Large Decline Research Articles

Clinical Implication of the Acumen Hypotension Prediction Index for Reducing Intraoperative Haemorrhage in Patients Undergoing Lumbar Spinal Fusion Surgery: A Prospective Randomised Controlled Single-Blinded Trial.

We investigated the clinical implication of the Hypotension Prediction Index (HPI) in decreasing amount of surgical haemorrhage and requirements of blood transfusion compared to the conventional method (with vs. without HPI monitoring). A prospective, randomised controlled-trial of 19- to 73-year-old patients (n = 76) undergoing elective lumbar spinal fusion surgery was performed. According to the exclusion criteria, the patients were divided into the non-HPI (n = 33) and HPI (n = 35) groups. The targeted-induced hypotension systolic blood pressure was 80–100 mmHg (in both groups), with HPI > 85 (in the HPI group). Intraoperative bleeding was lower in the HPI group (299.3 ± 219.8 mL) than in the non-HPI group (532 ± 232.68 mL) (p = 0.001). The non-HPI group had a lower level of haemoglobin at the end of the surgery with a larger decline in levels. The incidence of postoperative transfusion of red blood cells was higher in the non-HPI group than in the HPI group (9 (27.3%) vs. 1 (2.9%)). The use of HPI monitoring may play a role in providing timely haemodynamic information that leads to improving the quality of induced hypotension care and to ameliorate intraoperative surgical blood loss and postoperative demand for blood transfusion in patients undergoing lumbar fusion surgery.

COVID-19 Lockdown: A Global Study Investigating the Effect of Athletes' Sport Classification and Sex on Training Practices.

To investigate differences in athletes' knowledge, beliefs, and training practices during COVID-19 lockdowns with reference to sport classification and sex. This work extends an initial descriptive evaluation focusing on athlete classification. Athletes (12,526; 66% male; 142 countries) completed an online survey (May-July 2020) assessing knowledge, beliefs, and practices toward training. Sports were classified as team sports (45%), endurance (20%), power/technical (10%), combat (9%), aquatic (6%), recreational (4%), racquet (3%), precision (2%), parasports (1%), and others (1%). Further analysis by sex was performed. During lockdown, athletes practiced body-weight-based exercises routinely (67% femalesand 64% males), ranging from 50% (precision) to 78% (parasports). More sport-specific technical skills were performed in combat, parasports, and precision (∼50%) than other sports (∼35%). Most athletes (range: 50% [parasports] to 75% [endurance]) performed cardiorespiratory training (trivial sex differences). Compared to prelockdown, perceived training intensity was reduced by 29% to 41%, depending on sport (largest decline: ∼38% in team sports, unaffected by sex). Some athletes (range: 7%-49%) maintained their training intensity for strength, endurance, speed, plyometric, change-of-direction, and technical training. Athletes who previously trained ≥5 sessions per week reduced their volume (range: 18%-28%) during lockdown. The proportion of athletes (81%) training ≥60min/session reduced by 31% to 43% during lockdown. Males and females had comparable moderate levels of training knowledge (56% vs 58%) and beliefs/attitudes (54% vs 56%). Changes in athletes' training practices were sport-specific, with few or no sex differences. Team-based sports were generally more susceptible to changes than individual sports. Policy makers should provide athletes withspecific training arrangements and educational resources to facilitate remote and/or home-based training during lockdown-type events.

Attributing differences of solar-induced chlorophyll fluorescence (SIF)-gross primary production (GPP) relationships between two C4 crops: corn and miscanthus

There remains limited information to characterize the solar-induced chlorophyll fluorescence (SIF)-gross primary production (GPP) relationship in C4 cropping systems. The annual C4 crop corn and perennial C4 crop miscanthus differ in phenology, canopy structure and leaf physiology. Investigating the SIF-GPP relationships in these species could deepen our understanding of SIF-GPP relationships within C4 crops. Using in situ canopy SIF and GPP measurements for both species along with leaf-level measurements, we found considerable differences in the SIF-GPP relationships between corn and miscanthus, with a stronger SIF-GPP relationship and higher slope of SIF-GPP observed in corn compared to miscanthus. These differences were mainly caused by leaf physiology. For miscanthus, high non-photochemical quenching (NPQ) under high light, temperature and water vapor deficit (VPD) conditions caused a large decline of fluorescence yield (Φ F ), which further led to a SIF midday depression and weakened the SIF-GPP relationship. The larger slope in corn than miscanthus was mainly due to its higher GPP in mid-summer, largely attributed to the higher leaf photosynthesis and less NPQ. Our results demonstrated variation of the SIF-GPP relationship within C4 crops and highlighted the importance of leaf physiology in determining canopy SIF behaviors and SIF-GPP relationships.

Is ultraviolet Radiation a Confounding Variable for COVID-19 in India?

The current global Coronavirus disease (COVID-19) became a pandemic due to its contagion nature and rapid spread throughout the world. The pandemic caused a lockdown resulting in a large decline in the level of anthropogenic emissions of tiny aerosol particles that altered the solar irradiance and decreased the quantity of aerosol, which opposes global warming. This study first demonstrates that surface ultraviolet radiation (UV) increased significantly during the lockdown period in four major Indian mega cities, whose magnitude varies based on city demography. Results shows that the correlation between the high rate of increase in Ultraviolet irradiance (UV-irradiance) on mortality and morbidity. Although there are numerous confounding factors for the pandemic, UV-irradiance could be one of the factors supporting the hypothesis that increased solar UV dose may increase rate of disinfection as radiation warps the structure of genetic material of the virus and deactivates it. Another factor which also have potential to add up increase of Vitamin D3 production per minute of exposure due to UV-irradiance resulting in an increased human immune system to fight COVID-19 more effectively. However, it is cautioned here that a high dose of direct UV exposure to humans may be fatal leading to skin damage and melanoma cancer. Hence, the harmful impact of UV-Irradiance on the human body and its application to possible disinfectant to virus deactivation should be understood in a proper perspective.

Is ultraviolet Radiation a Confounding Variable for COVID-19 in India?

The current global Coronavirus disease (COVID-19) became a pandemic due to its contagion nature and rapid spread throughout the world. The pandemic caused a lockdown resulting in a large decline in the level of anthropogenic emissions of tiny aerosol particles that altered the solar irradiance and decreased the quantity of aerosol, which opposes global warming. This study first demonstrates that surface ultraviolet radiation (UV) increased significantly during the lockdown period in four major Indian mega cities, whose magnitude varies based on city demography. Results shows that the correlation between the high rate of increase in Ultraviolet irradiance (UV-irradiance) on mortality and morbidity. Although there are numerous confounding factors for the pandemic, UV-irradiance could be one of the factors supporting the hypothesis that increased solar UV dose may increase rate of disinfection as radiation warps the structure of genetic material of the virus and deactivates it. Another factor which also have potential to add up increase of Vitamin D3 production per minute of exposure due to UV-irradiance resulting in an increased human immune system to fight COVID-19 more effectively. However, it is cautioned here that a high dose of direct UV exposure to humans may be fatal leading to skin damage and melanoma cancer. Hence, the harmful impact of UV-Irradiance on the human body and its application to possible disinfectant to virus deactivation should be understood in a proper perspective.

Earnings Growth and Acquisition Returns: Do Investors Gamble in the Takeover Market?

AbstractWe document a strong positive initial market reaction to merger announcements from bidders with either large earnings growth or significant earnings decline, relative to those with neutral earnings change, reflecting a U-shaped pattern between bidders’ earnings growth and announcement returns. However, the higher initial returns for bidders with earnings decline subsequently reverse, whereas the higher returns for bidders with high growth do not. We further show that the return patterns are driven by a tendency for retail investors to gamble that merger and acquisition deals initiated by poorly performing bidders will generate high synergies.

Current Conditions and Projected Changes in Crop Water Demand, Irrigation Requirement, and Water Availability over West Africa

Climate variability and change greatly affect agricultural and water resource management over West Africa. This paper presents the current characteristics and projected change in regional crop water demand (CWD), irrigation requirement (IR), and water availability (WA) over West Africa. Observed and simulated daily rainfall, minimum temperature, maximum temperature, and evapotranspiration are used to derive the above agro-meteorological and hydrological variables. For future periods, high-resolution climate data from three regional climate models under two different scenarios, i.e., representative concentration pathway (RCP) 4.5 and 8.5, are considered. Evaluation of the characteristics of present-day CWD, IR, and WA indicated that the ensemble mean of the model-derived outputs reproduced the prevailing spatial patterns of CWD and IR. Moreover, the wetter part of the domain, especially along the southern coast, was correctly delineated from the drier northern regions, despite having biases. The ensemble model also simulated the annual cycle of water supply and the bimodal pattern of the water demand curves correctly. In terms of future projections, the outcomes from the study suggest an average increase in the CWD by up to 0.808 mm/day and IR by 1.244 mm/day towards the end of the twenty-first century, compared to the baseline period. The hot-spot areas, where there is higher projected increment in CWD and IR, are over Senegal, Southern Mali, and Western Burkina Faso. In most cases, WA is projected to decrease towards the end of the twenty-first century by −0.418 mm/day. The largest decline in WA is found to be over Guinea and most of the eastern parts of West Africa. Despite the current under-utilization of the existing groundwater resources, the threat of global warming in reducing future WA and increasing CWD suggested caution on the scale of irrigation schemes and management strategies. The outcomes from the study could be a crucial input for the agricultural and water managers for introducing effective measures to ensure sustainability of irrigated farm lands.

Evaluation of Blood Loss in Conventional vs MAKOplasty Total Knee Arthroplasty

BackgroundPrimary total knee arthroplasty (TKA) has been historically associated with considerable blood loss. Allogenic transfusions, the standard of care for blood loss following TKA, carry inherent risks. With the expanding use of robotic technology in TKA, one theoretical advantage is decreased blood loss and postoperative blood transfusions requirements. The purpose of this study was to compare postoperative hemoglobin levels and the percentage of patients requiring a transfusion of allogenic packed red blood cells after conventional TKA (CTKA) vs robot-assisted TKA (RATKA). MethodsThis is a retrospective review of 486 consecutive patients undergoing either CTKA or RATKA between October 30, 2018, and June 25, 2020, by a single fellowship-trained arthroplasty surgeon. Mako SmartRobotics (Stryker, Kalamazoo, MI) was used for RATKA cases. Primary outcomes included preoperative vs postoperative hemoglobin values and postoperative blood transfusion rates between the 2 groups. ResultsThe mean hemoglobin on postoperative day 1 was 10.7 gm/dl (±1.3) in the CTKA group and 10.9 gm/dl (±1.3) in the RATKA group, P = .24. The largest decline in hemoglobin from preoperative to within 2 days postoperatively was 3.1 gm/dl (±1.1) in the CTKA group and 3.1 gm/dl (±1.1) in the RATKA group, P = .92. The percentage of patients requiring a blood transfusion was 1.1% in the CTKA group and 1.3% in the RATKA group, P = .79. ConclusionsRATKA and CTKA groups did not have significant differences in postoperative hemoglobin changes or the need for postoperative blood transfusions.

Depressive Symptoms and Cognitive Decline Among Chinese Rural Elderly Individuals: A Longitudinal Study With 2-Year Follow-Up.

BackgroundDepressive symptoms and mild cognitive impairment (MCI) are highly prevalent in rural China. The study aimed to investigate the longitudinal associations between changes in depressive symptoms and cognitive decline and MCI incidence among Chinese rural elderly individuals.MethodsA 2-year follow-up study was conducted among 1,477 participants from the Anhui Healthy Longevity Survey (AHLS). Depressive symptoms were assessed by the 9-item Patient Health Questionnaire (PHQ-9), and cognitive status was evaluated by the Mini Mental State Examination (MMSE). Multivariable linear regression and logistic regression were employed.ResultsEvery 1-unit PHQ-9 score increase was significantly associated with more cognitive decline (β = 0.157, 95% CI: 0.092, 0.221, p < 0.001) and a higher risk of MCI incidence (OR = 1.063, 95% CI: 1.025, 1.103, p = 0.001). The participants who experienced worsening of depression symptoms had a larger decline in the 2-year MMSE score (β = 0.650, 95% CI: 0.039, 1.261, p = 0.037) and elevated risks of incident MCI (OR = 1.573, 95% CI: 1.113, 2.223, p = 0.010).LimitationsScreening tools rather than standard diagnostic procedures were used in the study. Moreover, the long-term associations still need further exploration since the follow-up time was short.ConclusionsIncreased depressive symptoms were associated with more cognitive decline and higher risks of incident MCI among Chinese rural residents.

Analysis on liver cancer mortality and cause eliminated life expectancy in key areas of 4 provinces, China, 2008-2018

Objective: To explore the changes of liver cancer mortality and the effect of liver cancer on life expectancy in key areas of four provinces in China from 2008 to 2018 and provide the basis for the evaluation of comprehensive prevention and control of cancer and promotion of the rational allocation of health resources. Methods: Based on the national cause-of-death surveillance in key areas of the 4 provinces from 2008 to 2018, we analyzed the mortality of liver cancer, cause eliminated life expectancy (CELE) and potential gains in life expectancy (PGLEs). Software Joinpoint 4.9.0.0 was used to calculate the average annual percentage change (AAPC). Arriaga's decomposition method was used to estimate the contribution of the changes of liver cancer mortality in each age group to life expectancy. Results: The standardized mortality of liver cancer in key areas of the 4 provinces showed a downward trend from 2008 to 2018 (AAPC=-4.37%, P<0.001). The changes of liver cancer mortality had a positive effect on the increase of life expectancy, with a contribution value of 0.240 years and a contribution degree of 5.62%. The positive effect was greatest in age group 45-49 years (0.041 years, 0.96%), and the negative effect was greatest in age group 50-54 years (-0.015 years, -0.35%). Compared with 2008, the life expectancy increased by 4.27 years (AAPC=0.59%, P<0.001), the liver cancer CELE increased by 4.20 years (AAPC=0.58%, P<0.001), the PGLEs decreased by 0.07 years (AAPC=-0.62%,P<0.001), and life loss rate decreased by 0.13% (AAPC=-1.18%, P=0.001). The liver cancer PGLEs increased in Yongqiao district, Anhui province (0.09 years), and decreased in other districts (counties), with the largest decline was in Fugou county, Henan province (-0.21 years). Conclusions: From 2008 to 2018, the standardized mortality rate of liver cancer in key areas of the 4 provinces decreased gradually, contributing to the growth of life expectancy. The life loss caused by liver cancer decreased gradually, but the PGLEs varied with districts (counties).

Impact of the Covid-19 pandemic on dental practices in Denmark

Objective To investigate the impact of the Covid-19 pandemic on the patient flow and economy as experienced by dental practices in Denmark. Material and methods A survey regarding experience of patient flow, economical turnover, financial strain and willingness to pay for large treatments during the first year of the Covid-19 pandemic (March 2020 to March 2021), along with information on the characteristics of the practice (specialist practice, ownership, practice operation and size) was distributed to all dental practices in Denmark in March 2021. Results Of the 1728 practices, 581 (33.6%) answered the survey. A decline in patient flow and a decline in economical turnover were reported by 79% and 84.4% of the practices, respectively. Financial strain was reported by 15.8% and an increased willingness to pay for large treatments was reported by 32.1%. A large decline in turnover and financial strain were associated with non-specialized practices, practices with a single owner and small practices. Logistic regressions showed that practices not receiving referrals had an odds ratio of 2.34 (CI: 1.32-4.14) for having a large decline in economic turnover compared with practices receiving referrals and that small practices had an odds ratio of 1.92 (CI: 1.16-3.19) for reporting financial strain compared with large practices. Conclusions Reportedly, the Covid-19 pandemic resulted in a decline in both patient flow and economical turnover in Danish dental practices. Large and more specialized practices seem to have managed the economic crisis better.

COVID-19 Pandemic vs. Pre-Pandemic Period: Changes in Hospital Admission Rates, Length of Stay, and In-Hospital Mortality of Common Neurologic Conditions

Background and Objective: COVID-19 pandemic caused massive adjustments to healthcare systems in the country. This study determined the change in hospital admission rates, length of hospital stay and in-hospital mortality of common (non-COVID related) neurologic conditions during the COVID-19 pandemic and pre-pandemic period. Methods: The study utilized a retrospective cross-sectional study of patients admitted under the Department of Neurology at Jose R. Reyes Memorial Medical Center from the period of March 2019 to March 2020 (pre-pandemic group), and April 2020 to April 2021 (COVID-19 pandemic). Admission rates, length of stay and in-hospital mortality were calculated for cerebrovascular diseases, CNS infections, CNS neoplasms and Seizure disorders. Results: There were 1090 admissions from April 2019 to March 2020 and 393 admissions from April 2020 to March 2021 with an over-all decline of 63%. During the pandemic, the duration of hospital stay was longer for CNS neoplasms. Duration of hospital stay for cerebrovascular disease, CNS infection, and seizure disorders were not significantly different. There was an increase in over-all in hospital mortality from 22.75% to 26.46% with significant increase in the case fatality rate of cerebrovascular diseases. Conclusion: We observed a large decline in the over-all admission rate and longer hospital stays. The over-all in-hospital mortality rate also increased during the pandemic period.

Effects of COVID-19 on China's civil aviation passenger transport market

COVID-19 has had an unprecedented impact on the civil aviation transportation sector. This study uses COVID-19 statistics and socioeconomic development data for various cities in China, combined with the Moran index and econometric models to analyse the spatial distribution of China's epidemic and civil aviation passenger throughput, as well as the impact of COVID-19 and socioeconomic factors on the civil aviation passenger transport market. We find that COVID-19 spread from Wuhan to the surrounding cities, showing a positive spatial autocorrelation; civil aviation passenger throughput decreased significantly in cities where the virus continued to spread and recurred frequently. Due to the effective prevention and control of the pandemic in China, the domestic passenger transport industry recovered rapidly, while international air passenger services continued to suffer; major cities with high social and economic development still show a large decline in passenger transport, but they are again undertaking most passenger transport services. COVID-19's impact on tourism has affected the civil aviation industry significantly, whose recovery depends on the tourism industry's recovery; this, in turn, is led by regions with a high degree of social and economic development.

Abstract 441: The impact of the COVID-19 on the screening of breast and cervical cancer in Korea

Abstract Background: The COVID-19 pandemic has affected use of healthcare services, especially disrupting individual participation in cancer screening programs. The National Cancer Screening Program (NCSP) of Korea provides screening services for six common cancers - stomach, liver, colorectum, breast, cervix, and lung. As complete national lockdown measures were not implemented, the NCSP continued operation during the three major COVID-19 waves in Korea, which allowed us to assess the changes in health-seeking behavior. We examined the cancer screening rates for breast and cervical cancers among NCSP participants in different geographic regions and by age group, in association with the COVID-19 pandemic. Methods: From the National Health Insurance Service database, we obtained information on the number of eligible population and NCSP participants from January 2019 to December 2020. The target group for biennial mammography screening is women aged 40 years and over, and that for biennial pap smear is women aged 20 years and over. We compared monthly screening rates for breast and cervical cancer between 2020 vs 2019 and described them as a percentage change. Results: The overall cancer screening rate has decreased in both cancers in 2020 compared with that of 2019: breast (55.8% vs 63.8%), cervical (52.2% vs 57.8%). Screening rates for both cancers declined in all age groups in March and December of 2020, which corresponds to the first and third COVID-19 wave. The month of March 2020 had the sharpest drop in screening rates, by 57.9% for breast cancer and 43.7% for cervical cancer compared with March 2019. In June 2020, screening rates for both cancers rebounded compared with 2019 (breast, +29.2%; cervical, +26.3%), which remained higher compared with the same months in 2019 until November 2020. By December 2020, screening rates for both cancers have dropped, compared with December 2019 (breast, -19.5%; cervical, -21.0%). For breast cancer, the screening rate decreased in all age groups, and the largest decline was observed in women aged 80 years and over. Although the cervical cancer screening rate has been steadily increasing since 2010, it decreased in all age groups in 2020 compared with that of 2019, with the exception of the 20-29 age group. Considering social distancing measures that were implemented nationwide during each COVID-19 wave, we observed a similar pattern of cancer screening rates in major cities. Conclusions: It was observed that after the two major COVID-19 waves, mammography and pap smear rates declined compared with that of 2019. The largest decline in cancer screening rates was seen in elderly women. The pattern of screening rate changes was comparable according to geographic region. In contrast to reports showing a deficit in cancer screening in other countries, our results suggest a substantial recovery in cancer screening in Korea. Additional analyses are needed to assess the effect of the 6-month extension of NCSP. Citation Format: Hyeree Park, Seung Hee Seo, Jong Heon Park, Bhumsuk Keam, Shin Hye Yoo, Aesun Shin. The impact of the COVID-19 on the screening of breast and cervical cancer in Korea [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 441.

Impact of the ‘Coal-to-Natural Gas’ Policy on Criteria Air Pollutants in Northern China

During the last decades, China had issued a series of stringent control measures, resulting in a large decline in air pollutant concentrations. To quantify the net change in air pollutant concentrations driven by emissions, we developed an approach of determining the closed interval of the deweathered percentage change (DPC) in the concentration of air pollutants on an annual scale, as well as the closed intervals of cumulative DPC in a year compared with that in the base year. Thus, the hourly mean mass concentrations of criteria air pollutants to determine their interannual variations and the closed intervals of their DPCs during the heating seasons from 2013 to 2019 in Qingdao (a coastal megacity) were analyzed. The seasonal mean SO2 concentration decreased from 2013 to 2019. The seasonal mean CO, NO2, and PM2.5 concentrations also generally decreased from 2013 to 2017, but increased unexpectedly in 2018 (from 0.9 mg m−3 (CO), 42 µg m−3 (NO2), and 51 µg m−3 (PM2.5) in 2017 to 1.1 mg m−3, 48 µg m−3, and 64 µg m−3 in 2018, respectively). The closed intervals of DPC in concentrations of CO, NO2, and PM2.5 from the 2017 heating season (2017/2018) to the 2018 heating season (2018/2019) were obtained at (27%, 30%), (15%, 18%), and (30%, 33%), respectively. Such high positive endpoint values of the closed intervals, in contrast to their small interval lengths, indicate increased emissions of these pollutants and/or their precursors in 2018/2019 compared with 2017/2018, by minimizing the meteorological influences. The rebounds of CO, NO2, and PM2.5 in 2018/2019 were likely associated with a doubled increase in natural gas (NG) consumption implemented by the “coal-to-NG” project, as the total energy consumption showed little difference. Our results suggested an important role of the “coal-to-NG” project in driving concentrations of air pollutant increases in China in 2018/2019, which need integrated assessments.

International Migration in the Russian Arctic: Scale, Structure and Influence of the Pandemic

The authors consider international migration in the Russian Arctic. The presence of a large-scale mining industry, a complex history of settlement and development, spatial and climatic features affect the migration processes in the Arctic. The study aims to assess the scale and structure of the international migration movement in the Arctic territories, as well as to identify changes caused by the COVID-19 coronavirus pandemic. The analysis is based on the results of population censuses, data from regional and municipal statistics, as well as information from digital databases on the incidence of coronavirus and migration. The article assesses the scale of international migration in the Arctic regions in the 20th – early 21st century. The genesis composition of the population showed that the significance of international migration is especially great for the Arctic territories in Western Siberia. The authors identified changes in the migration mobility of the population under the influence of the COVID-19 pandemic. An analysis of the age and sex composition of migrants and the main migration flows showed that by the end of 2020, the intensity of international migration in the Russian Arctic decreased insignificantly, and in the most remote parts it even increased. Municipal statistics made it possible to identify the most attractive destinations for international migration before and during the pandemic. In 2021, a larger decline in international migratory mobility can be expected. The results obtained can be used to conduct socio-demographic policy and build demographic forecasts for the Arctic territories. Future research should focus on examining the long-term effects of the pandemic on international migration.

Research and Application of Bottom Water Control and Suppression Technology by CO2 Huff-and-Puff

In order to solve the problems about rapid increasement rate of water cut and large production decline in bottom water heavy oil reservoir due to active bottom water and high crude oil viscosity, the research on CO2 huff-and-puff technology is carried out. The results showed that the mechanism of CO2 huff-and-puff was mainly to reduce the viscosity of heavy crude oil, carbonate reacted with bottom water and formed interlayer to achieve viscosity reduction and precipitation. The comprehensive water cut was decreased by 35%, and the average oil production of a single well was increased by 3∼4 times. Therefore, CO2 huff-and-puff technology was one of technologies about bottom water control and oil production stabilization, and it is of great significance to enhance oil production in heavy oil bottom water reservoirs.

An assessment of data accuracy and best practice recommendations for observations of lichens and other taxonomically difficult taxa on iNaturalist

We assess the identification accuracy of ‘research grade’ observations of lichens posted on the online platform iNaturalist. Our results show that these observations are frequently misidentified or lack the necessary chemical and (or) microscopic information for accurate identification. Lichens are a taxonomically difficult group, but they are ubiquitous and eye-catching and are regularly the subject of observations posted on iNaturalist. Therefore, we provide best practice recommendations for posting lichen observations and commenting on observations. Data from iNaturalist are a valuable tool for understanding and managing biodiversity, particularly at this crucial time when large scale biodiversity decline is occurring globally. However, the data must be accurate for them to effectively support biodiversity conservation efforts. Our recommendations are also applicable to other taxonomically difficult taxa.

Trajectories of glycemic control with clinical pharmacy specialist management of veterans with type 2 diabetes.

Improved control of glycemic control likely lowers the risk of diabetes complications and clinical pharmacy specialist (CPS) services can improve glycemic control. Though the pattern of control may also matter in terms of outcomes. The objective of this study was to examine the longitudinal trajectories of HbA1c among a large population of Veterans with type 2 diabetes who received CPS-led diabetes management. This is an observational, multicenter cohort study of Veterans with type-2 diabetes managed by CPSs between 7/1/2013 and 7/1/2017 with baseline glycosylated hemoglobin (HbA1c) level ≥8%. Two years of HbA1c measurements were used to group patients into distinct patterns of HbA1c trajectories over time using group-based trajectory modeling. Characteristics associated with successful HbA1c trajectories and association of assigned trajectories with all-cause and diabetes-related hospitalizations were analyzed using logistic regression. A total of 4119 Veterans were included and able to be successfully segmented into six distinct HbA1c trajectory groups over time: High Gradually Decreasing (n=325, 7.9%), Moderate Early Decline (n=1692, 41.1%), Large Early Decline (n=231, 5.6%), Uncontrolled Stable (n=1468, 35.6%), Early Decline/Subsequent Increase (n=266, 6.5%), and Very Uncontrolled Stable (n=137, 3.3%). The distinguishing factor between successful and less successful trajectories appears to be the progress made within the first six months of pharmacist management. Significant variability exists in the pattern of glycemic control over time of type 2 diabetes patients managed by clinical pharmacy specialists. Limited resources should be first prioritized to managing patients with very elevated HbA1c and into the first six months of CPS management.

Trends in incidence and mortality of brain cancer: An observational study of the Global Burden of Disease database from 1990 to 2019.

e18720 Background: Brain cancer is relatively rare accounting for approximately 1.3% of all cancer diagnoses in the US annually, however it has a particularly poor prognosis with 5-year survival at 33%. The morbidity and mortality associated with brain cancer is high, while global epidemiological data relating to it remains scarce. This study investigates brain cancer incidence, mortality and disability-adjusted life years (DALYs) in the EU 15+ countries and six WHO world regions. Methods: We extracted data for 19 countries, including the EU nations as well as other selected high-income countries including the UK and USA from the Global Burden of Disease (GBD) database. This data included age-standardized incidence ratio (ASIR), age-standardized mortality ratio (ASMR) and DALY from brain cancer (ICD 10 codes C70-C72, D42-D43.9, D44.3-D44.5) between 1990 and 2019. Joinpoint analyses were used to describe trends further. Results: Greece was noted to have the highest DALY for both sexes with 252/100,000 and 174/100,000 respectively for males and females. The majority of countries saw a drop in DALY during the study period (14/19 for males and 19/19 for females). Greece also reported the highest ASMR over the study period for both sexes at 7.8/100,000 and 5.3/100,000 respectively for males and females. The majority of countries also saw a decline in ASMR (12/19 for males and 16/19 for females) with Belgium noting the largest decline for males and females at -27.2% and -34.3% respectively. Denmark was noted to have the highest ASIR in 2019 for both sexes with 17.9/100,000 and 16.4/100,000 respectively for males and females. Most countries reported an increase in ASIR over the study period (17/19 for males and 15/19 for females). Denmark displayed the greatest increase in incidence for both sexes with an 84.5% and 64.3% increase, respectively, for males and females. Notably, the countries with the highest incidences and DALYs, Denmark, Luxembourg, and Greece, also had the highest mortality. All countries saw a decline in the mortality-to-incidence ratio over the study period, with Denmark and Ireland showing the greatest drop for both sexes. Conclusions: Over the study period, the burden of brain cancer has decreased in most countries as measured by DALY, ASMR, and mortality-to-incidence ratios. However, incidence rates have increased. The reduced disease burden may be due to the use of temazolamide which has improved outcomes in MGMT methylated and IDH mutated gliomas, with PCV chemotherapy with radiation therapy having similar effects for high risk low grade gliomas. The preferential use of bevacizumab may explain some of the differing trends between European and other developed countries. Future work is required to delineate the diverging trends between global disease burden and incidence while highlighting the etiology of these changes.