Predictors of length of hospital stay after total hip replacement

Purpose: To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders. Methods: Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded. Results: 64% of Patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in Patients aged \u3e65 years than those younger (13 vs. 9 days, p65 years than those younger (61% vs. 37% or 24%, p65 years (pConclusions: Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care

Multidecadal Changes in the Relationship between ENSO and Wet-Season Precipitation in the Arabian Peninsula

Abstract Multidecadal variations in the relationship between El Niño–Southern Oscillation (ENSO) and the Arabian Peninsula rainfall are investigated using observed data for the last 60 years and various atmospheric general circulation model (AGCM) experiments. The wet season in the Arabian Peninsula from November to April was considered. The 6-month averaged Arabian rainfall was negatively correlated with ENSO for an earlier 30-yr period from 1950 to 1979 and positively correlated to ENSO for a more recent period from 1981 to 2010. The multidecadal variations can be attributed to the variations in Indian Ocean SST anomalies accompanied by ENSO. In the early 30-yr period, ENSO accompanied relatively large SST anomalies in the Indian Ocean, whereas in the recent 30-yr period it accompanied relatively small SST anomalies in the Indian Ocean. The atmospheric anomalies in the Arabian region during ENSO are combined responses to the Pacific and Indian Ocean SST anomalies, which offset each other during ENSO. The recent El Niño events accompanied negative 200-hPa geopotential height (GH) anomalies over the Arabian region, mainly forced by the Pacific SST anomalies, resulting in an increase of precipitation over the region. In contrast, in the early 30-yr period, Indian Ocean SST anomalies played a dominant role in the atmospheric responses over the Arabian region during ENSO, and the negative GH anomalies and more precipitation over the Arabian region were mainly forced by the negative SST anomalies over the Indian Ocean, which appeared during La Niña. These observed findings are confirmed by various AGCM experiments

Hydrophilic polymers based sustained release matrix tablets of Ibuprofen: Optimization of formulation using Box-Behnken statistical design

The current study was aimed to formulate sustained release matrix tablets of Ibuprofen; a Propionic acid derivative, and is non-steroidal anti-inflammatory agent (NSAID) with analgesic and antipyretic properties and optimize by using a 3-factor 3-level Box-Behnken statistical design as an optimization tool. Matrix tablets were prepared by direct compression technique using HPMC(X1), NaCMC(X2) and Xanthan Gum(X3) as independent variables and % release at 2hr (Y1), % release at 12hr (Y2) and hardness (Y3) of tablet were selected as dependent variables. Regression analysis was performed on dissolution data and construct polynomial regression models for these response variables. Polynomial models were further validated using ANOVA and results indicate that all the polymers used have significant effect on selected response (p<0.05). Contour plots were drawn to evaluate the effect of polymer combination on selected responses. The results obtained from kinetic modeling indicate that drug release follows the non-fickian diffusion process. Hence Box-Behnken statistical design facilitates the formulation and optimization of Ibuprofen sustained release matrix tablets to achieve better bioavailability. Keywords: Matrix tablets, Sustained release, Ibuprofen, Ant-inflammatory, Box-Behnken statistical desig

Projected Changes in Climate Extremes Using CMIP6 Simulations Over SREX Regions

This paper presents projected changes in extreme temperature and precipitation events by using Coupled Model Intercomparison Project phase 6 (CMIP6) data for mid-century (2036–2065) and end-century (2070–2099) periods with respect to the reference period (1985–2014). Four indices namely, Annual maximum of maximum temperature (TXx), Extreme heat wave days frequency (HWFI), Annual maximum consecutive 5-day precipitation (RX5day), and Consecutive Dry Days (CDD) were investigated under four socioeconomic scenarios (SSP1-2.6; SSP2-4.5; SSP3-7.0; SSP5-8.5) over the entire globe and its 26 Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate ChangeAdaptation (SREX) regions. The projections show an increase in intensity and frequency of hot temperature and precipitation extremes over land. The intensity of the hottest days (as measured by TXx) is projected to increase more in extratropical regions than in the tropics, while the frequency of extremely hot days (as measured by HWFI) is projected to increase more in the tropics. Drought frequency (as measured by CDD) is projected to increase more over Brazil, the Mediterranean, South Africa, and Australia. Meanwhile, the Asian monsoon regions (i.e., South Asia, East Asia, and Southeast Asia) become more prone to extreme flash flooding events later in the twenty-first century as shown by the higher RX5day index projections. The projected changes in extremes reveal large spatial variability within each SREX region. The spatial variability of the studied extreme events increases with increasing greenhouse gas concentration (GHG) and is higher at the end of the twenty-first century. The projected change in the extremes and the pattern of their spatial variability is minimum under the low-emission scenario SSP1-2.6. Our results indicate that an increased concentration of GHG leads to substantial increases in the extremes and their intensities. Hence, limiting ­CO2 emissions could substantially limit the risks associated with increases in extreme events in the twenty-first century

Projected changes in temperature and precipitation over the United States, Central America and the Caribbean in CMIP6 GCMs

The Coupled Model Intercomparison Project Phase 6 (CMIP6) dataset is used to examine projected changes in temperature and precipitation over the United States (U.S.), Central America and the Caribbean. The changes are computed using an ensemble of 31 models for three future time slices (2021–2040, 2041–2060, and 2080–2099) relative to the reference period (1995–2014) under three Shared Socioeconomic Pathways (SSPs; SSP1-2.6, SSP2-4.5, and SSP5-8.5). The CMIP6 ensemble reproduces the observed annual cycle and distribution of mean annual temperature and precipitation with biases between − 0.93 and 1.27 °C and − 37.90 to 58.45%, respectively, for most of the region. However, modeled precipitation is too large over the western and Midwestern U.S. during winter and spring and over the North American monsoon region in summer, while too small over southern Central America. Temperature is projected to increase over the entire domain under all three SSPs, by as much as 6 °C under SSP5-8.5, and with more pronounced increases in the northern latitudes over the regions that receive snow in the present climate. Annual precipitation projections for the end of the twenty-frst century have more uncertainty, as expected, and exhibit a meridional dipole-like pattern, with precipitation increasing by 10–30% over much of the U.S. and decreasing by 10–40% over Central America and the Caribbean, especially over the monsoon region. Seasonally, precipitation over the eastern and central subregions is projected to increase during winter and spring and decrease during summer and autumn. Over the monsoon region and Central America, precipitation is projected to decrease in all seasons except autumn. The analysis was repeated on a subset of 9 models with the best performance in the reference period; however, no signifcant diference was found, suggesting that model bias is not strongly infuencing the projections.Universidad de Costa Rica/[805-B9-454]/UCR/Costa RicaNational Science Foundation/[AGS-1849654]/NSF/Estados UnidosNational Science Foundation/[AGS-1623912]/NSF/Estados UnidosDepartment of Energy/[2316‐T849‐08]/DOE/Estados UnidosNational Oceanic and Atmospheric Administration/[2316‐T849‐08]/NOAA/Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigaciones Geofísicas (CIGEFI)UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigación en Ciencias del Mar y Limnología (CIMAR

Saudi-KAU Coupled Global Climate Model: Description and Performance

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Assessment of CMIP6 performance and projected temperature and precipitation changes over South America

We evaluate the performance of a large ensemble of Global Climate Models (GCMs) from the Coupled Model Intercomparison Project Phase 6 (CMIP6) over South America for a recent past reference period and examine their projections of twenty-first century precipitation and temperature changes. The future changes are computed for two time slices (2040–2059 and 2080–2099) relative to the reference period (1995–2014) under four Shared Socioeconomic Pathways (SSPs, SSP1–2.6, SSP2–4.5, SSP3–7.0 and SSP5–8.5). The CMIP6 GCMs successfully capture the main climate characteristics across South America. However, they exhibit varying skill in the spatiotemporal distribution of precipitation and temperature at the sub-regional scale, particularly over high latitudes and altitudes. Future precipitation exhibits a decrease over the east of the northern Andes in tropical South America and the southern Andes in Chile and Amazonia, and an increase over southeastern South America and the northern Andes—a result generally consistent with earlier CMIP (3 and 5) projections. However, most of these changes remain within the range of variability of the reference period. In contrast, temperature increases are robust in terms of magnitude even under the SSP1–2.6. Future changes mostly progress monotonically from the weakest to the strongest forcing scenario, and from the mid-century to late-century projection period. There is an increase in the seasonality of the intra-annual precipitation distribution, as the wetter part of the year contributes relatively more to the annual total. Furthermore, an increasingly heavy-tailed precipitation distribution and a rightward shifted temperature distribution provide strong indications of a more intense hydrological cycle as greenhouse gas emissions increase. The relative distance of an individual GCM from the ensemble mean does not substantially vary across different scenarios. We found no clear systematic linkage between model spread about the mean in the reference period and the magnitude of simulated sub-regional climate change in the future period. Overall, these results could be useful for regional climate change impact assessments across South America

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe