The Genomic Health of Ancient Hominins.

The genomes of ancient humans, Neandertals, and Denisovans contain many alleles that influence disease risks. Using genotypes at 3,180 disease-associated loci, we estimated the disease burden of 147 ancient genomes. After correcting for missing data, genetic risk scores (GRS) were generated for nine disease categories and the set of all combined diseases. We used these genetic risk scores to examine the effects of different types of subsistence, geography, and sample age on the number of risk alleles in each ancient genome. On a broad scale, hereditary disease risks are similar for ancient hominins and modern-day humans, and the GRS percentiles of ancient individuals span the full range of what is observed in present-day individuals. In addition, there is evidence that ancient pastoralists may have had healthier genomes than hunter-gatherers and agriculturalists. We also observed a temporal trend whereby genomes from the recent past are more likely to be healthier than genomes from the deep past. This calls into question the idea that modern lifestyles have caused genetic load to increase over time. Focusing on individual genomes, we found that the overall genomic health of the Altai Neandertal is worse than 97% of present-day humans and that Ötzi, the Tyrolean Iceman, had a genetic predisposition for gastrointestinal and cardiovascular diseases. As demonstrated by this work, ancient genomes afford us new opportunities to diagnose past human health, which has previously been limited by the quality and completeness of remains.

NCHS urban-rural classification scheme for counties.

OBJECTIVES: This report details the National Center for Health Statistics' (NCHS) development of the 2006 NCHS Urban-Rural Classification Scheme for Counties and provides some examples of how the scheme can be used to describe differences in health measures by urbanization level. METHODS: The 2006 NCHS urban-rural classification scheme classifies all U.S. counties and county-equivalents into six levels--four for metropolitan counties and two for nonmetropolitan counties. The Office of Management and Budget's delineation of metropolitan and nonmetropolitan counties forms the foundation of the scheme. The NCHS scheme also uses the cut points of the U.S. Department of Agriculture Rural-Urban Continuum Codes to subdivide the metropolitan counties based on the population of their metropolitan statistical area (MSA): large, for MSA population of 1 million or more; medium, for MSA population of 250,000-999,999; and small, for MSA population below 250,000. Large metro counties were further separated into large central and large fringe metro categories using classification rules developed by NCHS. Nonmetropolitan counties were assigned to two levels based on the Office of Management and Budget's designated micropolitan or noncore status. The 2006 scheme was applied to data from the National Vital Statistics System (NVSS) and the National Health Interview Survey (NHIS) to illustrate its ability to capture health differences by urbanization level. RESULTS AND CONCLUSIONS: Application of the 2006 NCHS scheme to NVSS and NHIS data shows that it identifies important health disparities among communities, most notably those for inner city and suburban communities. The design of the NCHS Urban-Rural Classification Scheme for Counties makes it particularly well-suited for assessing and monitoring health differences across the full urbanization continuum.

Landscape character assessment using region growing techniques in geographical information systems.

Landscape character can be defined as the presence, variety and arrangement of landscape features, which give a landscape a specific identity and make it stand out from surrounding landscapes. Landscape character contributes to the esthetical and perceptional value of an area, which is important for the development of non-production functions in the countryside as demanded by society. In this paper we present a new methodology for landscape character assessment using the pattern of landscape features as stored in a GIS to delineate, characterize and evaluate landscapes using a region growing algorithm. We have applied this methodology in a case study area in the north of The Netherlands and compared the results with a series of expert classifications of the study area. The results of the region growing algorithms were good and interpretable in relation to the underlying data. The resemblance between the expert classification and the classification based on the region growing results varied between 34% and 100% for the different landscape types. The differences between the two data sets can be explained in terms of input data and knowledge about the study area. The classification of the region growing algorithm was more consistent than the expert classification throughout the study area. The presented methodology for landscape character assessment is proposed as support for spatial planning processes and policy development for landscape conservation by providing a quantitative tool to analyze landscape patterns, to discriminate between the various landscapes in a study area and by elucidating features that are important for the identity of a region.

Assessing the spatial distribution of grassland age in a marginal European landscape.

Grassland age is increasingly recognised to be an indicator for present-day biodiversity, e.g. plant species richness, and is also important for other landscape functions. We developed a methodological approach to systematically assess the spatial distribution of grassland age in marginal European landscapes. This approach - applied to the Lahn-Dill Highlands (1270 km(2)), a marginal landscape in Hesse, Germany - comprises three steps: (1) in a two-stage stratification process, we pre-stratified the study area according to recent land-cover patterns and their changes between 1955 and 1995 (stratification I) and classified grassland types by combining data on soil moisture, base-richness, and elevation (stratification II). From 50 grassland types, we randomly selected 1000 representative grassland patches. (2) We determined the age of these patches by means of aerial photograph interpretation of a chronosequence dating back to 1953 and classified each patch with respect to the age classes young (<18 years), mid-aged (18-47 years), and old (>47 years). (3) Based on this information, we calculated grassland type-specific probabilities for grassland patches to belong to the respective age classes. These probabilities were projected to districts by direct extrapolation. An exemplary validation of extrapolation results for two test areas was performed. The results revealed that 49% of the investigated patches were old grassland. The remaining patches were mid-aged (36%) or young grassland (15%). The extrapolation results indicated accordingly a predominance of old grassland at the district scale. Occurrences of mid-aged grassland were concentrated in districts with a pronounced land-cover change, whereas young grassland is apparently evenly distributed across the study area. Validation results suggest that our approach is suitable for a realistic estimation of grassland age in marginal European landscapes. The method may be applied in landscape models of various disciplines that rely on large-scale information on grassland age.

Don't fight the site: three geomorphic considerations in catchment-scale river rehabilitation planning.

Three geomorphic considerations that underpin the design and implementation of realistic and strategic river conservation and rehabilitation programs that work with the nature are outlined. First, the importance of appreciating the inherent diversity of river forms and processes is discussed. Second, river dynamics are appraised, framing the contemporary behavioral regime of a reach in relation to system evolution to explain changes to river character and behavior over time. Third, the trajectory of a reach is framed in relation to downstream patterns of river types, analyzing landscape connectivity at the catchment scale to interpret geomorphic river recovery potential. The application of these principles is demonstrated using extensive catchment-scale analyses of geomorphic river responses to human disturbance in the Bega and Upper Hunter catchments in southeastern Australia. Differing implications for reach- and catchment-scale rehabilitation planning prompt the imperative that management practices work with nature rather than strive to 'fight the site.'

Potential effects of direct transfer payments on farmland habitat diversity in a marginal European landscape.

Farmland habitat diversity in marginal European landscapes changed significantly in the past decades. Further changes toward homogenization are expected, particularly in the course of European agricultural policy. Based on three alternative transfer payment schemes, we modeled spatially explicit potential effects on the farmland habitat diversity in a marginal European landscape. We defined (1) a scenario with direct transfer payments coupled to production, (2) a scenario with direct transfer payments decoupled from production, and (3) a scenario phasing out all direct transfer payments. We characterized habitat diversity with three indices: habitat richness, evenness, and rarity. The habitat pattern in 1995 served as reference for comparison. All scenarios predicted a general trend of homogenization of the farmland habitat pattern, yet to a differing extent. Transfer payments coupled to production (Scenario 1) favored the abandonment of agricultural production, particularly in low-productive areas and arable land use in more productive areas. Habitat richness and habitat evenness had intermediate values in this scenario. Decoupling transfer payments from production (Scenario 2) supported grassland as most profitable farming system. This led to a grassland-dominated landscape with low values of all habitat diversity indices. Phasing out transfer payments (Scenario 3) resulted in complete abandonment or afforestation of agricultural land and extremely low values in all habitat diversity indices. Scenario results indicate that transfer payments may prevent cessation of agricultural production, but may not counteract homogenization in marginal landscapes. Conserving high farmland habitat diversity in such landscapes may require support schemes, e.g., Pillar Two of EU Common Agricultural Policy.

Waterbird population changes in the wetlands at Chongming Dongtan in the Yangtze River estuary, China.

We studied the changes in wetland habitats and waterbird communities between the 1980s and the 2000s at Chongming Dongtan, a Ramsar site in the Yangtze River estuary, an ecologically important region. This region is an important stopover site for shorebirds along the East Asian-Australasian flyway and is extensively used by waterfowl. A net loss of 11% of the wetland area was estimated during study periods at Chongming Dongtan. The change was dependent on wetland types: while the area of artificial habitats such as paddy fields and aquacultural ponds more than doubled, more than 65% of natural habitats including sea bulrush (Scirpus mariqueter) and common reed (Phragmites australis) marshes were lost over the two decades. An exotic plant species introduced from North America, smooth cordgrass (Spartina alterniflora), occupied 30% of the vegetated intertidal zone by the 2000s. Although waterbird species richness did not change between the 1980s (110) and the 2000s (111), 13 species found in 1980s were replaced by 14 newly recorded species. Moreover, there were more species with declining trends (58) than with increasing trends (19). The population trends of species were affected by residential status and habitat types. Transients, wintering migrants, and habitat specialists were more likely to show declining trends compared to those breeding at Dongtan (including year-round and summer residents) and habitat generalists. Furthermore, species associated mainly with natural wetlands were more likely to decline than those associated mainly with artificial wetlands. These patterns suggest that the loss and change of wetland habitats at Chongming Dongtan adversely affected local population dynamics and might have contributed to the global decline of some waterbird species. Because Chongming Dongtan provides stopover and wintering habitats for many migratory waterbirds, protection and restoration of natural wetlands at Chongming Dongtan are urgently needed.

Long-term changes in game species over a long period of transformation in the Iberian Mediterranean landscape.

Agricultural change has transformed large areas of traditional farming landscapes, leading to important changes in the species community assemblages in most European countries. We suspect that the drastic changes in land-use that have occurred in Andalusia (southern Spain) over recent decades, may have affected the distribution and abundance of game species in this region. This article compares the distribution of the main game species in Andalusia during the 1960s and 1990s, using data from maps available from the Mainland Spanish Fish, Game and National Parks Service and from recent datasets on hunting yield distributions, respectively. Big-game and small-game species were significantly segregated in southern Spain during the 1990s, as two clearly independent chorotypes (groups of species whose abundances are similarly distributed) were obtained from the classification analysis. In contrast, big-game and small-game species were not significantly segregated several decades ago, when there was only one chorotype consisting of small-game species and wild boar. The other three ungulates did not constitute a significant chorotype, as they showed positive correlations with some species in the group mentioned above. These changes seem to be a consequence of the transformations that have occurred in the Iberian Mediterranean landscape over the last few decades. The abandoning of traditional activities, and the consequent formation of dense scrubland and woodland, has led to an expansion of big-game species, and a decrease of small-game species in mountain areas. Moreover, agricultural intensification has apparently depleted small-game species populations in some agricultural areas. On the other hand, the increasingly intensive hunting management could be artificially boosting this segregation between small-game and big-game species. Our results suggest that the conservation and regeneration of traditional agricultural landscapes (like those predominating in the 1960s) should be a priority for the conservation of small-game species.

Developing rapid methods for analyzing upland riparian functions and values.

Regulators protecting riparian areas need to understand the integrity, health, beneficial uses, functions, and values of this resource. Up to now most methods providing information about riparian areas are based on analyzing condition or integrity. These methods, however, provide little information about functions and values. Different methods are needed that specifically address this aspect of riparian areas. In addition to information on functions and values, regulators have very specific needs that include: an analysis at the site scale, low cost, usability, and inclusion of policy interpretations. To meet these needs a rapid method has been developed that uses a multi-criteria decision matrix to categorize riparian areas in Washington State, USA. Indicators are used to identify the potential of the site to provide a function, the potential of the landscape to support the function, and the value the function provides to society. To meet legal needs fixed boundaries for assessment units are established based on geomorphology, the distance from "Ordinary High Water Mark" and different categories of land uses. Assessment units are first classified based on ecoregions, geomorphic characteristics, and land uses. This simplifies the data that need to be collected at a site, but it requires developing and calibrating a separate model for each "class." The approach to developing methods is adaptable to other locations as its basic structure is not dependent on local conditions.

Prevalence of conservation design in an agriculture-dominated landscape: the case of Northern Indiana.

We examined the prevalence of residential development that occurs with consideration of the natural features of the site, known as conservation design, within county-level planning jurisdictions across Northern Indiana. Using data from telephone interviews with representatives of planning departments, jurisdictions were ranked based on reported use of conservation design. Three categories of use emerged from the data: no use, use of individual practices associated with conservation design, and integration of multiple conservation design practices. Qualitative data analysis revealed that conservation design practices were not being used widely and, when used, were often used to fulfill stormwater requirements. Statistical analysis, using data from interviews, spatial data sets, and the U.S. Census Bureau, identified several significant positive predictors of the levels of conservation design use including conversion of forest or agricultural land cover to urban uses and education levels in the jurisdiction. Many of the interviewees noted that agricultural land is perceived to meet open space needs within their counties. Given that agricultural land does not fully meet all ecosystem needs, education about the benefits of other types of open space is suggested.

China's classification-based forest management: procedures, problems, and prospects.

China's new Classification-Based Forest Management (CFM) is a two-class system, including Commodity Forest (CoF) and Ecological Welfare Forest (EWF) lands, so named according to differences in their distinct functions and services. The purposes of CFM are to improve forestry economic systems, strengthen resource management in a market economy, ease the conflicts between wood demands and public welfare, and meet the diversified needs for forest services in China. The formative process of China's CFM has involved a series of trials and revisions. China's central government accelerated the reform of CFM in the year 2000 and completed the final version in 2003. CFM was implemented at the provincial level with the aid of subsidies from the central government. About a quarter of the forestland in China was approved as National EWF lands by the State Forestry Administration in 2006 and 2007. Logging is prohibited on National EWF lands, and their landowners or managers receive subsidies of about 70 RMB (US$10) per hectare from the central government. CFM represents a new forestry strategy in China and its implementation inevitably faces challenges in promoting the understanding of forest ecological services, generalizing nationwide criteria for identifying EWF and CoF lands, setting up forest-specific compensation mechanisms for ecological benefits, enhancing the knowledge of administrators and the general public about CFM, and sustaining EWF lands under China's current forestland tenure system. CFM does, however, offer a viable pathway toward sustainable forest management in China.

Natural resource assessment: an approach to science based planning in national parks.

We conducted a natural resource assessment at two national parks, New River Gorge National River and Shenandoah National Park, to help meet the goals of the Natural Resource Challenge--a program to help strengthen natural resource management at national parks. We met this challenge by synthesizing and interpreting natural resource information for planning purposes and we identified information gaps and natural significance of resources. We identified a variety of natural resources at both parks as being globally and/or nationally significant, including large expanses of unfragmented, mixed-mesophytic forests that qualify for wilderness protection, rare plant communities, diverse assemblages of neotropical migratory birds and salamanders, and outstanding aquatic recreational resources. In addition, these parks function, in part, as ecological reserves for plants in and wildlife. With these significant natural resources in mind, we also developed a suite of natural resource management recommendations in light of increasing threats from within and outside park boundaries. We hope that our approach can provide a blueprint for natural resource conservation at publically owned lands.

A rapid method to score stream reaches based on the overall performance of their main ecological functions.

A method was developed to score the ecological condition of first- to third-order stream reaches in the Auckland region of New Zealand based on the performance of their key ecological functions. Such a method is required by consultants and resource managers to quantify the reduction in ecological condition of a modified stream reach relative to its unmodified state. This is a fundamental precursor for the determination of fair environmental compensation for achieving no-net-loss in overall stream ecological value. Field testing and subsequent use of the method indicated that it provides a useful measure of ecological condition related to the performance of stream ecological functions. It is relatively simple to apply compared to a full ecological study, is quick to use, and allows identification of the degree of impairment of each of the key ecological functions. The scoring system was designed so that future improvements in the measurement of stream functions can be incorporated into it. Although the methodology was specifically designed for Auckland streams, the principles can be readily adapted to other regions and stream types.

Medicare reimbursement, nurse staffing, and patient outcomes.

There is widespread concern about the quality of health care in the US, and the effect of provider payments on the quality of care is an important and unsettled issue in this debate. The critical question is whether changes in provider payments affect health. To date there is relatively little research on this question. Here, we present evidence of the effect of plausibly exogenous changes in Medicare reimbursement--caused by geographical reclassification--on hospital staffing (nurses) and patient outcomes. We find that changes in Medicare reimbursement levels of approximately 10% have no meaningful effect on hospital use of resources or patient outcomes.

Enabling clinicians to easily find location-based travel health recommendations-is innovation needed?

Background: The types of place names and the level of geographic detail that patients report to clinicians regarding their intended travel itineraries vary. The reported place names may not match those in published travel health recommendations, making traveler-specific recommendations potentially difficult and time-consuming to identify. Most published recommendations are at the country level; however, subnational recommendations exist when documented disease risk varies within a country, as for malaria and yellow fever. Knowing the types of place names reported during consultations would be valuable for developing more efficient ways of searching and identifying recommendations, hence we inventoried these descriptors and identified patterns in their usage. Methods: The data analyzed were previously collected individual travel itineraries from pretravel consultations performed at Global TravEpiNet (GTEN) travel clinic sites. We selected a clinic-stratified random sample of records from 18 GTEN clinics that contained responses to an open-ended question describing itineraries. We extracted and classified place names into nine types and analyzed patterns relative to common travel-related demographic variables. Results: From the 1756 itineraries sampled, 1570 (89%) included one or more place names, totaling 3366 place names. The frequency of different types of place names varied considerably: 2119 (63%) populated place, 336 (10%) tourist destination, 283 (8%) physical geographic area, 206 (6%) vague subnational area, 163 (5%) state, 153 (5%) country, 48 (1%) county, 12 (1%) undefined. Conclusions: The types of place names used by travelers to describe travel itineraries during pretravel consultations were often different from the ones referenced in travel health recommendations. This discrepancy means that clinicians must use additional maps, atlases or online search tools to cross-reference the place names given to the available recommendations. Developing new clinical tools that use geographic information systems technology would make it easier and faster for clinicians to find applicable recommendations for travelers.

Privacy protection versus cluster detection in spatial epidemiology.

OBJECTIVES: Patient data that includes precise locations can reveal patients' identities, whereas data aggregated into administrative regions may preserve privacy and confidentiality. We investigated the effect of varying degrees of address precision (exact latitude and longitude vs the center points of zip code or census tracts) on detection of spatial clusters of cases. METHODS: We simulated disease outbreaks by adding supplementary spatially clustered emergency department visits to authentic hospital emergency department syndromic surveillance data. We identified clusters with a spatial scan statistic and evaluated detection rate and accuracy. RESULTS: More clusters were identified, and clusters were more accurately detected, when exact locations were used. That is, these clusters contained at least half of the simulated points and involved few additional emergency department visits. These results were especially apparent when the synthetic clustered points crossed administrative boundaries and fell into multiple zip code or census tracts. CONCLUSIONS: The spatial cluster detection algorithm performed better when addresses were analyzed as exact locations than when they were analyzed as center points of zip code or census tracts, particularly when the clustered points crossed administrative boundaries. Use of precise addresses offers improved performance, but this practice must be weighed against privacy concerns in the establishment of public health data exchange policies.

Interstate comparisons of public hospital outputs using DRGs: are they fair?

OBJECTIVE: To assess whether there is variation among Australian States in the reporting and coding of important and relevant secondary diagnoses in public hospital data. Such variation is a potentially important problem because it may invalidate interstate (and other) comparisons of hospital outputs based on Diagnosis Related Groups (DRGs). METHODS: Our outcome measure was the percentage of separations in the lowest-resource split for adjacent DRGs. To reduce potential bias due to interstate differences in the complexity of cases treated in public hospitals, we directly standardised by adjacent-DRG and analysed two subgroups of adjacent-DRGs where there is less discretion about the threshold for admission: obstetrics and major medical conditions. RESULTS: There was important interstate variation in the percentage of separations in the lowest-resource split. The statistically significant differences represent a large number of medical records that might have been documented or coded differently if the separation had occurred in another State. For example, if Queensland had the same standardised percentage as South Australia, then an extra 10,100 separations in Queensland would have been allocated to a DRG with a higher cost weight. CONCLUSIONS: The task of perfecting a national database is never complete and it makes sense to superimpose a permanent cycle of monitoring, followed by more detailed audits. The methods used in this paper could be routinely used to screen administrative hospital data to identify where detailed audits with feedback might be implemented with best effect. Unless interstate variation in the reporting and coding of important additional diagnoses is reduced, measuring public hospital outputs using DRGs will be of limited value at a national level.

United States coronary mortality trends and community services associated with occupational structure, among blacks and whites, 1984-1998.

This paper examines the association between US county occupational structure, services availability, prevalence of risk factors, and coronary mortality rates by sex and race, for 1984-1998. The 3137 US counties were classified into five occupational structure categories; counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I (5-16%), counties with the highest percentages were in category V (32-59%). Directly age-adjusted coronary heart disease (CHD) mortality rates, for aged 35-64 years, (from vital statistics and Census data), per-capita services (County Business Patterns), and the prevalence of CHD risk factors (Behavioral Risk Factor Surveillance Surveys data) were calculated for each occupational structure category. CHD mortality rates and the prevalence of risk factors were inversely monotonically associated with occupational structure categories for white men and women but not among black men and women. Numbers of producer services for banking, business credit, overall business services and personnel/employment services were 2-12 times greater in category V versus I counties. Consumer services such as fruit/vegetable markets, fitness facilities, doctor offices and social services were 1.6-3 times greater in category V versus I counties. Residential racial segregation scores remained high in most areas despite declines during 1980-1990; occupational segregation by race and gender were shown indicating continued institutional racism. An ecological model for conceptualizing communities and health and the overall influence of state and national occupational structure is discussed; intervention strategies such as decreased wage disparities and 'living wage' standards and development is discussed.

Use of routinely collected past surveillance data in identifying and mapping high-risk areas in a malaria endemic area of Sri Lanka.

Stratification of malaria endemic areas on eco-epidemiological criteria is an important step in planning and implementing malaria control programs. The uses of stratification of malaria endemic areas lead to better targeting of control measures such as residual insecticide spraying in countries where unstable malaria transmission occur. In this study, two methods that can be used for stratification of malaria endemic areas in Sri Lanka using routinely collected surveillance data over a period of 9 years are described. In the first method, the median Annual Parasite Incidence (API) was used as the criterion to classify an area as at risk for malaria while in the second method, the API and the Falciparum Rate (FR) were used as the criteria. Risk maps were produced by plotting the results of the analyses on maps generated by EPIMAP. The potential uses of risk maps are discussed.

Geomorphology and habitat diversity in the Pantanal.

The present study deals with the inter-relations in the relief which forms the Bacia do Alto Rio Paraguay (BAP) in mid-west Brazil. The overall aim is to discuss the relationship between relief forms and the biodiversity of the Pantanal. The BAP is a natural environmental system with contrasts in two of the compartments on which it is formed: the plateau, the most elevated compartment, highly transformed by human activities, and the plain which forms the Pantanal, which is more preserved and less transformed in relation to productive activities. The analysis was performed based on publications with a geomorphologic focus, examining the different relief units of the BAP and the dynamics of the revealing processes of landscape change which the Pantanal has undergone since the end of the Pleistocene.