As natural habitats continue to shrink in Kenya's Amboseli Ecosystem, livestock depredation by lions Panthera leo threatens both the livelihoods of pastoralist communities and the lion populations affected by retaliatory killings. Finding ways for people and carnivores to coexist at the landscape scale is crucial to the long-term persistence of many threatened animal populations. The fortification of existing traditional bomas to make them predator-proof reduces night-time depredation of livestock. However, the sustainability and cost-effectiveness of such an initiative rely on boma owners taking responsibility for the upkeep and repair of their bomas. In August 2018 we surveyed 88 predator-proof bomas constructed during 2012–2018 and recorded their characteristics and levels of damage. We examined which variables influence disrepair, using a series of statistical analyses, including generalized linear mixed models. Our results reveal there was more disrepair in bomas constructed with wooden posts, confirming the benefit of using recycled plastic posts; in bomas with lower livestock density, suggesting that fewer animals could cause more damage or that such damage is not repaired; and in bomas located further away from a neighbouring predator-proof boma, suggesting a social element in encouraging or enabling boma owners to carry out maintenance. We recommend the consideration and further investigation of this social influence in guiding and improving the sustainability of conservation programmes that use predator-proof bomas, with a view to reducing negative interactions between pastoralists and lions.

Background: Antibiotic time outs (ABTOs), formal reassessments of all new antimicrobial regimens by the care team, can optimize antimicrobial regimens, reducing antimicrobial overuse and potentially improving outcomes. Implementation of ABTOs is a substantial challenge. We used quality improvement methods to implement robust, meaningful, team-driven ABTOs in general medicine ward services. Methods: We identified and engaged stakeholders to serve as champions for the quality improvement initiative. On October 1, 2018, 2 internal medicine teaching services (services A and B), began conducting ABTOs on all patients admitted to their services receiving systemic antimicrobials for at least 36 hours. Eligible patients were usually identified by the team pharmacist. ABTOs were completed within 72 hours of antibiotic initiation and were documented in the electronic medical record (EMR) by providers using a template. The process was modified as necessary in response to feedback from frontline clinicians using plan-do-study-act (PDSA) methods. We subsequently spread the project to 2 additional internal medicine services (services C and D); 2 family medicine teams (services E and F); and 1 general pediatric service (service G). The project is ongoing. We collected data for the following metrics: (1) proportion of ABTO-eligible patients with an ABTO; (2) proportion of ABTOs conducted within the recommended time frame; (3) documented plan changes as a result of ABTO (eg, change IV antibiotics to PO); (4) proportion of documented plan changes actually completed within 24 hours. Results: Within 12 weeks, services A and B were successfully completing time outs in >80% of their patients. This target was consistently reached by services C, D, E, F, and G almost immediately following launch on those services. As of June 29, 2019, >80% of eligible patients across all participating services have had a time out conducted for 16 consecutive weeks. ABTOs have resulted in a change in management in 35% of cases, including IV-to-PO change in 19% of cases and discontinuation in 5%. Overall, 77% of time outs occurred during the 36–72-hour window. Ultimately, 95% of documented plan changes were completed within 24 hours. Conclusions: ABTOs are effective but implementation is challenging. We achieved high compliance with ABTOs without using electronic reminders. Our results suggest that ABTOs were impactful in the non–critical-care general medicine setting. Next steps include (1) development of EMR-based tools to facilitate identifying eligible patients and ABTO documentation; (2) continued spread through our health care system; and (3) analysis of ABTO impact using ABTO-unexposed patients as a control group.

Funding: None

Disclosures: None

Surface debris covers much of the western portion of the McMurdo Ice Shelf and has a strong influence on the local surface albedo and energy balance. Differential ablation between debris-covered and debris-free areas creates an unusual heterogeneous surface of topographically low, high-ablation, and topographically raised (‘pedestalled’), low-ablation areas. Analysis of Landsat and MODIS satellite imagery from 1999 to 2018, alongside field observations from the 2016/2017 austral summer, shows that pedestalled relict lakes (‘pedestals’) form when an active surface meltwater lake that develops in the summer, freezes-over in winter, resulting in the lake-bottom debris being masked by a high-albedo, superimposed, ice surface. If this ice surface fails to melt during a subsequent melt season, it experiences reduced surface ablation relative to the surrounding debris-covered areas of the ice shelf. We propose that this differential ablation, and resultant hydrostatic and flexural readjustments of the ice shelf, causes the former supraglacial lake surface to become increasingly pedestalled above the lower topography of the surrounding ice shelf. Consequently, meltwater streams cannot flow onto these pedestalled features, and instead divert around them. We suggest that the development of pedestals has a significant influence on the surface-energy balance, hydrology and flexure of the ice shelf.

Bowel cancer risk is strongly influenced by lifestyle factors including diet and physical activity. Several studies have investigated the effects of adherence to the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) cancer prevention recommendations on outcomes such as all-cause and cancer-specific mortality, but the relationships with molecular mechanisms that underlie the effects on bowel cancer risk are unknown. This study aimed to investigate the relationships between adherence to the WCRF/AICR cancer prevention recommendations and wingless/integrated (WNT)-pathway-related markers of bowel cancer risk, including the expression of WNT pathway genes and regulatory microRNA (miRNA), secreted frizzled-related protein 1 (SFRP1) methylation and colonic crypt proliferative state in colorectal mucosal biopsies. Dietary and lifestyle data from seventy-five healthy participants recruited as part of the DISC Study were used. A scoring system was devised including seven of the cancer prevention recommendations and smoking status. The effects of total adherence score and scores for individual recommendations on the measured outcomes were assessed using Spearman’s rank correlation analysis and unpaired t tests, respectively. Total adherence score correlated negatively with expression of Myc proto-oncogene (c-MYC) (P=0·039) and WNT11 (P=0·025), and high adherers had significantly reduced expression of cyclin D1 (CCND1) (P=0·042), WNT11 (P=0·012) and c-MYC (P=0·048). Expression of axis inhibition protein 2 (AXIN2), glycogen synthase kinase (GSK3β), catenin β1 (CTNNB1) and WNT11 and of the oncogenic miRNA miR-17 and colonic crypt kinetics correlated significantly with scores for individual recommendations, including body fatness, red meat intake, plant food intake and smoking status. The findings from this study provide evidence for positive effects of adherence to the WCRF/AICR cancer prevention recommendations on WNT-pathway-related markers of bowel cancer risk.

On 2 March 2016, several small en échelon tabular icebergs calved from the seaward front of the McMurdo Ice Shelf, and a previously inactive rift widened and propagated by ~3 km, ~25% of its previous length, setting the stage for the future calving of a ~14 km2 iceberg. Within 24 h of these events, all remaining land-fast sea ice that had been stabilizing the ice shelf broke-up. The events were witnessed by time-lapse cameras at nearby Scott Base, and put into context using nearby seismic and automatic weather station data, satellite imagery and subsequent ground observation. Although the exact trigger of calving and rifting cannot be identified definitively, seismic records reveal superimposed sets of both long-period (>10 s) sea swell propagating into McMurdo Sound from storm sources beyond Antarctica, and high-energy, locally-sourced, short-period (<10 s) sea swell, in the 4 days before the fast ice break-up and associated ice-shelf calving and rifting. This suggests that sea swell should be studied further as a proximal cause of ice-shelf calving and rifting; if proven, it suggests that ice-shelf stability is tele-connected with far-field storm conditions at lower latitudes, adding a global dimension to the physics of ice-shelf break-up.

Morphosyntactic dialect variation, once a neglected area of dialect research, has recently witnessed a large growth in interest. Various methods from geospatial data analysis have been applied to morphosyntactic data. To date, the focus has largely been on analyzing the distribution of stable patterns of variation. This article extends this work to examine patterns of ongoing change. It uses a body of data from the Syntactic Atlas of Welsh Dialects and the Siarad Corpus of spoken Welsh to examine the innovation and diffusion of a new second-person singular pronoun, chdi, testing the usefulness of Geographically Weighted Regression (GWR) as a method for identifying and modeling patterns of ongoing syntactic change. It is shown that GWR provides plausible models of the diachronic development of changes that are still in progress. Furthermore, it allows us to test whether rates of change are constant across geographical space, allowing us to test whether the Constant Rate Hypothesis (that diffusion of change proceeds at the same rate in different environments) holds between dialects.

This study investigates consumer preferences for a marketing system that improves integration of farmers into a local food system. Attribute-based methods are used to estimate consumer willingness to pay for a locally grown product that is bundled with a local food bank (LFB) donation. Estimates reveal that, on average, households are willing to pay 11% more for locally grown relative to nonlocal agricultural products. When the locally grown product attribute is combined with a donation to support a LFB, the premium nearly doubles. Results suggest that the proposed system could provide resources to strengthen local food distribution networks.

Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care.