Evaluation of bias correction methods for a multivariate drought index: case study of the Upper Jhelum Basin

Bias correction (BC) is often a necessity to improve the applicability of global and regional climate model (GCM and RCM, respectively) outputs to impact assessment studies, which usually depend on multiple potentially dependent variables. To date, various BC methods have been developed which adjust climate variables separately (univariate BC) or jointly (multivariate BC) prior to their application in impact studies (i.e., the component-wise approach). Another possible approach is to first calculate the multivariate hazard index from the original, biased simulations and bias-correct the impact model output or index itself using univariate methods (direct approach). This has the advantage of circumventing the difficulties associated with correcting the inter-variable dependence of climate variables which is not considered by univariate BC methods. Using a multivariate drought index (i.e., standardized precipitation evapotranspiration index – SPEI) as an example, the present study compares different state-of-the-art BC methods (univariate and multivariate) and BC approaches (direct and component-wise) applied to climate model simulations stemming from different experiments at different spatial resolutions (namely Coordinated Regional Climate Downscaling Experiment (CORDEX), CORDEX Coordinated Output for Regional Evaluations (CORDEX-CORE), and 6th Coupled Intercomparison Project (CMIP6)). The BC methods are calibrated and evaluated over the same historical period (1986–2005). The proposed framework is demonstrated as a case study over a transboundary watershed, i.e., the Upper Jhelum Basin (UJB) in the Western Himalayas. Results show that (1) there is some added value of multivariate BC methods over the univariate methods in adjusting the inter-variable relationship; however, comparable performance is found for SPEI indices. (2) The best-performing BC methods exhibit a comparable performance under both approaches with a slightly better performance for the direct approach. (3) The added value of the high-resolution experiments (CORDEX-CORE) compared to their coarser-resolution counterparts (CORDEX) is not apparent in this study.</p

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019

Background Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings An estimated 1·57 billion (95% uncertainty interval 1·51–1·64) people globally had hearing loss in 2019, accounting for one in five people (20·3% [19·5–21·1]). Of these, 403·3 million (357·3–449·5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430·4 million (381·7–479·6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127·1 million people [112·3–142·6]). Of all people with a hearing impairment, 62·1% (60·2–63·9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65·8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2·45 billion (2·35–2·56) people will have hearing loss, a 56·1% (47·3–65·2) increase from 2019, despite stable age-standardised prevalence. Interpretation As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Evaluation of bias correction methods for a multivariate drought index: case study of the Upper Jhelum Basin

Bias correction (BC) is often a necessity to improve the applicability of global and regional climate model (GCM and RCM, respectively) outputs to impact assessment studies, which usually depend on multiple potentially dependent variables. To date, various BC methods have been developed which adjust climate variables separately (univariate BC) or jointly (multivariate BC) prior to their application in impact studies (i.e., the component-wise approach). Another possible approach is to first calculate the multivariate hazard index from the original, biased simulations and bias-correct the impact model output or index itself using univariate methods (direct approach). This has the advantage of circumventing the difficulties associated with correcting the inter-variable dependence of climate variables which is not considered by univariate BC methods.Using a multivariate drought index (i.e., standardized precipitation evapotranspiration index - SPEI) as an example, the present study compares different state-of-the-art BC methods (univariate and multivariate) and BC approaches (direct and component-wise) applied to climate model simulations stemming from different experiments at different spatial resolutions (namely Coordinated Regional Climate Downscaling Experiment (CORDEX), CORDEX Coordinated Output for Regional Evaluations (CORDEX-CORE), and 6th Coupled Intercomparison Project (CMIP6)). The BC methods are calibrated and evaluated over the same historical period (1986-2005). The proposed framework is demonstrated as a case study over a transboundary watershed, i.e., the Upper Jhelum Basin (UJB) in the Western Himalayas.Results show that (1) there is some added value of multivariate BC methods over the univariate methods in adjusting the inter-variable relationship; however, comparable performance is found for SPEI indices. (2) The best-performing BC methods exhibit a comparable performance under both approaches with a slightly better performance for the direct approach. (3) The added value of the high-resolution experiments (CORDEX-CORE) compared to their coarser-resolution counterparts (CORDEX) is not apparent in this study

Evaluation of machine learning techniques for inflow prediction in Lake Como, Italy

Accurate streamflow prediction is a fundamental task for integrated water resources management and flood risk mitigation. The purpose of this study is to forecast the water inflow to lake Como, (Italy) using different machine learning algorithms. The forecast is done for different days ranging from one day to three days. These models are evaluated by three statistical measures including Mean Absolute Error, Root Mean Squared Error, and the Nash-Sutcliffe Efficiency Coefficient. The experimental results show that Neural Network performs better for streamflow estimation with MAE and RMSE followed by Support Vector Regression and Random Forest

Intelligent image processing techniques for cancer progression detection, recognition and prediction in the human liver

Clinical Decision Support (CDS) aids in early diagnosis of liver cancer, a potentially fatal disease prevalent in both developed and developing countries. Our research aims to develop a robust and intelligent clinical decision support framework for disease management of cancer based on legacy Ultrasound (US) image data collected during various stages of liver cancer. The proposed intelligent CDS framework will automate real-time image enhancement, segmentation, disease classification and progression in order to enable efficient diagnosis of cancer patients at early stages. The CDS framework is inspired by the human interpretation of US images from the image acquisition stage to cancer progression prediction. Specifically, the proposed framework is composed of a number of stages where images are first acquired from an imaging source and pre-processed before running through an image enhancement algorithm. The detection of cancer and its segmentation is considered as the second stage in which different image segmentation techniques are utilized to partition and extract objects from the enhanced image. The third stage involves disease classification of segmented objects, in which the meanings of an investigated object are matched with the disease dictionary defined by physicians and radiologists. In the final stage; cancer progression, an array of US images is used to evaluate and predict the future stages of the disease. For experiment purposes, we applied the framework and classifiers to liver cancer dataset for 200 patients. Class distributions are 120 benign and 80 malignant in this dataset