Imaging Appropriateness in Pediatric Radiology during COVID-19 Pandemic: A Retrospective Comparison with No COVID-19 Period

During the COVID-19 pandemic, the number of accesses to the Pediatric Emergency Department (pED) in Italy sharply decreased by 30%. The purpose of this study is to evaluate how this novel setting impacted on management of children with trauma, and the use and appropriateness of imaging studies in such patients at the pED. All imaging studies performed in patients with trauma at the pED of a tertiary children’s Hospital during the first wave of the COVID-19 pandemic (between March and May 2020) were reviewed, in comparison with a control time interval (March to May 2019). In the pre-COVID control era, 669 imaging studies documented bone fractures in 145/568 children (25.5%). In the COVID-era, 79/177 (44.6%) pediatric patients showed bone fractures on 193 imaging studies. Comparative analysis shows a 71% decrease in imaging studies, and the proportion of negative imaging studies (with no evidence of bone fractures) dropped in 2020 by 19% compared to the 2019 control era (p < 0.001). The sharp decrease of negative studies suggests that the rate of appropriateness was higher during COVID-era, suggesting some attitude toward defensive medicine in the previous control year, as a result of some degree of imaging inappropriateness. The impact of a pandemic on emergency medicine may offer a unique opportunity to revisit diagnostic and therapeutic protocols in pediatrics.

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COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126573 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6573

Author(s):

Laura Ruzzini ◽

Sergio De Salvatore ◽

Daniela Lamberti ◽

Pierluigi Maglione ◽

Ilaria Piergentili ◽

...

Keyword(s):

Emergency Department ◽

Demographic Data ◽

Epidemiological Data ◽

Pediatric Emergency ◽

Fracture Pattern ◽

Admission Diagnosis ◽

Time Interval ◽

Pediatric Emergency Department ◽

Emergency Situations ◽

The Impact

The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March–4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries’ protocols, could be helpful to solve problems in case of worldwide emergency situations.

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Carbon Dynamics in the Northeastern Qinghai–Tibetan Plateau from 1990 to 2030 Using Landsat Land Use/Cover Change Data

Remote Sensing ◽

10.3390/rs12030528 ◽

2020 ◽

Vol 12 (3) ◽

pp. 528 ◽

Cited By ~ 1

Author(s):

Jingye Li ◽

Jian Gong ◽

Jean-Michel Guldmann ◽

Shicheng Li ◽

Jie Zhu

Keyword(s):

Land Use ◽

Tibetan Plateau ◽

Carbon Storage ◽

Sharp Decrease ◽

Total Carbon ◽

Qinghai Lake ◽

Lake Basin ◽

Ecosystem Carbon ◽

Trade Offs ◽

The Impact

Land use/cover change (LUCC) has an important impact on the terrestrial carbon cycle. The spatial distribution of regional carbon reserves can provide the scientific basis for the management of ecosystem carbon storage and the formulation of ecological and environmental policies. This paper proposes a method combining the CA-based FLUS model and the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model to assess the temporal and spatial changes in ecosystem carbon storage due to land-use changes over 1990–2015 in the Qinghai Lake Basin (QLB). Furthermore, future ecosystem carbon storage is simulated and evaluated over 2020–2030 under three scenarios of natural growth (NG), cropland protection (CP), and ecological protection (EP). The long-term spatial variations in carbon storage in the QLB are discussed. The results show that: (1) Carbon storage in the QLB decreased at first (1990–2000) and increased later (2000–2010), with total carbon storage increasing by 1.60 Tg C (Teragram: a unit of mass equal to 1012 g). From 2010 to 2015, carbon storage displayed a downward trend, with a sharp decrease in wetlands and croplands as the main cause; (2) Under the NG scenario, carbon reserves decrease by 0.69 Tg C over 2020–2030. These reserves increase significantly by 6.77 Tg C and 7.54 Tg C under the CP and EP scenarios, respectively, thus promoting the benign development of the regional ecological environment. This study improves our understanding on the impact of land-use change on carbon storage for the QLB in the northeastern Qinghai–Tibetan Plateau (QTP).

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Time-to-Treatment in Oral Cancer: Causes and Implications for Survival

Cancers ◽

10.3390/cancers13061321 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1321

Author(s):

Constanza Saka-Herrán ◽

Enric Jané-Salas ◽

Antoni Mari-Roig ◽

Albert Estrugo-Devesa ◽

José López-López

Keyword(s):

Oral Cancer ◽

Previous Treatment ◽

Diagnostic Procedures ◽

Original Data ◽

Primary Treatment ◽

Medical Attention ◽

Time Interval ◽

Pre Treatment ◽

The Impact ◽

Lack Of Knowledge

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

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Time interval between rectal cancer resection and reintervention for anastomotic leakage and the impact of a defunctioning stoma: A Dutch population‐based study

Colorectal Disease ◽

10.1111/codi.15878 ◽

2021 ◽

Author(s):

Anne‐Loes K. Warps ◽

Rob A. E. M. Tollenaar ◽

Pieter J. Tanis ◽

Jan Willem T. Dekker ◽

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Population Based ◽

Time Interval ◽

Dutch Population ◽

Population Based Study ◽

Defunctioning Stoma ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

The Impact

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The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma

Cancers ◽

10.3390/cancers13102398 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2398

Author(s):

Matteo Serenari ◽

Enrico Prosperi ◽

Marc-Antoine Allard ◽

Michele Paterno ◽

Nicolas Golse ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Hepatic Resection ◽

Primary Outcome ◽

Polynomial Regression ◽

Secondary Outcome ◽

Time Interval ◽

Comprehensive Complication Index ◽

Fractional Polynomial ◽

The Impact

Hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a previous HR is supposed to worsen post-SLT outcomes. Data of patients treated by SLT between 2000 and 2018 at two tertiary referral centers were analyzed. The primary outcome of the study was to analyze the impact of HR on post-LT complications. A Comprehensive Complication Index ≥ 29.6 was chosen as cutoff. The secondary outcome was HCC-related death by means of competing-risk regression analysis. In the study period, 140 patients were included. Patients were transplanted in a median of 23 months after HR (IQR 14–41). Among all the features analyzed regarding the prior HR, only time interval between HR and SLT (time HR-SLT) was an independent predictor of severe complications after LT (OR = 0.98, p < 0.001). According to fractional polynomial regression, the probability of severe complications increased up to 15 months after HR (43%), then slowly decreased over time (OR = 0.88, p < 0.001). There was no significant association between HCC-related death and time HR-SLT at the multivariable competing risks regression model (SHR, 1.06; 95% CI: 0.69–1.62, p = 0.796). This study showed that time HR-SLT was key in predicting complications after LT, without affecting HCC-related death.

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Effect of the Assimilation Frequency of Radar Reflectivity on Rain Storm Prediction by Using WRF-3DVAR

Remote Sensing ◽

10.3390/rs13112103 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2103

Author(s):

Yuchen Liu ◽

Jia Liu ◽

Chuanzhe Li ◽

Fuliang Yu ◽

Wei Wang

Keyword(s):

Data Assimilation ◽

Northern China ◽

Horizontal Resolution ◽

Radar Reflectivity ◽

Small Scale ◽

Time Interval ◽

Outer Domain ◽

Storm Prediction ◽

The Impact ◽

Assimilation Time

An attempt was made to evaluate the impact of assimilating Doppler Weather Radar (DWR) reflectivity together with Global Telecommunication System (GTS) data in the three-dimensional variational data assimilation (3DVAR) system of the Weather Research Forecast (WRF) model on rain storm prediction in Daqinghe basin of northern China. The aim of this study was to explore the potential effects of data assimilation frequency and to evaluate the outputs from different domain resolutions in improving the meso-scale NWP rainfall products. In this study, four numerical experiments (no assimilation, 1 and 6 h assimilation time interval with DWR and GTS at 1 km horizontal resolution, 6 h assimilation time interval with radar reflectivity, and GTS data at 3 km horizontal resolution) are carried out to evaluate the impact of data assimilation on prediction of convective rain storms. The results show that the assimilation of radar reflectivity and GTS data collectively enhanced the performance of the WRF-3DVAR system over the Beijing-Tianjin-Hebei region of northern China. It is indicated by the experimental results that the rapid update assimilation has a positive impact on the prediction of the location, tendency, and development of rain storms associated with the study area. In order to explore the influence of data assimilation in the outer domain on the output of the inner domain, the rainfall outputs of 3 and 1 km resolution are compared. The results show that the data assimilation in the outer domain has a positive effect on the output of the inner domain. Since the 3DVAR system is able to analyze certain small-scale and convective-scale features through the incorporation of radar observations, hourly assimilation time interval does not always significantly improve precipitation forecasts because of the inaccurate radar reflectivity observations. Therefore, before data assimilation, the validity of assimilation data should be judged as far as possible in advance, which can not only improve the prediction accuracy, but also improve the assimilation efficiency.

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Financing Growth through Remittances and Foreign Direct Investment: Evidences from Balkan Countries

Journal of Risk and Financial Management ◽

10.3390/jrfm14030117 ◽

2021 ◽

Vol 14 (3) ◽

pp. 117

Author(s):

Esmeralda Jushi ◽

Eglantina Hysa ◽

Arjona Cela ◽

Mirela Panait ◽

Marian Catalin Voica

Keyword(s):

Developing Economies ◽

Central Banks ◽

Sustainable Growth ◽

Time Interval ◽

Foreign Direct Investments ◽

Factors Affecting ◽

Balkan Countries ◽

To Come ◽

Sustainable Economic Growth ◽

The Impact

The ultimate goal of central banks, worldwide, is to promote the foundations for sustainable economic growth. In the case of developing economies, in particular, such objective requires time, huge efforts, attention, and plenty of resources in order to be accomplished to the fullest degree. This paper thoroughly investigates key factors affecting Balkan countries’ economic development (as measured by gross domestic product (GDP) growth), focusing especially on the impact of remittances. The analysis was done over an 18-year time interval (2000–2017) and builds on 144 observations. The data figures were retrieved from the World Bank database while two dummies were created to test the impact of the last financial crisis (2008–2012). Econometric tools were employed to carry out a broad analysis on the interdependencies that exist and, in particular, to determine the role of remittance income on growth. The vector auto regressive model was estimated using EViews software, and was used to come up with relevant insights. Empirical findings suggest the following: population growth, remittances, and labor force participation are insignificant factors for sustainable growth. On the other hand, previous levels of GDP, trade, and foreign direct investments (FDIs) appear to be relevant for the predictor. This research provides up-to-date conclusions, which can be considered during the decision-making process of central banks, as well as by government policymakers.

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A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents

BMC Public Health ◽

10.1186/s12889-021-11315-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michelle Seiler ◽

Georg Staubli ◽

Julia Hoeffe ◽

Gianluca Gualco ◽

Sergio Manzano ◽

...

Keyword(s):

Public Health ◽

Regional Differences ◽

Online Survey ◽

Pediatric Emergency ◽

The South ◽

Public Health Agencies ◽

The North ◽

Regional Strategies ◽

Health Agencies ◽

The Impact

Abstract Background We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. Methods Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April–June 2020). They were asked to rate their concern about their children or themselves having COVID-19. Results A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P < 0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P < 0.001) or their child (mean 4.79 and 3.17, respectively; P < 0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P < 0.001). Conclusion The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.

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