95th Percentile Research Articles

BioVars - A bioclimatic dataset for Europe based on a large regional climate ensemble for periods in 1971–2098

Abstract Ongoing ecological research is concerned with analysing climate-induced changes in species distribution. For this purpose, the projection must have high-quality bioclimatic variables from historical and future climatic periods for the projection. To date, there are many global bioclimatic variables on this topic. Nevertheless, a consistent dataset with identical model variables from historic and projected periods is rare. We present 26 bioclimatic variables that are calculated based on a large ensemble consisting of 70 bias-adjusted GCM-RCM simulations for 1971–2098. Both, the historic and the projection periods were calculated using the same models to ensure consistency between the periods. The variables are validated against E-OBS observations from which we calculated the same bioclimatic variables. For projection periods we chose 20 year ranges between 2021–2098. Here, we offer two versions of them: (1) variables separated into RCP 2.6, 4.5 and 8.5, including percentiles among the realisations and within the RCPs; and (2) variables per realisation separately. We then extracted the temporal 5th, 50th and 95th percentile per period as representing values.

A Collection of Machine Learning Models for Improved Airport Operations Amidst Adverse Weather Conditions

In the face of escalating climate change, airports worldwide are finding themselves at the mercy of extreme weather events. This research paper presents a comprehensive system that models key indicators, aiding airport management during such challenging weather conditions. The system adopts an integrated approach, combining various machine learning models to provide a detailed projection of an airport's future state, drawing from past occurrences. The heart of the system is a model that focuses on the airport's peak service rate. This model meticulously correlates weather conditions and runway configurations with the 99th percentile of observed throughput from the training dataset. As such, the peak service rate model provides an estimate of the airport's capacity, which is essential for effective planning and resource allocation. Moreover, the system includes a predictive model that assesses the likelihood of air traffic flow management regulations based on weather data and calendar information. The robustness of this model against noise and uncertainty in the training dataset is fortified by the application of confident learning techniques and the inclusion of monotonic constraints. The system further enhances its capabilities by forecasting the potential entry rate of regulations, expressed in hourly arrivals, providing valuable insights that can guide proactive decision-making. By seamlessly integrating these three models, the system serves as an effective tool for airport operators and airlines. It enables operational optimisation and the development of strategic plans to mitigate the effects of increasing weather-related disruptions.

Microscopic and Biomechanical Analysis of PEEK Interspinous Spacers for Spinal Fusion Applications

Spinal fusion is a surgical intervention used to join two or more vertebrae in the spine. An often-used method involves the placement of intervertebral spacers. They are commonly composed of biocompatible materials like polyetheretherketone. It has strength, longevity, and the capacity to interact harmoniously with the human body. Standardized mechanical tests were performed on two distinct implants to assess their biomechanical characteristics. The studies were conducted at a velocity of 2 mm/min. The stopping criteria were determined based on the loads sustained by the 50th percentile. Furthermore, the chemical composition of the implants was assessed using Raman spectroscopy. The implant created via subtractive manufacturing has a significant change in its elastic region at a force of 1300 N, and it begins subsidence when vertebrae are subjected to a load of 1500 N. The integration of microscopic characterization techniques with the mechanical analysis of prostheses in numerous case studies facilitates the biomechanical evaluation of implants.

Co-occurring climate events and environmental justice in California, 2018–2019

Abstract Climate change will increase the frequency of extreme weather events. This means climate-driven events like wildfires and power outages will likely co-occur more often, potentially magnifying their health risks. We characterized three types of climate-driven events—anomalously warm temperatures, wildfire burn zone disasters, and long power outages—in 58 California counties during 2018–2019. We defined county-day anomalously warm temperatures when daily average temperatures exceeded 24 °C and the 85th percentile of the long-term county average. We defined county-day wildfire burn zone disasters when an active wildfire burn zone intersected a county, burned 1+ structures, killed a civilian, or received a Federal Emergency Management Agency Fire Management Declaration, and overlapped with a community. For a subset of the 38 counties (66%), long power outage county days were identified using PowerOutage.us data when an outage affected >0.5% of county customers for 8+ h. Co-occurring events were when 2+ of these events occurred on the same county day. Using the CDC/ATSDR Social Vulnerability Index (SVI), we determined whether co-occurring events disproportionately affected vulnerable populations. Nearly every county (97%) experienced at least one day of anomalously warm temperatures, 57% had at least one wildfire burn zone disaster day, and 63% (24/38 counties with available data) had at least one long power outage day. The most common co-occurring events (anomalously warm temperatures and wildfire burn zone disasters) impacted 24 (41%) counties for 144 total county-days. We did not find a clear connection between co-occurring events and social vulnerability. We observed an inverse correlation between co-occurring wildfire burn zone disasters and long power outage days with SVI, and a positive correlation between co-occurring anomalously warm and long power outage days with SVI. This analysis can inform regional resource allocation and other state-wide planning and policy objectives to reduce the adverse effects of climate-driven events.

Development of Finite Element Human Body Model (IITDHBM) of the 50th Percentile Indian Male in the Standing Posture (IM50S) for Use in Extreme Loading Conditions

Development of Finite Element Human Body Model (IITDHBM) of the 50th Percentile Indian Male in the Standing Posture (IM50S) for Use in Extreme Loading Conditions

Addressing the "Black Hole" of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study.

Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Although there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis that does not facilitate evidence-based and individualized care. We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on the available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care. Our 3-step user-centered design approach consisted of identifying clinical requirements through the analysis of evidence reviews, iteratively identifying task-based user requirements and developing a working web-based prototype, and evaluating usability through scenario-based interviews and the System Usability Scale. The 5 participating users had an average of 18.5 years of practicing chiropractic medicine. Clinical requirements included 44 patient interview and examination items. Of these, 13 interview items were enabled for all patients and 13 were enabled conditional on other input items. One examination item was enabled for all patients and 16 were enabled conditional on other items. One item was a synthesis of interview and examination items. These items provided evidence of 12 possible working diagnoses of which 3 were macrodiagnoses and 9 were microdiagnoses. Each diagnosis had relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. User input led to key refinements in the design, such as organizing the input questions by microdiagnosis, adding a patient summary screen that persists during data input and when reviewing output, adding more information buttons and graphics to input questions, and providing traceability by highlighting the input items used by the clinical logic to suggest a working diagnosis. Users believed that it would be important to have the tool accessible from within an electronic health record for adoption within their workflows. The System Usability Scale score for the prototype was 84.75 (range: 67.5-95), considered as the top 10th percentile. Users believed that the tool was easy to use although it would require training and practice on the clinical content to use it effectively. With such training and practice, users believed that it would improve care and shed light on the "black hole" of LBP diagnosis and treatment. Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care.

Clock Proteins Have the Potential to Improve Term Delivery Date Prediction: A Proof-of-Concept Study

Our ability to accurately predict the delivery date of term pregnancies is limited by shortcomings of modern-day clinical tools and due date estimation methods. The pregnancy clock is a series of coordinated and harmonized signals between mother, fetus, and placenta that regulate the length of gestation. Clock proteins are thought to be important mediators of these signals, yet few studies have investigated their potential utility as predictors of term delivery date. In this study, we performed a cross-sectional proteome analysis of 2648 serum samples collected between 18 and 28 weeks of gestation from mothers who delivered at term. The cohort included pregnancies both with and without complications. A total of 15 proteins of diverse functionalities were shown to have a direct association with time to birth (TTB), 11 of which have not been previously linked to gestational age. The protein A Distintegrin and Metalloproteinase 12 (ADA12) was one of the 15 proteins shown to have an association with TTB. Mothers who expressed the highest levels of ADA12 in the cohort (90th percentile) gave birth earlier than mothers who expressed the lowest levels of ADA12 (10th percentile) at a statistically significant rate (median gestational age at birth 390/7 weeks vs. 393/7 weeks, p < 0.001). Altogether, these findings suggest that ADA12, as well as potentially other clock proteins, have the potential to serve as clinical predictors of term delivery date in uncomplicated pregnancies and represent an important step towards characterizing the role(s) of clock proteins in mediating pregnancy length.

The Consequences of Preterm Birth in the Children of Mothers with Inflammatory Bowel Disease: A Nationwide Cohort Study.

Mothers with inflammatory bowel disease (IBD) are at increased risk of delivering their infants preterm. In the general population, chronic diseases in adulthood as well as increased morbidity and mortality are associated with being born preterm. We aimed to examine whether this was true for preterm versus full-term infants born to mothers with IBD. This is an observational cohort study based on the Danish Health Registries. The study population comprised all live-born singleton children, born to mothers with IBD, during the study period of 1995 through 2016. We estimated the risk of selected chronic diseases in offspring born preterm to mothers with IBD. These included epilepsy, chronic lung disease and asthma, depression and bipolar affective disorder, autism spectrum disorders, schizophrenia/psychosis, attention-deficit hyperactivity disorder, and mental retardation/intellectual disabilities. We adjusted for relevant confounders. In all, 736 children were born preterm, and 9655 were born full-term to mothers with IBD. The median, 25th, and 75th percentiles of the follow-up time of the children were 11.1 (6.4, 16.3) years and 11.4 (7.3, 16.3) years for the full-term and preterm cohorts, respectively. There was a statistically significant increased risk of mental retardation/intellectual disabilities in preterm versus full-term children (aHR 2.15; 95% CI 1.07-4.36). We also found a non-significantly increased risk of epilepsy (1.11; 0.51-2.42), chronic lung disease and asthma (1.10; 0.76-1.60), schizophrenia/psychosis (1.17; 0.50-2.73), and attention-deficit/hyperactivity disorder 1.15 (0.83-1.60). Our study indicates the possibility of chronic health consequences in children born preterm to mothers with IBD.

Trends in Alzheimer's-Related Mortality Among Type 2 Diabetes Patients in the United States: 1999-2019.

Recent research has shown that type 2 diabetes mellitus (T2DM) has increased the burden of Alzheimer's disease (AD) in the US aging population. However, trends in mortality from this comorbidity among adults aged ≥ 65 years have not been investigated. This study examined trends and disparities in AD-related mortality among older US adults with T2DM from 1999 to 2019. Data from the CDC WONDER database were analysed to assess AD-related mortality in patients with T2DM aged ≥ 65 between 1999 and 2019. Age-adjusted mortality rates (AAMRs) per 100,000 people and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, age, urbanisation and geographical region. From 1999 to 2019, there were 71,550 deaths with T2DM and AD among adults aged ≥ 65. AAMRs rose from 4.12 in 1999 to 11.65 in 2019, with the sharpest increase between 2014 and 2017 (APC: 10.81; 95% CI: -3.20 to 13.43). Women had slightly higher AAMRs than men, with rates increasing from 4.71 in 1999 to 11.61 in 2019 for women, and from 4.08 to 11.70 for men. Hispanic individuals saw the highest increase in AAMR (11.15), followed by non-Hispanic Black (9.30) and White populations (7.92). AAMRs were highest in the West (10.91) and the Midwest (9.62), while the Northeast (4.70) had the lowest. Nonmetropolitan areas had consistently higher AAMRs (10.74) than large metropolitan areas (6.68) and small/medium metropolitan areas (9.25). States in the top 90th percentile for T2DM-AD mortality included California, South Dakota and Kentucky, where rates were approximately eight times higher than in states in the lowest 10th percentile. This study reveals a significant rise in T2DM-AD comorbidity-related mortality among older adults, especially among Hispanics, women and rural residents. These findings underscore the need for targeted interventions to reduce the burden in vulnerable populations.

Prenatal exposure to heat and humidity and infant birth size in Ghana.

Previous studies - primarily in high income countries - have shown that high prenatal temperatures are associated with adverse birth outcomes. However, these studies are mostly focused on average exposure across the full gestational period or short-term exposure immediately prior to delivery and may miss important sensitive windows of exposure in utero. Further, nearly all use ambient air temperature data, which neglect physiologically important interactions between air temperature and humidity. The Ghana Randomized Air Pollution and Health Study (GRAPHS) recruited pregnant individuals from 2013 to 2015 from communities in the Kintampo North Municipality and Kintampo South District of Ghana. We estimated daily maximum shaded wet bulb globe temperature (WBGTmax) and heat index (HImax) during pregnancy and examined associations with birth weight, birth length, head circumference, and incidence of low birth weight, preterm birth, and small for gestational age. Using linear regression analyses, trimester average models identified that higher WBGTmax in the first trimester was associated with larger head circumference; second trimester was associated with shorter birth length, lower birth weight and higher odds of preterm birth, and third trimester was associated with shorter gestational age and larger head circumference. Time-varying analyses using distributed lag nonlinear models find that, compared to the median, lower WBGTmax and HImax (25th percentile) during the first half of pregnancy was associated with higher birth weight and longer birth length. Compared to the median, lower WBGTmax and HImax (25th percentile) in the second half of pregnancy was associated with smaller head circumference while higher wet bulb globe temperature (75th percentile) was associated with larger head circumference. Overall, our study identified that higher WBGTmax and HImax are associated with pregnancy duration and newborn size. Given the overall trend in our study area of rising temperatures, these data suggest that adaptation strategies are urgently needed to protect child health.

A combined wavelet analysis-quantile mapping (WA-QM) method for bias correction: capturing the intra-annual temporal patterns in climate model precipitation simulations and projections

Abstract Despite recent improvements, global climate models (GCMs) still have biases that prevent their direct application. Quantile mapping (QM) has been widely used in bias correction (BC) due to its effectiveness in aligning the cumulative density function of climate model data with observations. However, QM has a significant limitation: it fails to consider the temporal correspondence between the model data and observations, which restricts its ability to represent intra-annual temporal patterns. To address this issue, this study integrated wavelet analysis (WA) into QM to develop a combined method termed WA-QM, which aimed to preserve QM’s efficacy in overall BC and preservation of climate change signals, while capturing the intra-annual temporal patterns. The effectiveness of WA-QM was investigated using monthly precipitation data from five Coupled Model Intercomparison Project Phase 6 models in the Pan Third Pole region, which includes Central Asia (CA), Southeast Asia, and the Tibetan Plateau. Quantile delta mapping (QDM) and scaled distribution mapping (SDM) served as the benchmark methods for assessment. The results indicated that integrating WA into QDM or SDM did not compromise the ability of QDM or SDM to correct overall biases and preserve the model’s climate change signal. Furthermore, WA could be an effective tool to overcome QM’s limitation in capturing intra-annual temporal patterns. The WA approach employed discrete wavelet transformation to decompose GCM data into various frequency bands and then adjusted their standard deviations and signs to ensure that their relative relationships were consistent with those in observations. Compared to the standalone QM approach, WA-QM showed greater accuracy in monthly statistical metrics. In the CA region, WA-SDM reduced the monthly root mean square error of the mean by 25.2%, the standard deviation by 17.6%, and the 90th percentile by 26.7% compared to SDM. The effectiveness of WA-QM was demonstrated across different data periods, spatial areas, and GCMs.

Analysis of lipogenic and metabolic subtypes and survival outcome in patients with pancreatic adenocarcinoma.

775 Background: Delayed diagnosis and rapid progression are major drivers of poor survival outcomes for Pancreatic Ductal Adenocarcinoma (PDAC). In previous studies, molecular profiling in tumor tissue has identified Cholesterogenic, Classical, or Exocrine-Like pathological subtypes associated with improved prognosis. Herein, in a clinical trial called Project Survival, we molecularly and clinically characterized a prospective PDAC biomarker cohort. This multicenter (n=6) clinical trial (NCT 02781012) of PDAC combined with high-fidelity longitudinal phenotypic characterization and multi-omic profiling was utilized to identify biomarkers with diagnostic and therapeutic utility. The study included assessment of plasma, serum, buffy coat, urine, saliva, and tumor tissue samples and followed 269 PDAC subjects for up to 7 years (Median survival was 700 days, with IQR of 822 days). Methods: We assessed plasma samples to identify circulating biomarkers using proteomics, metabolomics, and lipidomics profiling. Multi-omic comparison of patients with Overall Survival (OS) above the 75th percentile (improved survival) against those with OS below the 25th percentile (poor survival) was performed. Results: We identified distinct panels of proteins, metabolites, and lipids that were associated with patient survival outcomes. Protein biomarkers that were increased in improved survival outcomes were associated with cholesterol metabolism (7/14, p-value = 0.00085) and glycolysis/gluconeogenesis (5/12, p-value = 0.00089), however, protein markers associated with immune surveillance and inflammation were associated with poorer survival. For metabolite biomarkers, 19 metabolites were increased in poorer survivors of which 13/19 were carnitine metabolites, and 42 metabolites were increased in patients with improved survival. Interestingly, only two lipid molecular species of the diacylglyceride family were increased in patients with poorer survival. Conclusions: Project Survival, a prospective biomarker-driven clinical trial identified distinct metabolic and molecular subtypes of patients which characterize survival outcome in PDAC. These subtypes go beyond tumor genomic characterization and align with distinct cholesterogenic and glucogenic phenotypes associated with survival outcomes, which can potentially be leveraged for therapeutic intervention strategies.

Air pollution, temperature and mumps: A time-series study of independent and interaction effects.

Understanding the associations of air pollutants and temperature with the incidence of mumps, and exploring the interaction effects of heat index (HI) and air pollutants, are crucial for disease intervention under the context of climate change. This time-series study was conducted in Jining city using data on daily mumps cases, meteorological factors and air pollutants obtained from 2015 to 2021. Distributed lag models combined with quasi-Poisson regressions were applied to examine these associations. The findings indicated a heightened risk of mumps in correlation with elevated exposure to PM2.5, PM10, and NO2. Specifically, the precent changes in the risk of mumps were 0.6 % and 0.3 % associated with per 10 μg/m3 increment in PM2.5 and PM10 at lag0 day, respectively. The cumulative effects of temperature were significantly associated with mumps, showing a "U"-shape pattern. Compared to the minimum effect value of 4 ℃, relative risk (RRs) of mumps for high and low temperature (at the 90th and 10th percentiles) were 1.961 (1.106-3.477) and 1.058 (0.976-1.158), respectively. There were significant synergistic effects between particulate matters (PMs) and HI. Compared to the low concentrations of PMs and normal heat index (NHI), co-exposure to high PMs and high heat index (HHI) has the highest risk (RRPM2.5: 1.32 and, RRPM10: 1.30). Individuals aged over 5 years was susceptible to particulate matters (PMs). Our results suggested that mitigating both PM and high temperature exposure may bring more health benefits for mumps incidence.

Anthropometric and Sociodemographic Correlates of Dental Caries and Gingival Health in Children With Special Healthcare Needs at a Saudi Tertiary Care Hospital.

To evaluate the impact of anthropometric and sociodemographic factors on dental caries and gingival health among children with special healthcare needs (SHCN). This cross-sectional study involved 108 children, aged 4-14 years, with congenital heart disease, childhood cancer, bleeding disorders, various syndromes, and multiple conditions. Caregivers completed a sociodemographic questionnaire, and children underwent dental examinations to assess caries, gingival health, and oral hygiene. Anthropometric measures-weight, height, and body mass index (BMI)-were obtained and categorized into percentiles (<10, 10-90, >90) using age- and gender-specific growth charts. Dental caries was highly prevalent (93.5%), with a mean dmft/DMFT value of 7.70 (SD ± 5.22). The mean gingival index was 0.43 (SD ± 0.52). Total dmft/DMFT values were significantly higher in children ≤6 years and those with fathers of lower educational levels. Poor oral hygiene was a strong predictor of adverse outcomes for both caries and gingival health. Higher gingival indices correlated with children in the >90th weight percentile. The findings highlight the need for comprehensive oral health interventions that integrate meticulous oral hygiene, paternal education, and holistic growth monitoring beyond BMI. The results support implementing a 3-month recall program for professional dental care, combined with individualized oral hygiene instruction for caregivers. This approach is particularly crucial for the younger age group (≤6 years) where targeted early intervention could significantly reduce caries risk.

Projections of future heat-related emergency hospitalizations for asthma under climate and demographic change scenarios: a Japanese nationwide time-series analysis

There is growing concern about climate impacts on human health. However, empirical evidence is lacking regarding future projections of heat-related asthma hospitalizations. This study aimed to project excess emergency hospitalizations for heat-related asthma exacerbation in Japan. Using Japanese nationwide administrative data from 2011 to 2019, we conducted an ecological time-series quasi-Poisson regression analysis to estimate the heat-related relative risk of emergency hospitalization for asthma over a lag of 0-3 days during the warm season (June to September). Heat exposure was defined as the region-specific daily mean temperature exceeding the locally defined minimum morbidity temperature percentile (MMP). Heat-related excess hospitalizations for asthma were projected under future climate and demographic change scenarios based on Shared Socioeconomic Pathways (SSPs). We identified 75,829 emergency hospitalizations for asthma. The heat-related relative risk of hospitalization was 1.22 (95% confidence interval (CI): 1.12-1.33) at the 99th percentile temperature relative to the MMP, with the highest estimates for cases aged 0-14 years. Heat-related excess hospitalizations were projected to increase by 6.78 (95%CI: 5.84-7.67) times in 2091-2099 versus 2011-2019 along SSP5-8.5 when constant population structure was assumed. The increasing trend persisted even when the future population decline was considered (4.19 (95%CI: 3.53-4.85) times in 2091-2099 versus 2011-2019 under SSP5-8.5). Future heat-related impacts on asthma exacerbation are expected to increase in Japan toward the end of this century, even when the future demographic change is considered. Our projections will contribute to resilient health systems adapting to ongoing climate change.

Trends in early onset colorectal cancer–related mortality among adults in the United States from 1999-2020.

42 Background: Colorectal cancer (CRC) has witnessed a decrease in incidence and mortality in the United States (US) for the past few decades likely due to increased screening and improvements in treatment . Despite the overall burden of CRC has declined and survival has been made for older adults, there is a simultaneous and alarming increase in CRCs diagnosed in individuals younger than 50 years of age. These Early Onset CRC (EOCRC) which now account for roughly 10% of new CRC cases in the US. The purpose of this study was to assess the trends and regional differences in EOCRC-related mortality among adults in the United States. Methods: Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2020 for -related mortality in adults &lt;45 years of age. Age-adjusted mortality rates (AAMRs) per 10,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, and geographic region. Results: Between 1999 and 2020, 32,850 EOCRC-related deaths occurred among adults 25-44 years. The AAMR increased from 2.1 in 1999 to 2.6 in 2020. Men had consistently higher AAMR than women from 1999 (AAMR men: 2.0 vs women: 1.6) to 2020 (AAMR men: 2.6 vs women: 2.0). Non Hispanic (NH) African Americans had the highest overall AAMR (3.1), followed NH White (2.2), NH Asians (1.6) and Hispanics (AAMR 1.5) Caucasians have had a significant increase in mortality over the past 2 decades ( APC 1.4 (95%Cl 1.1-.7)) whereas the Hispanics have shown an APC of 4 (95% Cl 2.3-5.8 from 2012-2020). AAMR also varied substantially by region (overall AAMR: Midwest 2.1; South: 2.4; West: 1.9; Northeast: 2.0). States in the top 90th percentile of EOCRC-related AAMR were Mississippi, Arkansas, Oklahoma, South Carolina, Alabama West Virginia, Louisiana ,Kentucky and Tennessee which had approximately double the AAMRs compared with states that fell into the lower 10th percentile. Conclusions: EOCRC-related mortality in U.S. adults has been steadily increasing over the past two decades . The highest AAMRs were observed among African American adults and men, and among patients living in the Southern , Midwestern regions and those living in the nonmetropolitan United States. Targeted strategies are needed to prevent and treat EOCRC among older adults to curb increasing levels of EOCRC-related mortality.

Mortality trends and racial disparities in hepatocellular carcinoma associated with metabolic syndrome in the United States and Texas: A 21-year analysis (1999-2020) using CDC WONDER database.

525 Background: The prevalence of hepatocellular carcinoma(HCC) and metabolic syndrome (MetS) is increasing globally. This study aims to examine annual trends of mortality in MetS-associated HCC in the United States and its state of Texas, from 1999 to 2020, to evaluate public health initiatives and identify socioeconomic factors. Methods: Mortality trends for adults aged ≥25 years with MetS-associated HCC were analyzed using CDC WONDER database, identifying deaths through ICD-10 codes C22.9 “Liver Malignant neoplasms” and E88.9 “Metabolic Syndrome”. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs, with 95% confidence intervals, were determined across various demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups. Results: Between 1999 and 2020, 271,046 documented deaths were attributed to HCC due to metabolic syndrome. The AAMR for MetS-related HCC mortality increased in the US from an adjusted rate (AR) (3.7) in 1999 to (4.5) in 2009 (APC:2.10%; 95% CI: -0.13% to 3.10%), after which it increased to (7.6) in 2018 (APC:5.83%; 95% CI:4.25% to 6.99%) and increased to 9.9 in 2020 (APC:13.19%; 95% CI:8.78% to 15.7%). In Texas, AAMR for MetS-related HCC mortality increased from AR (4.9) in 1999 to (8.9) in 2015 (APC:3.95%; 95% CI:3.11% to 4.69%) after which it increased to (15.3) in 2020 (APC:10.64%; 95% CI:8.18% to 17.33%). Men had consistently higher AAMRs than women (12.4 vs. 8). The AAMR in U.S. men increased from (5.1) in 1999 to (12.4) in 2020. The AAMR in U.S. women increased from (2.7) in 1999 to (8) in 2020. The non-Hispanic (NH) American Indian or Alaska Native population has the greatest AAMR (13.4), followed by the NH Black or African American(AA) (12.7) and the Hispanic or Latino population with AAMR (10.9). The low-risk population was NH White with AAMR (9.6) and NH Asian or Pacific Islander (6.6). The AAMR also varied by region (South:11.5; Midwest:9.9; West:9.4; Northeast:7.4) and non-metropolitan areas had higher AAMR (small metro:12.1; non-core areas:11; micropolitan areas:11.7) than metropolitan areas (large central metropolitan: 8.8; large fringe areas: 8.7). The states in the upper 90th percentile of MetS-related HCC AAMRs were Texas, Louisiana, Arkansas, Michigan, Nevada exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile Nebraska, Wisconsin, Washington, Maine. Conclusions: Mortality rates from hepatocellular carcinoma associated with metabolic syndrome have risen in the United States and Texas over the past two decades. However, significant demographic and geographic disparities in MetS-related HCC mortality continue, emphasizing the need for further investigation and the development of targeted treatment strategies.

Establishing national diagnostic reference levels in fluoroscopy and fluoroscopically guided interventions in Ireland and comparing these with national diagnostic reference levels in Europe and internationally.

The purpose of this work was to establish national Irish diagnostic reference levels (DRLs) for a clinically representative and comprehensive list of clinical indications, anatomical regions, and common procedures for fluoroscopy and fluoroscopically guided interventions and compare these, where possible, to other DRLs established at a national level. A list of clinical indications, anatomical regions and common procedures was established. A national database of service providers was used to identify all medical radiological facilities providing fluoroscopy and fluoroscopically guided intervention services. These facilities were issued with an online survey. National Pka DRLs were set as the 75th percentile of the distribution of median values obtained. A national median dose was also established which is the 50th percentile of the median doses provided by facilities for the same patients and conditions as the national DRL value. The broad categorisation of equipment type was also considered. Where statistically significant differences were found between different detector types, detector specific national DRLs were established (flat panel detector and image intensifier specific DRLs). National Pka DRLs were established for 52 fluoroscopy and fluoroscopically guided intervention clinical indications, anatomical regions, and procedures. In addition, equipment specific (flat panel detector and image intensifier based systems) adult DRLs were established for the EVAR and lumbar puncture under fluoroscopy procedures. Paediatric DRLs were established for two fluoroscopy and fluoroscopically guided intervention clinical indications, anatomical regions, and procedures across various weight categories. Comparisons with other nationally set DRLs and other relevant literature suggest that Irish DRLs are typically lower than those established elsewhere. This work provided a unique opportunity to establish national DRLs based on census data for a wide range of clinical indications, anatomical regions, and procedures across adult and paediatric fluoroscopy and fluoroscopically guided interventions. Where comparisons with other nationally established work was possible Irish values are largely below other DRLs.

Reference Values of Handgrip and Lower Extremity Strength for Vietnamese Men and Women: The Vietnam Osteoporosis Study.

Falls and sarcopenia are significant public health issues in Vietnam. Despite muscle strength being a critical predictor for these conditions, reference data on muscle strength within the Vietnamese population are lacking. To establish the reference ranges for muscle strength among Vietnamese individuals. The study involved 4096 individuals, including 1419 men and 2677 women aged 18 years and above, from the Vietnam Osteoporosis Study. Muscle strength was assessed using a Baseline hand dynamometer for handgrip strength and a Back-Leg-Chest dynamometer for leg strength. We calculated mean values, standard deviations, interquartile ranges, and peak muscle strength (pMS) for both handgrip and leg strength across various ages. Reference curves were created with the Generalised Additive Model for Location Scale and Shape, and polynomial regression models were employed to analyse the relationship between muscle strength and age. Advancing age was significantly associated with lower muscle strength. Peak muscle strength typically occurred between ages 30 and 40, with earlier peaks in women, especially in leg strength. Men consistently showed higher muscle strength than women, with variations depending on the measurement site. Specifically, average handgrip strength was 36.4 kg ± 8.4 (mean ± SD) for men and 23.2 kg ± 6.0 for women (p < 0.001). Leg strength averaged 63.9 kg ± 27.2 for men and 29.5 kg ± 13.9 for women (p < 0.001). Additionally, we produced a percentile chart illustrating muscle weakness ranges based on the 25th percentile of muscle strength and the appendicular skeletal muscle mass index (ASMI) for the Vietnamese population. These data provide reference ranges for evaluating muscle strength in the Vietnamese population, offering crucial insights for identifying individuals at risk of falls or sarcopenia in clinical settings.

Barriers to Research for Academic Otologists/Neurotologists in the United States.

The physician-scientist workforce is shrinking in the United States. Academic otologists/neurotologists face a diverse set of barriers to successful careers. We aimed to characterize the factors affecting contemporary otology/neurotology surgeon-scientists. An electronic survey was distributed to faculty members of the American Neurotology Society and the American Otological Society in 2021. The survey queried demographics, practice setting, compensation, and barriers to conducting research for respondents in academic practice. One hundred fifty-seven otologists/neurotologists responded to the survey, corresponding to an overall response rate of 25%. Of the respondents, 94 were in academic practice. The median protected research time was 0.5 days/wk, whereas the mode was zero. Across academic rank, salary compensation was lower for academic surgeons with active research funding and for female academic surgeons as compared with their male counterparts. Grant-funded female academic surgeons had significantly worse compensation compared with rank-matched male surgeons with similar protected time. No grant-funded female earned more than the 30th percentile for their rank. Identified barriers to research were pressure to maintain clinical productivity, insufficient protected time, and personal/family demands. Respondents highlighted several areas for improvement: compensation for research activity, administrative support, and improved grant funding mechanisms for clinician-scientists. Otology/neurotology surgeon-scientists face barriers to research, including limited protected time, poor administrative support, increasingly competitive funding environments, and misaligned compensation models. New initiatives by the National Institute on Deafness and other Communication Disorders aim to increase the surgeon-scientist workforce, but their success may depend upon removing identified barriers at the level of academic institutions.