Assessment of the effects of climate change on water balance components in the upper Erer subbasin, Ethiopia

Eastern Ethiopia watersheds are located in transition zone from Arid to semi-humid climate and in expanding to westwards the west annual rainfall is highly declining. This paper explains future hydrological response impacts under changing climate using ensemble average of the CORDEX RCMs for historical (1979-2014) and future (2024-2070) periods. The result revels the monthly average temperature varies (0.04-6.25°C) for RCP-4.5, while it varies (0.03-6.59°oC) for RCP-8.5. The monthly average rainfall to be decline by 90.71 mm and rise by 211. 22 mm for RCP-4.5, while it is going to decline by 84.97 mm and rise by 235.62 mm for RCP-8.5. The adjusted SWAT model was used to detect the changes of projected hydrological response from reference period. Balance components of the baseline period was compared to future period. The result shows the change in decrease of annual mean surface flow (4.98 %-5.63 %), groundwater flow (5.63 %-6.68 %), evapotranspiration (2.45 %-2.57 %) and water yield (5.54 %-5.21 %) to be expected from RCP-4.5 to RCP-8.5. The findings of this paper provide valuable assistance to water resource planners by enhancing their comprehension of change in climate effects at local level.

An Evaluation of Projection Methods for Detailed Small Area Projections: An Application and Validation to King County, Washington

Population projections are used by a number of local agencies to better prepare for the future resource needs of counties, ensuring that educational, health, housing, and economic demands of individuals are met. Meeting the specific needs of a county's population, such as what resources to provide, where to target resources, and ensure an equitable distribution of those resources, requires population projections which are both demographically detailed, such as by age, race, and ethnicity, and geographically precise, such as at the census tract level. Despite this need, an evaluation of which methods are best suited to produce population projections at this level are lacking. In this study, we evaluate the accuracy of several cohort-based methods for small area population projections by race and ethnicity. We apply these methods to population projections of King County, Washington and assess the validity of projections using past population estimates. We find a clear pattern that demonstrates while simplified methods perform well in near term forecasts, methods which employ smoothing strategies perform better in long-term forecasting scenarios. Furthermore, we demonstrate that model's incorporating multiple stages of smoothing can provide detailed insights into the projected population size of King county and the places and groups which will most contribute to this growth. Detailed projections, such as those provided by multi-stage smoothing methods, enable city planners and policy makers a detailed view of the future structure of their county's population and provide for them a resource to better meet the needs of future populations.

The growing cancer burden: Age-period-cohort projections in Aotearoa New Zealand 2020-2044

BACKGROUND

Cancer is a major cause of premature death and inequity, and global case numbers are rapidly expanding. This study projects future cancer numbers and incidence rates in Aotearoa New Zealand.

METHODS

Age-period-cohort modelling was applied to 25-years of national data to project cancer cases and incidence trends from 2020 to 2044. Nationally mandated cancer registry data and official historical and projected population estimates were used, with sub-groups by age, sex, and ethnicity.

RESULTS

Cancer diagnoses were projected to increase from 25,700 per year in 2015-2019 to 45,100 a year by 2040-44, a 76% increase (2.3% per annum). Across the same period, age-standardised cancer incidence increased by 9% (0.3% per annum) from 348 to 378 cancers per 100,000 person years, with greater increases for males (11%) than females (6%). Projected incidence trends varied substantially by cancer type, with several projected to change faster or in the opposite direction compared to projections from other countries.

CONCLUSIONS

Increasing cancer numbers reinforces the critical need for both cancer prevention and treatment service planning activities. Investment in developing new ways of working and increasing the workforce are required for the health system to be able to afford and manage the future burden of cancer.

Temperature projections and heatwave attribution scenarios over India: A systematic review

The average global temperature is rising due to anthropogenic emissions. Hence, a systematic approach was used to examine the projected impacts of rising global temperatures on heatwaves in India and provide insights into mitigation and adaptation strategies. With over 24,000 deaths attributed to heatwaves from 1992 to 2015, there is an urgent need to understand India's vulnerabilities and prepare adaptive strategies under various emission scenarios.This situation is predicted to worsen as heatwaves become more frequent, intense, and long-lasting. Severe heatwaves can exacerbate chronic health conditions, vector-borne diseases, air pollution, droughts and other socio-economic pressures causing higher mortality and morbidity. Heatwaves with severe consequences have increased and are expected to become more frequent in Indian climatic and geographical conditions. As per the future projection studies, the temperature could rise ±1.2° C to ±3.5° C and will start reducing by the end of 2050. The study also provides data from the research that employs climatic models and statistical approaches for a more precise characterization of heat extremes and improved projections. Also, the study appraises the past, present and future heatwave trend projections. Most of these studies compute future projections using the Coupled Model Intercomparison Project (CMIP5) models and Representative Concentration Pathway (RCP). Limited systematic reports have been found using CMIP6, whereas the best-suited and widely used method was the RCP8.5. The study findings will aid in identifying the zones most susceptible to heatwave risk and provide actionable projections for policymakers to examine the existing evidence for developing proper planning and policy formulation, considering the future climate and temperature projections.

Epidemiological Trends and Projections of Incidence, Prevalence, and Disease Related Mortality Associated With Peripheral Arterial Disease: Observations Using Nationwide Danish Data

OBJECTIVE

Peripheral arterial disease (PAD) trends remain unclear because contemporary data are sparse and conflicting. This nationwide cohort study quantified changes in PAD incidence, prevalence, and all cause mortality, and projected prevalence development through to 2040.

METHODS

Population based registries covering the entire Danish population aged ≥ 40 years from 2000 to 2018 were linked to assess trends in PAD incidence, prevalence, and all cause mortality, overall and by sex and age groups. Based on observed trends in incidence and mortality, and estimated future annual age distribution and population mortality, the PAD prevalence through to 2040 was projected.

RESULTS

The Danish population aged 40 - 99 years in 2000 - 2018 included 4 811 281 individuals, among whom 145 870 incident PAD diagnoses were identified. The age and sex standardised PAD incidence decreased from 2.26 per 1 000 person years in 2000 to 1.65 in 2018 (incidence RR 0.74, 95% CI 0.72 - 0.77). The incidence was approximately 20% higher in men than women but declined similarly over time. Concurrently, PAD prevalence in the Danish adult population increased from 1.3% to 1.6% (prevalence ratio 1.28, 95% CI 1.26 - 1.30). Among patients aged ≥ 80 years, the prevalence reached 5.7% in women and 7.9% in men. The age and sex standardised annual mortality among patients with PAD decreased from 9.8% in 2000 to 7.2% in 2018 (mortality ratio 0.75, 95% CI 0.72 - 0.78). Projections of PAD prevalence demonstrated that the rising PAD prevalence will continue until around 2030, followed by a decline towards 2040. Among individuals aged ≥ 80 years, the prevalence was projected to plateau at 8.9% for men and 6.2% for women before declining.

CONCLUSION

Within an unselected nationwide population, the incidence and all cause mortality of PAD have declined over the last two decades. Concurrently, prevalence increased and is projected to increase further over the coming decade, emphasising the growing burden of this common atherosclerotic disease in ageing populations.

Time trends in loneliness from 1984 to 2019 among 27,032 older adults in Norway: A HUNT study

The aging population and increasing evidence of the detrimental health impacts of loneliness emphasize the importance of studying and predicting changes in loneliness prevalence among older adults. To understand and project changes in loneliness over time, we examined 35-year trends in adults aged 70 and older, considering factors such as sex, age, and living situation. Cross-sectional data from 27,032 home-dwelling adults aged 70 years and older who participated in at least one of the four Norwegian HUNT surveys from 1984 to 2019, and Norwegian population data from Statistics Norway were used for the analyses. Loneliness was self-reported, and the prevalence of loneliness was standardized to the Norwegian population at the survey year by age and sex. The results showed that the prevalence of loneliness significantly decreased between each survey. The higher categories of loneliness (a good amount, very much) decreased, from 11.4% (1995-97), 6.7% (2006-08), and 5.8% (2017-19). Across surveys, loneliness was significantly more common among women, the oldest, and those living alone. The prevalence of loneliness among the oldest adults living alone increased from 2006 to 2019. The gradual decline in loneliness observed from 1995 to 2019 coincided with notable societal changes in Norway. We estimated that the number of older adults experiencing loneliness in Norway could rise from 184,000 in 2020 to 286,000 in 2035, and potentially reach 380,000 in 2050.

Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2040-2060

Background

National projections of future joint arthroplasties are useful in understanding the changing burden of surgery and related outcomes on the health system. The aim of this study is to update the literature by producing Medicare projections for revision total joint arthroplasty procedures from 2040 through 2060.

Methods

The study uses 2000-2019 data from the CMS Medicare Part-B National Summary and combines procedure counts using CPT codes for revision total joint arthroplasty procedures. In 2019, revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) procedures totaled 53,217 and 30,541, respectively, forming a baseline from which we generated point forecasts between 2020 and 2060 and 95% forecast intervals (FI).

Results

On average, the model projects an annual growth rate of 1.77% for rTHAs and 4.67% for rTKAs. By 2040, rTHAs were projected to be 43,514 (95% FI = 37,429-50,589) and rTKAs were projected to be 115,147 (95% FI = 105,640-125,510). By 2060, rTHAs was projected to be 61,764 (95% FI = 49,927-76,408) and rTKAs were projected to be 286,740 (95% FI = 253,882-323,852).

Conclusions

Based on 2019 total volume counts, the log-linear exponential model forecasts an increase in rTHA procedures of 42% by 2040 and 101% by 2060. Similarly, the estimated increase for rTKA is projected to be 149% by 2040 and 520% by 2060. An accurate projection of future revision procedure demands is important to understand future healthcare utilization and surgeon demand. This finding is only applicable to the Medicare population and demands further analysis for other population groups.

Predicted changes in future precipitation and air temperature across Bangladesh using CMIP6 GCMs

Understanding spatiotemporal variability in precipitation and temperature and their future projections is critical for assessing environmental hazards and planning long-term mitigation and adaptation. In this study, 18 Global Climate Models (GCMs) from the most recent Coupled Model Intercomparison Project phase 6 (CMIP6) were employed to project the mean annual, seasonal, and monthly precipitation, maximum air temperature (Tmax), and minimum air temperature (Tmin) in Bangladesh. The GCM projections were bias-corrected using the Simple Quantile Mapping (SQM) technique. Using the Multi-Model Ensemble (MME) mean of the bias-corrected dataset, the expected changes for the four Shared Socioeconomic Pathways (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5) were evaluated for the near (2015-2044), mid (2045-2074), and far (2075-2100) futures in comparison to the historical period (1985-2014). In the far future, the anticipated average annual precipitation increased by 9.48%, 13.63%, 21.07%, and 30.90%, while the average Tmax (Tmin) rose by 1.09 (1.17), 1.60 (1.91), 2.12 (2.80), and 2.99 (3.69) °C for SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5, respectively. According to predictions for the SSP5-8.5 scenario in the distant future, there is expected to be a substantial rise in precipitation (41.98%) during the post-monsoon season. In contrast, winter precipitation was predicted to decrease most (11.12%) in the mid-future for SSP3-7.0, while to increase most (15.62%) in the far-future for SSP1-2.6. Tmax (Tmin) was predicted to rise most in the winter and least in the monsoon for all periods and scenarios. Tmin increased more rapidly than Tmax in all seasons for all SSPs. The projected changes could lead to more frequent and severe flooding, landslides, and negative impacts on human health, agriculture, and ecosystems. The study highlights the need for localized and context-specific adaptation strategies as different regions of Bangladesh will be affected differently by these changes.

Estimations of future reservoir volumes under different climate scenarios for a tropical reservoir in a small Caribbean Island, Trinidad

Freshwater resources supply has always presented challenges and considering a changing climate quantifying the available water in the future is important. In the Caribbean, based on projections it is likely that the island of Trinidad would receive less intense rainfall, experience more dry days, become drier and warmer, and the water resources be decreased. In this study, the impact of a changing climate on the Navet Reservoir in Trinidad was investigated and reservoir volumes were quantified for the period 2011-2099. This period was subdivided into three time periods, 2011-2040, 2041-2070, and 2071-2099, and evaluated under the representative concentration pathways (RCPs): RCPs 2.6, 4.5, 6.0, and 8.5. Utilizing a calibrated/validated Soil Water Assessment Tool (SWAT) model for the Navet Reservoir together with projections from five general circulation models (GCMs), future monthly and seasonal reservoir volumes were estimated. The GCM precipitation and temperature data were bias-corrected using linear scaling and variance scaling methods. It was found that reservoir volumes are likely to be the lowest during the period 2041-2070 at the Navet Reservoir. Additionally, the projected reservoir volumes are reliable, resilient, and not vulnerable. These results may be used by water managers in the adaptation and mitigation of the impacts of a changing climate, thus, building resilience in the water sector.

Impact of interventions scenarios targeting three main vascular risk factors on the future burden of dementia in France

The epidemiological and societal burden of dementia is expected to increase in the coming decades due to the world population aging. In this context, the evaluation of the potential impact of intervention scenarios aiming at reducing the prevalence of dementia risk factors is an active area of research. However, such studies must account for the associated changes in mortality and the dependence between the risk factors. Using micro-simulations, this study aims to estimate the changes in dementia burden in France in 2040 according to intervention scenarios targeting the prevention or treatment of hypertension, diabetes and physical inactivity. Accounting for their communality and their effects on mortality, the results show that the disappearance of hypertension, diabetes and physical inactivity in France in 2020 could decrease dementia prevalence by 33% among men and 26% among women in 2040 and increase the life expectancy without dementia at age 65 by 3.4 years (men) and 2.6 years (women). Among the three factors, the prevention of hypertension would be the most efficient. These projections rely on current estimates of the risk of dementia and death associated with risk factors. Thanks to the R package developed they could be refined for different countries or different interventions and updated with new estimates.

Future climate imposes pressure on vulnerable ecological regions in China

Ecological regions of medium fragility account for 55 % of China's land. Large-scale afforestation and land reclamation have been carried out in these areas over the past few decades. However, how future climate change poses risks and challenges to them remains unclear. By establishing a multi-algorithm framework combining machine learning algorithms with multi-source dataset, our work predicts Normalized Difference Vegetation Index (NDVI, a proxy for vegetation greenness) and its variations in the 21st century under different climate scenarios. We find that vegetation greening (i.e., NDVI increase) in northern and southwestern China is unstable over four 20-year periods from 2020 to 2100. However, a strikingly prominent greening is expected to occur on the Qinghai-Tibet Plateau until the end of this century. Future warming can not only exacerbate the difficulties of vegetation conservation and restoration in vulnerable ecological regions, also threaten these new croplands, stymieing ambitions to increase crop production in China. Our results underscore the crucible that a warming climate presents to current restoration projects. We highlight the urgency of adapting to climate change to achieve ambitious goals of carbon sequestration and food security in China.

Predicting future cancer incidence by age, race, ethnicity, and sex

INTRODUCTION

Cancer remains a substantial burden on society. Our objective was to update projections on the number of new cancer diagnoses in the United States by age, race, ethnicity, and sex through 2040.

MATERIALS AND METHODS

Population-based cancer incidence data were obtained using Surveillance, Epidemiology, and End Results (SEER) data. Population estimates were made using the 2010 US Census data population projections to calculate future cancer incidence. Trends in age-adjusted incidence rates for 23 cancer types along with total cancers were calculated and incorporated into a second projection model.

RESULTS

If cancer incidence remains stable, annual cancer diagnoses are projected to increase by 29.5% from 1.86 million to 2.4 million between 2020 and 2040. This increase outpaces the projected US population growth of 12.3% over the same period. The population of older adults is projected to represent an increasing proportion of total cancer diagnoses with patients ≥65 years old comprising 69% of all new cancer diagnoses and patients ≥85 years old representing 13% of new diagnoses by 2040. Cancer diagnoses are projected to increase in racial minority groups, with a projected 44% increase in Black Americans (from 222,000 to 320,000 annually), and 86% in Hispanic Americans (from 175,000 to 326,000 annually).

DISCUSSION

The landscape of cancer care will continue to change over the next several decades. The burden of disease will remain substantial, and the growing proportion of older and minority patients with cancer remains of particular interest. These projections should help guide future health policy and research priorities.

Benthic ecosystem functioning under climate change: modelling the bioturbation potential for benthic key species in the southern North Sea

Climate change affects the marine environment on many levels with profound consequences for numerous biological, chemical, and physical processes. Benthic bioturbation is one of the most relevant and significant processes for benthic-pelagic coupling and biogeochemical fluxes in marine sediments, such as the uptake, transport, and remineralisation of organic carbon. However, only little is known about how climate change affects the distribution and intensity of benthic bioturbation of a shallow temperate shelf sea system such as the southern North Sea. In this study, we modelled and projected changes in bioturbation potential (BP_p) under a continuous global warming scenario for seven southern North Sea key bioturbators: Abra alba, Amphiura filiformis, Callianassa subterranea, Echinocardium cordatum, Goniada maculata, Nephtys hombergii, and Nucula nitidosa. Spatial changes in species bioturbation intensity are simulated for the years 2050 and 2099 based on one species distribution model per species driven by bottom temperature and salinity changes using the IPCC SRES scenario A1B. Local mean bottom temperature was projected to increase between 0.15 and 5.4 °C, while mean bottom salinity was projected to moderately decrease by 1.7. Our results show that the considered benthic species are strongly influenced by the temperature increase. Although the total BP remained rather constant in the southern North Sea, the BP_p for four out of seven species was projected to increase, mainly due to a simultaneous northward range expansion, while the BP_p in the core area of the southern North Sea declined for the same species. Bioturbation of the most important species, Amphiura filiformis and Echinocardium cordatum, showed no substantial change in the spatial distribution, but over time. The BP_p of E. cordatum remained almost constant until 2099, while the BP_p of A. filiformis decreased by 41%. The northward expansion of some species and the decline of most species in the south led to a change of relative contribution to bioturbation in the southern North Sea. These results indicate that some of the selected key bioturbators in the southern North Sea might partly compensate the decrease in bioturbation by others. But especially in the depositional areas where bioturbation plays a specifically important role for ecosystem functioning, bioturbation potential declined until 2099, which might affect the biochemical cycling in sediments of some areas of the southern North Sea.

Burden of lung cancer along with attributable risk factors in China from 1990 to 2019, and projections until 2030

OBJECTIVE

This study aimed to identify and project the epidemiological trends and the burden of lung cancer in China.

METHODS

We extracted incidence, mortality, disability-adjusted life-years (DALYs) and age-standardized rates of lung cancer in China, between 1990 and 2019, from the Global Burden of Disease Study (2019). The estimated annual percentage change (EAPC) was applied to quantify the trends of lung cancer burden. Furthermore, we used the Bayesian age-period-cohort model to project the incidence and mortality in the next decade.

RESULTS

From 1990 to 2019, the estimated national number of lung cancer incident cases increased by 224.0% to 832,920, deaths increased by 195.4% to 757,170 and DALYs increased by 146.1% to 17,128,580, respectively. Meanwhile, the ASIR, ASMR and ASDR showed an upward trend (EAPC of 1.33, 0.94 and 0.42, respectively). The ASIR and ASMR among males were about 2 times more than females, but the increase in ASIR in females (EAPC = 2.24) was more obvious than those in males (EAPC = 0.10) from 2020 to 2030. In China, smoking remained responsible for the highest burden of lung cancer, but the contribution of ambient particulate matter pollution to DALYs increased from 10.6% in 1990 to 22.5% in 2019 in total population. Moreover, we predicted that the number of deaths from lung cancer will increase by 42.7% in China by 2030.

CONCLUSION

In China, the burden of lung cancer has been increasing over the past three decades, which highlights more targeted intervention measures are needed to reduce the burden of lung cancer.

Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models

Background

Overweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning.

Methods

Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model.

Results

The prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely.

Conclusions

Our projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13685-w.

Tropical western and central Pacific marine heatwave data calculated from gridded sea surface temperature observations and CMIP6

Processed marine heatwave metrics are provided for the tropical western and central Pacific Ocean region (120°E-140°W, 40°S-15°N). The metrics are computed from daily sea surface temperature (SST) data, from both observations and models. The observed marine heatwave data are calculated from NOAA 0.25° daily Optimum Interpolation Sea Surface Temperature (OISST) over the period 1982–2019. The modelled marine heatwave data are from analysis of 18 model simulations as part of the Coupled Model Intercomparison Project, Phase 6 (CMIP6) over the period 1982–2100, where two future scenarios have been analysed. The marine heatwave data are provided on a grid point basis across the domain. Marine heatwave timeseries metrics are also provided for three case study regions: Fiji, Samoa, and Palau.

IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045

AIMS

To provide global, regional, and country-level estimates of diabetes prevalence and health expenditures for 2021 and projections for 2045.

METHODS

A total of 219 data sources meeting pre-established quality criteria reporting research conducted between 2005 and 2020 and representing 215 countries and territories were identified. For countries without data meeting quality criteria, estimates were extrapolated from countries with similar economies, ethnicity, geography and language. Logistic regression was used to generate smoothed age-specific diabetes prevalence estimates. Diabetes-related health expenditures were estimated using an attributable fraction method. The 2021 diabetes prevalence estimates were applied to population estimates for 2045 to project future prevalence.

RESULTS

The global diabetes prevalence in 20-79 year olds in 2021 was estimated to be 10.5% (536.6 million people), rising to 12.2% (783.2 million) in 2045. Diabetes prevalence was similar in men and women and was highest in those aged 75-79 years. Prevalence (in 2021) was estimated to be higher in urban (12.1%) than rural (8.3%) areas, and in high-income (11.1%) compared to low-income countries (5.5%). The greatest relative increase in the prevalence of diabetes between 2021 and 2045 is expected to occur in middle-income countries (21.1%) compared to high- (12.2%) and low-income (11.9%) countries. Global diabetes-related health expenditures were estimated at 966 billion USD in 2021, and are projected to reach 1,054 billion USD by 2045.

CONCLUSIONS

Just over half a billion people are living with diabetes worldwide which means that over 10.5% of the world's adult population now have this condition.

Future burden of primary and revision hip arthroplasty in Germany: a socio-economic challenge

INTRODUCTION

Total hip arthroplasty (THA) rates have increased dramatically in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of THA. Simultaneously, a rising number of revision procedures is expected, which will put an enormous economic burden on future health care systems.

METHODS

Nationwide data provided by the Federal Statistical Office of Germany were used to quantify primary and revision arthroplasty rates as a function of age and gender. Projections were performed with use of Negative Binomial and Poisson regression models on historical procedure rates in relation to population projections from 2020 to 2060.

RESULTS

A 62% increase in the incidence rate of primary THAs is projected until 2060. At the same time, the annual total number of revision procedures is forecast to rise about 40% by the year 2060. The highest numbers of revision arthroplasties were calculated around year 2043. The greatest proportions of revision surgery will be observed in women and in those aged 70 years or older. The revision burden is projected to stabilize around 15% by 2060.

CONCLUSIONS

The present projections allow a quantification of the increasing economic burden that (revision) THA will place on the German health care system in the upcoming decades. This study may serve as a model for other countries with similar demographic development as the country-specific approach predicts a substantial increase in the number of these procedures. This highlights the need for appropriate financial and human resource management in the future.

Is there increased value in robotic arm-assisted total hip arthroplasty? : a nationwide outcomes, trends, and projections analysis of 4,699,894 cases

AIMS

The current study aimed to compare robotic arm-assisted (RA-THA), computer-assisted (CA-THA), and manual (M-THA) total hip arthroplasty regarding in-hospital metrics including length of stay (LOS), discharge disposition, in-hospital complications, and cost of RA-THA versus M-THA and CA-THA versus M-THA, as well as trends in use and uptake over a ten-year period, and future projections of uptake and use of RA-THA and CA-THA.

METHODS

The National Inpatient Sample was queried for primary THAs (2008 to 2017) which were categorized into RA-THA, CA-THA, and M-THA. Past and projected use, demographic characteristics distribution, income, type of insurance, location, and healthcare setting were compared among the three cohorts. In-hospital complications, LOS, discharge disposition, and in-hospital costs were compared between propensity score-matched cohorts of M-THA versus RA-THA and M-THA versus CA-THA to adjust for baseline characteristics and comorbidities.

RESULTS

RA-THA and CA-THA did not exhibit any clinically meaningful reduction in mean LOS (RA-THA 2.2 days (SD 1.4) vs 2.3 days (SD 1.8); p < 0.001, and CA-THA 2.5 days (SD 1.9) vs 2.7 days (SD 2.3); p < 0.001, respectively) compared to their respective propensity score-matched M-THA cohorts. RA-THA, but not CA-THA, had similar non-home discharge rates to M-THA (RA-THA 17.4% vs 18.5%; p = 0.205, and 18.7% vs 24.9%; p < 0.001, respectively). Implant-related mechanical complications were lower in RA-THA (RA-THA 0.5% vs M-THA 3.1%; p < 0.001, and CA-THA 1.2% vs M-THA 2.2%; p < 0.001), which was associated with a significantly lower in-hospital dislocation (RA-THA 0.1% vs M-THA 0.8%; p < 0.001). Both RA-THA and CA-THA demonstrated higher mean higher index in-hospital costs (RA-THA $18,416 (SD $8,048) vs M-THA $17,266 (SD $8,396); p < 0.001, and CA-THA $20,295 (SD $8,975) vs M-THA $18,624 (SD $9,226); p < 0.001, respectively). Projections indicate that 23.9% and 3.2% of all THAs conducted in 2025 will be robotic arm- and computer-assisted, respectively. Projections indicated that RA-THA use may overtake M-THA by 2028 (48.3%) and reach 65.8% of all THAs by 2030.

CONCLUSION

Technology-assisted THA, particularly RA-THA, may provide value by lowering in-hospital early dislocation rates and and other in-hospital metrics compared to M-THA. Higher index-procedure and hospital costs warrant further comprehensive cost analyses to determine the true added value of RA-THA in the episode of care, particularly since we project that one in four THAs in 2025 and two in three THA by 2030 will use RA-THA technology. Cite this article: Bone Joint J 2021;103-B(9):1488-1496.

Second wave of COVID-19 in Italy: Preliminary estimation of reproduction number and cumulative case projections

The second wave of a novel coronavirus in Italy has caused 247,369 new cases and 1782 deaths only in October 2020. This significantly alarming infectious disease controlling board to impose again mitigation measures for controlling the epidemic growth. In this paper, we estimate the latest COVID-19 reproduction number (R_0) and project the epidemic size for the future 45 days. The R_0 value has calculated as 2.83 (95% CI: 1.5-4.2) and the cumulative incidences 100,015 (95% CI; 73,201-100,352), and daily incidences might be reached up to 15,012 (95% CI: 8234-16,197) respectively.

How will COVID-19 impact Australia's future population? A scenario approach

The impact of COVID-19 has been massive and unprecedented, affecting almost every aspect of our daily lives. This paper attempts to quantify the impact of COVID-19 on the future size, composition and distribution of Australia's population by projecting a range of scenarios. Drawing on the academic literature, historical data and informed by expert judgement, four scenarios representing possible future courses of economic and demographic recovery are formulated. Results suggest that Australia's population could be 6 per cent lower by 2040 in a Longer scenario than in the No Pandemic scenario, primarily due to a huge reduction in international migration. Impacts on population ageing will be less severe, leading to a one percentage point increase in the proportion of the population aged 65 and over by 2040. Differential impacts will be felt across Australian States and Territories, with the biggest absolute and relative reductions in growth occurring in the most populous states, Victoria and New South Wales. Given the ongoing nature of the crisis at the time of writing, there remains significant uncertainty surrounding the plausibility of the proposed scenarios. Ongoing monitoring of the demographic impacts of COVID-19 are important to ensure appropriate planning and recovery in the years ahead.

Planning the hepatitis C virus elimination in Cyprus: A modeling study

BACKGROUND

Hepatitis C virus (HCV) infection is a major global public health problem. In the Republic of Cyprus, the estimated prevalence of chronic hepatitis C (CHC) among the general population is 0.6%, while the CHC prevalence among people who inject drugs (PWID) is estimated at 46%. Direct-acting antivirals that can eliminate HCV are not yet widely available in the Republic of Cyprus. However, when direct-acting antivirals become available, a long-term strategic plan to guide elimination efforts will be needed to maximize the effect of treatment.

AIM

To determine the programmatic targets to eliminate HCV in the Republic of Cyprus.

METHODS

A dynamic, stochastic, individual-based model of HCV transmission, disease progression, and cascade of care was calibrated to data from Cyprus. The model stratifies the population into the infected general population and the PWID population. A variety of test, prevention, and treatment strategies concerning the general population, PWID, or both were examined. The time horizon of the analysis was until 2034.

RESULTS

Under the status quo scenario, the model predicted that 75 (95% confidence interval (CI): 60, 91) and 575 (95%CI: 535, 615) liver-related deaths and new infections would occur by 2034, respectively. Launching an expanded treatment program, without screening interventions, would cause modest outcomes regarding CHC prevalence (16.6% reduction in 2034 compared to 2020) and liver-related deaths (10 deaths would be prevented compared to the status quo scenario by 2034). Implementing a test and treat strategy among the general population but without any intervention in the PWID population would suffice to meet the mortality target but not the incidence target. To achieve HCV elimination in Cyprus, 3080 (95%CI: 3000, 3200) HCV patients need to be diagnosed and treated by 2034 (2680 from the general population and 400 from PWID), and harm reduction coverage among PWID should be increased by 3% per year (from 25% in 2020 to 67% in 2034).

CONCLUSION

Elimination of HCV is a demanding public health strategy, which requires significant interventions both among the general population and high-risk groups.

Projected hydrologic changes over the north of the Iberian Peninsula using a Euro-CORDEX multi-model ensemble

This study explores the impacts of climate change on the hydrology of the headwater areas of the Duero River Basin, the largest basin of the Iberian Peninsula. To this end, an ensemble of 18 Euro-CORDEX model experiments was gathered for two periods, 1975-2005 and 2021-2100, under two Representative Concentration Pathways (RCP4.5 and RCP8.5), and were used as the meteorological forcings of the Variable Infiltration Capacity (VIC) during the hydrological modelling exercise. The projected hydrologic changes for the future period were analyzed at annual and seasonal scales using several evaluation metrics, such as the delta changes of the atmospheric and land variables, the runoff and evapotranspiration ratios of the overall water balance, the snowmelt contribution to the total streamflow and the centroid position for the daily hydrograph of the average hydrologic year. Annual streamflow reductions of up to 40% were attained in various parts of the basin for the period 2071-2100 under the RCP8.5 scenario, and resulted from the precipitation decreases in the southern subwatersheds and the combined effect of the precipitation decreases and evapotranspiration increases in the north. The runoff and the evapotranspiration ratios evinced a tendency towards an evaporative regime in the north part of the basin and a strengthening of the evaporative response in the south. Seasonal streamflow changes were mostly negative and dependent on the season considered, with greater detriments in spring and summer, and less intense ones in autumn and winter. The snowmelt contribution to the total streamflow was strongly diminished with decreases reaching -80% in autumn and spring, thus pointing to a change in the snow regime for the Duero mountains. Finally, the annual and seasonal changes of the centroid position accounted for the shape changes of the hydrograph, constituting a measure of seasonality and reflecting high correlations degrees with the streamflow delta changes.

Evaluation and Future Projection of Extreme Climate Events in the Yellow River Basin and Yangtze River Basin in China Using Ensembled CMIP5 Models Data

The Yellow River Basin (YLRB) and Yangtze River Basin (YZRB) are heavily populated, important grain-producing areas in China, and they are sensitive to climate change. In order to study the temporal and spatial distribution of extreme climate events in the two river basins, seven extreme temperature indices and seven extreme precipitation indices were projected for the periods of 2010-2039, 2040-2069, and 2070-2099 using data from 16 Coupled Model Intercomparison Project Phase 5 (CMIP5) models, and the delta change and reliability ensemble averaging (REA) methods were applied to obtain more robust ensemble values. First, the present evaluation indicated that the simulations satisfactorily reproduced the spatial distribution of temperature extremes, and the spatial distribution of precipitation extremes was generally suitably captured. Next, the REA values were adopted to conduct projections under different representative concentration pathway (RCP) scenarios (i.e., RCP4.5, and RCP8.5) in the 21st century. Warming extremes were projected to increase while cold events were projected to decrease, particularly on the eastern Tibetan Plateau, the Loess Plateau, and the lower reaches of the YZRB. In addition, the number of wet days (CWD) was projected to decrease in most regions of the two basins, but the highest five-day precipitation (Rx5day) and precipitation intensity (SDII) index values were projected to increase in the YZRB. The number of consecutive dry days (CDD) was projected to decrease in the northern and western regions of the two basins. Specifically, the warming trends in the two basins were correlated with altitude and atmospheric circulation patterns, and the wetting trends were related to the atmospheric water vapor content increases in summer and the strength of external radiative forcing. Notably, the magnitude of the changes in the extreme climate events was projected to increase with increasing warming targets, especially under the RCP8.5 scenario.

European trends in breast cancer mortality, 1980-2017 and predictions to 2025

BACKGROUND

Breast cancer mortality in European women has been falling for three decades. We analysed trends in mortality from breast cancer in Europe over the period 1980-2017 and predicted number of deaths and rates to 2025.

METHODS

We extracted death certification data for breast cancer in women for 35 European countries, between 1980 and 2017, from the World Health Organisation database. We computed the age-standardised (world standard population) mortality rates per 100,000 person-years, by country and calendar year. We obtained also predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025.

RESULTS

The mortality rate declined from 15.0 in 2012 to 14.4 in 2017 per 100,000 women (-3.9%) for the European Union (EU)-27. This fall was greater in the EU-14 (-5.2%), whereas rates rose in the transitional countries during this period by 1.9%. Mortality rate predictions across Europe are expected to reach relatively uniform levels in 2025. During the studied period, favourable trends in mortality emerged in most countries, with the greatest decrease in Denmark, whereas Poland and Romania showed an upward trend. The largest predicted decrease in breast cancer mortality was estimated for the United Kingdom (12.2/100,000 women in 2025), leading to the estimated avoidance of 150,000 breast cancer deaths over the period 1994-2025 and 470,000 in the EU-27.

CONCLUSIONS

Favourable trends in breast cancer mortality were observed in most European countries, and they will continue to fall in the coming years. Less favourable patterns were still observed among the transitional countries than other European areas.

A high-resolution downscaled CMIP5 projections dataset of essential surface climate variables over the globe coherent with the ERA5 reanalysis for climate change impact assessments

A high-resolution climate projections dataset is obtained by statistically downscaling climate projections from the CMIP5 experiment using the ERA5 reanalysis from the Copernicus Climate Change Service. This global dataset has a spatial resolution of 0.25°x 0.25°, comprises 21 climate models and includes 5 surface daily variables at monthly resolution: air temperature (mean, minimum, and maximum), precipitation, and mean near-surface wind speed. Two greenhouse gas emissions scenarios are available: one with mitigation policy (RCP4.5) and one without mitigation (RCP8.5). The downscaling method is a Quantile Mapping method (QM) called the Cumulative Distribution Function transform (CDF-t) method that was first used for wind values and is now referenced in dozens of peer-reviewed publications. The data processing includes quality control of metadata according to the climate modeling community standards and value checking for outlier detection.

A temperature binning approach for multi-sector climate impact analysis

Characterizing the future risks of climate change is a key goal of climate impacts analysis. Temperature binning provides a framework for analyzing sector-specific impacts by degree of warming as an alternative or complement to traditional scenario-based approaches in order to improve communication of results, comparability between studies, and flexibility to facilitate scenario analysis. In this study, we estimate damages for nine climate impact sectors within the contiguous United States (US) using downscaled climate projections from six global climate models, at integer degrees of US national warming. Each sector is analyzed based on socioeconomic conditions for both the beginning and the end of the century. The potential for adaptive measures to decrease damages is also demonstrated for select sectors; differences in damages across adaptation response scenarios within some sectors can be as much as an order of magnitude. Estimated national damages from these sectors based on a reactive adaptation assumption and 2010 socioeconomic conditions range from $600 million annually per degree of national warming for winter recreation to $8 billion annually per degree of national warming for labor impacts. Results are also estimated per degree of global temperature change and for 2090 socioeconomic conditions.

Climate change effects on marine protected areas: Projected decline of benthic species in the North Sea

Climate change is a global threat for marine ecosystems, their biodiversity and consequently ecosystem services. In the marine realm, marine protected areas (MPAs) were designated to counteract regional pressures, but they might be ineffective to protect vulnerable species and habitats, if their distribution is affected by global climate change. We used six Species Distribution Models (GLM, MARS, FDA, RF, GBM, MAXENT) to project changes in the distribution of eight benthic indicator and key species under climate change in the North Sea MPAs for 2050 and 2099. The projected distribution area of most species will be stable or even increase within the MPAs between 2001 and 2050. Thereafter, the distribution area decreased, especially within MPAs in the central North Sea by 2099, and some key species even disappeared from the MPAs. Consequently, the monitoring and protection of benthic species might not be possible within static MPA borders under climate change.

An observation-based scaling model for climate sensitivity estimates and global projections to 2100

We directly exploit the stochasticity of the internal variability, and the linearity of the forced response to make global temperature projections based on historical data and a Green's function, or Climate Response Function (CRF). To make the problem tractable, we take advantage of the temporal scaling symmetry to define a scaling CRF characterized by the scaling exponent H, which controls the long-range memory of the climate, i.e. how fast the system tends toward a steady-state, and an inner scale τ ≈ 2   years below which the higher-frequency response is smoothed out. An aerosol scaling factor and a non-linear volcanic damping exponent were introduced to account for the large uncertainty in these forcings. We estimate the model and forcing parameters by Bayesian inference which allows us to analytically calculate the transient climate response and the equilibrium climate sensitivity as: 1 . 7 - 0.2 + 0.3   K and 2 . 4 - 0.6 + 1.3   K respectively (likely range). Projections to 2100 according to the RCP 2.6, 4.5 and 8.5 scenarios yield warmings with respect to 1880-1910 of: 1 . 5 - 0.2 + 0.4 K , 2 . 3 - 0.5 + 0.7   K and 4 . 2 - 0.9 + 1.3   K. These projection estimates are lower than the ones based on a Coupled Model Intercomparison Project phase 5 multi-model ensemble; more importantly, their uncertainties are smaller and only depend on historical temperature and forcing series. The key uncertainty is due to aerosol forcings; we find a modern (2005) forcing value of [ - 1.0 , - 0.3 ] Wm - 2 (90 % confidence interval) with median at - 0.7 Wm - 2 . Projecting to 2100, we find that to keep the warming below 1.5 K, future emissions must undergo cuts similar to RCP 2.6 for which the probability to remain under 1.5 K is 48 %. RCP 4.5 and RCP 8.5-like futures overshoot with very high probability.

Coordinating expectations through central bank projections

Central banks are increasingly communicating their economic outlook in an effort to manage the public and financial market participants' expectations. We provide original causal evidence that the information communicated and the assumptions underlying a central bank's projection can matter for expectation formation and aggregate stability. Using a between-subject design, we systematically vary the central bank's projected forecasts in an experimental macroeconomy where subjects are incentivized to forecast the output gap and inflation. Without projections, subjects exhibit a wide range of heuristics, with the modal heuristic involving a significant backward-looking component. Ex-Ante Rational dual projections of the output gap and inflation significantly reduce the number of subjects' using backward-looking heuristics and nudge expectations in the direction of the rational expectations equilibrium. Ex-Ante Rational interest rate projections are cognitively challenging to employ and have limited effects on the distribution of heuristics. Adaptive dual projections generate unintended inflation volatility by inducing boundedly-rational forecasters to employ the projection and model-consistent forecasters to utilize the projection as a proxy for aggregate expectations. All projections reduce output gap disagreement but increase inflation disagreement. Central bank credibility is significantly diminished when the central bank makes larger forecast errors when communicating a relatively more complex projection. Our findings suggest that inflation-targeting central banks should strategically ignore agents' irrationalities when constructing their projections and communicate easy-to-process information.

Current incidence and future projections of fragility hip fractures in Sri Lanka

IN SRI LANKA, THE CRUDE AND STANDARDIZED HIP FRACTURE RATES IN 2018 WERE 88.3 AND 115.5 PER 100,000 PERSON-YEARS, RESPECTIVELY. IN 2018, 3824 HIP FRACTURES WOULD HAVE OCCURRED IN THE COUNTRY AND THIS IS LIKELY TO REACH 12,068 IN 2051: PURPOSE: This study was designed to calculate the current crude, standardized, and age- and sex-specific fragility hip fracture incidence in Sri Lanka and hip fracture projection for 2051. Currently such data are not available.

METHODS

New fragility hip fractures (resulting from falls from standing height or less) that occurred in the Southern province of Sri Lanka from Sep 2017 to 2018 were collected prospectively by visiting and contacting all health care centers that provide care for fracture patients. Traumatic fractures, old fractures, and fractures among residents outside Southern province were excluded. We calculated current crude, standardized (US standardized population 2000), and age- and sex-specific fragility hip fracture incidence. The number of hip fractures that would occur in 2051 was estimated based on the population projections of the country.

RESULTS

There were 554 patients admitted during 1-year period from September 2017 giving crude hip fracture incidence of 88 per 100,000 person-years (95% CI 85-90). The crude hip fracture rates among women and men were 132.2 and 35.3 per 100,000 person-years, respectively. The standardized hip fracture rate was 115.5 per 100,000 person-years. According to the data, 3824 (95% CI 3200-4583) hip fractures would have occurred island-wide during the study period. This number is likely to reach 12,068 (95% CI 10405-13,990) in 2051 when the age-specific population projections are taken into consideration.

CONCLUSIONS

Although the observed hip fracture rate was low when compared with other countries, the number of hip fracture would increase from the current 10 per day to around 33 in 2051.

Modelling climate change impacts on attributable-related deaths and demographic changes in the largest metropolitan area in Portugal: A time-series analysis

Previous studies have consistently analyzed the impact that extreme temperatures will have on human health. However, there are very few data on temperature-related mortality burden considering future demographic changes in a context of climate change in Portugal. This study aims to quantify the impact of climate change on heat-, cold-, and net change mortality burdens, taking into account the future demographic changes in Lisbon Metropolitan Area, Portugal. We applied a time-series generalized linear model with a quasi-Poisson model via a distributed lag nonlinear model to project temperature-related mortality burden for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that the total attributable fraction due to temperature, extreme and moderate cold, is statistically significant in the historical period and the future projected scenarios, while extreme and moderate heat were only significant in the projected future summer period. Net differences were attributed to moderate cold in the future winter months. Projections show a consistent and significant increase in future heat-related mortality burden. The attributable fraction due to heat in the future period, compared to the historical period, ranges from 0 to 1.5% for moderate heat and from 0 to 0.5% for extreme heat. Adaptation should be implemented at the local level, so as to prevent and diminish the effects on citizens and healthcare services, in a context of climate change.

Evaluation of an a priori scatter correction algorithm for cone-beam computed tomography based range and dose calculations in proton therapy

BACKGROUND AND PURPOSE

Scatter correction of cone-beam computed tomography (CBCT) projections may enable accurate online dose-delivery estimations in photon and proton-based radiotherapy. This study aimed to evaluate the impact of scatter correction in CBCT-based proton range/dose calculations, in scans acquired in both proton and photon gantries.

MATERIAL AND METHODS

CBCT projections of a Catphan and an Alderson phantom were acquired on both a proton and a photon gantry. The scatter corrected CBCTs (corrCBCTs) and the clinical reconstructions (stdCBCTs) were compared against CTs rigidly registered to the CBCTs (rigidCTs). The CBCTs of the Catphan phantom were segmented by materials for CT number analysis. Water equivalent path length (WEPL) maps were calculated through the Alderson phantom while proton plans optimized on the rigidCT and recalculated on all CBCTs were compared in a gamma analysis.

RESULTS

In medium and high-density materials, the corrCBCT CT numbers were much closer to those of the rigidCT than the stdCBCTs. E.g. in the 50% bone segmentations the differences were reduced from above 300 HU (with stdCBCT) to around 60-70 HU (with corrCBCT). Differences in WEPL from the rigidCT were typically well below 5 mm for the corrCBCTs, compared to well above 10 mm for the stdCBCTs with the largest deviations in the head and thorax regions. Gamma pass rates (2%/2mm) when comparing CBCT-based dose re-calculations to rigidCT calculations were improved from around 80% (with stdCBCT) to mostly above 90% (with corrCBCT).

CONCLUSION

Scatter correction leads to substantial artefact reductions, improving accuracy of CBCT-based proton range/dose calculations.

Associations of five food- and water-borne diseases with ecological zone, land use and aquifer type in a changing climate

BACKGROUND

Food- and water-borne pathogens exhibit spatial heterogeneity, but attribution to specific environmental processes is lacking while anthropogenic climate change alters these processes. The goal of this study was to investigate ecology, land-use and health associations of these pathogens and to make future disease projections.

METHODS

The rates of five acute gastrointestinal illnesses (AGIs) (campylobacteriosis, Verotoxin- producing Escherichia coli, salmonellosis, giardiasis and cryptosporidiosis) from 2000 to 2013 in British Columbia, Canada, were calculated across three environmental variables: ecological zone, land use, and aquifer type. A correlation analysis investigated relationships between 19 climatic factors and AGI. Mean annual temperature at the ecological zone scale was used in a univariate regression model to calculate annual relative AGI risk per 1 °C increase. Future cases attributable to climate change were estimated into the 2080s.

FINDINGS

Each of the bacterial AGI rates was correlated with several annual temperature-related factors while the protozoan AGIs were not. In the regression model, combined relative risk for the three bacterial AGIs was 1.1 [95% CI: 1.02-1.21] for every 1 °C in mean annual temperature. Campylobacteriosis, salmonellosis and giardiasis rates were significantly higher (p < 0.05) in the urban land use class than in the rural one. In rural areas, bacteria and protozoan AGIs had significantly higher rates in the unconsolidated aquifers. Verotoxin-producing Escherichia coli rates were significantly higher in watersheds with more agricultural land, while rates of campylobacteriosis, salmonellosis and giardiasis were significantly lower in agricultural watersheds. Ecological zones with higher bacterial AGI rates were generally projected to expand in range by the 2080s.

INTERPRETATION

These findings suggest that risk of AGI can vary across ecosystem, land use and aquifer type, and that warming temperatures may be associated with an increased risk of food-borne AGI. In addition, spatial patterns of these diseases are projected to shift under climate change.

Large Rises in Thoracolumbar Fusions by 2040: A Cause for Concern with an Increasingly Elderly Surgical Population

BACKGROUND

With a growing aging population in the United States, the number of operative lumbar spine pathologies continues to grow. Therefore, our objective was to estimate the future demand for lumbar spine surgery volumes for the United States to the year 2040.

METHODS

The National/Nationwide Inpatient Sample was queried for years 2003-2015 for anterior interbody and posterior lumbar fusions (ALIF, PLF) to create national estimates of procedural volumes for those years. The average age and comorbidity burden was characterized, and Poisson modeling controlling for age and sex allowed for surgical volume prediction to 2040 in 10-year increments. Age was grouped into categories (<25, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and >85 years), and estimates of surgical volumes for each age subgroup were created.

RESULTS

ALIF volume is expected to increase from 46,903 to 55,528, and PLF volume is expected to increase from 248,416 to 297,994 from 2020 to 2040. For ALIF, the largest increases are expected in the 45-54 years (10,316 to 12,216) and 75-84 years (2,898 to 5,340) age groups. Similarly the largest increases in PLF will be seen in the 65-74 years (71,087 to 77,786) and 75-84 years (28,253 to 52,062) age groups.

CONCLUSIONS

The large increases in expected volumes of ALIF and PLF could necessitate training of more spinal surgeons and an examination of projected costs. Further analyses are needed to characterize the needs of this increasingly large population of surgical patients.

Municipal solid waste available to the Chinese energy sector - Provincial projections to 2050

A shift is underway in China, from perceiving municipal solid waste (MSW) as a strictly environmental concern to identifying MSW as a resource. China exhibits a growing focus on using MSW in the energy sector while putting more emphasis on waste sorting and recycling in general and sorting food waste in particular. Timely planning of MSW treatment capacity requires reliable forecasts of future MSW quantities and their characteristics. This article uses econometric analysis to perform regional specific projections for collected MSW. Four scenarios are presented, three of which include sorting of food waste from the mixed MSW stream and/or capping mixed MSW generation. In the different scenarios, aggregated on a national level, mixed MSW ranges from 159 million metric tons (MMT) to 340 MMT and sorted food waste from MSW from zero to 109 MMT in 2050. Conclusions show that sorting of food waste will create stable levels of mixed MSW in many provinces and that there is a risk of overinvestments in MSW incineration capacity in most provinces.

Predicting Trends in Cervical Spinal Surgery in the United States from 2020 to 2040

OBJECTIVE

We sought to predict surgical volumes for 2 common cervical spine procedures from 2020 to 2040.

METHODS

Using the National Inpatient Sample from 2003-2016, nationwide estimates of anterior cervical diskectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) volumes were calculated using International Classification of Diseases, Ninth and Tenth Revision (ICD-9, ICD-10) procedure codes. With data from the U.S. Census Bureau, estimates of the U.S. population were used to create Poisson models controlling for age and sex. Age was categorized into ranges (<25 years old, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and >85), and estimates of surgical volume for each age group were created.

RESULTS

From 2020-2040, increases in surgical volume from 13.3% (153,288-173,699) and 19.3% (29,620-35,335) are expected for ACDF and PCDF, respectively. For ACDF, the largest increases are expected in the 45-54 (42,077-49,827) and 75-84 (8065-14,862) age groups, whereas for PCDF, the largest increases will be seen in the 75-84 (3710-6836) age group. In accordance with an aging population, modest increases will be seen for ACDF (858-1847) and PCDF (730-1573) in the >85-year-old cohort.

CONCLUSIONS

As expected, large growth in cervical spine surgical volumes is likely to be seen, which could indicate a need for increased numbers of spinal neurosurgeons and orthopedic surgeons. Further studies are needed to investigate the needs of the field in light of these expected increases in volume.

COVID-19 outbreak reproduction number estimations and forecasting in Marche, Italy

Background

COVID-19 disease is becoming a global pandemic and more than 200 countries were affected because of this disease. Italy is one of the countries is largely suffered with this virus outbreak, and about 180,000 cases (as of 20 April 2020) were registered which explains the large transmissibility and reproduction case numbers.

Objective

In this study, we considered the Marche region of Italy to compute different daily transmission rates (R_t) including five provinces in it. We also present forecasting of daily and cumulative incidences associated after the next thirty days. The Marche region is the 8th in terms of number of people infected in Italy and the first in terms of diffusion of the infection among the 4 regions of the center of Italy.

Methods

Epidemic statistics were extracted from the national Italian Health Ministry website. We considered outbreak information where the first case registered in Marche with onset symptoms (26 February 2020) to the present date (20 April 2020). Adoption of incidence and projections with R statistics was done.

Results

The median values of R_t for the five provinces of Pesaro and Urbano, Ancona, Fermo, Ascoli Piceno, and Macerata, was 2.492 (1.1–4.5), 2.162 (1.0–4.0), 1.512 (0.75–2.75), 1.141 (1.0–1.6), and 1.792 (1.0–3.5) with 95% of CI achieved. The projections at end of 30th day of the cumulative incidences 323 (95% CI), and daily incidences 45 (95% CI) could be possible.

Conclusions

This study highlights the knowledge of essential insights into the Marche region in particular to virus transmission dynamics, geographical characteristics of positive incidences, and the necessity of implementing mitigation procedures to fight against the COVID-19 outbreak.

Covid-19 epidemic in Italy: evolution, projections and impact of government measures

We report on the Covid-19 epidemic in Italy in relation to the extraordinary measures implemented by the Italian Government between the 24th of February and the 12th of March. We analysed the Covid-19 cumulative incidence (CI) using data from the 1st to the 31st of March. We estimated that in Lombardy, the worst hit region in Italy, the observed Covid-19 CI diverged towards values lower than the ones expected in the absence of government measures approximately 7-10 days after the measures implementation. The Covid-19 CI growth rate peaked in Lombardy the 22nd of March and in other regions between the 24th and the 27th of March. The CI growth rate peaked in 87 out of 107 Italian provinces on average 13.6 days after the measures implementation. We projected that the CI growth rate in Lombardy should substantially slow by mid-May 2020. Other regions should follow a similar pattern. Our projections assume that the government measures will remain in place during this period. The evolution of the epidemic in different Italian regions suggests that the earlier the measures were taken in relation to the stage of the epidemic, the lower the total cumulative incidence achieved during this epidemic wave. Our analyses suggest that the government measures slowed and eventually reduced the Covid-19 CI growth where the epidemic had already reached high levels by mid-March (Lombardy, Emilia-Romagna and Veneto) and prevented the rise of the epidemic in regions of central and southern Italy where the epidemic was at an earlier stage in mid-March to reach the high levels already present in northern regions. As several governments indicate that their aim is to "push down" the epidemic curve, the evolution of the epidemic in Italy supports the WHO recommendation that strict containment measures should be introduced as early as possible in the epidemic curve.

Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

AIMS

Diabetes and its complications have a significant economic impact on individuals and their families, health systems and national economies.

METHODS

The direct health expenditure of diabetes was calculated relying on the following inputs: diagnosed and undiagnosed diabetes prevalence estimates, United Nations population estimates, World Health Organization health expenditure per capita and ratios of health expenditure for people with diabetes compared to people without diabetes.

RESULTS

The estimated global direct health expenditure on diabetes in 2019 is USD 760 billion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045. There is a wide variation in annual health expenditures on diabetes. The United States of America has the highest estimated expenditure with USD 294.6 billion, followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively. The age group with the largest annual diabetes-related health expenditure is 60-69 years with USD 177.7 billion, followed by 50-59 years, and 70-79 years with USD 173.0 billion and USD 171.5 billion, respectively. Slightly higher diabetes-related health expenditure is seen in women than in men (USD 382.6 billion vs. USD 377.6 billion, respectively). The same difference is expected to be present in 2030 and 2045.

CONCLUSIONS

There were large disparities between high-, middle- and low-income countries with total health expenditures in high-income countries being over 300 times those in low-income countries. The ratio for annual direct health expenditure per person between these groups of countries is more than 38-fold.

Gender and Regional Differences in Lung Cancer Mortality in Brazil

Background and Objective:

This was a population-based ecological with data of deaths from the Mortality Information System. The objective of this study was to analyze the temporal trends of mortality induced by bronchi and lung cancer in Brazil and its geographical regions between 2001 and 2015 and secondly to calculate predictions for 2016-2030.

Material and Methods:

The mortality trends were analyzed by the Joinpoint regression and calculation of predictions was used the Nordpred software.

Results:

There was a reduction trend in lung cancer mortality among Brazilian men living in South and Southeast regions of Brazil. However, there was an increasing trend in lung cancer mortality among Brazilian women living in Northeast, Southeast, and South regions of Brazil. When comparing the last observed period and the last foreseen period for males, it is expected an increase of 12.86% in the number of deaths, justified mainly by the change in population structure, with a reduction in the risk of death by the disease. For women, the expected increase is 26.22%, justified both by population structure, and the increased risk of deaths from the disease. The higher rates will be observed in the southern region of the country, for both sexes.

Conclusion:

The mortality induced by lung and bronchial cancer in Brazil was unevenly distributed. However lung cancer incidence had a reducing trend, the mortality caused following it was increased among men. For women, the rates are rising, and until 2030, the mortality load will continue to rise for both.

Global methane emissions from coal mining to continue growing even with declining coal production

This paper presents projections of global methane emissions from coal mining under different coal extraction scenarios and with increasing mining depth through 2100. The paper proposes an updated methodology for calculating fugitive emissions from coal mining, which accounts for coal extraction method, coal rank, and mining depth and uses evidence-based emissions factors. A detailed assessment shows that coal mining-related methane emissions in 2010 were higher than previous studies show. This study also uses a novel methodology for calculating methane emissions from abandoned coal mines and represents the first estimate of future global methane emissions from those mines. The results show that emissions from the growing population of abandoned mines increase faster than those from active ones. Using coal production data from six integrated assessment models, this study shows that by 2100 methane emissions from active underground mines increase by a factor of 4, while emissions from abandoned mines increase by a factor of 8. Abandoned mine methane emissions continue through the century even with aggressive mitigation actions.

The impact of population ageing on end-of-life care in Scotland: projections of place of death and recommendations for future service provision

BACKGROUND

Global annual deaths are rising. It is essential to examine where future deaths may occur to facilitate decisions regarding future service provision and resource allocation.

AIMS

To project where people will die from 2017 to 2040 in an ageing country with advanced integrated palliative care, and to prioritise recommendations based on these trends.

METHODS

Population-based trend analysis of place of death for people that died in Scotland (2004-2016) and projections using simple linear modelling (2017-2040); Transparent Expert Consultation to prioritise recommendations in response to projections.

RESULTS

Deaths are projected to increase by 15.9% from 56,728 in 2016 (32.8% aged 85+ years) to 65,757 deaths in 2040 (45% aged 85+ years). Between 2004 and 2016, proportions of home and care home deaths increased (19.8-23.4% and 14.5-18.8%), while the proportion of hospital deaths declined (58.0-50.1%). If current trends continue, the numbers of deaths at home and in care homes will increase, and two-thirds will die outside hospital by 2040. To sustain current trends, priorities include: 1) to increase and upskill a community health and social care workforce through education, training and valuing of care work; 2) to build community care capacity through informal carer support and community engagement; 3) to stimulate a realistic public debate on death, dying and sustainable funding.

CONCLUSION

To sustain current trends, health and social care provision in the community needs to grow to support nearly 60% more people at the end-of-life by 2040; otherwise hospital deaths will increase.

On the need to integrate uncertainty into U.S. water resource planning

A changing climate is expected to introduce uncertainty into water resource management decision making. We examined the latest publicly-available, state-level guidance regarding the management of water supplies and demands concerning risks associated with drought, flooding, and climate change. We found state-level guidance supplementing the federally-backed flood mitigation program to be updated most regularly (54% in the last 5 years; 84% in the last decade). Yet, the underlying floodplain mapping data these local planning efforts rely on are acknowledged by the Federal Emergency Management Agency (FEMA) to be chronically outdated. Drought planning guidance was found to be most outdated (16% last updated in the last 5 years; 18% almost two decades ago), and across the U.S., almost universally (94%) reactive (emergency response) rather than proactive (mitigation or management). Although 79-94% of states provide some level of guidance regarding water supply and demand, the projections themselves may significantly predate the guidance. Many (70%) U.S. states still lack climate change impact guidance, particularly non-coastal states and those impacted by increased water scarcity rather than flooding. Strategies are rare (4%) for addressing the impacts of increased variability and uncertainty to meet inelastic demands with finite supplies. We conclude significant gaps exist in planning to address known or projected risks of climate-related impacts. Specific recommendations, including the implementation of a nationwide water census, are provided to improve both the data and knowledge base of water management and reduce current vulnerabilities.

Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

AIMS

To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045.

METHODS

A total of 255 high-quality data sources, published between 1990 and 2018 and representing 138 countries were identified. For countries without high quality in-country data, estimates were extrapolated from similar countries matched by economy, ethnicity, geography and language. Logistic regression was used to generate smoothed age-specific diabetes prevalence estimates (including previously undiagnosed diabetes) in adults aged 20-79 years.

RESULTS

The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). One in two (50.1%) people living with diabetes do not know that they have diabetes. The global prevalence of impaired glucose tolerance is estimated to be 7.5% (374 million) in 2019 and projected to reach 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045.

CONCLUSIONS

Just under half a billion people are living with diabetes worldwide and the number is projected to increase by 25% in 2030 and 51% in 2045.

Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals

BACKGROUND

Hepatitis C virus (HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral (DAA) treatment coverage, to compute the total costs (including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.

AIM

To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.

METHODS

A previously validated mathematical model was adapted to the Greek HCV-infected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs (direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.

RESULTS

Without the implementation of awareness or screening campaigns, approximately 20000 patients would be diagnosed and treated with DAAs by 2030. This strategy would result in a 19.6% increase in HCV-related mortality in 2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by 78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros (€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very cost-effective. Furthermore, HCV elimination strategy would save €560-895 million by 2035.

CONCLUSION

Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.

Yield potential definition of the chilling requirement reveals likely underestimation of the risk of climate change on winter chill accumulation

Evaluation of chilling requirements of cultivars of temperate fruit trees provides key information to assess regional suitability, according to winter chill, for both industry expansion and ongoing profitability as climate change progresses. Traditional methods for calculating chilling requirements use climate-controlled chambers and define chilling requirements (CR) using a fixed bud burst percentage, usually close to 50% (CR-50%). However, this CR-50% definition may estimate chilling requirements that lead to flowering percentages that are lower than required for orchards to be commercially viable. We used sweet cherry to analyse the traditional method for calculating chilling requirements (CR-50%) and compared the results with a more restrictive method, where the chilling requirement was defined by a 90% bud break level (CR_m-90%). For sweet cherry, this higher requirement of flowering success (90% as opposed to 50%) better represents grower production needs as a greater number of flowers leads to greater potential yield. To investigate the future risk of insufficient chill based on alternate calculations of the chilling requirement, climate projections of winter chill suitability across Europe were calculated using CR-50% and CR_m-90%. Regional suitability across the landscape was highly dependent on the method used to define chilling requirements, and differences were found for both cold and mild winter areas. Our results suggest that bud break percentage levels used in the assessment of chilling requirements for sweet cherry influence production risks of current and future production areas. The use of traditional methods to determine chilling requirements can result in an underestimation of productivity chilling requirements for tree crops like sweet cherry which rely on a high conversion of flowers to mature fruit to obtain profitable yields. This underestimation may have negative consequences for the fruit industry as climate change advances with climate risk underestimated.

A forecasting model of disease prevalence based on the McKendrick-von Foerster equation

A new model for disease prevalence based on the analytical solutions of McKendric-von Foerster's partial differential equations is developed. Derivation of the model and methods to cross check obtained results are explicitly demonstrated. Obtained equations describe the time evolution of the healthy and unhealthy age-structured sub-populations and age patterns of disease prevalence. The projection of disease prevalence into the future requires estimates of time trends of age-specific disease incidence, relative survival functions, and prevalence at the initial age and year available in the data. The computational scheme for parameter estimations using Medicare data, analytical properties of the model, application for diabetes prevalence, and relationship with partitioning models are described and discussed. The model allows natural generalization for the case of several diseases as well as for modeling time trends in cause-specific mortality rates.

Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty

PURPOSE

Annual rates of knee arthroplasty are increasing in all developed countries, imposing a significant economic and organizational burden; it is crucial to forecast the future need for knee arthroplasty, to assist stakeholders in planning strategies and investments, especially in a country like Italy, with the largest proportion of elderly citizens in Europe. Few epidemiological studies have been performed worldwide to estimate the demand for future knee replacement, and a variety of methods have been proposed.

METHODS

We investigated the epidemiology of knee arthroplasty performed in Italy in the last 15 years and projected incidence rates up to the year 2050, utilizing, comparing, and adapting the available methodologies.

RESULTS

From 2001 to 2016, 812,639 primary TKA were performed in Italy on patients over 40. The total number of surgeries increased by 262% with an average annual growth rate of 6.6%.

CONCLUSIONS

Adopting the best fitting projection method, an increase of 45% in incidence rate is expected for 2050.

Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios

The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to Bhold warming well below 2 °C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 °C". The 1.5 °C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 °C) and more extreme GMT increases (3 and 4 °C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 °C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 °C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.