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Insights From a Multi-Method Recharge Estimation Comparison Study.

ABSTRACT: Although most recharge estimation studies apply multiple methods to identify the possible range in recharge values, many do not distinguish clearly enough between inherent uncertainty of the methods and other factors affecting the results. We investigated the additional value that can be gained from multi-method recharge studies through insights into hydrogeological understanding, in addition to characterizing uncertainty. Nine separate groundwater recharge estimation methods, with a total of 17 variations, were applied at a shallow aquifer in northwest Ethiopia in the context of the potential for shallow groundwater resource development. These gave a wide range of recharge values from 45 to 814?mm/a. Critical assessment indicated that the results depended on what the recharge represents (actual, potential, minimum recharge or change in aquifer storage), and spatial and temporal scales, as well as uncertainties from application of each method. Important insights into the hydrogeological system were gained from this detailed analysis, which also confirmed that the range of values for actual recharge was reduced to around 280-430?mm/a. This study demonstrates that even when assumptions behind methods are violated, as they often are to some degree especially when data are limited, valuable insights into the hydrogeological system can be gained from application of multiple methods.

SUBMITTER: Walker D

PROVIDER: S-EPMC6849517 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Insights From a Multi-Method Recharge Estimation Comparison Study.

Walker David D Parkin Geoff G Schmitter Petra P Gowing John J Tilahun Seifu A SA Haile Alemseged T AT Yimam Abdu Y AY

Ground water 20180719 2

Although most recharge estimation studies apply multiple methods to identify the possible range in recharge values, many do not distinguish clearly enough between inherent uncertainty of the methods and other factors affecting the results. We investigated the additional value that can be gained from multi-method recharge studies through insights into hydrogeological understanding, in addition to characterizing uncertainty. Nine separate groundwater recharge estimation methods, with a total of 17 ...[more]

PMID: 29896911

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Project description:ImportanceRecent studies have shown that Friedewald underestimates low-density lipoprotein cholesterol (LDL-C) at lower levels, which could result in undertreatment of high-risk patients. A novel method (Martin/Hopkins) using a patient-specific conversion factor provides more accurate LDL-C levels. However, this method has not been tested in proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor-treated patients.ObjectiveTo investigate accuracy of 2 different methods for estimating LDL-C levels (Martin/Hopkins and Friedewald) compared with gold standard preparative ultracentrifugation (PUC) in patients with low LDL-C levels in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk (FOURIER) trial.Design, setting, and participantsThe FOURIER trial was a randomized clinical trial of evolocumab vs placebo added to statin therapy in 27 564 patients with stable atherosclerotic cardiovascular disease. The patients' LDL-C levels were assessed at baseline, 4 weeks, 12 weeks, 24 weeks, and every 24 weeks thereafter, and measured directly by PUC when the level was less than 40 mg/dL per the Friedewald method (calculated as non-HDL-C level - triglycerides/5). In the Martin/Hopkins method, patient-specific ratios of triglycerides to very low-density lipoprotein cholesterol (VLDL-C) ratios were determined and used to estimate VLDL-C, which was subtracted from the non-HDL-C level to obtain the LDL-C level.Main outcomes and measuresLow-density lipoprotein cholesterol calculated by the Friedewald and Martin/Hopkins methods, with PUC as the reference method.ResultsFor this analysis, the mean (SD) age was 62.7 (9.0) years; 2885 of the 12 742 patients were women (22.6%). A total of 56 624 observations from 12 742 patients had Friedewald, Martin/Hopkins, and PUC LDL-C measurements. The median difference from PUC LDL-C levels for Martin/Hopkins LDL-C levels was -2 mg/dL (interquartile range [IQR], -4 to 1 mg/dL) and for Friedewald LDL-C levels was -4 mg/dL (IQR, -8 to -1 mg/dL; P < .001). Overall, 22.9% of Martin/Hopkins LDL-C values were more than 5 mg/dL different than PUC values, and 2.6% were more than 10 mg/dL different than PUC levels. These were significantly less than respective proportions with Friedewald estimation (40.1% and 13.3%; P < .001), mainly because of underestimation by the Friedewald method. The correlation with PUC LDL-C was significantly higher for Martin/Hopkins vs Friedewald (ρ, 0.918 [95% CI 0.916-0.919] vs ρ, 0.867 [0.865-0.869], P < .001).Conclusions and relevanceIn patients achieving low LDL-C with PCSK9 inhibition, the Martin/Hopkins method for LDL-C estimation more closely approximates gold standard PUC than Friedewald estimation does. The Martin/Hopkins method may prevent undertreatment because of LDL-C underestimation by the Friedewald method.Trial registrationClinicalTrials.gov Identifier: NCT01764633.

Project description:BackgroundEnsuring good adherence is critical to the success of anti-retroviral treatment (ART). However, in resource-poor contexts, where paediatric HIV burden is high there has been limited progress in developing or adapting tools to support adherence for HIV-infected children on ART and their caregivers. We conducted formative research to assess children's adherence and to explore the knowledge, perceptions and attitudes of caregivers towards children's treatment.MethodsAll children starting ART between September 2002 and January 2004 (when ART was at cost in Malawi) were observed for at least 6 months on ART. Their adherence was assessed quantitatively by asking caregivers of children about missed ART doses during the previous 3 days at monthly visits. Attendance to clinic appointments was also monitored. In June and July 2004, four focus group discussions, each with 6 to 8 caregivers, and 5 critical incident narratives were conducted to provide complementary contextual data on caregivers' experiences on the challenges to and opportunities of paediatric ART adherence.ResultsWe followed prospectively 47 children who started ART between 8 months and 12 years of age over a median time on ART of 33 weeks (2-91 weeks). 72% (34/47) never missed a single dose according to caregivers' report and 82% (327/401) of clinic visits were either as scheduled, or before or within 1 week after the scheduled appointment. Caregivers were generally knowledgeable about ART and motivated to support children to adhere to treatment despite facing multiple challenges. Caregivers were particularly motivated by seeing children begin to get better; but faced challenges in meeting the costs of medicine and transport, waiting times in clinic, stock outs and remembering to support children to adhere in the face of multiple responsibilities.ConclusionIn the era of rapid scale-up of treatment for children there is need for holistic support strategies that focus on the child, the caregiver and the health worker and which are situated within the reality of fragile health systems. The findings highlight the need for cost-free and less complex paediatric ART regimes and culturally appropriate tools to support children's adherence.

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Insights From a Multi-Method Recharge Estimation Comparison Study.

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Insights From a Multi-Method Recharge Estimation Comparison Study.

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