An Evaluation of Projection Methods for Detailed Small Area Projections: An Application and Validation to King County, Washington.

Population projections are used by a number of local agencies to better prepare for the future resource needs of counties, ensuring that educational, health, housing, and economic demands of individuals are met. Meeting the specific needs of a county's population, such as what resources to provide, where to target resources, and ensure an equitable distribution of those resources, requires population projections which are both demographically detailed, such as by age, race, and ethnicity, and geographically precise, such as at the census tract level. Despite this need, an evaluation of which methods are best suited to produce population projections at this level are lacking. In this study, we evaluate the accuracy of several cohort-based methods for small area population projections by race and ethnicity. We apply these methods to population projections of King County, Washington and assess the validity of projections using past population estimates. We find a clear pattern that demonstrates while simplified methods perform well in near term forecasts, methods which employ smoothing strategies perform better in long-term forecasting scenarios. Furthermore, we demonstrate that model's incorporating multiple stages of smoothing can provide detailed insights into the projected population size of King county and the places and groups which will most contribute to this growth. Detailed projections, such as those provided by multi-stage smoothing methods, enable city planners and policy makers a detailed view of the future structure of their county's population and provide for them a resource to better meet the needs of future populations.

Identifying opportunities to optimize mass drug administration for soil-transmitted helminths: A visualization and descriptive analysis using process mapping.

BACKGROUND: The control of soil-transmitted helminths (STH) is achieved through mass drug administration (MDA) with deworming medications targeting children and other high-risk groups. Recent evidence suggests that it may be possible to interrupt STH transmission by deworming individuals of all ages via community-wide MDA (cMDA). However, a change in delivery platforms will require altering implementation processes. METHODS: We used process mapping, an operational research methodology, to describe the activities required for effective implementation of school-based and cMDA in 18 heterogenous areas and over three years in Benin, India, and Malawi. Planned activities were identified during workshops prior to initiation of a large cMDA trial (the DeWorm3 trial). The process maps were updated annually post-implementation, including adding or removing activities (e.g., adaptations) and determining whether activities occurred according to plan. Descriptive analyses were performed to quantify differences and similarities at baseline and over three implementation years. Comparative analyses were also conducted between study sites and areas implementing school-based vs. cMDA. Digitized process maps were developed to provide a visualization of MDA processes and inspected to identify implementation bottlenecks and inefficient activity flows. RESULTS: Across three years and all clusters, implementation of cMDA required an average of 13 additional distinct activities and was adapted more often (5.2 adaptations per year) than school-based MDA. An average of 41% of activities across both MDA platforms did not occur according to planned timelines; however, deviations were often purposeful to improve implementation efficiency or effectiveness. Visualized process maps demonstrated that receipt of drugs at the local level may be an implementation bottleneck. Many activities rely on the effective setting of MDA dates and estimating quantity of drugs, suggesting that the timing of these activities is important to meet planned programmatic outcomes. CONCLUSION: Implementation processes were heterogenous across settings, suggesting that MDA is highly context and resource dependent and that there are many viable ways to implement MDA. Process mapping could be deployed to support a transition from a school-based control program to community-wide STH transmission interruption program and potentially to enable integration with other community-based campaigns. TRIAL REGISTRATION: NCT03014167.

Using Detection And Attribution To Quantify How Climate Change Is Affecting Health.

The question of whether, how, and to what extent climate change is affecting health is central to many climate and health studies. We describe a set of formal methods, termed detection and attribution, used by climatologists to determine whether a climate trend or extreme event has changed and to estimate the extent to which climate change influenced that change. We discuss events where changing weather patterns were attributed to climate change and extend these analyses to include health impacts from heat waves in 2018 and 2019 in Europe and Japan, and we show how such impact attribution could be applied to melting ice roads in the Arctic. Documenting the causal chain from emissions of greenhouse gases to observed human health outcomes is important input into risk assessments that prioritize health system preparedness and response interventions and into financial investments and communication about potential risk to policy makers and to the public.