Number Of Years Research Articles

Procedural safety of rotational atherectomy and modified balloon angioplasty: insights from a German national registry.

Modified balloons (MB) and rotational atherectomy (RA) are recommended tools for treatment of coronary plaques with superficial calcium. Knowledge about in-hospital safety is limited. Patients with coronary artery disease who underwent coronary angiography with RA or MB angioplasty in Germany were identified via ICD and OPS codes from 2017 to 2020. Acute coronary syndromes were excluded. Since patients were not randomized toward MB or RA, potential confounding factors were taken into account using the propensity score methods. Thereby, inverse probability weighting was applied. Ten thousand.ninety-twopatients underwent RA with an increasing trend from 1817 in 2017 toward 3166 in 2020. MBs were used in 22,378 patients also with an increasing trend from 4771 in 2017 toward 6078 in 2020. Patients receiving RA were older (74.23 ± 8.68 vs. 71.86 ± 10.02, p < 0.001), had a higher Charlson Comorbidity Index (2.07 ± 1.75 vs. 1.99 ± 1.76, p = 0.001) and more frequently left main (17.96% vs. 12.91%, p < 0.001) or three vessel disease (66.25% vs. 58.10%, p < 0.001). Adjusted procedural risk of major adverse cardiac and cerebrovascular events (MACCE) was similar in both groups, while pericardial effusion (RR 2.69; 95% CI 1.88-3.86, p < 0.001), pericardial puncture/pericardiotomy/pericardial tamponade (RR 2.66; 95% CI 1.85-3.81, p < 0.001) and bleeding (RR 1.65; 95% CI 1.12-2.43, p < 0.011) occurred more frequently in patients receiving RA. Patients treated with RA at high volume centers were hospitalized shorter (p = 0.005) and had a lower rate of acute cerebrovascular events (p < 0.001). Rate of MACCE, bleeding and pericardial puncture were not influenced by the annual RA numbers per center. MBs had a lower risk of bleeding and pericardial puncture. Patients treated at centers with high annual RA procedure numbers had a lower risk of acute cerebrovascular events and were hospitalized shorter.

Demographic and temporal trends in mental health and substance use services provided by primary care physicians in British Columbia, Canada

BackgroundAs the demand for mental health and substance use (MHSU) services increases, there will be an even greater need for health human resources to deliver this care. This study investigates how family physicians’ (FP) contact volume, and more specifically, MHSU contact volume, is shaped by demographic trends among FPs in British Columbia, Canada.MethodsWe used annual physician-level administrative billing data and demographic information on FPs in British Columbia between 1996 and 2017. This study analyzes trends in primary care service provision among graduating cohorts of FPs, FPs of different ages (as measured by years since graduation), and FPs practicing during different time periods. Additionally, analyses are stratified by FP sex to account for potential differences in labour supply patterns between male and female FPs.ResultsOur results show that while FPs’ overall contacts with patients decreased between 1996 and 2017, their annual number of MHSU contacts increased, which was largely driven by an increase in substance use visits. Demographically, the proportion of female FPs in the labour force rose over time. Observed trends were similar, though not identical in male and female FPs, as males tended to have higher overall contact volume (both total contacts and MHSU), but also steeper declines in contact volume in later careers. The number of contacts (both total and MHSU) changed across career stage - rising steadily from start to mid-career, peaking at 20–30 years in practice, and decreasing steadily thereafter. This was evident for all cohorts and consistent over the 21-year study period but flattened in amplitude over time. Our findings also point to potential cohort effects on labour supply. The inverse U-shaped career trend extended to MHSU contacts, but its peak seems to have shifted to a later career stage (peaking at 30–40 years of practice) over time.ConclusionsOur study shows changing dynamics in MHSU service delivery among FPs over time, across the life span and between FP sexes that are likely to influence access to care beyond simply the number of FPs. Given the healthcare needs of the population, these findings point to potential future changes in provision of MHSU services.

The potential impact of universal screening for vasa previa in the prevention of stillbirths.

To estimate the number of pregnancies complicated by vasa previa annually in nine developed countries, and the potential preventable stillbirths associated with undiagnosed cases. We also assessed the potential impact of universal screening for vasa previa on reducing stillbirth rates. We utilized nationally-reported birth and stillbirth data from public databases in the United States, UnitedKingdom, Canada, Germany, Ireland, Greece, Sweden, Portugal, and Australia. Using the annual number of births and the number and rate of stillbirths in each country,and the published incidence of vasa previa and stillbirth rates associated with the condition, we estimated the expected annual number of cases of vasa previa, those that would result in a livebirth, and the potential preventable stillbirths with and without prenatal diagnosis. There were 6,099,118 total annual births with 32,550 stillbirths, corresponding to a summary stillbirth rate of 5.34per 1,000 pregnancies. The total expected vasaprevia caseswas estimated to be 5,007 (95 % CI: 3,208-7,201). The estimated number of livebirths would be 4,937 (95 % CI: 3,163-7,100) and 3,610 (95 % CI: 2,313-5,192) in pregnancies with and without a prenatal diagnosis of VP.This implies that prenatal diagnosis would potentially prevent 1,327 (95 %CI: 850-1,908) stillbirths in these countries, corresponding toa potential reduction in stillbirth rate by 4.72 % (95 % CI: 3.80-5.74) if routine screeningfor vasa previa wasperformed. Our study highlights the importance of universal screening for vasa previa and suggests that prenatal diagnosis of prevention could potentially reduce 4-5 % of stillbirths.

International wildlife trade quotas are characterized by high compliance and coverage but insufficient adaptive management

Effective management of international wildlife trade is crucial to ensure sustainability. Quotas are a common trade management tool and specify an annual number of individuals to be exported, yet at present there is no global assessment of quota coverage and compliance. Using over 7,000 country–year specific reptile quotas established under the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) covering 343 species, we quantify quota coverage, compliance, trade trends pre-quota and post-quota setting and whether quotas likely represent adaptive management. Quotas predominantly concerned live wild-sourced reptiles, with only 6.6% of live non-zero quotas exceeded and 4.5% of zero quotas subverted. For 62.3% of species, quotas were established higher than pre-quota trade, with traded volumes post-quota mainly unchanged or higher than pre-quota establishment, thus potentially facilitating sustainable trade. Over 38% of quota series of species remained at the same level each year, with the longest-running quotas proportionately updated the least, indicating that many quotas do not change adaptively in response to changing threats to species through time. Greater specificity in exactly what quotas cover, justification for unchanged quotas and transparency over quota determination are needed to ensure that high compliance equates to sustainable use.

L-Band Synthetic Aperture Radar and Its Application for Forest Parameter Estimation, 1972 to 2024: A Review.

Optical remote sensing can effectively capture 2-dimensional (2D) forest information, such as woodland area and percentage forest cover. However, accurately estimating forest vertical-structure relevant parameters such as height using optical images remains challenging, which leads to low accuracy of estimating forest stocks like biomass and carbon stocks. Thus, accurately obtaining vertical structure information of forests has become a significant bottleneck in the application of optical remote sensing to forestry. Microwave remote sensing such as synthetic aperture radar (SAR) and polarimetric SAR provides the capability to penetrate forest canopies with the L-band signal, and is particularly adept at capturing the vertical structure information of forests, which is an alternative ideal remote-sensing data source to overcome the aforementioned limitation. This paper utilizes the Citexs data analysis platform, along with the CNKI and PubMed databases, to investigate the advancements of applying L-band SAR technology to forest canopy penetration and structure-parameter estimation, and provides a comprehensive review based on 58 relevant articles from 1978 to 2024 in the PubMed database. The metrics, including annual publication numbers, countries/regions from which the publications come, institutions, and first authors, with the visualization of results, were utilized to identify development trends. The paper summarizes the state of the art and effectiveness of L-band SAR in addressing the estimation of forest height, moisture, and forest stocks, and also examines the penetration depth of the L-band in forests and highlights key influencing factors. This review identifies existing limitations and suggests research directions in the future and the potential of using L-band SAR technology for forest parameter estimation.

Utilization of recurrent laryngeal nerve monitoring during thyroid surgery in china: a point prevalence survey (2015-2023).

The survey aimed to elucidate the complete range of national practices, including all technical and non-technical aspects, as well as surgical stratification and maturation, of the use of intraoperative neuromonitoring (IONM) during thyroid surgery in China. Six national questionnaires, developed by the Chinese Neural Monitoring Study Group (CNMSG) between 2015 and 2023, were used to collect and analyze data regarding the clinical application, education, and scientific research related to IONM in Chinese medical institutions. Among the surveyed hospitals, 45% reported an average annual surgical volume exceeding 3,000 cases, with 82.5% performing more than 80% of the surgeries for malignant thyroid tumors. Additionally, 97.5% of the hospitals reported a<3% incidence of postoperative hoarseness with IONM. Statistical analysis from 2011 to 2015 found that the incidence of postoperative hoarseness decreased by 30% in 2013 compared with 2011, when the technology was introduced. Preoperative and postoperative laryngoscopies were routinely performed by 82.5% and 15% of the hospitals, respectively. For 65% of the hospitals, the publication of the Chinese edition of neuromonitoring guidelines in 2013 prompted the utilization of IONM technology. An average annual number of IONM applications exceeding 500 cases (18.5% the average volume) was reported by 80% of the hospitals, while 62.5% reported a cumulative number of applications greater than 5,000 cases (47.1% the average cumulative volume). Regarding technical parameters, 75% of the hospitals reported an intraoperative V1 amplitude of >500µV, and 70% reported an intraoperative loss of signal (LOS) rate of<3%. 92.5% of the surveyed hospitals believed that IONM could help identify dissociated nerves, and 95% of the surveyed hospitals believed that IONM could reduce nerve damage. However, 72.5% of the respondents thought that cost was the main limitation. Furthermore, 67.5% of the hospitals reported that half of their thyroid surgical team members were trained in IONM, with 17.5% reporting that all team members were trained. Areas for reinforced training included IONM research methods and directions (72.5%), and analysis and treatment of abnormal EMG signals (72.5%). Research projects related to IONM were conducted by 42.5% of the hospitals, while 52.5% had published papers on neuromonitoring. IONM was independently and incrementally associated with the annual surgical volume. This survey emphasized the importance of national collaboration and/or a registry for the uptake, consolidation, and development of CNMSG consensus.

Donor-derived infections-Insights from Singapore, Japan, and Thailand.

Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor-derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia. We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand. Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV-1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT-PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported. The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region.

International Collaboration in Taiwan Emergency Department Publications: A Social Network Analysis.

Emergency medicine (EM) is a growing specialty both clinically and academically. Academic EM development can be measured by number of scientific publications. This study aimed to evaluate the academic international cooperation trend of Taiwan emergency departments (EDs) in the past two decades using social network analysis (SNA). The study population were publications with first author affiliated with Taiwan EDs and the study duration was publication year before 2021. The enrolled publications were categorized into two groups: Group one, all authors were affiliated with Taiwan (domestic publications) and Group two, authors were affiliated with Taiwan and other countries (international publications). The primary outcome measurement was the degree centrality of Taiwan before 2021. The secondary outcome measurements included the trend in annual publication number of Group one and Group two, the trend in country number of each year in Group two, the top five countries that collaborate with Taiwan, the difference between the median of citation numbers in Group one and Group two, and the difference between the median of author numbers in Group one and Group two. A total 4,363 publications were enrolled, of which 4,046 publications were classified in Group one and 317 publications were in Group two. The annual publication number of both groups increased significantly. The annual country number of collaboration with Taiwan ED publications had also significantly increased. The median of citation number and author number in Group two were both significantly higher than Group one. The top five countries collaborating with Taiwan were the United States, China, Malaysia, Japan, and Australia. Taiwan EDs' growing international collaboration in the past two decades indicated a capacity to conduct multi-country research. International collaboration publications obtained higher citations compared to domestic publications. Researchers should enhance international collaborations for academic advancement.

Trends in extreme rainfall and their relationship to flooding episodes in Vhembe district, South Africa

Extreme weather events, such as heavy rainfall, are being increased by climate change in various regions, and such events often cause floods. This study examined the trends and variability of extreme rainfall indices using daily rainfall data (1981–2023) from three study sites at different socio-economic development spectra in Vhembe District, Limpopo Province, South Africa. The analyses focus on indices such as the annual total rainfall from wet days (PRCPTOT), the maximum number of consecutive dry days (CDD) and wet days (CWD), annual maximum 1-day and 5-day rainfall (RX1 day and RX5 day), the Simple Daily Intensity Index (SDII), the number of days exceeding varying amounts of precipitation (R10, R20, R40) and the annual number of wet days with rainfall greater than the 95th and 99th percentile (R95p and R99p) of the 1981–2023 daily rainfall. We discuss the observed trends in extreme rainfall indices in light of the actual flood occurrences to establish linkages. Several statistically significant and marginal changes in extreme rainfall trends were identified and provided key insights into reported flooding events in the district—flooding episodes were mainly attributed to the significant increases in total precipitation (PRCPTOT) and rainfall exceeding the 99th percentile of daily rainfall (R99p). Other significant contributors were declining CDD and increasing RX1day at Duthuni, increasing R40 at Musina as well as increasing R1 and declining CDD at Sane. However, the low altitude, urbanization, poor waste management and inadequate drainage systems were among the key non-climatic drivers of flood risk across the study sites, but these warrant further investigation. The complex interplay between climatic and non-climatic drivers of flood risk underscores the importance of localized climate studies and the need for adaptive strategies to minimize loss and damage. Overall, this research provides valuable insights into localized extreme rainfall trends, which are essential for developing site-specific flood mitigation and adaptation strategies. However, such initiatives require placing vulnerable communities at the centre in order to develop solutions that are locally led and relevant.

231. DESCRIBING THE LANDSCAPE OF ESOPHAGECTOMY BETWEEN EASTERN AND WESTERN ESOPHAGEAL SOCIETIES: COMPARATIVE STUDIES FROM THE JAPANESE NCD AND DUTCH DUCA

Abstract Objective Differences in clinicopathological characteristics of patients with esophageal cancer between countries may exist and impact on perioperative and surgical treatment as well as outcomes. Identification of these discrepancies may help the interpretation of present and future studies. Methods Data on patient demographics, comorbidity, pathology, surgical procedure, and short-term outcomes were retrieved, and compared between countries. Furthermore, we conducted a risk factor analysis focused on the major postoperative complications after esophagectomy to reveal the similarities and differences in risk factors. Results The mean annual number of resections for oesophageal cancer was 6673 in NCD (5.3 cases per 100,000 population) and 551 (3.1 cases per 100,000 population) in DUCA. Patients from the NCD were older and had a lower BMI. Complete minimally invasive esophagectomy was performed in 52.7% in NCD and 85% in DUCA. A cervical anastomosis was performed in 83.5% of patients in the NCD and in 33.8% in the DUCA likely reflecting differences in the location of primary tumors. Mortality within 30 days after surgery in the NCD and DUCA was 0.8% and 2.7%, respectively. Risk factors for postoperative major complications were similar between countries. Conclusions Although there were differences in patient variables, no significant differences were observed in short-term outcomes and risk factors of postoperative complications. The current results provide insight into contemporary demographics and outcomes of esophageal cancer resections from two an Asian and Western perspective.

P045 HEALTH AND CARE STATUS OF HYPERTENSIVE PATIENTS IN PRIMARY CARE UNITS IN THE CONOCOTO-QUITO-ECUADOR DISTRICT: BASELINE OF THE HEARTS INITIATIVE - 2019

Background: Hypertension is a significant global public health problem due to the burden of disease and premature death it causes. Its control depends on the quality and timeliness of diagnosis, treatment, and patient follow-up. Studies show an increase in prevalence, poor control, and low coverage in the diagnosis, treatment, and follow-up of hypertensive patients. In response to this problem, since 2019 the Ministry of Health of Ecuador has implemented the HEARTS Initiative proposed by PAHO in primary health care units. This study is part of the baseline prior to its implementation. Objective: To identify the health and care status of hypertensive patients attending primary care units in the Conocoto district. Methodology: A descriptive retrospective study was conducted, reviewing the medical records of 681 patients who attended follow-up consultations in the 9 health units of the district. Results: The average age of the patients was 67.12 years (SD 14.2), with 72.1% being women and 96.7% of mixed ethnicity. The average annual number of consultations was 4.24; 40.4% of the patients were overweight and 41% obese. Of the patients who underwent laboratory tests, 45.1% had hypercholesterolemia, 48% had low HDL, and 10.9% had impaired renal function. An electrocardiogram was performed in 3.4% and a funduscopy in 1.7%. Most patients received counselling on lifestyle changes; 31.9% of the patients had uncontrolled hypertension; depending on the health unit this ranged from 11.3% to 52.3%. Conclusions: The lack of hypertension control is lower than reported in other studies, although many patients do not have the minimum necessary tests. Follow-up should be improved, not only of blood pressure control but also of the patient's clinical condition.

Direct Economic Burden of Cubital Tunnel Surgery in the United States: Total Payments and Components of Cost

Despite its widespread prevalence, the cost of cubital tunnel syndrome (CuTS) in the United States to patients and insurers is not well understood. The purpose of this study was to quantify the direct payments associated with operative treatment of CuTS. We hypothesized that CuTS represents a substantial cost to the payer in facility fees, surgeon fees and other expenses. Utilizing the MarketScan database of insured patients (commercial and Medicaid), we identified a cohort of 41,777 patients aged 18-64 years with surgically treated CuTS from 2006 to 2018. We estimated the median 90-day payments from encounters associated with cubital tunnel release (CuTR) and/or ulnar nerve transposition surgery by summing all payments for claims within 90 days after the index surgery. Published estimates of the annual number of cubital tunnel surgeries were used to calculate the annual expenditure. Of 41,777 patients, the median (interquartile range [IQR]) values of total direct payments were $5,522 [$3,426, $9,541]. With an estimated 94,645 cases/year, this leads to an annual payment of more than $522 million. Index facility payments (median[IQR] $2,555 [$1,359, $4,708] were the highest, followed by index provider payments ($1,691 [$1,328, $2,217]). The median index surgeon payment (median[IQR] $905 [$707, $1,184]) represented just over half of the provider payments. Post-operative care had a median [IQR] payment of $377 ($424, $1,987). Limitations of claims databases prevented assessment of other indirect costs associated with cubital tunnel surgery. Payments for the surgical treatment of CuTS from the index surgery to 90 days post-operatively have an estimated median of $5,522 per patient, totaling $52 million annually. Index facility fees are responsible for more than 46% of payments, while index payments to surgeons represent approximately 16%. Defining this data is critical to understanding one component of the economic impact of CuTS. Level IV.

Clip versus coil shift for aneurysm treatment in Brazil: an exploratory analysis of trends in a 10-year time-series.

Regarding intracranial aneurysm treatment, the clip versus coil debate remains inconclusive and lacking studies in Brazil. To examine trends in the management of intracranial aneurysms in Brazil over time, both ruptured and unruptured. A descriptive and exploratory study was conducted based on data of neurovascular procedures for aneurysm treatment using the Brazilian Public Health System database (DATASUS). The variables analyzed were the number of procedures, mortality rates, length of hospital stays, and global costs of hospitalization, from 2010 to 2019. Temporal trend analysis and statistical comparisons were conducted to assess changes over time and differences between the treatment options. The mean annual number of aneurysm treatments with endovascular embolization was 2206.30 (± 309.5), with a non-significant increasing trend (B = 55.66; p = 0.104). Conversely, microsurgical clipping exhibited a significant decreasing trend (B = -69.97; p < 0.001) with a mean of 1133.1 (± 223.12) procedures. The mortality rate associated with clipping procedure was higher in the period, with a mean difference of 5.23 (± 0.39); ([CI95%: 4.36; 6.10]; p < 0.001) and showed an increase trend, while embolization showed a stable trend. The length of in-hospital stay remained stable for clipping but increased for embolization. Costs associated with clipping increased over time, whereas costs for embolization decreased. This study highlights a significant shift in the treatment of aneurysm towards Endovascular Embolization. Despite higher costs, endovascular procedures were associated with lower mortality rates and shorter hospital stays. These findings provide valuable insights into aneurysm treatment patterns and indicators in a middle-income country's Public Health System.

Effects of a Prophylactic Treatment with Horseradish Root and Nasturtium Herb on Urinary Tract Infections in Individuals with Chronic Neurogenic Lower Urinary Tract Dysfunction: A Retrospective Cohort Study

Introduction: Recurrent urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) and greatly affect their quality of life. There is currently no established prophylactic measure based on evidence. We have therefore evaluated the effects of a horseradish root and nasturtium herb product on the frequency of UTIs in a retrospective cohort. Methods: Clinical data of patients with chronic NLUTD who were receiving the phytotherapeuticum for at least 12 months were analyzed. The number of UTIs was categorized as no UTIs, sporadic UTIs (1–2/year) and recurrent UTIs (≥3/year). The change in the annual number of patient-reported symptomatic UTIs and antibiotic prescriptions was investigated. Results: Data of 43 individuals (mean age 49 ± 13 years, median NLUTD duration 17.9 years) were analyzed. The proportion of individuals with recurrent UTIs decreased significantly (p < 0.0001) from 58.1% (42.1–73.0%) to 23.3% (11.8–38.6%) during phytotherapy, whereas the proportion of individuals without UTIs increased significantly (p = 0.001) from 14.0% (5.3–27.9%) to 39.5% (25.0–55.6%). In addition, there was a significant (p = 0.008) decrease in the number of antibiotic prescriptions. Conclusion: Prophylactic treatment with horseradish root and nasturtium herb seems to be a promising option for the prevention of UTIs.

A cross-sectional epidemiological study of animal bite victims in district hospital Alwar, Rajasthan, India

Background: Rabies, an invariably fatal viral disease, transmitted to humans through animal bites, mostly dogs. According to WHO, each year, 23000-25000 people die in the SEA region due to rabies. These accounts for approximately 45% human deaths due to rabies worldwide. Objective was to study epidemiological trend of animal bite in Alwar district hospital. Methods: A retrospective, record-based study was conducted in 200 animal bite victims presenting to district hospital Alwar, Rajasthan wherein information on monthly number of animal bite cases was collected from records section of the hospital. Information on annual number of animal bite cases was available from the annual report of the hospital from 2018 onwards, this data was used for studying the monthly variation in animal bite cases. Data were compiled and analyzed using Microsoft Excel. Results: Among 200 victims 76.3% were males, 56.7% belongs to 15-45 years, 61.6% were living in urban area, 31.3% and 21.7% of the victims were agriculture worker and laborers respectively. Among 95.8% victims bitten by dog, 89% of them were stray. 89.4% had category III bite, lower extremity affected in 60.8%, fate of animal was unknown in 78.6% and 46% of the victims were bitten during evening hours. Conclusions: Majority of bites were by stray dogs, unprovoked and category III bites. This indicates the need of large amount of anti-rabies serum or HRIG thereby increasing the cost of management of animal bite cases. There is a need to control stray dog population and immunize pet dogs.

Assessing Past and Future Heat and Cold Waves over Iraq Using CMIP6 Model

The United Nations classified Iraq as one of the most vulnerable countries to climate change. Temperatures continue to rise leading to more heat waves, droughts, sandstorms, and desertification. This study aims to investigate the characteristics of heat waves over Iraq from 1982 to 2050 using CMIP6 model at RCP4.5 scenarios. The results clearly showed that the effects of climatic changes were evident in the maximum and minimum temperatures inside Iraq. Average temperature increased of 1.9°C between 1982 and 2020. During 1999, there was a sharp increase in summer days for all stations. The annual number of summer days for the stations (Basra, Nasiriyah, Baghdad, Rutba, Sulaymaniyah, and Mosul) was (195, 193, 177, 108, 106, and 142), while in 2039 the number of summer days was found to be (212, 206, 194, 143, 144, and 149), respectively. The increase in the number of discrete heat wave events began in 2020 and will continue until 2050 for almost the entire territory of Iraq. The warmest day in Basra was in July 2016 with 53.2°C, while the projection of the warmest day was found in July 2046 with 55.7°C. The coldest daily temperature reached -5.03 °C for Baghdad in 1997 and -10.1°C for Sulaymaniyah in 1985, while the projection of the coldest day was -16.2°C over Sulaymaniyah in 2039. The trend of the number of days contributing to cold wave events was decreasing for all stations whereas the coldest year for all stations was 1992 for the entire period (1982 to 2020). Heat waves accelerated from the beginning of the study period in 1982 and continued to increase until the end of the study in 2050 in Iraq.

Quantitative Measurement of the Direct Public Health Impact of Medicines Withdrawals in Europe: Development of a Modelling Method and Proof-of-Concept Study to Estimate the Morbidity and Mortality Prevented by Regulatory Action.

Removing medicines from market may benefit public health by preventing adverse drug reactions (ADRs), which should be quantified. This study's aim was to identify a model to quantify the impact of medicines' marketing authorisation (MA) withdrawal and revocation in terms of preventing morbidity and mortality. MA withdrawals and revocations for safety reasons in France, Germany and/or the United Kingdom between July 2012 and December 2016 were identified for prescription medicines. Annual exposure was estimated for each medicine, using IQVIA Medical Research Data (IMRD)-France, IMRD-Germany and IMRD-UK primary care electronic health record databases. European Medicines Agency records provided reasons for regulatory action for each medicine. Absolute risks of ADRs which led to MA withdrawal were estimated for patients exposed to each medicine by systematic review of quantitative research. Public health impact, expressed as annual number of ADRs avoided, was estimated by modelling exposure and ADR risk. Four MA withdrawals and two revocations met study inclusion criteria. Each product's usage decreased following MA withdrawal or revocation. Absolute risk for ADRs was 0.1%-41.25%. To estimate impact of each withdrawal or revocation, its average annual exposure within each IMRD population was multiplied by the absolute risk to give the crude number of ADRs prevented annually due to regulatory action. This model quantifies the public health impact of MA withdrawal and revocation in terms of serious morbidity, resulting from eliminated or reduced usage of medicines. This method can be applied to products in other settings to quantify the impact of other pharmacovigilance actions.

Assessing the impact of climate change and reservoir operation on the thermal and ice regime of mountain rivers using the XGBoost model and wavelet analysis

This study presents an analysis of the influence of climatic conditions and the operation of a dam reservoir on the occurrence of ice cover and water temperature in two rivers (natural and transformed by reservoir operations) located in the Carpathian Mountains (central Europe). The analyses are based on data obtained from four hydrological and two climatological stations. The Extreme Gradient Boosting (XGBoost) machine learning model was used to quantitatively separate the effects of climate change from the effects arising from the operation of the dam reservoir. An analysis of the effects of reservoir operation on the phase synchronization between air and river water temperatures based on a continuous wavelet transform was also conducted. The analyses showed that there has been an increase in the average air temperature of the study area in November by 1.2 °C per decade (over the period 1984–2016), accompanied by an increase in winter water temperature of 0.3 °C per decade over the same period. As water and air temperatures associated with the river not influenced by the reservoir increased, there was a simultaneous reduction in the duration of ice cover, reaching nine days per decade. The river influenced by the dam reservoir showed a 1.05 °C increase in winter water temperature from the period 1994–2007 to the period 1981–1994, for which the operation of the reservoir was 65% responsible and climatic conditions were 35% responsible. As a result of the reservoir operation, the synchronization of air and water temperatures was disrupted. Increasing water temperatures resulted in a reduction in the average annual number of days with ice cover (by 27.3 days), for which the operation of the dam reservoir was 77.5% responsible, while climatic conditions were 22.5% responsible.

The Impact of GeneXpert Cerebrospinal Fluid Testing on Tuberculous Meningitis Diagnosis in Routine Care in Botswana

Abstract Background Tuberculous meningitis (TBM) disproportionately impacts high–HIV prevalence, resource-limited settings where diagnosis is challenging. The GeneXpert platform has utility in TBM diagnosis, but uptake remains limited. In Botswana, before the introduction of GeneXpert, tuberculosis (TB) testing was only available through mycobacterial culture at the National TB Reference Laboratory. Data describing routine use of Xpert MTB/RIF for cerebrospinal fluid (CSF) testing in resource-limited settings are scarce. Methods Electronic records for patients with CSF tested in government facilities in Botswana between 2016 and 2022 were obtained from a central online repository as part of ongoing national meningitis surveillance. Samples were excluded from 1 site where Xpert MTB/RIF is performed universally. The proportion receiving TB-specific investigation on CSF and the number positive for Mycobacterium tuberculosis following increased Xpert MTB/RIF capacity were determined. Results The proportion of CSF samples receiving TB-specific investigation increased from 4.5% (58/1288) in 2016 to 29.0% (201/693) in 2022, primarily due to increased analysis with Xpert MTB/RIF from 0.9% (11/1288) to 23.2% (161/693). There was an overall decline in the annual number of CSF samples analyzed, but the proportion with microbiologically confirmed TBM increased from 0.4% to 1.2%. The proportion of samples tested for TB that were collected from health care facilities &amp;gt;100 km from the National TB Reference Laboratory increased with Xpert MTB/RIF rollout from 65.9% (87/132) to 78.0% (494/633). Conclusions In Botswana, access to TB culture is challenging in remote populations; more accessible near-patient testing using Xpert MTB/RIF increased the number of patients receiving TB-specific testing on CSF and the number of confirmed TBM cases.

Do Babesia microti Hosts Share a Blood Group System Gene Ortholog, Which Could Generate an Erythrocyte Antigen That Is Essential for Parasite Invasion?

The United States of America (US) has the highest annual number of human babesiosis cases caused by Babesia microti (Bm). Babesia, like malaria-causing Plasmodium, are protozoan parasites that live within red blood cells (RBCs). Both infectious diseases can be associated with hemolysis and organ damage, which can be fatal. Since babesiosis was made a nationally notifiable condition by the Centers for Disease Control and Prevention (CDC) in January 2011, human cases have increased, and drug-resistant strains have been identified. Both the Bm ligand(s) and RBC receptor(s) needed for invasion are unknown, partly because of the difficulty of developing a continuous in vitro culture system. Invasion pathways are relevant for therapies (e.g., RBC exchange) and vaccines. We hypothesize that there is at least one RBC surface antigen that is essential for Bm invasion and that all Bm hosts express this. Because most RBC surface antigens that impact Plasmodium invasion are in human blood group (hBG) systems, which are generated by 51 genes, they were the focus of this study. More than 600 animals with at least one hBG system gene ortholog were identified using the National Center for Biotechnology Information (NCBI) command-line tools. Google Scholar searches were performed to determine which of these animals are susceptible to Bm infection. The literature review revealed 28 Bm non-human hosts (NHH). For 5/51 (9.8%) hBG system genes (e.g., RhD), no NHH had orthologs. This means that RhD is unlikely to be an essential receptor for invasion. For 24/51 (47.1%) hBG system genes, NHH had 4-27 orthologs. For the ABO gene, 15/28 NHH had an ortholog, meaning that this gene is also unlikely to generate an RBC antigen, which is essential for Bm invasion. Our prior research showed that persons with blood type A, B, AB, O, RhD+, and RhD- can all be infected with Bm, supporting our current study's predictions. For 22/51 (43.1%) hBG system genes, orthologs were found in all 28 NHH. Nineteen (37.3%) of these genes encode RBC surface proteins, meaning they are good candidates for generating a receptor needed for Bm invasion. In vitro cultures of Bm, experimental Bm infection of transgenic mice (e.g., a CD44 KO strain), and analyses of Bm patients can reveal further clues as to which RBC antigens may be essential for invasion.