Trends In Frequency Research Articles

The southward shift of hurricane genesis over the northern Atlantic Ocean

The southward shift of hurricane genesis over the northern Atlantic Ocean

Long-term temporal and seasonal trends of infective endocarditis

Abstract Background Over the past two decades, the epidemiology of infective endocarditis (IE) has changed significantly with the increase of life expectancy, use of cardiac implantable devices, and more invasive procedures. There is an ongoing shift in the incidence of IE, but a temporal/seasonal association with specific pathogens is yet to be investigated. Aims In this study, we aimed to assess (1) whether there is a temporal trend / increase in IE incidence in recent years, and (2) if there is a seasonality among specific IE-related pathogens. Methods We conducted a single center retrospective study of all consecutive patients in a 6-year period between 2017 and 2022, with a diagnosis of definite infective endocarditis as assessed by the modified Duke criteria. All electronic medical records were reviewed for demographics, blood cultures dates and results, and echocardiographic results were analyzed. The blood cultures collection date was used to define the time of the year for IE. Seasons were defined according to the northern hemisphere as Winter (January to March), Spring (April to June), Summer (July to September) and Autumn (October to December). If blood cultures were negative, the date of the first echocardiography with signs of infective endocarditis was noted. Results A total of 103 cases of IE were identified over a 6-year period. Mean age of IE patients was 70±13 years, 31.1% were female (n=32). No significant difference was found over the years. Overall, 76.7% had one isolated pathogen (n=79), 3.9% had 2 different pathogens (n=4), and 19.4% had persistent negative blood cultures (n=20). The most predominant infective agent was Streptococcus species (30.1% of cases, n=31), followed by Staphylococcus species (29.1%, n=30) and Enterococcus species (18.4%, n=19). The most affected valve was native aortic valve (35.9%, n=37), followed by native mitral valve (30.1%, n=31) and biological prosthetic aortic valve (17.5%, n=18). Summer had the fewer cases of IEs (18.4%), while Spring is the season with more IEs (32.0%). Negative blood cultures were more frequent in the Spring (24.2%). In Autumn, the proportion of Staphylococcus IE increases to 36% of all infections in this season. The most frequent pathogen in Winter and Spring is Streptococcus, representing 34.6% and 36.4% of IEs in these seasons. Conclusion In our population, there was no significant increase in the incidence of IEs over the years. However, there was a seasonal trend both in frequency and in specific pathogens: Summer had fewer IEs and Spring was the season with the highest frequency; Streptococcus is the most frequent pathogen in both Winter and Spring. These results may not represent the reality nationwide, and further epidemiological studies would be necessary to establish a trend.

Trends in age and antithrombotic therapy in patients who underwent transurethral resection of bladder tumor and perioperative complications.

We investigated the subsequent trends in age and antithrombotic therapy in patients who underwent transurethral resection of bladder tumor (TURBT) and examined the rate of perioperative complications. Medical records of patients who underwent TURBT were retrospectively analyzed. We arbitrarily divided the observation years into three periods (I: 2007-2013, II: 2014-2018, and III: 2019-2023) to compare the trends in age and frequency of perioperative complications after TURBT between patients taking and those not taking antithrombotic drugs. The number of patients who underwent TURBT was 173, 224, and 224 in periods I, II, and III, respectively. The proportion of patients receiving antithrombotic drugs was similar among the three periods (34.1%, 29.9%, and 37.5% in periods I, II, and III, respectively). The percentage of patients taking antithrombotic medications who were aged ≥80 was gradually increasing. The usage of warfarin (25.4%, 13%, and 4.2% in periods I, II, and III, respectively) and aspirin (65.1%, 40.3%, and 32.3% in periods I, II, and III, respectively) was decreased, whereas direct oral anticoagulant (1.6%, 18.2%, and 35.4% in periods I, II, and III, respectively) and clopidogrel (4.8%, 15.6%, and 16.7% in periods I, II, and III, respectively) administrations was increased. The rate of hemorrhagic and cardiocirculatory complications was higher in patients receiving antithrombotic drugs than in patients not receiving them. Of the patients receiving antithrombotic therapy, two patients with a history of cardiac infarction and deep vein thrombosis passed away after TURBT due to ischemic heart disease. The age of patients receiving antithrombotic drugs has increased, and antithrombotic drug types have changed among those who underwent TURBT. Further attention to hemorrhagic and lethal cardiocirculatory complications after TURBT will be required in a super-aged society.

Hospital Variability in the Use of Vasoactive Agents in Patients Hospitalized for Acute Decompensated Heart Failure for Clinical Phenotypes.

The absence of practice standards in vasoactive agent usage for acute decompensated heart failure has resulted in significant treatment variability across hospitals, potentially affecting patient outcomes. This study aimed to assess temporal trends and institutional differences in vasodilator and inotrope/vasopressor utilization among patients with acute decompensated heart failure, considering their clinical phenotypes. Data were extracted from a government-funded multicenter registry covering the Tokyo metropolitan area, comprising consecutive patients hospitalized in intensive/cardiovascular care units with a primary diagnosis of acute decompensated heart failure between January 2013 and December 2021. Clinical phenotypes, that is, pulmonary congestion or tissue hypoperfusion, were defined through a comprehensive assessment of clinical signs and symptoms, vital signs, and laboratory findings. We assessed the frequency and temporal trends in phenotype-based drug utilization of vasoactive agents and investigated institutional characteristics associated with adopting the phenotype-based approach using generalized linear mixed-effects models, with random intercepts to account for hospital-level variability. Among 37 293 patients (median age, 80 years; 43.7% female), 88.6% and 21.2% had pulmonary congestion and tissue hypoperfusion status, respectively. Throughout the study period, both overall and phenotype-based vasodilator utilizations showed significant declines, with overall usage dropping from 61.4% in 2013 to 48.6% in 2021 (Ptrend<0.001). Conversely, no temporal changes were observed in overall inotrope/vasopressor utilization from 24.6% in 2013 to 25.8% in 2021 or the proportion of phenotype-based utilization. Notably, there was considerable variability in phenotype-based drug utilization among hospitals, with a median ranging from 48.3% to 77.8%. In multivariable-adjusted models, a higher number of board-certified cardiologists were significantly associated with lower rates of phenotype-based vasodilator utilization and reduced inappropriate inotrope/vasopressor utilization, while tertiary care hospitals were linked to more appropriate inotrope/vasopressor utilization. Substantial variability existed among hospitals in phenotype-based drug utilization of vasoactive agents for patients with acute decompensated heart failure, highlighting the need for standardized treatment protocols. URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000013128.

Long-term outcome and predictors of vagus nerve stimulation for drug-resistant epilepsy: Real-world evidence from the Korean national hospital consortium.

This study aimed to assess the long-term outcome and prognostic factors of vagus nerve stimulation (VNS) for drug-resistant epilepsy (DRE) using real-world data. We included 189 DRE patients who underwent VNS implantation between 2005 and 2018 at nine national hospitals in Korea. Seizure-frequency data obtained quarterly one year before and after surgery and annually up to four years after surgery were collected from medical records. Health resource utilization trends over the four years preceding and following surgery were assessed through linkage with national health insurance data. We performed interrupted time series analysis to examine the trend in seizure frequency before and after one year following surgery. The seizure frequency exhibited a decreasing trend in 27.5 % and an increasing trend in 3.8 % during the first year following VNS implantation without a significant change in efficacy over the subsequent three years. Patients with focal spikes with secondary bilateral synchrony (SBS) in electroencephalography had a higher responder rate (adjusted odds ratio (aOR)= 3.06 [1.36-6.90]), whereas those with Lennox-Gastaut syndrome had a lower responder rate (aOR=0.38 [0.15-0.94]). One-year seizure-freedom was achieved in 6.0 % of patients at some point during the four-year follow-up. Over an eight-year period, the number of antiseizure medications (ASMs) tended to increase before surgery and remained at a median of 5 [4-6] after surgery. While the total medical and epilepsy-related costs tended to decrease after surgery, the ASM cost continued to increase. VNS was substantially beneficial for one in four patients with DRE, offering the chance of seizure-freedom. However, the efficacy of VNS fell within the efficacy range of recently introduced medical treatments and did not lead to a decrease in the ASM burden. Focal spike with SBS is a potential biomarker for a favorable response to VNS.

Algal blooms intensify in global large lakes over the past two decades

Abstract The recent increase in algal blooms in lakes, potentially exacerbated by climate warming, is of global concern. However, a spatially and temporally detailed characterization of algal bloom trends at a global scale has been lacking, posing challenges to definitively attribute warming as a primary driver. Here, we used daily MODIS satellite observations from 2003 to 2022 to analyze algal bloom trends in 1,956 large freshwater lakes worldwide. Among these lakes, 620 have experienced algal bloom events in over half of the years during the past two decades, with an upward trend in bloom frequency observed in 504 lakes. This trend is particularly prominent in subtropical regions and has become most pronounced after 2015. The global median annual bloom frequency has significantly increased at a rate of +1.8%/yr over the past two decades, showing a significant correlation with air temperatures (r2=0.43, P&amp;lt;0.05). Furthermore, in 44.8% of the bloom-affected lakes, we observed a strong correlation between air temperature and bloom frequency. Our study helps clarify the factors contributing to the global expansion of algal blooms and emphasizes the urgent need to recognize and address this growing environmental challenge within the context of climate warming.

Amino Acids Frequency and Interaction Trends: Comprehensive Analysis of Experimentally Validated Viral Antigen-Antibody Complexes.

Antibodies have specific binding capabilities and therapeutic potential for treating various diseases, including viral infections. The amino acid composition of the hypervariable complementarity determining regions (CDR) loops and the framework regions (FR) are the determining factors for the affinity and therapeutic efficacy of the antibodies. In this study selected and curated, 77 viral antigen-human antibody complexes from Protein data bank from the Thera-SAbdab database were analyzed. The results revealed diversity indices within specific CDR regions, amino acid frequencies, paratope-epitope interactions, bond formations, and bond types among the analyzed viral Ag-Ab complexes. The finding revealed that Ser, Gly, Tyr, Thr, and Phe are prominently present in the antibody CDRs. Analysis of CDR profiles indicated an average amino acid diversity of 60-80% in heavy chain CDRs and 45-60% in light chain CDRs. Aromatic residues, particularly Tyr, Phe, and Trp showed significant involvement in the paratope-epitope interactions in the heavy chain, while Tyr, Ser, and Thr were key contributors in the light chain. Furthermore, the study examined the occurrence of amino acids in both light and heavy chains of viral Ag- human Ab complexes, analyzing the presence of amino acids as single residues, dipeptides and tripeptides. The analysis is crucial for enhancing the antibody engineering processes including, design, optimization, affinity enhancement, and overall antibody development.

Metabolic response to burn injury: a comprehensive bibliometric study.

Burns lead to systemic changes manifested by systemic disturbances in water-electrolyte balance and systemic metabolic and inflammatory responses. The hypermetabolic response after a burn injury relies on metabolic, hormonal, and inflammatory dysregulation mechanisms. This study aimed to provide a comprehensive bibliometric analysis of the burn metabolism research field, identifying key trends, influential contributors, and emerging research hotspots to inform future investigative efforts. Ultimately, we conducted an extensive review of the literature, synthesizing the findings to clarify the present understanding within our field of study. We obtained 8,823 scientific publications on burn injury and metabolism from the core Web of Science (WOS) database collection. In this work, biblioshiny was used to visualize and analyze the data, and VOSviewer was used to verify the results. From a total of 8,823 publications, we found a general upward trend in annual publications and citation frequency. According to Bradford's Law, 21 high-production journals were classified as core sources based on the number of publications, and the most productive journal was Burns. The most published countries and authors in this field were the United States and Herndon DN. The most local cited document in this field was the article titled "Catecholamines: Mediator of the Hypermetabolic Response to Thermal Injury" authored by Wilmore DW. The thematic map showed that studies on injury, thermal injury, and sepsis were relatively mature. In contrast, research on metabolism, stress, and responses, and research on mortality, resistance, and management were less well-developed but were essential for the field. Research on burns and metabolism is increasing. Based on the bibliometric analysis, our study summarized the complex interplay between burn-induced systemic metabolic alterations and inflammatory responses, emphasizing the significance of hypermetabolism and its management. The role of propranolol, insulin, oxandrolone, and nutritional interventions in modulating the hypermetabolic state was discussed. Additionally, our study underscored the challenges of managing sepsis and drug-resistant infections in burn patients as an important future area of research.

Spatiotemporal patterns in precipitation whiplash over China during 1901–2100 based on CMIP6 simulations

Abstract The increasing risk of precipitation whiplash, characterized by rapid transitions between extreme drought and wet conditions, is largely related to atmospheric circulation changes due to anthropogenic greenhouse gas emissions. This study aims to examine the changing patterns of precipitation whiplash events for future projections (2021–2100) with regard to the current climate (1981–2020), and to unveil the relations between intensity, duration, and frequency of these events for various return periods across different regions of China. Multi-source observational datasets were also used to analyze the trend of precipitation whiplash indices for the current climate and to assess the ability of the CMIP6 ensemble model for reproducing the characteristics of precipitation whiplash events. The Intensity-Duration-Frequency (IDF) curves were estimated by using the nonstationary Generalized Extreme Value (GEV) model combined with Bayesian inference. The results show an increasing trend in frequency, intensity, and severity of precipitation whiplash events, particularly for the long-term future, while the duration of these transitions shows a decreasing trend. The peak occurrence months during the long-term future period exhibit notable changes in most parts of China. Specifically, the dry-to-wet whiplash events occur approximately two months earlier than in the current period, while the wet-to-dry whiplash occurs approximately two months later. The results also indicated that IDF curves shifted upward, particularly in the long-term future projections, suggesting an increased likelihood of more severe events. The findings of this study will serve as an essential reference for local authorities to develop more effective water resource management and disaster mitigation policies to tackle the impact of future climate change.

Adult With Tinea Capitis: A Five-Year (2015-2019) Trend Study Among Patients Attending the Aristide Le Dantec University Hospital in Dakar, Senegal.

Although tinea capitis (TC) is most commonly diagnosed in children, several studies have also shown that it is far from unusual in adults. To determine the frequency and risk factors of TC in adults in Dakar, Senegal. A cross-sectional study including all patients who visited the Parasitology and Mycology Lab at Aristide Le Dantec University Hospital for suspicion of TC was conducted from 1 January 2015 to 31 December 2019. The diagnosis was performed using conventional techniques. In sum, 458 adults were included. The majority (89%) were female. The patients' mean age was 35 ± 12 years (ranges: 18-84). Of the 458, 92 (20%) were confirmed with TC. The frequency trend, by year, showed a significant decrease ranging from 26.3% in 2015 to 19.2% in 2019. By sex, females (20.5%) were more affected than males (17.6%). According to age, the elderly present the highest infestation rate (36.4%). TC was diagnosed alone in 91.3%. T. soudanense (57.6%) was the most common species, followed by M. audouinii (34.8%). TC is frequent among adults in Senegal, particularly in women, and the main causal agent is T. soudanense. Its duration seems to indicate a chronic form previously acquired between 1 and 10 years ago. Thus, early management will be essential to avoid epidemic proportions.

Treatment modalities and trends for hospitalized patients with neovascular glaucoma: A retrospective study of 10 years.

To analyze the treatment modalities and trends for neovascular glaucoma (NVG) over the past 10 years, we conducted a retrospective analysis at Zhongshan Ophthalmic Center on 1331 NVG inpatients who received 1459 treatments for 1383 eyes between January 1, 2012, and December 31, 2021. Over time, we observed a progressive annual increase in both the number of patients and the volume of surgeries for NVG, with an annual percentage change (APC) of 10.23% (95% confidence interval [CI]: 5.5-15.2%, P = 0.001) and 11.59% (95% CI: 6.6-16.9%, P = 0.001), respectively. Drainage valve implantation (46.88%), cyclodestructive procedures (22.55%) and trabeculectomy (6.24%) were the three most commonly selected treatment options. The frequency of drainage valve implantation (APC = 6.59%, 95% CI = 0.9-12.6%, P = 0.028), cyclodestructive procedures (APC = 17.26%, 95% CI = 9.3-25.8%, P = 0.001) and trabeculectomy (APC = 21.93%, 95% CI = 1.6-46.3%, P = 0.036) increased. The proportion of drainage valve implantation gradually decreased (APC = -4.48%, 95% CI = -8.6 to -0.2%, P = 0.042), while that of cyclodestructive procedures increased (APC = 5.08%, 95% CI = 0.6-9.8%, P = 0.042), with no significant alteration observed in the proportion of trabeculectomy (APC = 9.26%, 95% CI = -8.8 to 30.9%, P = 0.290). Over the course of the study, both the cases of NVG and the volume of related surgeries escalated year by year. Among the three most frequently employed procedures-drainage valve implantation, cyclodestructive procedures and trabeculectomy-annual frequency trends revealed an increase in drainage valve implantation alongside a decreasing proportion, while cyclodestructive procedures exhibited a rising trend in both frequency and proportion; simultaneously, trabeculectomy showed an increasing frequency without a significant change in its proportion.

Changes in the frequency and persistence of the Vangengeim-Girs macro-circulation forms in the period 1979–2023

The significantly faster increase in Arctic temperature compared to the global average is causing changes in wind patterns in the mid-latitudes of the upper troposphere. Studies suggest possible changes in the geometry of wind fields, evident in the waviness of geopotential lines or in a series of discrete circulation patterns. This study aligns with the latter research focus. The objective of the analysis is to estimate long-term trends in the Vangengeim-Girs (V-G) macroforms from 1979 to 2023, and since 1999, which is considered a breaking point in the course of Arctic warming. Trend coefficients were estimated for the 45-year period and in moving 21-year window for characteristics describing V-G forms variability. The results indicate a nonlinear trend in the annual frequency of W and E forms, the number of E episodes, and the duration of C and W episodes. Other parameters maintained a consistent direction of change (+/−) throughout the study period: frequency of C(+), number of W(+), C(+), WEC(+) episodes, duration of WEC(−) and E(−). Processes indicating an increase in meridionality include the decline in W frequency after 2005, the rise in E frequency after 2003, the increase in C frequency and the number of C episodes from 1979 to 2023, and the rise in the number of E episodes along with a significant decline in W episode duration after 1999. Additionally, significant trends in the increase (decrease) in the number (duration) of all episodes suggest an increase in day-to-day circulation variability.

Trends in the critical frequency &lt;i&gt;foF&lt;/i&gt;2 at stations of the Northern and Southern hemispheres

A search for long-term trends in the F2 layer critical frequency foF2 is performed based on vertical sounding observations at three stations of the Northern Hemisphere (Juliusruh, Boulder, and Moscow) and three stations of the Southern Hemisphere (Townsville, Hobart, and Canberra). A method developed and extensively described by the authors is used. The data for two winter months in each hemisphere for five near-noon LT moments were analyzed. Three solar activity (SA) proxies (F30, Ly-α, and MgII) were used to eliminate SA effects. Negative trends are obtained for all considered situations (station, month, LT moment, SA proxy). The trends agree well with each other both if stations of the Northern and Southern hemispheres are compared individually or in aggregate.

Frequency-specific cortico-subcortical interaction in continuous speaking and listening.

Speech production and perception involve complex neural dynamics in the human brain. Using magnetoencephalography, our study explores the interaction between cortico-cortical and cortico-subcortical connectivities during these processes. Our connectivity findings during speaking revealed a significant connection from the right cerebellum to the left temporal areas in low frequencies, which displayed an opposite trend in high frequencies. Notably, high-frequency connectivity was absent during the listening condition. These findings underscore the vital roles of cortico-cortical and cortico-subcortical connections within the speech production and perception network. The results of our new study enhance our understanding of the complex dynamics of brain connectivity during speech processes, emphasizing the distinct frequency-based interactions between various brain regions.

A short communication regarding the trends and prevalence of H. Pylori in unselected gastric mucosal biopsy samples at a tertiary care hospital in Karachi, Pakistan: a five-year retrospective study.

A spiral gram-negative bacteria, known as helicobacter pylori, is frequently discovered in the stomach and is linked to a number of clinical disorders. Understanding its prevalence and trends is crucial for both improved clinical outcomes as well as greater epidemiological insight into the region. The current retrospective study was planned to analyse the prevalence and frequency trends of helicobacter pylori in gastric mucosal samples from a Karachi-based tertiary care centre. Data from a 5-year period was analysed. Sampled individuals' age, gender, site of infection and histopathological findings were noted. A decreasing trend in helicobacter pylori infections in biopsy samples was observed. Gender and age showed no significant association (p>0.05), while infection site and histopathological findings exhibited significant correlations (p<0.05). Antrum predominated for all types of gastritis. The study highlighted a declining trend in helicobacter pylori prevalence in Karachi over 5 years. Further multicentre studies with larger samples may provide deeper insights into helicobacter pylori trends in Pakistan.

Trends in Oceanic Precipitation Characteristics Inferred From Shipboard Present‐Weather Reports, 1950–2019

AbstractShipboard present‐weather reports from 1950 to 2019 are aggregated and composited yearly and seasonally on a grid to characterize the global climatology and apparent long‐term trends in the relative frequency of four categories of oceanic precipitation: drizzle, moderate, and heavy non‐drizzle, precipitation associated with thunderstorms and deep convection, and frozen‐phase precipitation. Although ship reports are susceptible to subjective interpretation, the inferred distributions of these phenomena are consistent with observations from other platforms such as satellites and coastal surface stations. These distributions highlight widespread 70‐year trends that are often consistent across both annual and seasonal frequencies, with statistical significance at 95% confidence. The relative frequency of ship‐reported drizzle has largely increased in the tropics annually and seasonally, with linear best‐fit relative increases by as much as 15% per decade. Decreased relative frequencies have been observed in parts of the subtropics and at higher latitudes. Heavier precipitation has encompassed a growing fraction of non‐drizzle precipitation reports over the subtropical North Pacific and Mediterranean. The relative frequency of thunderstorm reports has declined over the open Atlantic but show positive trends over the Mediterranean and the western Atlantic. The trends in relative frozen precipitation occurrence suggest a poleward retreat of areas receiving frozen precipitation in the Northern Hemisphere. Possible mechanisms for these ship‐observed trends are discussed and placed in the context of the modeled effects of climate change on global precipitation.

On the dynamics of ozone depletion events at Villum Research Station in the High Arctic

Abstract. Ozone depletion events (ODEs) occur every spring in the Arctic and have implications for the region's atmospheric oxidizing capacity, radiative balance, and mercury oxidation. Here, we comprehensively analyze ozone, ODEs, and their connection to meteorological and air mass history variables through statistical analyses, back trajectories, and machine learning (ML) at Villum Research Station, Station Nord, Greenland, from 1996 to 2019. We show that the ODE frequency and duration peak in May, followed by April and March, which is likely related to air masses spending more time over sea ice and increases in radiation from March to May. Back trajectories indicate that, as spring progresses, ODE air masses spend more time within the mixed layer, and the geographic origins move closer to Villum. Positive trends in ODE frequency and duration are observed during May (low confidence) and April (high confidence), respectively. Our analysis revealed that ODEs are favorable under sunny, calm conditions, with air masses arriving from northerly wind directions with sea ice contact. The ML model was able to reproduce the ODE occurrence and illuminated that radiation, time over sea ice, and temperature were important variables for modeling ODEs during March, April, and May, respectively. Several variables displayed threshold ranges for contributing to the positive prediction of ODEs vs. non-ODEs, notably temperature, radiation, wind direction, time spent over sea ice, and snow on land. Our ML methodology provides a framework for investigating and comparing the environmental drivers of ODEs between different Arctic sites and can be applied to other atmospheric phenomena (e.g., atmospheric-mercury depletion events).

Aggressiveness of Care at the End of Life of Children Dying with Cancer in Public Hospitals-A Nationwide Retrospective Cohort Study.

Background: Little is known about the aggressiveness of cancer care at the end of life (ACCEoL) for children with cancer in countries where palliative care (PC) is scarce. Objective: The aim of this study was to determine the frequency and time trends of ACCEoL in the pediatric population in a Western European country. Setting/Subjects: We conducted a retrospective cohort study analyzing children between 0 and 17 years who died of cancer in public hospitals in Portugal, from January 2010 to December 2015. Measurements: Hospital admissions during the last month of life were identified and we analyzed the length of stay and procedures performed. The ACCEoL was measured with a composite indicator. Results: We identified 300 children, with a median age of 9 years. A total of 58.7% were male and 31.3% had central nervous system tumors. We found at least one indicator of ACCEoL in 87.8% of patients. "More than 14 days spent in the hospital" (51.0%) and "more than one hospitalization" (43.3%) were the most frequent individual indicators. Infants and children with hematological malignancies had a numerically higher percentage of ACCEoL. We found no statistically significant differences in the frequencies of the ACCEoL among the subgroups. The prevalence of ACCEoL remained stable over the period. Conclusions: In our cohort about 9 out of 10 children with cancer experienced at least one indicator of ACCEoL, a rate higher than in countries with well-developed PC services. There is a need to improve the care in the last months of life for children with cancer.

Guide catheter extension use in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS CTO registry.

There are limited data on the use of guide catheter extensions (GCE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the frequency and temporal trends of GCE use in a large multicenter CTO-PCI registry and compared the clinical and angiographic characteristics and outcomes of cases with vs without GCE use. A GCE was used in 4106 of 14 521 CTO PCIs (28%) with increasing frequency from 18.8% in 2012 to 29.9% in 2023. The most used GCE size was 6 French (Fr) (45%), followed by 7 Fr (34%), and 8 Fr (21%). CTOs that required GCE use were more likely to have unfavorable lesion characteristics such as moderate-to-severe calcification (59% vs 40%, P less than .0001), moderate-to-severe tortuosity (35% vs 28%, P less than .0001), proximal cap ambiguity (39% vs 33%, P less than .0001), and had higher J-CTO scores (2.78 ± 1.15 vs 2.20 ± 1.27, P less than .0001). Advanced techniques like the retrograde approach (44% vs 24%, P less than .0001) and antegrade dissection and re-entry (28% vs 17%, P less than .0001) were more likely to be used in GCE cases. Technical success (86.6% vs 86.8%, P = .816) was similar between the 2 groups. However, major adverse cardiovascular events (MACE) (3.8% vs 2.4%, P less than .0001) and procedural complications (11.2% vs 8.7%, P less than .0001) were more frequent in the GCE group. In summary, GCE use in CTO PCI significantly increased between 2012 and 2023. Cases that required GCEs were more complex and had similar technical success, but higher incidence of MACE compared with cases that did not require GCEs.

Are trauma and orthopaedic consultant posts decreasing in frequency and increasing in subspecialisation?

BackgroundThe needs of the population and changes to the configuration of the NHS affect the role of the Trauma & Orthopaedic (T&O) surgeon. This impacts training and the number of consultant posts available at Certificate of Completion of Training. Aim of this study was to review advertised T&O Consultant posts and determine the trends in frequency and sub-specialisation requirements between 2011 and 2020 to assess the perceived reduction in advertised posts and increasing subspecialisation, also looking at the impact to the NHS.Methods451 volumes of the BMJ were reviewed over Jan 2011 – April 2020. The total number of jobs advertised were recorded. Additionally, for each post, sub-specialisation, region and substantive or locum tenure were recorded. Statistical analysis was conducted with both negative binomial repeated measure and binomial repeated measure with multi-level structures along with GARCH model.Results1141 jobs were advertised. There has been a decreasing trend in the total number of advertised posts of 13% per annum. Proportion of specialty jobs remain constant yearly. Posts listing Trauma as a subspeciality clearly decreased after 2012. Decreases were present in Northwest region and Scotland in number of posts. There has also been an increasing trend of advertisement of substantive posts, with locum posts forming less than 13% of total advertisements.ConclusionsWe found no significant increase in job specialisation contrary to previous literature. Overall, total number of Consultant posts in T&O decreased over this time period, especially in the North West region and Scotland. The needs of the population and NHS services need to be considered.