Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Diagnosis of boreal summer intraseasonal oscillation in high resolution NCEP climate forecast system

The present study examines the ability of high resolution (T382) National Centers for Environmental Prediction coupled atmosphere–ocean climate forecast system version 2 (CFS T382) in simulating the salient spatio-temporal characteristics of the boreal summertime mean climate and the intraseasonal variability. The shortcomings of the model are identified based on the observation and compared with earlier reported biases of the coarser resolution of CFS (CFS T126). It is found that the CFS T382 reasonably mimics the observed features of basic state climate during boreal summer. But some prominent biases are noted in simulating the precipitation, tropospheric temperature (TT) and sea surface temperature (SST) over the global tropics. Although CFS T382 primarily reproduces the observed distribution of the intraseasonal variability over the Indian summer monsoon region, some difficulty remains in simulating the boreal summer intraseasonal oscillation (BSISO) characteristics. The simulated eastward propagation of BSISO decays rapidly across the Maritime Continent, while the northward propagation appears to be slightly slower than observation. However, the northward propagating BSISO convection propagates smoothly from the equatorial region to the northern latitudes with observed magnitude. Moreover, the observed northwest-southeast tilted rain band is not well reproduced in CFS T382. The warm mean SST bias and inadequate simulation of high frequency modes appear to be responsible for the weak simulation of eastward propagating BSISO. Unlike CFS T126, the simulated mean SST and TT exhibit warm biases, although the mean precipitation and simulated BSISO characteristics are largely similar in both the resolutions of CFS. Further analysis of the convectively coupled equatorial waves (CCEWs) indicates that model overestimates the gravest equatorial Rossby waves and underestimates the Kelvin and mixed Rossby-gravity waves. Based on analysis of CCEWs, the study further explains the possible reasons behind the realistic simulation of northward propagating BSISO in CFS T382, even though the model shows substantial biases in simulating mean state and other BSISO modes