95th Percentile Research Articles

Co-occurrence of marine and atmospheric heatwaves with drought conditions and fire activity in the Mediterranean region

Climate change has become a major concern in the twenty-first century, leading to the amplification of extreme events and, consequently, to severe impacts on society, economy and ecosystems. Heatwave conditions in particular, often coupled with extended periods of dryness, have an important contribution in exacerbating rural fires. Here, we propose to analyse the co-occurring interplay between atmospheric heatwaves and droughts in southern Europe, and marine heatwaves in the East Atlantic and the Mediterranean Sea, between 2001 and 2022, highlighting their linkage to wildfires, on both an individual and compound approach. Positive correlations between air and sea temperatures and negative correlations between air temperature and precipitation values were found. Our analysis reveals that severe wildfires are mostly associated with reduced precipitation and/or elevated air temperatures during the summer season, alongside heightened sea surface temperatures. Marine hot (drier) conditions are prevalent for months in which burned areas remain below (above) the 80th percentile. Months marked by higher fire activity are predominantly associated with extreme climatic conditions, showcasing a substantial occurrence of compound events. This study highlights the potential of considering both land-based atmospheric and marine conditions when exploring compound extremes, crucial for mitigating climatic disasters. Moreover, it highlights the role played by compound extreme events in fire management strategies, particularly considering the present context of climate change and the increasing frequency and severity of extreme events threatening ecosystem stability.

Relationship between fish traits and the methane‐derived carbon contribution to fish in a shallow lake

Abstract Although the transfer of methane‐derived carbon (MDC) to benthic macroinvertebrates such as chironomid larvae and oligochaetes has been well documented, knowledge of the transfer of MDC to fish is limited. We investigated the MDC contribution to 28 fish species through their growth stages and examined the relationship between fish traits including body size, and MDC contribution to fish within species in Lake Kasumigaura, Japan. We used carbon stable isotope ratios and a two‐source mixing model (methane‐oxidation bacteria [MOB] and particulate organic matter) to estimate the MDC contribution to fish. The MDC contribution to individual fish ranged from 0% to 21.5%. Anguilla japonica showed the highest MDC contribution (mean 3.8%). Fish species were classified into four groups according to two criteria: (a) whether the correlation between the MDC contribution and fish size (within species) was significantly negative (negative vs. not significant; ns); and (b) whether the 90th percentile of MDC contribution was 0% or not. The mean MDC contribution was highest (2.18% ± 2.93%, 12 species) for the group with (a)ns/(b)>0%, including the high contribution species such as Abbottina rivularis (mean 5.5%) and Biwia zezera (mean 9.8%). This group (12 species) included relatively high numbers of benthic habitat use (eight species) and omnivores (nine species). The mean MDC contributions were almost zero for the group with (a)ns/(b)=0% (seven species), which included only two species of benthic habitat use and one species of omnivores. The mean MDC contributions were intermediate for the other groups with (a)negative/(b)>0% (1.30% ± 1.17%, seven species) and (a)negative/(b)=0% (0.10%, two species). The negative correlation between fish size within species and MDC contribution in groups with (a)negative/(b)>0% and (a)negative/(b)=0% indicated that ontogenetic habitat and dietary shifts induced changes in MDC transfer. Our results suggest that 21 out of 28 fish species were involved in the MDC transfer in a shallow lake, but variation in MDC transfer could be explained by fish traits (trophic guild and habitat use). Although the mean MDC contribution to all fish species was low (0.61% ± 1.97%), the roughly estimated annual consumption rate of fish on MOB corresponded to approximately 10% of the MOB production in the sediment, suggesting that fish contribute to methane dynamics from the perspective of biogeochemical cycles.

Neighbourhood environment and early menarche among adolescent girls of five countries

Introduction We aim to investigate the relationship between individuals’ perceptions of their neighbourhood environment and early menarche. Methods This was a retrospective cohort study of 7,486 girls of Ethiopia, India, South Korea, the United Kingdom (UK), and the United States (US), born in 1997–2011 was analysed. Early menarche was defined as being below the 10th to 20th percentiles in each cohort, considering the varying distributions across countries. Perceived neighbourhood environments were assessed based on the responses for neighbourhood pollution, safety, and recreational facilities. We calculated the relative risk (RR) of early menarche for unfavourable environment. Results The mean age at menarche was lowest in South Korea (10.6 years) and highest in Ethiopia (13.7 years). Unfavourable environment was associated with higher risk of early menarche overall (RR = 1.34, 95% confidence interval [CI]:1.09–1.65) and each country (3.03, 95% CI: 1.15–7.96 in Ethiopia; 1.99, 95% CI: 0.97–4.10 in India, 1.23, 95% CI: 0.67–2.27 in Korea; 1.26, 95% CI: 0.96–1.64 in the UK). Specifically, pollution (1.29, 95% CI: 1.03–1.62) and low safety (1.19, 95% CI: 1.60–1.88) were associated with early menarche. Conclusions Our finding highlights the potential role of perceived neighbourhood environment in the timing of puberty.

(De facto) historical ethnic borders and land tenure in Sub-Saharan Africa

We study the role of proximity to historical ethnic borders in determining individual land ownership in Sub-Saharan Africa. Following an instrumental variable strategy, we document that individuals have a lower likelihood of owning land near historical ethnic borders. In particular, the likelihood of owning land decreases by 15 percentage points, i.e., about 1/3 of the mean rate of landownership, for rural migrants who move from 57 km (90th percentile) to 2 km (10th percentile) from the border. This result aligns with the view that competition for land is stronger and property rights are weaker close to historical ethnic borders in Sub-Saharan Africa.

Implications for Socio-environmental Determinants of Health-Informed Health Worker Wellness Programs: Findings from a Cross-Sectional Study.

To explore how socio-environmental factors may potentially impact health outcomes across different groups of health workers (HW). Data from the California Healthy Places Index (HPI) and administrative dataset including 12,715 HWs were analyzed using analysis of variance and two-step cluster analysis to evaluate variations in socio-environmental factors across 11 HW job categories. While physicians had the highest average HPI percentiles (69th percentile) across almost all HPI components, the lower-wage HWs consistently ranked below the state average (50th percentile). Overall, the HPI percentile was lowest for environmental living conditions and pollution for all HCWs (30th percentile). The education (52nd percentile) and economic components (59th percentile) were higher than the state average. The findings from this highlight the importance of socio-environmental determinants of health-informed employee wellness programs and research studies.

Benchmarking soil organic carbon (SOC) concentration provides more robust soil health assessment than the SOC/clay ratio at European scale

Increasing soil organic carbon (SOC) confers benefits to soil health, biodiversity, underpins carbon sequestration and ameliorates land degradation. One recommendation is to increase SOC such that the SOC to clay ratio (SOC/clay) exceeds 1/13, yet normalising SOC levels based on clay alone gives misleading indications of soil structure and the potential to store additional carbon. Building on work by Poeplau & Don (2023) to benchmark observed against predicted SOC, we advance an alternative indicator: the ratio between observed and “typical” SOC (O/T SOC) for pan-European application. Here, “typical” SOC is the average concentration in different pedo-climate zones, PCZs (which, unlike existing SOC indicators, incorporate land cover and climate, alongside soil texture) across Europe, determined from mineral (<20 % organic matter) topsoils (0–20 cm) sampled during 2009–2018 in LUCAS, Europe's largest soil monitoring scheme (n = 19,855). Regression tree modelling derived 12 PCZs, with typical SOC values ranging 5.99–39.65 g kg−1. New index classes for comparison with SOC/clay grades were established from the quartiles of each PCZ's O/T SOC distribution; these were termed: “Low” (below the 25th percentile), “Intermediate” (between the 25th and 50th percentiles), “High” (between the 50th and 75th percentiles), and “Very high” (above the 75th percentile). Compared with SOC/clay, O/T SOC was less sensitive to clay content, land cover, and climate, less geographically skewed, and better reflected differences in soil porosity and SOC stock, supporting 2 EU Soil Health Mission objectives (consolidating SOC stocks; improving soil structure for crops and biota). These patterns held for 2 independent datasets, and O/T SOC grades were sensitive enough to reflect land management differences across several long-term field experiments. O/T SOC used in conjunction with several other physical, chemical and biological soil health indicators can help support the EU Soil Monitoring Law and achieve several United Nations Sustainable Development Goals.

Identification of critical drought thresholds affecting vegetation on the Mongolian Plateau

The increasing frequency of drought events due to global climate change has significant impacts on ecosystems, often resulting in reduced vegetation productivity. However, vegetation responses to drought often exhibit non-linear threshold phenomena, where vegetation growth sharply decreases once water stress reaches a certain level. Our study, conducted on the Mongolian Plateau, focuses on revealing the drought response thresholds and distribution patterns of different vegetation types. These thresholds mark critical turning points from high drought resistance to high vulnerability in vegetation response and serve as early warning indicators, crucial for accurately assessing how terrestrial ecosystems adapt to climate change. We utilized remote sensing observation datasets and inversion datasets spanning from 2001 to 2020, including six representative vegetation indices. The results indicate that: (1) Over 70 % of the Mongolian Plateau experiences low vegetation growth (<10th) predominantly influenced by drought, with low vegetation growth often occurring when water availability falls below the 30th percentile; (2) Areas with higher vegetation coverage and relatively moist climates have lower proportions of drought thresholds, implying that more complex ecosystems can better mitigate water stress, while background climatic conditions also regulate vegetation response to water availability; (3) According to multi-model climate predictions, the overall probability of drought risk on the Mongolian Plateau is projected to significantly increase during 2080–2100, especially in drought-prone regions. These findings provide important insights into better understanding the impacts of drought on ecosystems. Additionally, they emphasize the urgency of taking early measures to adapt to future drought risks.

Speed-securing measures on rural roads in Sweden: An observational study

Objective Speed-securing measures are intended to, as the name suggests, to secure that the speeds of road users do not exceed the safe speed for a given type of environment. The purpose of this study was to make an evaluation of existing speed-securing measures on rural roads in Sweden to see how well they manage to limit the speed. Methods and data A total of 34 unique locations have been filmed with drones with varying speed limits between 40 and 70 km/h. The analysis focused on the radius of both the individual vehicle trajectories and the radius of the roads themselves and how they relate to the speed choice of the drivers (including the 85th percentile speed). Results The result shows a moderate correlation between both types of radii and the speed choice of the drivers. In addition, the result also shows only a weak correlation between the driven radius and the radius of the roads themselves. Finally, the result also shows that only 17 locations manage to keep the 85th percentile speeds under the speed limit. Conclusion Overall, the study suggests that the radius of the infrastructure is an important factor to lower the speed but the lack of a clear relationship between the driven radius and the radius of the road shows that more research is needed to properly understand why some locations work better than others.

Data-Driven Thyroglobulin Cutoffs for Low- and Intermediate-Risk Thyroid Cancer Follow-Up: ITCO Real-World Analysis.

The utility of thyroglobulin (Tg) in the follow-up of differentiated thyroid cancer (DTC) patients has been well-documented. Although third-generation immunoassays have improved accuracy, limitations persist (interfering anti-Tg antibodies and measurement variability). Evolving treatment strategies require a reevaluation of Tg thresholds for optimal patient management. To assess the performance of serum Tg testing in two populations: patients receiving total thyroidectomy and radioiodine remnant ablation (RRA), or treated with thyroidectomy alone. Prospective observational study. Setting. Centers contributing to the Italian Thyroid Cancer Observatory (ITCO) database. We included 540 patients with 5 years of follow-up and negative anti-Tg antibodies. Serum Tg levels assessed at 1-year follow-up visit. Detection of structural disease within 5 years of follow-up. After excluding 26 patients with structural disease detected at any time point, the median Tg did not differ between patients treated with or without radioiodine. Data-driven Tg thresholds were established based on the 97th percentile of Tg levels in disease-free individuals: 1.97 ng/mL for patients undergoing thyroidectomy alone (lower than proposed by the MSKCC protocol and ESMO Guidelines, yet demonstrating good predictive ability, with a negative predictive value (NPV) of 98%) and 0.84 ng/mL for patients receiving post-surgical RRA. High sensitivity and NPV supported the potential of these thresholds in excluding structural disease. This real-world study provides evidence for the continued reliability of 1-year serum Tg levels. The data-driven Tg thresholds proposed offer valuable insights for clinical decision-making in patients undergoing total thyroidectomy with or without RRA.

Extreme temperatures, PM2.5 and trajectories of impaired thyroid hormone sensitivity: A longitudinal study of patients with schizophrenia

BackgroundThe climate change scenario has witnessed an increase in extreme temperature events (ETEs), including heat waves and cold spells, and a heightened occurrence of compounding with fine particulate matter (PM2.5). However, the impact of this phenomenon on the sensitivity to thyroid hormones (THs) in humans is unclear, especially in a group as specific as schizophrenia. MethodsA longitudinal study was constructed using longitudinal measurements of thyroid function in schizophrenia in the Anhui Mental Health Center. The latent growth mixture model was applied to assess the optimal trajectory of change in impaired THs sensitivity. We then used logistic regression to explore associations between heat waves, cold spells, and PM2.5 with impaired THs sensitivity trajectories in the total population and different gender and age subgroups. Furthermore, the effect of the frequency, intensity, and duration of ETEs in the above associations was explored, as well as an assessment of the interaction between ETEs and PM2.5. ResultsAmong 931 participants, we identified two classifications of trajectories of impaired THs sensitivity: “Low-stable” (n = 836, 89.80 %) and “Rise-slight down” (n = 95, 10.20 %). Logistic regression showed significant associations between each additional day of heat waves (≥3 days with temperature thresholds above the 95th percentile) and cold spells (≥3 days with temperature thresholds below the 5th percentile) and “Rise-slight down” trajectory, with odds ratios (95 % confidence intervals) of 1.06 (1.02, 1.10) and 1.19 (1.14, 1.24), respectively, and the strength of this association increased with the intensity and duration of ETEs. Subgroup analyses indicated that the association was more pronounced in males and the age group above 40 years. Furthermore, PM2.5 was found to interact with heat waves, with high concentrations exacerbating the effects of heat waves. ConclusionsOur findings suggest that mitigating both ETEs and PM2.5 exposures may bring health co-benefits in preventing thyroid impairment in schizophrenia.

The Risk Management of COVID-19: Lessons from Financial Economics and Financial Risk Management

The United States had one of the worst outcomes in the management of COVID-19 risk, with a death rate in the 94th percentile of all countries. Setting aside the obvious politicized nature of COVID-19 public health recommendations and mandates, we argue that best practices in financial risk management provide parallels that could have served as valuable guidance. We demonstrate here that considerable signals were missed that would have required very little effort and would have been consistent with sound risk management. We also identify examples of misleading information such as that COVID-19 was particularly hard on the elderly. The data actually show that it had a much greater marginal impact on those not elderly. We show here that financial economists and risk managers have a strong knowledge base of how to process vast quantities of data to distinguish signals from noise and have much to teach the public health establishment.

Evaluation of the Screening Performance of Ultrasonographic Abdominal Circumference and Estimated Fetal Weight in Predicting Small for Gestational age Newborns

OBJECTIVES: We aimed to evaluate the screening performance of estimated fetal weight (EFW) and abdominal circumference (AC) measurements in predicting newborns with birth weight (BW) less than the 10th percentile for birth age (BW &lt;10p). STUDY DESIGN: Three hundred thirty-one pregnant women who met the inclusion and exclusion criteria were included in the study. The groups were divided into two groups: those diagnosed with FGR (FGR group) and those not diagnosed (non-FGR)after the 32nd week of gestation. Demographic and obstetric histories, ultrasonographic and clinical features, and neonatal outcomes of the groups were recorded, and comparisons between the groups were conducted. The screening performances of AC and EFW were compared for predicting newborns with BW&lt;10p and assessing neonatal outcomes. RESULTS: AC or EFW measures below 10% (AC&lt;10p or EFW&lt;10p) demonstrated the highest screening performance for BW&lt;10p, with 91.7% sensitivity and 91% specificity. AC&lt;10p demonstrated the highest performance in predicting neonatal intensive care unit (NICU) admission, with 75.9% sensitivity and 89.1% specificity. For neonates with a 5-minute APGAR score of less than 7, AC&lt;10p or EFW&lt;10p had 88.2% sensitivity and 69.7% specificity. CONCLUSION: This study shows that AC and EFW measurements can be used together or separately to predict newborns who are small for their gestational age (SGA). Using values below 10% of either AC or EFW together gives the best results in terms of sensitivity and specificity.

Association of CSF α-Synuclein Seeding Amplification Assay Results With Clinical Features of Possible and Probable Dementia With Lewy Bodies.

The clinical diagnosis of dementia with Lewy bodies (DLB) depends on identifying significant cognitive decline accompanied by core features of parkinsonism, visual hallucinations, cognitive fluctuations, and REM sleep behavior disorder (RBD). Hyposmia is one of the several supportive features. α-Synuclein seeding amplification assays (αSyn-SAAs) may enhance diagnostic accuracy by detecting pathologic αSyn seeds in CSF. In this study, we examine how different clinical features associate with CSF αSyn-SAA positivity in a large group of clinically diagnosed participants with DLB. Cross-sectional and longitudinal CSF samples from the multicentered observational cohort study of the DLB Consortium and similar studies within the Parkinson's Disease Biomarker Program, contributed by academic medical centers in the United States, underwent αSyn-SAA testing. Participants included those clinically diagnosed with DLB and 2 control cohorts. Associations between core DLB features and olfaction with αSyn-SAA positivity were evaluated using logistic regression. CSF samples from 191 participants diagnosed with DLB (mean age 69.9 ± 6.8, 15% female), 50 age-matched and sex-matched clinical control participants, and 49 younger analytical control participants were analyzed. Seventy-two percent (137/191) of participants with DLB had positive αSyn-SAAs vs 4% of the control groups. Among participants with DLB, those who were αSyn-SAA-positive had lower Montreal Cognitive Assessment scores (18.8 ± 5.7 vs 21.2 ± 5.2, p = 0.01), had worse parkinsonism on the Movement Disorders Society Unified Parkinson's Disease Rating Scale part III (33.8 ± 15.1 vs 25.6 ± 16.4, p = 0.001), were more likely to report RBD (114/133 [86%] vs 33/53 [62%], p < 0.0001), and had worse hyposmia on the University of Pennsylvania Smell Identification Test (UPSIT) (94/105 [90%] below 15th percentile vs 14/44 [32%], p < 0.0001). UPSIT percentile had the highest area under the curve (0.87, 95% CI 0.81-0.94) in predicting αSyn-SAA positivity and participants scoring at or below the 15th percentile of age and sex normative values had 18.3 times higher odds (95% CI 7.52-44.6) of having a positive αSyn-SAA test. Among 82 participants with longitudinal CSF samples, 81 (99%) had the same αSyn-SAA result for initial and follow-up specimens. A substantial proportion of clinically diagnosed participants with DLB had negative αSyn-SAA results. Hyposmia was the strongest clinical predictor of αSyn-SAA positivity. Hyposmia and αSyn-SAA may have utility in improving the diagnostic assessment of individuals with potential DLB. This study provided Class III evidence that CSF αSyn-SAA distinguishes patients with clinically diagnosed DLB from normal controls.

Comparison of SGA and Severe SGA rates using six size standards – Is there a difference?

BackgroundSmall for gestational age (SGA) neonates are known to be at an elevated risk for neonatal morbidity. Despite this, there is a growing array of proposed size standards for identifying SGA fetuses. Given the inherent differences in design, acquisition methods, and the characteristics of the populations they represent, the generalizability of these standards to diverse populations remains uncertain. IntroductionThis study aimed to assess variations in rates of SGA and severe SGA using six distinct size standards: Hadlock, Fetal Medicine Foundation (FMF), World Health Organization (WHO), Intergrowth-21 (IG-21), and two locally derived population-based size standards. The objective was to examine the differences in SGA and severe SGA rates among these size standards. MethodsA retrospective cohort study was conducted, encompassing all singleton deliveries in two tertiary referral hospital campuses with an annual birth count exceeding 10,000, from January 2019 to July 2022. SGA and severe SGA were defined as birthweights below the 10th or 3rd percentile, respectively, based on each growth standard. The study design included details on the setting, subjects (singleton deliveries), and the chosen size standards. Comparative analyses were performed to assess variations in SGA and severe SGA rates among these size standards. ResultsOur study analyzed 32,912 singleton deliveries. We found that the choice of growth standard significantly impacted the rates of both SGA and severe SGA infants. Notably, the WHO criteria identified 5,548 (16.9 %) fetuses as SGA, compared to only 1,716 (5.2 %) using the INTERGROWTH-21 standard (p < 0.001). Similarly, for severe SGA, the FMF charts classified 2098 (6.37 %) infants, significantly higher than the 320 (1 %) identified by Dolberg’s local population-based charts (p < 0.001). ConclusionOur study demonstrates a significant variety of SGA and severe SGA rates using different size standards. Therefore, the decision on the size standards in use is critical given the significant influence on clinical management. SynopsisThere are significant variations in SGA and Severe SGA rates depending on the chosen size standard.

Legacy and novel brominated flame retardants in outdoor settled dusts and pine needles in a megacity of Eastern China: Interpretation of plant uptake

Brominated flame retardants, considered emerging contaminants, are widespread and persist in the environment. This study investigated the contamination of legacy and novel brominated flame retardants in paired outdoor settled dusts and pine needles sampled from a megacity in the Eastern China. The measured total concentrations of PBDEs (∑27PBDEs) in outdoor settled dusts and pine needles were in the range of 77.4–345.2 ng/g dw and 20.7–120.0 ng/g dw, respectively, and equivalent ranges for novel brominated flame retardants (∑11NBFRs) were 25.7–1917.2 ng/g dw and 9.4–38.7 ng/g dw, respectively. BDE-209 and DBDPE dominated PBDEs and NBFRs profiles, respectively, in both dusts and pine needles. Outdoor settled dusts exhibited greater potentials to accumulate high-brominated PBDE homologues and EH-TBB while pine needles tended to accumulate low-brominated PBDE homologues, BTBPE and TBC. The plant uptake of BFRs was interpreted by McLachlan's framework on the assumption that the levels of BFRs in outdoor settled dusts and particle phase of air were positively correlated. The accumulation of PBDEs in pine needles was dominated by equilibrium partitioning between the vegetation and the gas phase when log KOA values <10 and by particle-bound deposition when log KOA values >13. However, NBFRs exhibited more complicated accumulation behavior. The predicted 50th percentile of the estimated daily intakes of ∑27PBDEs via outdoor settled dusts exposure for adults and children were 3.5 × 10−2 and 1.4 × 10−1 ng/kg body weight (bw)/day, respectively, and equivalent values for ∑11NBFRs were 1.6 × 10−2 ng/kg bw/day and 6.3 × 10−2 ng/kg bw/day, respectively. The calculated hazard index (HI) values were far <1, indicating exposure of BFRs via outdoor settled dust intake would not pose potential non-carcinogenic health risks to both adults and children.

Application of Mechanistic Multiparameter Optimization and Large-Scale In Vitro to In Vivo Pharmacokinetics Correlations to Small-Molecule Therapeutic Projects.

Computational chemistry and machine learning are used in drug discovery to predict the target-specific and pharmacokinetic properties of molecules. Multiparameter optimization (MPO) functions are used to summarize multiple properties into a single score, aiding compound prioritization. However, over-reliance on subjective MPO functions risks reinforcing human bias. Mechanistic modeling approaches based on physiological relevance can be adapted to meet different potential key objectives of the project (e.g., minimizing dose, maximizing safety margins, and/or minimizing drug-drug interaction risk) while retaining the same underlying model structure. The current work incorporates recent approaches to predict in vivo pharmacokinetic (PK) properties and validates in vitro to in vivo correlation analysis to support mechanistic PK MPO. Examples of use and impact in small-molecule drug discovery projects are provided. Overall, the mechanistic MPO identifies 83% of the compounds considered as short-listed for clinical experiments in the top second percentile, and 100% in the top 10th percentile, resulting in an area under the receiver operating characteristic curve (AUCROC) > 0.95. In addition, the MPO score successfully recapitulates the chronological progression of the optimization process across different scaffolds. Finally, the MPO scores for compounds characterized in pharmacokinetics experiments are markedly higher compared with the rest of the compounds being synthesized, highlighting the potential of this tool to reduce the reliance on in vivo testing for compound screening.

Long-Term Variability of Surface Ozone and Its Associations with NOx and Air Temperature Changes from Air Quality Monitoring at Belsk, Poland, 1995–2023

Surface ozone (O3) and nitrogen oxides (NOx = NO + NO2) measured at the rural station in Belsk (51.83° N, 20.79° E), Poland, over the period of 1995–2023, were examined for long-term variability of O3 and its relationship to changes in the air temperature and NOx. Negative and positive trends were found for the 95th and 5th percentile, respectively, in the O3 data. A weak positive correlation (statistically significant) of 0.33 was calculated between O3 and the temperature averaged from sunrise to sunset during the photoactive part of the year (April–September). Recently, O3 maxima have become less sensitive to temperature changes, reducing the incidence of photochemical smog. The ozone–climate penalty factor decreased from 4.4 µg/m3/°C in the 1995–2004 period to 3.9 µg/m3/°C in the 2015–2023 period. The relationship between Ox (O3 + NO2) and NOx concentrations averaged from sunrise to sunset determined the local and regional contribution to Ox variability. The seasonal local and regional contributions remained unchanged in the period of 1995–2023, stabilizing the average O3 level at Belsk. “NOx-limited” and “VOC-limited” photochemical regimes prevailed in the summer and autumn, respectively. For many winter and spring seasons between 1995 and 2023, the type of photochemical regime could not be accurately determined, making it difficult to build an effective O3 mitigation policy.

Improving Time to Antibiotics in Patients with Long Bone Open Fractures Presenting to the Pediatric Emergency Department.

To evaluate a new triage workflow aimed at improving time to intravenous antibiotics in open fractures to under 60 minutes of arrival to the Pediatric Emergency Department. Design: A prospective, multi-disciplinary, quality improvement project. A tertiary care, Level 1 Pediatric Trauma hospital in New York. Patients aged 17 and under with long bone open fractures between June 1, 2020 and May 31, 2021, excluding those transferred from an outside hospital, with non-long bone fractures and non-fractured, injured extremities.Outcome Measures and Comparisons: The new workflow involved splint removal and skin assessment during triage to identify open fractures. Serial Plan-Do-Study-Act (PDSA) cycles aimed to refine this workflow and reduce antibiotic administration time. Primary outcome: Percentage of open fracture patients receiving intravenous (IV) antibiotics within 60 minutes. Secondary outcome: Assessment of triage documentation regarding splint presence and removal. An exact Wilcoxon two-sample test compared time from patient arrival (quick-registration) to antibiotic administration before, during and after workflow implementation on 6/1/2020. A total of 51 patients (33 male) aged 17 and under, with open fractures were reviewed: 25 during the pre-intervention phase 1/1/18-5/31/20, 14 during the intervention phase 6/1/20-5/31/21, and 12 during the post-intervention phase 6/1/21-11/30/21. Continuous improvement efforts via PDSA cycles focusing on education, reinforcement, recognition, and barrier identification increased the percentage of patients receiving antibiotics within 60 minutes from 36% to 87.5%. Median time and Interquartile range (IQR: 25th percentile-75th percentile) from quick-registration to administration was 86 minutes (IQR: 51-147) before 6/1/2020, and 34 minutes (IQR: 16- 42) thereafter. The implemented triage workflow led to improved time to antibiotics to within 60 minutes for patients with long bone open fractures in the Pediatric Emergency Department. Level III. See Instructions for Authors for a complete description of levels of evidence.

Improved processing workflow and student transparency with student mistreatment reports leads to graduation questionnaire data gains

Mistreatment of students has been historically documented as common in U.S. medical schools, but graduate questionnaire (GQ) data from the Association of American Medical Colleges (AAMC) displays high numbers of students who have experienced mistreatment but not reported the incident. There are many reasons within the literature as to why students do not report their experiences, including fear of academic repercussion or a misunderstanding of what constitutes as mistreatment. Our institution found through GQ data that there was a shortcoming in understanding policies and knowledge of procedures associated with mistreatment, and student focus group responses showed that many students were not confident that their reports would receive follow-up on the part of the institution. These factors led to the formation of a task force to investigate our school’s workflow once a report of concern for mistreatment is received and examine measures to increase transparency to the student body that their reports are acted upon. We took measures to place a greater emphasis on communication with students during the mistreatment report workflow, as well as releasing name-blinded data within our weekly student communication emails regarding reports that had been processed and resolved. The results after one year of these efforts saw our GQ percentile data jump from falling between the 10th to 25th percentile to the 90th percentile for student awareness of mistreatment policies and from between the 25th to 50th percentile to between the 75th to 90th percentile for student knowledge of mistreatment procedures. These jumps in GQ figures provide insight for policy changes that could benefit other institutions struggling with building a safe environment for students to confidently report incidents of mistreatment with knowledge that their concerns are important and acted upon.

The study of vaginal wall thickness in adults based on histopathological measurements

To accurately measure the vaginal mucosa thickness across different age groups using histopathologic techniques and investigate the factors that may influence the thickness changes. This study aims to provide clinicians with objective evidence of variations in vaginal mucosal thickness, facilitating personalized medical decisions for patients. A retrospective analysis was conducted on clinical data from 348 patients who underwent local vaginal wall resection at the West China Second University Hospital, Sichuan University, from January 2021 and May 2022. The thickness of vaginal mucosa, epithelium and lamina propria was measured precisely under the microscope. And the 10th, 25th, 50th, 75th, and 90th percentile values of vaginal mucosa thickness across different age groups were counted and charted a dot-line plot. The percentile values for vaginal mucosa thickness exhibited a decreasing trend with increasing age; vaginal mucosa thickness showed significant correlations with times of delivery (P = 0.031) and age (P < 0.001), both of which were negatively associated. And vaginal mucosa thickness demonstrated no significant correlation with body mass index (BMI) (P = 0.325), times of abortions (P = 0.511), times of gestation (P = 0.101), menstrual cycle (P = 0.533), or types of delivery (P = 0.056); epithelial thickness showed significant associations with age (P < 0.001) and types of delivery (P = 0.017), both of which were negative correlations. Moreover, BMI (P = 0.429), times of abortions (P = 0.764), delivery (P = 0.079), gestation (P = 0.475), and menstrual cycle (P = 0.950) were nonassociated with epithelial thickness; lamina propria thickness displayed a significant correlation only with age (P = 0.002), and there were no obvious correlations observed between lamina propria thickness and BMI (P = 0.374), times of abortion (P = 0.417), delivery (P = 0.053), gestation (P = 0.101), types of delivery (P = 0.132) and menstrual cycle (P = 0.495). Moreover, when the age segmentation was thresholded at 35 and 50 years, both epithelial thickness and vaginal mucosa thickness were significantly correlated with age (P < 0.05). Lamina propria thickness was associated with age when the age threshold was set at 35 years (P = 0.007), whereas it showed no strong link with age when the age threshold was 50 years (P = 0.072). This study has innovatively established percentile reference values for vaginal mucosa thickness based on histopathology, furnishing clinicians with objective evidence of variations in vaginal mucosal thickness to facilitate personalized medical decisions for patients. The findings demonstrated a strong link between vaginal mucosa thickness and age, with epithelium likely playing a predominant role, while the association with lamina propria appeared to be less significant. Further research involving a larger sample size is warranted to elucidate the potential relationship with the lamina propria.