95th Percentile Research Articles

P-285 Serum progesterone level may not impact ongoing pregnancy rate (OPR) in patients with endometriosis undergoing frozen-warmed-blastocyst transfer employing hormone replacement treatment (HRT) with subcutaneous progesterone

Abstract Study question Do serum progesterone (P4) levels on frozen embryo transfer (FET)-1 day impact OPRs in patients with endometriosis undergoing HRT-FET with subcutaneous progesterone (sc P)? Summary answer In HRT cycles employing sc P, serum P4 levels on FET-1 day do not affect OPRs in patients with or without endometriosis. What is known already In HRT-FET cycles employing vaginal P, reproductive outcomes are improved by serum P4 monitoring and employing a rescue protocol, if needed. However, there is paucity of data for the need of serum P4 monitoring in HRT cycles employing sc P. Endometriosis is associated with P4 resistance. There is only one study evaluating the impact of serum P4 levels on reproductive outcomes in patients with endometriosis; in this study lacking a control group and employing vaginal P gel 90 mg/12 hours supplemented by daily 50 mg intramuscular P, a threshold of 37.1 ng/ml has been reported for improved live birth rates. Study design, size, duration Retrospective cohort study. 451 consecutive patients undergoing their first HRT- vitrified warmed blastocyst transfer during November 2021-June 2023 at Anatolia IVF Centre were included. 44 patients had endometriosis with surgical and/or ultrasound findings and the remaining 407 patients did not harbor endometriosis. The presence of adenomyosis was an exclusion criterion. Following 10-12 days of 6 mg/day estradiol valereate use, sc P 25 mg/12hours (Prolutex, Ibsa) was administered. The primary outcome measure was OPR. Participants/materials, setting, methods Serum P4 levels were measured 4-5 hours after morning administration of sc P on FET-1 day. The impact of serum P4 on OPRs was assessed at various percentiles adjusting for female age, body mass index, prior birth, preimplantation genetic testing for aneuploidy, number/grade of blastocysts transferred. Multivariate regression models were performed in the whole cohort incorporating polynomial P4 terms and endometriosis interactions; optimal model for OPR prediction was selected using the lowest Akaike Information Criteria. Main results and the role of chance Patients with (27/44, 61.4%) and without (214/407, 52.6%) endometriosis had comparable OPRs. In the endometriosis group, the 10th, 50th, and 90th percentiles of serum P4 were 15.6, 25.1, and 35.4 ng/ml, respectively, compared to 14.9, 23.5, and 35.6 ng/ml in the non-endometriosis group. In the endometriosis group, the OPRs were 60.0%, 66.7%, 56.3%, and 60.0% for the <10p, 10-50p, 50-90p, >90p groups, respectively. These figures were 46.3%, 50.3%, 56.8%, and 51.2%, in the non-endometriosis group, respectively. In the endometriosis group, taking the 50-90p group as the reference, the adjusted odds ratios (aORs) for OPR of < 10p, 10-50p, and >90p groups were 1.24 [0.03, 50.45], 1.77 [0.31, 10.24], and 2.08 [0.05, 80.23], respectively. In the non-endometriosis group, the respective aORs were 0.85 [0.40, 1.79], 0.80 [0.49, 1.29], and 0.72 [0.34, 1.50]. In the multivariate regression analysis to determine the optimal model, neither serum P4 levels (aOR for linear term: 1.11 [0.98, 1.26]; for quadratic term: 0.998 [0.996, 1.00]) nor the diagnosis of endometriosis (OR: 1.48 [0.74, 2.98]) significantly predicted ongoing pregnancy after adjusting for confounders. Additionally, the optimal model did not include the interaction term, suggesting that endometriosis does not significantly modify the impact of serum P4 levels on OPRs. Limitations, reasons for caution The study’s limitations include retrospective study design, a limited sample size of the endometriosis cohort, absence of laparoscopy for endometriosis exclusion in the non-endometriosis group, and lack of data on endometriosis phenotypes. Wider implications of the findings In HRT-FET cycles employing sc P 25 mg/12hours neither serum P4 nor the presence of endometriosis have an impact on OPRs. Endometriosis may not modify the impact of serum P4 on OPRs suggesting a lack of P resistance in such cycles or the overcoming of P resistance by this regimen. Trial registration number not applicable

PRIORITI: Phase 4 study of triptorelin or active surveillance in high-risk prostate cancer.

To evaluate the efficacy and safety of triptorelin after radical prostatectomy (RP) in patients with negative lymph nodes. PRIORITI (NCT01753297) was a prospective, open-label, randomized, controlled, phase 4 study conducted in China and Russia. Patients with high-risk (Gleason score ≥ 8 and/or pre-RP prostate-specific antigen [PSA] ≥ 20ng/mL and/or primary tumor stage 3a) prostate adenocarcinoma without evidence of lymph node or distant metastases were randomized to receive triptorelin 11.25mg at baseline (≤ 8weeks after RP) and at 3 and 6 months, or active surveillance. The primary endpoint was biochemical relapse-free survival (BRFS), defined as the time from randomization to biochemical relapse (BR; increased PSA>0.2ng/mL). Patients were monitored every 3 months for at least 36 months; the study ended when 61 BRs were observed. The intention-to-treat population comprised 226 patients (mean [standard deviation] age, 65.3 [6.4] years), of whom 109 and 117 were randomized to triptorelin or surveillance, respectively. The median BRFS was not reached. The 25th percentile time to BRFS (95% confidence interval) was 39.1 (29.9-not estimated) months with triptorelin and 30.0 (18.6-42.1) months with surveillance (p=0.16). There was evidence of a lower risk of BR with triptorelin versus surveillance but this was not statistically significant at the 5% level (p=0.10). Chemical castration was maintained at month 9 in 93.9% of patients who had received triptorelin. Overall, triptorelin was well tolerated and had an acceptable safety profile. BRFS was observed to be longer with triptorelin than surveillance, but the difference was not statistically significant.

O-021 Magnetic Resonance Imaging (MRI) evaluation of Quinagolide Vaginal Ring (QVR) treatment on endometrioma, Deep Infiltrating Endometriosis (DIE), and adenomyosis lesion characteristics: QLARITY trial results

Abstract Study question Can MRI provide a useful assessment of changes to endometrioma, DIE, and adenomyosis lesion burden resulting from QVR treatment? Summary answer MRI successfully measured changes in the number, size, diffusion, and perfusion biomarkers of endometriotic and adenomyotic lesions enabling evaluation of QVR treatment efficacy. What is known already Endometriosis and adenomyosis are associated with chronic pelvic pain, painful menses, and infertility. Determining treatment efficacy is reliant on patient reported outcomes (PRO) which are sensitive to response style effects and may lag changes in underlying pathology. Availability of biomarkers measuring lesion burden could accelerate the development of therapies treating disease rather than managing symptoms. MRI is routinely used in oncology to provide non-invasive biomarkers of treatment effect, a paradigm adapted in this trial. Quinagolide is a dopamine D2 receptor agonist formulated in an extended-release vaginal ring in development for treatment of endometriosis based on presumed inhibition of lesion angiogenesis. Study design, size, duration QLARITY was a randomized, placebo-controlled phase 2 trial investigating the mechanism of action of QVR (1080 µg) administered for four menstrual cycles. Randomization was 1:1 QVR (n = 35) to placebo vaginal ring (n = 32). Primary endpoint was change in the sum of lesion sizes by type from baseline to end of cycle 4 as measured by MRI. Secondary endpoints included changes in lesion volume, PROs and adverse events. MRI-derived imaging biomarkers were analyzed as exploratory endpoints. Participants/materials, setting, methods Women, 18-45 years old with at least one type of lesion (endometrioma, adenomyosis, and/or DIE) visualized by MRI, were enrolled. The analyses were performed by treatment for each of the three lesion types individually and for all types combined. Change in lesion size was analyzed using ANCOVA adjusted for baseline. Number of subjects with lesion regression was analyzed using a Chi-Square test. MRI-derived diffusion and perfusion imaging biomarkers were analyzed as exploratory endpoints. Main results and the role of chance Demographics and baseline characteristics were comparable between treatment groups. Patients had a mean age of 36.1 years and had been diagnosed for 5.25 years on average. Most patients (n = 42, 62.7%) had 2-4 lesions. No statistically significant changes in the sum of lesion sizes or PROs (Numerical Rating Scale, Biberoglu and Behrman Scale, and Endometriosis Health Profile-30) after treatment were noted, when compared to placebo. However, across all lesion types, a statistically significantly higher proportion of QVR patients than placebo patients demonstrated lesion regression of ≥ 65.0% volume (61.3% vs 35.5%, p = 0.042). In the DIE group, lesion regression occurred in more patients treated with QVR than those on placebo (36.8% vs 7.7%, p = 0.016). For diffusion imaging biomarkers, a significant difference in the diffusion coefficient standard deviation of DIE lesions (p = 0.039) was found in the QVR group compared to placebo. For perfusion imaging biomarkers, a statistically significant relationship with the treatment was identified in the endometrioma group for the 25th percentile of difference in fractional volume of extravascular extracellular space (mean difference −1.69, p = 0.009) from baseline. Incidence and severity of adverse events were similar between QVR and placebo. Limitations, reasons for caution MRI cannot currently detect superficial, highly vascularized endometriosis, which may be more responsive to QVR treatment than the more advanced stage of endometriosis (indicated by relatively large endometrioma and DIE) imaged in QLARITY. Moreover, 4 cycles may not be of sufficient duration for optimal treatment of these lesions. Wider implications of the findings QLARITY provides support for the use of MRI to diagnose and characterize changes in endometriotic/adenomyotic lesions. It is also the first MRI characterization of the placebo response in this population. Imaging biomarkers show promise in generating insights. QVR is safe and well tolerated; further studies of its efficacy are warranted. Trial registration number NCT03749109

Consistency between the ACGIH TLV for hand activity and proposed action levels for wrist velocity and forearm muscular load based on objective measurements: an example from the assembly industry

Objectives. This study aimed to investigate the consistency between results of the American Conference for Governmental Occupational Hygienists (ACGIH) threshold limit value (TLV) for hand activity and proposed action levels of objective measurements in risk assessments of work-related musculoskeletal disorders. Methods. Wrist velocities and forearm muscular load were measured for 11 assemblers during one working day. Simultaneously, each assembler’s hand activity level (HAL) during three sub-cycles was rated twice on two separate occasions by two experts, using a HAL scale. Arm/hand exertion was also rated by the assemblers themselves using a Borg scale. In total, 66 sub-cycles were assessed and assigned to three exposure categories: A) below ACGIH action limit (AL) (green); B) between AL and TLV (yellow); and C) above TLV (red). The median wrist velocity and the 90th percentile of forearm muscular load obtained from the objective measurements corresponding to the sub-cycles were calculated and assigned to two exposure categories: A) below or C) above the proposed action level. Results. The agreement between ACGIH TLV for hand activity and the proposed action level for wrist velocity was 87%. Conclusions. The proposed action level for wrist velocity is highly consistent with the TLV. Additional studies are needed to confirm the results.

Characteristics of Marine Heatwaves in the Southeastern Baltic Sea Based on Long-Term In Situ and Satellite Observations

Marine heatwaves (MHWs) are known to pose a threat to aquatic ecosystems and coastal communities and, as a result, they receive significant attention nowadays, thus motivating our scientific interest in better understanding the regional patterns of these events. In this study, we analyze MHWs in the SE part of the Baltic Sea, defining them as anomalously warm water events, where the water temperature exceeds the 90th percentile threshold of the corresponding calendar day for at least five or more consecutive days. Our study is based on a combination of long-term (1993–2023) in situ data, field measurements, and satellite-derived sea surface temperature data during the warm (May–August) period. Study results suggest that although short-lived (5–9 days) MHW events typically dominate throughout the analyzed period, the occurrences of longer (more than three weeks) and more intense MHWs have increased in our study region in the recent decade. The heatwaves are observed both in coastal and open waters, with SST anomalies up to around 5–6 °C above the 90th percentile threshold during extreme events, extending thermal influence as deep as 20 m during prolonged and more intense events. We believe that the results of this study contribute to a better understanding of MHW patterns in the study region, which is important from an ecological and socio-economic point of view, providing valuable insights for human health aspects as well.

Growth charts for children aged 6–17 years in Shanxi, China: comparison with other cities of China and WHO

BackgroundGrowth charts are an important method for evaluating a child’s health, growth, and nutritional status. It is essential to monitor the growth of children and adolescents using growth charts.ObjectivesTo present body mass index (BMI)-for-age references reflecting children’s growth in Shanxi. We also compare our new data with growth references of other cities of China and World Health Organization (WHO) growth standards.MethodsA stratified cluster random sampling method was used to recruit 5461 children and adolescents aged 6–17 years. Height and weight were measured and BMI was calculated. The LMS method was used to calculate the percentile values of body mass index by sex and age. Smoothed BMI-for-age growth curves were presented for both sexes and compared with reference data from other cities of China and WHO.ResultsBMI centiles increased with age but with different patterns in both boys and girls. The centile curves from the 3rd to the 50th had a slight increase, while a sharp increase was seen from 11 to 17 years in boys and from 6 to 14 years in girls in the higher centiles. In comparison with other cities of China, the values for the 50th percentile are higher than those reported for children from China 2009, Shanghai, Changsha and China 2010 in both sexes. In comparison with WHO growth references, Chinese girls and boys had higher values in all percentiles, whereas curves of girls look roughly the same. The medians for BMI in Shanxi increase linearly from 6 to 17 years in boys.ConclusionsThe BMI percentiles of children aged 6–17 years in Shanxi differed significantly from the growth reference curves of other cities of China and WHO. Recommending the provision of BMI reference curves for local children and adolescents to assess their growth and development and monitor their nutritional status.Early detection of overweight and obesity in children provides a scientific basis for the prevention and control of overweight and obesity in children.

Drivers of public procurement prices: Evidence from pharmaceutical markets

This paper examines the determinants of public procurement prices using comprehensive data on pharmaceutical purchases by the public sector in Chile. We first document sizable price differences between buyers for the same product and quantity purchased: the difference between the average prices paid by buyers at the 90th and 10th percentiles of the distribution is 16 percent. Our main results are related to the importance of market structure in explaining the dispersion in procurement prices. We find that market structure explains three times more dispersion than buyer effects. Moreover, we leverage exogenous variation in market structure due to patent expirations to estimate that the entry of an additional seller decreases average procurement prices by 11.7 percent, which is 72 percent of the price differences implied by the gap between the 90th and 10th percentiles of estimated buyer effects. These results suggest that supply-side factors are relevant determinants of public procurement prices and that their quantitative importance may exceed that of demand-side factors previously emphasized in the literature.

External validation of the FAscore scale to evaluate the risk of atrial fibrillation in patients with arterial hypertension

Background and aimTo use a risk scale or predictive model outside the population of origin, it is necessary to evaluate the predictive indicators through external validation. The aim was to validate the FAscore, originally constructed in hypertensive patients in primary care in the Valencian Region, in an external cohort with hypertension in primary care in the Basque Country. MethodsA retrospective cohort study was designed to perform an external validation of the FAscore app in patients affiliated with 26 health centers in the municipality of Bilbao. The area under the ROC curve and predictive indicators were calculated with their 95% confidence intervals. ResultsThirty-six thousand eight hundred nine patients were included: 53.6% (n=19,719) were women, the mean age was 75.1 years, 41.8% (n=15,381). Over the four-year follow-up period, 1420 patients were diagnosed with AF (cumulative incidence 3.9%). The median risk estimated by FAscore was 4.5%, and the 5th, 25th, 75th, and 95th percentiles were 1.0%, 2.5%, 6.1%, and 14.8%, respectively. The ROC curve for the risk estimated by FAscore and the cases of atrial fibrillation observed was AUC 0.715 (95% CI 0.703–0.727). The 5% risk cutoff provides a sensitivity of 70.8%, specificity of 61.0%, positive predictive value of 6.8%, negative predictive value of 98.1%, and positive and negative likelihood ratios of 1.82 and 0.48, respectively. ConclusionThis study reports on the external validation of the atrial fibrillation risk scale in hypertensive patients, which shows an acceptable predictive capacity. The best-performing risk cutoff, providing good predictive indicators, can be set at 5%.

Reassessing Urban Park Accessibility: An Improved Two-Step Catchment Area Method Based on the Physical Activity Services Perspective

Urban parks, as important carrier of outdoor physical activity, can effectively reduce the incidence of chronic diseases and promote public health. The accessibility of parks directly affects residents’ levels of physical activity. However, current accessibility assessments do not consider physical activity needs into account and are unable to adapt to the current developmental needs of a healthy China. We propose a framework for evaluating park accessibility oriented towards a physical activity service perspective. First, we introduced a park attractiveness index based on physical activity preferences. The index encompasses not only objective park features but also subjective environmental perception features, which are evaluated using deep-learning techniques. Furthermore, the size of the park catchment area was correlated with the park attractiveness index, and the likelihood of park selection based on people's physical activity preferences was computed. Fuzhou City's Gulou District was selected for this case study. The results show the following: (1) Our proposed evaluation model can identify more underserved neighborhoods in scenarios geared toward physical activity requirements than traditional approaches. (2) The distribution of parks in the Gulou District was not sufficiently balanced, with the accessibility value at the 90th percentile only slightly higher than the average value of 6.35. There was obvious spatial differentiation, with a pattern of high values in the central area and low values in the surrounding areas. (3) Approximately 12.70% of the population is located within service-blind zones and the overall level of accessibility is poor. This study offers novel ideas and approaches for optimizing the spatial layout of urban parks within a health-oriented framework. This aids planners and policymakers in enhancing the spatial layout of parks and ensuring equitable access to urban parks that foster physical activity.

Rate of polyethylene wear correlates with earlier glenoid implant failure in anatomic total shoulder arthroplasty with cemented all-polyethylene glenoid components

BackgroundGlenoid component loosening is the most common cause of anatomic total shoulder arthroplasty failure, and osteolysis is a common intraoperative and radiographic finding associated with these failed arthroplasties. While preclinical testing can estimate failure mode and wear rates in the laboratory, there is limited in vivo data measuring polyethylene wear rate and location. MethodsUsing an IRB-approved total joint arthroplasty retrieval collection, 56 cemented all-polyethylene glenoid components from eleven different manufacturers were analyzed for in vivo dimensional change. We used the differential thickness measurement between the anteroposterior and superoinferior axes of each radially symmetrical implant to determine the dimensional change along that axis. A physiologic wear vector was determined for each retrieved device. ResultsThe implants had a median dimensional change of 0.13 mm/year (range 0.01-1.01mm/year) and the 25th and 75th percentiles were 0.060 and 0.22 mm/year, respectively. The average time to revision of devices with <0.1mm/year of wear was 140.9 months, while the averages for devices between 0.1-0.2mm/year and ≥0.2mm/year were 80.7 and 54.0 months, respectively. Devices with ≥0.2mm/year of wear had significantly shorter time to revision than those with <0.1mm/year (P=0.0006). The devices had a similar material loss distribution in both SI and AP directions, with 29 (52%) devices having a greater material loss in the SI distribution and the remaining 27 (48%) devices in the AP axis. The physiologic wear vector had a mean of 47.3 degrees, with a relatively even distribution across all angles, suggesting that glenoid component loosening can occur along multiple axes. ConclusionWe conclude that polyethylene wear is a contributing factor for early failure of cemented all-polyethylene glenoid implants and that anatomic total shoulder arthroplasty may benefit from advances in polyethylene processing. We also suggest that in vitro testing of new polymers and designs should incorporate motion vectors beyond the traditional IS rocking horse test.

Assessing national trends in indications for pediatric total thyroidectomy

PurposeThe most common indications for total thyroidectomy (TT) in children are malignancy and thyrotoxicosis due to Graves' disease (GD). However, the incidence of patients with GD among patients undergoing TT is unknown. This study aims to examine trends in pediatric TT. Materials and methodsThe US Agency for Health Research and Quality Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried to identify patients who underwent TT between 1997 and 2019. Weighted national estimates were obtained. Statistical analysis was completed using univariate logistic regression and one-sided Mann-Kendall Test. ResultsAn estimated 4803 pediatric patients underwent TT within the study years. GD was the indication in 25 % of cases. Mann-Kendall testing showed a trend toward an increasing proportion of TT for GD without reaching statistical significance (z = 1.3609, S = 12, p = 0.0688). Statistically significant univariate associations were found among those who underwent thyroidectomy for GD compared to other indications, as they were more likely to be female (β = 0.286, 95 % CI [0.058, 0.514], p = 0.014), Black, or Hispanic (β = 1.392 [1.064, 1.721], p < 0.001; and β = 0.562 [0.311, 0.814], p < 0.001, respectively). Additionally, they were less likely to have private insurance (β = −0.308 [−1.076, −0.753], p = 0.002) and more likely to live in a ZIP code associated with a median household income below the 50th percentile (β = 0.190 [0.012, 0.369], p = 0.036). The associations with the female sex, Black race, and Hispanic race persisted in multivariate analysis. ConclusionGD appears to be an increasingly prevalent indication for TT. Patient characteristics differ from those who undergo TT for other diagnoses.

Report on the establishment of the safe shelf life of certain ready‐to‐eat foods, sliced and prepacked in retail, in relation to the risk of Listeria monocytogenes

Abstract The Barcelona Public Health Agency (ASPB) asked the Scientific Advisory Committee on Food Safety for an opinion on the safe shelf life of Listeria monocytogenes in certain products (cheeses, cooked meats, including pâtés, and cured meats) sliced and prepackaged prior to retail sale. In order to assess in which cases or under which conditions ready‐to‐eat foods under study may promote the growth of pathogenic microorganisms during their shelf life, the methodology proposed by EFSA (2020) was used. In addition, the predictive model of growth / non‐growth boundaries, based on the gamma concept approach, was applied. To carry out this assessment, the ASPB provided a total of 90 samples (32 in 2020 and 58 in 2021) divided into 4 categories of ready‐to‐eat foods: cheese, cooked ham, pâté / foie and cured ham. In all cases, the food was sliced or cut into portions in retail establishments of the city of Barcelona, and packaged in different formats: vacuum‐packed, in a heat‐sealed or shrink‐wrapped tray, or wrapped in film. The results of the evaluation indicated that the ready‐to‐eat pre‐packaged foods evaluated for the group of cheeses, cooked ham, pâtés and foie required the indication of a “use by” date, as the handling conditions expose the product to a potential L. monocytogenes contamination and the pH and aw (water activity) characteristics associated with these products support its growth. Considering a reasonably foreseeable scenario in relation to storage temperature conditions in retail (2 days at 5°C) and in a domestic refrigerator (5 days at 9.5°C), the safe shelf life of the products that would more favour the growth of L. monocytogenes would be between 4.5 and 4.9 days (corresponding to the 5th and 10th percentile, respectively). This estimate is the result of a conservative approach that provides a margin of safety to the outcome of the evaluation.

Chronic Kidney Disease and Growth Failure in Children.

Chronic kidney disease (CKD) is a significant challenge for pediatric endocrinologists, as children with CKD may present a variety of endocrine complications. Growth failure is common in CKD, and its severity is correlated with the degree of renal insufficiency. Management strategies include addressing reversible comorbidities, optimizing nutrition, and ensuring metabolic control. Kidney replacement therapy, including transplantation, determines a significant improvement in growth. According to a recent Consensus Statement, children with CKD stage 3-or on dialysis older >6 months-are eligible for treatment with recombinant growth hormone (rGH) in the case of persistent growth failure. Treatment with rGH may be considered for those with height between the 3rd and 10th percentile and persistent growth deceleration. In children who received kidney transplantation but continue to experience growth failure, initiation of GH therapy is recommended one year post-transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not an option. In children with CKD, due to nephropathic cystinosis and persistent growth failure, GH therapy should be considered at all stages of CKD. Potential adverse effects and benefits must be regularly assessed during therapy. Treatment with GH is safe in children with CKD. However, its general efficacy is still controversial. All possible problems with a negative impact on growth should be timely addressed and resolved, whenever possible with a personalized approach to the patient. GH therapy may be useful in promoting catch-up growth in children with residual growth potential. Future research should focus on refining effective therapeutic strategies and establishing consensus guidelines to optimize growth outcomes in this population.

Mortality Risk of Low BMI in Life Insurance Applicants.

-This study seeks to quantify the mortality effect of low levels of body mass index (BMI) on life insurance applicants who, based on their laboratory profile and other information, appear to be suitable for life insurance coverage. -It has been demonstrated that low BMI is associated with higher mortality risk than normal or near-normal BMI. -Data were collected from over 4.7 million life insurance applicants with available BMI tested between 1995 and 2021, and vital status was assessed via the Social Security Death Master File. Cox models treating BMI as continuous and as a categorical variable were constructed, controlling for age, and split by sex after excluding those with laboratory or biometric test results, which were far enough outside the normal range to imply elevated mortality. -Models treating BMI as a continuous variable and allowing an interaction term for age showed that low BMI was strongly associated with mortality at ages 50 and above in both sexes. In the categorical models, only the lowest category of BMI (below the 1st percentile) in men aged 40-60, the lowest 2 categories (below the 5th percentile) in women aged 40-60, and the lowest 3 categories (below the 10th percentile) in those aged 60-80 years, were significantly associated with elevated mortality. No elevated mortality was detected in those under age 40 with low BMI. -Based on this study, low BMI is associated with elevated mortality in otherwise healthy applicants, but this association is dependent on age.

A multi-centennial drought reconstruction from tree-rings reveals a growing threat to Christmas Island’s water resources

Small islands that depend on limited freshwater resources are at significant risk from seasonal drought, which poses a major threat to both their ecosystems and communities. Christmas Island, located in the eastern Indian Ocean, presents an example for which severe drought conditions during the wet season not only affects its freshwater resources but also biodiversity on the island, including the migration pattern of the iconic red crab species. However, short-term instrumental climate records on this island make it hard to quantify drought variability and assess its associated risks. Tree growth is affected by drought via reduced soil moisture, and hydroclimate reconstruction from tree-ring chronologies can therefore provide longer-term information on historical variability of dry and wet periods. Here, we reconstructed the wet season (December-May) self-calibrating Palmer Drought Severity Index (scPDSI) for Christmas Island using 64 remote tree-ring chronologies from Asia, Australia, and New Zealand. scPDSI was reconstructed using the Point-to-Point Regression (PPR) method and compared with regional marine coral proxies for independent verification. The remote tree-ring chronologies explained more than 66 percent of scPDSI variance (R-squared) over the calibration period. The trees identified as significant predictors in the regression model were primarily located in areas affected by the Indo-Pacific climate drivers including the Indian Ocean Dipole (IOD). The reconstructions span 1540 CE to 2000. During the first four centuries of this period, the frequency of extreme (5th percentile) droughts and pluvial events rarely exceeded one event per 13 years. In contrast, the frequency of both extremes experienced an unprecedented increase during the 20th century, and with a notable shift towards dry conditions. These findings highlight a significant shift towards more frequent and severe dry conditions during the wet season on Christmas Island, posing a challenge to water resource management and potentially threatening the island's ecosystem and services to the community.

Integrating rainfall index-based insurance with optimal crop management strategies can reduce financial risks for Australian dryland cotton farmers

Drought undermines the financial sustainability of farmers. While farmers have adopted various strategies to mitigate some drought impacts, they remain exposed to substantial drought risk. Insurance could be useful in managing climatic risks and for encouraging farmers to take sensible risks (e.g., changing their sowing date to increase yield), but it can be costly. Here, we tested whether the integration of a change in sowing date with rainfall index-based insurance could improve farmer profitability and income stability. We used the Agricultural Production Systems Simulator (APSIM)-Cotton model to simulate cotton lint yields for various sowing dates, taking into account different management strategies, across three dry-land cotton research farm sites – Dalby, Goondiwindi, and Theodore – from 1940 to 2022. We designed the index-based insurance payout when the average rainfall received during the growing season falls below a predefined level, such as the 5th, 10th, or 20th percentile of rainfall. Our study, which involved 3.9 million cotton lint simulations and 3,000 rainfall index-based insurance products, showed that combining a shift in sowing date with insurance can lead to an income improvement of up to 21.5% at some study sites. Additionally, in drought years, the income improvement for farmers who combined optimal sowing dates with rainfall index-based insurance was up to 48.0%. The framework developed in this study could aid in devising financial strategies to enhance farming resilience during climate extremes.

Estimation of maximum body size in fossil species: A case study using Tyrannosaurus rex.

Among extant species, the ability to sample the extremes of body size-one of the most useful predictors of an individual's ecology-is highly unlikely. This improbability is further exaggerated when sampling the already incomplete fossil record. We quantify the likelihood of sampling the uppermost limits of body size in the fossil record using Tyrannosaurus rex Osborn, 1905 as a model, selected for its comparatively well-understood life history parameters. We computationally generate a population of 140 million T. rex (based on prior estimates), modelling variation about the growth curve both with and without sexual dimorphism (the former modelled after Alligator mississippiensis), and building in sampling limitations related to species survivorship and taphonomic bias, derived from fossil data. The 99th percentile of body mass in T. rex has likely already been sampled, but it will probably be millennia before much larger giants (99.99th percentile) are sampled at present collecting rates. Biomechanical and ecological limitations notwithstanding, we estimate that the absolute largest T. rex may have been 70% more massive than the currently largest known specimen (~15,000 vs. ~8800 kg). Body size comparisons of fossil species should be based on ontogenetically controlled statistical parameters, rather than simply comparing the largest known individuals whose recovery is highly subject to sampling intensity.

Elevated ambient temperature associates with increased CVD-risk among hemodialysis patients

IntroductionAmbient temperatures have increased due to climate change in many parts of the world. Due to loss of renal function which impacts regulation of thermoregulatory mechanisms the ability to adapt and resilient to changing conditionals is particularly concerning among individuals with kidney failure. The aim of this study is to assess the effect of heat on mortality and health care utilization among US hemodialysis patients. MethodsWe conducted a retrospective analysis 2011-2016 in contiguous United States during warmer months among eligible dialysis patients identified in the United States Renal Data system. Daily ambient temperature was estimated on a 1 km grid and assigned to ZIP-code. Case-crossover design with conditional Poisson models were used to assess the risk of developing adverse health outcomes associated with temperature exposure. ResultsOverall, exposure to high temperature is associated with elevated risk for both mortality and health care utilization among hemodialysis patients. The risk ratios for all-cause mortality and daily temperature were 1.07 (95% CI: 1.03-1.11), 1.17 (1.14-1.21) for fluid disorder-related hospital admissions, and 1.19 (1.16-1.22) for cardiovascular event-related emergency department visits, comparing 99th percentile vs. 50th percentile daily temperatures. Larger effects were observed for cumulative lagged exposure three-days prior to the outcome and for Southwest and Northwest climate regions. ConclusionHeat exposure is associated with elevated risk for CVD-related mortality and health care utilization among this vulnerable population. Furthermore, the effect appears to be potentially cumulative in the short-term, and varies geographically.

Adapting UWB AoA estimation towards unseen environments using transfer learning and data augmentation

Ultra-wideband technology has become increasingly prevalent in localization systems, particularly with the emergence of multi-antenna systems capable of estimating both distance and angle of arrival (AoA) for incoming signals. However, most scientific research analyses the accuracy of AoA in one specific environment for which the estimator is trained. In this paper, we analyze the performance of various AoA estimation algorithms, such as deep convolutional neural networks (DCNN), multiple signal classification (MUSIC), and phase difference of arrival (PDoA), in unseen environments. Prior work already demonstrated the superior performance of ML for AoA estimation compared to PDoA or MUSIC. We show that MUSIC, PDoA and ML solutions suffer from degradation in unseen environments at the 90th percentile of error, with ML-based AoA estimation degrading by about 14 degrees in unseen environments compared to 4 degrees for PDoA. We demonstrate that while PDoA more effectively corrects AoA at the median level in unseen environments, ML-based methods excel at correcting higher-percentile AoA errors, including outliers. Finally, we propose a novel framework to further improve the correction of AoA outliers for DCNN-based AoA estimators using data augmentation and transfer learning, resulting in a median angular error of only 5 degrees in unseen environments, even considering a field of view up to 90 degrees.

Head injury mechanisms of the occupant under high-speed train rear-end collision

To improve the passive safety of high-speed trains, it is very important to understand the mechanism of head injury in high-speed train collisions. In this study, the head injury mechanisms of occupants in high-speed train rear-end collisions were investigated based on the occupant-seat coupling model, which included a dummy representing the Chinese 50th percentile adult male. The typical injury responses in terms of skull fractures, brain contusions, and diffuse axonal injury (DAI) were analyzed. Meanwhile, the influences of collision speed and seat parameters on head injury response were examined. The simulation results indicate that the skull fractures primarily occur at the skull base region due to excessive neck extension, while the brain contusions and DAI result from the relative displacement of different brain regions. The increase in collision speed will promote the probability of skull fracture, brain contusion, and DAI. Seat design modifications, such as reduced seat spacing, increased seat backrest angles, and selecting the appropriate cushion angle (76°) and friction coefficient (0.15), can effectively mitigate probably occupant's head injury.