95th Percentile Research Articles

Cardiovascular morbidity risk attributable to thermal stress: analysis of emergency ambulance dispatch data from Shenzhen, China

BackgroundClimate change has raised scientific interest in examining the associations of weather conditions with adverse health effects, while most studies determined human thermal stress using ambient air temperature rather than the thermophysiological index.ObjectivesTo evaluate the association between emergency ambulance dispatches (EADs) related to cardiovascular causes and heat/cold stress in Shenzhen, a city in southern China, with the aim of providing new insights for local policymakers.MethodsA time series analysis using ambulance dispatch data of cardiovascular diseases in Shenzhen, China (2013–2019) was conducted. A quasi-Poisson nonlinear distributed lag model was applied to explore the relationship between emergency ambulance dispatches (EADs) due to cardiovascular causes and thermal stress (determined by Universal Thermal Climate Index, UTCI). Attributable fractions were estimated to identify which UTCI ranges have a greater health impact.ResultsThe relationship between UTCI and EADs due to cardiovascular diseases exhibits a reverse J-shaped curve. The effects of cold stress were immediate and long-lasting, whereas the effects of heat stress were non-significant. Compared with the optimal equivalent temperature (71st percentile of UTCI, 29.22 °C), the relative risks for cumulative (0–21 days) exposures to cold stress (1st percentile, − 0.13 °C; 5th percentile, 7.68 °C) were 1.55 (95%CI:1.28,1.88) and 1.44 (95%CI:1.22,1.69), respectively. Thermal (cold and heat) stress was responsible for 10.81% (95%eCI: 5.67%,15.43%) of EADs for cardiovascular diseases, with 9.46% (95%eCI: 3.98%,14.40%) attributed to moderate cold stress (2.5th ~ 71st percentile). Greater susceptibility to cold stress was observed for males and the elderly. Heat stress showed harmful effects in the warm season.ConclusionsOur results demonstrated that cold exposure elevates the risk of EADs for cardiovascular causes in Shenzhen, and moderate cold stress cause the highest burden of ambulance dispatches. Health authorities should consider effective adaptation strategies and interventions responding to cold stress to reduce the morbidity of cardiovascular diseases.

CFD-14: detecting literacy and dyslexia risks in early and primary education

This study validates the CFD-14 questionnaire, designed for families to detect early risk of literacy difficulties and dyslexia in compulsory schooling. The sample included families of 1385 students from preschool (5 years old) and 1st to 6th grade of primary education, with a median age of 9 years and two months. The CFD-14 comprises 14 items reflecting common dyslexia indicators. Its one-dimensional factorial structure was confirmed, demonstrating reliability and criterion validity through five evidences: correlation of questionnaire scores with teacher and family assessments, comparison of CFD-14 scores between a dyslexic group (n = 13) and the general sample, analysis between families with and without a history of difficulties, and comparison between groups with persistent spelling errors and those without. A direct score at the 90th percentile was identified as the objective criterion to pinpoint students at risk of literacy difficulties.

Reference Values for Handgrip Strength, Five Times Sit-to-stand, and Gait Speed in Patients on Hemodialysis.

Low levels of muscle strength and function predict adverse clinical outcomes in patients on hemodialysis; however, reference values remain lacking. We described reference values for handgrip strength, five times sit-to-stand (STS-5), and 4-m gait speed in a large-scale sample in patients on hemodialysis. Baseline data from the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis (SARC-HD) study were analyzed. Muscle strength was evaluated using handgrip strength and the STS-5, whereas physical performance was evaluated using usual 4-m gait speed before a midweek dialysis session. Sex- and age-specific smoothed reference curves for each test at the 3rd, 15th, 50th, 85th, and 97th percentiles were constructed using generalized additive models for location shape and scale. Comparisons between sex and age were also performed. Data from 1004 patients (39% female; 19 to 96 years; 49% ≥ 60 years) were analyzed. Declines in muscle strength and physical performance were observed with advancing age in both sexes. However, among males, muscle strength and performance were similar between 18 and 49 years of age. Males exhibited substantially greater performance in handgrip strength (10.3 kg, 95% confidence interval (CI) 9.1 to 11.4) and 4-m gait speed (-0.10 seconds, 95% CI: -0.14 to -0.05) compared to females. Older patients, independent of sex, exhibited poorer performance on most tests. Lower handgrip strength in the arm with arteriovenous fistula was observed in both sexes (males -2.3 kg, 95% CI: -2.8 to -1.7; and females -2.1 kg, 95% CI: -2.6 to -1.6). Reference values obtained in this study may be used in clinical and research settings to identify patients on hemodialysis with low physical function according to sex and age. Future studies should test these reference values as potential predictors of adverse clinical outcomes.

Adverse pregnancy outcomes and the abnormal umbilical cord coiling index.

The abnormal umbilical cord coiling index (UCI) may be one of the ways to predict adverse pregnancy outcomes. This study attempted to determine the association between abnormal UCI and maternal, fetal, and neonatal outcomes. This longitudinal study was conducted on 400 women referred for delivery from April to August 2021. UCI was calculated by dividing the total number of coils by the total length of the umbilical cord in centimeters. In eligible cases, the length of the umbilical cord and the number of vascular coils along the total umbilical cord were measured after birth. UCI less than the 10th percentile and more than the 90th percentile was considered abnormal, and between the 10th and 90th percentiles was considered normal. Data were analyzed using SPSS version 20. P < 0.05 were considered statistically significant. The mean length of the umbilical cord was 56.12±8.38 cm, the number of umbilical cord rings was 13.70±3.51, and the UCI was 0.24±0.07. In the regression analysis, women with gestational diabetes had a significant association with abnormal UCI (P = 0.044). Thus, the probability of abnormal UCI was about 3.5 times higher in women with gestational diabetes than in normal pregnancies. Also, the history of stillbirth had a significant association with abnormal UCI (P < 0.05). It is recommended to perform a UCI examination after delivery as part of a neonatal examination to find an explanation for maternal, fetal, and neonatal outcomes.

A Machine Learning Model Based on Global Mammographic Radiomic Features Can Predict Which Normal Mammographic Cases Radiology Trainees Find Most Difficult.

This study aims to investigate whether global mammographic radiomic features (GMRFs) can distinguish hardest- from easiest-to-interpret normal cases for radiology trainees (RTs). Data from 137 RTs were analysed, with each interpreting seven educational self-assessment test sets comprising 60 cases (40 normal and 20 cancer). The study only examined normal cases. Difficulty scores were computed based on the percentage of readers who incorrectly classified each case, leading to their classification as hardest- or easiest-to-interpret based on whether their difficulty scores fell within and above the 75th or within and below the 25th percentile, respectively (resulted in 140 cases in total used). Fifty-nine low-density and 81 high-density cases were identified. Thirty-four GMRFs were extracted for each case. A random forest machine learning model was trained to differentiate between hardest- and easiest-to-interpret normal cases and validated using leave-one-out-cross-validation approach. The model's performance was evaluated using the area under receiver operating characteristic curve (AUC). Significant features were identified through feature importance analysis. Difference between hardest- and easiest-to-interpret cases among 34 GMRFs and in difficulty level between low- and high-density cases was tested using Kruskal-Wallis. The model achieved AUC = 0.75 with cluster prominence and range emerging as the most useful features. Fifteen GMRFs differed significantly (p < 0.05) between hardest- and easiest-to-interpret cases. Difficulty level among low- vs high-density cases did not differ significantly (p = 0.12). GMRFs can predict hardest-to-interpret normal cases for RTs, underscoring the importance of GMRFs in identifying the most difficult normal cases for RTs and facilitating customised training programmes tailored to trainees' learning needs.

Nurses' Perceptions and Behaviours Regarding Climate Change and Health: A Quantile Regression Analysis.

The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels. A cross-sectional study was used. This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool. Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change-health-related information, and experience in setting climate change-health goals and strategies significantly influenced PBCH. We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels. By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients. Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses. This study adhered to the STROBE guidelines. No Patient or Public Contribution.

Wire-in-needle versus conventional syringe-on-needle technique for ultrasound-guided central venous catheter insertion in the internal jugular vein: the WIN randomized trial.

There are different techniques for ultrasound-guided central venous catheter (CVC) insertion. When using the conventional syringe-on-needle technique, the syringe needs to be removed from the needle after venous puncture to pass the guidewire through the needle into the vein. When, alternatively, using the wire-in-needle technique, the needle is preloaded with the guidewire, and the guidewire-after venous puncture-is advanced into the vein under real-time ultrasound guidance. We tested the hypothesis that the wire-in-needle technique reduces the time to successful guidewire insertion in the internal jugular vein compared with the syringe-on-needle technique in adults. We randomized 250 patients to the wire-in-needle or syringe-on-needle technique. Our primary endpoint was the time to successful guidewire insertion in the internal jugular vein. Two hundred and thirty eight patients were analyzed. The median (25th percentile, 75th percentile) time to successful guidewire insertion was 22 (16, 38) s in patients assigned to the wire-in-needle technique and 25 (19, 34) s in patients assigned to the syringe-on-needle technique (estimated location shift: 2s; 95%-confidence-interval: - 1 to 5s, p = 0.165). CVC insertion was successful on the first attempt in 103/116 patients (89%) assigned to the wire-in-needle technique and in 113/122 patients (93%) assigned to the syringe-on-needle technique. CVC insertion-related complications occurred in 8/116 patients (7%) assigned to the wire-in-needle technique and 19/122 patients (16%) assigned to the syringe-on-needle technique. The wire-in-needle technique-compared with the syringe-on-needle technique-did not reduce the time to successful guidewire insertion in the internal jugular vein. Clinicians can consider either technique for ultrasound-guided CVC insertion in adults.

Improving Patient Wait Times on the First Day of Radiotherapy Treatment

Long wait times on starting day of radiotherapy (day 1) can cause dissatisfaction among both patients and healthcare providers. Reducing these wait times will decrease stress and decongest hospital facilities especially in current coronavirus disease 2019 times. A multidisciplinary core team was formed during the Stanford-India Collaborative Quality Improvement training to reduce the median wait times on day 1 of treatment from 6 to 4.5 hours (a 25% reduction). Several factors were identified on the fishbone diagram, and key causes were identified using a Pareto chart and action prioritization matrix. The Plan-Do-Study-Act Cycle strategy was undertaken for the identified interventions. The outcome measure was time from arrival at the hospital to entry into a treatment room. Data were obtained from time charts at various stations and electronic records. The secondary measures were visual analog scale (VAS) scores, 80th percentile wait times, and the day-2 delay percentage. The balancing measure was “new errors” due to interventions. The interventions included the completion of all administrative tasks not needing patients' presence on the day before day 1. Baseline data from 198 patients and postintervention data from 160 patients were compared and analyzed. The median wait time at baseline, which was 6 hours, was reduced to 4.2 hours. The VAS score showed 70.4, 67.7, and 71.9% satisfaction for the resident physician, therapists, and patients, respectively. The 80th percentile wait times reduced from 8 to 5.7 hours; and the day 2 starting rate decreased from 22.5 to 2.04%, with no new errors reported. Radiotherapy day 1 wait times can be safely decreased, leading to improved satisfaction among patients and healthcare providers, by utilizing classic quality improvement methods and tools.

Evaluation of Selected Factors Affecting the Speed of Drivers at Signal-Controlled Intersections in Poland

In traffic engineering, vehicle speed is a critical determinant of both the risk and severity of road crashes, a fact that holds particularly important for signalized intersections. Accurately selecting vehicle speeds is crucial not only for minimizing accident risks but also for ensuring the proper calculation of intergreen times, which directly influences the efficiency and safety of traffic flow. Traditionally, the design of signal programs relies on fixed speed parameters, such as the posted speed limit or the operational speed, typically represented by the 85th percentile speed from speed distribution data. Furthermore, many design guidelines allow for the selection of these critical speed values based on the designer’s own experience. However, such practices may lead to discrepancies in intergreen time calculations, potentially compromising safety and efficiency at intersections. Our research underscores the substantial variability in the speeds of passenger vehicles traveling intersections under free-flow conditions. This study encompassed numerous intersections with the highest number of accidents, using unmanned aerial vehicles to conduct surveys in three Polish cities: Toruń, Bydgoszcz, and Warsaw. The captured video footage of vehicle movements at predetermined measurement sections was analyzed to find appropriate speeds for various travel maneuvers through these sections, encompassing straight-through, left-turn, and right-turn relations. Our analysis focused on how specific infrastructure-related factors influence driver behavior. The following were evaluated: intersection type, traffic organization, approach lane width, number of lanes, longitudinal road gradient, trams or pedestrian or bicycle crossing presence, and even roadside obstacles such as buildings, barriers or trees, and others. The results reveal that these factors significantly affect drivers’ speed choices, particularly in turning maneuvers. Furthermore, it was observed that the average speeds chosen by drivers at signalized intersections did not reach the permissible speed limit of 50 km/h as established in typical Polish urban areas. A key outcome of our analysis is the recommendation for a more precise speed model that contributes to the design of signal programs, enhancing road safety, and aligning with sustainable transport development policies. Based on our statistical analyses, we propose adopting a more sophisticated model to determine actual vehicle speeds more accurately. It was proved that, using the developed model, the results of calculating the intergreen times are statistically significantly higher. This recommendation is particularly pertinent to the design of signal programs. Furthermore, by improving speed accuracy values in intergreen calculation models with a clear impact on increasing road safety, we anticipate reductions in operational costs for the transportation system, which will contribute to both economic and environmental goals.

Impact of metals exposure on lung function and serum club cell secretory protein among schoolchildren: A mixture and mediation analysis

Particulate matter (PM) and its harmful components are significant contributors to respiratory diseases and impaired lung function, especially in children. Club cell secretory protein (CC16) is a maker of lung epithelium or club cell injuries. To date, the relationship between metals related with PM and CC16 and lung function impairment has been overlooked in children. We enrolled 603 schoolchildren exposed to different levels of PM in China. We found per doubling increase, urinary thallium, and iron was associated with a 3.42 % (95 % CI: 0.01, 6.72) and 3.09 % (95 % CI: 0.55, 5.56) decrease of serum CC16, respectively, whereas urinary cadmium was associated with a 4.74 % (95 % CI: 1.29, 8.31) increase of serum CC16. The Bayesian kernel machine regression (BKMR) model confirmed these associations and showed a potential synergistic interaction between thallium and cadmium. Urinary metal mixtures were associated with lower CC16 when they were below the 35th percentile compared with their median. Serum CC16 mediated 11.47 % (95 % CI: 0.06, 45.00) of the association between urinary thallium and FEV1/FVC decline. The inverted U-shaped association with CC16 and the mediation role of CC16 on associations with lung function provide insight into the mechanisms underlying lung injury induced by metals related with PM.

Nanoparticle-Binding Immunoglobulins Predict Variable Complement Responses in Healthy and Diseased Cohorts.

Systemic administration of nanomedicines results in the activation of the complement cascade, promoting phagocytic uptake and triggering proinflammatory responses. Identifying the biomarkers that can predict the "risk" of abnormally high complement responders can improve the safety and efficacy of nanomedicines. Polyethylene glycol (PEG) and dextran are two types of clinically approved polymer coatings that trigger complement activation. We performed a multifaceted analysis of the factors affecting the complement activation by PEGylated liposomal doxorubicin (PLD) and dextran-coated superparamagnetic iron oxide nanoworms (SPIO NWs) in plasma from patients with different inflammatory disease conditions and healthy donors. The complement activation (measured as deposition of the complement protein C3) varied greatly, with 29-fold and 26-fold differences for PLD and SPIO NWs, respectively. Chronic inflammation, acute infection, use of steroids, and sex had minor effects on the variable complement activation, whereas age inversely correlated with the complement activation. C-reactive protein level was not predictive of high (top 20th percentile) complement responses. Plasma concentrations of the main complement factors, as well as total IgG and IgM, showed no correlation with the activation by either nanoparticle. On the other hand, plasma concentrations of anti-PEG IgG and IgM showed a strong positive correlation with the activation by PLD. Particularly, titers of anti-PEG IgM showed the best predictive value for the "risk" of high complement activation by PLD. Titers of antidextran IgG and IgM showed a lower correlation with the activation by SPIO NWs and poor predictive value of the top 20% complement responses. Nanoparticle-bound immunoglobulins showed the best correlation with complement activation and a strong predictive value, supporting the critical role of immunoglobulins in inciting complement. The opsonization of PLD with C3 in plasma with high anti-PEG antibodies was predominantly via the alternative pathway. Characterizing the nature of nanoparticle-binding antibodies has important implications in mitigating and stratifying nanomedicine safety.

Combined health effects of air pollutant mixtures on respiratory mortality using BKMR in Hangzhou, China

ABSTRACT Previous research on respiratory system mortality primarily focused on understanding their combined effects and have neglected the fact that air pollution mixtures are interrelated. This study used Bayesian kernel machine regression (BKMR) to analyze the relationship between air pollutant mixtures and respiratory mortality in Hangzhou, China from 2014 to 2018. The results showed a significant association between pollutant mixtures and respiratory system mortality primarily driven by PM2.5 and SO2. The joint exposure of air pollutants was positively correlated with respiratory system mortality at lag 01 and lag 02 days. The estimated joint effects of log-transformed mixture air pollution exposure on log-transformed respiratory system mortality increased from −0.02 (95% CI: −0.08–0.02) and −0.01 (95% CI: −0.05–0.04) at the 25th percentile to 0.06 (95% CI: 0.01–0.12) and 0.04 (95% CI: −0.001, 0.09) at the 75th percentile. Additionally, there was evidence of an interaction between O3 and PM10. This study confirms that exposure to multiple pollutants is a significant public health problem facing the Hangzhou population given the compounded effect proven with regression analysis, while furthermore, the control of PM2.5 and SO2 also represents a serious concern. Implications: Evidence indicates interactions between O3 and PM10. This study demonstrates that exposure to multiple pollutants exerts combined effects on the public health of the Hangzhou population, highlighting the importance of controlling PM2.5 and SO2.

Baseline Diameter Does Not Predict Growth Rate in a Presurgical Ascending Thoracic Aortic Aneurysm Population.

Patients with ascending thoracic aortic aneurysm are recommended to undergo routine imaging surveillance. Although maximal diameter is the primary metric of disease severity, recent American College of Cardiology/American Heart Association guidelines emphasize the importance of aortic growth in determining surgical candidacy and risk. As diameter increases, it is assumed that aortic growth rate accelerates because of increased wall tension; however, this relationship is poorly studied. We aim to investigate the relationship between ascending thoracic aortic aneurysm diameter and growth rate using vascular deformation mapping, a validated technique for 3-dimensional growth mapping with submillimeter accuracy. We retrospectively identified adult patients with ascending aortic dilation (≥4.0 cm) and serial gated computed tomography angiograms separated by ≥2 years, excluding confirmed heritable thoracic aortic disease. Ascending growth rate was defined as 90th percentile radial wall deformation by vascular deformation mapping. Maximal diameter measurements were derived from the baseline computed tomography angiogram, and aortic length and body size-adjusted indexes were calculated. Among 258 included patients (63.2% men; age of 63 years [interquartile range, 55-69 years]), mean±SD baseline diameter was 46.3±3.6 mm and median growth rate was 0.21 mm/year (interquartile range, 0.13-0.38 mm/year). No correlation was noted between growth rate and baseline diameter (r=0.02, P=0.74) or other aortic size metrics. On multivariate analysis, age was independently predictive of growth rate (β=-0.007, P=0.021), alongside weight (β=0.003, P=0.016) and the presence of moderate or severe aortic valve insufficiency (β=0.146, P=0.049). Maximal aortic diameter is not predictive of aortic growth rate, in this contemporary cohort of patients with sizes under current surgical thresholds (<55 mm).

Trends in Acute Kidney Injury Related Deaths in the US from 1999 to 2020

Background Acute kidney injury requiring dialysis is linked to long-term care demands, higher hospital mortality, and increased healthcare expenses. We aim to assess nationwide trends and regional variations in acute kidney injury-related mortality in the US. Materials and Methods We used death certificates from the CDC WONDER database (1999-2020) to calculate age-adjusted mortality rates (AAMRs) and annual percent change (APC). The data were stratified by year, gender, race/ethnicity, and geographic region. Results From 1999 to 2020, there were a total of 4,599,652 deaths attributed to acute kidney injury. The AAMR for acute kidney injury-related deaths surged from 11.4 in 1999 to 20.1 in 2020. Men consistently exhibited higher AAMRs than women throughout the study period (overall AAMR in men: 20.1; women: 13.2). When examining average AAMRs by race/ethnicity, Black/African Americans recorded the highest rates at 21.9, followed by American Indian or Alaskan Native (16.4), Whites (15.6), Hispanics (14.5), and Asian/Pacific Islander (10.7). Significant regional disparities were observed, with the southern region reporting the highest AAMR (17.2) and non-metropolitan areas having higher AAMRs than metropolitan areas (18.3 vs. 15.6). States in the top 90th percentile for acute kidney injury deaths included Indiana, Kentucky and South Carolina, which had nearly double the AAMR compared to states like New York, Utah, and Vermont. Conclusion In the last two decades, the United States has experienced a troubling increase in acute kidney injury-related deaths, emphasizing the urgent need for targeted and equitable healthcare interventions to address persistent disparities in gender, race, geography, and urbanization.

Clinical associations of complement-activating collectins, collectin-10, collectin-11 and mannose-binding lectin in preterm neonates.

Premature and low-birthweight infants are at especially high risk of perinatal complications, including impaired thermoregulation, infections and respiratory distress. Such adverse effects and the need for invasive procedures are associated with high mortality among preterms. This study focused on the influence of the innate immune system and tested the levels of collectins, collectin-10 (CL-10), collectin-11 (CL-11) and mannose-binding lectin (MBL) in preterm neonates. Cord blood was collected from 535 preterms (born at gestational age ≤37 weeks). COLEC10 and COLEC11 polymorphisms were analyzed by real-time PCR and those of MBL2 by PCR/PCR-RFLP. The concentrations of collectins in sera from cord blood were determined with ELISA. Low concentrations of CL-10 in cord sera (<462 ng/ml corresponding to the 10th percentile) were significantly associated with births at GA ≤32 weeks. Median levels of both CL-10 and CL-11 were significantly lower in preterms with very low birthweight (<1500 g), low Apgar 1' score and those who needed prolonged hospitalisation. Lower median CL-10 was also observed in fetal growth restriction cases. An important finding was the decreased concentrations of CL-10, CL-11 and MBL in respiratory distress syndrome (RDS). For CL-10 and CL-11, that relationship was confined to infants born at GA ≥33 weeks and/or with body mass at birth ≥1500 g. Only CL-10 was found to influence susceptibility to early-onset infections. COLEC11 heterozygosity for the activity-decreasing polymorphism (rs7567833, +39618 A>G, His219Arg) was more common in preterm premature rupture of membranes (pPROM) cases, compared with corresponding reference groups. Furthermore, C/T or T/T genotypes at COLEC11 at rs3820897 (-9570 C>T) as well as MBL deficiency-associated MBL2 gene variants were more common in preterms diagnosed with RDS than among unaffected newborns. The complement-activating collectins investigated here could be important for maintaining homeostasis in preterm neonates. Despite similar structure and specificity, MBL, CL-10 and CL-11 manifest a different spectrum of clinical associations.

Respiratory Intervals and Swimming Speed as Remotely Sensed Health Metrics in Free-Ranging Killer Whales (Orcinus orca).

Respiratory rate (mean number of breaths per minute) and respiratory interval (mean time between breaths) can offer insight into a diving mammal's activity state, metabolic rate, behavior, and synchronization due to social cohesion. Also, respiratory rate can reflect an individual animal's health and has the potential to be an informative remotely assessed health metric for monitoring individual animal health in endangered whale species and populations such as southern resident killer whales (Orcinus orca). Using data collected from noninvasive, land-based theodolite tracking, we analyzed swimming speed and surfacing intervals (i.e., mean dive time or mean time between breaths) from 20,613 surfacings of 98 individuals from two populations of the fish-eating, resident killer whale ecotype, namely, one growing (northern resident) and one declining and endangered (southern resident) population. Focal animal sampling was used to measure behavior of individuals of known age and sex in various activity states. Our objective was to evaluate variability and generate normal ranges for respiratory intervals and swimming speeds for killer whales of the Northeast Pacific Ocean resident, fish-eating ecotype to identify baseline respiratory intervals. We found that median respiratory intervals for fish-eating killer whales were between 26 and 29 s for all activity states and that swimming speeds varied by activity state. Median swimming speeds were similar for foraging and traveling (1.6 and 1.7 m/s, respectively), but were significantly slower during resting (1.1 m/s) and social activity (1.3 m/s) states. Three southern resident killer whales in poor body condition (had body condition scores in the lowest 20th percentile of the population) swam at reduced speeds and had shorter median respiratory intervals than outwardly healthy whales of similar age and sex. Respiratory rates, respiratory intervals, and swimming speeds are valuable remotely sensed metrics of health for free-swimming killer whales, especially when combined with other metrics as is the standard in veterinary examinations.

Risks Associated with Prolonged Latent Phase of Labor.

We sought to assess the impact of a prolonged latent phase (PLP) on maternal and neonatal morbidity. This is a secondary analysis of a prospective cohort study conducted 2010 to 2015 that included all term gravidas who reached active labor (6 cm). Primary outcomes were composite maternal morbidity (maternal fever, postpartum hemorrhage, transfusion, endometritis, and severe perineal lacerations) and composite neonatal morbidity (respiratory distress syndrome, mechanical ventilation, birth injury, seizures, hypoxic ischemic encephalopathy, therapeutic hypothermia, or umbilical artery pH ≤ 7.1). Outcomes were compared between patients with and without PLP, defined as ≥90th percentile of labor duration between admission and active phase. Results were stratified by induction of labor (IOL) versus spontaneous labor. A stratified analysis was performed by mode of delivery. Multivariable logistic regression was used to adjust for confounders. In this cohort of 6,509 patients, 51% underwent IOL. A total of 650 patients had a PLP with a median length of 8.5 hours in spontaneous labor and 18.8 hours in IOL. Among patients with PLP, there was a significant increase in composite maternal morbidity with both IOL (adjusted odds ratio [aOR]: 1.36, 95% confidence interval [CI]: 1.01, 1.84) and spontaneous labor (aOR: 1.49, 95% CI: 1.09, 2.04) and an increase in composite neonatal morbidity with spontaneous labor only (aOR: 1.57, 95% CI: 1.01, 2.45). Cesarean delivery occurred more often in PLP group (14.0 vs. 25.1%). Among patients who underwent cesarean delivery, PLP remained associated with increased odds of maternal morbidity compared with those with normal latent phase. PLP at or above the 90th percentile in patients who reach active labor is associated with increased risk of maternal morbidity that is not mediated by cesarean delivery. PLP in spontaneous labor is associated with increased neonatal morbidity. These data suggest that further research is needed to establish latent phase cutoffs that may be incorporated into labor management guidelines. · Latent labor ≥90th percentile is associated with increased maternal morbidity in induced and spontaneous labor.. · Latent labor ≥90th percentile in spontaneous but not induced labor is associated with increased neonatal morbidity.. · Cesarean delivery alone does not explain this increased maternal morbidity..

Pancreatitis polygenic risk score is independently associated with all-cause acute pancreatitis risk in the UK Biobank.

Acute pancreatitis (AP) is a complex disease most commonly caused by gallstones, alcohol intake, or hypertriglyceridemia. Even in subjects with hypertriglyceridemia, the risk of AP is heterogeneous. Identifying individuals with a high genetic susceptibility to AP could contribute to a better risk stratification in the clinic. This study aimed to determine if a weighted polygenic risk score (PRS) of common variants in pancreatitis susceptibility genes can independently predict all-cause AP incidence in the general population. A weighted PRS was calculated for 484932 individuals from the UK Biobank, including 3346 individuals who developed AP during follow-up. The PRS included eight single nucleotide polymorphisms in known pancreatitis susceptibility genes. Individuals with a pancreatitis PRS above the 90th percentile had a 1.21-fold (1.03-1.43; P=0.02) increased risk of AP compared with those with a pancreatitis PRS below the 90th percentile. When comparing individuals in the third tertile versus the first tertile, the risk of AP was 1.13-fold (1.00-1.28; P=0.06) higher. Individuals with both a high triglyceride (TG) level and a high pancreatitis PRS (third tertile) had a 2.31-fold (1.83-2.93; P=3.4×10-12) increased risk of AP compared with those with a low pancreatitis PRS and a low TG level (first tertile). Overall, the association between pancreatitis PRS and incident AP was independent of baseline TG level. Results of this study suggest that the accumulation of common variants in pancreatitis susceptibility genes is associated with all-cause AP incidence. Pancreatitis PRS could help clinicians identify patients who may be at higher risk of AP and who may benefit from more aggressive treatment.

China's GDP at risk: The role of housing prices

This paper studies the impact of house prices on the distribution of GDP growth in China (the 5th, median, and 95th percentiles). We show that house price appre-ciation positively affects future GDP growth, with a more significant impact on the tail outcomes - GDP at risk. Moreover, we find that housing bust is associated with GDP growth vulnerability; a sharp decline in house prices generates severe economic downturns. Our finding is supported by the investment channel, a housing boom stim-ulates investment, which boosts GDP growth. However, the subsequent housing bust suppresses investment, leading to increased downside risks to GDP growth.

Spatiotemporal patterns and drivers of extreme fire severity in Spain for the period 1985–2018

Extreme fire severity patterns driven by climate change have deep consequences on vegetation, subsequent fire regimes and have consequences on the effectiveness of extinction. In this work, we aimed to determine if extreme fire severity defined as the 90th percentile of RdNBR has changed in Spain in the last 3 decades, if extreme fire severity patterns have differed among the different vegetation types and what drivers have influenced extreme fire severity in both summer and non-summer fires. We have used perimeters of large wildfires (≥100 ha, n = 1719) from 1985 to 2018 in four pyroregions and the main dominant vegetation types. We have analyzed time series for each pyroregion and vegetation type to determine if there were significant trends and breakpoints in extreme fire severity. We have also analyzed the effects of drought, weather, topography and vegetation on extreme fire severity in seasonal wildfires.Extreme fire severity increased in summer fires from 1985 to 2018, especially in the East and North pyroregions, while the Southwest pyroregion reached highest values in summer. There has been an increase of severity in shrubland, mosaic vegetation and conifer forests in summer. Broadleaved forests had the lowest values of fire severity and did not show any trend in the period considered. The most important drivers of extreme fire severity are, in order of importance, pyroregion, elevation, slope, vapor pressure deficit (VPD) and vegetation type for summer fires, and VPD, vegetation types, pyroregion, windspeed and drought for non-summer fires. Global change is increasing climate-related events. Our results indicate that extreme fire severity in summer has been on the rise in recent decades in Spain, suggesting that, in a climate warming context, without strategic management of these increasingly flammable landscapes, further increases may be likely.