The relationship between seasonality, latitude and tuberculosis notifications in Pakistan

Abstract Background Pakistan ranks amongst the top 20 highest burden tuberculosis (TB) countries in the world. Approximately 369,548 cases of TB (all forms) were notified in 2018, with an estimated incidence of 265 per 100,000 people per year. In other settings, TB has been shown to demonstrate seasonal variation, with higher incidence in the spring/summer months and lower incidence in the autumn/winter; the amplitude of seasonal variation has also been reported to be higher with increasing distance from the equator. Methods Notifications of newly-diagnosed pulmonary and extrapulmonary TB cases were obtained for 139 districts in Pakistan from 2011 to 2017. Data were provided by the Pakistan National TB Control Programme, Islamabad, Pakistan. Statistical analyses were performed to determine whether there was seasonal variation in TB notifications in Pakistan; whether the amplitude of seasonal variation in TB notifications varied according to latitude; whether the amplitude of seasonal variation of TB in Pakistan differed between extrapulmonary TB vs. pulmonary TB. To assess the quarterly seasonality of TB, we used the X-13-ARIMA-SEATS seasonal adjustment programme from the United States Census Bureau. The mean difference and corresponding 95% confidence intervals of seasonal amplitudes between different latitudes and clinical phenotype of TB were estimated using linear regression. Results TB notifications were highest in quarter 2, and lowest in quarter 4. The mean amplitude of seasonal variation was 25.5% (95% CI 25.0 to 25.9%). The mean seasonal amplitude of TB notifications from latitude 24.5°N- < 26.5°N was 29.5% (95% CI 29.3 to 29.7%) whilst the mean seasonal amplitude of TB notifications from latitude 34.5°N - < 36.5°N was 21.7% (95% CI 19.6 to 23.9%). The mean seasonal amplitude of TB notifications across Pakistan between latitudes 24.5°N to 36.5°N reached statistically significant difference (p < 0.001). The amplitude of seasonal variation was greater for extrapulmonary TB (mean seasonal amplitude: 32.6, 95% CI 21.4 to 21.8%) vs. smear positive pulmonary TB mean seasonal amplitude: 21.6, 95% CI 32.1 to 33.1%), p < 0.001. Conclusion TB notifications in Pakistan exhibit seasonal variation with a peak in quarter 2 (April–June) and trough in quarter 4 (October–December). The amplitude of seasonality decreases with increasing latitude, and is more pronounced for extrapulmonary than for pulmonary TB.

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The Relationship Between Seasonality, Latitude and Tuberculosis Notifications in Pakistan

10.21203/rs.3.rs-44743/v1 ◽

2020 ◽

Author(s):

Mohsin F. Butt ◽

Sidra Younis ◽

Zhenqiang Wu ◽

Syed H. Hadi ◽

Abdullah Latif ◽

...

Keyword(s):

Seasonal Variation ◽

Mean Amplitude ◽

The United States ◽

Control Programme ◽

Seasonal Adjustment ◽

United States Census ◽

United States Census Bureau ◽

Pulmonary Tb ◽

Significant Difference ◽

The Mean

Abstract BackgroundPakistan is amongst the top 20 highest burden tuberculosis (TB) countries in the world. Approximately 369,548 cases of TB (all forms) were notified in 2018, with an estimated incidence of 265 per 100,000 people per year. In other settings, TB has been shown to demonstrate seasonal variation, with higher incidence in the spring/summer months and lower incidence in the autumn/winter; the amplitude of seasonal variation has also been reported to be higher with increasing distance from the equator.MethodsNotifications of newly-diagnosed pulmonary and extrapulmonary TB cases were obtained for 139 districts in Pakistan from 2011–2017. Data were provided by the Pakistan National TB Control Programme, Islamabad, Pakistan. Statistical analyses were performed to determine whether there was seasonal variation in TB notifications in Pakistan; whether the amplitude of seasonal variation in TB notifications varied according to latitude; whether the amplitude of seasonal variation of TB in Pakistan differed between extrapulmonary TB vs. pulmonary TB. To assess the quarterly seasonality of TB, we used the X-13-ARIMA-SEATS seasonal adjustment programme from the United States Census Bureau. The mean difference and corresponding 95% confidence intervals of seasonal amplitudes between different latitudes and type of TB were estimated using linear regression.ResultsTB notifications were highest in quarter 2, and lowest in quarter 4. The mean amplitude of seasonal variation was 25.5% (95% CI 25.0–25.9%). The mean seasonal amplitude of TB notifications from latitude 24.5ºN-<26.5ºN was 29.5% (95% CI 29.3–29.7%) whilst the mean seasonal amplitude of TB notifications from latitude 34.5ºN -<36.5ºN was 21.7% (95% CI 19.6–23.9%). The mean seasonal amplitude of TB notifications across Pakistan between latitudes 24.5ºN to 36.5ºN reached statistically significant difference (p < 0.001). The amplitude of seasonal variation was greater for extrapulmonary TB (mean seasonal amplitude: 21.6%, 95% CI 32.1–33.1%) vs. smear positive pulmonary TB (mean seasonal amplitude 32.6%, 95% CI 21.4–21.8%), p < 0.001.ConclusionTB notifications in Pakistan exhibit seasonal variation with a peak in quarter 2 (April-June) and trough in quarter 4 (October-December). The amplitude of seasonality decreases with increasing latitude, and is more pronounced for extrapulmonary TB than for pulmonary TB.

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The relationship between seasonality, latitude and tuberculosis notifications in Pakistan.

10.21203/rs.3.rs-44743/v2 ◽

2020 ◽

Author(s):

Mohsin F. Butt ◽

Sidra Younis ◽

Zhenqiang Wu ◽

Syed H. Hadi ◽

Abdullah Latif ◽

...

Keyword(s):

Seasonal Variation ◽

Mean Amplitude ◽

The United States ◽

Control Programme ◽

Seasonal Adjustment ◽

United States Census ◽

United States Census Bureau ◽

Pulmonary Tb ◽

Significant Difference ◽

The Mean

Abstract BackgroundPakistan is amongst the top 20 highest burden tuberculosis (TB) countries in the world. Approximately 369,548 cases of TB (all forms) were notified in 2018, with an estimated incidence of 265 per 100,000 people per year. In other settings, TB has been shown to demonstrate seasonal variation, with higher incidence in the spring/summer months and lower incidence in the autumn/winter; the amplitude of seasonal variation has also been reported to be higher with increasing distance from the equator.MethodsNotifications of newly-diagnosed pulmonary and extrapulmonary TB cases were obtained for 139 districts in Pakistan from 2011-2017. Data were provided by the Pakistan National TB Control Programme, Islamabad, Pakistan. Statistical analyses were performed to determine whether there was seasonal variation in TB notifications in Pakistan; whether the amplitude of seasonal variation in TB notifications varied according to latitude; whether the amplitude of seasonal variation of TB in Pakistan differed between extrapulmonary TB vs. pulmonary TB. To assess the quarterly seasonality of TB, we used the X-13-ARIMA-SEATS seasonal adjustment programme from the United States Census Bureau. The mean difference and corresponding 95% confidence intervals of seasonal amplitudes between different latitudes and type of TB were estimated using linear regression.ResultsTB notifications were highest in quarter 2, and lowest in quarter 4. The mean amplitude of seasonal variation was 25.5% (95% CI 25.0% to 25.9%). The mean seasonal amplitude of TB notifications from latitude 24.5ºN-<26.5ºN was 29.5% (95% CI 29.3% to 29.7%) whilst the mean seasonal amplitude of TB notifications from latitude 34.5ºN -<36.5ºN was 21.7% (95% CI 19.6% to 23.9%). The mean seasonal amplitude of TB notifications across Pakistan between latitudes 24.5ºN to 36.5ºN reached statistically significant difference (p<0.001). The amplitude of seasonal variation was greater for extrapulmonary TB (mean seasonal amplitude: 32.6%, 95% CI 21.4% to 21.8%) vs. smear positive pulmonary TB mean seasonal amplitude: 21.6%, 95% CI 32.1% to 33.1%), p<0.001.ConclusionTB notifications in Pakistan exhibit seasonal variation with a peak in quarter 2 (April-June) and trough in quarter 4 (October-December). The amplitude of seasonality decreases with increasing latitude, and is more pronounced for extrapulmonary TB than for pulmonary TB.

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Economic Competition and Racial/Ethnic Disparities in Sentencing: A Test of Economic Threat Perspective

Social Sciences ◽

10.3390/socsci10060206 ◽

2021 ◽

Vol 10 (6) ◽

pp. 206

Author(s):

Christopher D’Amato ◽

Bryan Holmes ◽

Ben Feldmeyer

Keyword(s):

Ethnic Disparities ◽

The United States ◽

Sentence Length ◽

Multilevel Regression ◽

United States Census ◽

United States Census Bureau ◽

Economic Competition ◽

Economic Threat ◽

Level Data ◽

Racial Ethnic

Economic threat arguments within the broader racial/ethnic threat theory suggest that economic competition between minorities and Whites encourages the majority group to apply formal social controls on minorities to maintain their advantaged positions. Prior sentencing research has given limited attention to economic threat and has only done so using cross-sectional measures, which does not capture changing economic circumstances (a key element of racial/ethnic threat). The goal of this study is to provide a test of economic threat—and racial/ethnic threat more broadly—utilizing time variant measures. To achieve this goal, we use case-level data from the Minnesota Sentencing Guidelines Commission (N = 122,666) and county-level data from the United States Census Bureau. Multilevel regression models reveal partial but limited support for economic threat. Specifically, counties with a growing portion of minorities living above the poverty line between 2000 and 2010 had larger minority disadvantages (in comparison to Whites) at incarceration. However, economic threat measures do not significantly contextualize minority–White sentence length differences, while the broader racial/ethnic threat measures do not significantly influence minority–White outcomes at the incarceration or sentencing length decision. The results suggest that economic threat may explain a small but limited portion of the racial disparities identified.

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Rurality of Residence and Inappropriate Antibiotic Use for ARI Among Young Tennessee Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa587 ◽

2020 ◽

Author(s):

Keerti L Dantuluri ◽

Jean Bruce ◽

Kathryn M Edwards ◽

Ritu Banerjee ◽

Hannah Griffith ◽

...

Keyword(s):

Incidence Rate Ratio ◽

Respiratory Infections ◽

Antibiotic Use ◽

The United States ◽

Census Bureau ◽

Outpatient Setting ◽

United States Census ◽

United States Census Bureau ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Abstract Background Antibiotic use is common for acute respiratory infections (ARI) in children, but much of this use is inappropriate. Few studies have examined whether rurality of residence is associated with inappropriate antibiotic use. We examined whether rates of ARI-related inappropriate antibiotic use among children vary by rurality of residence. Methods We conducted a retrospective cohort study of children aged 2 months – 5 years enrolled in Tennessee Medicaid between 2007 and 2017 and diagnosed with ARI in the outpatient setting. Study outcomes included ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. Multivariable Poisson regression was used to measure associations between rurality of residence, defined by the United States Census Bureau, and the rate of study outcomes, while accounting for other factors including demographics and underling comorbidities. Results 805,332 children met selection criteria and contributed 1,840,048 person-years (p-y) of observation. Children residing in completely rural, mostly rural, and mostly urban counties contributed 70,369 (4%) p-y, 479,121 (26%) p-y, and 1,290,558 p-y (70%), respectively. Compared with children in mostly urban counties (238 per 1000 p-y), children in mostly rural (450 per 1000 p-y) and completely rural counties (468 per 1000 p-y) had higher rates of inappropriate antibiotic use (adjusted incidence rate ratio [aIRR]: 1.34 (95% confidence interval [CI]: 1.33 – 1.35) and aIRR: 1.33 (CI: 1.32 – 1.35), respectively). Conclusion Inappropriate antibiotic use is common among young children with ARI, with higher rates in rural compared to urban counties. These differences should inform targeted outpatient antibiotic stewardship efforts.

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Abstract P403: Seasonal Variation in the Daily Urinary Sodium Excretion in Outpatients From the Northern Japan

Hypertension ◽

10.1161/hyp.70.suppl_1.p403 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Tomoko Hashimoto

Keyword(s):

Seasonal Variation ◽

Sodium Excretion ◽

Salt Intake ◽

Sodium Intake ◽

Urinary Sodium Excretion ◽

Urinary Sodium ◽

Reliable Estimate ◽

Significant Difference ◽

The Mean ◽

Northern Japan

Although the daily urinary sodium excretion (UNaV) is considered to provide the most reliable estimate of the daily sodium intake, it may be affected by salt loss due to sweating in summer. However, theseasonal variation in the daily UNaV associated with a normal lifestyle is unknown. This study was performed in 348 outpatients from the Morioka region during three seasons: summer(summer 1), winter, and the following summer (summer 2). The daily UNaV (g salt/day) was estimated by the second morning urine method three times during each season. Seasonal variation was defined as a significant trend across the three seasons together with a significant difference between winter and both summers. In women, the daily UNaV was higher in winter (11.8±3.0 g salt/day) than in summer 1 (11.2±2.9g salt/day) or summer 2 (11.0±2.9 g salt/day). In contrast, there was no marked seasonal variation in men. An analysis stratified by age (4 quartiles) identified seasonal variation in the older 2 quartiles of women (aged ≧68 years). In these women, the mean seasonal difference in the daily UNaV was 0.9 g of salt/day for both winter vs. summer 1 and winter vs. summer 2, while it was 0.1-0.8 g of salt/day in the other groups. Seasonal variation in the daily UNaV only occurred in older female patients and was relatively small. This is evidence for restricting salt intake throughout the year and should reassure patients who are anxious about salt loss due to sweating in summer.

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The Tax Cuts and Jobs Act and the Middle Class

JABM JOURNAL of ACCOUNTING - BUSINESS & MANAGEMENT ◽

10.31966/jabminternational.v26i01.398 ◽

2019 ◽

Vol 26 (01) ◽

pp. 53

Author(s):

Deborah Combs ◽

Brian Nichols

Keyword(s):

Middle Class ◽

The United States ◽

Census Bureau ◽

Tax Rates ◽

United States Census ◽

United States Census Bureau ◽

Definition Of ◽

Almost All ◽

Jobs Act ◽

Tax Cuts

This paper explores how the tax cuts and jobs act of 2017 impacts middle-class taxpayers by calculating the tax liability at different levels of income and deductions in 2017 versus 2018. The results confirm the statements supporting the positive effect of the tax change for the middle class. The tax cut and jobs act eliminates personal exemptions, changes the standard deductions at various incomes and family sizes, and lowers marginal tax rates. After providing details of the act, this research examines the definition of the U.S. middle class by using prior research from the Pew Research Center, the United States Census Bureau, and the federal reserve to determine which income levels are attributable to the middle class. Then the tax liability for these income classes is calculated for single and married filing jointly taxpayers in both 2017 and 2018 to determine if the tax cuts and jobs act reduces the tax liability for the middle class. The results show that in almost all scenarios the tax liability in 2018 will be lower than in 2017, regardless of whether standard or itemized deductions are taken. The marriage penalty is no longer applicable, and the new tax act provides a substantial benefit to large families

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Marry Your Like: Assortative Mating and Income Inequality

The American Economic Review ◽

10.1257/aer.104.5.348 ◽

2014 ◽

Vol 104 (5) ◽

pp. 348-353 ◽

Cited By ~ 115

Author(s):

Jeremy Greenwood ◽

Nezih Guner ◽

Georgi Kocharkov ◽

Cezar Santos

Keyword(s):

Income Inequality ◽

Assortative Mating ◽

Household Income ◽

The United States ◽

Census Bureau ◽

United States Census ◽

United States Census Bureau ◽

Positive Assortative Mating ◽

High Level ◽

Married Female

Has there been an increase in positive assortative mating? Does assortative mating contribute to household income inequality? Data from the United States Census Bureau suggests there has been a rise in assortative mating. Additionally, assortative mating affects household income inequality. In particular, if matching in 2005 between husbands and wives had been random, instead of the pattern observed in the data, then the Gini coefficient would have fallen from the observed 0.43 to 0.34, so that income inequality would be smaller. Thus, assortative mating is important for income inequality. The high level of married female labor-force participation in 2005 is important for this result.

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VESTIBULAR AFFERENTS POPULATION ACTIVATED BY VARIOUS MODES FOR ELICITING OCULAR AND CERVICAL VESTIBULAR-EVOKED MYOGENIC POTENTIALS

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237211002864 ◽

2011 ◽

Vol 23 (06) ◽

pp. 527-532 ◽

Cited By ~ 1

Author(s):

Shou-Jen Wang ◽

Fu-Shan Jaw ◽

Yi-Ho Young

Keyword(s):

Healthy Subjects ◽

Mean Amplitude ◽

Vestibular Evoked Myogenic Potentials ◽

Force Level ◽

Characteristic Parameters ◽

Stimulation Mode ◽

Vestibular Afferents ◽

Significant Difference ◽

The Mean

This study compared cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVEMPs) between air-conducted sound (ACS) and bone-conducted vibration (BCV) modes to determine whether these two stimulation modes activate the same population of primary vestibular afferents. Fifteen healthy subjects underwent cVEMP and oVEMP tests using ACS stimuli at 127 dB pe SPL and BCV stimuli at 128 dB force level. The characteristic parameters of cVEMPs and oVEMPs were compared between ACS and BCV modes. The mean p13 and n23 latencies of ACS-cVEMPs were significantly longer than those of BCV-cVEMPs. Likewise, the mean nI and pI latencies for ACS-oVEMPs were also significantly longer than those for BCV-oVEMPs. There was no significant difference in the mean amplitude of cVEMPs between the ACS and BCV modes. However, comparing the oVEMP amplitude, a relationship: (Amplitude of BCV-oVEMP) = 2.3 x (Amplitude of ACS-oVEMP) was demonstrated. In conclusion, the population of primary vestibular afferents activated by ACS and BCV stimuli is similar for cVEMPs. In contrast with oVEMPs, BCV mode activates more number of primary vestibular afferents than ACS mode does. In interpreting oVEMP and cVEMP results, stimulation mode should be checked first.

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Comprehension of Online Educational Material Regarding Orofacial Clefts

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619839576 ◽

2019 ◽

Vol 56 (9) ◽

pp. 1206-1212

Author(s):

Diana S. Jodeh ◽

Aleshia J. Pringle ◽

S. Alex Rottgers

Keyword(s):

Web Sites ◽

Web Site ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

The United States ◽

Educational Material ◽

Reading Level ◽

Significant Difference ◽

The Mean ◽

American Society

Background:Cleft lip and palate are among the common birth defects in the United States. Management is complex and may be difficult for parents and patients to understand. The goal of this study was to evaluate the readability of online educational material provided by the American Society of Plastic Surgeons (ASPS) and the American Cleft Palate-Craniofacial Association (ACPA) websites regarding cleft lip and palate and to assess parents’ comprehension.Methods:Parents of children younger than 10 years of age presenting to the plastic and reconstructive surgery clinic at Johns Hopkins All Children’s Hospital for conditions other than cleft lip and palate were recruited for participation. Parents were given the literature published on the ASPS and ACPA web sites to review and were asked to complete a 5-question test specifically targeted to the content of the passage they reviewed. We tested the readability of the 2 online passages using Readability Studio software (Oleander Software Solutions Ltd).Results:Sixty parents completed the study. Across all groups, the mean score was 4.35 of a possible 5. The mean score was 4.4 for the ASPS web site and 4.29 for the ACPA web site. Fifty-three percent of participants answered all questions correctly. No significant difference in scores was noted between web sites ( P = .48).Conclusions:Despite containing content of varying reading-level difficulty, the literature posted on the ACPA and ASPS web sites concerning cleft lip and palate conveyed information equally well to the target parent demographic with high levels of comprehension.

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