Equity of access to critical care services in Scotland: A Bayesian spatial analysis.

BACKGROUND: There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes. METHODS: This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag-York-Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes. RESULTS: A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality. CONCLUSION: Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.

Deep learning for automated detection of Drosophila suzukii: potential for UAV-based monitoring.

BACKGROUND: The fruit fly Drosophila suzukii, or spotted wing drosophila (SWD), is a serious pest worldwide, attacking many soft-skinned fruits. An efficient monitoring system that identifies and counts SWD in crops and their surroundings is therefore essential for integrated pest management (IPM) strategies. Existing methods, such as catching flies in liquid bait traps and counting them manually, are costly, time-consuming and labour-intensive. To overcome these limitations, we studied insect trap monitoring using image-based object detection with deep learning. RESULTS: Based on an image database with 4753 annotated SWD flies, we trained a ResNet-18-based deep convolutional neural network to detect and count SWD, including sex prediction and discrimination. The results show that SWD can be detected with an area under the precision recall curve (AUC) of 0.506 (female) and 0.603 (male) in digital images taken from a static position. For images collected using an unmanned aerial vehicle (UAV), the algorithm detected SWD individuals with an AUC of 0.086 (female) and 0.284 (male). The lower AUC for the aerial imagery was due to lower image quality caused by stabilisation manoeuvres of the UAV during image collection. CONCLUSION: Our results indicate that it is possible to monitor SWD using deep learning and object detection. Moreover, the results demonstrate the potential of UAVs to monitor insect traps, which could be valuable in the development of autonomous insect monitoring systems and IPM. © 2020 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Spontaneous very preterm birth in relation to social class, and smoking: a temporal-spatial analysis of routinely collected data in Aberdeen, Scotland (1985-2010).

OBJECTIVE: To examine trends of spontaneous very preterm birth (vPTB) and its relationship with maternal socioeconomic status and smoking. METHODS: This was a population-based cohort study in Aberdeen Maternity Hospital, UK. The cohort was restricted to spontaneous singleton deliveries occurring in Aberdeen from 1985 to 2010. The primary outcome was very preterm birth which was defined as <32 weeks gestation and the comparison group was deliveries ≥37 weeks of gestation. The main exposures were parental Social Class based on Occupation, Carstairs' deprivation index and smoking during pregnancy. Logistic regression was used to estimate the association between vPTB and the exposures. RESULTS: There was an increased likelihood of vPTB in those with unskilled-occupations compared to professional-occupations [aOR:2.77 (95%CI:1.54-4.99)], in those who lived in the most deprived areas compared to those in the most affluent [aOR: 2.16 (95% CI: 1.27-3.67)] and in women who smoked compared to those who did not [aOR: 1.74 (95% CI: 1.36-2.21)]. The association with Carstairs index was no longer statistically significant when restricted to smokers but remained significant when restricted to non-smokers. CONCLUSION: The strongest risk factor for vPTB was maternal smoking while socioeconomic deprivation showed a strong association in non-smokers. Smoking cessation interventions may reduce vPTB. Modifiable risk factors should be explored in deprived areas.

Geographical access to critical care services in Scotland.

BACKGROUND: Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. METHODS: This was a descriptive, geographical analysis of population access to 'intermediate' and 'definitive' critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter. Access was analysed by health board, rurality and as a country using freely available geographically referenced population data. RESULTS: Ninety-six percent of the population reside within a 45-min drive of the nearest intermediate critical care facility, and 94% of the population live within a 45-min ambulance drive time to the nearest intensive care unit. By helicopter, these figures were 95% and 91%, respectively. Some health boards had no access to definitive critical care services within 45 min via helicopter or road. Very remote small towns and very remote rural areas had poorer access than less remote and rural regions.

Analysis of aeromedical retrieval coverage using elliptical isochrones: An evaluation of helicopter fleet size configurations in Scotland.

BACKGROUND: Trauma systems in remote and rural regions often rely on helicopter emergency medical services to facilitate access to definitive care. The siting of such resources is key, but often relies on simplistic modeling of coverage, using circular isochrones. Scotland is in the process of implementing a national trauma network, and there have been calls for an expansion of aeromedical retrieval capacity. The aim of this study was to analyze population and area coverage of the current retrieval service configuration, with three aircraft, and a configuration with an additional helicopter, in the North East of Scotland, using a novel methodology. Both overall coverage and coverage by physician-staffed aircraft, with enhanced clinical capability, were analyzed. METHODS: This was a geographical analysis based on calculation of elliptical isochrones, which consider the "open-jaw" configuration of many retrieval flights. Helicopters are not always based at hospitals. We modeled coverage based on different outbound and inbound flights. Areally referenced population data were obtained from the Scottish Government. RESULTS: The current helicopter network configuration provides 94.2% population coverage and 59.0% area coverage. The addition of a fourth helicopter would marginally increase population coverage to 94.4% and area coverage to 59.1%. However, when considering only physician-manned aircraft, the current configuration provides only 71.7% population coverage and 29.4% area coverage, which would be increased to 91.1% and 51.2%, respectively, with a second aircraft. CONCLUSIONS: Scotland's current helicopter network configuration provides good population coverage for retrievals to major trauma centers, which would only be increased minimally by the addition of a fourth aircraft in the North East. The coverage provided by the single physician-staffed aircraft is more limited, however, and would be increased considerably by a second physician-staffed aircraft in the North East. Elliptical isochrones provide a useful means of modeling "open-jaw" retrieval missions and provide a more realistic estimate of coverage. LEVEL OF EVIDENCE: Epidemiological study, level IV; therapeutic study, level IV.

Feasibility and utility of population-level geospatial injury profiling: prospective, national cohort study.

BACKGROUND: Geospatial analysis is increasingly being used to evaluate the design and effectiveness of trauma systems, but there are no metrics to describe the geographic distribution of incidents. The aim of this study, therefore, was to evaluate the feasibility and utility of using spatial analysis to characterize, at scale, the geospatial profile of an injured population. METHODS: This is a prospective national cohort study of all trauma patients attended to by the Scottish Ambulance Service in a complete year (between July 1, 2013, and June 30, 2014). Incident location and severity were collected at source. Incident distribution was evaluated using geostatistical techniques. RESULTS: There were 80,391 recorded incidents involving traumatic injury. Incident density was highest in the central Southern part of the country and along the East coast, broadly following the population distribution and road network. The overall distribution was highly clustered, and centered on the central Southern and Eastern parts of the country. When analyzed by triage category, the distribution of incidents triaged to major trauma center care was slightly less clustered than that of incidents triaged to trauma unit or local emergency hospital care, but the spread was similar. When analyzed by type of injury, assaults and falls were more clustered than incidents relating to traffic and transportation. CONCLUSION: This study demonstrates the feasibility and power of describing the geographic distribution of a group of injured patients. The methodology described has potential application for injury surveillance and trauma system design and evaluation.