BackgroundAdverse events (AEs) in acute care hospitals are frequent and associated with significant morbidity, mortality, and costs. Measuring AEs is necessary for quality improvement and benchmarking purposes, but current detection methods lack in accuracy, efficiency, and generalizability. The growing availability of electronic health records (EHR) and the development of natural language processing techniques for encoding narrative data offer an opportunity to develop potentially better methods. The purpose of this study is to determine the accuracy and generalizability of using automated methods for detecting three high-incidence and high-impact AEs from EHR data: a) hospital-acquired pneumonia, b) ventilator-associated event and, c) central line-associated bloodstream infection.MethodsThis validation study will be conducted among medical, surgical and ICU patients admitted between 2013 and 2016 to the Centre hospitalier universitaire de Sherbrooke (CHUS) and the McGill University Health Centre (MUHC), which has both French and English sites. A random 60% sample of CHUS patients will be used for model development purposes (cohort 1, development set). Using a random sample of these patients, a reference standard assessment of their medical chart will be performed. Multivariate logistic regression and the area under the curve (AUC) will be employed to iteratively develop and optimize three automated AE detection models (i.e., one per AE of interest) using EHR data from the CHUS. These models will then be validated on a random sample of the remaining 40% of CHUS patients (cohort 1, internal validation set) using chart review to assess accuracy. The most accurate models developed and validated at the CHUS will then be applied to EHR data from a random sample of patients admitted to the MUHC French site (cohort 2) and English site (cohort 3)—a critical requirement given the use of narrative data –, and accuracy will be assessed using chart review. Generalizability will be determined by comparing AUCs from cohorts 2 and 3 to those from cohort 1.DiscussionThis study will likely produce more accurate and efficient measures of AEs. These measures could be used to assess the incidence rates of AEs, evaluate the success of preventive interventions, or benchmark performance across hospitals.

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The effects of drought are modulated by the presence-or the absence-of appropriate policies and institutional efforts, adequate infrastructure and the degree of its functionality, among other factors. As the major droughts of the past years have proven in many countries, institutions-formal or informal-are a key determinant of drought resilience. Given a meteorological anomaly, vulnerability to drought will depend on a range of structural conditions, the management context, the state of routine maintenance and corresponding budget allocations, the presence of information systems and flows, and so forth.These factors in turn condition communities' preparedness and capacity to efficiently respond to drought when it hits.Resilience depends on the interplay of the natural environment, built infrastructure, institutions, and human behavior. Resilience is about having options, and buffers.This study responds to a request from the Government of Angola in late 2018 to help it transition from a reactive response mode to a proactive and resilience-focused model of dealing with drought in the South of Angola. Toward this end, the study presents a practical approach and actionable proposals to support the Government of Angola in its shift towards fostering climate resilience.The work presented here aims at providing a better understanding of southern Angola's vulnerability to drought, focusing on the structural conditions of access to water as well as the governance context.Based on this improved understanding, the study informs the design of key solutions, including strengthening governance to promote resilience, investing in the sustainable development of water resources, and a strategy for prioritizing related interventions across the region.This study focuses on rural communities across the South, and specifically on helping to find adequate water-access solutions for them. Its approach and findings complement parallel, ongoing efforts by the Government of Angola to increase water security through the construction of dams and water transfers in the Cuvelai, Cunene, and Cubango basins, as well as dams in the Namibe coastal basins. This study targets those rural communities that will be beyond the reach of these government efforts.

Nel richiamare la legge quadro sugli incendi boschivi L. 353/2000 ed in particolare la problematica della pianificazione AIB nelle aree protette statali, si individua il ruolo e vengono sintetizzate le azioni del Ministero dell'Ambiente e della Tutela del Territorio e del Mare-Divisione X della Direzione Protezione Natura volte a favorire detta pianificazione. Nel contempo, la raccolta ormai quasi decennale dei dati sugli incendi boschivi nei Parchi nazionali, attraverso il commento ad alcune tabelle riassuntive, permette di avere un piccolo quadro storico dell'andamento complessivo a livello nazionale che risulta tendenzialmente positivo.

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