95th Percentile Research Articles

Role of walkability, bike infrastructure, and greenspace in combatting chronic diseases: A heterogeneous ecological analysis in the United States

Associations of built and natural environment and bike infrastructure features with neighborhood-level hypertension and obesity prevalence across the U.S. are not well explored. Identifying the environmental determinants of neighborhood-level disease prevalence can support community-based nonpharmacologic interventions. Additionally, little is known about the extent of heterogeneity in built and natural environment impacts. Quantifying heterogeneity can help identify places where the greatest health gains can be obtained from infrastructural investments. Using a new neighborhood-level database, we assessed heterogeneous associations of neighborhood built and natural environment and bike infrastructure features with nationwide hypertension and obesity rates using a simultaneous quantile regression framework. A walkability index, access to green space, and bicycle infrastructure were negatively correlated with hypertension and obesity after controlling for social vulnerability. The associations of key environmental and bike infrastructure factors exhibited considerable heterogeneity. For a unit increase in the walkability index, the potential reduction in hypertension prevalence at the 10th percentile was 3.4 times the reduction at the 95th percentile. Likewise, the potential reduction in obesity prevalence at the 10th percentile was 1.8 times the reduction at the 95th percentile. Provision of on-street and off-street bike lanes was correlated with lower hypertension and obesity, although the impacts varied across the quantiles of health outcomes. Urban design policies promoting walkability, providing on-street and off-street bicycle facilities, and enhancing greenspace can be important strategies to combat hypertension and obesity. Our study underscores the importance of incorporating environmental features into future iterations of national disease prevalence data programs in the U.S.

Reference values and associated factors of controlled attenuation parameter and liver stiffness in adults: A cross-sectional study

Background & aimsThe utilization of non-invasive techniques for liver fibrosis and steatosis assessment has gained acceptance as a viable substitute for liver biopsy in clinical practice. This study aimed to establish normative data for the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) by age and gender, as well as to explore the relationship between anthropometric measures, clinical status, and biochemical profile according to the 90th percentile cut-off values for CAP/LSM in a U.S. adult population. Methods and resultsIn this cross-sectional analysis, 7.522 US adults aged 20–80 years from the National Health and Nutrition Examination Survey (NHANES 2017–2020) were included. CAP and LSM were quantified using the FibroScan® 502-v2 device. A comprehensive range of data was collected, including sociodemographic, anthropometric, biochemical, lifestyle, and clinical conditions. Participants were segmented by sex and age. The median ± standard deviation (SD) for CAP was significantly lower in women (258.27 ± 61.02 dB/m) than in men (273.43 ± 63.56 dB/m), as was the median ± SD for LSM (women: 5.50 ± 4.12 kPa, men: 6.36 ± 5.63 kPa). Although median CAP and LSM values displayed an upward trend with age, statistical significance was not achieved. Notably, higher liver CAP values (above the 90th percentile) correlated with more pronounced clinical and biochemical profile differences compared to lower CAP values (below the 90th percentile) (p < 0.001). ConclusionsOur study provides age- and sex-stratified standard values for CAP and LSM in a sizeable, nationally representative cohort of adults. The evidence of sex-specific variations in TE test results from our study sets the stage for future research to further corroborate these findings.

Assessing the impact of bias correction approaches on climate extremes and the climate change signal

AbstractWe assess the impact of three bias correction approaches on present day means and extremes, and climate change signal, for six climate variables (precipitation, minimum and maximum temperature, radiation, vapour pressure and mean sea level pressure) from dynamically downscaled climate simulations over Queensland, Australia. Results show that all bias‐correction methods are effective at removing systematic model biases, however the results are variable and season‐dependent. Importantly, our results are based on fully independent cross‐validation, an advantage over similar studies. Linear scaling preserves the climate change signals for temperature, while quantile mapping and the distribution‐based transfer function modify the climate change signal and patterns of change. The Perkins score for all the values above the 95th percentile and below the 5th percentile was used to evaluate how well the climate model matches the observational data. Bias correction improved Perkins score for extremes for some variables and seasons. We rank the bias‐correction methods based on the Kling–Gupta efficiency (KGE) score calculated during the validation period. We find that linear scaling and empirical quantile mapping are the best approaches for Queensland for mean climatology. On average, bias correction led to an improvement in the KGE score of 23% annually. However, in terms of extreme values, quantile mapping and statistical distribution‐based transfer function approaches perform best, and linear scaling tends to perform worst. Our results show that, except linear scaling, all approaches impact the climate change signal.

The Impacts of Changing Winter Warm Spells on Snow Ablation Over Western North America

AbstractAn increase in winter air temperature can amplify snowmelt and sublimation in mountain regions with implications to water resources and ecological systems. Winter Warm Spells (WWS) are defined as a winter period (December to February, DJF) of at least 3 consecutive days with daily maximum temperature anomaly above the 90th percentile (using a moving‐average of 15 days between 2001 and 2013). We calculate WWS for every 4‐km grid cell within an atmospheric model over western North America to characterize WWS and analyze snow ablation and their changes in a warmer climate. We find that days with ablation during WWS represent a small fraction of winter days (0.6 days), however, 49% of total winter ablation (33.4 mm/DJF) occurs during WWS. Greater extreme ablation rates (99th percentile) occur 18% more frequently during WWS than during non‐WWS days. Ablation rates during WWS in humid regions are larger (9 mm d−1) than in dry regions (7 mm d−1) in a warmer climate, which can be explained by differences in the energy balance and the snowpack's cold content. We find that warmer (0.8°C), longer (1.8 days) and more frequent (3.7 more events) WWS increase total winter ablation (on average 109% or 18 mm/DJF) in a warmer climate. Winter melt during WWS in warm and humid places is expected to increase about 3 times more than in the cold and dry region. This study provides a comprehensive description of WWS and their impact on snowpack dynamics, which is relevant to reservoir operations and water security.

Motor unit potential recruitment reference values in common upper and lower extremity muscles

ObjectiveTo define reference values for motor unit (MU) recruitment during needle EMG of six commonly examined muscles at low to moderate contraction. MethodsNeedle examination was performed for each muscle in a total of 111 subjects without neuromuscular disorders. Fastest firing rates and recruitment ratios (RRs) were calculated in at least 5 sites within each muscle. Upper limits of normal based on 97th percentile for fastest MU firing rates and RRs were calculated for each muscle. The means of fastest firing rates were compared among muscles using the Friedman and Wilcoxon signed rank tests. ResultsThe upper limits of normal were 12–15 Hz for fastest firing rates and were slightly higher in the deltoid and triceps than the other muscles. ConclusionFiring rates >15 Hz recorded at multiple sites within a single muscle exceed the 97th percentile of normal subjects and may suggest reduced MU recruitment. In some muscles, rates >12 Hz might support mildly reduced recruitment. Recruitment ratios varied depending on number of firing MUs, whereas the fastest firing MU rate did not. SignificanceThe determination of reference values for fastest MU firing rates can help to identify mild reduction in recruitment with more accuracy.

Physician workload and practice management in pediatric gastroenterology.

The pediatric gastroenterology workforce has grown in the last few decades. The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) formed a task force to understand current pediatric gastroenterology organizations' practicestructures. 19-item electronic survey was distributed to NASPGHAN members who were clinical or academic division directors. 30% responded to the survey, all directors of academic practices. The median number of clinical sessions per week was seven sessions, and the median individual work relative value unit(wRVU) target for practices was 4000-4500. Healthcare team ratios compared to provider clinical full-time equivalentwere reported as the following: Nursing 0.80, medical assistant 0.29, dietitian 0.29, social worker 0.14, and psychologist 0.13. Regarding compensation, 68.0% were salaried with bonus based on billing or director decision, 28.0% were salaried with no incentive pay, and 4.0% were salaried with a portion at risk if the target was not met, and a bonus was given if the target was met. Most practices participated in a wellness activity with the most common strategies being didactic lectures about physician burnout (80%), annual burnout check-ins (68%), and/or after-hours social activities(60%). Pediatric gastroenterology practices vary regarding clinical sessions per week and annual wRVU targets with the median at sevensessions per week and an annual goal of 4000-4500 wRVUs, similar to reported national benchmark goals at the 50th percentile. Healthcare teams, including nursing, medical assistants, dietitians, social workers, and psychologists, had similar ratios of staff to providers for all sizes and types of practices. Most practices are engaging in wellness initiatives.

Assessment of the prevalence of inadequate iron intakes in premenopausal females based on the reference values of the European Food Safety Authority using cross-sectional food consumption data

BackgroundThe iron intake requirement distribution for premenopausal females is not symmetric, which invalidates the EAR cut-point approach for assessing the prevalence of iron inadequacy. Therefore, Beaton’s Full Probability Approach (PA) must be used. Although the PA requires information on the entire iron intake requirement distribution, the European Food Safety Authority (EFSA) only provided the EAR (50th percentile), 90th, 95th (population reference intake), and 97.5th percentiles. ObjectivesThis study aimed to reliably estimate the prevalence of iron inadequacy in premenopausal females using the PA, based on the intake requirements established by EFSA, and compare the results with those obtained from the EAR cut-point method. MethodsHabitual iron intakes were calculated using the statistical program to assess dietary exposure with data from 484 females (20–45 y) from the Dutch National Food Consumption Survey 2012–2016. Iron requirements of EFSA (including additionally obtained information) were applied. Results from the PA were compared to results obtained with the EAR cut-point method. Sensitivity analyses examined the impact of lower iron intake distributions on differences in estimated inadequate intakes between PA and EAR cut-point methods. ResultsA 2-fold higher prevalence of iron inadequacy among Dutch premenopausal females was observed when employing the PA compared to the EAR cut-point method, using EFSA’s reference values. Sensitivity analysis showed that the EAR cut-point method could also result in large overestimations for populations with lower intake distributions. ConclusionsThis study provided an example of using the PA method by using additionally derived information on the full requirement distribution underlying EFSA’s reference values. Results showed once more the unsuitability of the EAR cut-point method to calculate the prevalence of iron inadequacy in premenopausal females. Hence, we recommend that institutions deriving dietary reference values provide all the information needed to use the correct method to determine inadequate intakes in the population.

Cumulative Exposures to Environmental and Socioeconomic Risk Factors in Milwaukee County, Wisconsin.

The environmental justice literature demonstrates consistently that low-income and minority communities are disproportionately exposed to environmental hazards. In this case study, we examined cumulative multipollutant, multidomain, and multimatrix environmental exposures in Milwaukee County, Wisconsin for the year 2015. We identified spatial hot spots in Milwaukee County both individually (using local Moran's I) and through clusters (using K-means clustering) across a profile of environmental pollutants that span regulatory domains and matrices of exposure, as well as socioeconomic indicators. The cluster with the highest exposures within the urban area was largely characterized by low socioeconomic status and an overrepresentation of the Non-Hispanic Black population relative to the county as a whole. In this cluster, average pollutant concentrations were equivalent to the 78th percentile in county-level blood lead levels, 67th percentile in county-level NO2, 79th percentile in county-level CO, and 78th percentile in county-level air toxics. Simultaneously, this cluster had an average equivalent to the 62nd percentile in county-level unemployment, 70th percentile in county-level population rate lacking a high school diploma, 73rd percentile in county-level poverty rate, and 28th percentile in county-level median household income. The spatial patterns of pollutant exposure and SES indicators suggested that these disparities were not random but were instead structured by socioeconomic and racial factors. Our case study, which combines environmental pollutant exposures, sociodemographic data, and clustering analysis, provides a roadmap to identify and target overburdened communities for interventions that reduce environmental exposures and consequently improve public health.

DOES MOTOR PROFICIENCY INFLUENCE SLEEP, PHYSICAL ACTIVITY AND MENTAL WELLBEING IN AUSTRALIAN CHILDREN?

INTRODUCTION Motor impairments such as poor timing, balance, sequencing, and dexterity often impact on the child’s quality of life, both physically and emotionally. Sleep and physical activity are modifiable behaviours that have a bi-directional association with mental health outcomes. However, there is very limited research on sleep in children with motor difficulties. The aim of this study is to examine if level of motor proficiency influences physical activity, sleep behaviour, and mental well-being. METHODS Children aged between 6 and 12 years attended one ∼90-minute testing session where they completed the Movement Assessment Battery for Children (MABC; 2nd edition), the Test of Gross Motor Development (TGMD; 3rd edition), and a brief physical activity assessment. Questionnaire were completed by the children and parents (Adolescents Motor Competence Questionnaire (AMCQ), Short Moods and Feelings, Kids Screen, Strength and Difficulties Questionnaire, Children’s Sleep Habits Questionnaire (CSHQ). RESULTS Currently, 15 children (9 males, mean age 9.2 ± 1.97 yrs) have completed the study. Preliminary results show a mean TGMD index of 104.93 ±1.97, suggesting motor skills performed to an average level. The MABC percentile rank was 56.93 ±27.05, one participant below 5th percentile (motor impairment). AMCQ mean 87.00±8.9, however four participants had perceived low motor competence. Interestingly mean sleep score suggests high sleep disturbance among the sample (CSHQ mean 42.33 ± 9.73) with 9 out of 15 participants identifying with a paediatric sleep disorder (three low motor competence and six high motor competence has a paediatric sleep disorder). CONCLUSION Results indicate some interesting findings with both high and low motor competence children demonstrating a sleep disorder. Further analysis looking at actigraph sleep data, sleep diary and physical activity collected over 7 days will be presented during the conference.

Association of carotid endarterectomy at low-volume centers with higher likelihood of major complications and nonroutine discharge.

Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%-5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge. Asymptomatic and symptomatic CAS patients undergoing CEA were retrospectively identified in the Nationwide Readmissions Database (2010-2018). The association of CEA volume with outcomes was explored as a continuous variable using locally estimated scatterplot smoothing. The identified volume cutoff was used to generate dichotomous volume cohorts, and multivariate analyses of patient and hospital characteristics were conducted to evaluate the association of CEA volume with major complications and discharge disposition. Between 2010 and 2018, 308,933 asymptomatic and 32,877 symptomatic patients underwent CEA. Analysis of CEA volume with outcomes as a continuous variable demonstrated that an increase in volume was associated with a lower risk until a volume of approximately 7 cases per year (20th percentile). A total of 6702 (2.2%) asymptomatic and 1040 (3.2%) symptomatic patients were treated at the bottom 20% of hospital procedure volume. Increased rates of complications were seen at low-volume centers among asymptomatic (3.66% vs 2.77%) and symptomatic (7.4% vs 6.87%) patients. Asymptomatic patients treated at low-volume centers had an increased likelihood of major complications (OR 1.26, 95% CI 1.07-1.49; p = 0.007) and nonroutine discharge (OR 1.36, 95% CI 1.24-1.50; p < 0.0001). Symptomatic patients treated at low-volume centers were also more likely to experience major complications (OR 1.47, 95% CI 1.07-2.02; p = 0.02) and nonroutine discharge (OR 1.26, 95% CI 1.07-1.47; p = 0.005). Mortality rates were similar between low- and high-volume hospitals among asymptomatic (0.36% and 0.32%, respectively) and symptomatic (1.06% and 1.49%, respectively) patients, while volume was not significantly associated with mortality among asymptomatic (OR 1.06, 95% CI 0.67-1.65; p = 0.81) and symptomatic (OR 0.81, 95% CI 0.43-1.54; p = 0.52) patients in multivariate analysis. CEA patients, asymptomatic or symptomatic, are at a higher risk of major complications and nonroutine discharge at low-volume centers. Analysis of CEA as a continuous variable demonstrated a cutoff at 7 cases per year, and further study may identify factors associated with improved outcome at the lowest-volume centers.

Management of procalcitonin test overuse in an emergency department through a computer algorithm.

To show the procalcitonin (PCT) test demand from an emergency department (ED) over several years, to decrease PCT measurement via a computerized algorithm based on C-reactive protein (CRP) value, and to evaluate the subsequent economic savings. A cross-sectional study was performed from January 1, 2018, to May 31, 2019, to evaluate an intervention to avoid PCT measurement in the ED of Hospital Universitario San Juan in Alicante in Spain, when CRP values are low. A PCT result of at least 1.5 ng/mL was agreed upon with ED providers in our study as the value for clinical decision-making, with values less than 1.5 ng/mL considered negative. We retrospectively reviewed all PCT and CRP values for ED patients and calculated the diagnostic indicators for PCT at 4 different CRP cutoffs using the PCT quantification as the gold standard. From July 1, 2019, to April 30, 2021, the agreed-upon strategy was implemented, and we counted the PCT tests avoided and calculated the savings. PCT was not measured when CRP values were less than the selected CRP cutoff of 0.8 mg/dL, at which false-negative results were 1% and the 99th percentile of PCT was 1.5 ng/mL. In the postintervention period, 1091 PCT values were not measured and $11,553.69 was saved. An intervention to decrease PCT measurement in the ED designed by the clinical laboratory staff in consensus with requesting clinicians and based on CRP values decreased PCT testing and generated significant economic savings.

Extremes of Emergency Department Boarding are Associated With Poorer Financial Performance Among Hospitals.

Boarding emergency department (ED) patients is associated with reductions in quality of care, patient safety and experience, and ED operational efficiency. However, ED boarding is ultimately reflective of inefficiencies in hospital capacity management. The ability of a hospital to accommodate variability in patient flow presumably affects its financial performance, but this relationship is not well studied. We investigated the relationship between ED boarding and hospital financial performance measures. Our objective was to see if there was an association between key financial measures of business performance and limitations in patient progression efficiency, as evidenced by ED boarding. Cross-sectional ED operational data were collected from the Emergency Department Benchmarking Alliance, a voluntarily self-reporting operational database that includes 54% of EDs in the United States. Freestanding EDs, pediatric EDs and EDs with missing boarding data were excluded. The key operational outcome variable was boarding time. We reviewed the financial information of these nonprofit institutions by accessing their Internal Revenue Service Form 990. We examined standard measures of financial performance, including return on equity, total margin, total asset turnover, and equity multiplier (EM). We studied these associations using quantile regressions of added ED volume, ED admission percentage, urban versus nonurban ED site location, trauma status, and percentage of the population receiving Medicare and Medicaid as covariates in the regression models. Operational data were available for 892 EDs from 31 states. Of those, 127 reported a Form 990 in the year corresponding to the ED boarding measures. Median boarding time across EDs was 148min (interquartile range [IQR]: 100-216). A significant relationship exists between boarding and the EM, along with a negative association with the hospital's total profit margin in the highest-performing hospitals (by profit margin percentage). After adjusting for the covariates in the regression model, we found that for every 10min above 90min of boarding, the mean EM for the top quartile increased from 245.8% to 249.5% (p <.001). In hospitals in the top 90th percentile of total margin, every 10min beyond the median ED boarding interval led to a decrease in total margin of 0.24%. Using the largest available national registry of ED operational data and concordant nonprofit financial reports, higher boarding among the highest-profitability hospitals (i.e., top 10%) is associated with a drag on profit margin, while hospitals with the highest boarding are associated with the highest leverage (i.e., indicated by the EM). These relationships suggest an association between a key ED indicator of hospital capacity management and overall institutional financial performance.

Late-xerostomia prediction model based on 18F-FDG PET image biomarkers of the main salivary glands

Background and purposeRecently, a comprehensive xerostomia prediction model was published, based on baseline xerostomia, mean dose to parotid glands (PG) and submandibular glands (SMG). Previously, PET imaging biomarkers (IBMs) of PG were shown to improve xerostomia prediction. Therefore, this study aimed to explore the potential improvement of the additional PET-IBMs from both PG and SMG to the recent comprehensive xerostomia prediction model (i.e., the reference model). Materials and methodsTotally, 540 head and neck cancer patients were split into training and validation cohorts. PET-IBMs from the PG and SMG, were selected using bootstrapped forward selection based on the reference model. The IBMs from both the PG and SMG with the highest selection frequency were added to the reference model, resulting in a PG-IBM model and a SMG-IBM model which were combined into a composite model. Model performance was assessed using the area under the curve (AUC). Likelihood ratio test compared the predictive performance between the reference model and models including IBMs. ResultsThe final selected PET-IBMs were 90th percentile of the PG SUV and total energy of the SMG SUV. The additional two PET-IBMs in the composite model improved the predictive performance of the reference model significantly. The AUC of the reference model and the composite model were 0.67 and 0.69 in the training cohort, and 0.71 and 0.73 in the validation cohort, respectively. ConclusionThe composite model including two additional PET-IBMs from PG and SMG improved the predictive performance of the reference xerostomia model significantly, facilitating a more personalized prediction approach.

Climatic resilience: Marine heatwaves do not influence the variations of green crab (Carcinus maenas) megalopae supply patterns to a Western Iberian estuary

Extreme climatic events like marine heatwaves (MHWs) are becoming more frequent, intense, and longer lasting all around the world. The consequences of these anomalously warm periods are devastating for marine ecosystems. Still, little is known about these extreme events off the western Iberia coast. Here we analyzed MHW events occurring from 1982 to 2020 on the Aveiro coast, western Iberia coast of Portugal. A total of 79 events were detected for the region, with an average duration of 15.8 days, and a mean intensity of 1.9 °C ± 0.4 °C above the 90th percentile of sea surface temperatures (SST) for the region. The maximum intensity of the events has increased by 0.5 °C over the last decade. The relation between SST, and therefore, MHW events, the North Atlantic Oscillation index (NAO), and the regional Iberian Upwelling Index (UI) was identified. The intense upwelling of the region seems to mitigate the duration of warming conditions, resulting in shorter MHW events. Furthermore, the impacts of SST and MHW events on the supply patterns of Carcinus maenas megalopae were examined, utilizing daily data from 2002, 2006–2009, 2012, and 2013, collected at the entrance of Ria de Aveiro. Cross-correlations were employed to assess the effect of SST on megalopae supply, while ordinary least square cumulative sums were used to identify variations over time. The influence of SST on supply was noticed with a 5-to-11-day lag, but this relation changed over the years. Contrary to our hypothesis, we found no evidence supporting a diminishment in megalopae supply due to MHW events. These elusive findings, coupled with the apparent lack of influence of these extreme events, highlight the relatively weak intensity and brief duration of the MHW events in the region, coupled with the high thermal tolerance of these species.

Heat wave time of emergence patterns: a matter of definition

Hot extremes, such as heatwaves, have been associated with health, economic, and ecosystem-wide impacts. The timing of emergence of changes in extremes due to anthropogenic climate change is a topic of broad scientific and societal importance. While various studies have estimated the timing and impacts of heatwaves, the definitional aspect of a heatwave in determining the relative time of emergence has not been addressed. We adopt two commonly used definitions of heatwave employed in different reports of the Intergovernmental Panel on Climate Change (IPCC) to evaluate the time at which the frequency of heatwaves becomes detectably different from the historical baseline using an ensemble of 10 GCMS from the CMIP6 archives forced by the SSP2–4.5 concentration pathway. For a heatwave definition of sustained temperatures exceeding 5 °C warmer above the historical climatology, time of emergence is earliest in high latitudes over land and displays correlation with the signal (amount of warming) and noise (variability). In contrast, for a heatwave definition of sustained temperatures exceeding the 90th percentile of historical climatology, time of emergence is earliest in low latitude regions and is correlated with the signal to noise ratio. This work underscores the importance of metric choice in estimating the timing of new climate regimes and that metric selection for informing adaptation timing should thus be tailored to the regional context.

Global ocean surface and subsurface temperature forecast skill over subseasonal to seasonal timescales

Global ocean surface and subsurface temperature forecast skill over subseasonal to seasonal timescales

The Changing Influence of Precipitation on Soil Moisture Drought With Warming in the Mediterranean and Western North America

AbstractAnthropogenic climate change has already affected drought severity and risk across many regions, and climate models project additional increases in drought risk with future warming. Historically, droughts are typically caused by periods of below‐normal precipitation and terminated by average or above‐normal precipitation. In many regions, however, soil moisture is projected to decrease primarily through warming‐driven increases in evaporative demand, potentially affecting the ability of negative precipitation anomalies to cause drought and positive precipitation anomalies to terminate drought. Here, we use climate model simulations from Phase Six of the Coupled Model Intercomparison Project (CMIP6) to investigate how different levels of warming (1, 2, and 3°C) affect the influence of precipitation on soil moisture drought in the Mediterranean and Western North America regions. We demonstrate that the same monthly precipitation deficits (25th percentile relative to a preindustrial baseline) at a global warming level of 2°C increase the probability of both surface and rootzone soil moisture drought by 29% in the Mediterranean and 32% and 6% in Western North America compared to the preindustrial baseline. Furthermore, the probability of a dry (25th percentile relative to a preindustrial baseline) surface soil moisture month given a high (75th percentile relative to a preindustrial baseline) precipitation month is 6 (Mediterranean) and 3 (Western North America) times more likely in a 2°C world compared to the preindustrial baseline. For these regions, warming will likely increase the risk of soil moisture drought during low precipitation periods while simultaneously reducing the efficacy of high precipitation periods to terminate droughts.

LP(A) IN HYPERTENSIVE PATIENTS AS A PREDICTOR OF CARDIOVASCULAR EVENTS

Objective: This study aims to analyze the relationship between Lp(a) levels and HT, determining whether this association implies an increased risk. In this way, the goal is to assess the utility of this relationship as an effective tool for cardiovascular risk stratification. Design and method: A retrospective study with a history of recent coronary events was conducted from June 2020 to September 2023. Data were obtained from the computerized medical records. Demographic data, history of HT diagnosis, BMI, current tobacco use, family history, sedentary behavior, pharmacological treatment with statins and antihypertensives were collected. Additionally, serum levels of total cholesterol (Col-T), LDL-chol, HDL-chol and Lp(a) were documented. The nature of the event (first occurrence or readmission) was also recorded. Statistics analysis of regression and variance (ANOVA) was performed. Results: A total of 105 patients were included. Age average was 59.7±13, 60% were obese, 39% were current smokers, 31% were diabetic and 66% had sedentary habits (mean ± SD). Chol-LDL values was 136.4±44 and Lp(a) 89±113 (mg/dL mean ± SD). Lp(a) showed a significant correlation with readmissions due to ischemic heart disease, sedentary behavior, and LDL-C levels. Additionally, its value is independent of the other variables. When the regression analysis of Lp(a) (Lowess) was performed, adjusting for age, it became evident that patients with arterial hypertension and cardiovascular events have much higher levels of Lp(a) compared to those without events. Figure 1 Conclusions: According to available studies, the guideline recommends a universal cutoff point of 100 nmol/L (approximately 50 mg/dL), which approximates the 80th percentile in Caucasian populations in the United States. However, the use of this cutoff point remains a topic of debate among many experts in the lipid community,. This study highlights that in a population of hypertensive patients with elevated Lp(a), early cardiovascular events are observed. The incorporation of this variable into the patients’ risk score could be a strategy for reducing cardiovascular events.

Reference Ranges for Arterial Oxygen Saturation, Heart Rate, and Cerebral Oxygen Saturation during Immediate Postnatal Transition in Neonates Born Extremely or Very Preterm

ObjectiveTo define percentile charts for arterial oxygen saturation (SpO2), heart rate (HR), and cerebral oxygen saturation (crSO2) during the first 15 minutes after birth in neonates born very or extremely preterm and with favorable outcome. Study designWe conducted a secondary-outcome analysis of preterm neonates included in the COSGOD III trial with visible cerebral oximetry measurements and with favorable outcome, defined as survival without cerebral injuries until term age. We excluded infants with inflammatory morbidities within the first week after birth. SpO2 was obtained by pulse oximetry, and electrocardiogram or pulse oximetry were used for measurement of HR. CrSO2 was assessed with near-infrared spectroscopy. Measurements were performed during the first 15 minutes after birth. Percentile charts (10th to 90th centile) were defined for each minute. ResultsA total of 207 preterm neonates with a gestational age of 29.7 (23.9-31.9) weeks and a birth weight of 1200 (378-2320) grams were eligible for analyses. The 10th percentile of SpO2 at minute two, five, ten and 15 was 32%, 52%, 83% and 85%, respectively. The 10th percentile of HR at minute two, five, ten and 15 was 70bpm, 109bpm, 126bpm and 134bpm, respectively. The 10th percentile of crSO2 at minute two, five, ten and 15 was 15%, 27%, 59% and 63%, respectively. ConclusionsThis study provides new centile charts for SpO2, HR, and crSO2 for extremely preterm neonates with favorable outcome. Implementing these centiles in guiding interventions during the stabilization process after birth might help to more accurately target oxygenation during postnatal transition period.

Establishing the homologous recombination score threshold in metastatic prostate cancer patients to predict the efficacy of PARP inhibitors

BackgroundThe homologous recombination deficiency (HRD) score serves as a promising biomarker to identify patients who are eligible for treatment with PARP inhibitors (PARPi). Previous studies have suggested a 3-biomarker Genomic Instability Score (GIS) threshold of ≥ 42 as a valid biomarker to predict response to PARPi in patients with ovarian cancer and breast cancer. However, the GIS threshold for prostate cancer (PCa) is still lacking. Here, we conducted an exploratory analysis to investigate an appropriate HRD score threshold and to evaluate its ability to predict response to PARPi in PCa patients. MethodsA total of 181 patients with metastatic castration-resistant PCa were included in this study. Tumor tissue specimens were collected for targeted next-generation sequencing for homologous recombination repair (HRR) genes and copy number variation (CNV) analysis. The HRD score was calculated based on over 50,000 single-nucleotide polymorphisms (SNP) distributed across the human genome, incorporating three SNP-based assays: loss of heterozygosity, telomeric allelic imbalance, and large-scale state transition. The HRD score threshold was set at the last 5th percentile of the HRD scores in our cohort of known HRR-deficient tumors. The relationship between the HRD score and the efficacy in 16 patients of our cohort who received PARPi treatment were retrospectively analyzed. ResultsGenomic testing was succeeded in 162 patients. In our cohort, 61 patients (37.7%) had HRR mutations (HRRm). BRCA mutations occurred in 15 patients (9.3%). The median HRD score was 4 (ranged from 0 to 57) in the total cohort, which is much lower than that in breast and ovarian cancers. Patients who harbored HRRm and BRCA or TP53 mutations had higher HRD scores. CNV occured more frequently in patients with HRRm. The last 5th percentile of HRD scores was 43 in the HRR-mutant cohort and consequently HRD high was defined as HRD scores ≥43. In the 16 patients who received PARPi in our cohort, 4 patients with a high HRD score achieved an objective response rate (ORR) of 100% while 12 patients with a low HRD score achieved an ORR of 8.3%. Progression-free survival (PFS) in HRD high patients was longer compared to HRD low patients, regardless of HRRm. ConclusionsA HRD score threshold of 43 was established and preliminarily validated to predict the efficacy of PARPi in this study. Future studies are needed to further verify this threshold.