countess of Villalonso: an Aristocrat during Philip II and Philip III’s Reign

This work intends to analyze the letters exchanged between doña Teresa de Saavedra y Zúñiga, countess of Villalonso, and Bartolomé de Cartagena, a merchant who lived in Seville. Those letters are a very detailed account of their financial relationship during two decades; but they also give us important information about the countess’ life. In her letters the countess discussed her domestic familial life but also made reference to her social position at Court, so we can reconstruct the strategies used by doña Teresa in order to accomplish all her objectives and the ways she used to present these goals to the others.

Task sharing within a managed clinical network to improve child health in Malawi

BACKGROUND: Eighty per cent of Malawi's 8 million children live in rural areas, and there is an extensive tiered health system infrastructure from village health clinics to district hospitals which refers patients to one of the four central hospitals. The clinics and district hospitals are staffed by nurses, non-physician clinicians and recently qualified doctors. There are 16 paediatric specialists working in two of the four central hospitals which serve the urban population as well as accepting referrals from district hospitals. In order to provide expert paediatric care as close to home as possible, we describe our plan to task share within a managed clinical network and our hypothesis that this will improve paediatric care and child health.

PRESENTATION OF THE HYPOTHESIS: Managed clinical networks have been found to improve equity of care in rural districts and to ensure that the correct care is provided as close to home as possible. A network for paediatric care in Malawi with mentoring of non-physician clinicians based in a district hospital by paediatricians based at the central hospitals will establish and sustain clinical referral pathways in both directions. Ultimately, the plan envisages four managed paediatric clinical networks, each radiating from one of Malawi's four central hospitals and covering the entire country. This model of task sharing within four hub-and-spoke networks may facilitate wider dissemination of scarce expertise and improve child healthcare in Malawi close to the child's home.

TESTING THE HYPOTHESIS: Funding has been secured to train sufficient personnel to staff all central and district hospitals in Malawi with teams of paediatric specialists in the central hospitals and specialist non-physician clinicians in each government district hospital. The hypothesis will be tested using a natural experiment model. Data routinely collected by the Ministry of Health will be corroborated at the district. This will include case fatality rates for common childhood illness, perinatal mortality and process indicators. Data from different districts will be compared at baseline and annually until 2020 as the specialists of both cadres take up posts.

IMPLICATIONS OF THE HYPOTHESIS: If a managed clinical network improves child healthcare in Malawi, it may be a potential model for the other countries in sub-Saharan Africa with similar cadres in their healthcare system and face similar challenges in terms of scarcity of specialists.

Protocol: Quality of Life, Decision Making, Costs and Impact on Carers in People Managed without Dialysis - The PACKS Study

Effektiv lagerstyrning med AHP och tvådimensionell artikelklassificering : En fallstudie på Permobil AB, Timrå

Costs related to inventory are usually a significant amount of the company’s total assets. Despite this, companies in general don’t pay a lot of interest in it, even if the benefits from effective inventory are obvious when it comes to less tied up capital, increased customer satisfaction and better working environment. Permobil AB, Timrå is in an intense period when it comes to revenue and growth. The production unit is aiming for an increased output of 30 % in the next two years. To make this possible the company has to improve their way to distribute and handle material,The purpose of the study is to provide useful information and concrete proposals for action, so that the company can build a strategy for an effective and sustainable solution when it comes to inventory management. Alternative methods for making forecasts are suggested, in order to reach a more nuanced perception of different articles, and how they should be managed. Analytic Hierarchy Process (AHP) was used in order to give specially selected persons the chance to decide criteria for how the article should be valued. The criteria they agreed about were annual volume value, lead time, frequency rate and purchase price. The other method that was proposed was a two-dimensional model where annual volume value and frequency was the criteria that specified in which class an article should be placed. Both methods resulted in significant changes in comparison to the current solution. For the spare part inventory different forecast methods were tested and compared with the current solution. It turned out that the current forecast method performed worse than both moving average and exponential smoothing with trend. The small sample of ten random articles is not big enough to reject the current solution, but still the result is a reason enough, for the company to control the quality of the forecasts.

The Mormon Trail: Historic Byway Inventory and Evaluation, 1998

A three-step approach was used to do the study of the Mormon Trail. These involved research, field data collection and evaluation of the project corridors. Step one involved research on the location of the Trail, associated sites and the historic land use near the Trail between 1846 and 1868. The next step involved defining roads to be inventoried and the actual field survey. Step three involved evaluation of the inventoried corridors. This evaluation procedure was based on the methodology currently used by Iowa DOT to evaluate candidate scenic byway routes but involved different evaluation factors. The numeric results of the two analyses can be directly compared. The results of the field survey and evaluation are shown in detail by county. Inventory and evaluation procedures for historic and cultural byways are discussed in Appendix A.

Qualités psychométriques de la version canadienne-française du Geriatric Anxiety Inventory

Afin de pallier au manque d’outils de dépistage efficaces et adaptés à la population âgée, le Geriatric Anxiety Inventory (GAI) et une forme courte (GAI-SF) ont été développés pour évaluer la sévérité des symptômes anxieux chez les aînés. La présente étude cherchait à évaluer les propriétés psychométriques de la version canadienne-française du GAI dans sa forme complète (GAI-FC) et courte (GAI-FC-SF) auprès de la population âgée québécoise francophone. Trois cent trente et une personnes de 65 ans et plus vivant dans la communauté ont participé à cette étude. Les propriétés psychométriques s’avèrent satisfaisantes pour le GAI-FC et le GAI-FC-SF avec, respectivement, une cohérence interne satisfaisante (α = ,94 et ,83), une validité convergente adéquate (r = ,50 à ,86 avec des instruments de mesure évaluant des concepts similaires ou reliés à l’anxiété), une bonne fidélité test-retest (r = ,89 et ,85) ainsi qu’une structure unifactorielle. Les résultats de cette étude appuient l’utilisation du GAI-FC et du GAI-FC-SF pour l’évaluation de l’anxiété chez les aînés québécois. Le GAI-FC-SF semble une alternative intéressante au GAI-FC comme outil de dépistage lorsque le temps disponible pour l’évaluation est limité. Mots-clés: Geriatric Anxiety Inventory, aînés, anxiété, trouble anxieux, instrument d’évaluation.