Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013–2020)

Since 2014, several global and national guidelines have been introduced to address the problem of antimicrobial resistance. We conducted a campaign in a tertiary hospital to promote appropriate quinolone use through educational lectures in 2018. The aim of this retrospective study was to evaluate the changes in the following: prescription characteristics, trend of oral quinolone use, and antibiotic susceptibility of bacteria from 2013 to 2020. Antimicrobial use was assessed as days of therapy per 1000 patient-days. We found a significant reduction in unnecessary antibiotic prescriptions between December 2013 and December 2020. Significant negative trends were detected in the use of quinolones over 8 years (outpatients, coefficient = −0.15655, p < 0.001; inpatients, coefficient = −0.004825, p = 0.0016). In particular, the monthly mean use of quinolones among outpatients significantly decreased by 11% from 2013 to 2014 (p < 0.05) and reduced further by 31% from 2017 to 2020 (p < 0.001). A significant positive trend was observed in the susceptibility of Pseudomonas aeruginosa to levofloxacin (p < 0.001). These results demonstrate that the use of oral quinolones was further reduced following educational intervention and the bacterial susceptibility improved with optimal quinolone usage compared to that in 2013.

Trend and change point detection of seasonal rainfall for effective crop planning over southern transition zone of Karnataka, India

The significance of the trends was tested by Mann-Kendall test for annual and seasonal rainfall. Among the 14 taluks, only Hassan taluk shows a significant positive trend in annual rainfall while eight taluks have shown non-significant positive trend and remaining five taluks have shown non-significant negative trend. The annual rainfall for the entire zone have shown non-significant positive trend. For the SWM season, Alur taluk shows a significant negative trend and eight taluks have shown non-significant positive trend. However, five taluks and whole zone showed a non-significant negative trend. Southwest monsoon and annual rainfall in Bhadravathi taluk was increased in 2007 (571.9 mm to 785.1 mm and 857.6 mm to 1090.9 mm, respectively) and in Shivamogga, the change in annual rainfall was decreased during 1983 (1497.5 mm to 944.0 mm) and 2011 (944.0 mm to 796.6 mm). The northeast monsoon rainfall was increased during 1992 (134.3 mm to 441.1 mm) and it was decreased during 1994 (441.1 mm to 162.0 mm) in Shikaripura taluk. Similarly, in Hunsur taluk, the SW Monsoon rainfall has increased (701.8 mm to 1010.2 mm) during 1991 and it was decreased during 2001 (1010.2 mm to 723.3 mm), in Periyapatna and Honnali taluk, Northeast monsoon rainfall has decreased during 2012 and 2011, respectively.

Evaluating the Presence of Software-as-a-Medical-Device in the Australian Therapeutic Goods Register

In recent years, medical device regulatory bodies have recognised software-as-a-medical-device (SaMD) as a distinct subgroup of devices. The field of SaMD has been rapidly evolving and encompasses a range of different digital solutions. Many organisations have now started to look into digital healthcare, as a way to solve key global challenges. However, there remains uncertainty regarding how many of these SaMD products are entering the market and to what extent these systems achieve a desired level of general safety once they are in the market. In this study, we utilise data collected from publicly available databases. The data are evaluated for trends and a descriptive analysis is performed of the recall and adverse events associated specifically with SaMD. We find that there is a significant positive trend (p < 0.05) of SaMD registrations, although the number of SaMD registrations remains relative low compared to non-SaMD. This rise in SaMD registrations coincides with increasing levels of recalls and adverse events. More importantly, it becomes apparent that adverse events notification is not yet fit for purpose with regards to SaMD.

Assessment of Seasonal Variability of Extreme Temperature In Mainland China Under Climate Change

Grain yield may be affected in the future by climate change. Some studies have suggested that variations in the seasonal cycle of temperature and season onset could affect the efficiency in the use of radiation by plants, which would then affect yield. However, the study of the temporal variation in extreme climatic variables is not sufficient in China. Therefore, this article evaluates the distribution of extreme temperature seasonality trends in mainland China, describes the trends in the seasonal cycle, and detects changes in extreme temperature characterized by the number of hot days (HD), and frost days (FD) and the frequency of warm days (Tx90p), cold days (Tx10p), warm nights (Tn90p) and cold nights (Tn10p). All data are from the EAR5 reanalysis for the 1979-2020 periods.The results show a statistically significant positive trend in the annual average amplitudes (A0) of extreme temperatures. The change in Txmax was the smallest, but it also accounted for 84.5% of the total area. The annual amplitude (A1) and phase (F1) experienced less variation than A0 for extreme temperatures in mainland China. A1 of the maximum temperature decreased significantly on the Tibetan Plateau and increased significantly in the Tianshan Mountains and Jungar Basin (mainly Taxman). F1 of the maximum temperature exhibit a negative trend in approximately 30% of mainland China, and the trend appeared in some regions except in the Northeast and Southwest. Although A1 of the minimum temperature was not as large as that of the maximum temperature, its distribution was very characteristic and it was almost bounded by the 400 mm isohyet, increasing in the Northwest and decreasing in the Southeast. In terms of the number of days, there was an increase in HD, Tx90p, and Tn90p, as well as a decrease in FD, Tx10p, and Tn10p. This number of days also indicates that temperature has increased over mainland China in the past 42 years.

The impact of SF₆ sinks on age of air climatologies and trends

Mean age of air (AoA) is a common diagnostic for the strength of the stratospheric overturning circulation in both climate models and observations. AoA climatologies and its trends over the recent decades of model simulations and proxies derived from observations of long-lived tracers do not agree. Satellite observations show much older air than climate models and while most models compute a clear decrease of AoA over the last decades, a thirty-year timeseries from measurements shows a statistically non-significant positive trend. Measurement-based AoA derivations are often based on observations of the trace gas SF6, a fairly long-lived gas with a near-linear increase of emissions during the recent decades. However, SF6 has chemical sinks in the mesosphere, which are not considered in most model studies. In this study, we explicitly compute the chemical SF6 sinks based on chemical processes in the global chemistry-climate model EMAC. We show that good agreement of stratospheric AoA in EMAC and MIPAS is reached through the inclusion of chemical SF6 sinks, as those lead to a strong increase of the stratospheric AoA and thereby to a better agreement with MIPAS satellite observations. Remaining larger differences in high latitudes are addressed and possible reasons are discussed. Subsequently, we demonstrate that also the AoA trends are strongly influenced by the chemical SF6 sinks. Under consideration of the SF6 sinks, the AoA trends over the recent decades reverse sign from negative to positive. We conduct sensitivity simulations which reveal that this sign reversal results neither from trends of the stratospheric circulation strength, nor from changes in the strength of the SF6 sinks. We illustrate that even a constant SF6 destruction rate causes a positive trend in the derived AoA, since the amount of depleted SF6 scales with the increasing SF6 abundance itself. In our simulations, this effect overcompensates the impact of the accelerating stratospheric circulation which naturally decreases AoA. Although various sources of uncertainties cannot be quantified in detail in this study, our results suggest that the inclusion of SF6 depletion in models has the potential to reconcile the AoA trends of models and observations.

Inter-annual and seasonal patterns of precipitable water vapour over Malaysia from 1990–2019 based on MERRA-2 reanalysis

In this study seasonal and inter-annual patterns as well as trend in the total precipitable water vapour (TPW) over Malaysia, based on a 30-year data from MERRA-2, have been evaluated using least square regression method. Indicator TPW revealed a pair of minima in February/August and maxima in May/November with highest and lowest long-term means found in East Malaysia. Long-term seasonal variability of TPW exhibited latitudinal dependency in both the NEM and SWM seasons. Indicator TPW showed respective southeast-northwest and southwest-northeast spatial distribution in West and East Malaysia, with the highest statistically significant positive trend found in the former.

Evapotranspiration Response to Climate Change in Semi-Arid Areas: Using Random Forest as Multi-Model Ensemble Method

Large ensembles of climate models are increasingly available either as ensembles of opportunity or perturbed physics ensembles, providing a wealth of additional data that is potentially useful for improving adaptation strategies to climate change. In this work, we propose a framework to evaluate the predictive capacity of 11 multi-model ensemble methods (MMEs), including random forest (RF), to estimate reference evapotranspiration (ET0) using 10 AR5 models for the scenarios RCP4.5 and RCP8.5. The study was carried out in the Segura Hydrographic Demarcation (SE of Spain), a typical Mediterranean semiarid area. ET0 was estimated in the historical scenario (1970–2000) using a spatially calibrated Hargreaves model. MMEs obtained better results than any individual model for reproducing daily ET0. In validation, RF resulted more accurate than other MMEs (Kling–Gupta efficiency (KGE) M=0.903, SD=0.034 for KGE and M=3.17, SD=2.97 for absolute percent bias). A statistically significant positive trend was observed along the 21st century for RCP8.5, but this trend stabilizes in the middle of the century for RCP4.5. The observed spatial pattern shows a larger ET0 increase in headwaters and a smaller increase in the coast.

Bladder cancer incidence and predictions: Observational Study (Monastir, Tunisia: (2002-2030)

Background Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality if not treated optimally. We aimed to describe bladder cancer incidence and trends from 2002 to 2013 and to estimate predictions up to 2030. Methods We performed an observational study from 2002 to 2013. Incidence was estimated by the crude incidence rate (CIR) and standardized incidence rate (SIR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software. Results A total of 1024 cases of bladder cancer was declared from 2002 to 2013 predominately among males with a rate of 90.4%. CIR was 16.79/100,000 inhabitants (inh) and SIR was 21.38/100,000 inh. By gender, SIR was 41.3/100,000 inh and 7.73/100,000 inh for males and females respectively. During our study period a significant positive trend was noted with a (b = 0.042, p &lt; 10-4). In 2030, the predicted incidence rate would increase to 28.4/100,000 inh. Conclusions The findings have highlighted the positive trend and the increased predicted incidence of bladder cancer in 2030. Thus, developing primary prevention strategies is crucial. Key messages Our results are important for health-care professionals to improve planning policies related to bladder cancer. Identifying associated factors is crucial to guide preventive strategies measures.

The Greening and Wetting of the Sahel Have Leveled off since about 1999 in Relation to SST

The Sahel, a semi-arid climatic zone with highly seasonal and erratic rainfall, experienced severe droughts in the 1970s and 1980s. Based on remote sensing vegetation indices since early 1980, a clear greening trend is found, which can be attributed to the recovery of contemporaneous precipitation. Here, we present an analysis using long-term leaf area index (LAI), precipitation, and sea surface temperature (SST) records to investigate their trends and relationships. LAI and precipitation show a significant positive trend between 1982 and 2016, at 1.72 × 10 −3 yr −1 (p < 0.01) and 4.63 mm yr−1 (p < 0.01), respectively. However, a piecewise linear regression approach indicates that the trends in both LAI and precipitation are not continuous throughout the 35 year period. In fact, both the greening and wetting of the Sahel have been leveled off (pause of rapid growth) since about 1999. The trends of LAI and precipitation between 1982 and 1999 and 1999–2016 are 4.25 × 10 − 3 yr −1 to − 0.27 × 10 −3 yr −1, and 9.72 mm yr −1 to 2.17 mm yr −1, respectively. These declines in trends are further investigated using an SST index, which is composed of the SSTs of the Mediterranean Sea, the subtropical North Atlantic, and the global tropical oceans. Causality analysis based on information flow theory affirms this precipitation stabilization between 2003 and 2014. Our results highlight that both the greening and the wetting of the Sahel have been leveled off, a feature that was previously hidden in the apparent long-lasting greening and wetting records since the extreme low values in the 1980s.

A bio-physicochemical perspective of the Bay of Bengal

Knowledge of bio-physicochemical variables is essential to better understand the functioning of tropical marine ecosystems, which are rich in biodiversity and provide nutrition and livelihoods to billions of people in the developing countries. This study analysed the spatial and temporal variability of phytoplankton and zooplankton with chlorophyll, primary productivity, temperature, salinity, oxygen and nutrients in the Bay of Bengal (BoB), collecting data from the World Ocean, and COPEPOD and Aqua MODIS records. The results indicated a strong gradient in bio-physicochemical conditions of the BoB, from the coast to the open sea. Specifically, the spatial variability in chlorophyll was negatively correlated (R2 = 0.59) with temperature and zooplankton, while a positive correlation (R2 = 0.70) was noted between chlorophyll and silicate, nitrate, phosphate, dissolved oxygen and salinity. All the variables exhibited a strong vertical gradient at depths up to 500 m. Temperature, nutrients, zooplankton and to a lesser extent salinity and rainfall had an influence on the annual abundance of phytoplankton. Over the long term, a significant positive trend in temperature and a significant negative trend in primary productivity were observed in the BoB. The findings of this study will be useful to draw insights on the state of fisheries habitats and the overall environmental conditions of the BoB in response to future climate changes.