Observed and Projected Scaling of Daily Extreme Precipitation with Dew Point Temperature at Annual and Seasonal Scales across the Northeast United Sates

This study investigates how extreme precipitation scales with dew point temperature across the Northeast U.S., both in the observational record (1948-2020) and in a set of downscaled climate projections in the state of Massachusetts (2006-2099). Spatiotemporal relationships between dew point temperature and extreme precipitation are assessed, and extreme precipitation – temperature scaling rates are evaluated on annual and seasonal scales using non-stationary extreme value analysis for annual maxima and partial duration series, respectively. A hierarchical Bayesian model is then developed to partially pool data across sites and estimate regional scaling rates, with uncertainty. Based on the observations, the estimated annual scaling rate is 5.5% per °C, but this varies by season, with most non-zero scaling rates in summer and fall and the largest rates (∼7.3% per °C) in the summer. Dew point temperatures and extreme precipitation also exhibit the most consistent regional relationships in the summer and fall. Downscaled climate projections exhibited different scaling rates compared to the observations, ranging between -2.5 and 6.2% per °C at an annual scale. These scaling rates are related to the consistency between trends in projected precipitation and dew point temperature over the 21st century. At the seasonal scale, climate models project larger scaling rates for the winter compared to the observations (1.6% per °C). Overall, the observations suggest that extreme daily precipitation in the Northeast U.S. only thermodynamic scales with dew point temperature in the warm season, but climate projections indicate some degree of scaling is possible in the cold season under warming.

Urinary N-Acetyl-β-d-glucosaminidase (uNAG) as an Indicative Biomarker of Early Diabetic Nephropathy in Patients with Diabetes Mellitus (T1DM, T2DM): A Systematic Review and Meta-Analysis

Diabetic nephropathy (DN) is the main cause of chronic kidney disease in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Renal tubular lysosomal enzyme activities like N-acetyl-β-d-glucosaminidase (NAG) have been shown to increase in patients developing DN. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of NAG, as a preventional biomarker in the early stages of DN in patients with diabetes mellitus. Two impartial reviewers conducted a complete PubMed search until July 2021. A 2 × 2 contingency table was created for each trial and sensitivity and specificity were estimated using a bivariate random effects model. To pool data and estimate the area under the curve (AUC), the hierarchical summary ROC (hsROC) approach was utilized. Deek’s test was used to estimate publication bias. The meta-analysis included 21 studies that evaluated 2783 patients with T1DM and T2DM, as well as 673 healthy individuals. The AUC of urinary NAG (uNAG) ranged from 0.69 (95% CI: 0.65–0.73) to 0.89 (95% CI: 0.86–0.92). According to the results, NAG in urine can be considered as a potential and effective biomarker for predicting DN in diabetic patients (T1DM, T2DM).

Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children under 5 Years of Age in South Africa (1997–2021): A Systematic Review

Using a systematic review method, the prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) in women of reproductive age (WRA) and children under 5 years of age was obtained to inform priorities in health planning and policy in South Africa. We searched electronic databases for articles published between 1997 and 2021. A total of 713 articles were identified, of which 14 articles comprising 9649 WRA and 4085 children were included. Since most of the included studies were of low quality, we did not pool data in a meta-analysis due to heterogeneity (I2 > 75%). In WRA, anaemia prevalence ranged from 22.0% to 44.0%; ID from 7.7% and 19.0%; and IDA from 10.5% to 9.7%. The prevalence of anaemia in pregnancy was 29.0% to 42.7%; and 60.6% to 71.3% in HIV-infected pregnant women. Three national surveys reported anaemia in children at 28.9%, 10.7%, and 61.3%, respectively. Overall, among the children under 5 years old, anaemia was more prevalent in 1-year-olds (52.0%) compared to the other age groups. Between 2005 and 2012, ID increased by 3.8% and IDA decreased by 83.2% in children. Anaemia in WRA and children under 5 years in South Africa was a moderate public health concern. Therefore, interventions addressing anaemia should be intensified, and policies on iron supplementation and food fortification need to be revised and aligned to the WHO multiple micronutrient supplementation recommendations.

Reported Outcomes and Outcome Measures in Proximal Interphalangeal Joint Arthroplasty: A Systematic Review

Purpose: There is a lack of scientific consensus on the best arthroplasty implant option for proximal interphalangeal joint (PIPJ) arthritis, due to diversity in outcome reporting and measurement methods. The development of a standardized core outcome set (COS) and standard outcome measures could mitigate this issue. This study catalogs the reported outcomes and outcome measures found in PIPJ arthroplasty studies, which can be used in the first step of developing a COS. Methods: A database search of MEDLINE, EMBASE, and Web of Science (January 1, 2010, to March 10, 2021) was performed to retrieve studies that reported outcomes of the 3 most common primary PIPJ arthroplasty implants: silicone, pyrocarbon, and metal-polyethylene. The primary objectives of this study include reported outcomes and outcome measures. Secondary objectives include clinimetric properties of outcome measures, study design, and implant types. Results: Fifty articles met inclusion criteria. Of the included studies, 41 (82%) were case series, 8 (16%) were cohort studies, and 1 (2%) was a randomized control trial. Thirty-three unique outcomes were identified. Fifteen (46%) outcomes were clinician-reported and 26 (79%) were patient-reported. Eighteen unique outcome measures were identified. Of the outcome measures, 15 (83%) were patient-reported, 1 (6%) was clinician-reported, and 2 (11%) were reported by both patients and clinicians. Conclusions: Substantial heterogeneity was found in reported outcomes and outcome measures across studies evaluating PIPJ arthroplasty, impeding knowledge translation. The development of a COS for PIPJ arthroplasty is necessary to help compare and pool data across studies, and advance scientific knowledge.

Correlation between masked hypertension and endothelial dysfunction measured by flow-mediated dilation: a protocol of systematic review and meta-analysis

IntroductionA surrogate marker to evaluate artery endothelial response when stimulated by reactive hyperaemia, known as brachial flow-mediated dilation (FMD), has prognostic value in predicting hypertensive organ damage and cardiovascular disease events. However, the degree of correlation between brachial FMD and masked hypertension (MH) outcomes is still unclear. Therefore, the purpose of this study is to pool data regarding FMD with respect to MH.Methods and analysisElectronic databases MEDLINE, EMBASE, China National Knowledge Infrastructure and Cochrane Library will be searched for the following keywords: endothelial dysfunction, flow-mediated dilation, and masked hypertension, masked uncontrolled hypertension (MUCH) and prehypertension. The following are the eligibility criteria: population—adults (18 years old or older) without hypertension at baseline, with suspected endothelial dysfunction, or from MH/MUCH populations (office blood pressure <140/90 mm Hg and home blood pressure ≥135 mm Hg and/or 85 mm Hg) and from controlled clinical trials, cohort studies, or randomised and controlled trials; exposures—any metrics for FMD; comparisons—participants without MH or MUCH; and outcome—change in FMD between the case group and the control group. Two authors will be engaged in screening and collecting data independently; disagreements will be resolved through discussion. Data extraction will include primary data designated as HR, OR, correlations and regression coefficients. Comprehensive Meta-Analysis V.2.0 will be used to conduct related subgroup and sensitivity analyses and publication bias.Ethics and disseminationThis study does not require ethics approval. It will be submitted to a peer-reviewed journal.PROSPERO registration numberCRD42020208362.

Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.

Event Related Potential Signal Capture Can Be Enhanced through Dynamic SNR-Weighted Channel Pooling

Background: Electroencephalography (EEG)-derived event-related potentials (ERPs) provide information about a variety of brain functions, but often suffer from low inherent signal-to-noise ratio (SNR). To overcome the low SNR, techniques that pool data from multiple sensors have been applied. However, such pooling implicitly assumes that the SNR among sensors is equal, which is not necessarily valid. This study presents a novel approach for signal pooling that accounts for differential SNR among sensors. Methods: The new technique involves pooling together signals from multiple EEG channels weighted by their respective SNRs relative to the overall SNR of all channels. We compared ERP responses derived using this new technique with those derived using both individual channels as well as traditional averaged-based channel pooling. The outcomes were evaluated in both simulated data and real data from healthy adult volunteers (n = 37). Responses corresponding to a range of ERP components indexing auditory sensation (N100), attention (P300) and language processing (N400) were evaluated. Results: Simulation results demonstrate that, compared to traditional pooling technique, the new SNR-weighted channel pooling technique improved ERP response effect size in cases of unequal noise among channels (p’s < 0.001). Similarly, results from real-world experimental data showed that the new technique resulted in significantly greater ERP effect sizes compared to either traditional pooling or individual channel approach for all three ERP components (p’s < 0.001). Furthermore, the new channel pooling approach also resulted in larger ERP signal amplitudes as well as greater differences among experimental conditions (p’s < 0.001). Conclusion: These results suggest that the new technique improves the capture of ERP responses relative to traditional techniques. As such, SNR-weighted channel pooling can further enable widespread applications of ERP techniques, especially those that require rapid assessments in noisy out-of-laboratory environments.

A RANDOMISED CONTROL STUDY TO COMPARE THE EFFICACY OF CEFUROXIME, CLARITHROMYCIN, AND LEVOFLOXACIN IN THE MANAGEMENT OF PAEDIATRIC UPPER RESPIRATORY TRACT INFECTION

Background: The upper respiratory infections cause considerable morbidity mainly in children due to the fact that they mainly affect children. Accordingly, a study was conducted on antibiotics to compare the effectiveness of clarithromycin, cefuroxime, and levofloxacin for treating upper respiratory tract infections (URTI) in children. Methods: A prospective observational study for a period of 6 months was conducted in the pediatrics department of RVM hospital. Outpatients under the age of 14 years given antibiotics for the treatment of URTI were included in the study. A total of 99 study subjects were included in the study, divided into three groups each containing 33 sample sizes (clarithromycin, cefuroxime, and levofloxacin). Patient data was collected using a form and verbal consent was obtained from patients/patient representatives, and drugs were given using the lottery method. Follow-up was done and noted for the 3rd, 5th, 7th day through telephonic calls, and the collected data were evaluated using statistical analysis. Results: Pool data from 99 patients shows that many patients belong to 0–5 years age groups (age distribution), and males were more than female (gender distribution). Clarithromycin (cure rate 3 days) and cefuroxime (cure rate 5 days) showed an equal rate of cure percentage (94%), while levofloxacin for 3–5 days with a 3% failure rate. A significant difference of p<0.05 (p=0.000) was observed and no adverse events were noted. Conclusion: The study findings showed, out of 3 drugs, clarithromycin and cefuroxime showed an equal efficacy rate of 94%, but clarithromycin showed shorter duration of outcome, i.e., 3 days. Hence, clarithromycin is effective than the other two drugs in the treatment of URTI.

Diagnose and Prediction of Different Machine Learning methods for Knee Osteoarthritis: a protocol for systematic review and meta-analysis

Background: Knee osteoarthritis (OA) is a chronic and progressive joint disease with a higher contributor to global disability, mainly in the elderly and particularly in women. The available diagnostic approaches such as X-ray, computed tomography and magnetic resonance imaging have large precision errors and low sensitivity. Machine learning (ML) is the application of probabilistic algorithms to train a computational model to make predictions, it has great potential to become a valuable clinical diagnostic tool. This review aims to determine the diagnosis and prediction accuracy of different machine learning methods for Knee Osteoarthritis Methods: Two reviewers systematically searched Cochrane, PubMed, EMBASE, and Web of Science (last updated in June 2020) for eligible articles. To identify potentially missed publications, the reference lists of the final included studies were manually screened. Outcomes assessed were test characteristics such as accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (ROC). We will use the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the risk of bias and applicability. Two independent reviewers will conduct all procedures of study selection, data extraction, and methodological assessment. Any disagreements will be consulted with a third reviewer. RevMan 5.3 software and Stata V15.0 will be used to pool data and to carry out the meta-analysis if it is possible. Results: This systematic review will provide a high-quality synthesis of machine learning for diagnose of knee Osteoarthritis from various evaluation aspects including accuracy, sensitivity, specificity and AUC.Conclusion: The findings of this systematic review will provide latest evidence of diagnosis and prediction of different machine learning for patients with knee Osteoarthritis.Ethics and dissemination: No individual patient data will be used in this study; thus, no ethics approval is needed.Systematic review registration: PROSPERO CRD: 42019133305

Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

ObjectiveTo determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020).SettingSecondary care.ParticipantsPatients (≥18 years) undergoing major elective surgery (curative or palliative).InterventionsAny intervention administered in the preoperative period with the aim of improving postoperative outcomes.Outcomes and measuresPrimary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use.Review methodsTwo authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials.Results178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: −1.81 days, 95% CI −2.31 to −1.31; −2.11 days, 95% CI −3.07 to −1.15; −1.67 days, 95% CI −2.31 to −1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64).ConclusionsSome prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low.PROSPERO registration numberCRD42015019191.