Early Adulthood Research Articles

Proposed criteria for the O'Sullivan McLeod syndrome: Case series and literature review

AbstractWe aimed to summarize the clinical characteristics of the O'Sullivan McLeod syndrome and propose the diagnostic criteria of the syndrome. We reviewed our database to identify patients with the O'Sullivan McLeod syndrome. Online databases including PubMed, EMBASE, and OVID were also searched for relevant cases. We identified a total of 24 cases, including 3 cases from our database and 21 ones from online searching. A predominance of male was observed [17 (73.9%)] with median onset age of 31 (range: 15–56) years old. The median (range) disease duration was 9 (0.5–28) years at the time of the visit. All patients showed involvement of hands and ~1/3 patients reported weakness and atrophy of right/left forearm. The upper arm was scarcely affected (8.7%). Needle electromyography suggested chronic denervation in C7‐T1 among the majority of involved cases (over 78%). Cervical magnetic resonance imaging showed longitudinal T2‐hypertenssive signals among 5/14 (35.7%) patients, which confined to the anterior horn area. No patients showed responsiveness to immunotherapy. Ten patients remained clinical stable during follow‐up, nine ones manifested chronic progressive course. The O'Sullivan and McLeod syndrome, characterized by progressive weakness and atrophy in upper limbs, might be an incurable disorder of lower motor neuron. Onset in early adulthood, the plateau period of over 12 months and years of chronic progression in clinical manifestations might be supportive indicators for the diagnosis of the syndrome. The prognosis is relatively good with no effective treatment.

Does maternal education moderate the relationship between adolescent cannabis use and mental health in early adulthood?

Socioeconomic disadvantage has been associated with cannabis use and poor mental health. It is therefore hypothesised that lower maternal education, a proxy for socioeconomic disadvantage, may increase the risk of cannabis-related mental health and substance use consequences. A total of 5099 participants from the Avon Longitudinal Study of Parents and Children reported cannabis use via questionnaires at 16 or 18. Logistic regression was used to examine the relationship between any and regular (weekly or more) adolescent cannabis use with depression, anxiety, psychotic experiences, and problematic cannabis use at age 24. Maternal education was included as an effect modifier. Missing data were addressed through multiple imputation using chained equations. In total, 36.5% of participants reported adolescent cannabis use and, of these, 14% reported regular use. Adolescent cannabis use was associated with an increased likelihood of anxiety and problematic cannabis use; however, there was little evidence of moderation by maternal education. Regular cannabis use was associated with an increased likelihood of problematic cannabis use, with little evidence of moderation by maternal education. There was weak evidence that the association between regular cannabis use and depression (interaction p-value = 0.024) and anxiety (interaction p-value = 0.056) was stronger in people with high maternal education. Adolescent cannabis use is associated with increased risk of anxiety and cannabis use disorder, but there was insufficient evidence that childhood socioeconomic position (proxied by maternal education) modifies this relationship. Improved public health messages for all adolescents about these risks may be warranted.

Self-Control Moralization: The Role of Moral Identity and Moral Foundations in Young Adults

Despite the morality and self-control relationship having been studied in the past, there is still not enough information about how different moral variables, and their possible interaction, affect self-control levels; especially when referring to young adulthood, a critical period for development of self-control and morality. Within the framework of self-control moralization, the current study aimed to explore whether self-control scores were affected by levels of moral identity and binding-individualizing foundations through early adulthood. Data were obtained by an online survey from a non-probabilistic sample (n=626) of young adults from Bolivia. Having found significant correlations between variables, hypotheses were tested employing t-tests and an ANCOVA, with age as a covariate. Findings showed that binding foundations, moral identity, age and the interaction between moral identity and both types of moral foundations had a significant effect on self-control scores and marginal means, with small to moderate effect sizes. Finally, finding’s implications within the theoretical framework of self-control moralization are discussed.

EP51 - Uses of pharmaceutical and mechanical VTE prophylaxis - A clinical audit

Abstract Aim Venous thromboembolism (VTE) is a serious global health care safety concern for both patients and staff. Although it has been amply demonstrated that pharmaceutical and mechanical methods of prophylaxis against VTE are effective, their application has been uneven and insufficient. The purpose of this audit was to assess junior physicians working in general surgery, regarding their adherence to local and NICE guidelines regarding the pharmacological VTE prophylaxis practice as well as the mechanical prophylaxis Methodology Pre-intervention audit took place for two weeks. Throughout the course, it covered every adult general surgical emergency inpatient admission at conquest hospital who were deemed indicated for VTE prophylaxis. Each evening while the patients were still in the hospital, data was collected using the prescription charts, nursing and medical notes. The proforma used for data collection detailed the characteristics of VTE risk, the prophylactic medication prescribed for each patient, TED stockings and whether or not this aligned with the NICE clinical guideline (CG) 46,6.8. Post intervention took place for two weeks after teaching of junior doctors and the same as above was carried out, using the new proforma Results Pre-intervention showed that 87% of patients had the proforma filled in and 100% of patients received the appropriate dose of pharmaceutical prophylaxis. However, less than 40% of patients received the appropriate mechanical prophylaxis. Therefore, intervention was made in the form of a new proforma and teaching to junior. Post intervention data is currently being carried out Conclusion Implementation was necessary to ensure that at-risk patients receive appropriate prophylaxis.

Correlation between personal characteristics and intention to perform bystander Cardiopulmonary Resuscitation

Out-of-hospital cardiac arrest is a major problem globally characterized by poor survival rates, particularly in residential settings. A delay in administering Cardiopulmonary Resuscitation (CPR) can reduce the survival rate, which is currently at 1 in 10. The chance of survival is influenced by several factors, including patient, population, and health system, particularly the actions of bystanders due to the need for immediate administration of CPR. Although the role of bystanders is very important in increasing the survival rate of cardiac arrest, not all individuals present at the scene are willing to carry out CPR due to personal characteristics. Therefore, this research aimed to explore the potential correlation between personal characteristics and the intention (willingness) to provide basic life support.The investigation was carried out in Malang City using descriptive correlation design and data were collected with questionnaires distributed through Google Forms. The sample consisted of residents of Malang City, with inclusion criteria comprising individuals aged between 17-65 years, not health workers or health students, and the ability to fill in data using Google Forms. After collection, the data obtained were processed descriptively using the SPSS 23 version.The results showed that among 283 respondents, 80.6% were in the early adult age range, 64% were female, 57.6% had the last education level SMA/SMK, and 65.4% were students. Furthermore, the analysis showed that the intentions of the majority of respondents were in the moderate range, accounting for 64.7%. Correlation analysis showed a significant association between personal characteristics and intention, where age, gender, level of education, occupation status, and experience had correlation scores of -0.089, 0.054, 0.107, 0.104, and -0.261.In conclusion, this research showed correlation strength for all characteristics ranging from very low to low, emphasizing the need to enhance the intention to perform bystander CPR across all levels. This is due to the very low correlation between community characteristics and intention. To overcome this challenge, a strategy that has been proven effective in increasing intention is educating the public regarding cardiac arrest assistance.

Using Multispectral Data from UAS in Machine Learning to Detect Infestation by Xylotrechus chinensis (Chevrolat) (Coleoptera: Cerambycidae) in Mulberries

The tiger longicorn beetle, Xylotrechus chinensis Chevrolat (Coleoptera: Cerambycidae), has posed a significant threat to mulberry trees in Greece since its invasion in 2017, which may be associated with global warming. Detection typically relies on observing adult emergence holes on the bark or dried branches, indicating severe damage. Addressing pest threats linked to global warming requires efficient, targeted solutions. Remote sensing provides valuable, swift information on vegetation health, and combining these data with machine learning techniques enables early detection of pest infestations. This study utilized airborne multispectral data to detect infestations by X. chinensis in mulberry trees. Variables such as mean NDVI, mean NDRE, mean EVI, and tree crown area were calculated and used in machine learning models, alongside data on adult emergence holes and temperature. Trees were classified into two categories, infested and healthy, based on X. chinensis infestation. Evaluated models included Random Forest, Decision Tree, Gradient Boosting, Multi-Layer Perceptron, K-Nearest Neighbors, and Naïve Bayes. Random Forest proved to be the most effective predictive model, achieving the highest scores in accuracy (0.86), precision (0.84), recall (0.81), and F-score (0.82), with Gradient Boosting performing slightly lower. This study highlights the potential of combining remote sensing and machine learning for early pest detection, promoting timely interventions, and reducing environmental impacts.

Biological response of Anticarsia gemmatalis (Lepidoptera: Noctuidae) to Bacillus thuringiensis berliner var. kurstaki at sublethal concentrations

The soybean caterpillar, Anticarsia gemmatalis Hubner (Lepidoptera: Noctuidae), damages this plant. This pest is controlled, mainly, with chemical products which makes it necessary to to develop management strategies for its management in the soybean crop. Feeding and development of A. gemmatalis larvae fed on soybean leaves treated with Bacillus thuringiensis Berliner var. kurstaki at different concentrations (0,5, 1, 2, 4, 6, 8 μg.mL-1 ) for 24 h were studied in the laboratory. The LC50 and LC90 after 24 h from hatching and at the last instar, development period, adult emergence, weight gain by larva, pupa weight, and dry food weight ingested besides of A. gemmatalis were evaluated. The LC90 value decrease with the development of this insect. Mortality in the third instar of this pest was proportional to the B. thuringiensis concentrations. Emergence of A. gemmatalis adults was higher with 0,5 μg.mL-1 concentration of this bacterium and in the control.

Effect of Dietary Enrichment with Hempseed (Cannabis sativa L.) on Blood Pressure Changes in Growing Mice between Ages of 5 and 30 Weeks

Dietary hempseed (Cannabis sativa L.) reduces blood pressure in adults and animal models of hypertension; however, whether hempseed consumption throughout early life reduces adult blood pressure is not known. This study tested the hypothesis that hempseed enrichment versus a control diet modifies the age-dependent pattern of blood pressure changes in growing female C57BL/6 mice and results in lower adult blood pressure. From ages 5 to 30 weeks, early post-weaning to mid-adulthood, mice were fed either a control AIN-93G (0%), 50 g/kg (5%), or 150 g/kg (15%) hempseed-supplemented diet (n = 8 per group). Biweekly measurements of systolic, diastolic, and mean arterial pressure were collected using the tail-cuff method. Mice fed 5% or 15% hempseed versus the control diet exhibited no significant differences in systolic, diastolic, or mean arterial blood pressure (repeated measures ANOVA main effect of diet, p > 0.05). Blood pressure did not differ significantly between diet groups in adulthood (p > 0.05). However, mice fed a control or 5% hempseed, but not 15% hempseed, diet exhibited blood pressure changes across age marked by significant increases during early adulthood (weeks 11–17) versus early post-weaning (week 5) (p < 0.05). In conclusion, long-term dietary hempseed enrichment at 5% and 15% concentrations during development does not reduce adult blood pressure, but a 15% dose blunts the temporary increase in blood pressure during early adulthood seen in mice fed a control diet.

Behavioral regression in shank3Δex4-22 mice during early adulthood corresponds to cerebellar granule cell glutamatergic synaptic changes.

Shank3, a gene encoding a synaptic scaffolding protein, is implicated in autism spectrum disorder (ASD) and is disrupted in Phelan-McDermid syndrome (PMS). Despite evidence of regression or worsening of ASD-like symptoms in individuals with PMS, the underlying mechanisms remain unclear. Although shank3 is highly expressed in the cerebellar cortical granule cells, its role in cerebellar function and contribution to behavioral deficits in ASD models are unknown. This study investigates behavioral changes and cerebellar synaptic alterations in shank3 Δex4-22 mice at two developmental stages. Shank3 Δex4-22 wildtype, heterozygous, and homozygous knockout mice lacking exons 4-22 (all functional isoforms) were subjected to a behavioral battery in both juvenile (5-7 weeks old) and adult (3-5 months old) mouse cohorts of both sexes. Immunostaining was used to show the expression of SHANK3 in the cerebellar cortex. Spontaneous excitatory postsynaptic currents (sEPSCs) from cerebellar granule cells (CGCs) were recorded by whole-cell patch-clamp electrophysiology. Deletion of shank3 ex4-22 caused deficits in motor function, heightened anxiety, and repetitive behaviors. These genotype-dependent behavioral alterations were more prominent in adult mice than in juveniles. Reduced social preference was only identified in adult shank3 Δex4-22 knockout mice and self-grooming was uniquely elevated only in males across both age groups. Immunofluorescence staining indicates the presence of SHANK3 predominantly in the dendrite-containing rosette-like structures in CGCs, colocalizing with presynaptic markers of glutamatergic mossy fiber. Electrophysiological findings identify a parallel relationship between the age-related exacerbation of behavioral impairments and the enhancement of sEPSC amplitude in CGCs. Other behavioral tests of muscle strength (grip strength test), memory (Barnes/water maze), and communication (ultrasonic vocalization), were not performed. Further study is necessary to elucidate how SHANK3 modulates synaptic function at the mossy fiber-granule cell synapse in the cerebellum. Our findings reveal an age-related exacerbation of behavioral impairments in shank3 Δex4-22 mutant mice. These results suggest that SHANK3 may play a role in maintaining glutamatergic receptors and synapses in CGCs, as well as the potential involvement of the cerebellum in ASD.

A robust brain network for sustained attention from adolescence to adulthood that predicts later substance use.

Substance use, including cigarettes and cannabis, is associated with poorer sustained attention in late adolescence and early adulthood. Previous studies were predominantly cross-sectional or under-powered and could not indicate if impairment in sustained attention was a predictor of substance use or a marker of the inclination to engage in such behavior. This study explored the relationship between sustained attention and substance use across a longitudinal span from ages 14 to 23 in over 1000 participants. Behaviors and brain connectivity associated with diminished sustained attention at age 14 predicted subsequent increases in cannabis and cigarette smoking, establishing sustained attention as a robust biomarker for vulnerability to substance use. Individual differences in network strength relevant to sustained attention were preserved across developmental stages and sustained attention networks generalized to participants in an external dataset. In summary, brain networks of sustained attention are robust, consistent, and able to predict aspects of later substance use.

Aerobic Exercise Training for the Aging Brain: Effective Dosing and Vascular Mechanism.

This article presents evidence supporting the hypothesis that starting aerobic exercise in early adulthood and continuing it throughout life leads to significant neurocognitive benefits compared with starting exercise later in life. Regular aerobic exercise at moderate-to-vigorous intensity during midlife is associated with significant improvement in cardiorespiratory fitness, which may create a favorable brain microenvironment promoting neuroplasticity through enhanced vascular function.

Effectiveness of Plant Oils for Bio-intensive Control of Uzi Fly Infestation in Mulberry Silkworm (Bombyx mori): A Comparative Study

A study was carried out to assess the effect of plant oils against the uzi fly (Exorista sorbillans Weidemann) and the mulberry silkworm (Bombyx mori Louis), at three different concentrations: 0.2, 0.4, and 0.8 percent. Among the treatments, 0.8 % of neem (Azadirachta indica) oil recorded reduced number of eggs laid (fecundity) (40.33), egg hatchability (46,00 %), and maggot recovery (34.00 %), followed by karanj (Pongamia pinnata) oil (54.00, 52,67 and 50.00%, respectively) and was statistically superior to control (114.33, 93.00% and 92%) and Nesolynx thymus (107.67, 90.00 and 89.00%). Significantly higher maggot (larvae) mortality was observed with 0.8 per cent neem oil (65.33 %), followed by karanj oil (35.33 %) compared to castor oil (24.67 %), and control treatment (11.00%). Spraying plant oil from neem and karanj, also drastically reduced the pupation rate %, adult emergence%, adult longevity, and fecundity of the uzi fly.

Knockdown of the glucosamine-6-phosphate N-acetyltransferase gene by RNA interference enhances the virulence of entomopathogenic fungi against rice leaffolder Cnaphalocrocis medinalis

Insect cuticle acts as a first line of defense and a physical protective barrier against entomopathogens. Chitin biosynthesis pathway plays a crucial role in chitin formation in the cuticle of insects. Glucosamine-6-phosphate N-acetyltransferase (GNA) is a key enzyme in insect chitin biosynthesis that regulate the chitin formation. However, how GNA-mediated cuticle metabolism influences virulence of entomopathogenic fungi is still unknown. In this study, CmGNA gene was cloned and characterized from the rice leaffolder Cnaphalocrocis medinalis. The CmGNA contains an open read frame (ORF) 600 nucleotides, encoding 199 amino acids with an isoelectric point of 8.65 and a molecular weight of 22.30 kDa. The expression profile showed that CmGNA was highly expressed in 4th instar larvae and in the cuticle. Here, we also reported the impact of CmGNA gene and entomopathogenic fungi, Metarhizium anisopliae and Beauveria bassiana, on expression pattern of chitin biosynthesis genes, feeding behavior, survival rate and average body weight of infected larvae, phenotypic deformities, rate of pupation, and adult emergence. Our results showed that knockdown of CmGNA and application of M. anisopliae and B. bassiana three days after RNA interference (RNAi) significantly decreased the expression of CmGNA and other associated genes, reduced feeding efficiency and survival rate, and caused loss of average body weight, less rate of pupation and adult emergence of infected larvae. Knockdown of CmGNA gene also increased the lethality of larvae caused by M. anisopliae and B. bassiana and resulted in significantly phenotypic deformities of infected larvae. Our findings illustrated that RNAi-mediated CmGNA knockdown disturbed the chitin synthesis genes that led to enhancing the virulence of M. anisopliae and B. bassiana, which can provide us new insights to develop novel biocontrol strategies against C. medinalis.

Pre-existing maternal cardiovascular disease and the risk of offspring cardiovascular disease from infancy to early adulthood.

A variety of maternal heart conditions are associated with abnormal placentation and reduced foetal growth. However, their impact on offspring's long-term cardiovascular health is poorly studied. This study aims to investigate the association between intrauterine exposure to pre-existing maternal cardiovascular disease (CVD) and offspring CVD occurring from infancy to early adulthood, using paternal CVD as a negative control. This nationwide cohort study used register data of live singletons without major malformations or congenital heart disease born between 1992 and 2019 in Sweden. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusted for essential maternal characteristics. Paternal CVD served as a negative control for assessment of unmeasured genetic and environmental confounding. Of the 2 597 786 offspring analysed (49.1% female), 26 471 (1.0%) were born to mothers with pre-existing CVD. During a median follow-up of 14 years (range 1-29 years), 17 382 offspring were diagnosed with CVD. Offspring of mothers with CVD had 2.09 times higher adjusted HR of CVD (95% CI 1.83, 2.39) compared with offspring of mothers without CVD. Compared with maternal CVD, paternal CVD showed an association of smaller magnitude (HR 1.49, 95% CI 1.32, 1.68). Increased hazards of offspring CVD were also found when stratifying maternal CVD into maternal arrhythmia (HR 2.94, 95% CI 2.41, 3.58), vascular (HR 1.59, 95% CI 1.21, 2.10), and structural heart diseases (HR 1.48, 95% CI 1.08, 2.02). Maternal CVD was associated with an increased risk of CVD in offspring during childhood and young adulthood. Paternal comparison suggests that genetic or shared familial factors may not fully explain this association.

Association of alcohol consumption with hypertension or prehypertension in Chinese adolescent: A cohort study of the China Health and Nutrition Survey.

This study was conducted to investigate the association between alcohol consumption in adolescence and the risk of hypertension or prehypertension development in early adulthood. This cohort study included adolescent participants aged 12-18 years from the 2000-2011 China Health and Nutrition Survey. Cox proportional risk regression models were used to analyze the associations of the frequency of alcohol consumption, alcohol intake, and type of alcohol with the risk of developing hypertension or prehypertension. Restricted cubic spline analysis was used to assess the dose-response relationships for alcohol intake and their hazard ratios (HRs). A total of 1556 participants were included in the final analysis. Among the overall population, 448 (30.81%) and 35 (34.31%) participants developed hypertension or prehypertension, respectively. Compared with no alcohol consumption, alcohol consumption ≥ 2 times/week and consumption of ≥2 types of alcohol were associated with an increased risk of hypertension and prehypertension, with HRs of 1.97 (95% confidence interval [CI] 1.17-3.34; p=0.011) and 1.77 (95% CI 1.01-3.09; p=0.046), respectively. Alcohol intake of>96mL/week was associated with an increased risk of hypertension and prehypertension, with HRs of 2.09 (95% CI 1.12-3.90; p=0.020) and 2.07 (95% CI 1.11-3.84; p=0.021), respectively. The restricted cubic spline analysis showed that the risk of developing high blood pressure or prehypertension tends to increase with increasing alcohol consumption. Heavy alcohol consumption in adolescence increased the risk of developing hypertension and prehypertension in early adulthood.

Differences in Grey Matter Concentrations and Functional Connectivity between Young Carriers and Non-Carriers of the APOE ε4 Genotype.

Background: The pathophysiology of Alzheimer's disease (AD) may begin developing years or even decades prior to the manifestation of its first symptoms. The APOE ε4 genotype is a prominent genetic risk for AD that has been found to be associated with brain changes across the lifespan since early adulthood. Thus, studying brain changes that may occur in young adults with an APOE ε4 status is highly relevant. Objective: Examine potential differences in grey matter (GM) and functional connectivity (FC) in brains of cognitively healthy young APOE ε4 carriers and non-carriers, denoted here as ε4(+) and ε4(-), respectively. Methods: Three Tesla magnetic resonance imaging (MRI) brain scans were acquired from cognitively healthy young participants aged approximately 20 years (n = 151). Voxel-based morphometry (VBM) analysis was employed to identify potential structural differences in GM between ε4(+) and ε4(-). In a subsequent seed-based connectivity (SBC) analysis, brain regions that structurally differed in the VBM analysis were considered as seeds and correlated with all the remaining voxels across the brains to then measure the differences in FC between groups. Results: The VBM analysis suggested that ε4(+) (n = 28) had greater GM densities relative to ε4(-) (n = 123) in the left hippocampus and the left posterior insula (puncorr < 0.001). However, the effect did not survive the correction for multiple comparisons, suggesting minimal structural differences in this age range. In contrast, the SBC analysis indicated that ε4(+) exhibited significantly decreased FC between the left hippocampus and areas of the left middle temporal gyrus (n = 27) compared to ε4(-) (n = 102). These results remained significant after multiple comparisons (pFDR < 0.05). Lastly, no statistically significant differences in FC between groups were observed for the left insular seed (pFDR > 0.05). Discussion: These results suggest early structural and functional brain changes associated with the APOE ε4 genotype on young adults. Yet, they must be cautiously interpreted and contrasted with both older adults with genetic risk for AD and patients diagnosed with AD.

Postpartum Psychosis as a Precursor to Schizophrenia: A Comprehensive Review.

Postpartum psychosis (PP) is a rare and severe mental health disorder occurring shortly after childbirth, characterized by symptoms such as delusions, hallucinations, and intense mood swings. This review examines the potential link between PP and the later development of schizophrenia, a chronic psychiatric condition that typically emerges in late adolescence or early adulthood. By reviewing existing literature and analyzing epidemiological and clinical data, this review aims to clarify whether PP can be a precursor to schizophrenia. Findings suggest that while the transition from PP to schizophrenia is not inevitable, there is an increased risk, with some studies indicating that a subset of women with PP may develop a chronic psychotic disorder later on. This underscores the importance of early detection, ongoing monitoring, and targeted interventions. The review emphasizes the need for improved diagnostic practices and preventive measures to better manage PP and its potential long-term effects. Enhanced understanding of this relationship can inform more effective treatment strategies and support better mental health outcomes for new mothers. Future research should focus on refining risk assessment tools, exploring underlying mechanisms, and developing comprehensive management approaches to address the challenges associated with PP and its potential progression to schizophrenia.

Psychosocial impact of hoarding symptoms in college students and the potential for early intervention

Objective: Hoarding disorder is a chronic and progressive psychiatric disorder that often begins in adolescence and early adulthood. The purpose of this study was to investigate the impact of hoarding severity on college students’ psychosocial functioning and possible methods of early intervention. Participants: Undergraduate students (N = 363) at a large public university in the United States. Methods: Participants completed a self-report battery that included their parental history of clutter, perceptions about possible interventions for clutter, and standardized measures of hoarding severity, psychiatric symptoms, and psychosocial functioning. Results: Hoarding symptom severity predicted significant unique variance in emotional support and companionship, even when controlling for comorbid psychiatric symptoms. The main reasons endorsed by participants for disorganization of their objects despite adequate storage space were “lack of time” (37%), “easily distracted” (26%), and “procrastination” (34%). Conclusions: Emerging adults may benefit from early intervention focused on time management, attentional control, and consistent motivation.

Longitudinal Changes in Bone Mineral Density in Adults with Cystic Fibrosis.

Improved survival in people with cystic fibrosis (pwCF) presents new complexities of care, including CF-related bone disease, a common complication in older pwCF. The trajectory of bone loss with age in this population remains unclear. The objective of this study was to estimate the average rate of change in bone mineral density (BMD) in adults with CF. This retrospective study included adults with CF, aged 25-48years, followed between January 2000 and December 2021. Subjects with at least one dual-energy X-ray absorptiometry (DXA) scan were included. Scans obtained post-transplantation, after the initiation of bisphosphonates or cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy were excluded. The primary outcome was BMD (g/cm2) at the lumbar spine (LS) and femoral neck (FN). A linear mixed-effects model with both random intercept and random slope terms was used to estimate the average annual change in BMD. A total of 1502 DXA scans in 500 adults (average age 28.4y) were included. There was a statistically significant annual decline in BMD of -0.008 gm/cm2/year (95% CI -0.009, -0.007) at the FN and -0.006 gm/cm2/year (95% CI -0.007, -0.004) at the LS. Relative to BMD at age 25, there was a -18.8% decline at the FN by age 48years and a -11% decline at the LS. Pancreatic insufficient (PI) subjects had a faster rate of decline in BMD compared to pancreatic sufficient (PS) subjects. After adjusting for markers of disease severity, the annual rate of decline remained significant. Individuals with CF experience bone loss at an age when it is not anticipated, thereby entering early adulthood, where further bone loss is inevitable especially with the decrease in estrogen during menopause, with suboptimal BMD. As the CF population ages, it will become very important to consider interventions to maximize bone health.

The relative age effect in selection of ab initio pilots–Revisiting Gladwell's famous claims

A relative age effect (RAE) has been found in education and sports, with students born earlier in the school year attaining higher levels of success. This was brought into public consciousness through Malcom Gladwell's Outliers: The Story of Success. However, the effect has not been thoroughly examined in other contexts. Thus, with regards to the context dependency of the RAE, and the specificity of which abilities it affects, there are unknowns. The aim of the present study was to scrutinize the tests in use in commercial aviation and explore whether there is a bias based on birthdate in competitive selection procedures assessing operational and cognitive abilities, outside of traditional education. Potential suboptimal selection has implications for flight safety. Associations were studied between relative age and test scores (of cognitive ability, manual spatial ability, and multitasking ability), as well as acceptance for higher education in commercial aviation in Sweden, in 1113 ab initio candidates. Relative age neither had a significant correlation with any of the six performance scores, nor with an aggregated factor score (r = −0.009, p = 0.791), nor predicted flight-school admission (b = 0.036, p = 0.210). Chronological age was associated with manual spatial ability, yet neither correlated with aggregate score nor with admission. The results may be an indication of the RAE having faded in early adulthood, and/or that indirect exposure of education does not benefit candidates in operational tests in early adulthood. Thus, neither relative age nor chronological age seemed to bias the results. For the effects of RAE to persist– or occur in operational abilities– competition between candidates in selection and subsequent relevant exposure (e.g., training/schooling), may be needed. Overall cognitive ability is likely more predictive of success when variance in specific enhancing exposure is limited.