Non-parametric Trend Test Research Articles

Abstract 18: Trends in Median CPR Duration Over Time in Patients With and Without Return of Spontaneous Circulation

Introduction: Survival after in-hospital cardiac arrest (IHCA) is increasing. In the Get-With-The-Guidelines-Resuscitation (GWTG-R) registry, longer median CPR duration in patients not achieving ROSC is associated with higher survival rates at the hospital level. We analyzed trends over time in median CPR duration by hospital in patients who achieved ROSC and those who did not, and stratified this analysis by age, gender and race. Methods: We included adult IHCA cases in GWTG-R from 2001-2017, excluding data from a given hospital and year if fewer than 5 eligible arrests were recorded. A nonparametric test for trend was done to evaluate median CPR duration over time in those with and without ROSC, in all patients and in groups stratified by age (<60, 61-80 and >80 years), gender, and race (white and black). Linear regression was done to evaluate the amount of change per year. Association with survival was tested using Pearsons correlation. Results: Of 359,107 IHCA events, 31,189 were excluded, leaving 327,918 for analysis. Over time, there was a significant increase in median CPR duration in patients who did not achieve ROSC, and a decrease in those who did attain ROSC.(Fig.) These trends persisted when stratified by gender, race and age. Each year was associated with a decrease in median CPR duration of 0.37 min (95% CI -0.41 to -0.33 min) in those with ROSC and an increase of 0.29 min (95% CI 0.25 to 0.33 min) in those without. There was a small but significant correlation between median CPR duration in those without ROSC and adjusted survival by hospital over time (r=0.224, p<0.0001). Conclusions: In the GWTG-R registry, median duration of CPR is decreasing over time in patients achieving ROSC, but increasing in those not achieving ROSC. The increasing trend in CPR duration in those without ROSC correlates positively with the trend in survival. Whether the increase in median CPR duration in those without ROSC is contributing causally to improvements in survival warrants further study.

Chromosome 1q Amplification Is Associated with a History of Prior Malignancies Among Patients Newly Diagnosed with Multiple Myeloma

Background: Over the past 20 years, observational data from usual care clinical oncology settings has been leveraged to inform estimates of cancer treatment-associated benefits and risks among patients not treated on clinical trials. Increasing genomic testing to inform treatment decisions in usual care settings now meaningfully augments traditional observational data, positioning it to provide insights beyond clinical care into tumor biology. We studied patients with newly diagnosed multiple myeloma (MM), comparing cytogenetic test patterns according to history of prior malignancy. Methods: In this retrospective cohort study, we identified 2,380 patients from the COTA real-world database (RWD) who were newly diagnosed with MM in the years 2010-2018. The COTA RWD is a de-identified composite of both abstracted electronic health record and administrative data pertaining to patients receiving their cancer care at one of COTA's clinical oncology practice partners. Among these patients, 1769 (74%) had evidence of MM-associated cytogenetic testing with fluorescent in-situ hybridization (FISH) within the 120 days surrounding their date of diagnosis. The 1,769 patients form the analytic cohort. We compared patients' FISH results for t(4;14), deletion(17p), t(14;16), deletion(13), t(14;20), t(6;14), t(11;14), deletion (1p), and amplification(1q) according to their history of prior malignancy. Results: Within the cohort, 263 prior malignancies were identified in 241 patients (14%, 241/1,769). Two-hundred and twenty-one patients (92%) had one prior malignancy, 28 (7.9%) had two prior malignancies, and one (<1%) had four prior malignancies. The most common prior malignancies were prostate (n=50), breast (n=19), melanoma (n=14), skin (n=13), and cervix (n=6). Amplification of the long arm of chromosome one (amp(1q)) was noted in 31% of patients (75/241) with a prior malignancy vs. 24% of patients (370/1,528) without (chi2 test p=0.02). Overall 25% of patients had amp(1q). No other translocations, amplifications, deletions were associated with prior cancers. A non-parametric test for trend revealed a strong positive association between patients' malignancy count (range 0-4) and amp1q (p<0.01). MM patients with prior lymphomas and prior melanomas also had high rates of amp(1q), though these were not significantly different from patients without these prior malignancies. In a multivariable logistic regression model that adjusted for patient demographic attributes, other known potentially collinear MM poor prognostic factors (i.e., revised ISS stage, IgA sub-type, lambda light chains) and adjusted standard errors for clustering of patients within treatment settings, a history of prostate cancer remained clinically and statistically significantly positively associated with amp(1q) (OR 2.1, 95% CI: 1.9-2.2) as did history of two or more prior malignancies (OR 2.8, 95% CI: 2.3-3.3). Of note, amp(1q) was positively associated with IgA subtype (OR 1.5, 95% CI: 1.3-1.6) and the presence of lambda subtype (OR 1.3, 95%CI: 1.3-1.4). Conclusions: Using RWD, we found that newly diagnosed MM patients with histories of prostate cancer and those with two or more prior malignancies were more likely to have amp(1q), a poor prognostic marker in MM. Gains in 1q have previously been identified among patients with prostate and lymphoid cancers, but to our knowledge this is the first study to identify an association with a prior history of cancer, especially prostate cancer, and amp(1q) in MM. This relationship is worth further exploration of whether there is a common pathway associated with for example risk of prostate cancer and amp(1q) in MM. Clinical trials are less likely to answer this question as patients with prior malignancies are often excluded from enrollment. Overall, the results reported suggest that RWD is an efficient and comparatively inexpensive tool to support research in cancer biology through hypothesis generating and testing analyses of linked real-world phenotypic and genotypic data. Disclosures Lamont: COTA: Employment. Yee:Celgene: Consultancy, Honoraria, Research Funding; Karyopharm: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Takeda: Consultancy; Adaptive: Consultancy; Amgen: Consultancy, Honoraria. Goldberg:Cancer Outcomes Tracking and Analysis (COTA) Inc.: Equity Ownership; COTA: Equity Ownership; Bristol-Myers Squibb: Consultancy. Norden:COTA: Employment, Equity Ownership.

Land Surface Phenologies and Seasonalities in the US Prairie Pothole Region Coupling AMSR Passive Microwave Data with the USDA Cropland Data Layer

Land surface phenologies and seasonalities in the US Prairie Pothole Region (PPR) were characterized using land surface variables derived from the coarse spatial resolution (25 km) Advanced Microwave Scanning Radiometer (AMSR) blended data for 2003 to 2016 linked with the optically based USDA NASS Crop Data Layer (CDL) at a much finer spatial resolution. Two transects of AMSR pixels—one in east-central North Dakota and the other in eastern South Dakota—were selected for analysis. The AMSR data were grouped earlier (2003–2005, 2007) and later (2013–2016) to emphasize temporal change and to avoid data discontinuity in 2011–2012 and a major drought in 2006. The nonparametric Mann-Kendall trend test on the CDL data revealed that area in grasslands and wetlands strongly decreased in both transects, while corn and soybean coverage strongly increased. In crop-dominated sites, the AMSR vegetation optical depth (VOD) time series caught the early spring growth, ploughing, and crop growth and senescence. In contrast, the VOD time series at grassland dominated sites exhibited a lower peak but extended growth period. Crop-dominated sites had significantly higher amplitude VODs in both periods and transects. Based on the paired two-sample t-test, neither the peak VOD amplitude nor the peak VOD timing measured in accumulated growing degree-days was significantly different between temporal groups in the North Dakota transect. In contrast, in South Dakota, both the peak VOD amplitude and its timing were significantly different with shifts to later peak timing during the 2013–2016 period. In addition, in South Dakota but not North Dakota, there were significantly earlier shifts in the timing of peak growing degree-days and peak precipitation water vapor. Both spatial and temporal changes in AMSR land surface variables are linked to shifts in land cover along the South Dakota transect as revealed in the CDL data. More research is required to understand the dynamics evident in the passive microwave time series.

Potential evapotranspiration trends in West Africa from 1906 to 2015

In this study, Climate Research Unit monthly observations were used to assess the trends of potential evapotranspiration (PET) over West Africa from 1906 to 2015. Trends and changes in PET during the 110-year study period and two reference climatological periods (1931–1960 and 1961–1990) were examined. Nonparametric trend test of the Mann–Kendall and Kolmogorov–Smirnov was employed to find the changes in trends of PET and their significance or otherwise. The contributions of some meteorological parameters (air temperatures, precipitation and cloud cover) to the observed trends in PET were also examined. Results of long-term data analysis showed mixed trends in PET in the three designated zones (Guinea, Savanna and Sahel) but notable significant increasing trends (0.165 mm per year) at p = 0.1 in Sahel. However, very sharp differences in PET were observed in both reference periods across the zones with significant decreasing trends (at p = 0.01) in PET during the first period but increasing significant trends (at p = 0.1) during the second. In spite of this pattern of variations, general reductions in PET (− 0.6% to − 1.2%) were observed, which were found to be triggered by decrease in temperature (− 0.13 to − 1.07%) and vapour pressure (− 0.02 to − 0.33%) as well as increase in cloudiness (0.01–0.05%). However, the magnitudes of changes in PET were found to be insignificant in all the zones. Maximum temperature, more than other dominant climatic parameters, contributed significantly (Theil–Sen’s regression: 23.5% ≤ β ≤ 50.3%; p = 0.01) to observed variations in PET.

Temporal Trends in the Incidence, Characteristics, and Outcomes of Hanging-Related Out-of-Hospital Cardiac Arrest

Aim: The aim of this study was to describe temporal trends in the incidence, characteristics, and outcomes of hanging-related out-of-hospital cardiac arrest (OHCA). Method: A retrospective study of all hanging-related OHCA in Victoria, Australia, between 2000 and 2017 was conducted. Trends in incidence, characteristics, and outcomes were assessed using linear regression and a non-parametric test for trend, as appropriate. Predictors of survival to hospital discharge were identified using multivariable logistic regression. Results: Between 2000 and 2017, emergency medical services (EMS)-attended 3,891 cases of hanging-related OHCA, of which 876 cases (23%) received an attempted resuscitation. The overall incidence rate of EMS-attended cases was 3.8 cases per 100,000 person-years increasing from 2.3 cases per 100,000 person-years in 2000 to 4.7 cases in 2017 (p for trend <0.001). Incidence rates increased approximately two-fold in young adults (18–44 years) and three-fold in middle aged adults (45–64 years). Despite improvement in the rate of bystander cardiopulmonary resuscitation (from 49% in 2000–2005 to 75% in 2012–2017), the survival to hospital discharge rate remained unchanged (3% overall). Among adult survivors with 12-month follow-up (n = 10), five patients responded to telephone interviews. Of those, three (60%) reported severe functional disability. Five patients responded to telephone interviews, of which 3 patients reported severe functional disability. An initial shockable rhythm (OR 23.17, 95% CI: 5.75, 93.36) or pulseless electrical activity (OR 13.14, 95% CI: 4.79, 36.03) were associated with survival. Conclusion: The incidence of hanging-related OHCA doubled over the 18 year period with no change to survival rates. New preventative strategies are needed to reduce the community burden of these events.

Trends in Adherence to Thromboprophylaxis Guideline in Patients Undergoing Radical Cystectomy

ObjectiveTo examine the use of in-hospital pharmacologic thromboprophylaxis (PTP) in patients undergoing radical cystectomy between 2004 and 2014 and to assess the risk of venous thromboembolism (VTE) across the study period. Material and MethodsWe identified 8322 patients without contraindications to PTP undergoing radical cystectomy in the US using the Premier Healthcare Database. Nonparametric Wilcoxon type test for trend was employed to examine the trend of PTP utilization across the study period. Ensuing, we employed multivariable logistic regression and generalized linear regression models to examine the odds of receiving PTP and the risk of being diagnosed with VTE, respectively. ResultsBased on VTE risk-stratification, the majority of patients (87.8%) qualified as “high-risk.” Across the study period the use of PTP increased (Odds ratio 1.02, 95% confidence interval (CI) 1.00-1.03, P = .044), but remained underutilized as the maximum percentage of patients receiving in-hospital PTP did not exceed 58.6%. The risk of VTE did not vary across the study period (risk ratio 0.97, 95%CI 0.92-1.02, P = .178). ConclusionUtilization of PTP increased throughout the study period, while the risk of VTE did not change. Future studies are necessary to improve implementation of guideline-driven care, as PTP remained underutilized throughout the study period.

Long-term trends in the epidemiology of out-of-hospital cardiac arrest precipitated by suspected drug overdose

BackgroundLittle is known about the long-term trends in the incidence and outcomes of drug overdose out-of-hospital cardiac arrests (OHCA). MethodBetween 2000 and 2017, we retrospectively reviewed drug overdose OHCAs from the Victorian Ambulance Cardiac Arrest Registry. Incidence was assessed using linear regression, and the baseline characteristics and survival outcomes were assessed using nonparametric test for trend. Arrest factors associated with survival to hospital discharge were assessed using logistic regression. The 12-month functional recovery and health related quality of life for survivors was summarised using descriptive statistics. ResultsThe incidence of emergency medical services (EMS)-attended and EMS-treated cases was 5.8 and 2.0 per 100,000 person-years, respectively, with no significant changes in trend over time. Return of spontaneous circulation increased from 23% to 34% (p for trend = 0.001), event survival increased from 23% to 30% (p for trend = 0.007), and survival to hospital discharge increased from 4% to 13% (p for trend = 0.03). Age, arrest witnessed by bystander or EMS, initial shockable rhythm or pulseless electrical activity, intubation, epinephrine and sodium bicarbonate administration were independently associated with survival. The adjusted-temporal trend for survival was not significant (per year increase; OR 1.02, 95% CI: 0.98, 1.07; p = 0.244). Of the 12-month survivors, 50% of the responders reported good functional recovery, and few reported severe problems with mobility, self-care, daily activity, pain, and anxiety/depression. ConclusionAlthough the incidence of drug overdose OHCA remained unchanged between 2000 and 2017, the rates of survival have significantly improved.

Females and Minority Racial/Ethnic Groups Remain Underrepresented in Emergency Medical Services: A Ten-Year Assessment, 2008–2017

Background: Workforce diversity can reduce communication barriers and inequalities in healthcare delivery, especially in settings where time pressure and incomplete information may exacerbate the effects of implicit biases. Emergency medical services (EMS) professionals represent a critical entry point into the healthcare system for diverse populations, yet little is known regarding changes in the demographic composition of this workforce. Our primary objective was to describe the gender and racial/ethnic composition of emergency medical technicians (EMTs) and paramedics who earned initial National EMS Certification from 2008 to 2017. Secondarily, we compared demographic characteristics of the 2017 EMT and paramedic cohorts to the U.S. population. Methods: As a proxy for recent graduates likely to enter the workforce, we conducted a serial cross-sectional analysis of all EMTs and paramedics earning initial National EMS Certification from January 1, 2008 to December 31, 2017. Cuzick’s non-parametric test of trend was used to assess for changes in the gender and racial/ethnic composition of the EMS cohorts over time. For 2017, we calculated differences the gender and racial/ethnic composition of the EMT and paramedic cohorts to the U.S population, stratifying by Census region. Results: The study population included 588,337 EMTs and 105,356 paramedics. The proportion of females earning initial EMT certification rose from 28% in 2008 to 35% in 2017. Throughout the study period, less than one-fourth of newly certified paramedics were female (range: 20–23%). The proportion of EMS professionals identifying as black remained near 5% among EMTs and 3% among paramedics. The proportion of newly-certified Hispanic EMS professionals rose from 10% to 13% among EMTs and from 6% to 10% among paramedics. Compared to the U.S. population, females and racial/ethnic minorities were underrepresented among EMTs and paramedics earning initial certification and these representation differences varied across geographic regions. Conclusions: The underrepresentation of females and minority racial/ethnic groups observed during this 10-year investigation of EMTs and paramedics earning initial certification suggests that EMS workforce diversity is unlikely to undergo substantial change in the near future. The representation gaps were larger and more stable among paramedics compared to EMTs and suggest an area where concerted efforts are needed to encourage students of diverse backgrounds to pursue EMS.

Analysis of Length of Growing Season in Some Agro-ecological Zones Using Non-parametric Trend Test

The ever increasing population and consequently increase in demand for food and the increasing exploitation of the land justifies the need for adequate studies on rainfall as an important factor affecting agricultural production. The date of the onset of rains is an important factor in planning agricultural operations such as land preparation and sowing. The study conducted agro-statistical analysis of rainfall characteristics over three different zones of Nigeria. Daily rainfall data were collected for the period between 1971 and 2005 for 6 stations and were subjected to standard analysis to determine trends and variations in the onset dates, cessation dates, length of rainy season, number of wet days, drought episodes. The results showed that the inter-annual variability of the onset dates is higher than that of cessation dates with a progressive shift in both onset and cessation dates. The length of rainy season varied from 77-291 days in Guinea zone, 77-243 days for Savannah and 73-155 days for the Sahel. Changes in the length of growing season ranged between -9 and -10 for Guinea zone, -21 and 11 days for Savannah zone and -28 and 20 days for the Sahel. Similarly, the numbers of wet days have declined over Nigeria. The information presented in this study are to serve as input for proper land and water resources management for productive agricultural enterprise across the three major agro-ecological zones of Nigeria.

A descriptive analysis of the epidemiology and management of paediatric traumatic out-of-hospital cardiac arrest

AimPaediatric traumatic out-of-hospital cardiac arrest (OHCA) is a rare event with few survivors. We examined long-term trends in the incidence and outcomes of paediatric traumatic OHCA and explored the frequency and timing of intra-arrest interventions. MethodsWe retrospectively analysed data from the Victorian Ambulance Cardiac Arrest Registry for cases involving traumatic OHCA in patients aged ≤16 years arresting between January 2000 to December 2017. Trends were assessed using linear regression and a non-parametric test for trend. ResultsA total of 292 cases were attended by emergency medical services (EMS), of which 166 (56.9%) received an attempted resuscitation. The overall incidence of EMS-attended cases was 1.4 cases per 100,000 person-years, with no significant changes over time. Unadjusted outcomes also remained unchanged, with 23.5% achieving return of spontaneous circulation and 3.7% surviving to hospital discharge. The frequency of trauma-specific interventions increased between 2000–2005 and 2012–2017, including needle thoracostomy from 10.5% to 51.0% (p trend <0.001), crystalloid administration from 31.6% to 54.9% (p trend = 0.004) and blood administration from 0.0% to 6.3% (p trend = 0.01). The median time from emergency call to the delivery of interventions were: 12.9 min (IQR: 8.5, 20.0) for cardiopulmonary resuscitation, 19.7 min (IQR: 10.7, 39.6) for external haemorrhage control, 29.8 min (IQR: 22.0, 35.4) for crystalloid administration and 31.5 min (IQR: 21.0, 38.0) for needle thoracostomy. ConclusionThe incidence and outcomes of paediatric traumatic OHCA remained unchanged over an 18 year period. Early correction of reversible causes by reducing delays to the delivery of trauma-specific interventions may yield additional survivors.

Trend assessment of annual instantaneous maximum flows in Turkey

ABSTRACTA comprehensive evaluation of trends in annual instantaneous maximum flows (AIMF) from 153 gauge stations located in 26 river basins in Turkey is presented. Two traditional non-parametric trend tests, the Mann-Kendall (MK) and Spearman’s rho (SR), are used to quantify the significance of trends, while Sen’s slope method is applied to determine the magnitude of trends. The traditional tests indicate that the AIMF records of 57 stations showed statistically decreasing trends, while those of six stations showed an increasing trend. Sen’s trend method, which provides more detailed assessment of the trends in different clusters (low, medium and high), was applied to the AIMF series and the results were compared with traditional tests. Sen’s trend method indicated that all flow clusters at nine stations have increasing or decreasing trends, although no significant trend was detected by the MK and SR tests.

Spatiotemporal Variation in the Continental US Streamflow in Association with Large-Scale Climate Signals Across Multiple Spectral Bands

The study attempts to investigate the significant spatiotemporal variations in the continental United States’ streamflow as a response to large-scale climate signals across multiple spectral bands (SBs). Using non-parametric (long-term) trend and (abrupt) shift detection tests, coupled with discrete wavelet transform, 237 unimpaired streamflow stations were analyzed over a study period of 62 years (1951 to 2012), looking at the water year and seasonal data, along with three discrete SBs of two, four, and eight years. Wavelet coherence analysis, derived from continuous wavelet transform, determined the association between the regional streamflow patterns and three large-scale climate signals, i.e., El Nino Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO), and Atlantic Multi-decadal Oscillation (AMO), across continuous SBs ranging from two to 16 years. The results indicated significant positive (negative) trends and shifts in the northeastern and north-central (northwestern) regions with an increase in the number of stations as the SBs increased. The spatiotemporal association between regional streamflow and the climate signals varied significantly (from no correlation, Rn2~ 0, to perfect correlation, Rn2~ 1.0) even amongst adjacent regions. Among the climate signals, ENSO showed the highest association (Rn2~ 1.0), having a consistent phase relationship with the regional streamflow patterns, especially in the higher SBs. PDO (with the least influence among the three signals) and AMO showed stronger associations, mostly in the lower SBs. These results may help explain the teleconnections between the climate signals and the US streamflow variations across multiple SBs, which may lead to improved regional flow regulations.

Impact of Climate Variability on the Rice Yield in Uttar Pradesh: an Agro-Climatic Zone Based Study

In the backdrop of the established fact that the climate and agricultural produce foster a close-knit relation, the present study explores the impacts of climate variability on the rice yields across diverse agro-climatic zones of Uttar Pradesh, India. The time-series non-parametric Mann-Kendall trend test was applied to study long term (both annual and seasonal) weather and yield data sets. Minimum temperature, encompassing all the zones, was found to be increasing within the range of 0.06 to 0.44 °C per decade. The ‘kharif’ season maximum temperature trends were found increasing in most zones. In terms of annual and seasonal rainfall trends, the results were mostly non-significant, except for Bhabhar and Tarai Zone which had witnessed a very high decadal trend indicating towards the occurrences of intense rainfall events. North Eastern Plain Zone needs a special mention owing to its large number of extreme rainfall events in three categories (>50 to 100 to 150 mm/day). Considering the annual/seasonal temperature and rainfall variability in the region, the warming trend along with spatio-temporally uncertain rainfall is likely to inflict significant impact upon the rice crop. Consequently, there is a dire need to devise strategies capable of dealing with the impacts of the prevailing climate variability on rice yields in this state of India through development of suitable adaptation options for sustainable production. The continuous and rigorous studies into this field of agro-meteorology subjected to impact assessment call for international action plans that are designed in a frame of ‘bottom-up approach’ or a ‘local to regional to country level’ strategic implementation of adaptation options to sustain yields in the rice fields.

Observed trends in climate extremes over Bangladesh from 1981 to 2010

CR Climate Research Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsSpecials CR 77:45-61 (2019) - DOI: https://doi.org/10.3354/cr01539 Observed trends in climate extremes over Bangladesh from 1981 to 2010 Md. Jamal Uddin Khan, A. K. M. Saiful Islam*, Mohan Kumar Das, Khaled Mohammed, Sujit Kumar Bala, G. M. Tarekul Islam Institute of Water and Flood Management, Bangladesh University of Engineering and Technology (BUET), Dhaka 1000, Bangladesh *Corresponding author: saiful3@gmail.com ABSTRACT: Bangladesh regularly faces various extreme events (floods, droughts, cyclones, and heat waves), but there is a knowledge gap between average climate and climate extremes over the country. The purpose of this study is to quantify the trends over Bangladesh for the period 1981-2010 using the extreme temperature and precipitation indices developed by the CCl/WCRP/JCOMM Expert Team on Climate Change Detection and Indices. We used precipitation and temperature data from 26 meteorological stations, calculated trends in the indices using Sen’s slope estimator, and tested significance using the non-parametric Mann-Kendall trend test. For the temperature indices, we found an overall increasing warming trend. Average annual maximum and minimum temperatures increased by 0.3 and 0.4°C decade-1 respectively. A faster rise of both maximum and minimum temperature was found compared with previous studies. The frequency of warm days increased by 12 days decade-1. The frequency of warm (cold) nights increased (decreased) by 7 (11) days decade-1. The overall warming was accelerated at the end of the climatic period (2001-2010). Precipitation indices showed an overall decreasing trend, in contrast to other studies in this region. Trends in consecutive dry days (CDD) indicated a drying tendency at a rate of 10 days decade-1. A decreasing rate of about 84 mm decade-1 was observed in annual average total precipitation. Except for CDD, most of the precipitation trends were statistically not significant and spatially incoherent. Statistically significant change was observed in extreme temperature events, with a strong and consistent spatial pattern. Our results pave the way for further investigations into future changes using results from climate simulations. KEY WORDS: Extreme indices · Expert Team on Climate Change Detection and Indices · ETCCDI · Bangladesh · Observed records · Climate change Full text in pdf format Supplementary material PreviousNextCite this article as: Khan MJU, Islam AKMS, Das MK, Mohammed K, Bala SK, Islam GMT (2019) Observed trends in climate extremes over Bangladesh from 1981 to 2010. Clim Res 77:45-61. https://doi.org/10.3354/cr01539 Export citation RSS - Facebook - Tweet - linkedIn Cited by Published in CR Vol. 77, No. 1. Online publication date: January 08, 2019 Print ISSN: 0936-577X; Online ISSN: 1616-1572 Copyright © 2019 Inter-Research.

Evolution of the genomic landscape of circulating tumor DNA (ctDNA) in metastatic prostate cancer over treatment and time

BackgroundTargeted therapies have shown promise for men with metastatic castration-resistant prostate cancer (mCRPC). Due to the difficulty with obtaining tumor tissue in bony metastases, liquid biopsies are a promising alternative to guide treatment selection. While concurrent tissue next-generation sequencing (tNGS) and liquid biopsy has high concordance, it is unknown whether the genomic landscape of metastatic prostate cancer (mPC) changes over time or treatment. Herein, we hypothesize that the genomic landscape of mPC evolves with new treatments and/or time between tests. Patients and MethodsMen with mPC from the University of Utah with matched tNGS and liquid biopsy were included. Clinical data was collected retrospectively. Exonic regions from 69 genes covered by both platforms were included for analysis. Paired t tests were used to assess number of genomic alterations (GAs) between testing platforms. Number of alterations was assessed by time and number of treatments between testing by multivariate nonparametric trend tests. Results101 men with mPC were eligible and included. In men with no new treatments and ≤ 1 year between tests, a similar number of GAs were detected in both tests (2.0 vs. 2.2). In contrast, men with ≥ 1 new treatment between tests had significantly more GAs after treatment (5.0 vs. 2.4, p = 0.005). Total number of GAs was correlated with number of new treatments between testing (p = 0.003) and not time between testing (p = 0.76). ConclusionThe genomic landscape of mPC evolves with subsequent therapies. This finding suggests that contemporary tumor genomic profile upon disease progression may optimize guidance towards subsequent therapy selection.

Effect of haemodialysis and residual renal function on serum levels of galectin-3, B-type natriuretic peptides and cardiac troponin T.

Levels of plasma markers of myocardial fibrosis (galectin-3), stretch (B-type natriuretic peptide (BNP)) and injury (high-sensitivity troponin T (hs-TnT)) are affected by haemodialysis, residual renal function (RRF) and cardiac pathology. We aimed to determine the association of RRF, urine output and haemodialysis itself on cardiac biomarkers in haemodialysis patients. Adult haemodialysis patients underwent venesection pre- and post-haemodialysis then echocardiography and inter-dialytic urine collection to calculate RRF (mL/min per 1.73m2 ) and urine output (mL/day). Galectin-3, BNP-32, NT-ProBNP and hs-TnT levels were compared across tertiles of echocardiographic parameters, RRF and urine output using the non-parametric test for trend across ordered groups. Twenty-three patients (17 male) with mean age 67.7±13.8 years and median (interquartile range) dialysis duration 13.6 (9.8-19.1) months participated. Galectin-3 was substantially lower following haemodialysis: 55 ng/mL (47-70) versus 23 ng/mL (19-27, P < 0.001), but other biomarkers changed little. By increasing RRF tertile, post-dialysis galectin-3 was 32.6 ng/mL (23.7-36.6), 21.9 ng/mL (19.0-23.2) and 19.0 ng/mL (16.9-21.0, P = 0.001); NT-ProBNP was 10 192 ng/L (2303-21 504), 2037 ng/L (1224-10 795) and 1481 ng/L (172-2890, P = 0.016). Results were similar for daily urine volume, but measured echocardiographic parameters were not associated with biomarker concentrations. Plasma concentration of galectin-3 is reduced by the haemodialysis procedure. Lower RRF and urine volume are strongly associated with higher levels of galectin-3 and NT-Pro-BNP. These associations are important to the clinical interpretation of these biomarker levels in haemodialysis patients.

Association of serum high-density lipoprotein cholesterol with microalbuminuria in type 2 diabetes patients

BackgroundThe association of serum high-density lipoprotein cholesterol (HDL-C) with microalbuminuria in type 2 diabetes mellitus (T2DM) remains controversial. Therefore, a cross-sectional study was conducted on patients with T2DM to investigate the relationship of HDL-C with microalbuminuria.MethodsA total of 524 participants with T2DM were recruited in this cross-sectional study. The patients were divided into four groups according to serum HDL-C quartile. A nonparametric test was employed to assess the relationships across quartiles with clinical parameters and demographics. Multivariate logistic regression analysis was further performed.ResultsOf the 524 patients, 138 (26.3%) were found to have microalbuminuria by urinary albumin excretion rate determination. Serum HDL-C levels in microalbuminuria group were significantly lower than those in non-microalbuminuria group (1.04 (0.90–1.21) vs. 1.10 (0.94–1.31) mmol/L, P = 0.002). The nonparametric test for trend showed that the prevalence of microalbuminuria was significantly reduced for subjects of the fourth quartile of HDL-C compared to the first to third quartile (13.5% vs. 33.1%, 28.6%, 29.4%, P = 0.001). Multivariate logistic regression showed that subjects within the highest quartile of HDL-C had lower odds of microalbuminuria than those within the lowest quartile of HDL-C (OR = 0.17, 95% CI 0.15–0.52, P = 0.004).ConclusionsHigher levels of serum HDL-C were associated with decreased rates of microalbuminuria in T2DM patients.

Role of the 4Kscore test as a predictor of reclassification in prostate cancer active surveillance.

Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher's exact test, as appropriate established differences between groups of reclassification. A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management.

Sensibility of the Hand in Children With Conservatively or Surgically Treated Upper Neonatal Brachial Plexus Lesion

BackgroundThe aim of this study was to assess the sensibility of the hand in children with a neonatal brachial plexus palsy (NBPP) involving the C5 and C6, and to correlate results with dexterity. MethodsFifty children with NBPP (30 after nerve surgery, mean age 9.8 years) and 25 healthy controls (mean age 9.6 years) were investigated. Sensibility was assessed with two-point discrimination and Semmes-Weinstein monofilaments. Dexterity was evaluated with a single item from the Movement Assessment Battery for Children-2. We compared the affected side with the nondominant hand of the control group. ResultsThe sensibility in the first and second fingers was significantly diminished in the NBPP for both two-point discrimination (P = 0.005 and P = 0.014, respectively) and monofilament test (P < 0.001). Dexterity was significantly lower in the NBPP group than in control group, corrected for age (P = 0.023). There was a significant difference toward decreasing hand function with decreasing sensibility according to the Semmes-Weinstein test for the thumb (Jonckheere–Terpstra nonparametric trend test, P = 0.036). ConclusionsThe sensibility of the thumb and index finger in children with an upper plexus lesion (either surgically or conservatively treated) is diminished. The decreased sensibility has a negative impact on hand function. Appreciation of diminished hand function in patients with NBPP involving C5 and C6 is important to optimize treatment.

Trends in the incidence and outcome of paediatric out-of-hospital cardiac arrest: A 17-year observational study

BackgroundSystem-based improvements to the chain of survival have yielded increases in survival from out-of-hospital cardiac arrest (OHCA) in adults. Comparatively little is known about the long-term trends in incidence and survival following paediatric OHCA. MethodsBetween 2000 and 2016, we included children aged ≤16 years who suffered a non-traumatic OHCA in the state of Victoria, Australia. Trends in incidence and unadjusted outcomes were assessed using linear regression and a non-parametric test for trend. Multivariable logistic regression with multiple imputation was used to identify arrest factors associated with event survival and survival to hospital discharge. ResultsOf the 1301 paediatric OHCA events attended by emergency medical services (EMS), 948 (72.9%) received an attempted resuscitation. The overall incidence of EMS-attended and EMS-treated events was 6.7 and 4.9 cases per 100,000 person-years, with no significant changes in trend. Although the proportion of cases with OHCA identified in the call and receiving bystander CPR increased over time, EMS response times also increased. Unadjusted event survival rose from 23.3% in 2000 to 33.3% in 2016 (p trend = .007), and survival to hospital discharge rose from 9.4% to 17.7% over the same period (p trend = .04). Increases in survival to hospital discharge were largely driven by initial shockable arrests, which rose from 33.3% in 2000 to 60.0% in 2016 (p trend = .005). Survival after initial shockable arrests was higher if the first shock was delivered by either first responder or public AED compared with paramedics (83.3% vs. 40.0%, p = .04). After adjustment, the odds of event survival and survival to hospital discharge increased independent of baseline characteristics, by 7% (OR 1.07, 95% CI: 1.03, 1.11; p = .001) and 8% (OR 1.08, 95% CI: 1.01, 1.15; p = .02) per study year, respectively. ConclusionsSurvival following paediatric OHCA increased in our region over a 17 year period. This was driven, in part, by improving outcomes for initial shockable arrests.