Global chessboard: Analyzing how geopolitical risk shapes renewable energy technology investments.

The allocation of budgets for renewable energy (RE) technology is significantly influenced by geopolitical risks (GPRs), reflecting the intricate interplay among global political dynamics, social media narratives, and the strategic investment decisions essential for advancing sustainable energy solutions. Against the backdrop of increasing worldwide initiatives to transition to RE sources, it is crucial to understand how GPR affects funding allocations, informing policy decisions, and fostering international collaboration to pursue sustainable energy solutions. Existing work probes the nonlinear effect of GPR on RE technology budgets (RTB) within the top 10 economies characterized by substantial research and development investments in RE (China, USA, Germany, Japan, France, South Korea, India, the United Kingdom, Australia, and Italy). Past research largely focused on panel data techniques to delve the interconnection between GPR and RE technology, overlooking the distinctive characteristics of individual economies. Contrarily, existing investigation implements the "Quantile-on-Quantile" tool to explore this association on an economy-particular basis, enhancing the precision of our analysis and offering both a comprehensive global perspective and nuanced perceptions for entire countries. The findings manifest a significant reduction in funding for RE technology associated with GPR across various quantile levels in the chosen economies. The disparities in results spotlight the necessity for policymakers to perform thorough assessments and carry out competent strategies to address the variations in GPR and RTB.

Coral restoration can drive rapid reef carbonate budget recovery.

Restoration is increasingly seen as a necessary tool to reverse ecological decline across terrestrial and marine ecosystems.1,2 Considering the unprecedented loss of coral cover and associated reef ecosystem services, active coral restoration is gaining traction in local management strategies and has recently seen major increases in scale. However, the extent to which coral restoration may restore key reef functions is poorly understood.3,4 Carbonate budgets, defined as the balance between calcium carbonate production and erosion, influence a reef's ability to provide important geo-ecological functions including structural complexity, reef framework production, and vertical accretion.5 Here we present the first assessment of reef carbonate budget trajectories at restoration sites. The study was conducted at one of the world's largest coral restoration programs, which transplants healthy coral fragments onto hexagonal metal frames to consolidate degraded rubble fields.6 Within 4 years, fast coral growth supports a rapid recovery of coral cover (from 17% ± 2% to 56% ± 4%), substrate rugosity (from 1.3 ± 0.1 to 1.7 ± 0.1) and carbonate production (from 7.2 ± 1.6 to 20.7 ± 2.2 kg m-2 yr-1). Four years after coral transplantation, net carbonate budgets have tripled and are indistinguishable from healthy control sites (19.1 ± 3.1 and 18.7 ± 2.2 kg m-2 yr-1, respectively). However, taxa-level contributions to carbonate production differ between restored and healthy reefs due to the preferential use of branching corals for transplantation. While longer observation times are necessary to observe any self-organization ability of restored reefs (natural recruitment, resilience to thermal stress), we demonstrate the potential of large-scale, well-managed coral restoration projects to recover important ecosystem functions within only 4 years.

Nutrient budgets and biogeochemical dynamics in the coastal regions of northern Beibu Gulf, South China Sea: Implication for the severe impact of human disturbance.

This study examined the nutrient budgets and biogeochemical dynamics in the coastal regions of northern Beibu Gulf (CNBG). Nutrient concentrations varied spatially and seasonally among the different bays. High nutrient levels were found in the regions with high riverine inputs and intensive mariculture. Using a three end-member mixing model, nutrient biogeochemistry within the ecosystem was estimated separately from complex physical mixing effects. Nutrient consumption dominated in most bays in summer, whereas nutrient regeneration dominated in winter, likely due to phytoplankton decomposition, vertical mixing and desorption. Through the Land-Ocean Interaction Coastal Zone (LOICZ) model, the robust nutrient budgets were constructed, indicating that the CNBG behaved as a sink of dissolved inorganic nitrogen, phosphorus and silicon. River-borne nutrient inputs were the dominant nutrient source, while residual flows and water exchange flows transported nutrient off the estuaries. This study could help us better understand nutrient cycles and nutrient sources/sinks in the CNBG.

Establishment of a simulation centre: Challenges and solutions.

The change in curriculum and increasing need for active healthcare professionals providing quality patient care has emphasised simulation-based regular training, reskilling and simulation centres to deliver these. However, there is limited literature on how to establish a simulation centre and overcome the challenges relating to developing faculty and maintaining the financial viability of these centres. Our review focuses on this gap in the current literature. The findings are presented as 1) identification of the methods of establishing a simulation centre, 2) setting up the resource in a simulation centre and 3) faculty development and curricular integration in a simulation centre. The space of a simulation centre depends on the organisation's or training body's needs. There is no single design which is recommended. Establishing a simulation centre should consider the needs of the organisation, educators and learners along with the available resources and ensure that curriculum integration and standards are met.

[Approach to Childhood Obesity in Spain. A comparison among autonomies]. / Abordaje de la obesidad infantil. Comparativa entre comunidades autónomas.

OBJECTIVE: Childhood obesity represents a serious public health problem and given its multifactorial nature and its consequences; it is necessary to carry out an effective approach. The Spanish system of autonomies, with delegated powers, could accentuate inequality in its approach. The objective of the study was to know the existence or not of these inequalities. METHODS: A descriptive cross-sectional study was carried out between the months of February-April 2022, in which the approach to childhood obesity was compared among the seventeen communities and two autonomous cities, through the analysis of the following indicators: pediatric staff, pediatric nursing, nutrition personnel and their legal recognition, the existence of comprehensive plans and health expenditure on childhood obesity. The search for information has been carried out through a bibliographic review and a request for access to public information to the corresponding regional councils. It were performed ratios of paediatricians and nurses per 1,000 inhabitants and health expenditure per inhabitant were calculated. RESULTS: It was observed that in Spain paediatricians have a ratio according to international recommendations (1.21), but not general and paediatric nursing (with a ratio of 0.65, which is equivalent to approximately 1,544 inhabitants for each nurse), and nutrition professionals. Among autonomies there were large variations for the three categories. Comprehensive plans were outdated or absent altogether, as well as the periodic analysis of obesity expenditure. CONCLUSIONS: The approach to childhood obesity seems to vary considerably among autonomies according to the analysed indicators. Thus, it would be advisable to lead all efforts to homogenize it, to improve care quality and prevention and treatment choices in all national regions.

OBJECTIVE: La obesidad infantil representa un grave problema de Salud Pública y, dado su carácter multifactorial y sus consecuencias, resulta necesario llevar a cabo un abordaje eficaz. El sistema de autonomías español, con competencias delegadas, podría acentuar la desigualdad en su abordaje. El objetivo del estudio fue conocer la existencia o no de dichas desigualdades. METHODS: Se llevó a cabo un estudio transversal descriptivo, entre los meses de febrero-abril de 2022, en el que se comparó el abordaje de la obesidad infantil entre las diecisiete comunidades y dos ciudades autónomas, mediante el análisis de los siguientes indicadores: personal de pediatría; enfermería pediátrica; personal de nutrición y su reconocimiento legal; existencia de planes integrales; y gasto sanitario para obesidad infantil. La búsqueda de información se realizó mediante revisión bibliográfica y solicitud de acceso a información pública a las correspondientes consejerías autonómicas. Hubo cálculo de ratios de pediatras y enfermeros por 1.000 habitantes y gasto sanitario por habitante. RESULTS: Se observó que a nivel nacional los pediatras poseen una ratio acorde a las recomendaciones internacionales (1,21), no así enfermería general y pediátrica (con una ratio de 0,65, que equivale a aproximadamente 1.544 habitantes por cada enfermera), ni el personal de nutrición. Entre comunidades autónomas se apreciaron grandes variaciones para las tres categorías. Los planes integrales de abordaje se encontraron desactualizados o, directamente, ausentes, al igual que el análisis periódico del gasto derivado de la obesidad. CONCLUSIONS: El abordaje de la obesidad infantil parece variar de forma considerable entre autonomías según los indicadores analizados. Por ello, sería recomendable encauzar todos los esfuerzos en homogenizarlo, para mejorar la calidad asistencial e igualar las oportunidades de prevención y tratamiento en todo el ámbito nacional.

Abordaje de la obesidad infantil. Comparativa entre comunidades autónomas / Approach to Childhood Obesity in Spain. A comparison among autonomies

Fundamentos: la obesidad infantil representa un grave problema de salud pública y, dado su carácter multifactorial y sus consecuencias, resulta necesario llevar a cabo un abordaje eficaz. El sistema de autonomías español, con competencias delegadas, podría acentuar la desigualdad en su abordaje. El objetivo del estudio fue conocer la existencia o no de dichas desigualdades. Métodos: se llevó a cabo un estudio transversal descriptivo, entre los meses de febrero-abril de 2022, en el que se comparó el abordaje de la obesidad infantil entre las diecisiete comunidades y dos ciudades autónomas, mediante el análisis de los siguientes indicadores: personal de pediatría; enfermería pediátrica; personal de nutrición y su reconocimiento legal; existencia de planes integrales; y gasto sanitario para obesidad infantil. La búsqueda de información se realizó mediante revisión bibliográfica y solicitud de acceso a información pública a las correspondientes consejerías autonómicas. Hubo cálculo de ratios de pediatras y enfermeros por 1.000 habitantes y gasto sanitario por habitante. Resultados: se observó que a nivel nacional los pediatras poseen una ratio acorde a las recomendaciones internacionales (1,21), no así enfermería general y pediátrica (con una ratio de 0,65, que equivale a aproximadamente 1.544 habitantes por cada enfermera), ni el personal de nutrición. Entre comunidades autónomas se apreciaron grandes variaciones para las tres categorías. Los planes integrales de abordaje se encontraron desactualizados o, directamente, ausentes, al igual que el análisis periódico del gasto derivado de la obesidad.Conclusiones: el abordaje de la obesidad infantil parece variar de forma considerable entre autonomías según los indicadores analizados. Por ello, sería recomendable encauzar todos los esfuerzos en homogenizarlo, para mejorar la calidad asistencial e igualar las oportunidades de prevención y tratamiento en todo el ámbito nacional.(au)

Background: childhood obesity represents a serious public health problem and given its multifactorial nature and its con-sequences; it is necessary to carry out an effective approach. The spanish system of autonomies, with delegated powers, could accentuate inequality in its approach. The objective of the study was to know the existence or not of these inequalities. Methods: a descriptive cross-sectional study was carried out between the months of february-april 2022, in which the approach to childhood obesity was compared among the seventeen communities and two autonomous cities, through the analysis of the following indicators: pediatric staff, pediatric nursing, nutrition personnel and their legal recognition, the existence of comprehensive plans and health expenditure on childhood obesity. The search for information has been carried out through a bibliographic review and a request for access to public information to the corresponding regional councils. It were performed ratios of paediatricians and nurses per 1,000 inhabitants and health expenditure per inhabitant were calculated.results: it was observed that in spain paediatricians have a ratio according to international recommendations (1.21), but not ge-neral and paediatric nursing (with a ratio of 0.65, which is equivalent to approximately 1,544 inhabitants for each nurse), and nutrition professionals. Among autonomies there were large variations for the three categories. Comprehensive plans were outdated or absent altogether, as well as the periodic analysis of obesity expenditure. Conclusions: the approach to childhood obesity seems to vary considerably among autonomies according to the analysed indicators. Thus, it would be advisable to lead all efforts to homogenize it, to improve care quality and prevention and treatment choices in all national regions.(AU)

Early impacts of the Pennsylvania Rural Health Model on potentially avoidable utilization.

The Pennsylvania Rural Health Model (PARHM) is a novel alternative payment model for rural hospitals that aims to test whether hospital-based global budgets, coupled with delivery transformation plans, improve the quality of health care and health outcomes in rural communities. Eighteen hospitals joined PARHM in 3 cohorts between 2019 and 2021. This study assessed PARHM's impact on changes in potentially avoidable utilization (PAU)-a measure of admission rates policymakers explicitly targeted for improvement in PARHM. Using a difference-in-differences analysis and all-payer hospital discharge data for Pennsylvania hospitals from 2016 through 2022, we found no significant overall reduction in community-level PAU rates up to 4 years post-PARHM implementation, relative to changes in rural Pennsylvania communities whose hospitals did not join PARHM. However, heterogeneous treatment effects were observed across cohorts that joined PARHM in different years, and between critical access vs prospective payment system hospitals. These findings offer insight into how alternative payment models in rural health care settings may have heterogeneous impacts based on contextual factors and highlight the importance of accounting for these factors in proposed expansions of alternative payment models for rural health systems.

Differences in organic carbon accumulation in mangrove soils due to foraging by herbivorous crabs.

Crabs in mangroves could enhance the transfer of organic carbon (OC) from leaf litter to soils, whose variation with the difference in crab size is, however, not well known. A 32-day laboratory feeding experiment was conducted to explore the effects of different sizes of the crabs Parasesarma plicatum foraging on leaf litter of Kandelia obovata on OC accumulation in mangrove soils. Mean rates of soil OC accumulation due to leaf foraging by large, medium, and small crabs were 21.11, 16.11, and 0.77 mg C ind-1 d-1, corresponding to the rates of OC removal from leaf litter of 62.60%, 51.37%, and 2.19%, respectively. Large and medium crabs ingested larger amounts of leaf litter, and soil OC accumulation rates resulting from leaf foraging by large and medium crabs were approximately 8 times higher than those by leaf litter decomposition and triple those by non-leaf foraging. Small crabs ingested the smallest amount of leaf litter, which was almost used for their growth and metabolism. These results underline the key ecological roles of leaf foraging by crabs, especially those with large and medium sizes, in OC accumulation in mangrove soils, which is conducive to estimating carbon sequestration in mangrove soils.

Comparison of nutrients status in Liaodong Bay and Northern Yellow Sea, China: Controlling factors and nutrient budgets.

Under the dual stress of global warming and human interaction, Liaodong Bay (LDB) and northern Yellow Sea (NYS) are undergoing significant ecological changes. Little is known about the driving nutrients characteristics supporting fishery resource output in these areas. We carried out three field observations in 2019 to investigate nutrient status. Results showed that dissolved inorganic nitrogen (DIN), dissolved inorganic phosphorus (DIP), and dissolved silica (DSi) concentrations changed seasonally, with lowest values in spring, and highest values in autumn. High DIN, DIP, and DSi concentrations were detected in LDB and NYS's estuary areas. The Yellow Sea Cold Water Mass plays a role in the distribution and seasonal variation of nutrients. Exchanges across the sediment-water interface, SFGD, atmospheric deposition, and the adjacent sea input dominated DIN dynamics of these areas. DIP primarily came from the adjacent sea input and DSi mainly originated from sediment release and the adjacent sea input. NYS seawater invasion accounted for 13.8% of DIN, 63.4% of DIP, and 35.1% of DSi in LDB. These results provide new insights to better facilitate the formulation of nitrogen and phosphorus reduction and control policies in these marginal seas.

Budget impact analysis for implementation decision making, planning, and financing.

Shelley et al. (in Accelerating integration of tobacco use treatment in the context of lung cancer screening: relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022;12:1076-1083) laid out how implementation science frameworks and methods can advance the delivery of tobacco use treatment services during lung cancer screening services, which until recently was mandated by the Centers for Medicare and Medicaid Services. Their discussion provides an important overview of the full process of implementation and highlights the vast number of decisions that must be made when planning for implementation of an evidence-based practice such as tobacco use treatment: what specific tobacco use treatment services to deliver, when to deliver those services within the lung cancer screening process, and what implementation strategies to use. The costs of implementation play a major role in decision making and are a key implementation determinant discussed in major implementation frameworks. When making decisions about what and how to implement, budget impact analyses (BIAs) can play an important role in informing decision making by helping practitioners understand the overall affordability of a given implementation effort. BIAs can also inform the development of financing strategies to support the ongoing sustainment of tobacco use treatment service provision. More attention is needed by the research community to produce high-quality, user-friendly, and flexible BIAs to inform implementation decision making in health system and community settings. The application of BIA can help ensure that the considerable time and effort spent to develop and evaluate evidence-based programs has the best chance to inform implementation practice.

Integrating the provision of tobacco use treatment services during lung cancer screening can increase the benefits of lung cancer screening. Shelley et al. lay out how implementation science can be leveraged to facilitate this integration and to highlight the vast array of decisions that must be made to plan for implementation. Practitioners must choose which tobacco use treatment services to deliver, when to deliver those services within the process of lung cancer screening, and how to implement services. The resources associated with these choices are a key determinant of decision making and successful implementation. We discuss how budget impact analyses (BIAs) can help organizations understand the likely costs of what it would take to get tobacco treatment services into place and sustain them over time, accounting for context-specific differences like wage rates or available resources. Researchers should strive to develop high-quality, user-friendly, and flexible BIAs to inform decision making around the integration of tobacco use treatment services during lung cancer screening in health system and community settings. Applications of BIAs extend beyond tobacco; regardless of substantive area, building BIAs is a collaborative effort that requires a team science approach.

Estimation of Societal Values of Health States Preferences at the National Level for Low- and Middle-Income Countries.

OBJECTIVES: Social preference values of health states are a fundamental input for the preparation of studies in health economics. Several countries have undertaken studies to obtain these values. Our objective was to conduct a structured and systematic literature review of articles that calculates this set of representative values at the national level in low- and middle-income countries (LMICs). METHODS: In this systematic review, we searched the Embase, MEDLINE, Ovid, SciELO, and LILACS databases, among others, for studies published up to June 2022 that estimated nationally representative health states preferences values for LMICs. We summarized the information qualitatively and assessed the risk of bias in each article using the consensus-based standards for selecting health measurement instruments checklist tool. RESULTS: Of the 23 663 articles identified, 35 studies were eligible for inclusion. The studies were from 19 countries in Latin-American, Europe, Africa, and Asia. No studies were found for low-income countries. The most commonly applied generic instrument for measuring health-related quality of life was the 5-level version of EQ-5D and 3-level version of EQ-5D. Preference was given to face-to-face administration of these instruments. The sociodemographic variables with the most significant negative correlation versus utility were older adults, marital status (widowed or divorced), and low educational level and income. CONCLUSIONS: Worldwide, there have been few studies that have estimated, in a nationally representative manner, the social values of health states preferences in LMICs. We consider the local estimate of this set of societal values relevant for any society to improve decision making in allocating resources in health budgets.

Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score.

Introduction: This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Methods: Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable. Results: Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. Conclusions: The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.

Reimbursement of care does not equal the distribution of hospital resources: an explorative case study on a missing link among Dutch hospitals.

BACKGROUND: Affordability and accessibility of hospital care are under pressure. Research on hospital care financing focuses primarily on incentives in the financial system outside the hospital. It is notable that little is known about (incentives in) internal funding in hospitals. Therefore, our study focuses on the budget allocation in hospitals: the distribution model. Based on our hypothesis that the reimbursement and distribution models in hospitals might interact, we gain knowledge about-, and insight into, the interaction of different reimbursement and distribution models used in Dutch hospitals, and how they affect the financial output of hospital care. METHODS: An online survey with 22 questions was conducted among financial senior management as an expert group in 49 Dutch hospitals. RESULTS: Ultimately, 38 of 49 approached experts fully completed the survey, which amounts to 78% of the hospitals we approached and 60% of all Dutch hospitals. The results on the reimbursement model indicate price * volume with adjusted prices above a maximum cap as the most common dominant contract type. On the internal distribution model, 75-80% of the experts reported incremental budgeting as the dominant budgeting method. Results on the interaction between the reimbursement and the distribution model show that both general and specific changes in contract agreements are only partially incorporated in hospital budgets. In 28 out of 31 hospitals with self-employed medical specialists, a relation is reported between the reimbursement model and the contracts with the Medical Consultant Group(s) in which the medical specialists are united. CONCLUSIONS: Our results in Dutch setting indicate a limited interaction between the reimbursement model and the distribution model. This lack of congruence between both models might limit the desired effects of incentives in contractual agreements aimed at the financial output. This applies to different reimbursement and distribution models. Further research into the various interactions and incentives, as visualized in our conceptual framework, could result in evidence-based advice for achieving affordable and accessible hospital care.

Effects of provisioning on the activity budget and foraging strategies of black-and-white snub-nosed monkeys (Rhinopithecus bieti) in the Baima Snow Mountain Nature Reserve, Yunnan, China.

Provisioning can significantly affect the ranging patterns, foraging strategies, and time budget of wild primates. In this study, we document for the first time, the effects of provisioning on the activity budget and foraging effort in an Asian colobine. Over 3-years, we used an instantaneous scanning method at 10-min intervals to collect data on the activity budget of a semiprovisioned breeding band (SPB) of black-and-white snub-nosed monkeys (Rhinopithecus bieti) (42-70 individuals) at Xiangguqing (Tacheng), Yunnan, China. We then compared the effects of provisioning in our study band with published data on a sympatric wild nonprovisioned breeding band (NPB) of R. bieti (ca. 360 monkeys) at the same field site. The SPB spent 25.6% of their daytime feeding, 17.1% traveling, 46.9% resting, and 10.3% socializing. In comparison, the NPB devoted more time to feeding (34.9%) and socializing (14.1%), less time to resting (31.3%), and was characterized by a greater foraging effort (1.74 versus 0.96, foraging effort = (feeding + traveling)/resting; see Methods). There was no difference between bands in the proportion of their activity budget devoted to traveling (15.7% vs. 17.1%). In addition, the SPB exhibited a more consistent activity budget and foraging effort across all seasons of the year compared to the NPB. These findings suggest that the distribution, availability, and productivity of naturally occurring feeding sites is a major determinant of the behavioral strategies and activity budget of R. bieti. Finally, a comparison of our results with data on six nonprovisioned R. bieti bands indicates that caution must be raised in meta-analyses or intraspecific comparisons of primate behavioral ecology that contain data generated from both provisioned and nonprovisioned groups.

2023 AAFP/IAAHPC feline hospice and palliative care guidelines.

The '2023 AAFP/IAAHPC Feline Hospice and Palliative Care Guidelines' are authored by a Task Force of experts in feline hospice and palliative care convened by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. They emphasize the specialized communication skills and ethical considerations that are associated with feline hospice and palliative care, with references to other feline practice guidelines for a more complete discussion of specific diseases, feline pain management best practices and cat friendly interactions. A comprehensive, multi-step hospice consultation allows for tailoring the approach to both the cat and the family involved in the care. The consultation includes establishing 'budgets of care', a concept that greatly influences what can be done for the individual cat. The Guidelines acknowledge that each cat and caregiver will be different in this regard; and establishing what is reasonable, practical and ethical for the individual cat and caregiver is important. A further concept of the 'care unit' is introduced, which is extrapolated from human hospice and palliative care, and encourages and empowers the caregiver to become a part of the cat's care every step of the way. Ethical considerations include a decision-making framework. The importance of comfort care is emphasized, and the latest information available about how to assess the quality of a cat's life is reviewed. Emotional health is as equally important as physical health. Hence, it is fundamental to recognize that compromised physical health, with pain and/or illness, impairs emotional health. A limited discussion on euthanasia is included, referring to the AAFP's End of Life Educational Toolkit for recommendations to help the caregiver and the veterinary professional ensure a peaceful passing and transition - one that reflects the best interests of the individual cat and caregiver.

Behavioral adjustments of endangered Barbary macaques (Macaca sylvanus) living at the edge of an agricultural landscape in Morocco.

Transition zones between natural and human-altered spaces are eroding in most terrestrial ecosystems. The persistence of animals in shared landscapes depends in part on their behavioral flexibility, which may involve being able to exploit human agricultural production. As a forest-dependent species, the Barbary macaque (Macaca sylvanus) is affected by the progressive conversion of forest-adjacent lands into crops. We explore how Barbary macaque behavior differs between groups living in a forest at the edge of agricultural zones (hereafter "disturbed groups") and groups inhabiting undisturbed forests (hereafter "natural groups"). We compare the diets, activity-budgets, home range sizes, daily path lengths, and sleeping site locations of the groups. We also quantify anthropogenic disturbances (i.e., rates of encounter with humans and dogs) and investigate relationships between such disturbances and the diets and activity budgets of macaques through multiple co-inertia analysis. Disturbed groups included high proportions of cultivated food items in their diet and encountered over 0.5/h anthropogenic disturbances. Activity-budgets differed between disturbed and natural groups and were mostly influenced by diets, not anthropogenic disturbances. Disturbed groups spent more time feeding and less time resting than natural ones. Patterns of space use differed markedly between groups, with disturbed groups displaying smaller home ranges, shorter daily path length, and much higher reutilization of sleeping sites than natural groups. This study highlights the dietary and behavioral flexibility of Barbary macaques living in human-altered environments. Their patterns of space use suggest a reduction in energy expenditure in the disturbed groups due to the inclusion of cultivated food items in their diet possibly leading to increased foraging efficiency. However, the high rates of anthropogenic encounters, including aggressive ones, are likely stressful and may potentially induce extra energy costs and lead to macaque injuries. This could result in demographic costs for crop-foraging groups, threatening the conservation of this endangered species.

Fluid migration pathways to groundwater in mature oil fields: Exploring the roles of water injection/production and oil-well integrity in California, USA.

Mature oil fields potentially contain multiple fluid migration pathways toward protected groundwater (total dissolved solids, TDS, in nonexempted aquifer <10,000 mg/L) because of their extensive development histories. Time-series data for water use, fluid pressures, oil-well construction, and geochemistry from the South Belridge and Lost Hills mature oil fields in California are used to explore the roles of injection/production of oil-field water and well-integrity issues in fluid migration. Injection/production of oil-field water modified hydraulic gradients in both oil fields, resulting in chemical transport from deeper groundwater and hydrocarbon-reservoir systems to aquifers in the oil fields. Those aquifers are used for water supply outside the oil-field boundaries. Oil wells drilled before 1976 can be fluid migration pathways because a relatively large percentage of them have >10 m of uncemented annulus that straddles oil-well casing damage and/or the base of groundwater with TDS <10,000 mg/L. The risk of groundwater-quality degradation is higher when wells with those risk factors occur in areas with upward hydraulic gradients created by positive net injection, groundwater withdrawals, or combinations of these variables. The complex changes in hydrologic conditions and groundwater chemistry likely would not have been discovered in the absence of years to decades of monitoring data for groundwater elevations and chemistry, and installation of monitoring wells in areas with overlapping risk factors. Important monitoring concepts based on results from this and other studies include monitoring hydrocarbon-reservoir and groundwater systems at multiple spatiotemporal scales and maintaining transparency and accessibility of data and analyses. This analysis focuses on two California oil fields, but the methods used and processes affecting fluid migration could be relevant in other oil fields where substantial injection/production of oil-field water occurs and oil-well integrity is of concern.

Approaches for enhancing the informativeness and quality of clinical trials: Innovations and principles for implementing multicenter trials from the Trial Innovation Network.

One challenge for multisite clinical trials is ensuring that the conditions of an informative trial are incorporated into all aspects of trial planning and execution. The multicenter model can provide the potential for a more informative environment, but it can also place a trial at risk of becoming uninformative due to lack of rigor, quality control, or effective recruitment, resulting in premature discontinuation and/or non-publication. Key factors that support informativeness are having the right team and resources during study planning and implementation and adequate funding to support performance activities. This communication draws on the experience of the National Center for Advancing Translational Science (NCATS) Trial Innovation Network (TIN) to develop approaches for enhancing the informativeness of clinical trials. We distilled this information into three principles: (1) assemble a diverse team, (2) leverage existing processes and systems, and (3) carefully consider budgets and contracts. The TIN, comprised of NCATS, three Trial Innovation Centers, a Recruitment Innovation Center, and 60+ CTSA Program hubs, provides resources to investigators who are proposing multicenter collaborations. In addition to sharing principles that support the informativeness of clinical trials, we highlight TIN-developed resources relevant for multicenter trial initiation and conduct.

The Costs of Operating a Student-run Free Clinic.

INTRODUCTION: Free clinics provide care for those who may otherwise not have access. While this care is often free for patients, it is not free to operate such clinics. This review will provide a budget and breakdown of all expenditures at a student-run free clinic along with average costs of services provided to patients. METHODS: Accounting data was used to categorize all expenses and generate an annual budget. An inventory tracking system was developed to measure the costs of all medical supplies and services accurately, providing information on costs per clinic and costs per patient for each provided service. RESULTS: The average cost per clinic was $53.55 (per patient: $2.14) for general clinic supplies, $43.74 (per patient: $7.29) for telehealth, $278.47 (per patient: $12.66) for laboratory services, $247.25 (per patient: $10.75) for pharmacy services, and $8.30 (per patient: $1.19) for social work. These costs contributed to a relative minority (< 33%) of the total costs to run a free clinic, where the highest costs were for volunteer appreciation and administrative overhead. Twelve categories of expenditures (administrative overhead, volunteer appreciation, medical and lab supplies, conferences and special projects, advertising and marketing, telehealth, pharmacy, specialty clinics, chronic care, patient transportation, social work, and accounting services) were ranked in order of necessity, and methods for cost reduction were discussed for each category. CONCLUSIONS: Categorizing costs can show where cost savings and cost-effective additions may be implemented. This study may serve as a financial and budgeting reference for other clinics.