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Abstract Background In the near future, the incidence of mosquito-borne diseases may expand to new sites due to changes in temperature and rainfall patterns caused by climate change. Therefore, there is a need to use recent technological advances to improve vector surveillance methodologies. Unoccupied Aerial Vehicles (UAVs), often called drones, have been used to collect high-resolution imagery to map detailed information on mosquito habitats and direct control measures to specific areas. Supervised classification approaches have been largely used to automatically detect vector habitats. However, manual data labelling for model training limits their use for rapid responses. Open-source foundation models such as the Meta AI Segment Anything Model (SAM) can facilitate the manual digitalization of high-resolution images. This pre-trained model can assist in extracting features of interest in a diverse range of images. Here, we evaluated the performance of SAM through the Samgeo package, a Python-based wrapper for geospatial data, as it has not been applied to analyse remote sensing images for epidemiological studies. Results We tested the identification of two land cover classes of interest: water bodies and human settlements, using different UAV acquired imagery across five malaria-endemic areas in Africa, South America, and Southeast Asia. We employed manually placed point prompts and text prompts associated with specific classes of interest to guide the image segmentation and assessed the performance in the different geographic contexts. An average Dice coefficient value of 0.67 was obtained for buildings segmentation and 0.73 for water bodies using point prompts. Regarding the use of text prompts, the highest Dice coefficient value reached 0.72 for buildings and 0.70 for water bodies. Nevertheless, the performance was closely dependent on each object, landscape characteristics and selected words, resulting in varying performance. Conclusions Recent models such as SAM can potentially assist manual digitalization of imagery by vector control programs, quickly identifying key features when surveying an area of interest. However, accurate segmentation still requires user-provided manual prompts and corrections to obtain precise segmentation. Further evaluations are necessary, especially for applications in rural areas.

AbstractAgeing and urbanisation pose significant challenges for public health and urban planning. Ageing populations are at particular risk from hazards arising from urbanisation processes, some of which are in turn exacerbated by climate change. One approach for mitigating the negative effects of urbanisation on ageing populations is the leveraging of the beneficial effects of urban green infrastructure as a public health intervention in the planning process. We assessed the potential of available theoretical frameworks to provide the context for such leverage. This involved active engagement with academics and practitioners specialising in ageing, green infrastructure and health and well-being through a knowledge-brokering approach. We concluded that an integrated and comprehensive framework on the socio-cultural-ecological determinants of health is lacking. To address this, we present a set of principles for overcoming challenges to knowledge integration when working at the intersection of green infrastructure, ageing, health and well-being. Our findings—and the co-production process used to generate them—have wider significance for trans-disciplinary research into the benefits of the natural environment to human health and well-being as well as other complex and interconnected topics associated with global grand challenges.

AbstractWith the current practice of therapeutic hypothermia for neonatal encephalopathy, disability rates and the severity spectrum of cerebral palsy are reduced. Nevertheless, safe and effective adjunct therapies are needed to optimize outcomes. This study’s objective was to assess if 18 mg/kg melatonin given rapidly over 2 h at 1 h after hypoxia-ischemia with cooling from 1–13 h was safe, achieved therapeutic levels within 3 h and augmented hypothermic neuroprotection. Following hypoxia-ischemia, 20 newborn piglets were randomized to: (i) Cooling 1–13 h (HT; n = 6); (ii) HT+ 2.5% ethanol vehicle (HT+V; n = 7); (iii) HT + Melatonin (HT+M; n = 7). Intensive care was maintained for 48 h; aEEG was acquired throughout, brain MRS acquired at 24 and 48 h and cell death (TUNEL) evaluated at 48 h. There were no differences for insult severity. Core temperature was higher in HT group for first hour after HI. Comparing HT+M to HT, aEEG scores recovered more quickly by 19 h (p < 0.05); comparing HT+V to HT, aEEG recovered from 31 h (p < 0.05). Brain phosphocreatine/inorganic phosphate and NTP/exchangeable phosphate were higher at 48 h in HT+M versus HT (p = 0.036, p = 0.049 respectively). Including both 24 h and 48 h measurements, the rise in Lactate/N-acetyl aspartate was reduced in white (p = 0.030) and grey matter (p = 0.038) after HI. Reduced overall TUNEL positive cells were observed in HT+M (47.1 cells/mm2) compared to HT (123.8 cells/mm2) (p = 0.0003) and HT+V (97.5 cells/mm2) compared to HT (p = 0.012). Localized protection was seen in white matter for HT+M versus HT (p = 0.036) and internal capsule for HT+M compared to HT (p = 0.001) and HT+V versus HT (p = 0.006). Therapeutic melatonin levels (15–30mg/l) were achieved at 2 h and were neuroprotective following HI, but ethanol vehicle was partially protective.

AbstractContinental-scale models of malaria climate suitability typically couple well-established temperature-response models with basic estimates of vector habitat availability using rainfall as a proxy. Here we show that across continental Africa, the estimated geographic range of climatic suitability for malaria transmission is more sensitive to the precipitation threshold than the thermal response curve applied. To address this problem we use downscaled daily climate predictions from seven GCMs to run a continental-scale hydrological model for a process-based representation of mosquito breeding habitat availability. A more complex pattern of malaria suitability emerges as water is routed through drainage networks and river corridors serve as year-round transmission foci. The estimated hydro-climatically suitable area for stable malaria transmission is smaller than previous models suggest and shows only a very small increase in state-of-the-art future climate scenarios. However, bigger geographical shifts are observed than with most rainfall threshold models and the pattern of that shift is very different when using a hydrological model to estimate surface water availability for vector breeding.

Abstract Heat- and cold-related mortality risks are highly variable across different geographies, suggesting a differential distribution of vulnerability factors between and within countries, which could partly be driven by urban-to-rural disparities. Identifying these drivers of risk is crucial to characterize local vulnerability and design tailored public health interventions to improve adaptation of populations to climate change. We aimed to assess how heat- and cold-mortality risks change across urban, peri-urban and rural areas in Switzerland and to identify and compare the factors associated with increased vulnerability within and between different area typologies. We estimated the heat- and cold-related mortality association using the case time-series design and distributed lag non-linear models over daily mean temperature and all-cause mortality series between 1990–2017 in each municipality in Switzerland. Then, through multivariate meta-regression, we derived pooled heat and cold-mortality associations by typology (i.e. urban/rural/peri-urban) and assessed potential vulnerability factors among a wealth of demographic, socioeconomic, topographic, climatic, land use and other environmental data. Urban clusters reported larger pooled heat-related mortality risk (at 99th percentile, vs. temperature of minimum mortality (MMT)) (relative risk = 1.17 (95%CI: 1.10; 1.24), vs peri-urban 1.03 (1.00; 1.06), and rural 1.03 (0.99; 1.08)), but similar cold-mortality risk (at 1st percentile, vs. MMT) (1.35 (1.28; 1.43), vs rural 1.28 (1.14; 1.44) and peri-urban 1.39 (1.27–1.53)) clusters. We found different sets of vulnerability factors explaining the differential risk patterns across typologies. In urban clusters, mainly environmental factors (i.e. PM2.5) drove differences in heat-mortality association, while for peri-urban/rural clusters socio-economic variables were also important. For cold, socio-economic variables drove changes in vulnerability across all typologies, while environmental factors and ageing were other important drivers of larger vulnerability in peri-urban/rural clusters, with heterogeneity in the direction of the association. Our findings suggest that urban populations in Switzerland may be more vulnerable to heat, compared to rural locations, and different sets of vulnerability factors may drive these associations in each typology. Thus, future public health adaptation strategies should consider local and more tailored interventions rather than a one-size fits all approach.

Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.

IntroductionA large treatment gap for common mental disorders (such as depression) exists in South Africa. Comorbidity with other chronic diseases, including HIV and diseases of lifestyle, is an increasing public health concern globally. Currently, primary health facilities as points of care for those with chronic disease provide limited services for common mental disorders. Assessing organisational readiness for change (ORC) towards adopting health innovations (such as mental health services) using contextually appropriate measures is needed to facilitate implementation of these services. This study aims to investigate the validity of the Texas Christian University Organisational Readiness for Change (TCU-ORC) scale in the South African context. Subsequently, we will develop a shortened version of this scale. This study is nested within Project MIND, a multiyear randomised controlled trial that is testing two different approaches for integrating counselling for common mental disorders into chronic disease care. Although the modified, contextually appropriate ORC measure resulting from the proposed study will be developed in the context of integrating mental health into primary healthcare services, the potential for the tool to be generalised to further understanding barriers to any change being implemented in primary care settings is high.Methods and analysisWe will establish internal consistency (Cronbach’s alpha coefficients), test-retest reliability (intraclass correlation coefficient) and construct validity of the long-form TCU-ORC questionnaire. Survey data will be collected from 288 clinical, management and operational staff from 24 primary health facilities where the Project MIND trial is implemented. A modified Delphi approach will assess the content validity of the TCU-ORC items and identify areas for potential adaptation and item reduction.Ethics and disseminationEthical approval has been granted by the South African Medical Research Council (Protocol ID EC004-2-2015, amendment of 20 August 2017). Results will be submitted to peer-reviewed journals relevant to implementation and health systems strengthening.