temporal fluctuations
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2021 ◽  
Author(s):  
Andrea Brizzi ◽  
Charles Whittaker ◽  
Luciana Servo ◽  
Iwona Hawryluk ◽  
Carlos Augusto Prete ◽  
...  

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.


Author(s):  
Stefan Grasl ◽  
Patrick Mekhail ◽  
Stefan Janik ◽  
Christoph M. Grasl ◽  
Erich Vyskocil ◽  
...  

Abstract Purpose Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff. Methods This retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal–Wallis test, Mann–Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences. Results A total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1–19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm—6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol. Conclusion The discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.


2021 ◽  
Author(s):  
Thierry Devos ◽  
Melody Sadler ◽  
David Toyosaburo Perry ◽  
Kumar Yogeeswaran

The present research examined whether temporal fluctuations in context ethnic diversity account for current levels of implicit ethnic-American associations. Temporal fluctuations in ethnic diversity at the metropolitan level were assessed using data from four decennial U.S. censuses (1980-2010) and distinguishing three dimensions of context ethnic diversity (minority representation, variety, and integration). Project Implicit data (2011-2017) indexed the extent to which American identity was implicitly associated with European Americans over Asian Americans (i.e., American = White associations). Data were analyzed using multilevel modeling (N = 152,011, nested within 226 metropolitan areas). Steeper increases in the proportion of Asian Americans were related to weaker implicit (but stronger explicit) American = White associations. Increases in ethnic integration accounted for stronger implicit American = White associations when integration fluctuations reflected accelerating rather than decelerating trends. These results suggest that current levels of implicit ethnic-national associations are linked to complex patterns of ethnic diversity fluctuations.


eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Fanny Janssen ◽  
Anastasios Bardoutsos ◽  
Shady El Gewily ◽  
Joop De Beer

Introduction: In Europe, women can expect to live on average 82 years, and men 75 years. Forecasting how life expectancy will develop in the future is essential for society. Most forecasts rely on a mechanical extrapolation of past mortality trends, which leads to unreliable outcomes because of temporal fluctuations in the past trends due to lifestyle 'epidemics'. Methods: We project life expectancy for 18 European countries by taking into account the impact of smoking, obesity, and alcohol on mortality, and the mortality experiences of forerunner populations. Results: We project that life expectancy in these 18 countries will increase from, on average, 83.4 years for women and 78.3 years for men in 2014 to 92.8 years for women and 90.5 years for men in 2065. Compared to others (Lee-Carter, Eurostat, United Nations), we project higher future life expectancy values and more realistic differences between countries and sexes. Conclusions: Our results imply longer individual lifespans, and more elderly in society. Funding: Netherlands Organisation for Scientific Research (NWO) (grant no. 452-13-001).


Geoderma ◽  
2021 ◽  
Vol 391 ◽  
pp. 114951
Author(s):  
Zachery R. Leitner ◽  
Aaron Lee M. Daigh ◽  
Jodi DeJong-Hughes

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