The changing relationship between bodyweight and longevity in high- and low-income countries.

Standard measures of bodyweight (overweight and obese, for example) fail to reflect differences across populations and technological progress over time. This paper builds on the pioneering work of Hans Waaler (1984) and Robert Fogel (1994) to empirically estimate how the relationship between body mass index (BMI) and longevity varies across high-, middle-, and low-income countries. Importantly, we show that these differences are so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined)-and in fact, relative to current standards, a larger share of low-income countries' populations can be unhealthily heavy.

U.S. global health aid policy and family planning in sub-Saharan Africa.

The Trump administration reinstated and expanded the Mexico City Policy (MCP) in 2017 as the Protecting Life in Global Health Assistance (PLGHA) policy, forbidding international organizations receiving all U.S. health assistance from promoting abortion. Existing evidence suggests that abortion rates rise under the MCP, but the direct effect of U.S. funding restrictions on supply and use of family planning has received less attention. By studying PLGHA's impact on health service delivery providers and women in eight sub-Saharan African countries, we are able to fill this gap. We find that health facilities provide fewer family planning services, including emergency contraception, and that women are less likely to use contraception and more likely to have given birth recently under the policy. These findings suggest that PLGHA has important unintended consequences that are detrimental to reproductive health and the autonomous decision-making of health service providers and women.

The importance of wage loss in the financial burden of illness: Longitudinal evidence from India.

BACKGROUND: A key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness, and large-scale health insurance expansions are a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income. In this paper, we quantify the economic burden of illness in India attributable - separately - to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution. METHODS: We use data from two longitudinal Indian household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1300 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). Our regression models include a series of fixed effects that account for time-invariant household- (or individual-) level and time-varying unobservables common across households. FINDINGS: We find that, in the VDSA sample, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample confirm that this socio-economic gradient is present in the Indian population generally. CONCLUSIONS: Wage loss accounts for a substantial share of the total economic burden of illness in India - and disproportionately so among the poorest households. Our findings imply that if UHC is to achieve its objective of protecting households against the financial risk of illness - particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.

Online Community and Citizen Science supports environmental science learning by young people.

Community and citizen science in online settings could be seen as a means for young people to engage with and contribute to authentic science. Yet, there is a limited understanding of who takes part in citizen science among young people, what they learn, and through which processes, particularly in online settings. In this exploratory study, we analysed 34 in-depth interviews and log files of young people aged 11-19 years old who took part in citizen science projects, hosted on the Zooniverse platform. Data analysis suggested that participation in online citizen science can bring environmental science learning benefits to young people, with some participants reporting evidence of agency with science, highlighted by taking action to do science in another context. Many participating youth exhibited substantial previous science experiences that helped them to take part and learn from citizen science projects. Considering findings from this study, we present a first working framework of how environmental science learning is enabled or hindered by certain types of participation, as a means to guide the design of online citizen science for young people. We recommend that the future project design, publicity and recruitment in online citizen science activities explicitly target the needs and interests of young people with diverse characteristics and competencies to truly open science to all.

A crowd of BashTheBug volunteers reproducibly and accurately measure the minimum inhibitory concentrations of 13 antitubercular drugs from photographs of 96-well broth microdilution plates.

Tuberculosis is a respiratory disease that is treatable with antibiotics. An increasing prevalence of resistance means that to ensure a good treatment outcome it is desirable to test the susceptibility of each infection to different antibiotics. Conventionally, this is done by culturing a clinical sample and then exposing aliquots to a panel of antibiotics, each being present at a pre-determined concentration, thereby determining if the sample isresistant or susceptible to each sample. The minimum inhibitory concentration (MIC) of a drug is the lowestconcentration that inhibits growth and is a more useful quantity but requires each sample to be tested at a range ofconcentrations for each drug. Using 96-well broth micro dilution plates with each well containing a lyophilised pre-determined amount of an antibiotic is a convenient and cost-effective way to measure the MICs of several drugs at once for a clinical sample. Although accurate, this is still an expensive and slow process that requires highly-skilled and experienced laboratory scientists. Here we show that, through the BashTheBug project hosted on the Zooniverse citizen science platform, a crowd of volunteers can reproducibly and accurately determine the MICs for 13 drugs and that simply taking the median or mode of 11-17 independent classifications is sufficient. There is therefore a potential role for crowds to support (but not supplant) the role of experts in antibiotic susceptibility testing.

Tuberculosis is a bacterial respiratory infection that kills about 1.4 million people worldwide each year. While antibiotics can cure the condition, the bacterium responsible for this disease, Mycobacterium tuberculosis, is developing resistance to these treatments. Choosing which antibiotics to use to treat the infection more carefully may help to combat the growing threat of drug-resistant bacteria. One way to find the best choice is to test how an antibiotic affects the growth of M. tuberculosis in the laboratory. To speed up this process, laboratories test multiple drugs simultaneously. They do this by growing bacteria on plates with 96 wells and injecting individual antibiotics in to each well at different concentrations. The Comprehensive Resistance Prediction for Tuberculosis (CRyPTIC) consortium has used this approach to collect and analyse bacteria from over 20,000 tuberculosis patients. An image of the 96-well plate is then captured and the level of bacterial growth in each well is assessed by laboratory scientists. But this work is difficult, time-consuming, and subjective, even for tuberculosis experts. Here, Fowler et al. show that enlisting citizen scientists may help speed up this process and reduce errors that arise from analysing such a large dataset. In April 2017, Fowler et al. launched the project 'BashTheBug' on the Zooniverse citizen science platform where anyone can access and analyse the images from the CRyPTIC consortium. They found that a crowd of inexperienced volunteers were able to consistently and accurately measure the concentration of antibiotics necessary to inhibit the growth of M. tuberculosis. If the concentration is above a pre-defined threshold, the bacteria are considered to be resistant to the treatment. A consensus result could be reached by calculating the median value of the classifications provided by as few as 17 different BashTheBug participants. The work of BashTheBug volunteers has reduced errors in the CRyPTIC project data, which has been used for several other studies. For instance, the World Health Organization (WHO) has also used the data to create a catalogue of genetic mutations associated with antibiotics resistance in M. tuberculosis. Enlisting citizen scientists has accelerated research on tuberculosis and may help with other pressing public health concerns.

The role of Mesothelin signaling in Portal Fibroblasts in the pathogenesis of cholestatic liver fibrosis.

Liver fibrosis develops in response to chronic toxic or cholestatic injury, and is characterized by apoptosis of damaged hepatocytes, development of inflammatory responses, and activation of Collagen Type I producing myofibroblasts that make liver fibrotic. Two major cell types, Hepatic Stellate Cells (HSCs) and Portal Fibroblasts (PFs) are the major source of hepatic myofibroblasts. Hepatotoxic liver injury activates Hepatic Stellate Cells (aHSCs) to become myofibroblasts, while cholestatic liver injury activates both aHSCs and Portal Fibroblasts (aPFs). aPFs comprise the major population of myofibroblasts at the onset of cholestatic injury, while aHSCs are increasingly activated with fibrosis progression. Here we summarize our current understanding of the role of aPFs in the pathogenesis of cholestatic fibrosis, their unique features, and outline the potential mechanism of targeting aPFs in fibrotic liver.

Regional Anesthesia for Symptomatic Treatment of Stingray Envenomation.

Stingray envenomation is common in coastal regions around the world and may result in intense pain that can be challenging to manage. Described therapies involve hot water immersion and potentially other options such as opioid and nonopioid analgesics, removal of the foreign body, wound debridement, antibiotics for secondary infection, and tetanus toxoid. However, for some patients, this may not be enough. Peripheral nerve blockade is a frequently used perioperative analgesic technique, but it has rarely been described in the management of stingray envenomation. Here, we report a case of stingray envenomation in an otherwise healthy 36-y-old male with pain refractory to traditional therapies. After admission for pain control, the patient received an ultrasound-guided sciatic popliteal nerve block. Upon completion of the peripheral nerve block, the patient reported rapid and complete resolution of the intense pain, which did not return thereafter.

A performance comparison of the most commonly used minimally invasive monitors of cardiac output.

BACKGROUND: Shock is common in critically ill and injured patients. Survival during shock is highly dependent on rapid restoration of tissue oxygenation with therapeutic goals based on cardiac output (CO) optimization. Despite the clinical availability of numerous minimally invasive monitors of CO, limited supporting performance data are available. METHODS: Following approval of the University of Saskatchewan Animal Research Ethics Board, we assessed the performance and trending ability of PiCCOplus™, FloTrac™, and CardioQ-ODM™ across a range of CO states in pigs. In addition, we assessed the ability of invasive mean arterial blood pressure (iMAP) to follow changes in CO using a periaortic transit-time flow probe as the reference method. Statistical analysis was performed with function-fail, bias and precision, percent error, and linear regression at all flow, low-flow (> 1 standard deviation [SD] below the mean), and high-flow (> 1 SD above the mean) CO conditions. RESULTS: We made a total of 116,957 paired CO measurements. The non-invasive CO monitors often failed to provide a CO value (CardioQ-ODM: 40.6% failed measurements; 99% confidence interval [CI], 38.5 to 42.6; FloTrac: 9.6% failed measurements; 99% CI, 8.7 to 10.5; PiCCOplus: 4.7% failed measurements; 99% CI, 4.5 to 4.9; all comparisons, P < 0.001). The invasive mean arterial pressure provided zero failures, failing less often than any of the tested CO monitors (all comparisons, P < 0.001). The PiCCOplus was most interchangeable with the flow probe at all flow states: PiCCOplus (20% error; 99% CI, 19 to 22), CardioQ-ODM (25% error; 99% CI, 23 to 27), FloTrac (34% error; 99% CI, 32 to 38) (all comparisons, P < 0.001). At low-flow states, CardioQ-ODM (43% error; 99% CI, 32 to 63) and Flotrac (45% error; 99% CI, 33 to 70) had similar interchangeability (P = 0.07), both superior to PiCCOplus (48% error; 99% CI, 42 to 60) (P < 0.001). Regarding CO trending, the CardioQ-ODM (correlation coefficient, 0.82; 99% CI, 0.81 to 0.83) was statistically superior to other monitors including iMAP, but at low flows iMAP (correlation coefficient, 0.58; 99% CI, 0.58 to 0.60) was superior to all minimally invasive CO monitors (all comparisons P < 0.001). CONCLUSIONS: None of the minimally invasive monitors of CO performed well at all tested flows. Invasive mean arterial blood pressure most closely tracked CO change at critical flow states.

RéSUMé: CONTEXTE: L'état de choc est fréquent chez les patients blessés et en urgence absolue. La survie pendant le choc dépend fortement de la restauration rapide de l'oxygénation tissulaire avec des objectifs thérapeutiques basés sur l'optimisation du débit cardiaque (DC). Malgré la disponibilité clinique de nombreux moniteurs minimalement invasifs du DC, il n'existe que des données limitées sur leur performance pour appuyer leur utilisation. MéTHODE: À la suite de l'approbation du comité d'éthique de la recherche animale de l'Université de la Saskatchewan, nous avons évalué la performance et la capacité de suivi des tendances des appareils PiCCOplus™, FloTrac™ et CardioQ-ODM™ sur une vaste gamme d'état de DC chez des cochons. Nous avons également évalué la capacité de la tension artérielle moyenne invasive (iMAP) à suivre les changements de DC en utilisant une sonde périaortique de débit basée sur le temps de transit comme méthode de référence. L'analyse statistique a été réalisée avec fonction-échec, biais et précision, pourcentage d'erreur et régression linéaire à des conditions de DC de tous les débits, de faible débit (> 1 écart-type [ET] au-dessous de la moyenne) et de débit élevé (> 1 ET au-dessus de la moyenne). RéSULTATS: Nous avons effectué un total de 116 957 mesures de DC appariées. Les moniteurs non invasifs de la DC n'ont souvent pas réussi à fournir une valeur de DC (CardioQ-ODM : 40,6% de mesures échouées; intervalle de confiance [IC] de 99 %, 38,5 à 42,6; FloTrac : 9,6 % de mesures échouées; IC 99 %, 8,7 à 10,5; PiCCOplus : 4,7 % de mesures échouées; IC 99 %, 4,5 à 4,9; toutes les comparaisons, P < 0,001). La tension artérielle moyenne invasive n'a fourni aucun échec plus souvent que n'importe lequel des moniteurs de DC testés (toutes les comparaisons, P < 0,001). Le PiCCOplus était le plus interchangeable avec la sonde de débit à tous les états de débit : PiCCOplus (erreur de 20 %; IC 99 %, 19 à 22), CardioQ-ODM (erreur de 25 %; IC 99 %, 23 à 27), FloTrac (erreur de 34 %; IC 99 %, 32 à 38) (toutes les comparaisons, P < 0,001). Aux états de débit faible, les moniteurs CardioQ-ODM (erreur de 43 %; IC 99 %, 32 à 63) et FloTrac (erreur de 45 %; IC 99 %, 33 à 70) présentaient une interchangeabilité similaire (P = 0,07), tous deux supérieurs au PiCCOplus (erreur de 48 %; IC 99 %, 42 à 60) (P < 0,001). En ce qui concerne le suivi des tendances de DC, le CardioQ-ODM (coefficient de corrélation, 0,82; IC 99 %, 0,81 à 0,83) était statistiquement supérieur aux autres moniteurs, y compris au iMAP, mais à faibles débits, l'iMAP (coefficient de corrélation, 0,58; IC 99 %, 0,58 à 0,60) était supérieure à tous les moniteurs de DC minimalement invasifs (toutes les comparaisons, P < 0,001). CONCLUSION: Aucun des moniteurs de DC minimalement invasif n'a donné de bons résultats à tous les débits testés. La tension artérielle moyenne invasive était le moniteur qui a suivi de plus près les changements de DC dans des états critiques de débit.

Technological Progress and Health Convergence: The Case of Penicillin in Postwar Italy.

Throughout history, technological progress has transformed population health, but the distributional effects of these gains are unclear. New substitutes for older, more expensive health technologies can produce convergence in population health outcomes but may also be prone to elite capture and thus divergence. We study the case of penicillin using detailed historical mortality statistics and exploiting its abruptly timed introduction in Italy after WWII. We find that penicillin reduced both the mean and standard deviation of infectious disease mortality, leading to substantial convergence across disparate regions of Italy. Our results do not appear to be driven by competing risks or confounded by mortality patterns associated with WWII.

Agreement between dried blood spots and HemoCue in Tamil Nadu, India.

India retains the world's largest burden of anemia despite decades of economic growth and anemia prevention programming. Accurate screening and estimates of anemia prevalence are critical for successful anemia control. Evidence is mixed on the performance of HemoCue, a point-of-care testing device most widely used for large-scale surveys. The use of dried blood spots (DBS) to assess hemoglobin (Hb) concentration is a potential alternative, particularly in field settings. The objective of this study is to assess Hb measurement agreement between capillary HemoCue and DBS among two age groups, children 6-59 months and females age 12-40 years. We analyzed data from the baseline round of a cluster randomized rice fortification intervention in Cuddalore district of Tamil Nadu, India. Capillary blood was collected from a subset of participants for Hb assessment by HemoCue 301 and DBS methods. We calculated Lin's concordance correlation coefficient, and tested bias by conducting paired t-tests of Hb concentration. Independence of the bias and Hb magnitude was examined visually using Bland-Altman plots and statistically tested by Pearson's correlation. We assessed differences in anemia classification using McNemar's test of marginal homogeneity. Concordance between HemoCue and DBS Hb measures was moderate for both children 6-59 months (ρc = 0.67; 95% CI 0.65, 0.71) and females 12-40 years (ρc = 0.67: 95% CI 0.64, 0.69). HemoCue measures were on average 0.06 g/dL higher than DBS for children (95% CI 0.002, 0.12; p = 0.043) and 0.29 g/dL lower than DBS for females (95% CI - 0.34, - 0.23; p < 0.0001). 50% and 56% of children were classified as anemic according to HemoCue and DBS, respectively (p < 0.0001). 55% and 47% of females were classified as anemic according to HemoCue and DBS, respectively (p < 0.0001). There is moderate statistical agreement of Hb concentration between HemoCue and DBS for both age groups. The choice of Hb assessment method has important implications for individual anemia diagnosis and population prevalence estimates. Further research is required to understand factors that influence the accuracy and reliability of DBS as a methodology for Hb assessment.

Intravenous dextrose versus ondansetron for prevention of postoperative vomiting in children: a randomized non-inferiority trial.

BACKGROUND: Postoperative vomiting (POV) in children is frequent. Dextrose-containing intravenous fluids in the perioperative period have shown improvement of POV in adults. Similar studies have not been done in children. AIM: The primary purpose was to study the efficacy of intraoperative intravenous dextrose for antiemetic prophylaxis in children undergoing ambulatory surgery. METHODS: A non-inferiority randomized clinical trial of healthy children (three to nine years old) undergoing ambulatory dental surgery was conducted. The control group received dexamethasone (0.15 mg·kg-1 iv) and ondansetron (0.05 mg·kg-1 iv); the intervention group received dexamethasone (0.15 mg·kg-1 iv) and intravenous 5% dextrose in 0.9% normal saline according to a weight-based maintenance rate. The primary outcome was POV in the postanesthetic care unit (PACU) within two hr after surgery. Secondary outcomes included POV within 24 hr from discharge and unplanned hospital admission. A non-inferiority analysis was conducted on the primary outcome using an absolute risk difference of 7.5% as the non-inferiority margin. RESULTS: Data from 290 patients were analyzed. Demographics and intraoperative anesthetic management were similar between groups. Vomiting in the PACU occurred in 7.6% and 3.5% of the dextrose and ondansetron groups, respectively, with a risk difference of 4.2% (95% confidence interval [CI], -1.0 to 9.5). Given that the upper limit of the 95% CI exceeded our non-inferiority margin, non-inferiority of dextrose compared with ondansetron was not shown. CONCLUSION: These results do not support the use of intravenous dextrose as a satisfactory alternative to ondansetron to prevent POV in ambulatory pediatric dental surgery patients. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01912807); registered 18 July 2013.

RéSUMé: CONTEXTE: Les vomissements postopératoires (VPO) sont fréquents chez l'enfant. Il a été démontré qu'en période périopératoire, les solutés intraveineux contenant du dextrose entraînaient une diminution des VPO chez l'adulte, mais des études similaires n'ont pas été réalisées auprès de populations pédiatriques. OBJECTIF: L'objectif principal était d'évaluer l'efficacité du dextrose intraveineux peropératoire en tant que prophylaxie antiémétique chez les enfants subissant une chirurgie ambulatoire. MéTHODE: Une étude clinique randomisée de non-infériorité a été réalisée auprès d'enfants en bonne santé (de trois à neuf ans) devant subir une chirurgie dentaire en ambulatoire. Le groupe témoin a reçu de la dexaméthasone (0,15 mg·kg−1 iv) et de l'ondansétron (0,05 mg·kg−1 iv); le groupe intervention a reçu de la dexaméthasone (0,15 mg·kg−1 iv) et du dextrose intraveineux 5 % dans une solution de normal salin 0,9 % selon une échelle basée sur le poids. Le critère d'évaluation principal était la présence de VPO en salle de réveil au cours des deux heures suivant la chirurgie. Les critères d'évaluation secondaires comprenaient les VPO au cours des 24 h suivant le congé et une admission non planifiée à l'hôpital. L'analyse de non-infériorité a été réalisée pour le critère d'évaluation primaire en se fondant sur une différence de risque absolu de 7,5 % comme marge de non-infériorité. RéSULTATS: Les données de 290 patients ont été analysées. Les données démographiques et de prise en charge anesthésique peropératoire étaient semblables entre les deux groupes. Des vomissements sont survenus en salle de réveil chez 7,6 % et 3,5 % des groupes dextrose et ondansétron, respectivement, avec une différence de risque de 4,2 % (intervalle de confiance [IC] 95 %, -1,0 à 9,5). Étant donné que la limite supérieure de l'IC 95 % excédait notre marge de non-infériorité, la non-infériorité du dextrose comparativement à l'ondansétron n'a pas été démontrée. CONCLUSION: Ces résultats n'appuient pas l'utilisation de dextrose intraveineux en tant qu'alternative à l'ondansétron afin de prévenir les VPO chez les patients pédiatriques de chirurgie dentaire ambulatoire. ENREGISTREMENT DE L'éTUDE: www. CLINICALTRIALS: gov (NCT01912807); enregistrée le 18 juillet 2013.

Modeling the size of small spills of pure volatile liquids for use in evaporation rate and air concentration modeling.

Exposure modeling is a valuable tool for assessing chemical vapor exposures that occur during transient events such as small spills of volatile liquids. Models are available to estimate liquid evaporation rates and resulting air concentrations. However, liquid evaporation rate models require the surface area of the puddle in order to provide vapor generation rates in terms of mass per time. This study developed an approach to model the surface area of small spills of pure liquids. A theoretical equation exists relating puddle depth to a liquid's surface tension, density, and contact angle. A contact angle is a characteristic of liquid-solid interactions at the edge of a puddle. If the depth of a puddle can be calculated and the volume of the liquid spilled is known, the surface area of the puddle can be determined. Values for density and surface tension are published. Contact angles, however, are not readily available. Five hundred and eighty experimental spills were conducted using acetone, ethanol and water. The effective contact angle for each spill was determined. Spill volumes varied from 1.0-30.0 mL. The height of the liquid release varied from 0-15 cm onto a variety of surfaces. The effective contact angle of a puddle was most strongly associated with the liquid's polarity. The height of the liquid release and type of surface had significant, but smaller effects on the puddle size. The effective contact angle of a puddle from a spill can be estimated as ln(Ï´eff) = 3.73 - 1.17 · 1χυ/f - 0.06 · h + S. In this equation, 1χυ/f is the polarity index of the liquid, h is the height of liquid release (cm), and S is a surface constant. Ï´eff can be used with the liquid density, surface tension and volume to calculate the surface area of the puddle. The surface area of the puddle can then be used in evaporation rate models to determine a vapor generation rate for input to vapor concentration models.

Rare cause of emergency in the first week of life: congenital hepatoblastoma (case report).

During the first week of life, a sudden deterioration in a newborn commonly includes investigations to rule out infections, lung pathologies, cardiac lesions, neurological insults, metabolic disorders or gastrointestinal emergencies. It is unusual, however, to consider malignancy as the primary causative factor. In this case report, we describe a rare and unusual presentation of congenital hepatoblastoma, its complications and management in a neonate with multi-organ dysfunction. A term infant presented with sudden deterioration, hemodynamic instability and an acute abdomen on his 4th day of life. Surgical exploration revealed a ruptured neoplasm that pathology diagnosed as a congenital hepatoblastoma. After the patient was stabilized, chemotherapy was initiated. At present, the patient is 8 months old and under continuous follow-up of oncology service. This case highlights the importance of considering rare diagnoses including congenital malignancy when investigating and managing a sick newborn with multi-organ dysfunction.

Can Bureaucrats Really Be Paid Like Ceos? Substitution Between Incentives and Resources Among School Administrators in China.

Unlike performance incentives for private sector managers, little is known about performance incentives for managers in public sector bureaucracies. Through a randomized trial in rural China, we study performance incentives rewarding school administrators for reducing student anemia-as well as complementarity between incentives and orthogonally assigned discretionary resources. Large (but not small) incentives and unrestricted grants both reduced anemia, but incentives were more cost-effective. Although unrestricted grants and small incentives do not interact, grants fully crowd-out the effect of larger incentives. Our findings suggest that performance incentives can be effective in bureaucratic environments, but they are not complementary to discretionary resources.

A giant umbilical cord: Benign finding or surgical emergency?

Congenital urachal anomalies are usually asymptomatic. However, infection or obstruction of urachal remnant may result in serious complications. The giant umbilical cords with suspected internal communications could contain remnants and require surgical exploration. With timely recognition and surgical intervention, the outcome is generally good.

The future is here! Pediatric surgery and the move to the royal college of physicians and surgeons of Canada's competence by design.

This interactive session was held at the 51st Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) in preparation for the transition of Pediatric Surgery training in Canada to Competency by Design (a CBME-based model of residency training developed by the Royal College of Physicians and Surgeons of Canada).

What Do We Know about Young Volunteers? An Exploratory Study of Participation in Zooniverse.

Citizen Science (CS) is an increasingly popular activity enacted either in the field or online. Volunteers participate in research activities such as data processing and analysis by, for example, identifying plants and animals. In this paper we examine young people's participation in online CS projects hosted on the Zooniverse platform. This is an exploratory study, the first of its kind that focuses on young people, mainly 16-19 years old. It uses data analytics and visualisation techniques to capture participation in online CS, and in particular to answer the following questions: (a) What does young people's participation look like in CS projects? (b) What Zooniverse projects do young people choose to participate in? and (3) What Zooniverse projects do young people choose together? Findings revealed five distinct engagement profiles characterising young people's participation and identified certain projects as been more popular across participants. Implications for the design of online citizen science projects targeting young people are discussed.

Author Correction: Time-lapse imagery and volunteer classifications from the Zooniverse Penguin Watch project.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy.

BACKGROUND: The Mexico City Policy, first announced by US President Ronald Reagan and since lifted and reinstated by presidents along partisan lines, prohibits US foreign assistance to any organisation that performs or provides counselling on abortion. Many organisations affected by this policy are also providers of modern contraception. If the policy reduces these organisations' ability to supply modern contraceptives, it could have the unintended consequence of increasing abortion rates. METHODS: We empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy across three presidential administrations (William Clinton, George W Bush, and Barack Obama). We combine individual-level data on pregnancies and abortions from 743 691 women, country-year data on modern contraception use, and annual data on development assistance for family planning and reproductive health in a difference-in-difference framework to examine relative changes in use of modern contraception, pregnancy, and abortion in response to the policy. FINDINGS: We found that when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy by 4·8 abortions per 10 000 woman-years (95% CI 1·5 to 8·1, p=0·0041) relative to women in low-exposure countries and relative to periods when the policy was rescinded in 1995-2000 and 2009-14, a rise of approximately 40%. We found a symmetric reduction in use of modern contraception by 3·15 percentage points (relative decrease of 13·5%; 95% CI -4·9 to -1·4; p=0·0006) and increase in pregnancies by 3·2 percentage points (relative increase of 12%; 95% CI 1·6 to 4·8; p<0·0001) while the policy was enacted. INTERPRETATION: Our findings suggest that curbing US assistance to family planning organisations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy. FUNDING: The William and Flora Hewlett Foundation, the Doris Duke Charitable Foundation, the David and Lucile Packard Foundation, and the Stanford Earth Dean's Fellowship.

The Canadian pediatric surgery workforce: A 5-year prospective study.

BACKGROUND: In 2014, a survey study of the Canadian pediatric surgery workforce predicted a need for 2 new pediatric surgeons/yr. in Canada. We sought to assess these predictions and evaluate the status of the workforce. METHODS: With IRB approval, a web-based survey was sent to pediatric surgery division chiefs in Canada each year (2013-2017). The survey data included: number of practicing pediatric surgeons, full time equivalent (FTE) positions, and fellowship graduates. RESULTS: There was a 100% response rate (18 divisions). From 2013 to 2017, the number of practicing pediatric surgeons and FTE positions increased (73 to 78, and 64.6 to 67.5, respectively). Eleven positions were vacated (4 retirement, 7 new practice), and 18 were filled. Eight were filled by new Canadian graduates, 7 by Canadians previously working in Canada or abroad, and 3 by European surgeons. Thirty-eight fellows completed training in Canada, including 24 non-Canadians who all left Canada. Nine Canadians who started practicing immediately after fellowship took positions in Canada (5) and the US (4). CONCLUSIONS: Predictions made in 2014 were largely accurate. There has been modest growth in the Canadian pediatric surgery workforce over the last 5 years. A significant mismatch continues to exist between Canadian pediatric surgery graduates and attending staff positions. TYPE OF STUDY: Survey. LEVEL OF EVIDENCE: V.