Non-parametric Trend Test Research Articles

A Comprehensive Assessment of Climate Change and Anthropogenic Effects on Surface Water Resources in the Lake Urmia Basin, Iran

In recent decades, the depletion of surface water resources within the Lake Urmia Basin (LUB), Iran, has emerged as a significant environmental concern. Both anthropogenic activities and climate change have influenced the availability and distribution of surface water resources in this area. This research endeavors to provide a comprehensive evaluation of the impacts of climate change and anthropogenic activities on surface water resources across the LUB. Various critical climatic and anthropogenic factors affecting surface water bodies, such as air temperature (AT), cropland (CL), potential evapotranspiration (PET), snow cover, precipitation, built-up areas, and groundwater salinity, were analyzed from 2000 to 2021 using the Google Earth Engine (GEE) cloud platform. The JRC-Global surface water mapping layers V1.4, with a spatial resolution of 30 m, were employed to monitor surface water patterns. Additionally, the Mann–Kendall (MK) non-parametric trend test was utilized to identify statistically significant trends in the time series data. The results reveal negative correlations of −0.56, −0.89, −0.09, −0.99, and −0.79 between AT, CL, snow cover, built-up areas, and groundwater salinity with surface water resources, respectively. Conversely, positive correlations of 0.07 and 0.12 were observed between precipitation and PET and surface water resources, respectively. Notably, the findings indicate that approximately 40% of the surface water bodies in the LUB have remained permanent over the past four decades. However, there has been a loss of around 30% of permanent water resources, transitioning into seasonal water bodies, which now account for nearly 13% of the total. The results of our research also indicate that December and January are the months with the most water presence over the LUB from 1984 to 2021. This is because these months align with winter in the LUB, during which there is no water consumption for the agriculture sector. The driest months in the study area are August, September, and October, with the presence of water almost at zero percent. These months coincide with the summer and autumn seasons in the study area. In summary, the results underscore the significant impact of human activities on surface water resources compared to climatic variables.

Spatio-Temporal Trend Analysis of Annual and Seasonal Rainfall in Ho Chi Minh City

Spatio-temporal variations and trends in climatic variables play an essential role in the adaptation and mitigation of climate change policy. This study analyzed spatial and temporal variability of annual and seasonal rainfall in Ho Chi Minh City based on non-parametric statistical trend tests and spatial interpolation techniques. In particular, Sen’s Slope Estimator and Inverse Distance Weighting (IDW) methods were applied to construct the spatial distribution of annual and seasonal rainfall over the city. The outcomes show that annual and seasonal rainfall experienced significant increasing trends. Generally, these findings draw out an overall picture of rainfall variability in terms of space and time, which makes it possible for local decision-makers to promote more promising action plans in order to respond to natural disasters in the context of climate change.

Vision Screenings and Ophthalmology Referrals Among a Sample of Pediatricians in Florida.

Introduction In Florida, mandated school vision screenings begin around the age of five.However, a joint statement in the ophthalmology community recommends that primary care providers, including pediatricians, screen for eye and vision symptoms and signs starting at birth. This suggests that pediatricians may be the first to catch signs of early vision loss and refer pediatric patients to an ophthalmologist. This study aims to understand the current vision screening practices of a sample of pediatricians in Florida and how comfort levels with vision screenings may impact ophthalmology referrals. Methods A survey with 36 questions was created by the authors of the study and sent to pediatricians through digital newsletters to the Florida Chapter of the American Academy of Pediatrics and pediatric departments at Florida universities. Descriptive statistics were gathered regarding the demographics of pediatricians surveyed, vision screening attitudes and practices, vision concerns and ophthalmology referrals from pediatric clinics, and the most common reasons for referral to an ophthalmologist. The Jonckheere-Terpstra nonparametric trend test was used to examine whether decreased comfort performing vision screening on a child was associated with lower rates of urgent referrals to an optometrist or ophthalmologist. Results Forty-six responses were collected. Seventy-eight percent of pediatricians reported performing early childhood vision screening (n=36). There was considerable variability in vision screening practices among the pediatricians studied, with only 66% beginning screenings from zero to twoyears of age (n=24). Fifty percent of respondents reported receiving no previous training on performing vision screening, and less than half of respondents reported feeling "somewhat comfortable" or "extremely comfortable" with performing the exam (n=22, 48%).The trend between decreased comfort performing pediatric vision screening and lower rates of urgent eye care referrals was approaching statistical significance (p=0.0705).The majority of urgent referrals were provided by respondents who were somewhat or extremely comfortable with screening (n=13, 65%). Conclusion From this sample of pediatricians in Florida, most respondents reported performing early childhood vision screening, but there was notable variability in the way screenings were performed among pediatricians. Moreover,many had never received training on performing the exam or did not feel comfortable performing them. Decreased comfort with vision screenings was almost significantly associated with decreased urgent referrals to an ophthalmologist.Future studies should examine whether increased training on vision screenings may help improve standardizationof screening practices among pediatrics and comfort with vision screenings.

Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes

Objectives Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue. Methods This retrospective, multi-center analysis encompassed all 9-1-1 responses from 8 accredited EMS systems between 1/1/2021 and 06/30/2023, utilizing the Medical Priority Dispatch System (MPDS). Independent variables included MPDS Protocol numbers and Determinant levels. EMS treatments and ED diagnoses/dispositions were categorized as time-critical using a multi-round consensus survey. The primary outcome was the proportion of EMS responses categorized as time-critical. A non-parametric test for trend was used to assess the proportion of time-critical responses Determinant levels. Based on group consensus, Protocol/Determinant level combinations with at least 120 responses (∼1 per week) were further categorized as safe to hold in queue (<1% time-critical intervention by EMS and <5% time-critical ED outcome) or unsafe to hold in queue (>10% time-critical intervention by EMS or >10% time-critical ED outcome). Results Of 1,715,612 EMS incidents, 6% (109,250) involved a time-critical EMS intervention. Among EMS transports with linked outcome data (543,883), 12% had time-critical ED outcomes. The proportion of time-critical EMS interventions increased with Determinant level (OMEGA: 1%, ECHO: 38%, p-trend < 0.01) as did time-critical ED outcomes (OMEGA: 3%, ECHO: 31%, p-trend < 0.01). Of 162 unique Protocols/Determinants with at least 120 uses, 30 met criteria for safe to hold in queue, accounting for 8% (142,067) of incidents. Meanwhile, 72 Protocols/Determinants met criteria for unsafe to hold, accounting for 52% (883,683) of incidents. Seven of 32 ALPHA level Protocols and 3/17 OMEGA level Protocols met the proposed criteria for unsafe to hold in queue. Conclusions In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.

A pilot study of implementing an adapted model for integration of interventions for people with alcohol use disorders in Tanzanian primary healthcare facilities

BackgroundEnsuring that evidence-based interventions for people with alcohol use disorders (AUD) are acceptable, effective, and feasible in different socio-cultural and health system contexts is essential. We previously adapted a model of integration of AUD interventions for the Tanzanian primary healthcare system. This pilot study aimed to assess the impact on AUD detection and the acceptability and feasibility of the facility-based components of this model from the perspective of healthcare providers (HCPs).MethodsThis mixed-methods study comprised a pre-post quasi-experimental study and a qualitative study. The integrated model included training HCPs in managing AUD, introducing systematic screening for AUD, documentation of AUD service utilization, and supportive supervision. We collected information on the number of people identified for AUD three months before and after piloting the service model. A non-parametric trend test, a distribution-free cumulative sum test, was used to identify a change in the identification rate of AUD beyond that observed due to secular trends or, by chance, three months before and after implementing the integrated AUD facility-based interventions. The Mann-Kendal test was used to assess the statistical significance of the trend. We conducted three focus group discussions exploring the experience of HCPs and their perspectives on facilitators, barriers, and strategies to overcome them. The focus group discussions were analyzed using thematic analysis.ResultsDuring the pre-implementation phase of the facility-based interventions of the adapted AUD model, HCPs assessed 322 people for AUD over three months, ranging from a minimum of 99 to a maximum of 122 per month. Of these, 77 were identified as having AUD. Moreover, HCPs screened 2058 people for AUD during implementation; a minimum of 528 to a maximum of 843 people were screened for AUD per month for the three months. Of these, 514 screened positive for AUD (AUDIT ≥ 8). However, this change in screening for AUD was not statistically significant (p-value = 0.06). HCPs reported that knowledge and skills from the training helped them identify and support people they would not usually consider having problematic alcohol use. Perceived barriers to implementation included insufficient health personnel compared to needs and inconvenient health management information systems. HCPs proposed strategies to overcome these factors and recommended multisectoral engagement beyond the health system.ConclusionsAlthough the change in the trend in the number of people screened for AUD by HCPs post-implementation was not statistically significant, it is still feasible to implement the facility-based components of the adapted integrated AUD model while addressing the identified bottlenecks and strategies for implementation. Therefore, a large-scale, adequately powered implementation feasibility study is needed. Findings from this study will be used to finalize the adapted model for integrating AUD interventions for future implementation and larger-scale evaluation.

Historical trends and future projections of annual rainfall from CMIP6 models in Ho Chi Minh City, Vietnam

Climate risks have posed a major threat to many local communities living in low-lying coastal megacities across the globe, including Ho Chi Minh City, Vietnam. Hence, this study first aimed to contribute towards a comprehensive understanding of temporal trend patterns of annual rainfall and absolute extremes in Ho Chi Minh City over the last 4 decades (1980-2022) through multiple non-parametric statistical trend tests. We employed the quantile delta mapping (QDM) method to develop daily bias-corrected rainfall data based on the outputs in the latest Coupled Model Intercomparison Project phase 6 (CMIP6) under 8 shared socio-economic pathway (SSP) greenhouse gas emission scenarios. Evaluation of model performance was implemented by repeatedly omitting 5 successive years in turn for estimating testing errors. The outcomes indicate the high applicability of well-calibrated transfer functions, even for high quantiles, to the production of future rainfall scenarios. The projected changes in annual rainfall and absolute extremes were obtained by estimating multi-model medians from CMIP6 models for future periods (i.e. 2021-2040, 2041-2060, 2061-2080, and 2081-2100), with reference to the base period (1995-2014). In general, annual rainfall in Ho Chi Minh City is projected to increase substantially, and Thu Duc station consistently shows the highest increases in annual rainfall. Projected changes are approximately 30.9% (8.3 to 77.8%) under the high-end scenario (i.e. SSP5-8.5) by the end of the 21st century. It is expected that these findings will yield several solid arguments for mitigating climate-related risks in Ho Chi Minh City.

A Comparison of the Rank-based and Slope-based Nonparametric Tests for Trend Detection in Climate Time Series

Trend detection in climate time series data is crucial for understanding climate change, predicting future climate patterns, assessing impacts, managing resources, and formulating policies. Several trend detection methods have been introduced in the literature, including parametric and non-parametric approaches. Nonparametric trend detection methods are often considered more preferable than parametric methods in certain situations due to their flexibility and robustness. Comparing various nonparametric methods of trend detection is vital in data analysis because different techniques can yield divergent results based on the same dataset. In this study, three nonparametric trend tests which were the MannKendall (MK), Sen’s Innovative Trend Analysis (ITA) and Modified Mann-Kendall by Sen’s Innovative Trend Analysis (MMK_ITA) were compared based on their power. The MK test is a rank-based test and the ITA is a slope-based test. Meanwhile, the combination of rank-based and slope-based methods is known as the MMK_ITA test. The power analysis was conducted through Monte Carlo simulation on normal, non-normal and autocorrelated time series. The simulation results indicated that test power relied on magnitude of linear trend slope, sample sizes, distribution type and variation in time series. These tests were then applied to monthly maximum temperature from 2002 until 2021 for Selangor, Malaysia. This study found that the slope-based test performed better compared to the rank-based test and their combined methods from the simulation studies and real data application based on the calculated power.

Statistical Analysis of Thirty-Year Rainfall Variability in Udaipur District, Rajasthan, India

The rainfall variability for the Udaipur district for thirty years (1991–2020) was statistically analysed in this study. The linear regression (parametric) and Mann–Kendall (non-parametric) trend test along with precipitation indices performed using rainfall data collected from 9 rain gauge stations situated in different parts of the Udaipur district, Rajasthan, India. An increasing trend was found between the months March to November in the Udaipur district, indicating that total annual rainfall has increased in these months during the study period. About 85.20% of the total annual rainfall is occurred due to the southwest monsoon during the rainy season. The PCI (21.74 to 57.92) and CV (11.04 to 21.23) values show the high-nonuniformity and less rainfall variability, respectively. The SRA values for each year have been greater than -0.84 (no drought category) during the study period. The rainfall deficiency took place only four out of 30 years of the study period, 1995, 1999, 2000, and 2002, which fall under the category of large deficiency. The values of the wetness index indicate that during the study period,2006 was the wettest year due to the maximum rainfall (Wi = 179.07) while 2000 was the driest year due to the minimum rainfall (Wi = 54.26). Total annual rainfall has increased in the last three decades, which shows the need for implementation of all necessary plans by the government for proper rainwater utilization and management to prevent future natural disasters like floods.

Reply to Comment on “Five Decades of Observed Daily Precipitation Reveal Longer and More Variable Drought Events Across Much of the Western United States”

AbstractPaciorek and Wehner raise important questions around our use of the Mann‐Kendall nonparametric trend test on smoothed data for analyzing long‐term hydrometeorological trends in Zhang et al. (2021, https://doi.org/10.1029/2020gl092293). We thank them for initiating this important conversation and their gracious cooperation in exploring the issues addressed in their comment. In this reply we confirm the inflation of significant p‐values by our choice to smooth, illustrate the relatively minor impacts on the main conclusions of our paper, and add our voices to those of Paciorek and Wehner in highlighting the lack of methodology for hypothesis testing across multiple stations that have spatial structure (i.e., testing for regionally consistent trends).

The Outcome of Antibiotic Overuse before and during the COVID-19 Pandemic in a Tertiary Care Hospital in Oman.

Antimicrobial resistance (AMR), a serious global public health challenge, may have accelerated development during the COVID-19 pandemic because antibiotics were prescribed for COVID-19. This study aimed to assess antibiotics use before and during the pandemic and correlate the results with the rate of resistant microorganisms detected in hospitalized patients during the study period. This single-center study looked retrospectively at four years of data (2018-2021) from Royal Hospital, Muscat, which is the biggest hospital in Oman with approximately 60,000 hospital admissions yearly. The consumption rate of ceftriaxone, piperacillin tazobactam, meropenem, and vancomycin was presented as the antibiotic consumption index, the ratio of defined daily dose (DDD) per 100 bed days. Analyses were performed using the nonparametric test for trend across the study period. Correlation between antibiotic consumption indexes and the isolated microorganisms in the four-year study period was performed using Spearman's rank correlation coefficient. We compared data from the pre-COVID-19 to the COVID-19 period. Though more patients were admitted pre-COVID-19 (132,828 versus 119,191 during COVID-19), more antibiotics were consumed during the pandemic (7350 versus 7915); vancomycin and ceftriaxone had higher consumption during than before the pandemic (p-values 0.001 and 0.036, respectively). Vancomycin-resistant Enterococcus (VRE) and Candida auris were detected more during the COVID-19 period with p-values of 0.026 and 0.004, respectively. Carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococcus spp., and C. auris were detected more often during the pandemic with p-values of 0.011, 0.002, and 0.03, respectively. Significant positive correlations between antibiotic consumption and drug-resistant isolates were noted. This study confirms that the overuse of antibiotics triggers the development of bacterial resistance; our results emphasize the importance of antibiotic control.

Effect of industrialization on the differences in sources and composition of ambient PM2.5 in two Southern Ontario locations

PM2.5 was sampled over a seven-year period (2013–2019) at two locations ∼50 km apart in Southern Ontario (concurrently for five years: 2015–2019). One is a heavily industrialized site (Hamilton), while the other was a rural site (Simcoe). To assess the impact of industrialization on the composition and sources of PM affecting air quality in these two locations, positive matrix factorization coupled with dispersion normalization (DN-PMF) was used to identify six and eight factors at Simcoe and Hamilton, respectively. The Simcoe factors in order of diminishing PM mass contribution were: particulate sulphate (pSO4), secondary organic aerosol (SOA), crustal matter, particulate nitrate (pNO3), biomass burning, and vehicular emissions. At Hamilton, the effects of industrialization were observed by the ∼36% higher average ambient PM2.5 concentration for the study period as well as the presence of factors unique to metallurgy, i.e., coking and steelmaking, compared to Simcoe. The coking and steelmaking factors contributed ∼15% to the PM mass at Hamilton. Seasonal variants of appropriate nonparametric trend tests with the associated slopes (Sen's) were used to assess statistically significant changes in the factor contributions to PM2.5 over time. Specifically at Hamilton, a significant decline in PM contributions was noted for coking (−0.03 μg/m³/yr or −4.1%/yr) while steelmaking showed no statistically significant decline over the study period. Other factors at Hamilton that showed statistically significant declines over the study period were: pSO4 (−0.27 μg/m³/yr or −12.6%/yr), biomass burning (−0.05 μg/m³/yr or −9.02%/yr), crustal matter (−0.03 μg/m³/yr or −5.28%/yr). These factors mainly accounted for the significant decline in PM2.5 over the study period (−0.35 μg/m³/yr or −4.24%/yr). This work shows the importance of long-term monitoring in assessing the unique contributions and temporal changes of industrialization on air quality in Ontario and similarly affected locations.

Global soil moisture trend analysis using microwave remote sensing data and an automated polynomial-based algorithm

The change in Soil Moisture Content (SMC) is one of the most crucial variables for regulating and analyzing basic hydrological processes, including runoff, evaporation, carbon and energy cycles, infiltration of water resources, droughts and floods, and desertification. This study aimed to detect and map the global SMC change using microwave remote sensing observations. Monthly SMC data from the Soil Moisture Ocean Salinity (SMOS) with a spatial resolution of 25 km were used to assess the SMC change from January 2010 to December 2021. Various trend patterns, including linear, quadratic, cubic, and concealed, were examined by applying a parametric polynomial fitting-based algorithm (Polytrend). In particular, approximately 16.93% of global land is subjected to soil moisture dynamics, of which 8.33% has become drier and 8.60% has become wetter. Both linear and nonlinear trends were observed in the global land areas that have experienced statistically significant changes. The concealed and linear trends were however the dominant trend patterns globally. The obtained trend results were further investigated using a well-known non-parametric trend test, Mann-Kendall, which showed 93.20% agreement, demonstrating the robustness and reliability of the observed trends.

Trends in Economic Burden and Mortality of Hospitalized Patients With Aortic Stenosis in Thailand

This study aimed to assess the temporal trends in aortic stenosis (AS)-related hospitalizations, in-hospital mortality, and economic burden in Thailand. The study cohort was derived from the electronic claim system of the National Health Security Office, which serves as a reimbursement database for all Thai beneficiaries under the Universal Health Coverage Scheme, covering ∼70% of the entire population. Hospitalization, mortality, and costs were estimated by year, with the primary diagnosis for AS-related hospitalizations identified using code I350. The Cochrane Armitage test was used to examine trends in AS-related hospitalization and in-hospital mortality, whereas a nonparametric trend test was used to analyze the trend of hospitalization costs. Of the 8-year period, 10,406 adults were admitted with a primary diagnosis of AS. AS-related hospitalizations increased from 1,274 in 2015 to 1,945 in 2022 (p = 0.251), with the most significant observed in the age group 60 to 79 years (p <0.001). In-hospital mortality increased from 4.8% to 6.1%. Hospitalization cost significantly increased from $2,879 to $3,443 (p <0.001), with an average length of stay of 6.6 ± 9.2 days. The trend of patients admitted with primary diagnosis of AS in Thailand has significantly increased in the age group 60 to 79 years. In-hospital admission is found at older age and is likely to have high mortality rate. The increased hospitalization cost may impose a substantial economic burden on the Thai health care system.

Disease awareness and knowledge of stroke- and atrial fibrillation risk factors in cardiovascular patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020-SC1-BHC-30-2019- 847770 Background Disease awareness is key for the uptake of preventive measures and positively affects self-management of atrial fibrillation patients (AF pat) or those at increased risk of AF. Less evidence exists about pat subjective risk awareness. We aims to identify the predictors of incorrect subjective risk estimation to guide future information of AF pat and stakeholders. Method In a prospective cardiology practice cohort (N=1200; age= 59.6 years; 34.4% women) with a median FU of 2.7 years we assessed the subjective estimation of: 1) the risk of stroke and AF in pat with an increased risk of AF (N=292) and 2) the stroke risk of AF pat (N=447). We used a 4-point Likert scale to measure the subjective risk estimation and matched the results with established risk scores and classified pat as "over", "under" and "correct" estimators. For non-AF cases we calculated the risk of incident AF using the CHARGE-AF- and the risk of stroke using a revised Framingham risk score to predict the 10-year probability of stroke. In AF pat we assessed their self-estimated risk of stroke compared to the CHA2DS2-VASc Score. We performed univariable association analyses of risk factors for over- or underestimation for stroke and AF with reference to correct estimators at baseline and FU and performed non-parametric tests for trend. Results At baseline N=52 AF pat, 10.6% and N=53 non-AF pat, 17.6% indicated that they are not able to estimate their stroke risk. This also applied for N=97 non-AF pat, 27.8% who were unable to estimate their AF risk. AF pat who underestimated their stroke risk were: significantly older (65.2 vs 59.8 years; p &amp;lt;.001), less frequently men (33.3% vs 44.4 %; p=0.023), had lower body weight (85.3 kg vs 82.5 kg p=0.023), fewer previous strokes (15.1% vs 8.3% p= 0.002) and had a higher chronic disease burden such as diabetes, hypertension, heart failure and coronary heart disease compared to AF pat with correct estimation. Non-AF cases at baseline estimated their AF risk (score value (vs): 1.0 vs 1.5; r= 0.216; p &amp;lt; 0.001) and the stroke risk (sv: 1.3 vs 1.9; r=0.263; p &amp;gt;.001) significantly higher than their current risk to develop the disease. AF risk estimation (sv: 1.2 vs 1.3; r=.216; p =098) and the stroke risk estimation (sv: 1.5 vs 1.4; r=0.035; p=0,458) were comparable to the score assessments in the FU for non-AF cases. AF pat estimated their stroke risk significantly higher than their current risk (sv: 1.0 vs 1.3; r= 0.125; p&amp;lt;.001). The same was observed during FU (score value 1.0 vs 1.3; r= 0.105; p&amp;lt;.001). Conclusions More than 10% of pat were unable to give an estimate of their risk due to lack of disease and risk factor knowledge. The minority correctly estimated their risk to develop AF and/or a stroke. Half of the pat overestimated their risk profile. The study identifies predictors related to the awareness and knowledge of the diseases and highlight the need for more explicit educational programs to improve AF awareness.

Dietary vitamin D intake and the bladder cancer risk: A pooled analysis of prospective cohort studies

Diet may play an essential role in the aetiology of bladder cancer (BC). Vitamin D is involved in various biological functions which have the potential to prevent BC development. Besides, vitamin D also influences the uptake of calcium and phosphorus, thereby possibly indirectly influencing the risk of BC. The aim of the present study was to investigate the relation between vitamin D intake and BC risk. Individual dietary data were pooled from ten cohort studies. Food item intake was converted to daily intakes of vitamin D, calcium and phosphorus. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs) were obtained using Cox-regression models. Analyses were adjusted for gender, age and smoking status (Model 1), and additionally for the food groups fruit, vegetables and meat (Model 2). Dose-response relationships (Model 1) were examined using a nonparametric test for trend. In total, 1994 cases and 518,002 non-cases were included in the analyses. The present study showed no significant associations between individual nutrient intake and BC risk. A significant decreased BC risk was observed for high vitamin D intake with moderate calcium and low phosphorus intake (Model 2: HRhigh vitD, mod Ca, low P: 0.77, 95% CI: 0.59-1.00). No significant dose-response analyses were observed. The present study showed a decreased BC risk for high dietary vitamin D intake in combination with low calcium intake and moderate phosphorus intake. The study highlights the importance of examining the effect of a nutrient in combination with complementary nutrients for risk assessment. Future research should focus on nutrients in a wider context and in nutritional patterns.

Are the Regional Precipitation and Temperature Series Correlated? Case Study from Dobrogea, Romania

In the context of climate change, this article tries to answer the question of whether a correlation exists between the precipitation and temperature series at a regional scale in Dobrogea, Romania. Six sets of time series are used for this aim, each of them containing ten series—precipitation and temperatures—recorded at the same period at the same hydro-meteorological stations. The existence of a monotonic trend was first assessed for each individual series. Then, the Regional time series (RTS) (one for a set of series) were built and the Mann–Kendall test was employed to test the existence of a monotonic trend for RTSs. In an affirmative case, Sen’s method was employed to determine the slope of the linear trend. Finally, nonparametric trend tests were utilized to verify if there was a correlation between the six RTSs. This study resulted in the fact that the only RTS presenting an increasing trend was that of minimum temperatures, and there was a weak correlation between the RTS of minimum precipitations and maximum temperatures.

New Normal in ITCZ and Its Role in Altering Agroclimatic Suitability for Rice Production

Intertropical Convergence Zone (ITCZ) primarily governs the convective rainfall potential of the summer monsoon in Asia. In the present study, non-parametric trend test with outgoing longwave radiation (OLR) for the summer monsoon period for the last 42 years (1980–2021) have been analyzed for ITCZ zone, representative zones of Hadley circulation and Walker circulation for exploring trend of the deep convection activity. Besides, various climatic variables like temperature (maximum, minimum, mean), precipitation, and cloud cover dataset are used for exploring trend in major rice growing regions of the world. The results indicate that there is a significantly decreasing trend of OLR in ITCZ zone during summer monsoon season. Contrarily, major rice growing regions of the world have witnessed a significantly increasing trend for the temperature parameter among all the zones. Rainfall and cloud cover have shown a typical trend i.e., increasing rainfall but decreasing cloud cover in the Southeast Asian and Maritime Continent rice growing regions. In rice suitable climate assessment, it has been found that the Maritime Continent rice growing region, the Indo-Gangetic Plain and the Southeast Asian rice growing regions have witnessed better rice suitable climates than other rice growing regions during the last 42 years (1980–2021).

Spatio-temporal analysis of climate and irrigated vegetation cover changes and their role in lake water level depletion using a pixel-based approach and canonical correlation analysis

Lake Urmia, located in northwest Iran, was among the world's largest hypersaline lakes but has now experienced a 7 m decrease in water level, from 1278 m to 1271 over 1996 to 2019. There is doubt as to whether the pixel-based analysis (PBA) approach's answer to the lake's drying is a natural process or a result of human intervention. Here, a non-parametric Mann-Kendall trend test was applied to a 21-year record (2000−2020) of satellite data products, i.e., temperature, precipitation, snow cover, and irrigated vegetation cover (IVC). The Google Earth Engine (GEE) cloud-computing platform utilized over 10 sub-basins in three provinces surrounding Lake Urmia to obtain and calculate pixel-based monthly and seasonal scales for the products. Canonical correlation analysis was employed in order to understand the correlation between variables and lake water level (LWL). The trend analysis results show significant increases in temperature (from 1 to 2 °C during 2000–2020) over May–September, i.e., in 87 %–25 % of the basin. However, precipitation has seen an insignificant decrease (from 3 to 9 mm during 2000–2019) in the rainy months (April and May). Snow cover has also decreased and, when compared with precipitation, shows a change in precipitation patterns from snow to rain. IVC has increased significantly in all sub-basins, especially the southern parts of the lake, with the West province making the largest contribution to the development of IVC. According to the PBA, this analysis underpins the very high contribution of IVC to the drying of the lake in more detail, although the contribution of climate change in this matter is also apparent. The development of IVC leads to increased water consumption through evapotranspiration and excess evaporation caused by the storage of water for irrigation. Due to the decreased runoff caused by consumption exceeding the basin's capacity, the lake cannot be fed sufficiently.

Emergency medical services clinicians in the United States are increasingly exposed to death.

Exposure to patient death places healthcare workers at increased risk for burnout and traumatic stress, yet limited data exist exploring exposure to death among emergency medical services (EMS) clinicians. Our objective was to describe changes in EMS encounters involving on-scene death from 2018 to 2021. We retrospectively analyzed deidentified EMS records for 9-1-1 responses from the ESO Data Collaborative from 2018 to 2021. We identified cases where patient dispositions of death on scene, with or without attempted resuscitation, and without EMS transport. A non-parametric test of trend was used to assess for monotonic increase in agency-level encounters involving on-scene death and the proportion of EMS clinicians exposed to ≥1 on-scene death. We analyzed records from 1109 EMS agencies. These agencies responded to 4,286,976 calls in 2018, 5,097,920 calls in 2019, 4,939,651 calls in 2020, and 5,347,340 calls in 2021.The total number of encounters with death on scene rose from 49,802 in 2018 to 60,542 in 2019 to 76,535 in 2020 and 80,388 in 2021. Agency-level annual counts of encounters involving death on scene rose from a median of 14 (interquartile range [IQR], 4-40) in 2018 to 2023 (IQR, 6-63) in 2021 (P-trend < 0.001). In 2018, 56% of EMS clinicians responded to a call with death on scene, and this number rose to 63% of EMS clinicians in 2021 (P-trend < 0.001). From 2018 to 2021, EMS clinicians were increasingly exposed to death. This trend may be driven by COVID-19 and its effects on the healthcare system and reinforces the need for evidence-based death notification training to support EMS clinicians.

Procedures of brain death diagnosis and organ explantation in a tertiary medical centre - a retrospective eight-year cohort study.

To assess the frequency and variables associated with the need for ancillary tests to confirm suspected brain death in adult patients, and to assess the time from brain death to organ explantation in donors. We further sought to identify modifiable factors influencing the time between brain death and start of surgery. Medical records and the Swiss organ allocation system registry were screened for all consecutive adult patients diagnosed with brain death at an intensive care unit of a Swiss tertiary medical centre from 2013 to 2020. The frequency and variables associated with the performance of ancillary tests (i.e., transcranial doppler, digital subtraction angiography, and computed tomography angiography) to confirm brain death were primary outcomes; the time from death to organ explantation as well as modifying factors were defined as secondary outcomes. Among 91 patients with a diagnosis of brain death, 15 were not explanted and did not undergo further ancillary tests. Of the remaining 76 patients, who became organ donors after brain death, ancillary tests were performed in 24%, most frequently in patients with hypoxic-ischaemic encephalopathy. The leading presumed causes of death (not mutually exclusive) were haemorrhagic strokes (49%), hypoxic-ischaemic encephalopathies (33%) and severe traumatic brain injuries (22%). Surgery for organ explantation was started within a median of 16 hours (interquartile range [IQR] 13-18) after death with delay increasing over time (nonparametric test for trend p = 0.05), mainly due to organ allocation procedures. Patients with brain death confirmed during night shifts were explanted earlier (during night shifts 14.3 hours, IQR 11.8-16.8 vs 16.3 hours, IQR 13.5-18.5 during day shifts; p = 0.05). Ancillary tests to confirm brain death are frequently performed, mainly in resuscitated patients. The delay to surgery for organ explantation after confirmed brain death was longer during day shifts, increased over time and was mainly determined by organ allocation procedures.