Segmented Regression Research Articles

Analysing hurricane-induced power outage using VIIRS/DNB time series: comparisons of three automated detection approaches

ABSTRACT Hurricanes are one of the primary causes of major power outages. Understanding the damage and recovery of the electricity system is useful to repair damaged power plants and transmission lines as well as improve electricity infrastructure resilience. Two major issues in the literature regarding disaster recovery estimation using night-time light (NTL) imagery limit future studies. One is the lack of automatic detection, and the other is the simplification of recovery assessment assuming the post-disaster level can return to the previous status. In this study, we proposed three methods including automated valley detection (AVD), segmented regression and autoregressive integrated moving average (ARIMA) model. Based on NTL time series data from January 2014 to July 2019, we applied these three approaches to measure power outage recovery in 2017 hurricane Maria in Puerto Rico. By comparing results derived from these three techniques, we find that the AVD model outperforms the other two methods, in terms of its robustness and accuracy, in assessing power outage recovery duration in a natural disaster event. The proposed method is valuable in capturing disaster information on different domains such as other critical urban infrastructure, economic activities and building typologies.

Controls on spatial variation in porewater methane concentrations across United States tidal wetlands

Tidal wetlands can be a substantial sink of greenhouse gases, which can be offset by variable methane (CH4) emissions under certain environmental conditions and anthropogenic interventions. Land managers and policymakers need maps of tidal wetland CH4 properties to make restoration decisions and inventory greenhouse gases. However, there is a mismatch in spatial scale between point-based sampling of porewater CH4 concentration and its predictors, and the coarser resolution mapping products used to upscale these data. We sampled porewater CH4 concentrations, salinity, sulfate (SO42−), ammonium (NH4+), and total Fe using a spatially stratified sampling at 27 tidal wetlands in the United States. We measured porewater CH4 concentrations across four orders of magnitude (0.05 to 852.9 μM). The relative contribution of spatial scale to variance in CH4 was highest between- and within-sites. Porewater CH4 concentration was best explained by SO42− concentration with segmented linear regression (p < 0.01, R2 = 0.54) indicating lesser sensitivity of CH4 to SO42− below 0.62 mM SO42−. Salinity was a significant proxy for CH4 concentration, because it was highly correlated with SO42− (p < 0.01, R2 = 0.909). However, salinity was less predictive of CH4 with segmented linear regression (p < 0.01, R2 = 0.319) relative to SO42−. Neither NH4+, total Fe, nor relative tidal elevation correlated significantly with porewater CH4; however, NH4+ was positively and significantly correlated with SO42− after detrending CH4 for its relationship with SO42− (p < 0.01, R2 = 0.194). Future sampling should focus on within- and between-site environmental gradients to accurately map CH4 variation. Mapping salinity at sub-watershed scales has some potential for mapping SO42−, and by proxy, constraining spatial variation in porewater CH4 concentrations. Additional work is needed to explain site-level deviations from the salinity-sulfate relationship and elucidate other predictors of methanogenesis. This work demonstrates a unique approach to remote team science and the potential to strengthen collaborative research networks.

Analysing the effects of National Centralised Drug Procurement and Price Negotiation Policies on novel hypoglycaemic drug usage and costs in Shanghai, China: an interrupted time series analysis

ObjectivesTo analyse the impacts of multiple rounds of National Centralised Drug Procurement Policy (NCDP) and National Drug Price Negotiation Policy (NDPN) on the utilisation, expenditure and daily cost of novel...

Carotid-femoral pulse wave velocity score, an estimator of cognitive performance in the elderly: results from the Toledo Study for Healthy Aging.

Ageing-related changes in the vascular wall influence the function of different organs; for this reason, we assessed how arterial stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) modulates: the basal cognitive performance and the change in cognitive performance over the follow-up time. We developed a prospective, population-based cohort study with 1581 participants aged > 65years were obtained from the Toledo Study for Healthy Aging. Participants from the second wave (2011-2013) were selected for the cross-sectional analysis. Those who also performed the cognitive assessment in the third wave (2015-2017) were selected for the prospective analysis. Arterial stiffness was evaluated by cf-PWV. Multivariate segmented regression models were used to evaluate the association between cf-PWV scores and basal neuropsychological evaluation scores and change of neuropsychological evaluation scores along follow-up. Cross-sectional analysis showed that as cf-PWV grew within the cf-PWV (5- < 10) category an improvement was observed in 7-min test, free short-term memory, and hole peg test. Furthermore, in the cf-PWV (> 13-18) category a decrease was observed in total short-term memory, free long-term memory, and total long-term memory. Prospective analysis showed a progressive worsening of cognitive function as cf-PWV increases within the cf-PWV (> 13-18) category in 7-min test, object denomination, immediate and short-term memory, and hole peg test, while in the cf-PWV (5- < 10) category, there was observed a decrease in Cumulative Executive Dysfunction Index score and short-term memory. In conclusion, a higher cf-PWV score is associated with worse cognitive performance, and with a worse evolution, reinforcing the need to plan interventions to delay arterial stiffness and its consequences.

Prolonged ischaemia during partial nephrectomy: impact of warm vs cold.

To evaluate the impact of prolonged ischaemia during partial nephrectomy (PN), which remains understudied despite its potential clinical relevance. Of 1371 patients managed with on-clamp PN (2011-2014), 759 (55%) had imaging and assessment of serum creatinine levels before and after PN within the appropriate timeframes necessary for inclusion. This timeframe was chosen to allow for a robust analysis of both warm and cold ischaemia. Recovery from ischaemia (Recischaemia) was defined as ipsilateral glomerular filtration rate (GFR) preserved, normalized by percentage ofparenchymal volume preserved (PPVP), and would be 100% if all nephrons recovered completely from ischaemia. Pearson correlation and multivariable linear regression models were used to assess associations between Recischaemia and ischaemia type and duration. Of 759 patients, 525 (69%) were managed with warm ischaemia. The median warm/cold ischaemia times were 22 and 30 min, respectively. Overall, the median percent ipsilateral GFR preserved, PPVP and Recischaemia were 79%, 83% and 96%, respectively. Segmented regression analysis demonstrated substantially greater decline in Recischaemia, beginning at approximately 30 min for warm ischaemia, which was not observed for hypothermia. Prolonged ischaemia (defined as >30 min) occurred in 197 patients (26%; 88 warm/109 cold). For limited ischaemia (≤30 min), hypothermia was often used for tumours with increased tumour size and complexity (P < 0.01), while for prolonged ischaemia, the warm/cold subgroups had similar patient and tumour characteristics. For limited ischaemia and prolonged hypothermia, median Recischaemia remained >95%, independent of ischaemia time. Differences in Recischaemia between the warm and cold cohorts became significant only after 30 min (P < 0.05). On multivariable analysis, prolonged warm ischaemia was associated with reduced Recischaemia (P = 0.02), which fell 3.9% for every additional 10 min beyond 30 min. Our data suggest that Recischaemia begins to decline significantly after 30 min during PN, although hypothermia was protective. Avoidance of prolonged warm ischaemia should be prioritized in patients with solitary kidneys and/or significant pre-existing chronic kidney disease.

Petrol Prices, Food Prices, and Inflation Perceptions in New Zealand—Evidence From a Threshold Analysis

ABSTRACTInflation perceptions shape inflation expectations. However, little is known about the factors influencing these perceptions. In this study, we address this gap by employing threshold regressions to analyze the associations between changes in petrol and food prices—two of the most conspicuous prices—and inflation perceptions in New Zealand. Findings reveal a positive association between petrol and food price inflation on the one hand and inflation perceptions on the other, with some evidence suggesting closer associations for food price inflation. Furthermore, the relationships do not change when high inflation rates are considered instead of low inflation rates. Finally, inflation perceptions are more closely related to petrol and food price inflation over the previous year than just the most recent quarter.

Impact of the COVID-19 Pandemic on the Detection of Leprosy in Micro-Regions with a High Risk of Illness in Minas Gerais, Brazil

Background: Leprosy control remains challenging in Brazil and has been aggravated by the COVID-19 pandemic. Objective: To analyze the impact of the COVID-19 pandemic on the epidemiological scenario of leprosy through the detection rate of new cases, the risk of illness, and the hidden prevalence of leprosy according to high-risk micro-region in Minas Gerais, Brazil. Methods: An ecological study conducted in the health micro-regions of Minas Gerais, using data on new leprosy cases diagnosed between 2015 and 2023. The annual detection rate of new cases, the risk of illness index and the hidden prevalence of leprosy were evaluated. The time trend was evaluated by calculating the annual percentage change (APC) of the detection rate, based on segmented linear regression, considered significant when it showed p &lt; 0.05. Results: The state of Minas Gerais showed a significant negative annual increase between 2015 and 2020 (APC = −7.91; 95%CI −21.76–−1.72), and in 2020 it showed an inflection point, with an annual increase of 9.91 in the period from 2020 to 2023. When evaluating the hidden prevalence of leprosy in Minas Gerais, we observed a reduction in the estimates’ average from 2015–2019 (2.78) to 2020–2023 (2.00). The state as a whole showed an upward trend in the risk of illness, with the average index varying from 0.28 (medium risk) to 0.55 (high risk). Conclusions: The pandemic has had a considerable and heterogeneous impact on the detection of new cases, as well as on the risk of becoming ill and the hidden prevalence of leprosy, with repercussions for the control of the endemic in populations. There is a need to implement public health policies that prioritize the early identification of cases and ensure that vulnerable populations are monitored.

Association between early fluid balance and outcomes in patients receiving continuous renal replacement therapy for cardiac surgery-associated acute kidney injury

Objective: To evaluate the association between fluid balance within 48 hours after initiating continuous renal replacement therapy (CRRT) and 90-day mortality of patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: Adult patients who received CRRT for CSA-AKI for more than 24 hours between January 2016 and December 2021 in the First Affiliated Hospital of Nanjing Medical University were prospectively included. Exposures were fluid input, fluid output, fluid balance and percentage of fluid overload change (defined as weight-standardized fluid input/output difference) within 48 hours after CRRT initiation. The primary outcome was 90-day mortality. The relationship between the exposures and 90-day mortality was determined by restricted cubic spline and segmented Cox regression. Results: The study enrolled 262 patients, and 90-day mortality was 60.3% (158/262). There were 171 males and 91 females, with a median age of 64 (54, 71) years. The dead patients (n=158) had more fluid input [6.43 (5.62, 7.34) L vs 6.07 (5.09, 6.90) L, P=0.013], greater fluid balance [-0.01 (-1.36, 1.34) L vs -0.65 (-1.71, 0.42) L, P=0.005] and higher percentage of fluid overload change [-0.01% (-2.17%, 2.01%) vs -0.85% (-2.49%, 0.52%), P=0.013] within 48 hours after CRRT initiation than the survived patients (n=104). The cumulative fluid balance and fluid overload changes have a "J" curve relationship with 90-day mortality. Higher positive fluid balance (adjusted HR per 1 L increase above 0.5 L=1.33, 95%CI: 1.17-1.50) and greater proportion of fluid overload changes (adjusted HR per 1% increase above 0.7%=1.20, 90%CI: 1.11-1.30) were associated with an increased risk of death. Cumulative fluid input was linearly related to the 90-day mortality. Higher input (adjusted HR per 1 L increase=1.13, 95%CI: 1.03-1.24) was associated with an increased risk of death. The cumulative fluid output showed a U-shaped relationship with risk of death. Both lower output (adjusted HR per 1 L increase below 6.7 L=0.73, 95%CI: 0.58-0.90) and higher output (adjusted HR per 1 L increase above 6.7 L=1.24, 95%CI: 1.01-1.53) were associated with increased risk of death. Conclusion: In patients with CSA-AKI, excessive fluid input, insufficient or excessive output and a positive fluid balance or percentage of fluid overload change within the first 48 hours after CRRT initiation are associated with increased risk of 90-day mortality.

Analysis of Underdeveloped Regency Using Logistic Threshold Regression Model

Regional development inequality causes some regions to lag behind other regions. An underdevelopedregency is a regency where territories and people are less developed than other regions nationally. Thegovernment has set a Human Development Index (HDI) target of 62.2 to 62.7 to accelerate the development of underdeveloped regency and prevent the regions from lagging. This study aims to evaluatethe HDI target and obtain the HDI value that reduces the risk of underdeveloped regency and acquiresvariables that affect underdeveloped regency’s status. The logistic threshold regression model is usedin this study with HDI as the threshold variable, 22 indicators for determining underdeveloped regencyas explanatory variables, and the underdeveloped regency’s status as the response variable. Thresholdregression can handle non-linear relationships between response and explanatory variables, includingvarious types of threshold models such as step, segmented, hinge, stegmented, and upper hinge. By applying a hinge threshold regression model using the R package ’chngpt,’ this study addresses non-linearrelationships and categorical responses. The results showed a threshold effect with a threshold value of62.9, indicating that the HDI target can reduce the region’s risk of being left behind.

Excessive External Borrowing in China: Evidence from a Nonparametric Threshold Regression Model with Fixed Effects

We investigated the excessive external financing problem in Chinese industrial firms by examining the potential threshold effect of the leverage ratio on the total factor productivity of firms. We hypothesized the existence of a turning point in leverage ratio at which the productivity of these firms is maximized, and this point may vary by firm ownership type. To test our hypotheses, we proposed a nonparametric panel threshold regression model. From a modeling perspective, our approach contributes to the literature by allowing the threshold variable to be endogenous, accounting for unobserved firm heterogeneities, and imposing no restrictions on the functional form of regression. We employed a two-step estimation procedure, first estimating the threshold using an extreme kernel estimator and then conducting local linear regression based on the estimated threshold. We obtained standard errors via bootstrapping and demonstrated the favorable numerical performance of our estimator through simulation studies. Consistent with our hypotheses, we found that excessive leverage relative to the identified turning point significantly restrains productivity growth. Additionally, the estimated turning point varies by ownership type, particularly in state-owned enterprises (SOEs), where leverage exceeding the threshold negatively impacts productivity. Consequently, regions with a higher concentration of SOEs experience stagnant productivity growth. Our results were statistically supported by nonparametric tests and remained consistent when using leverage growth rate as an alternative measure of external financing.

Impact of COVID-19 on the utilisation of maternal health services in Bangladesh: A division-level analysis.

The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic. Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019). Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery. The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

Spatial and Temporal Analysis of Hospitalizations Due to Primary Care-Sensitive Conditions Related to Diabetes Mellitus in a State in the Northeast of Brazil.

Hospitalizations due to primary care-sensitive conditions (PCSCs) can be considered a proxy for the effectiveness of primary healthcare (PHC), especially diabetes mellitus (DM). The aim of this study was to analyze the temporal, spatial, and space-time patterns of PCSCs associated with DM in a state in Northeast Brazil from 2008 to 2022. An ecological and time-series study that included all records related to PCSCs-DM from the 75 municipalities of Sergipe was conducted. Segmented linear regression, global (I) and local (LISA) Moran indices, spatial scanning, Spearman correlation tests, bivariate I, and LISA were used in our analysis to examine the temporal trends and clusters of high spatial risk. Overall, 14,390 PCSCs-DM were recorded between 2008 and 2022. There was a higher prevalence of PCSCs-DM among women (53.75%) and individuals over 70 years old (57.60%). Temporal trends in PCSCs-DM were increasing with regard to the overall rate (AAPC: 2.39); males (AAPC: 3.15); age groups ≤ 19 years (AAPC: 6.13), 20-39 years (AAPC: 4.50), and 40-59 years (AAPC: 2.56); and 3 out of the 7 health regions. There was a positive spatial correlation between per capita income (I = -0.23; p = 0.004) and diabetic foot examination being performed by a nurse in a PHC (I = -0.18; p = 0.019) setting. The heterogeneous spatial distribution of DM hospitalizations demonstrated that this condition is a persistent public health problem in Sergipe.

Has lake brownification ceased? Stabilization, re-browning, and other factors associated with dissolved organic matter trends in eastern Canadian lakes

The increase in dissolved organic carbon (DOC) concentrations in freshwater systems has received considerable attention due to its implications for drinking water treatment and numerous limnological processes. While past studies have documented the influence of recovery from acidification and climate change on long-term DOC trends, the emerging importance of these explanatory factors remains less understood. In addition, few studies have followed up on recent trends in sites that have undergone increases in DOC. Using a dataset from 1980 to 2020, we investigated interannual variations in DOC and dissolved organic nitrogen (DON) in 49 lakes across four eastern Canadian regions with a history of increases in DOC. We identified recent shifts in DOC patterns using LOESS smoothing and piecewise regression. We observed a stabilizing pattern or even a decrease (p < 0.001) in high acidification regions (Dorset and Nova Scotia), where increases in DOC were previously documented. At the low acid deposition region, IISD-Experimental Lakes Area, an increasing pattern in DOC stabilized in the early 2000s; however, DOC appears to be increasing again in recent years (p = 0.03). Our analysis identified precipitation and SO4 deposition as the primary explanatory variables for DOC patterns (explaining 56–71% of variance). However, because acid deposition has declined substantially, climate and local watershed factors are becoming increasingly influential, leading to the emergence of new DOC patterns. Long-term changes in DOC and DON were not always synchronous, as these were often correlated with different factors (e.g., DON with ammonium deposition). This resulted in observable shifts in DOC:DON ratios, indicative of changes in dissolved organic matter (DOM) composition. We underscore the importance of ongoing monitoring in diverse regions because of the changing nature of environmental variables and new emerging trends.

Trend of hand, foot and mouth disease before, during, and after China's COVID control policies in Zhejiang, China.

To describe the trends in the incidence of hand, foot and mouth disease (HFMD) before, during, and after China's Coronavirus Disease (COVID) control policies, and to interpret the influence on HFMD incidence at different control stages in Zhejiang Province. We collected data on HFMD cases in Zhejiang between 2014 and 2023. We compared the constituent ratios of cases at different COVID control stages by sex, age, child groups, and pathogens and weekly seasonal indices to observe seasonal variations in the incidence of HFMD. An interrupted time-series segmented regression analysis was applied to estimate the influence on HFMD incidence at different control stages. Stratified and sensitivity analyses were conducted to validate the findings. A considerable proportion of cases occurred among children living separately. The proportions of children in kindergartens or nurseries and children aged 2-4 years were relatively low at the strict control stage compared to the other three stages. Enteroviruses other than enterovirus 71 and coxsackie virus A16 were the dominant HFMD pathogens, and the proportion showed an increasing trend. The usual spring-summer peak in HMFD incidence did not occur in 2020, and the periodicity of the biennial peak was disrupted for a year. The summer peak in 2023 was higher than that in the other years, and was delayed by 3 weeks. The trend changes in weekly HFMD cases during the strict control and regular control stages were - 15% (IRR: 0.85, 95% CI: 0.81-0.89) and 17% (IRR: 1.17, 95% CI: 1.12-1.23), respectively. However, the change was not statistically significant during the reopening stage (IRR: 1.41, 95% CI: 0.34-5.88). The expected number of cases increased by 1.12 times (95% CI: 243.17, 53.45%) during the reopening stage compared to what would have occurred if the zero-COVID policy had continued in 2023. Non-pharmaceutical interventions (NPIs) for COVID-19 control can mitigate HFMD. However, after the dynamic zero-COVID policy ended, the HFMD incidence returned to historical levels. Strict NPIs such as traffic restrictions and kindergarten closures cannot be sustained long-term. NPIs such as improving personal hygiene for routine prevention are highly recommended.

Influence of Digital Economy on Urban Energy Efficiency in China

The digital economy (DE) is characterized by invention, low energy consumption, cross-sector integration, and open sharing. It can effectively enhance social production methods, influence consumer behavior, and provide new pathways to enhance total factor energy efficiency (TFEE). This paper studies 280 Chinese cities, employing the entropy method and data envelopment analysis (DEA) model to evaluate and analyze urban DE and TFEE. It also constructs a system generalized method of moments model (SGMM model) and a threshold regression model (TR model) to examine the impact of the DE on TFEE in China. The main study findings include the following: (1) The regression results of the SGMM model indicate that the effect of DE on TFEE in Chinese cities shows a U-shaped trend. (2) The regression results of the TR model further confirm a U-shaped association connecting DE and TFEE, with the threshold estimated at 0.304. (3) The economic factors and industrial structure have a major impact on inhibiting the improvement of TFEE, whereas technological advancements and environmental regulations significantly facilitate its improvement.

Global thresholds for the climate-driven effects of vegetation restoration on runoff and soil erosion

Runoff generation is intimately related to topography, climate, and vegetation. However, the combined impacts of different vegetation restorations on runoff under global climate change have not been quantitatively assessed. When climate exceeds specific thresholds, the inhibitory effect of vegetation restoration on runoff may diminish. Here, we collected 771 observations for meta-analysis and used segmented regression to determine the global threshold response of vegetation restoration for climate-related variables on runoff and soil erosion. We found the effect of vegetation restoration in inhibiting soil erosion and runoff increased when MAP (mean annual precipitation) exceeded the thresholds of about 331 mm and 540 mm, respectively. Furthermore, at rainfall intensity above the threshold of 48 mm/h, the effect of vegetation restoration on erosion control increases. Comprehensive analysis indicates that grassland revegetation is more successful in decreasing of runoff and soil erosion in the North Temperate Zone. Temperature and precipitation directly or indirectly influenced the effects of shrubland runoff reduction, and the relationship varied with changes in temperature and precipitation. Our findings contribute to guiding regional governments and decision makers in developing and implementing rational vegetation restoration measures for sustainable water resource management in the future.

The Influence of Population Aging on Living Carbon Emissions in the Yellow River Basin: Comparisons Between Urban and Rural Areas

ABSTRACTPopulation aging presents a major challenge to China's economic and social development. While some research has addressed the relationship between population aging and energy consumption or generalized carbon emissions, its impact on living carbon emissions has been less explored. This study uses provincial panel data from the Yellow River Basin (2006–2020) and employs a threshold regression model to analyze the relationship between population aging and living carbon emissions. A Multiple Mediation Effect Model is also applied to explore the mechanisms behind this relationship, with a comparative analysis between urban and rural areas. The results indicate a U‐shaped nonlinear effect of population aging on living carbon emissions, which are initially inhibited and then promoted, with different “turning points” for rural and urban regions. As income levels rise, population aging has a marginally increasing effect on living carbon emissions. However, upgrading the consumption expenditure structure, expanding family size, and increasing clean energy consumption can help mitigate the promoting effect of aging on emissions. The mediation model identifies four pathways through which population aging influences living carbon emissions, with income level and consumption expenditure structure playing key roles. This study offers policy insights for addressing urban‐rural disparities and fostering sustainable regional development.

Impact of the COVID-19 pandemic on breast cancer surgeries in a Canadian population.

The COVID-19 pandemic significantly impacted breast cancer (BC) surgeries. Most studies showing reduced BC surgical volumes during the pandemic are from single institutions, few have described volume changes in different types of surgical procedures. This study aimed to assess the impact of the pandemic on BC surgery volumes and types at a population level. Patients diagnosed with BC between January 1, 2018, and June 25, 2022, in Ontario, Canada, were analysed from population-based datasets. Time periods were defined as pre-pandemic (Jan 2018-Mar 2020), immediate pandemic (Mar-Jun 2020), and peri-pandemic (Jun 2020-Jun 2022). Weekly BC surgery volume and type (lumpectomy, mastectomy, or mastectomy with immediate reconstruction) were evaluated using segmented negative binomial regression models. Among 44 226 patients, 50 440 surgeries were performed. Weekly BC surgeries decreased by 16.9% during the immediate pandemic compared to pre-pandemic levels (180.5 vs. 217.1; p = 0.03). Surgical volumes recovered to pre-pandemic levels by June 2021. Mastectomies represented a higher proportion of BC surgeries during the pandemic (31.1% pre, 36.3% immediate, 32.4% peri-pandemic; p < 0.01). The proportion of mastectomies with immediate reconstruction remained stable during the immediate pandemic but increased in the peri-pandemic (20.1% vs. 17%; p < 0.01). There was a significant reduction in all BC surgeries during the pandemic. Mastectomies accounted for a higher proportion of BC surgeries in the pandemic period however access to reconstruction was maintained. Surgical volumes recovered within a year despite ongoing pandemic hospitalizations. Future studies are needed to explore the pandemic's long-term impact on BC care.

Effects of COVID-19, control measures, and program adaptation on prevention of mother-to-child HIV transmission service uptake in Central Region, Uganda

BackgroundCoronavirus disease 2019 (COVID-19) control measures presented impediments for prevention of mother-to-child transmission of HIV (PMTCT) programming in Uganda. Nationwide control measures implemented April—June 2020 included a public transport ban and mandatory travel permits for pregnant women to access clinics. Program adaptations instituted for continuity of services included community drug delivery and home-based DNA-PCR testing for HIV-exposed infants (HEI). We examined the effect of COVID-19 control measures and program adaptations on PMTCT service uptake in central Uganda.MethodsWe analysed data for pregnant women living with HIV (WLHIV) and HEI receiving PMTCT services in eight districts in central Uganda. We abstracted data from medical records at 96 public clinics for six months pre-lockdown (October 2019–March 2020), three months of lockdown (April–June 2020), and six months post-lockdown (July–December 2020). We measured monthly antiretroviral therapy (ART) refill attendance, health facility deliveries, and timely DNA-PCR testing of HEI for HIV (within two months of birth). We conducted segmented ordinary least squares regression of interrupted time series and adjusted for month-to-month changes using Cumby-Huizinga test. We reported results using coefficients and 95% confidence intervals (CIs).ResultsAt the start of pre-lockdown (October 2019), there were 448 deliveries, 2,676 ART refills and 556 timely HEI tests. The pre-lockdown trend for ART refills increased while deliveries and HEI tests declined. At the start of lockdown (April 2020), all indicators declined, although significantly for facility deliveries (-60; 95% CI: -102, -18). Lockdown monthly trends were positive with 68 more HEI tested per month (95% CI:42, 93) and 51 more deliveries (95% CI: 9, 94) but insignificantly negative for ART refills. At start of post-lockdown (July 2020), HEI testing declined (-28; 95%CI: -48, -8). Post-lockdown HEI testing trend was negative with 70 fewer HEI tested per month (95%CI: -79, -62) while no difference in trend for deliveries and ART refills.ConclusionCOVID-19 control measures had a significant immediate negative impact on pregnancy deliveries at health facilities. During lockdown, all service rates rapidly recovered through program adaptations, significantly for HEI testing and deliveries. Maintaining these adaptations might help restore the positive trend in timely HIV testing for HEI.

The Nexus Between De‐Globalization and OFDI From Emerging Economies: Moderating Roles of Institution and Government

ABSTRACTThe recent wave of de‐globalization has slowed the outward foreign direct investment (OFDI) process globally, with varying effects across countries. Using panel data from 25 emerging economies between 1980 and 2018, we examine the impact of de‐globalization on OFDI. Our findings show that higher de‐globalization pressure from developed countries drives emerging economies to invest more globally. Threshold regressions reveal that this positive effect is significant only when a minimum GDP threshold is met. Moreover, better institutional quality and increased government involvement strengthen the positive impact of de‐globalization on OFDI.