Mann-Kendall Trend Test Research Articles

Testing of UV fluorescence marking with daily recaptures of a low-mobile bush-cricket species

The primary goal of developing new mark–release–recapture (MRR) methods is to make MMR more cost-effective and able to provide more information. To test the effectiveness of UV fluorescence marking, a case study was carried out on an Isophya costata population occurring in a mown grassland with a heterogeneous vegetation pattern. The marked individuals were examined daily, from the emergence of imagos until the mowing of the habitat. The 40 marked insects (20 males and 20 females) were recaptured in 206 cases over 16 days (32.2% of the potential maximal recaptures). The finding of males was 26.2% successful, and the finding of females was 38.1% successful. Females released in shorter and sparse vegetation were recaptured more than those released in dense vegetation or than males. Recaptures showed a significant decrease during the study period in almost all groups based on Mann–Kendall trend tests. Detections were made on the upper third of the vertical structure of the vegetation in 88% of cases. In most of the detections (males: 70%, females: 62%), the axis of the insect’s body was more likely to be located vertically. The results showed that the chance of detection is significantly reduced when the position of the insect’s body is facing the axis of UV illumination. Thus, the visibility of individuals can be greatly increased by marking all sides of the body.

Shifting cold regions streamflow regimes in North America affect flood frequency analysis

ABSTRACT Over threshold flood events in seventy years of data from 202 reference hydrometric stations in Canada and the United States were separated into nival, mixed, and pluvial flood types. While Mann-Kendall trend tests showed few significant trends in flood magnitude, significant changes in flood type fraction were found over time, with annual mean temperature, and with annual precipitation. Nival events decreased in frequency over the seventy-year period in 16% of sites, while mixed and pluvial events increased (5%, 12%). These changes indicate a shift from nival events towards more pluvial dominated systems. Fewer significant changes in flood type fraction were found with analysis against four climate indices. Flood frequency analysis using a combined distribution approach with the three flood types resulted in larger magnitude design flow estimates (median increase of 20 – 30 %) in comparison with the results from considering the data to be a single population.

Establishing Climate Change on Rainfall Trend, Variation and Change Point Pattern in Umuahia, Nigeria

This study investigates the prevailing conditions of changing climatic trends and change point dates in Umuahia, Nigeria, using daily annual maximum series (AMS) rainfall data spanning 31 years. The Indian Meteorological Department (IMD) was employed to downscale the time series data into durations ranging from 5 minutes to 24 hours. Mann-Kendall (MK) trend and Sen's Slope Estimator (SSE) tests revealed a statistically significant increasing trend across all durations. The Sen's Slope magnitude ranged from 0.1373 mm/year for 5-minute duration to 0.9045 mm/year for 24-hour duration, corresponding to a variation rate of 9.05 mm/decade for the 24-hour duration. Trend change-point analysis, utilizing Distribution-free CUSUM and Sequential Mann-Kendall tests, identified 2002 as the initial rainfall change-point date. These results provide robust evidence of positive changing climatic conditions for rainfall in Umuahia, indicating that non-stationary Intensity-Duration-Frequency (IDF) modelling may be more appropriate for flood risk management and urban planning in this area.

Impact of climatic trends on the water demand and irrigation planning for annual crops in the São Francisco River basin, Brazil

This study evaluated the spatial distribution of precipitation (P) and Peman-Monteith reference ET (ETo) in Brazil's São Francisco River basin (1961–2022). The analysis included Mann-Kendall trend tests and future IPCC projections on P and ETo to assess the need for supplemental irrigation (SI) of maize crop over twelve hypothetical growing seasons. The average annual P in the basin was 1300 mm year−1, decreasing from the Upper to the Lower section. Annual ETo averaged 1670 mm year−1, with higher depths in the Middle and Lower-middle sections. Trends for both P and ETo were significant(p < 0.05) in 58% of the basin. The overall trend magnitude in P was positive (average of about 0.5 mm year−2). Trend was decreasing in 56% of the sites (3.2 mm year−2) and increasing in 44% of them (5.3 mm year−2). For ETo, the overall trend was also positive (average of 3.0 mm year−2), with increasing trend in 79% of the sites (4.6 mm year−2) and a decreasing trend of 3.8 mm year−2 in 21% of the area. The need of SI varied both over the year with peaks in the May–August period and over the basin with higher depths in the Middle and Lower-middle sections. Large SI values (>800 mm) were associated with the dry season and areas with persistent trends in decreasing P and increasing ETo. Future IPCC projections indicate increased SI depths in most of the basin by 2081–2100, with the Middle and Lower-middle sections facing potentially unsustainable level for crop production.

Analysis of Diurnal Air Temperature Trends and Pattern Similarities in Highland and Lowland Stations of Italy and UK

ABSTRACTIn this study, an analysis of hourly air temperatures in four groups of 32 stations from the UK highland (5 stations), UK lowland (4 stations), Italian highland (11 stations), and Italian lowland (12 stations) at different altitudes was carried out over the period from 2002 to 2021. The study aimed to examine the trends of each hour of the day during this period, over different averaging time windows (10‐day, 30‐day, and 60‐day). The trends were computed using the Mann–Kendall trend test and Sen's slope estimator. The similarity of trends within and across the groups of stations was assessed using the hierarchical clustering with dynamic time warping technique. An additional analysis was conducted to show the correlation of trends among the group of stations using the correlation distance matrix. Hierarchical clustering and distance correlation analysis show trend similarities and correlations, also indicating dissimilarities among different groups. Using 30‐day averages, significant warming trends in specific months at the Italian stations are evident, especially in February, July, August, and December. The UK highland stations did not show statistically significant trends, but clear pattern similarities were found within the groups, especially in certain months. The ultimate goal of this article is to provide insights into temperature dynamics and climate change characteristics on regional and diurnal scales.

Aerosol loading in the guinea coast climate region of Nigeria: comparison of MODIS and AERONET data sources

This study compares aerosol optical depth (AOD) measurements from satellite data with that from a ground-based station. It aims at validating monthly AOD data from the Moderate Resolution Imaging Spectroradiometer (MODIS) Deep Blue (DB) collection 6.1 (Aqua and Terra) at 550 nm against AOD data from the Aerosol Robotic Network (AERONET) station at 500 nm in Ilorin over the period 2003–2022. The analysis focuses on eight selected cities/locations within the Guinea Coast region of Nigeria. Descriptive and inferential statistical methods, including correlation, regression, standard deviation, coefficient of variation, the Mann–Kendall trend test, root mean square error (RMSE), mean absolute error (MAE), and relative mean bias (RMB), were employed. The results indicate a positive correlation in most locations, with correlation values ranging from 0.3 to 0.7. The correlation between the datasets in Ilorin showed a positive and significant relationship while the other seven locations presented a weak and insignificant relationship. Additionally, the period from 2013–2022 showed better correlation compared to 2003–2012. AOD levels were highest during the harmattan season (DJF), exceeding 0.8, and lowest during the monsoon (JJA) and post-monsoon (SON) seasons, with values below 0.5, reflecting the effects of wet scavenging. The highest agreement between MODIS Aqua and AERONET data was observed during the harmattan season. The study also found that MODIS tends to overestimate AOD compared to AERONET and that MODIS-AOD exhibits greater spread and variability than AERONET-AOD.

Efficacy of a burn prevention educational program to diminish the incidence of burn injuries in the pediatric population

BackgroundPediatric burn injuries are a significant public health issue in low- and middle-income countries, leading to substantial morbidity and mortality. This study aimed to evaluate the efficacy of the No+Quema2 educational program, implemented in Aguascalientes, Mexico, in preventing burn injuries among children under nine years old. MethodsThe No+Quema2 program, initiated in 2014, included educational courses for children, training for health workers, and specialized care for children with burn sequelae. Epidemiological data on burn injuries from 2014 to 2022 were retrieved from the National System of Epidemiological Surveillance of the Health Ministry of Mexico. Monthly incidence rates per 100,000 inhabitants were analyzed using the Mann-Kendall trend test and segmentation analysis to detect trends and changes. ResultsThe program trained over 25,000 scholars from 1750 elementary schools and distributed medical kits for immediate burn care. Additionally, 200 children with burn sequelae received scheduled treatment. The analysis showed a significant decrease in the state incidence rate of burn injuries compared to the national mean post-implementation. The estimated number of burn injuries prevented during the study period was approximately 3839, or 604 per year. ConclusionThe No+Quema2 program has made a significant impact on burn prevention among children in Aguascalientes, Mexico. Despite the limitations of relying on government-reported data, the correlation between the program's activities and the observed decrease in burn injuries is promising. These findings underscore the critical importance of the No+Quema2 program's activities in achieving sustained, targeted educational interventions and long-term reductions in burn injury incidence. They also highlight the need for more robust study designs to validate these outcomes, emphasizing the importance of evidence-based strategies in future burn prevention efforts.

Variability of seasonal temperature from 1990 to 2020 within Oum Er Rbia hydraulic basin (Morocco): Study of trends and anomalies

Abstract The fifth report of the Intergovernmental Panel on Climate Change (IPCC) indicates that global temperatures have increased during the 20th century. In Morocco, numerous studies have unveiled that the nation has been contending with the effects of global warming for several decades, attributed to its geographical location. The studies have mainly focused on the evolution of rainfall and the recurrence of droughts. Nevertheless, temperature variations remain less addressed, especially at large spatial scales. This paper aims to study the seasonal temperature variability in the large hydraulic basin of Oum Er Rbia, focusing on its anomalies and trends as well as identifying their impacts on the basin’s territory. Indeed, the large basin of Oum Er Rbia occupies more than 48,.000 km2 and is characterized by an arid to semi-arid climate. Its water resources are important and play an essential role in the country’s socio-economic development. This basin is well-known for its agricultural activity. Although its water and economic potential are significant, the great basin is considered vulnerable to climatic variations, which strongly condition its development. Considering the significance of temperature trends within the framework of global warming, this current study delves into the topic of seasonal temperature variability within the expansive hydraulic basin of Oum Er Rbia. Based on statistical analysis using the temperature anomaly index and the Mann-Kendall trend test, this study reveals that strong interannual variability marked the evolution of seasonal temperatures during the period of 1990-2020, with a remarkable upward trend during the autumn and spring. When the temperature increase, the temperature increases in turn: thus, the negative impacts affect both water resources and the agriculture sector, which suffers from the combined effect of increased evapotranspiration and reduction of irrigation water.

Fentanyl, Heroin, Methamphetamine, and Cocaine Analyte Concentrations in Urine Drug Testing Specimens

The US is experiencing a protracted drug overdose crisis primarily associated with exposure to illicitly manufactured fentanyl (IMF), methamphetamine, and cocaine. Overdose risk and treatment responses may be directly affected by absolute drug exposure concentrations and drug use prevalence. To quantify changes in absolute drug exposure concentrations from 2013 to 2023. This cross-sectional study analyzed urine drug testing (UDT) results from urine specimens collected between January 1, 2013, and August 22, 2023, in 49 states and the District of Columbia. Urine specimens were obtained from patients aged 18 years or older who presented to substance use disorder treatment clinics. The UDT was ordered by clinicians based on medical necessity. Urine specimens were analyzed for the following drugs or metabolites (analytes tested in parentheses): fentanyl (fentanyl), heroin (6-monoacetylmorphine), cocaine (benzoylecgonine), and methamphetamine (methamphetamine) using liquid chromatography with tandem mass spectrometry. Relative concentrations of fentanyl, heroin, cocaine, and methamphetamine. Creatinine-normalized drug concentration values were log-transformed prior to visualization and statistical analyses. The Mann-Kendall trend test was performed to examine trends over time. To estimate the geospatial and temporal patterns of drug concentration, a second series of models (1 for each drug) with an interaction effect for clinic location and collection year were fit. A total of 921 931 unique UDT samples were collected from patients (549 042 males [59.6%]; median [IQR] age, 34 [27-44] years). The adjusted fentanyl concentration in urine specimens was 38.23 (95% CI, 35.93-40.67) ng/mg creatinine in 2023 and 4.61 (95% CI, 3.59-5.91) ng/mg creatinine in 2013. The adjusted methamphetamine concentration was 3461.59 (95% CI, 3271.88-3662.30) ng/mg creatinine in 2023 and 665.27 (95% CI, 608.51-727.32) ng/mg creatinine in 2013. The adjusted cocaine concentration was 1122.23 (95% CI, 1032.41-1219.87) ng/mg creatinine in 2023 and 559.71 (95% CI, 524.69-597.06) ng/mg creatinine in 2013. The adjusted heroin concentration was 58.36 (95% CI, 48.26-70.58) ng/mg creatinine in 2023 and 146.59 (95% CI, 136.06-157.92) ng/mg creatinine in 2013. Drug concentrations varied across US Census divisions. This cross-sectional study found that absolute concentrations of fentanyl, methamphetamine, and cocaine in urine specimens increased from 2013 to 2023, with a decrease in heroin concentration during that period. The findings suggest that exposure to these substances, as well as the illicit drug supply, has fundamentally changed in many parts of the US, highlighting the need to reinforce surveillance initiatives and accelerate efforts to treat individuals with IMF and/or stimulant exposure.

Spatiotemporal climate variability and food security implications in the Central Ethiopia Region

Studies focusing on the spatiotemporal distribution of climatic parameters and meteorological drought are of paramount significance for countries like Ethiopia, where climate change and variability cause major losses to rain-dependent agriculture. In this study, the National Meteorology Institute of Ethiopia provided an Enhanced National Climate Services (ENACTS) dataset at a spatial resolution of approximately 4 km by 4 km over 38 years (1981–2018) was used to study climate trends, spatiotemporal variability, and meteorological drought in the Central Ethiopia Region. Coefficient of variation (CV), Standardized Rainfall Anomaly (SRA), Standardized Precipitation Index (SPI), Mann-Kendall trend test, and Sen's slope were used for the analysis. The findings suggest that Belg rainfall (also known as "small-rain") varied greatly in space and time over the study area, with area-averaged CV of 29 % and pixel-level CVs ranging from 63 to 93 %. The average precipitation during Belg experienced a 15 % decrease from 2000 to 2019 compared to the preceding two decades, from 1981 to 1999. The maximum temperature has increased significantly during the Annual, Belg, and Bega seasons. The SPI and SRA showed that there have been multiple drought episodes with rising negative rainfall anomalies, with a drought occurring every 2.9 years during the Kiremt (also called "big rain", spanning from June to September) and Belg seasons. The growing negative rainfall anomaly, high CV, and highly significant increase in mean maximum temperature during the Belg season is concerning for food security and poverty eradication. The notable rise in rainfall during the June (sowing period) and November (harvesting period) also hurts crop production during the main cropping season. Thus, developing appropriate adaptation strategies and policies oriented toward climate-resilient agriculture is crucial to meet the global sustainable development goals (SDGs) and Africa Union's Agenda 2063.

The Analysis of NPP Changes under Different Climatic Zones and under Different Land Use Types in Henan Province, 2001–2020

Net Primary Productivity (NPP) is a crucial indicator of ecological environment quality. To better understand the carbon absorption and carbon cycling capabilities of Henan Province, this study investigates the trends and driving factors of NPP across different climatic zones and land use types. The Theil–Sen Median trend analysis method and the Mann–Kendall trend test are employed to monitor NPP changes from 2001 to 2020. The average annual NPP in Henan Province during this period was 414.61 gC·m−2·year−1, showing a significant increasing trend with a growth rate of 3.73 gC·m−2·year−1. Spatially, both the annual average NPP and its increase rate were higher in the western part of Henan compared to the eastern part, and NPP variability was more stable in the southern region than in the northern region. By classifying climatic zones and using the Geodetector method to assess NPP sensitivity to natural factors, the results show that climate and vegetation factors jointly influence NPP variations, with annual precipitation being the primary natural factor affecting NPP trends in Henan Province from 2001 to 2020. By analyzing the NPP gain and loss matrix, the impact of land use changes on NPP was evaluated. Forests had the highest average annual NPP at 483.52 gC·m−2·year−1, and the conversion of arable land to urban areas was identified as the primary land change type leading to NPP reductions. In the subtropical zone of Henan, forests, croplands, and grasslands exhibited higher NPP values and increase rates compared to those in the warm belt. This study provides new insights into the spatial variation of NPP caused by changes in climatic zones and land use types.

Emerging trends and demographic disparities in anal cancer mortality across the United States census regions: An analysis of National Center for Health Statistics mortality data.

Anal cancer, despite its rarity, is a matter of serious concern in the United States, with an uptrend in recent years and marked racial disparities in mortality rates. The aim of this work was to investigate anal cancer mortality trends and sex race disparities in the United States from 1999 to 2020. This is a retrospective study using data from the CDC WONDER database (1999-2020). We investigated deaths attributed to anal cancer, identified by the ICD-10 code C21.1, and excluded individuals aged 14 years and under. The Mann-Kendall trend test was used to investigate temporal trends and a t-test was used to compare continuous variables. Both male and female age-adjusted mortality attributed to anal cancer increased significantly during the study period across all subgroups, including race (Black and White), US Census region (Northeast, Midwest, South and West) and age (15-64 and ≥65 years) (p < 0.001 for all comparisons). For each subgroup, women demonstrated significantly higher rates of mortality than men, except in the Black population, where Black men had higher rates than Black women (0.40 vs. 0.29, p < 0.001). Additionally, Black men had significantly higher mean mortality rates than White men (0.40 vs. 0.27, p < 0.001). The highest rates of anal cancer mortality were among geriatric individuals, especially women aged ≥65 years, at 1.18 per 100 000. The rise in anal cancer mortality and racial and sex disparities present a significant challenge for healthcare providers and policy makers. Further studies are required to devise evidence-based strategies to effectively tackle this challenge.

Response of remote sensing-based climatic indicators to drought conditions during El Niño events and implications for water–food–energy nexus

ABSTRACT Hydrometeorological extremes, such as droughts, are a major threat to society and can have extensive damaging effects. In this study, daily rainfall estimates from the Climate Hazards Group InfraRed Precipitation with Stations (CHIRPS) quasi-global rainfall dataset were used to calculate the Standardised Precipitation Index (SPI) for the assessment of meteorological drought in Southern Province, Zambia. Normalised Difference Vegetation Index (NDVI) imagery (250 m resolution) from MODIS-Terra, for the period 2000–2021, were used to derive the Standardised Vegetation Index (SVI) in order to assess agricultural drought. The Mann–Kendall trend test and Sen's slope were used to determine the spatial-temporal trends and their magnitudes. This study demonstrated that the droughts of the Southern Province of Zambia can be classified into two categories: regressive and aggressive droughts. Regressive droughts are associated with moderate to strong El Niño events. Although El Niño events undermine water security, regressive droughts tend to result in resilient vegetation owing to residue soil moisture. In contrast, aggressive droughts are characterised by an increase in drought intensity as the season progresses. Water security prospects in the region should focus on climate-smart approaches, such as managed aquifer recharge, to ensure water availability even under extreme drought conditions.

Characteristics and outcomes of home parenteral nutrition among children with severe neurological impairment.

To describe the characteristics, secular trends, and outcomes of home parenteral nutrition (HPN) use among children with severe neurological impairment (SNI) and non-primary digestive disorders from 2010 to 2023 and compare outcomes to children with primary digestive disorders on HPN. A retrospective review of all children with SNI and non-primary digestive disorders, where HPN was initiated between January 2010 and September 2023 at a tertiary care pediatric hospital. The Mann-Kendall trend test was used to assess trends in HPN initiation. We compared acute care service utilization in the year prior and following HPN initiation. Mortality and ability to achieve enteral autonomy outcomes were compared to those of children with HPN and primary digestive disorders. Of the 205 included children with HPN, 18 children had SNI and non-primary digestive disorders, 187 children had primary digestive disorders. There was an increase in HPN initiation among children with SNI and non-primary digestive disorders (p = 0.002) between 2010 and 2020. Among children with SNI and non-primary digestive disorders, HPN-related complications (line-associated infection/thrombus, nephrolithiasis, cholelithiasis) occurred in 72%. There was no change in acute care utilization in the year prior versus year following HPN initiation. Compared with the primary digestive disorders group, children with SNI and non-primary digestive disorders were less likely to achieve enteral autonomy (p < 0.0001); however, no significant differences in mortality were observed (22% vs. 8%, p = 0.09). HPN is increasingly being used among SNI children with non-primary digestive disorders. Compared to children with primary digestive disorders on HPN, those with SNI are less likely to achieve enteral autonomy.

Change and coincidence risk analysis of floods in the Mahanadi River Basin, India

ABSTRACT Coincidence flood risk due to the simultaneous flood occurrences on both mainstream and its tributary results in downstream inundation of a confluence. Therefore, this study was taken up for coincidence flood risk analysis of Mahanadi River basin considering the annual maximum (AM) and the peak over threshold (POT) series. In this study, the Mann–Kendall trend test was performed to analyze the trend in flood magnitudes, while circular statistics was used to analyze the persistence in flood timing. The joint distributions between the streams were established using bivariate copula functions considering flood magnitudes and occurrence dates as variables. The results of MK test revealed a mixture of significant and insignificant trends for AM series for the selected stations, while the trends were insignificant for POT series. Additionally, the flood occurrence dates showed a high level of persistence. It is evident from the results that the coincidence risk is high for Seorinarayan–Bamnidhi confluence point with a risk value of 7.63 × 10−3. The coincidence risk increases mostly from late July to mid-September, and the coincidence risk is high for more frequently occurring flood events. The obtained results will help in prioritizing flood hazard zones for effective flood mitigation strategies in Mahanadi River basin.

Evolution characteristics and attribution analysis of runoff in the coal mining area in northwest China: A case study of the Kuye River Basin

ABSTRACT The Kuye River Basin is the main coal-producing area in northwest China, and it is also a typical arid and semi-arid area. Under the combined influence of climate change and human activities, the runoff of the basin decreases noticeably. The Mann–Kendall trend test, the Hurst index, cumulative anomaly, and wavelet analysis were used to analyze the runoff evolution characteristics of the Kuye River, and the contributions of climate change and human activities to the runoff reduction were quantitatively separated by the slope-changing ratio of the cumulative quantity. The results showed that the runoff decreased significantly from 1970 to 2020, and there was an obvious abrupt change in 1996, while the change trends in precipitation and evaporation were not significant. The contributions of climate change and human activities to runoff reduction were 22.71 and 77.29%, respectively, and human activities have become the dominant factor in runoff variations. Coal mining and the implementation of soil and water conservation measures are considered to be the main human activities contributing to the reduction in runoff. In particular, mining activities reduce groundwater recharge to rivers, which provides a profound understanding of the effect of human activities in mining areas on runoff variation.

Climatic and non-climatic factors driving the livelihood vulnerability of smallholder farmers in Ahafo Ano North District, Ghana

Smallholder farmers in Ahafo Ano North District, Ghana, face multiple climatic and non-climatic issues. This study assessed the factors contributing to the livelihood vulnerability of smallholder farmers in this district by household surveys with 200 respondents and focus group discussions (FGDs) with 10 respondents. The Mann–Kendall trend test was used to assess mean annual rainfall and temperature trends from 2002 to 2022. The relative importance index (RII) value was used to rank the climatic and non-climatic factors perceived by respondents. The socioeconomic characteristics affecting smallholder farmers’ perceptions of climatic and non-climatic factors were evaluated by the binary logistic regression model. Results showed that mean annual rainfall decreased (P>0.05) but mean annual temperature significantly increased (P<0.05) from 2002 to 2022 in the district. The key climatic factors perceived by smallholder farmers were extreme heat or increasing temperature (RII=0.498), erratic rainfall (RII=0.485), and increased windstorms (RII=0.475). The critical non-climatic factors were high cost of farm inputs (RII=0.485), high cost of healthcare (RII=0.435), and poor condition of roads to farms (RII=0.415). Smallholder farmers’ perceptions of climatic and non-climatic factors were significantly affected by their socioeconomic characteristics (P<0.05). This study concluded that these factors negatively impact the livelihoods and well-being of smallholder farmers and socioeconomic characteristics influence their perceptions of these factors. Therefore, to enhance the resilience of smallholder farmers to climate change, it is necessary to adopt a comprehensive and context-specific approach that accounts for climatic and non-climatic factors.

See one, do one, teach one - Trends in resident autonomy and teaching assistant cases during general surgery residency in the United States: A nationwide retrospective analysis

IntroductionAutonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce. MethodsA retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume. ResultsBetween 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 ​% increase; τ ​= ​0.610, p ​= ​0.001). There was a concurrent 72.7 ​% increase in TA cases from a median of 22–38 (τ ​= ​0.574, p ​= ​0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017.The uptrend in TA cases was associated with the significant increase in colorectal (τ ​= ​0.559, p ​= ​0.001), general surgery-other (τ ​= ​0.404, p ​= ​0.018), and hepatopancreaticobiliary (HPB) (τ ​= ​0.596, p ​= ​0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ ​= ​0.956, p=<0.001), HPB (τ ​= ​0.713, p=<0.001) and colorectal (τ ​= ​0.522, p ​= ​0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ ​= ​−0.485, p ​= ​0.006) and vascular surgery (τ ​= ​0.603, p ​= ​0.001) dropped significantly.The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 ​%) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023. ConclusionsOver the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.

Trends and Outcomes in Elective Pediatric Surgery During Weekends

PurposeLimited operating room availability constrains hospital scheduling capacity for elective surgical cases. Leveraging weekends for elective surgical cases could increase operative capacity but must be balanced with practical considerations. Our study aimed to characterize trends and outcomes for elective pediatric surgeries performed during weekends. MethodsThis retrospective cohort study used the Pediatric Health Information System database from 2016 to 2019 to identify surgeries in children <18 years of age from 38 hospitals. Six elective surgeries, commonly performed on the weekend, were selected for analysis. Trends in elective surgeries during weekends (Saturday or Sunday) were evaluated using the Mann-Kendall trend test. Multivariable regression models were used to compare complications and costs between weekend and weekday surgeries. ResultsOf the 233,266 elective surgeries evaluated, 357 (0.15%) were performed during weekend hours. The proportion of surgeries performed on weekends was stable over time (p = 0.65). Following adjustment for clinicodemographic and hospital-level factors, no differences were observed when comparing weekend to weekday surgeries in terms of surgical complications [adjusted Odds Ratio: 1.59; 95% Confidence Interval (CI): 0.65–3.90; p = 0.32] or mortality (n = 1 in cohort). Weekend surgeries were associated a small additional cost compared to weekday surgeries (β-coefficient $312; 95% CI: $152 to $473; p < 0.01). ConclusionElective pediatric surgeries performed during weekends were uncommon, stable in occurrence, and not associated with substantial increases in complications or costs compared to weekday surgeries. Increasing surgical capacity by extending into weekend scheduling merits further assessment of patient and provider satisfaction, unexpected human resource costs, and thoughtful case selection to ensure patient safety. Level of EvidenceIII. Type of StudyRetrospective Cohort Study.

Impact of lung allocation policy change on Hispanic lung transplant outcomes: Addressing disparities and improving access

ObjectiveRacial disparities in organ allocation may result in differential survival for marginalized groups. This study aims to examine the impact of the November 2017 lung allocation policy change (LAPC) on trends and outcomes of Hispanic lung transplant (LT) recipients. MethodsThe United Network for Organ Sharing database was used to identify adult (older than age 18 years) LT recipients between January 2010 and March 2023. Recipients were categorized into 3 self-identified racial groups (Hispanic, non-Hispanic White, and non-Hispanic other). The Mann-Kendall trend test was used to assess the trend in rates of Hispanic LT over 5 years pre- and 5 years post-LAPC. The primary outcome was 1-year mortality. ResultsA total of 28,495 recipients from 80 centers were included, with 15,343 (53.8%) prepolicy change and 13,152 (46.2%) postpolicy change. The racial distribution of LT recipients was pre-LAPC: Hispanic: 1013 (6.6%), White: 12,601 (82.1%), Other: 1729 (11.3%) and post-LAPC: Hispanic: 1522 (11.6%), White: 9873 (75.0%), Other: 1757 (13.4%) (P < .001). Between 2013 and 2017, the proportion of Hispanic LT recipients increased from 6.0% to 7.6% (P = .221). Post-LAPC, the proportion increased from 8.5% in 2018 to 14.4% in 2022 (P < .027). Unadjusted 1-year survival rates were pre-LAPC: Hispanic: 88.8%, White: 87.6%, Other: 86.8% (log-rank P = .260) and post-LAPC: Hispanic: 90.6%, White: 88.2%, Other: 86.1% (log-rank P < .001). ConclusionsThe LAPC has led to increased access to LT and improved 1-year survival rates among Hispanic patients. However, efforts should continue to address disparities among other racial groups and ensure equitable outcomes for all recipients of LT.