Non-parametric Trend Test Research Articles

Characterization of Groundwater Chemistry and Fluoride in Groundwater Quality Monitoring Network of Korea

This study presents the data analysis results of groundwater chemistry and the occurrence of fluoride in groundwater obtained from the groundwater quality monitoring network of Korea. The groundwater data were collected from the National Groundwater Information Center and censored for erratic values and charge balance (±10%). From the geochemical graphs and various ionic ratios, it was observed that the Ca-HCO3 type was predominant in Korean groundwater. In addition, water-rock interaction was identified as a key chemical process controlling groundwater chemistry, while precipitation and evaporation were found to be less important. According to a non-parametric trend test, at p=0.05, the concentration of fluoride in groundwater did not increase significantly and only 4.3% of the total groundwater exceeded the Korean drinking water standard of 1.5 mg/L. However, student t-tests revealed that the fluoride concentrations were closely associated with the lithologies of tuff, granite porphyry, and metamorphic rocks showing distinctively high levels. This study enhances our understanding of groundwater chemical composition and major controlling factors of fluoride occurrence and distribution in Korean groundwater.

No Change in the Use of Antivenom in Copperhead Snakebites in Ohio.

Historically, copperhead snake (Agkistrodon contortrix) envenomations were not treated with antivenom owing to related adverse events and little benefit. However, recent studies have shown improved outcomes with antivenom use. We hypothesized that the frequency of antivenom use for copperhead envenomation in Ohio has increased as benefits of administration became more widely known. All copperhead snakebites reported to the Ohio poison control centers from 2006 through 2016 were compiled. Antivenom use, bite severity, and disposition were abstracted. A nonparametric test for trend was used to evaluate changes over time for the number of patients treated with antivenom and patient disposition. Logistic regression was used to assess the odds of admission vs discharge with antivenom administration, bite severity, age, and sex as independent variables. Ninety-eight patients reported copperhead snakebites to the poison control centers. The test of trend showed no change in the proportion of patients treated with antivenom by year (P=0.42). There was no difference in the proportion of patients discharged home (P=0.38) per year. Logistic regression showed antivenom use was associated with an odds ratio for admission of 46.7 (95% CI: 7.3-296.4). The frequency of antivenom use for copperhead bites did not significantly increase between 2006 and 2016. Administration of antivenom was associated with a large increase in the odds of admission to the hospital, even when controlling for bite severity. Further education regarding the benefits and safety of antivenom may increase its use for copperhead snakebites, but may lead to an increase in hospital admissions.

Comparing recruitment strategies to engage hard-to-reach men who have sex with men living with HIV with unsuppressed viral loads in four US cities: Results from HPTN 078.

IntroductionThere is an urgent need to identify men who have sex with men (MSM) living with HIV with unsuppressed viral loads to prevent transmission. Though respondent‐driven sampling (RDS) is traditionally used for hard‐to‐reach populations, we compare how RDS and direct recruitment (DR) perform in identifying MSM living with HIV with unsuppressed viral loads and identifying MSM with socio‐demographics characteristic of hard‐to‐reach populations.MethodsThis is a cross‐sectional analysis among 1305 MSM who were recruited from March 2016 to December 2017 for a case management intervention trial (HPTN 078). We recruited participants across four cities using RDS and DR methods: Birmingham, AL; Atlanta, GA; Baltimore, MD; and Boston, MA. Participants completed a socio‐demographic questionnaire and underwent HIV testing. We compare the proportion of MSM with HIV and unsuppressed viral loads (HIV RNA ≥ 1000 copies/ml) based on recruitment method using Pearson chi‐square tests. We also compare differences in race, income, healthcare coverage, education, sexual orientation, hidden sexuality and comfort with participating in the LGBT community between recruitment methods and perform non‐parametric trend tests to see how demographics change across RDS recruitment waves.ResultsRDS recruited 721 men (55.2%) and DR yielded 584 men (44.8%). Overall, 69% were living with HIV, of whom 18% were not virally suppressed. HIV prevalence was higher among those recruited via DR (84%) compared to RDS (58%), p < 0.0001. Twenty per cent of DR recruits were not virally suppressed compared to 15% of RDS, though this was not significant. DR yielded a significantly higher proportion of Black participants and those with less than a high school diploma. The prevalence of low income, no healthcare coverage, bisexuality and hidden sexuality increased across RDS waves.ConclusionsDR was more efficient in identifying MSM living with HIV with unsuppressed viral loads; however, there was a higher proportion of hard‐to‐reach MSM who were low income, lacked health coverage, were bisexual and were not open with their sexuality in deeper waves of RDS. Researchers should consider supplementing RDS recruitment with DR efforts if aiming to identify MSM with unsuppressed viral loads via RDS.

An assessment of the construct validity of the Child Health Utility 9D-CHN instrument in school-aged children: evidence from a Chinese trial

BackgroundAlthough there is emerging data regarding the psychometric properties of the Child Health Utility-9D instrument, more evidence is required with respect to its validity for use in different country settings. The aim of this study was to examine the construct validity of the CHU-9D-CHN instrument in Chinese children.MethodsBaseline Health-Related Quality of Life (HRQoL) and demographic data were collected from children recruited to the CHIRPY DRAGON obesity prevention intervention randomised controlled trial in China. HRQoL was measured using the Chinese version of the CHU-9D instrument (CHU-9D-CHN) and the PedsQL instrument. CHU-9D-CHN utility scores were generated using two scoring algorithms [UK and Chinese tariffs]. Discriminant validity, known-group validity and convergent validity were evaluated using non-parametric test for trend, Kruskal–Wallis test and Spearman correlation coefficient analysis respectively.ResultsData was available for 1,539 children (mean age 6 years). The CHU-9D-CHN was sensitive to known group differences determined by the median PedsQL total score. Furthermore, the mean CHU-9D-CHN utility values decreased linearly with increasing levels of severity on each dimension of the PedsQL for emotional and social functioning domains. They decreased monotonically with increasing levels of severity on each dimension of the PedsQL for physical and school functioning domains (p < 0.001). Contrary to studies conducted in Western countries, and although not statistically significant, we found an indication that HRQoL, using both the CHU-9D-CHN and the PedsQL, was higher in children whose parents had lower levels of education, compared to those whose parents were university educated. The correlation between the CHU-9D-CHN utility values using UK and Chinese tariffs, and PedsQL total scores showed a statistically significant moderate positive correlation (Spearman’s rho = 0.5221, p < 0.001 and Spearman’s rho = 0.5316, p < 0.001), respectively. However, each CHU-9D-CHN dimension was either weakly, or very weakly correlated with each of the predetermined PedsQL domain functioning scores.ConclusionsOverall, the findings provide some support for the construct validity of the CHU-9D-CHN within a Chinese population aged 6–7 years. However, some uncertainty remains. We recommend future studies continue to test the validity of the CHU-9D in different country settings.Trial registration: ISRCTN Identifier ISRCTN11867516, Registered on 19/08/2015

AGE-SPECIFIC BLASTULATION RATES IN EMBRYO CRYOPRESERVATION CYCLES YIELDING A CRYOPRESERVED BLASTOCYST

AGE-SPECIFIC BLASTULATION RATES IN EMBRYO CRYOPRESERVATION CYCLES YIELDING A CRYOPRESERVED BLASTOCYST

Rate of RhD-alloimmunization after the transfusion of multiple RhD-positive primary red blood cell-containing products.

Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products transfused. RhD-negative patients between 13 and 50 years who were transfused with ≥1 RhD-positive red blood cell (RBC) or whole blood units between January 1, 2000 and December 31, 2019 in a healthcare network were identified. Study patients had to have had at least one antibody detection test performed ≥14 days after the index RhD-positive transfusion and not receive RhIg. Patients were stratified into groups that received 1, 2, 3-5, 6-10, 11-20, and >20 RhD-positive transfusions and the RhD-alloimmunization rate was determined for each group. There were 335 patients included; 52/335 (15.5%) were females. Overall, there were 117/335 (34.9%, CI: 29.8%-40.3%) recipients who became RhD-alloimmunized. There was no significant dosage effect in the RhD-alloimmunization rates as the exposure to RhD-positive units increased from one RhD-positive unit to more than 20 RhD-positive units (p= .270 for non-parametric trend test). In an exploratory analysis, patients who received 100% of their RhD-positive transfusions within 72 h of the index transfusion had a significantly higher rate of RhD-alloimmunization compared to those who were transfused over a longer period of time (42.3% vs. 21.4%, respectively; p= .001). These results suggest that there may not be an increased RhD-alloimmunization risk with transfusing multiple RhD-positive units after one RhD-positive unit has been transfused. These findings need confirmation in larger studies.

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A simple climate change assessment is carried out on annual air temperatures including average, maximum and minimum temperatures in Rendani, Manokwari for the period of 1993-2019. Parametric linear regression and nonparametric Mann-Kendall trend test (MK), Modified Mann-Kendall (MMK), Sen's Slope Estimator (SSE)are used to analyze trends and index numbers for analyzing the temperature changes. Homogenity test is performed using double mass curve and assumption of normality in the distribution is also investigated to meet the requirements of the linear regression trend test. There as a significant upward trend in the mean and minimum temperature with a slope of 0.029ºC/year and 0.069ºC/year, respectively. Meanwhile, the maximum temperature test shows no trend with a slope of 0.009ºC/year. Analysis of temperature changes using index numbers shows an increase in annual average temperature of 2.8% or 0.7°C, maximum temperature of 1.2% or 0.4°C, and minimum temperature of 3.1% or 0.8°C. The increase in annual air temperature in Manokwari City can generally be caused by several factors such as El Nino phenomenon, urbanization, population growth, and deforestation.

The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study.

To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG). Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used. Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival. Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.

Nonoverlapping Block Stratified Random Sampling Approach for Assessment of Stationarity

Assessment of stationarity in any hydroclimatic time series is a vital task for hydrologic design and climate change assessments. Methods that rely on the presence of statistically significant trends or change points to derive inferences about stationarity may fail to check for all the time-invariant characteristics of time series. An approach that uses nonoverlapping stratified random sampling blocks of time series and nonparametric tests is proposed and evaluated in this study to assess stationarity. Chronologically continuous data from contiguous blocks are evaluated using two-sample and multisample nonparametric tests for the assessment of distributional, median and variance similarity, invariance of statistical moments, and autocorrelation at several lags. Explicit methods for the evaluation of different characteristics of time series are also developed to assess the two forms (viz., weak and strict) of stationarity. The multiple test evaluations are weighted using the analytical hierarchy process (AHP) to draw conclusions about stationarity. The proposed approach is tested using several real-world and synthetically generated hydroclimatic data sets through extensive simulations. Stationarity assessments derived from nonparametric trend and unit root tests have been compared to those from the approach developed. Results from this study point to the correct identification of weak and strict stationarity in real-world hydroclimatic time series compared to similar evaluations from unit root and trend tests. The robustness of the approach is also confirmed by an accurate assessment of the stationarity of several synthetic time series representing various hydroclimatic processes at different time scales. The proposed approach is a conceptually simple and superior alternative to trend and unit root tests since it provides a comprehensive assessment of stationarity using multiple nonparametric tests.

Trend Detection in the Presence of Positive and Negative Serial Correlation: A Comparison of Block Maxima and Peaks‐Over‐threshold Data

AbstractSerial correlation in a hydrometeorological time series can have deleterious effects on trend detection tests. To account for significant autocorrelation detected in datasets, various techniques have been developed over time, each having their own assumptions and accuracy. Furthermore, the existence of positive or negative serial correlation has dissimilar effects on these statistical techniques. This research compares the power and Type I error rates of various well‐known and several newer techniques to account for positive and negative serial correlation in combination with the Mann‐Kendall nonparametric trend test. The study additionally explores the application of these techniques in the presence of higher order dependence structures. Through a case study of southern Ontario watersheds, it is determined that the block maxima series (BMS) data are more likely to have significant negative lag‐1 serial correlation. Peaks‐over‐threshold (POT) data are more likely to be serially correlated and this autocorrelation is more likely to be positive. It is determined that in the case of positively serially correlated AR(1) data, block bootstrap (BBS), Hamed and Rao (1998), variance correction (VCCF1), Yue and Wang (2004), variance correction (VCCF2), and sieve bootstrap (SBS) are the most robust. Alternatively, in the case of negative AR(1) autocorrelation, the corrected trend‐free prewhitening approach (CTFPW), modified trend‐free prewhitening (MTFPW), bias corrected prewhitening (BCPW), and VCCF1 are recommended. In the presence of higher order dependence structures, VCCF1 (with all significant lags included) and VCCF2 (with all lags included) should be applied cautiously. Lastly, an assessment of the causality of the serial correlation is provided.

Incidence of Pregnancy-Associated Cancer in Two Canadian Provinces: A Population-Based Study.

Pregnancy-associated cancer—that is diagnosed in pregnancy or within 365 days after delivery—is increasingly common as cancer therapy evolves and survivorship increases. This study assessed the incidence and temporal trends of pregnancy-associated cancer in Alberta and Ontario—together accounting for 50% of Canada’s entire population. Linked data from the two provincial cancer registries and health administrative data were used to ascertain new diagnoses of cancer, livebirths, stillbirths and induced abortions among women aged 18–50 years, from 2003 to 2015. The annual crude incidence rate (IR) was calculated as the number of women with a pregnancy-associated cancer per 100,000 deliveries. A nonparametric test for trend assessed for any temporal trends. In Alberta, the crude IR of pregnancy-associated cancer was 156.2 per 100,000 deliveries (95% CI 145.8–166.7), and in Ontario, the IR was 149.4 per 100,000 deliveries (95% CI 143.3–155.4). While no statistically significant temporal trend in the IR of pregnancy-associated cancer was seen in Alberta, there was a rise in Ontario (p = 0.01). Pregnancy-associated cancer is common enough to warrant more detailed research on maternal, pregnancy and child outcomes, especially as cancer therapies continue to evolve.

A new approach for suspended sediment load calculation based on generated flow discharge considering climate change

Abstract Use of general circulation models (GCMs) is common for forecasting of hydrometric and meteorological parameters, but the uncertainty of these models is high. This study developed a new approach for calculation of suspended sediment load (SSL) using historical flow discharge data and SSL data of the Idanak hydrometric station on the Marun River (in the southwest of Iran) from 1968 to 2014. This approach derived sediment rating relation by observed data and determined trend of flow discharge time series data by Mann-Kendall nonparametric trend (MK) test and Theil-Sen approach (TSA). Then, the SSL was calculated for a future period based on forecasted flow discharge data by TSA. Also, one hundred annual and monthly flow discharge time series data (for the duration of 40 years) were generated by the Markov chain and the Monte Carlo (MC) methods and it calculated 90% of total prediction uncertainty bounds for flow discharge time series data by Latin Hypercube Sampling (LHS) on Monte Carlo (MC). It is observed that flow discharge and SSL will increase in summer and will reduce in spring. Also, the annual amount of SSL will reduce from 2,811.15 ton/day to 1,341.25 and 962.05 ton/day in the near and far future, respectively.

Contemporary Practices and Complications of Surgery for Thoracic Outlet Syndrome in the United States

Thoracic outlet syndrome (TOS) surgery is relatively rare and controversial, given the challenges in diagnosis as well as wide variation in symptomatic and functional recovery. Our aims were to measure trends in utilization of TOS surgery, complications, and mortality rates in a nationally representative cohort and compare higher versus lower volume centers. The National Inpatient Sample was queried using International Classification of Diseases, Ninth Revision, codes for rib resection and scalenectomy paired with axillo-subclavian aneurysm (arterial [aTOS]), subclavian deep vein thrombosis (venous [vTOS]), or brachial plexus lesions (neurogenic [nTOS]). Basic descriptive statistics, nonparametric tests for trend, and multivariable hierarchical regression models with random intercept for center were used to compare outcomes for TOS types, trends over time, and higher and lower volume hospitals, respectively. There were 3,547 TOS operations (for an estimated 18,210 TOS operations nationally) performed between 2010 and 2015 (89.2% nTOS, 9.9% vTOS, and 0.9% aTOS) with annual case volume increasing significantly over time (P=0.03). Higher volume centers (≥10 cases per year) represented 5.2% of hospitals and 37.0% of cases, and these centers achieved significantly lower overall major complication (defined as neurologic injury, arterial or venous injury, vascular graft complication, pneumothorax, hemorrhage/hematoma, or lymphatic leak) rates (adjusted odds ratio [OR] 0.71 [95% confidence interval 0.52-0.98]; P=0.04], but no difference in neurologic complications such as brachial plexus injury (aOR 0.69 [0.20-2.43]; P=0.56) or vascular injuries/graft complications (aOR 0.71 [0.0.33-1.54]; P=0.39). Overall mortality was 0.6%, neurologic injury was rare (0.3%), and the proportion of patients experiencing complications decreased over time (P=0.03). However, vTOS and aTOS had >2.5 times the odds of major complication compared with nTOS (OR 2.68 [1.88-3.82] and aOR 4.26 [1.78-10.17]; P<0.001), and ∼10 times the odds of a vascular complication (aOR 10.37 [5.33-20.19] and aOR 12.93 [3.54-47.37]; P<0.001], respectively. As the number of complications decreased, average hospital charges also significantly decreased over time (P<0.001). Total hospital charges were on average higher when surgery was performed in lower volume centers (<10 cases per year) compared with higher volume centers (mean $65,634 [standard deviation 98,796] vs. $45,850 [59,285]; P<0.001). The annual number of TOS operations has increased in the United States from 2010 to 2015, whereas complications and average hospital charges have decreased. Mortality and neurologic injury remain rare. Higher volume centers delivered higher value care: less or similar operative morbidity with lower total hospital charges.

Spatial and temporal variabilities in baseflow characteristics across the continental USA

Trends in baseflows based on observed daily streamflow data are evaluated in this study at several sites in the least anthropogenically affected watersheds in the USA. Trends were determined for annual maximum, annual mean, and annual median baseflow. Baseflow values derived at 574 stations in the USA for the 44 years from 1970 through 2013 are analyzed using two nonparametric trend tests (Spearman’s rho (SR) test and Mann-Kendall (MK)). Results from the trend tests are compiled for 18 major regions to understand the spatial variability of changes in baseflows across the USA. Results from SR tests indicate that almost half of the stations show statistically significant trends in annual maximum baseflows. Trends in annual median baseflows show that 32.06% of the gauging stations have downward trends, and a total of 56.45% of sites show significant trends for annual mean baseflows. The Souris-Red-Rainy, Missouri, and California watershed regions have a larger number of sites with higher upward trends compared with those from other regions in the USA. The results from the SR test indicate that 262 sites have statistically significant trends in annual maximum baseflow compared with the 254 sites with similar trends noted from the MK test. Based on limited data, it can be concluded that baseflow and precipitation values accumulated for the same month are correlated in some regions. In general, the number of sites with decreasing trends for annual maximum, mean, and median baseflows is larger than the number of sites with increasing trends. Decreasing trends in baseflows are cause for concern and have serious implications on future planning for low flow management strategies for several streams in the USA.

An international evaluation of trends and outcomes of living donor liver transplantation: United States, United Kingdom, and Canada

Presenter: Tommy Ivanics MD | University Health Network, Toronto General Hospital Background: Living donor liver transplantation (LDLT) offers an opportunity to decrease the liver transplant waitlist and reduce waitlist mortality. We sought to compare donor and recipient characteristics and post-transplant outcomes after LDLT in the United States (US), United Kingdom (UK), and Canada, where deceased donors provide the majority of organs available for transplantation. Methods: We studied adults (≥18-years) who underwent primary LDLT between Jan-2008 and Dec-2018 from three national liver transplantation registries: United Network for Organ Sharing (UNOS;US), National Health Service Blood and Transplantation (NHSBT;UK), and the Canadian Organ Replacement Registry (CORR;Canada). Patients undergoing re-transplantation, multi-visceral transplantation, or had waitlist drop-out were excluded. Recipient and donor characteristics were compared across countries. A non-parametric Cox-Stuart trend test for LDLT was performed in each country. Post-transplant survival was evaluated using the Kaplan-Meier method, and multivariable adjustments were performed using Cox Proportional Hazard models. Results: A total of 3,086 LDLTs were performed (US:n = 2,433; UK:n = 97; Canada:n = 556). A trend toward increased LDLT over time was present in the US (Cox-Stuart trend test: US: p = 0.08; UK:p = 0.73; Canada: p = 0.49). Overall, the proportion of LDLTs compared to other grafts has remained stable (Figure 1) with Canada maintaining the highest proportion over time (proportion of LDLT 2008: US 3.4%; UK:1.7%; Canada: 20.1%; p<0.001; 2018: US: 5.0%; UK: 0.4%; Canada: 13.8%; p<0.001). The US and Canadian recipients had the highest body mass index (median [IQR]], US 26 [23-30]; UK 24 [22-28]; Canada 26 [23-29]; overall p<0.001) and the highest donor age (years, median [IQR]: US 36 [28-45]; UK 33 [25-40]; Canada 35 [27-46]; overall p = 0.010). The laboratory Model for End-Stage Liver disease (MELD) score was highest in Canada (median [IQR]: US 15 [11-19]; UK 11 [8-18]; Canada 17 [13-21]; p<0.001). UK had a higher proportion of hepatitis C virus as disease etiology (US 2%; UK 21%; Canada 12%;p<0.001) whereas the US had a higher proportion of non-alcoholic steatohepatitis (US 17%; UK 11%; Canada 7%;p<0.001). Time on the waitlist was longest in the US (days, median [IQR]; US 151 [79-308]; UK 92 [7-202]; Canada 122 [64-230];overall p<0.001). At 1-year there was a non-statistically significant superior survival in Canada (1-year%[95%CI]]; US 93.0% [(92.0-94.1]; UK 91.4% [85.8-97.3]; Canada 95.8% [94.1-97.5];p = 0.06]. The 3-, 5-, 10-year survival rate was superior in Canada (3-year% [95%CI]; US 88.1% [86.8-89.5]; UK 90.0% [84.0-96.5]; Canada 92.1% [89.8-94.5];p = 0.04), (5-year%[95%CI]; US 83.5% [81.8-85.3]; UK 85.4% [77.1-94.5]; Canada 89.9% [87.1-92.7];p = 0.005), and (10-year%; US 71.1% [67.6-74.8]; UK 66.7% [45.0-98.8]; Canada 82.7% [78.2-87.5];p = 0.001). The median survival was not reached in any of the registries. After adjustment for characteristics of donors, recipients, annual center volume, and year of transplantation, all countries had an equivalent hazard of mortality post-LT ([HR] for mortality, US Reference, UK HR:1.26, 95%CI 0.67-2.39;p = 0.47; Canada HR:0.61,95%CI 0.30-1.26;p = 0.18). Stratification by hepatocellular carcinoma status did not alter the patterns observed in the data. Conclusion: LDLT use has remained stably low in western countries. Despite this, long-term survival is excellent. Continued efforts to increase LDLT in these countries is thus warranted due to the growing waitlist and differences in allocation that may disadvantage patients currently awaiting liver transplantation.

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil.

INTRODUCTION We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients’ levels of education. CONCLUSIONS The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

Evaluation of Groundwater Quality Using Groundwater Quality Index (GWQI) in Sharjah, UAE

The rapid growth in the world population resulted in an increase of the freshwater needs in many sectors. Groundwater is the most important freshwater source specially for arid and semi-arid regions due to lack of surface water sources and low precipitation rates in those regions. In this study, monthly groundwater quality data were collected from eleven well fields in Sharjah over the period of 2004-2017. Water quality parameters including bicarbonate, calcium, chloride, fluoride, magnesium, sodium and sulphate were selected for the analysis. In the study, water quality index (WQI) process is used to develop groundwater quality index (GWQI) for Sharjah using above mentioned water quality parameters. Mann-Kendall and Spearman’s Rho tests were adopted as non-parametric trend tests for temporal (trend) analysis of GWQI, whereas inverse distance weighting interpolation was used in GWQI spatial trend analysis. Temporal trend analysis results showed significant trends in 8 out of 11 well fields. Spatial analysis showed the highest values for salinity ions in the well fields closest to the northern region, whereas the lowest values were detected in the southern region.

Conflito trabalho-família em segurança pública: Uma revisão integrativa

Currently, it is clear that the new work settings mediate professional and family life relationships, therefore, we can define work-family conflict as a type of conflict between roles in which pressures from work and family domains are mutually incompatible at some level. The goal of this research was to analyze national and international publications about work-family conflict in public security, based on an integrative review. The searches were done using the software Publish or Perish, during the last two decades. After applying the inclusion and exclusion criteria, 39 articles were analyzed. In order to identify the tendency of growth or decrease in publications, the Mann-Kendall non-parametric trend test was used. The results indicate a predominance of publications in the USA, with an increase of studies in India. It is concluded that there is an increase in publications about the subject, considering the discovery of its relevance to the population investigated.

The Pragmatic Impact of Frailty on Outcomes of Coronary Artery Bypass Grafting

Although not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. Using administrative coding, we evaluated the impact of frailty on in-hospital death, complications, and resource use in a nationally representative cohort of patients undergoing isolated coronary artery bypass grafting (CABG). Patients aged 18 years and older who underwent isolated CABG across the United States were identified using the 2005 to 2016 National Inpatient Sample. Frailty was defined using a derivative of the validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Mortality, length of stay, inflation-adjusted costs, and postoperative complications were evaluated using multilevel multivariable regression. Of an estimated 2,137,618 patients undergoing isolated CABG, 85,879 (4.0%) were considered frail. The proportion of frail patients increased over the study period (nonparametric test for trend P= .002), while annual mortality rates declined (nonparametric test for trend P <.001). Frail patients were older (68.9 ± 10.7 years vs 65.0 ± 10.6 years, P < .001), and more commonly female (32.8% vs 26.2%, P < .001). After adjustment, frailty was associated with increased odds of in-hospital death (adjusted odds ratio [AOR], 2.49; 95% confidence interval [CI], 2.30-2.70; P < .001), major complications (AOR, 2.55; 95% CI, 2.39-2.71; P < .001), increased length of stay (AOR, 1.40; 95% CI, 1.09-2.11; P < .001), and costs (AOR, 1.03; 95% CI, 1.02-1.07; P < .001). Frailty, as identified by administrative coding, serves as a strong independent predictor of death and complications after CABG. Incorporation of frailty into risk models may aid in counseling patients about operative risk and benchmarking outcomes.

Long-term persistence in discharge time series of mountainous catchments in the Elbe River basin

Abstract. Statistical detection of trends in hydrometeorological time series is a crucial task when revealing how river systems react to environmental and human-induced changes. It was shown that the autocorrelation structure of a series influences the power of parametric and nonparametric trend tests. While the order of short-memory processes can be sufficiently captured by AR(I)MA models, the determination of the Hurst exponent, which describes the long memory, is still challenging, considering that the available methods partially give different results. In the Elbe River basin, Europe, several studies focusing on the detection (or description) of long-term persistence were performed. However, different lengths of series and different methods were used. The aim of the present work is to gather the results gained in various parts of the Elbe basin in Central Europe and to compare them with our estimation of the Hurst exponent using six discharge series observed in selected subbasins. Instead of the dependence of the exponent on the catchment area suggested by the theory of aggregated short-memory processes, we rather found a relationship between this parameter and the series length. As the theory is not supported by our findings, we suppose that the Hurst phenomenon is caused by a complex interplay of low-frequency climate variability and catchment processes. Experiments based on distributed water balance models should be the further research objective, ideally under the umbrella of mutual international projects.