95th Percentile Research Articles

Coagulation profiles and percentiles in neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia: A step toward more accurate transfusion thresholds.

In the literature, there are no studies about the transfusion threshold for neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). In order to facilitate accurate interpretation of coagulation results in these neonates, we aimed to generate specific reference intervals in this specific population. This retrospective study included all HIE neonates admitted from 2014 to 2022 to undergo TH. All infants during TH underwent blood exams, including the coagulation profile. Our primary outcome was to assess the estimates of the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for each parameter on admission (before transfusion). By the receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) and the best cut-off point were used to evaluate the ability of the prothrombin time expressed as international normalized ratio (PT-INR) to predict the risk of any bleeding. A total of 143 infants were included in this study. On admission, the median fibrinogen value was 205mg/dL, prothrombin time 18.6seconds, PT-INR 1.50, activated partial thromboplastin time 38.3seconds, thrombin time 18.6seconds, antithrombin 57.0%. The optimal cut-off of PT-INR in predicting the risk of any bleeding was greater than 1.84 (AUC.623, p=.024). For the first time, we proposed the percentiles of coagulation parameters in our cohort of neonates with HIE. Furthermore, we found that a PT-INR greater than 1.84 can significantly predict the risk of any bleeding. Further studies are needed to determine if a restrictive versus a liberal transfusion approach can be equally safer for these high-risk infants.

Population-wide eGFR percentiles in younger adults and clinical outcomes.

Identifying meaningful estimated glomerular filtration rate (eGFR) reductions in younger adults (<65 years) could guide prevention efforts. To aid in interpretation and identification of young adults at risk, we examined the association of population-level eGFR percentiles relative to the median by age and clinical outcomes. We conducted a retrospective cohort study of 8.7 million adults from Ontario, Canada from age 18 to 65 from 2008 to 2021 with an eGFR measure (both single outpatient value and repeat measures). We calculated median eGFR values by age and examined the association of reduced eGFR percentiles (≤10th, 5th, 2.5th and 1st) with outcomes using time to event models. Outcomes were a composite of all-cause mortality, major adverse cardiac outcomes (MACE) with/without heart failure (MACE+) and kidney failure as well as each component individually. From age 18 to 65, the median eGFR declined with age (range 128 to 90) and across percentiles [eGFR ranges 102 to 68 for ≤10th, 96 to 63 for ≤5th, 90 to 58 for ≤2.5th and 83 to 54 for 1st]. The adjusted rate for any adverse outcome was elevated at ≤ 10th percentile (HR 1.14 95%CI 1.10-1.18) and was consistent for all-cause mortality, MACE, MACE+ and predominant for kidney failure (HR 5.57 95%CI 3.79-8.19) compared to the median eGFR for age. Young adults with an eGFR in the lower percentiles were less likely to be referred to a specialist, have a repeat eGFR or albumin to creatinine ratio measure. eGFR values at the 10th percentile or lower based on a population-level distribution are associated with adverse clinical outcomes and in younger adults (18 to 39) this corresponds to a higher level of eGFR that may be underrecognized. Application of population-based eGFR percentiles may aid interpretation and improve identification of younger adults at risk.

Assessment of Gross Motor Skills in Ponseti-treated Children With Idiopathic Clubfoot at 3 Years Old: Insights from the Peabody Developmental Motor Scale 2.

Congenital talipes equinovarus, or clubfoot, can lead to lifelong functional impairments, including diminished gross motor skills (GMS), if left untreated. The Ponseti method corrects idiopathic clubfoot through casting and bracing. Given the importance of GMS in childhood development, this technique must be optimized to support childhood and long-term health outcomes. This study examined immediate posttreatment GMS in 3-year-old children treated with Ponseti, hypothesizing that they would perform on par with their nonclubfoot peers. Data from 45 children (33 to 46mo of age) treated for idiopathic clubfoot were analyzed. The Peabody Developmental Motor Scales, 2nd edition, was used to assess GMS, and logistic regression identified factors influencing Gross Motor Quotient (GMQ) scores. Approximately half (n=22) of the patients exhibited below-average GMS (11th to 25th percentile), with 11 scoring below the 10th percentile. Initial deformity severity, gender, and cast numbers did not impact GMQ. Repeat percutaneous tenotomy was associated with lower GMQs. Brace compliance significantly reduced odds of low GMQs by up to 80%. Age at testing and additional surgery were also linked to below-average and poor GMQs. GMS appeared to be impaired in almost half of the 3-year-old patients treated for idiopathic clubfoot, so our hypothesis was disproven. Repeat percutaneous tenotomy was associated with lower GMS, necessitating future recognition of patients who might be at risk of relapse. Brace noncompliance emerged as a significant risk factor, emphasizing early identification of these patients and education for their parents. This study offers a benchmark for clinicians and parents, but research on long-term outcomes is needed. Level II, prospective cohort study.

Phonological assessment for Greek (PAel) test: Reliability and validity in 4-to 6-year-old preschool children

ABSTRACT Single-word phonological tests are widely used for detecting children at risk for Speech Sound Disorders (SSDs). However, specific conceptual and operational criteria should be evaluated to ensure that these assessments are valid and reliable and can serve as diagnostic tools. The current study aimed to investigate the validity and reliability of the screener of a phonological Greek instrument, named the Phonological Assessment for Greek (PAel) comparing the phonological performance of typically developing (TD) children and children with SSDs, aged 4 to 6 years. The participants were 20 TD children and 40 children with SSDs. All participants completed the screener of PAel, the 70-word list of the standardised Test of Phonetic and Phonological Development (TPPD), and a language test, namely the Action Picture Test. Participants who scored below the 25th percentile on the language test were excluded. Phonological analysis revealed that PAel has high content validity. The participants who had received a diagnosis of SSDs presented restricted consonant and cluster inventories and significantly lower whole-word match levels in comparison to their TD peers. The overall Spearman’s correlation coefficients between PAel and TPPD were 0.611 for TD children (p < 0.001) and 0.875 for children with SSDs (p < 0.001), indicating good criterion validity. The tool demonstrated strong test-retest reliability and inter-rater reliability with Spearman values exceeding 0.85, and Intra-class correlation coefficients over 0.90. Overall, the results suggest that PAel has satisfactory reliability and validity and can be used as an assessment tool to detect children at risk for SSDs.

Determining cut-off scores for simulated tasks in Brazilian Air Force military personnel

IntroductionCombat readiness assessments through simulated tasks (STs) have been developed for the Brazilian Air Force (BAF) to establish physical employment standards. Previous research has established BAF critical combat tasks with...

Argentine and World Health Organization head circumference standards: A comparison study.

Introduction. Several studies have shown population differences in head circumference (HC) that question the universal validity of the World Health Organization (WHO) standard to assess head growth. Objectives. To compare the Argentine reference charts for HC from 0 to 5 years of age with the WHO standards. Population and methods. The 3rd and 97th percentiles for HC based on the Argentine reference charts were compared with the corresponding WHO standard and the percentage of children classified as having microcephaly (HC < 3rd percentile of the WHO) and macrocephaly (HC > 97th percentile of the WHO) at specific ages between 0 and 5 years were estimated. Results. The comparison of the Argentine reference charts with the WHO standards shows that, in both males and females, at the 3rd percentile, the Argentine reference charts are below the WHO standards from 1 to 6 months of age, similar from 9 to 18 months of age, and then above until 60 months old. In relation to the 97th percentile, the Argentine reference charts are above the WHO standards from birth to 60 months in both boys and girls. Conclusions. The head size of Argentine children is different from that established by the WHO standards. The adoption of the WHO standards for our population increases the percentage of macrocephaly diagnosis at all ages.

Normative data for the squat, bench press and deadlift exercises in powerlifting: Data from 809,986 competition entries

ObjectivesStrength assessment and comparison to normative values are an important benchmarking and diagnostic tool in human health and performance. However, population specific normative data are often several decades old, often lack information about adolescent and adult strength levels and are not representative of the strength levels of strength trained individuals. The purpose of this study was to develop contemporary strength norms for the squat, bench press, and deadlift using powerlifters competing in un-equipped, drug-tested competitions. DesignRetrospective cross-sectional analysis. MethodsRetrospective data from global drug-tested, unequipped powerlifting competitions were collated with 809,986 samples (571,650 males, 238,336 females) included. Strength was assessed according to sex, United Nations age classifications, and competitive powerlifting weight class. Strength was expressed relatively (ratio of weight lifted/bodyweight) and computed for the 10th–90th percentile for each of the above categories. ResultsRelative strength was greatest for young adults (18–35 years; 90th percentile for squat [male: 2.83 × bodyweight, female: 2.26], bench press [male: 1.95, female: 1.35], deadlift [male: 3.25, female: 2.66]) before declining thereafter for all three exercises. Although lower than their younger counterparts, very old adults (>80 years) had 90th percentile data for the squat of male: 1.72 and female: 1.01, bench press: male: 1.31 and female: 0.92, and deadlift: male: 2.30 and female: 1.68. Relative strength was also greatest for the lightest female and male weight classes, respectively. ConclusionsThese findings provide a comprehensive, accurate and precise representation of strength for drug-tested, unequipped powerlifters in each category and serve as a point of reference for other trained population groups. To facilitate uptake and ease of comparison, we have developed a freely available online tool.

Utility of block-matching and 3D filter for reproducibility of lung density and denoising in low-dose chest CT: A pilot study

PurposeThis study aimed to acquire an image quality consistent with that of full-dose chest computed tomography (CT) when obtaining low-dose chest CT images and to analyze the effects of block-matching and 3D (BM3D) filters on lung density measurements and noise reduction in lung parenchyma. MethodsUsing full-dose chest CT images, we evaluated lung density measurements and noise reduction in lung parenchyma images for low-dose chest CT. Three filters (median, Wiener, and the proposed BM3D) were applied to low-dose chest CT images for comparison and analysis with images from full-dose chest CT. To evaluate lung density measurements, we measured CT attenuation at the 15th percentile of the lung CT histogram. The coefficient of variation (COV) and contrast-to-noise ratio (CNR) were used to evaluate the noise level. ResultsThe 15th percentile of the lung CT histogram showed the smallest difference between full- and low-dose CT when applying the BM3D filter, and the highest difference between full- and low-dose CT without filters (full-dose = − 926.28 ± 0.32, BM3D = − 926.65 ± 0.32, and low-dose = − 959.43 ± 0.95) (p < 0.05). The COV was smallest when applying the BM3D filter, whereas the CNR was the highest (p < 0.05). ConclusionsThe results of the study prove that the BM3D filter can reduce image noise while increasing the reproducibility of the lung density, even for low-dose chest CT.

Impact of Maternal Pre-Pregnancy Underweight on Cord Blood Metabolome: An Analysis of the Population-Based Survey of Neonates in Pomerania (SNiP)

Intrauterine growth restriction leads to an altered lipid and amino acid profile in the cord blood at the end of pregnancy. Pre-pregnancy underweight is an early risk factor for impaired fetal growth. The aim of this study was to investigate whether a pre-pregnancy body mass index (ppBMI) of &lt;18.5 kg/m2, as early as at the beginning of pregnancy, is associated with changes in the umbilical cord metabolome. In a sample of the Survey of Neonates in Pomerania (SNIP) birth cohort, the cord blood metabolome of n = 240 newborns of mothers with a ppBMI of &lt;18.5 kg/m2 with n = 208 controls (ppBMI of 18.5–24.9 kg/m2) was measured by NMR spectrometry. A maternal ppBMI of &lt;18.5 kg/m2 was associated with increased concentrations of HDL4 cholesterol, HDL4 phospholipids, VLDL5 cholesterol, HDL 2, and HDL4 Apo-A1, as well as decreased VLDL triglycerides and HDL2 free cholesterol. A ppBMI of &lt;18.5 kg/m2 combined with poor intrauterine growth (a gestational weight gain (GWG) &lt; 25th percentile) was associated with decreased concentrations of total cholesterol; cholesterol transporting lipoproteins (LDL4, LDL6, LDL free cholesterol, and HDL2 free cholesterol); LDL4 Apo-B; total Apo-A2; and HDL3 Apo-A2. In conclusion, maternal underweight at the beginning of pregnancy already results in metabolic changes in the lipid profile in the cord blood, but the pattern changes when poor GWG is followed by pre-pregnancy underweight.

Evaluation of concentration and characterization of potential toxic elements and fluorine in ambient air dust from Iran’s industrial capital: A health risk assessment using Monte Carlo simulation

The emission and adsorption of mineral elements to dust from geogenic and anthropogenic sources are health challenges in residential areas. This study investigated, for the first time to the best of our knowledge, the presence of potentially toxic elements (PTEs), rare earth elements (REE) and fluorine (F) in collected dust samples from central Iran. Their associated health risks were estimated based on the Monte Carlo simulation. Results show that the morphology of the collected dust was uniform spherical particles and the predominant elements were Si and Ca. The highest concentration of PTEs was for Ca (mean: 36574 mg/kg) and Fe (mean: 30189 mg/kg) and the mean concentrations of As, Ni, Pb, Mn and Zn exceeded World Health Organization (WHO) guidelines, likely due to the anthropogenic activities such as metal melt factories. Fluorine averaged 159.4 mg/kg, and some detected elements originated from industrial and natural sources. The 5th, 50th, and 95th percentiles of the estimated Hazard Index (HI) were 0.13, 0.43, and 0.77, respectively, in adults and 1.00, 3.03, and 5.99, respectively, in children. The carcinogenic risk (LTCR) for adults and children exceeded the safety range (1 × 10−4), and their highest percentile was calculated at about 2.03 × 10−4 and 1.83 × 10−4, respectively. Furthermore, Ni was the most effective elements in LTCR. As a consequence, findings suggest a high potential carcinogenic risk due to the emission of dust in central Iran, especially for children, and the controlling of possible sources would benefit public health.

Merging TROPOMI and eddy covariance observations to quantify 5-years of daily CH4 emissions over coal-mine dominated region

A simple and flexible mass balance approach was applied to observations of XCH4 from TROPOMI to estimate CH4 emissions over Shanxi Province, including the impacts of advective transport, pressure transport, and atmospheric diffusion. High-frequency eddy-covariance flux observations were used to constrain the driving terms of the mass balance equation. This equation was then used to calculate day-to-day and 5 km × 5 km grided CH4 emissions from May 2018 to July 2022 based on TROPOMI RPRO column CH4 observations. The Shanxi-wide emissions of CH4, 126 ± 58.8 ug/m2/s, shows a fat tail distribution and high variability on a daily time scale (the 90th percentile is 2.14 times the mean and 2.74 times the median). As the number of days in the rolling average increases, the change in the variation decreases to 128 ± 35.7 ug/m2/s at 10-day, 128 ± 19.8 ug/m2/s at 30-day and 127 ± 13.9 ug/m2/s at 90-day. The range of values of the annual mean emissions on coal mine grids within Shanxi for the years 2018 to 2022 was 122 ± 58.2, 131 ± 71.2, 111 ± 63.6, 129 ± 87.1, and 138 ± 63.4 ug/m2/s, respectively. The 5-year average emissions from TROPOMI are 131 ± 68.0 ug/m2/s versus 125 ± 94.6 ug/m2/s on the grids where the EDGAR bottom-up database also has data, indicating that those pixels with mines dominate the overall emissions in terms of both magnitude and variability. The results show that high-frequency observation-based campaigns can produce a less biased result in terms of both the spatial and temporal distribution of CH4 emissions as compared with approaches using either low-frequency data or bottom-up databases, that coal mines dominate the sources of CH4 in Shanxi, and that the observed fat tail distribution can be accounted for using this approach.

Merging TROPOMI and eddy covariance observations to quantify 5-years of daily CH4 emissions over coal-mine dominated region

A simple and flexible mass balance approach was applied to observations of XCH4 from TROPOMI to estimate CH4 emissions over Shanxi Province, including the impacts of advective transport, pressure transport, and atmospheric diffusion. High-frequency eddy-covariance flux observations were used to constrain the driving terms of the mass balance equation. This equation was then used to calculate day-to-day and 5 km × 5 km grided CH4 emissions from May 2018 to July 2022 based on TROPOMI RPRO column CH4 observations. The Shanxi-wide emissions of CH4, 126 ± 58.8 ug/m2/s, shows a fat tail distribution and high variability on a daily time scale (the 90th percentile is 2.14 times the mean and 2.74 times the median). As the number of days in the rolling average increases, the change in the variation decreases to 128 ± 35.7 ug/m2/s at 10-day, 128 ± 19.8 ug/m2/s at 30-day and 127 ± 13.9 ug/m2/s at 90-day. The range of values of the annual mean emissions on coal mine grids within Shanxi for the years 2018 to 2022 was 122 ± 58.2, 131 ± 71.2, 111 ± 63.6, 129 ± 87.1, and 138 ± 63.4 ug/m2/s, respectively. The 5-year average emissions from TROPOMI are 131 ± 68.0 ug/m2/s versus 125 ± 94.6 ug/m2/s on the grids where the EDGAR bottom-up database also has data, indicating that those pixels with mines dominate the overall emissions in terms of both magnitude and variability. The results show that high-frequency observation-based campaigns can produce a less biased result in terms of both the spatial and temporal distribution of CH4 emissions as compared with approaches using either low-frequency data or bottom-up databases, that coal mines dominate the sources of CH4 in Shanxi, and that the observed fat tail distribution can be accounted for using this approach.

Validation of cool-season snowfall forecasts at a high-elevation site in Utah’s Little Cottonwood Canyon

Abstract Producing a quantitative snowfall forecast (QSF) typically requires a model quantitative precipitation forecast (QPF) and snow-to-liquid ratio (SLR) estimate. QPF and SLR can vary significantly in space and time over complex terrain, necessitating fine-scale or point-specific forecasts of each component. Little Cottonwood Canyon (LCC) in Utah’s Wasatch Range frequently experiences high-impact winter storms and avalanche closures that result in substantial transportation and economic disruptions, making it an excellent testbed for evaluating snowfall forecasts. In this study, we validate QPFs, SLR forecasts, and QSFs produced by or derived from the Global Forecast System (GFS) and High-Resolution Rapid Refresh (HRRR) using liquid precipitation equivalent (LPE) and snowfall observations collected during the 2019/20 – 2022/23 cool seasons at the Alta–Collins snow-study site (2945 m MSL) in upper LCC. The 12-h QPFs produced by the GFS and HRRR underpredict the total LPE during the four cool seasons by 33% and 29%, respectively, and underpredict 50th, 75th, and 90th percentile event frequencies. Current operational SLR methods exhibit mean absolute errors of 4.5 – 7.7. In contrast, a locally trained random forest algorithm reduces SLR mean absolute errors to 3.7. Despite the random forest producing more accurate SLR forecasts, QSFs derived from operational SLR methods produce higher critical success indices since they exhibit positive SLR biases that offset negative QPF biases. These results indicate an overall underprediction of LPE by operational models in upper LCC and illustrate the need to identify sources of QSF bias to enhance QSF performance.

Validation of cool-season snowfall forecasts at a high-elevation site in Utah’s Little Cottonwood Canyon

Abstract Producing a quantitative snowfall forecast (QSF) typically requires a model quantitative precipitation forecast (QPF) and snow-to-liquid ratio (SLR) estimate. QPF and SLR can vary significantly in space and time over complex terrain, necessitating fine-scale or point-specific forecasts of each component. Little Cottonwood Canyon (LCC) in Utah’s Wasatch Range frequently experiences high-impact winter storms and avalanche closures that result in substantial transportation and economic disruptions, making it an excellent testbed for evaluating snowfall forecasts. In this study, we validate QPFs, SLR forecasts, and QSFs produced by or derived from the Global Forecast System (GFS) and High-Resolution Rapid Refresh (HRRR) using liquid precipitation equivalent (LPE) and snowfall observations collected during the 2019/20 – 2022/23 cool seasons at the Alta–Collins snow-study site (2945 m MSL) in upper LCC. The 12-h QPFs produced by the GFS and HRRR underpredict the total LPE during the four cool seasons by 33% and 29%, respectively, and underpredict 50th, 75th, and 90th percentile event frequencies. Current operational SLR methods exhibit mean absolute errors of 4.5 – 7.7. In contrast, a locally trained random forest algorithm reduces SLR mean absolute errors to 3.7. Despite the random forest producing more accurate SLR forecasts, QSFs derived from operational SLR methods produce higher critical success indices since they exhibit positive SLR biases that offset negative QPF biases. These results indicate an overall underprediction of LPE by operational models in upper LCC and illustrate the need to identify sources of QSF bias to enhance QSF performance.

Evaluating the feasibility and acceptability of a co-designed physical activity intervention for rural middle schoolers: a pilot study

BackgroundLack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth.MethodsThis prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis.ResultsKey findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the “good” threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport.ConclusionsThis study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents.

Evaluating the feasibility and acceptability of a co-designed physical activity intervention for rural middle schoolers: a pilot study

BackgroundLack of physical activity is a concern for children across diverse backgrounds, particularly affecting those in rural areas who face distinct challenges compared to their urban counterparts. Community-derived interventions are needed that consider the unique context and additional physical activity barriers in under-resourced rural settings. Therefore, a prospective pre-post pilot/feasibility study of Hoosier Sport was conducted over 8-weeks with 6th and 7th grade children in a low-socioeconomic rural middle school setting. The primary objective of the present study was to assess trial- and intervention-related feasibility indicators; and the secondary objective was to collect preliminary assessment data for physical activity levels, fitness, psychological needs satisfaction, and knowledge of physical activity and nutrition among participating youth.MethodsThis prospective 8-week pilot/feasibility study took place in the rural Midwestern United States where twenty-four middle school students participated in a mixed-methods pre-post intervention during physical education classes. The intervention included elements like sport-based youth development, individualized goal setting, physical activity monitoring, pedometer usage, and health education. Data were collected at baseline (T1) and post-intervention (T3), with intermediate measures during the intervention (T2). Qualitative data were integrated through semi-structured interviews. Analytical methods encompassed descriptive statistics, correlations, repeated measures ANOVA, and thematic analysis.ResultsKey findings indicate robust feasibility, with intervention-related scores (FIM, AIM, and IAM) consistently surpassing the “good” threshold and 100% retention and recruitment success. Additionally, participants showed significant physical performance improvement, shifting from the 25th to the 50th percentile in the 6-minute walk test (p < 0.05). Autonomy and competence remained high, reflecting positive perceptions of program practicality. Nutrition knowledge, initially low, significantly improved at post-intervention (p < 0.01), highlighting the efficacy of targeted nutritional education in Hoosier Sport.ConclusionsThis study pioneers a community-engaged model for physical activity intervention in under-resourced rural settings. Positive participant feedback, coupled with improvements in physical fitness and psychosocial factors, highlights the potential of the co-design approach. The findings offer valuable insights and a practical template for future community-based research, signaling the promising impact of such interventions on holistic well-being. This research lays the foundation for subsequent phases of the ORBIT model, emphasizing collaborative, community-driven approaches to address the complex issue of declining physical activity levels among adolescents.

Assessing macroeconomic tail risk

Abstract Real GDP and industrial production in the US display substantial asymmetry and tail risk. Is this asymmetry driven by a specific structural shock? Our empirical approach, based on quantile regressions and local projections, suggests otherwise. We find that the 10th percentile of predictive growth distributions responds between three and six times more than the median to monetary policy shocks, financial shocks, uncertainty shocks, and oil price shocks, indicating a common transmission mechanism. We present two data-generating processes that are capable of matching this finding: A threshold VAR model and a nonlinear equilibrium model.

Clinicopathological and molecular genetic features of confined placental mosaicism

Objective: To investigate the clinicopathological and genetic features of confined placental mosaicism (CPM) and its effect on fetal intrauterine growth. Methods: Fourteen CPM cases of Haidian Maternal and Children Health Hospital were collected from May 2018 to March 2022. Clinicopathological examination on placental specimens and molecular genetic analysis were performed. Results: The age of the parturient women ranged from 27 to 34 years, with an average age of (30.0±3.54) years. The gestational weeks ranged from 35+1 to 41+2 weeks. There were 4 premature births and 10 term births, among which 6 were female and 8 were male fetuses. Nine cases (9/14) had adverse pregnancy outcomes, including 7 cases of fetal growth restriction. The weight of CPM placenta decreased, with 6 cases below the 10th percentile of weight standards and 5 cases between the 10th and 25th percentile. All 14 CPM placental specimens showed morphological changes of perfusion dysfunction to varying degrees, with mainly placental-maternal vascular malperfusion followed by placental-fetal vascular malperfusion. The mosaic chromosomes in different CPM cases varied, with 16-trisomy/monosomy mosaicism being the most common followed by 7-trisomy and 21-trisomy/monosomy mosaicism. The mosaic proportion was unequal in different parts of the same CPM placenta, with the mosaic proportion of umbilical cord, fetal membranes, fetal surface, maternal surface, and edge ranging from 1% to 70%. Conclusions: The mosaic chromosomes in different CPM cases vary, and the mosaic proportion is unequal in different parts of the same CPM placenta. The pathological morphology is mainly manifested as perfusion dysfunction, which can lead to adverse pregnancy outcomes such as fetal growth restriction and preterm birth.

Gastrointestinal and Gastroesophageal Reflux Scale Reference Values.

The purpose of this study was to determine age-based reference values for the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. GIGER data from healthy, full-term born children under 2 years of age were used to determine reference values. For each age group, median, interquartile range, 90th, and 95th percentile scores were calculated for each subscale and the total score. 90th percentile scores were also calculated for each of the 36 items based on the full sample. Data from 625 children were used to determine reference values for children 0-2, 2-4, 4-6, 6-8, 8-10, 10-12, and 12-24 months. In healthy, full-term infants, gastrointestinal and gastroesophageal reflux symptoms improved over the first 24 months of life, with the most improvement occurring over the first 2 months. The GIGER is a 36-item measure of gastrointestinal and gastroesophageal reflux symptoms for children under 2 years old that has evidence of adequate psychometrics for clinical practice and research. The age-based reference values established in this study can be used to guide score interpretation and determine when a child's symptoms warrant further investigation. This may help identify infants and toddlers with significant symptoms earlier so that they can obtain the care they need.

Climatology and trends of atmospheric water vapour transport in New Zealand

AbstractAtmospheric moisture transport is crucial for understanding New Zealand’s climate dynamics, particularly with respect to extreme precipitation events. While the majority of previous studies have focussed on Atmospheric Rivers (ARs), this study examines the entire spectrum of water vapour transport and its link to extreme precipitation using 40 years (1981–2020) of Integrated Water Vapour Transport (IVT) data over the region. Although ARs are important drivers of extreme precipitation, they are infrequent as they account for less than 10% of total moisture transport at most coastal locations. Extreme water vapour transport (defined by the 90th percentile IVT threshold) corresponds more closely with precipitation extremes than ARs alone, even using an expanded AR detection range. Here, IVT is classified into strength categories from weak to strong. Over the study period, all but the weakest category of IVT has increased in frequency of occurrence over most of the South Island, while decreasing in northern North Island. Similarly, monthly IVT anomaly trends show a positive trend in the South Island and negative trend in the northern North Island during warmer months. Separate analysis of moisture weighted wind speeds (UV) and total column water vapour (TCWV) revealed that even though the dynamic component of IVT has decreased in many locations, the increase in TCWV across New Zealand is the driving factor underpinning the IVT trends. Correspondingly, these findings indicate the importance of analysis both dynamic and thermodynamic factors in seeking to understand hydrometeorological variation and when investigating the responses to climate change.