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This is the first large scale analysis of feline desexing practices in Australia using outcomes documented in the patient medical record. The findings complement those of previous studies that used survey data to analyse the attitudes and opinions of veterinary professionals and owners to desexing31,34,38. The prevalence of desexing among cats in Australia, found to be 83.6%, confirms that desexing rates in Australia are among the highest reported internationally. Survey-based studies have reported that approximately 90% of cats in Australia are desexed, compared with 80% in the USA, and 43% in Italy39,40,41,42,43,44,45. A recent EPR-based study conducted in the UK reported the prevalence of feline desexing as 77%46. While population-wide analyses of desexing status provide a useful snapshot of practices in a region, most do not consider reproductive history.
A clear shift over time towards desexing cats at a younger age was evident here. EAD was 1.76 times more likely to have been carried out among desexed cats born between 2010 to 2017, than in those born between 1995 and 2009. This move towards earlier desexing was apparent in all age groups studied. Despite this trend, EAD had been carried out in only 21.5% of desexed females in the recent period. In fact, only 59.8% of females had been desexed by 6 months of age, which is the traditional recommendation and the most common recommendation reported by vets in Australia31,47. Despite a move towards earlier desexing, opportunities to control reproduction by prepubertal desexing are still being lost.
For an individual female cat, desexing at 6 months or later may be of little consequence, since they may not yet have reached puberty or had access to a mate. A recent survey of cat owners in Australia and New Zealand however found that 66% of cats had outdoor access45. From a population control perspective, eliminating the possibility of pregnancy by adopting EAD as standard has merit. The body of scientific evidence generated specifically to address the short-term and long-term safety of EAD overwhelmingly validates this practice4,17,22,23,24,25,26,27,28,29.
The impact that tighter control of reproduction among owned cats would have on shelter and stray populations is not yet clear. Populations of owned cats (completely reliant on humans) feral cats (living independently of humans) and stray cats (intermediate relationship with humans) do not exist in isolation48. Anthropogenic factors, including the provision of food, abandonment, and failure to curb reproduction, influence cat abundance and movement through these populations. Modelling population dynamics in owned, unowned (stray and feral) and shelter-housed cats holds promise to inform cat management strategies in the future49.
In multivariable models, for cats born 2010–2017, sex, breed, state and socioeconomic indices were all significantly associated with both desexing status and age at surgery. Females were less likely than males to be desexed and, among desexed cats, females were less likely than males to have been desexed at ≤ 4 months, supporting future measures to promote EAD in female cats. The reasons for this difference were not investigated but, conceivably, it may be due to higher fees for desexing females at some practices, or a greater awareness of spraying and roaming behaviours in males than pregancies in young female cats.
Not surprisingly purebred cats were less likely to be desexed than mixed breeds. In contrast, the finding that purebred cats were 2.7 times less likely to undergo EAD was unexpected because breeders commonly request EAD so that progeny for the pet market can be sold without delay50. It is plausible that this result reflects a greater demand in Australia for EAD from the charity and shelter sector, where mixed breed cats predominate, than from breeders. In line with this possibility, recent surveys found 70–80% of cats in Australia and New Zealand are of mixed breed and acquired from shelters, veterinary clinics, friends and as strays40,45,51. The higher odds of EAD in males than females was even greater among purebred cats, a result that may have been influenced by the practice of retaining more entire females than males for breeding.
The breeding season in Australia and New Zealand extends year round with peaks of kittening in spring and summer inferred from shelter admissions9,52,53. Cats born in winter had the lowest odds of being desexed in each age group. One explanation for this finding is that promotion of desexing by veterinary practices and welfare groups is less likely in winter because fewer kittens are born. This seasonal difference is certainly seen in the UK, where the RSPCA conducts desexing campaigns in Autumn to prevent the peak of spring litters54.
State or territory influenced both whether a cat was desexed, and the odds of EAD. Compared with cats in New South Wales (NSW), those in Victoria (VIC) and South Australia (SA) were more likely, and those in Queensland (QLD) less likely to be desexed. Again, compared with NSW, the odds of being desexed at ≤ 4 months were 1.45 greater for cats in VIC and 1.5–2.3 times less for those in QLD, SA and ACT. Desexing is handled inconsistently between Australia’s states and territories. Mandatory desexing legislation exists in ACT (by 3 months of age) and in SA, Tasmania (TAS), WA (by 6 months of age), with some exceptions. No legal requirement to desex cats exists at state level in VIC, QLD, NSW or Northern Territory (NT), although desexing is indirectly incentivized in NSW (by 6 months of age) and VIC (by 3 months of age) where registration is mandatory, and reduced registration fees are applied for desexed cats. No consistent relationship between our findings and state legislation related to desexing cats was identified. In fact, in ACT, where desexing of pet cats at 3 months of age has been a legal requirement since 2007, the second lowest odds of EAD were identified. Most veterinarians practicing in ACT (90%), surveyed 10 years after the legislation was introduced, gave recommendations inconsistent with the legislation and 35% were unaware that desexing by 3 months was mandatory in the ACT34. Whether and how legislation might be an appropriate tool to influence reproduction in owned cats and, indirectly, overpopulation should be further investigated.
Socioeconomic conditions influenced both whether a cat was desexed or not, and the age at desexing. Entire cats were more common in remote, low income and disadvantaged areas. This finding is concerning, given that outdoor access was more likely in non-urban than urban areas in a study of households in Australia and New Zealand45, implying more opportunity to find a mate. In addition, stray cat density correlated positively with socioeconomic deprivation in a New Zealand-based study employing geographically weighted regression analyses55. Together, these findings support the promotion of desexing campaigns in non-urban areas.
Economic indicators such as household income influenced whether a cat was desexed; the odds of being desexed were around 1.2 times greater in the highest compared to the lowest income areas. A similar, but more dramatic effect was reported in a study conducted in the USA where the prevalence of desexing increased from 51.4% to 96.2% as household income increased43. Among desexed cats, EAD was least likely in low income areas, but highest in the most socio-economically disadvantaged areas. Although this might seem paradoxical, IRSD is based on broader indicators of disadvantage than income alone. A UK study, similarly, identified that EAD was most likely in the most deprived regions, and that chances of being desexed by 6 months were more likely in higher income areas56. Possible explanations for these observations include the preferential targeting of areas of greatest disadvantage, rather than those with fewer economic resources, by discount desexing programs promoting EAD, or preferential sourcing of kittens in disadvantaged areas from organizations that routinely practice EAD, such as shelters.
There are limitations to our study that should be considered when interpreting the results. Cats that were either not registered with a veterinary practice, or were registered with a practice that did not contribute to VCA during the study periods were not studied. Therefore actual desexing prevalences are almost certainly lower than the estimates reported here. The study population represents cats that are accessible for desexing and is expected to comprise cats kept as pets, for breeding, owned by shelters, semi-owned cats and others. Provenance and lifestyle were not investigated because we chose not to collect data from the examination text field in VCA because of its low positive predictive value57, and because these data are inconsistently recorded. This precluded the analysis of other variables that may have been related to desexing outcomes such access to outdoors and the number and species of pets. Data collection was not uniform across Australia and variations in sample size, for example between states, may have affected our results. Also it is possible that data for the same cat presenting at more than one practice could be counted more than once, although a previous study using VCA found that  More

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This study comprehensively evaluated the risk associations between cause-specific ambulance services, extreme temperatures, and mass concentrations of PM2.5 and its constituents. The significant cold effects on chest pain and headache/dizziness/vertigo/fainting/syncope and heat effects on coma and unconsciousness and lying at public were observed, while the risk of ambulance services of OHCA was elevated in both extreme heat and cold environments. Ambulance services of respiratory distress, lying at public, and OHCA increased as the PM2.5 concentration increased, and the risk was significant at the PM2.5 concentration of 20–60 60 μg/m3 for ambulance services of lying at public and higher than 60 μg/m3 for respiratory distress. After controlling for effects of daily average temperature and PM2.5 concentration, this study still identified the significant effects of sulfate and EC on ambulance services of lying at public and OC on headache/dizziness/vertigo/fainting/syncope as the concentrations of PM2.5 constituents were at 90th percentile.
Limited studies assessed associations between ambulance calls and ambient environment9,13,19,22,23,24,25,26,27. Studies in Emilia-Romagna in Italy23, Brisbane in Australia26, Taiwan19, and Huainan and Luoyang in China22,24, have indicated the numbers of ambulance calls associated with extreme heat; the risks generally increase as the daily temperature exceeds 27 °C19,23,26. However, no consistent finding for cold threshold was identified19,28. Kaohsiung City has a tropical climate (daily temperature ranging from 13.5 °C to 31.5 °C), but it is cooler than cities located near the equator, e.g., Singapore and Manila. Except for ambulance service of OHCA, we found that the significant risks associated with temperature were only identified in environments with extreme temperatures ( 90th percentiles; Fig. 3).
Fine particulate matter (PM2.5) are characterized with a small diameter ( More

Study area
The study area is a one-hectare (ha) subtropical mixed young forest in the age of 20 to 30 years of Hong Kong. It is located at Shek Kong (22.428774, 114.114968), in between the Kadoorie Farm and Botanic Garden (KFBG) and Kadoorie Institute, The University of Hong Kong (HKU) as shown in Fig. 1. This is a forest dynamic plot under ‘The Center for Tropical Forest Science–Forest Global Earth Observatory (CTFS-ForestGEO) (https://forestgeo.si.edu/). It acts as a research base on the forest dynamics, forest biodiversity, carbon sequestration and more, which also provide opportunity for public involvement in scientific research.
Figure 1

The study area: 1 hectare subtropical moist young forest plot, a full demonstration plot of the Forest Global Earth observatory (ForestGEO) project (https://forestgeo.si.edu/), located in Hong Kong in understanding the long-term forest dynamic. The map is generated by Authors using ArcMap version 10.5 (https://desktop.arcgis.com/en/arcmap/).

Full size image

The one-hectare forest plot was demarcated by 25 quadrats in 20 m × 20 m each, which were further sub-divided into sixteen 5 m × 5 m sub-quadrats; delineated with permanent marker poles by the professional surveying team. The forest survey was launched on January 11th, 2012 and completed on September 6th, 2012. A total of 63 species, 10,442 individual trees with 20,888 stems were recorded in the site. The stem locations (UTM WGS84 coordinate system) were recorded in nearest 5 cm, and DBH were measured at 1.3 m at breast height in nearest 1 mm. The dominant species are Litsea rotundifolia, Psychotria asiatica, Ilex asprella and Aporosa dioica, which all are native species and accounted for over 80% of stems with the study area. The forest condition of the study area is shown in Table 2.
Table 2 The forest condition and descriptive statistics.
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Methods
A three-stage methodological framework was outlined for this study as shown in Figs. 2 and 3. In the first stage, parameters including DBH, wood density and stem location were recorded for field-measured AGB computation. DBH was directly obtained from site, wood density (in g cm−3) was obtained from the global wood density database43,44 or World Agroforestry database45 (http://db.worldagroforestry.org//wd), up to species level. If the species was not recorded in the database, the value was replaced by its genus averaged wood density value. Tree height was derived from the LiDAR data with reference to the recorded x,y location of the stems. The second stage is LiDAR AGB model derivation. Five allometric models (Model 1 to Model 5) were used to estimate the AGB of individual trees based on field-measured parameters. The allometric model with the lowest model error was selected to compute the ‘Field-measured AGB’, which would be used as the dependent variable to develop the LiDAR-derived AGB model. The LiDAR plots metrics were generated in various plot-size (i.e., 10 m radius, 5 m radius and 2.5 m radius) within the study area. Stepwise linear regression was used to select the important and significant predictors in each regression model. Three different model forms were tested (Model I, II, III as discussed in “Stage 2: LiDAR AGB model derivation” section), The LiDAR derived AGB regression models would be evaluated by means of assumption tests and bootstrapping; as well as cross-validation (CV) in the last stage of model evaluation and validation.
Figure 2

The workflow of the study. Stage 1: allometric modeling to compute ground-truth AGB. Five allometric models were compared and the best one is selected to calibrate model in the next stage. Stage 2: LiDAR AGB Model Derivation, by comparing LiDAR plot metrics derived in different plot size (i.e. 10 m, 5 m, 2.5 m radius). Stage 3: Model Evaluation & Validation on the best model selected from Stage 2 (Source: Authors).

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Figure 3

The graphical abstract of the study (Source: Authors).

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Stage 1: allometric modeling
20,888 stems from 63 species, were planned to be used to develop the allometric models. Amongst, the 81% of the wood density value were measured up to species level (i.e., 51 species) and 19% were up to genus level (i.e., 12 species). However, as the tree height parameter was retrieved from the LiDAR 1 m Canopy Height Model (CHM), 263 stems found no value and thus the sample size reduced to 20,625 stems. The DBH of stems ranged from 1.0 cm to 57.1 cm, with mean of 2.55 cm and S.D. of 2.38 cm.
The selected five allometric models included two pantropical models by Chave et al.16; two subtropical models by Xu et al.46 and one local model by Nichol and Sarker47 were assessed. The inclusion of the subtropical models from Xu et al.46 is because of the similar forest type (i.e., subtropical moist forest from southern China) with our study area; whereas the pantropical models from Chave et al.16 is due to its large database across the pantropical regions yet not being explored adequately its applicability in subtropical forests.
The five allometric models were compared by One-way ANOVA and the Tukey HSD post-hoc analysis48. Model 1 (Eq. (3)) was the best model proposed by Chave et al.16, comprised of wood density (ρ), diameter-at-breast height (DBH) and height (H) as shown below (AIC = 3130):

$$AGB=0.0673times {left(rho {(DBH)}^{2}Hright)}^{0.976}$$
(3)

However, it is very unlikely to have a precise tree height data in a closed canopy49. Therefore, an alternative allometric equation without height was then proposed by Chave et al.16 and adopted as Model 2 (Eq. (4)) in our study (AIC =  − 4293):to represent the subtropical AGB

$$AGB=expleft[-1.803-0.976E+0.976text{ln}left(rho right)+2.673text{ln}left(DBHright)-0.0299left[{(text{ln}(DBH))}^{2}right]right]$$
(4)

The bioclimatic variable, “E”, which made up of three parameters to account for climatic variations: Temperature seasonality (TS), Long-term Maximum Climatological Water Deficit (CWD) and Precipitation Seasonality (PS). The formula of the bioclimatic variable, “E”, is shown below (Eq. (5)):

$$E={left(0.178 times TS-0.938 times CWD-6.61 times PSright)}^{{10}^{-3}}$$
(5)

The monthly mean temperature (℃), precipitation (mm) and evapotranspiration (mm) data were obtained from the Hong Kong Observatory50 in the period of 1981 to 2010 to compute the three variables. E was then computed as 0.261 and was input into Eq. (4) to derive the ground-truth AGB of individual stems.
The AGB models developed by Xu et al.46 were conducted in the subtropical mixed-species moist forest in southern part of China. Two allometric models from the study were selected to represent the subtropical AGB model. Model 3 (Eq. (6)) assumed tree height is available (by extracting from LiDAR):

$$AGB=text{exp}(-2.334+2.118text{ln}(DBH)+0.5436text{ln}(H)+0.5953text{ln}(rho ))$$
(6)

Meanwhile, an alternative allometric model would be used by assuming tree height was not available, which is the Model 4 (Eq. (7)) of this study:

$$AGB=text{exp}(-1.8226+2.4105text{ln}left(DBHright)+0.5781text{ln}(rho ))$$
(7)

Nichol and Sarker47 developed a local allometric model for Hong Kong by harvesting 75 trees from 15 dominant species of Hong Kong. DBH and H within 50 circular sample plots from a variety of tree stands were measured, which were then used to establish allometric model with field measured AGB. The best allometric model was a model using DBH as the sole parameter and thus selected as the Model 5 (Eq. (8)) of this study:

$$AGB=text{exp}(-1.8226+2.4105text{ln}left(DBHright)+0.5781text{ln}(rho ))$$
(8)

Stage 2: LiDAR AGB model derivation
The airborne LiDAR data used in this study was captured by Optech Gemini ALTM Airborne Laser Terrain Mapper and acquired by The Government of the Hong Kong Special Administrative Region from December 1st, 2010 to January 8th, 2011. A total of 5575 ground truth points were generated, with horizontal accuracy of 0.294 m (95% confidence interval (C.I.)). Vertical accuracy was also assessed against the orthometric heights of Hong Kong Principal Datum (HKPD), the average vertical accuracy was 0.1 m (95% C.I.). Multiple returns were recorded per pulse up to four range measurements (i.e., first, second third and last). The LiDAR acquisition parameters are shown in Table 3.
Table 3 The LiDAR acquisition parameters.
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Prior to generation of the plot metrics, the LiDAR data was pre-processed by creating the ground TIN by extracting only the ground returns. The extraction and processing were performed in ArcMap 10.5 with LAStools extension (https://rapidlasso.com/lastools/) and the FUSION 3.7 (http://forsys.cfr.washington.edu/fusion/fusionlatest.html). The canopy surface was defined using all non-ground returns with height above 2.0 m. The reason of choosing 2.0 m as the threshold was to avoid canopy returns to be mixed with ground returns51. Moreover, ‘all returns’ were used instead of the ‘first returns’, since the former provided more information on the lower canopies or understory51, while over 50% of returned points in our study area were classified as medium or low vegetation. The ground TIN was subtracted from the canopy surface to compute the normalized height value of each canopy point. The LiDAR metrics were then derived from the normalized height point cloud.
To be compatible with the LiDAR dataset and to facilitate the plot delineation procedure, the entire 1 ha study area was divided into circular plots with three plot sizes: (1) twenty-five 10 m radius plots (16,182 stems), (2) one-hundred 5 m radius plot (15,538 stems) and (3) four-hundred 2.5 m radius plots (15,100 stems) as shown in Fig. 4a–d. Circular plots were considered more favorable than rectangular or square plots, since the periphery-to-area ratio was the smallest and thus minimized the number of edge trees52.
Figure 4

The (a) 1 ha rectangular plot clipped into (b) twenty-five 10 m radius circular plots; (c) one-hundred 5 m radius plots; and (d) four-hundred 2.5 m radius plots respectively; for the LiDAR metrics derivation. The maps are generated by Authors using ArcMap version 10.5 (https://desktop.arcgis.com/en/arcmap/).

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The 59 plot metrics, under the descriptive, height, intensity and canopy cover categories, were derived by the ‘cloudmetrics’ function in FUSION version 3.7. The LiDAR metrics, and its log-transformed metrics were input into stepwise regression model as independent predictors of AGB. Significant predictors were selected (F  1.0 were removed) into the regression model. Three sets of regression models were generated (Table 4) and the allometric models tended to be linear and normal after logarithmic transformation18,19.
Table 4 The input variables for the three regression models.
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Observing the normal Q–Q plot (Fig. 5a) of the dependent variable (i.e., AGB) and the Kolmogorov–Smirnov statistic (d = 0.216, p  0.200) indicated a normal distribution (Fig. 5b) and which became the Model II. The further log-transformation into Model III did not indicate significant improvement and thus Model II in various plot sizes were to be further explored.
Figure 5

The normal Q–Q plot, in 10 m radius plot size, of (a) raw AGB and (b) log-AGB. After logarithmic transformation, the AGB (dependent variable) was normalized.

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Assumption tests including test on normality, homoscedasticity and absence of multi-collinearity were conducted. The Normal P–P plot, scatter plots on residuals, ‘Tolerance’ index and Variance Inflation Factor (VIF) were applied to detect the violation of assumptions. If the ‘Tolerance’ index is smaller than 0.1, or VIF is greater than 10, it indicates a significance chance of collinearity53.
Stage 3: model evaluation and validation
AGB regression models were to be evaluated in this stage. The Model R2, Adjusted R2, Mean-absolute-deviation (MAE) and Root-mean-squared-error (RMSE) were reported to indicate the explanatory power of the model. R2 showed the amount of explained variance by the model, MAE was the average magnitude of error without considering the direction (Eq. (9)). RMSE (Eq. (10)) was the square root of the averaged squared residual and being sensitive to outliers (i.e., larger error) as the errors are squared. The RMSE would be reported in the unit of kg/ha.

$$MAE =frac{sum_{i=1}^{n}left|(widehat{y}-y)right|}{n}$$
(9)

$$RMSE= sqrt[]{frac{{{sum }_{i=1}^{n}(widehat{y}-y)}^{2}}{n}}$$
(10)

(widehat{text{y}}) is the ith estimate for AGB of each plot, y is the ith observation of that plot, divided by the (n), denoting the sample size.
However, as the regression model was built with limited sample plots, it might subject to model overfitting. Bootstrapping was adopted to assess statistical accuracy in terms of the confidence intervals54. Ultimately, it provides a robust estimation of the standard errors, confidence intervals for estimates, including the model regression coefficient, mean and correlation coefficients. The model uncertainty of this study was assessed by 1000 runs of bootstrapping. The 95% “Bias-corrected and accelerated (BCa) confidence interval (C.I.)” on the beta coefficient of model predictors was reported.
Leave-one-out cross validation (LOOCV) was utilized for model validation. The model would be trained by all data points except the one being left out for validation55. The Predicted Residual Error Sum of Squares, PRESS, was the sum of the ‘squared deleted residuals’ (SSDR) of the n−1 observation. Predicted R2 was computed by dividing PRESS by the total sum of square residual (SSTO) expressed in Eq. (11). The RMSE of the CV model was also reported as Eq. (12). The RMSE of the CV model without overfitting shall be approximate to that of the original model.

$${R}_{pred}^{2}=1-frac{PRESS}{SSTO}$$
(11)

$$C{V}_{RMSE}= sqrt[]{frac{PRESS}{d.f.}},$$
(12)

d.f. stands for degree of freedom (i.e., d.f. = 21). These model calibration and validation work were conducted in IBM SPSS Statistics version 24. More