Nonstationary warm spell frequency analysis integrating climate variability and change with application to the Middle East.

The Middle East can experience extended wintertime spells of exceptionally hot weather, which can result in prolonged droughts and have major impacts on the already scarce water resources of the region. Recent observational studies point at increasing trends in mean and extreme temperatures in the Middle East, while climate projections seem to indicate that, in a warming weather scenario, the frequency, intensity and duration of warm spells will increase. The nonstationary warm spell frequency analysis approach proposed herein allows considering both climate variability through global climatic oscillations and climate change signals. In this study, statistical distributions with parameters conditional on covariates representing time, to account for temporal trend, and climate indices are used to predict the frequency, duration and intensity of wintertime warm spells in the Middle East. Such models could find a large applicability in various fields of climate research, and in particular in the seasonal prediction of warm spell severity. Based on previous studies linking atmospheric circulation patterns in the Atlantic to extreme temperatures in the Middle East, we use as covariates two classic modes of ‘fast’ and ‘slow’ climatic variability in the Atlantic Ocean (i.e., the Northern Atlantic Oscillation and the Atlantic Multidecadal Oscillation respectively). Results indicate that the use of covariates improves the goodness-of-fit of models for all warm spell characteristics

90Y Radioembolization for Hepatic Malignancy in Patients with Previous Biliary Intervention: Multicenter Analysis of Hepatobiliary Infections

PurposeTo determine the frequency of hepatobiliary infections after transarterial radioembolization (TARE) with yttrium 90 (90Y) in patients with liver malignancy and a history of biliary intervention.Materials and MethodsFor this retrospective study, records of all consecutive patients with liver malignancy and history of biliary intervention treated with TARE at 14 centers between 2005 and 2015 were reviewed. Data regarding liver function, 90Y dosimetry, antibiotic prophylaxis, and bowel preparation prophylaxis were collected. Primary outcome was development of hepatobiliary infection.ResultsOne hundred twenty-six patients (84 men, 42 women; mean age, 68.8 years) with primary (n = 39) or metastatic (n = 87) liver malignancy and history of biliary intervention underwent 180 procedures with glass (92 procedures) or resin (88 procedures) microspheres. Hepatobiliary infections (liver abscesses in nine patients, cholangitis in five patients) developed in 10 of the 126 patients (7.9%) after 11 of the 180 procedures (6.1%; nine of those procedures were performed with glass microspheres). All patients required hospitalization (median stay, 12 days; range, 2–113 days). Ten patients required percutaneous abscess drainage, three patients underwent endoscopic stent placement and stone removal, and one patient needed insertion of percutaneous biliary drains. Infections resolved in five patients, four patients died (two from infection and two from cancer progression while infection was being treated), and one patient continued to receive suppressive antibiotics. Use of glass microspheres (P = .02), previous liver resection or ablation (P = .02), and younger age (P = .003) were independently predictive of higher infection risk.ConclusionInfectious complications such as liver abscess and cholangitis are uncommon but serious complications of transarterial radioembolization with 90Y in patients with liver malignancy and a history of biliary intervention.© RSNA, 2018Online supplemental material is available for this article

Inhaled corticosteroids in childhood asthma: the story continues

Inhaled corticosteroids (ICS) are the most effective anti-inflammatory drugs for the treatment of persistent asthma in children. Treatment with ICS decreases asthma mortality and morbidity, reduces symptoms, improves lung function, reduces bronchial hyperresponsiveness and reduces the number of exacerbations. The efficacy of ICS in preschool wheezing is controversial. A recent task force from the European Respiratory Society on preschool wheeze defined two different phenotypes: episodic viral wheeze, wheeze that occurs only during respiratory viral infections, and multiple-trigger wheeze, where wheeze also occurs in between viral episodes. Treatment with ICS appears to be more efficacious in the latter phenotype. Small particle ICS may offer a potential benefit in preschool children because of the favourable spray characteristics. However, the efficacy of small particle ICS in preschool children has not yet been evaluated in prospective clinical trials. The use of ICS in school children with asthma is safe with regard to systemic side effects on the hypothalamic–pituitary–adrenal axis, growth and bone metabolism, when used in low to medium doses. Although safety data in wheezing preschoolers is limited, the data are reassuring. Also for this age group, adverse events tend to be minimal when the ICS is used in appropriate doses

Volume-Duration-Frequencies for Ungaged Catchments in Texas

This report summarizes results from studies to determine relationships among the volume, duration and frequencies of floods in ungaged catchments in Texas. Methodologies were adopted for determining flood volumes at unregulated, non-urban catchments. Separate methodologies were developed for small and large watersheds. Regression equations were developed for twelve regions to estimate flood volumes for different durations and recurrence intervals. "Window Test" was conducted to establish a methodology to separate small and large watersheds based on their response characteristics. Regional flood volume-duration-frequency equations were developed for 8 of the 12 regions. This report, which includes information from reports released earlier at the completion of individual phases, consists of two volumes. Volume I (titled Volume-Duration-Frequencies for Ungaged Catchments in Texas: Calculation of Regional Regression Equations) presents the regional regression equations developed, while Volume II (titled Volume-Duration-Frequencies Ungaged Catchments in Texas: Computations of Flood Volumes of Varying Durations and Frequencies for Catchments with Areas Greater than 300 Square Miles) lists the actual flood volumes computed for different duration- frequencies at all rural, unregulated sites that have at least 300 square miles of contributing drainage area

SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above) for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotro pism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effect iveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: R andomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1 - L2 level and a fter conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine) with an incremental dosage of 1ml at a time, till the complete onset o f analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia ( P re & post operatively), duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorde d. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac. 10% of patients had fair quality of analgesia and relaxation only. In 3% patients the epidural block failed, in whom general anaesthesia was given. Overall success rate was 97%. Intraoperative and post - operative complications were very minimal. No cases of hypotension, bradycardia, nausea vomiting, total spinal block and respiratory depres sion were seen. CONCLUSION: From the present study it can be inferred that 0.5% Bupivacaine 5 - 6 ml is effective for segmental epidural block for inguinal hernia repair. Segmental epidural block is safe anaesthesia with minimal physiological alterations. Wi th less side effect

Influence of socio-economic status on financial stability of the general public during the Covid-19 pandemic: prospective cross-sectional study

Abstract Covid 19 pandemic has not only led to disruption of public health but it has also resulted in massive economic shock across the world due to business interruptions and shutdowns form social distancing measures. Different communities are facing varying consequences but daily wage workers and farmers remain the most effected groups. This has also led to risk of unemployment, which has worst impact on livelihood of common man. According to WHO, nearly half of the world’s 3.3 billion global workforce are at risk of losing their live hood. These economic crises have shown effect on the psychological and social well being of individual. The research agenda includes accessing the current socioeconomic status of general public. Their financial stability in global crisis and whether they can recover their loss.The current article will be carried out to assess the socioeconomic status of general public and their financial stability or loss incurred with pandemic.</jats:p

Assessment of influence of social media and peer groups on increasing the prevalence of vaccine hesitancy in India: a prospective cross-sectional survey

Abstract Since March 11, 2020, when the World Health Organization proclaimed the fast spread of SARS-CoV-2 a worldwide pandemic, the majority of afflicted nations have continued to adopt non-pharmaceutical interventions (NPIs, such as physical separation, hand cleanliness, and mask usage), which have been effective in suppressing viral transmission. However, given the fast spread of SARS-CoV-2 and the outbreak's high fatality rate, it is generally agreed that a safe and effective vaccine is essential for controlling the pandemic. Vaccination coverage is one of the most effective and cost-efficient health interventions available for the prevention and control of infectious illnesses, including the COVID-19. While producing an effective and safe COVID-19 vaccine is not straightforward, it's manufacturing, storage, distribution, and administration may offer additional difficulties, particularly in underdeveloped nations. The purpose of the present study sought to determine the general population's acceptability, the prevalence of vaccine hesitancy, and the influence of social media and peer groups towards the COVID19 vaccination in India.</jats:p