End Date Research Articles

Unraveling the effects of snow cover change on vegetation productivity: Insights from underlying surface types

AbstractChanges in snow cover have an important effect on vegetation gross primary productivity (GPP), but the role of underlying surface types in this effect still remains unclear. The underlying surface refers to the surface of the Earth and is located at the bottom of the snow cover during the snow season. Here, we focus on the influence of snow cover change on GPP in Northeast China from 1982 to 2015, revealing the various dependencies of the association between snow cover and GPP on forest, grassland, and dryland. The results show that the increases in GPP in dryland and grassland are primarily influenced by the increase in snow water equivalent, while the variations in GPP in forest are primarily influenced by snow phenological indicators, with snow cover end date and snow cover days dominating GPP in the early and peak growing seasons, respectively. Additionally, snow cover can have a rather strong time‐lagged effect on GPP by changing the soil temperature in dryland. Our findings emphasize the importance of considering underlying surface types in the snow–GPP relation and provide insight into how climate change may affect ecosystems in regions with comparable underlying surface types.

Real-World Evidence of FOLFIRI Combined with Anti-Angiogenesis Inhibitors or Anti-EGFR Antibodies for Patients with Early Recurrence Colorectal Cancer After Adjuvant FOLFOX/CAPOX Therapy: A Japanese Claims Database Study.

Oxaliplatin-containing adjuvant regimens (folinic acid, fluorouracil, and oxaliplatin/capecitabine and oxaliplatin [FOLFOX/CAPOX]) are used after curative resection of colorectal cancer (CRC). However, real-world evidence regarding treatment sequences and outcomes in patients with early recurrence CRC after adjuvant chemotherapy is limited. We aimed to describe the patient characteristics, treatment sequence, and overall duration of second-line (2L) therapy in patients with early recurrence CRC who received adjuvant chemotherapy (FOLFOX/CAPOX) followed by folinic acid, fluorouracil, and irinotecan (FOLFIRI) + anti-angiogenesis drugs (AA) or FOLFIRI + anti-epidermal growth factor receptor (EGFR) antibodies. This retrospective study analyzed Japanese administrative data from November 2014 to March 2023 of adult patients who underwent CRC resection surgery, started FOLFOX/CAPOX ≤3 months (mo) after surgery, and had early CRC recurrence. Early recurrence was defined as initiation of FOLFIRI+AA or FOLFIRI+anti-EGFR antibodies as 2L therapy, ≤12 mo of discontinuing adjuvant chemotherapy. Patient characteristics, treatment sequence, median time to treatment discontinuation (mTTD), i.e., duration between the start and end dates of 2L therapy (Kaplan-Meier method), and factors associated with 2L time to treatment discontinuation constituted the study outcomes (Cox regression model). Subgroup analyses were performed for timing of early CRC recurrence (≤6 mo and 6-12 mo) and tumor sidedness. Among the 832 selected patients (median age [minimum-maximum] 67 (24-86) years, 56.4% male), CAPOX (71.3%) was more commonly used than FOLFOX (28.7%) as adjuvant therapy. FOLFIRI+AA (72.5%) was used more commonly than FOLFIRI+anti-EGFR antibodies (27.5%) in 2L. AA and anti-EGFR antibodies groups had similar mTTD: 6.2 mo (95% confidence interval 5.8, 6.9) and 6.1 mo (95% confidence interval 5.2, 7.4). Age ≥70 years showed significant association with shorter 2L treatment duration (hazard ratio 1.2, 95% confidence interval 1.0, 1.4; p = 0.03). The AA cohort's mTTD was numerically shorter in the ≤6 mo recurrence subgroup compared with the 6-12 mo recurrence subgroup (6.1 mo vs 8.1 mo); the anti-EGFR antibodies cohort had similar mTTD (5.8 mo vs 6.2 mo). The AA and anti-EGFR antibodies cohorts also had similar mTTD in the left-sided CRC subgroup (6.5 mo vs 6.2 mo), but not in the right-sided subgroup (5.6 mo vs 3.9 mo). This is the first administrative data-based real-world evidence on treatment sequence and outcomes for patients with early recurrence CRC treated with FOLFIRI+AAs or FOLFIRI+ anti-EGFR antibodies after adjuvant FOLFOX/CAPOX therapy in Japan. Both regimens had similar TTD, but relapse timing and tumor sidedness may influence their efficacy.

Effectiveness of BNT162b2 COVID-19 primary series vaccination in children aged 5–17 years in the United States: a cohort study

BackgroundCOVID-19 vaccines are authorized for use in children in the United States; real-world assessment of vaccine effectiveness in children is needed. This study’s objective was to estimate the effectiveness of receiving a complete primary series of monovalent BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine in US children.MethodsThis cohort study identified children aged 5–17 years vaccinated with BNT162b2 matched with unvaccinated children. Participants and BNT162b2 vaccinations were identified in Optum and CVS Health insurance administrative claims databases linked with Immunization Information System (IIS) COVID-19 vaccination records from 16 US jurisdictions between December 11, 2020, and May 31, 2022 (end date varied by database and IIS). Vaccinated children were followed from their first BNT162b2 dose and matched to unvaccinated children on calendar date, US county of residence, and demographic and clinical factors. Censoring occurred if vaccinated children failed to receive a timely dose 2 or if unvaccinated children received any dose. Two COVID-19 outcome definitions were evaluated: COVID-19 diagnosis in any medical setting and COVID-19 diagnosis in hospitals/emergency departments (EDs). Propensity score-weighted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models, and vaccine effectiveness (VE) was estimated as 1 minus HR. VE was estimated overall, within age subgroups, and within variant-specific eras. Sensitivity, negative control, and quantitative bias analyses evaluated various potential biases.ResultsThere were 453,655 eligible vaccinated children one-to-one matched to unvaccinated comparators (mean age 12 years; 50% female). COVID-19 hospitalizations/ED visits were rare in children, regardless of vaccination status (Optum, 41.2 per 10,000 person-years; CVS Health, 44.1 per 10,000 person-years). Overall, vaccination was associated with reduced incidence of any medically diagnosed COVID-19 (meta-analyzed VE = 38% [95% CI, 36–40%]) and hospital/ED–diagnosed COVID-19 (meta-analyzed VE = 61% [95% CI, 56–65%]). VE estimates were lowest among children 5–11 years and during the Omicron-variant era.ConclusionsReceipt of a complete BNT162b2 vaccine primary series was associated with overall reduced medically diagnosed COVID-19 and hospital/ED–diagnosed COVID-19 in children; observed VE estimates differed by age group and variant era.RegistrationThe study protocol was publicly posted on the BEST Initiative website (https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf).

Tuberculosis and osteoporotic fracture risk: development of individualized fracture risk estimation prediction model using a nationwide cohort study.

Tuberculosis (TB) is linked to sustained inflammation even after treatment, and fracture risk is higher in TB survivors than in the general population. However, no individualized fracture risk prediction model exists for TB survivors. We aimed to estimate fracture risk, identify fracture-related factors, and develop an individualized risk prediction model for TB survivors. TB survivors (n = 44,453) between 2010 and 2017 and 1:1 age- and sex-matched controls were enrolled. One year after TB diagnosis, the participants were followed-up until the date of fracture, death, or end of the study period (December 2018). Cox proportional hazard regression analyses were performed to compare the fracture risk between TB survivors and controls and to identify fracture-related factors among TB survivors. During median 3.4 (interquartile range, 1.6-5.3) follow-up years, the incident fracture rate was significantly higher in TB survivors than in the matched controls (19.3 vs. 14.6 per 1,000 person-years, p < 0.001). Even after adjusting for potential confounders, TB survivors had a higher risk for all fractures (adjusted hazard ratio 1.27 [95% confidence interval 1.20-1.34]), including hip (1.65 [1.39-1.96]) and vertebral (1.35 [1.25-1.46]) fractures, than matched controls. Fracture-related factors included pulmonary TB, female sex, older age, heavy alcohol consumption, reduced exercise, and a higher Charlson Comorbidity Index (p < 0.05). The individualized fracture risk model showed good discrimination (concordance statistic = 0.678). TB survivors have a higher fracture risk than matched controls. An individualized prediction model may help prevent fractures in TB survivors, especially in high-risk groups.

Health service use of infants involved in family justice care and supervision proceedings in Wales: a data linkage study

IntroductionWhen a child has suffered, or is at risk of suffering, significant harm from parents or caregivers, the local authority may issue Section 31 (s.31) Care and Supervision proceedings under the Children Act (1989). ObjectivesWe compared the healthcare use of infants less than one year old subject to s.31 proceedings in Wales (n = 1,332),to that of a comparison group of infants not subject to s.31 proceedings (n = 204,417), between January 2011 and February 2020. MethodsPopulation-based e-cohort study utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. Infants in s.31 proceedings were identified using the Children and Family Court Advisory and Support Service dataset. This was linked to demographic and healthcare datasets, to identify General Practice (GP) visits, emergency department (ED) attendances, and hospital admissions (emergency and elective); before the study end date or the child's first birthday for the comparison group, orbefore the s.31 application date.Regression analysis calculated event rate ratios [RR] and incidence rate ratios [IRR] for healthcare events, adjusting for widerdeterminants of health (e.g. perinatal factors, maternal mental health, deprivation), and investigated reasons for healthcare use. ResultsInfants in s.31 proceedings had ahigher number and incidence of healthcare events compared with the comparison group, across all healthcare settings. Differences were greatest for emergency hospital admissions (IRR = 4.03, 95% confidence interval [CI] = 3.53 - 4.59; RR = 4.60, CI = 3.90 - 5.41). "Injury and poisoning" was the main reason for emergency admissions amongst infants in s.31 proceedings. For ED presentations, emergency hospital admissions, and GP visits, there were proportionally more events for these infants across all top ten reasons for healthcare. ConclusionsFindings highlight greater healthcare utilisation for infants involved in s.31 proceedings in Wales, helping to build a better understanding of their needs and vulnerabilities.

Impact of right ventriculotomy on cardiac function after pulmonary valve sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis.

Pulmonary valve-sparing repair of tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis has the advantage of reduced incidence of late pulmonary valve regurgitation and better-preserved cardiac function. However, a right ventriculotomy is sometimes necessary in order to adequately relieve subvalvular pulmonary stenosis. We aimed to compare postoperative cardiac function and patients' symptoms between pulmonary valve-sparing repair with and without right ventriculotomy. We retrospectively collected data from electronic medical records of Ramathibodi Hospital from 1st January 2013 to 31st October 2023. Patients diagnosed with tetralogy of Fallot and double outlet right ventricle with pulmonary stenosis who underwent pulmonary valve-sparing repair were included. Patients who underwent other types of repairs and whose medical record data were significantly missing were excluded. Demographic data, operative, and postoperative details were collected and reviewed. There were 49 patients included in our study with 10 patients undergoing pulmonary valve-sparing repair with and the other 39 without right ventriculotomy. Before-discharge echocardiographic parameters were generally similar between both groups (tricuspid annular plane systolic excursion = 0.9 versus 0.89 cm, P = 0.737; pressure gradient across pulmonary valve across pulmonary valve = 24 versus 19 mmHg, P = 0.275; left ventricular end-systolic volume index = 17.84 versus 19.19 ml/m2, P = 0.437; left ventricular end-diastolic volume index = 63.79 versus 61.13 ml/m2, P = 0.436). Patients' symptoms were also not statistically different. There was no early and late death up to the end date of our study. Right ventriculotomy in pulmonary valve-sparing repair did not result in worse postoperative cardiac function and symptoms. This suggested that the previously thought-to-be hazardous incision could be strongly considered if mandated.

On the survival and habitat use of hatchery-reared cisco (Coregonus artedi) in Lake Erie

Cisco (Coregonus artedi) have been extirpated from Lake Erie in North America since the 1960s, but they once supported one of the largest Laurentian Great Lakes fisheries. Numerous potential impediments to rehabilitation have been identified, including summer habitat refugia and predation. We used acoustic telemetry to investigate the thermal habitat use and survival of hatchery-reared adult cisco in Lake Erie. Fish were experimentally released (n = 50 per site) offshore at Dunkirk, New York, in the eastern basin and Huron, Ohio, in the central basin. Cisco in both basins found suitable summer oxythermal habitat in the metalimnion, suggesting that coldwater habitat availability is likely not an impediment for reestablishment. However, track end dates or predation dates were distributed across only four months with the last detection at 155 days. Predation sensors combined with temperature values during digestion indicated different potential predators: lake trout (Salvelinus namaycush) for the Dunkirk group and walleye (Sander vitreus) for the Huron group. Additionally, digestion temperatures of two tags indicated bird predation was also important, likely underestimated and suggested substantial use of the epilimnion by tagged fish. The results highlight the need for additional studies to address stocking optimization questions in support of future reintroduction experiments and related cisco conservation efforts.

A new temperature–photoperiod coupled phenology module in LPJ-GUESS model v4.1: optimizing estimation of terrestrial carbon and water processes

Abstract. Vegetation phenological shifts impact the terrestrial carbon and water cycle and affect the local climate system through biophysical and biochemical processes. Dynamic global vegetation models (DGVMs), serving as pivotal simulation tools for investigating climate impacts on terrestrial ecosystem processes, incorporate representations of vegetation phenological processes. Nevertheless, it is still a challenge to achieve an accurate simulation of vegetation phenology in the DGVMs. Here, we developed and implemented spring and autumn phenology algorithms into one of the DGVMs, LPJ-GUESS. The new phenology modules are driven by temperature and photoperiod and are parameterized for deciduous trees and shrubs by using remotely sensed phenological observations and the reanalysis data from ERA5. The results show that the LPJ-GUESS with the new phenology modules substantially improved the accuracy in capturing the start and end dates of growing seasons. For the start of the growing season, the simulated RMSE for deciduous trees and shrubs decreased by 8.04 and 17.34 d, respectively. For the autumn phenology, the simulated RMSE for deciduous trees and shrubs decreased by 22.61 and 17.60 d, respectively. Interestingly, we have also found that differences in the simulated start and end of the growing season also alter the simulated ecological niches and competitive relationships among different plant functional types (PFTs) and subsequentially influence the terrestrial carbon and water cycles. Hence, our study highlights the importance of accurate phenology estimation to reduce the uncertainties in plant distribution and terrestrial carbon and water cycling.

Comparison of Tuberculin Skin Testing and Interferon-γ Release Assays in Predicting Tuberculosis Disease

Elimination of tuberculosis (TB) disease in the US hinges on the ability of tests to detect individual risk of developing disease to inform prevention. The relative performance of 3 available TB tests-the tuberculin skin test (TST) and 2 interferon-γ release assays (IGRAs; QuantiFERON-TB Gold In-Tube [QFT-GIT] and SPOT.TB [TSPOT])-in predicting TB disease development in the US remains unknown. To compare the performance of the TST with the QFT-GIT and TSPOT IGRAs in predicting TB disease in high-risk populations. This prospective diagnostic study included participants at high risk of TB infection (TBI) or progression to TB disease at 10 US sites between 2012 and 2020. Participants of any age who had close contact with a case patient with infectious TB, were born in a country with medium or high TB incidence, had traveled recently to a high-incidence country, were living with HIV infection, or were from a population with a high local prevalence were enrolled from July 12, 2012, through May 5, 2017. Participants were assessed for 2 years after enrollment and through registry matches until the study end date (November 15, 2020). Data analysis was performed in June 2023. At enrollment, participants were concurrently tested with 2 IGRAs (QFT-GIT from Qiagen and TSPOT from Oxford Immunotec) and the TST. Participants were classified as case patients with incident TB disease when diagnosed more than 30 days from enrollment. Estimated positive predictive value (PPV) ratios from generalized estimating equation models were used to compare test performance in predicting incident TB. Incremental changes in PPV were estimated to determine whether predictive performance significantly improved with the addition of a second test. Case patients with prevalent TB were examined in sensitivity analysis. A total of 22 020 eligible participants were included in this study. Their median age was 32 (range, 0-102) years, more than half (51.2%) were male, and the median follow-up was 6.4 (range, 0.2-8.3) years. Most participants (82.0%) were born outside the US, and 9.6% were close contacts. Tuberculosis disease was identified in 129 case patients (0.6%): 42 (0.2%) had incident TB and 87 (0.4%) had prevalent TB. The TSPOT and QFT-GIT assays performed significantly better than the TST (PPV ratio, 1.65 [95% CI, 1.35-2.02] and 1.47 [95% CI, 1.22-1.77], respectively). The incremental gain in PPV, given a positive TST result, was statistically significant for positive QFT-GIT and TSPOT results (1.64 [95% CI, 1.40-1.93] and 1.94 [95% CI, 1.65-2.27], respectively). In this diagnostic study assessing predictive value, IGRAs demonstrated superior performance for predicting incident TB compared with the TST. Interferon-γ release assays provided a statistically significant incremental improvement in PPV when a positive TST result was known. These findings suggest that IGRA performance may enhance decisions to treat TBI and prevent TB.

Market Dynamics: Enhancing Supply Chain Efficiency Through Demand Prediction

This research gives a state-of-the-art solution for web-based demand forecasting. Machine learning methods are employed to build the approach, which takes use of Seasonal Autoregressive Integrated Moving Average (SARIMA) modeling. Customers may utilize our system to provide product codes combined with the period's start and end dates in order to correctly anticipate future demand patterns. Through the combination of previous sales data with current market circumstances, competitive plans, and other external variables, our system is able to discover complicated consumer patterns. This gives data that may be utilized for inventory management, pricing strategies, and production scheduling. All things considered, the holistic plan optimizes resource usage, eliminates waste, and supports consumer satisfaction. A data-driven solution that takes advantage of AI capabilities is being offered as part of this joint endeavor. This solution is positioned to assist numerous sectors, including manufacturing, retail, and healthcare, and it will boost operational efficiency and sustainable development in a global economic framework. Keywords— Product Demand Forecasting, Inventory Management, Production Planning, Time Series Analysis, Predictive Analytics, Inventory Optimization, Demand Prediction System, Real-time Forecasting, Data-driven Decision Making, Supply Chain Optimization, Price Elasticity Analysis, Demand Volatility Management, Retail Analytics.

Dashboard Design for New Employee Candidate Program at XYZ Bank Using Tabelau

Bank XYZ is one of the government-owned companies engaged in banking and is one of the largest banks in Indonesia. Bank XYZ has a division called XYZ Corpu which aims to support the company's business operations by developing employee competencies. One of the training programs conducted at XYZ Corpu is the ODP (Officer Development Program). ODP participants are prospective XYZ Bank employees who enter through several selection stages and then carry out training for 12 months which applies a knockout system if the participants are not competent. ODP participants will undergo 12 months of education and training with several stages of the journey. To make it easier to get important information such as the distribution of participants based on the location of the placement division, placement city, distribution of journey end dates, and journey stages. So this research designs a dashboard to make it easier for management to get important information for decision making. This research uses Pentaho tools to perform ETL processes and Tableau tools to create dashboards. Based on the design made, the dashboard user/manager can anticipate or detect early delays in the process of making rundowns for the next journey stage through this dashboard. Based on the OLAP design of this research, the ODP distribution fact table and dimension table consisting of location, journey, city, start date, end date, batch, gender, university and major are formed. Based on the design made, dashboard users/managers can anticipate or detect early delays in the process of making rundowns for the next journey stage through this dashboard. With this dashboard, it can find out the most universities and study programs for more precise decision making. The dashboard created in this study has a data filtering feature that is useful for searching for certain data more quickly.

Nuclear fusion losing the race with global warming

According to plans for development of fusion energy, the first stage is construction of device tokamak ITER [1] with main task of establishing burning gas plasma with required stability and duration. This stage should be accomplished by 2035, starting in 2005. The next stage should be the construction of complex DEMO [2] with the task of producing all the equipment for energy production and finally producing large amounts of carbon free energy. We do not want to make predictions on the outcome of fusion program, wishing the final success to the thousands of scientists and engineers who are contributing to this heroic effort. However, there are reasons to think (Seife [18], Stork[7]) that the time is too short. Starting with a planned date of end of work with ITER by 2035, we estimate that one needs to add 25 years for development of DEMO. By 2060 it would be too late to initiate actions to stop global warming. In the present situation we propose the intervention use of nuclear fission energy. New nuclear fission energy of PWR type could be available not later than 2034, some 25 years before expected fusion energy device could start. Our proposal could be of dramatic importance depending on the evolution of global warming.

Investigating Father or Partner Involvement in Family Integrated Care in Neonatal Units: Protocol for a Prospective, Multicenter, Multiphase Study

Neonatal unit (NU) admissions for premature babies can last for months, which can significantly impact parental mental health (MH) with symptoms of depression, stress, and anxiety. Literature suggests fathers experience comparable MH symptoms to mothers. Family integrated care (FICare) is a culture where parents are collaborators and partners in caring for their hospitalized newborns. FICare improves infant outcomes and maternal MH. Similar reports on fathers are limited. The primary aim of this study is to investigate the impact of supporting father or partner engagement in FICare of preterm infants on their MH up to 6 weeks postdischarge. The secondary aim is to investigate the impact on maternal MH. This is a 2-phase study: phase 1 to gather baseline information and phase 2 to assess the impact of enhanced father or partner engagement in FICare on their MH, involving 2 NUs (tertiary and level 2). Enhanced FICare will be developed and introduced (eg, information booklet, workbook, classes, and a father peer-support group) alongside standard FICare practices. Father or partner MH will be assessed with semistructured qualitative interviews and validated questionnaires: Generalized Anxiety Disorder Assessment, Patient Health Questionnaire, and Parental Stressor Scale: Neonatal Intensive Care Unit from NU admission to 6 weeks postdischarge. Mothers will be assessed by focus groups and the same questionnaires. Descriptive statistics and appropriate comparative tests, such as the 2-tailed t test, will be used to analyze and compare phase 1 and 2 data. Qualitative data will be coded line by line with the use of NVivo (Lumivero) and thematically analyzed. Simultaneously, systematic reviews (SRs) of fathers' experiences of FICare and their MH outcomes will be conducted. The study was approved by the National Research Ethics Committee (22/EM/0140) in August 2022. A parent advisory group was formed to advise on the study methodology, materials, involvement of participant parents, and dissemination of study findings. A recent SR demonstrated that data saturation is likely to be achieved by interviewing 9 to 17 participants. We will study a maximum of 20 parents of infants born at less than 33 weeks' gestation in each phase. As of October 2023, the study was ongoing. The SR studies are registered with the PROSPERO database (324275 and 306760). The projected end date for data collection is July 2024; data analysis will be conducted in November 2024 and publication will occur in 2025. The study aims to demonstrate the feasibility of using a father or partner-sensitive FICare model for parents of premature babies with a positive impact on their MH. It will demonstrate the feasibility of providing FICare to extremely premature babies receiving intensive care. This study may support the development of inclusive FICare guidelines for nonbirthing parents and their extremely premature infants. ClinicalTrials.gov: NCT06022991; https://classic.clinicaltrials.gov/ct2/show/NCT06022991. DERR1-10.2196/53160.

Impacts of climate change on airborne Quercus pollen trends in Andalusia region (southern Spain)

Quercus species are the most frequent autochthonous arboreal taxa in the natural areas of Andalusia region (southern Spain). Due to their abundance and anemophilous character, high airborne pollen concentrations are detected in natural and urban areas of the region. Variations in its reproductive phenology can be considered an important bio-indicator regarding the impacts of climate change on vegetation in the Mediterranean region. This study aims to analyze trends in flowering patterns using airborne pollen concentrations from the capital cities of the 8 provinces of Andalusia region and to study its relationships with meteorological parameters and climate change over decades. Variations in time and intensity of flowering have been studied using different methods for defining the pollen season. This study demonstrates that for comparing results, it is relevant to choose the right definition to calculate the pollen season. The analysis of historical databases of Quercus airborne pollen in Andalusia showed variations in the floral phenology with an increase in the intensity of the pollen season throughout the studied period and an advance in the start trends due to the increase of temperature. Nevertheless, this increase might have been smoothed by the decrease of precipitations in some sampler locations, a limiting factor in the area. It has been also observed a delay in the end dates that caused a lengthening of the season. Climate change could be provoking longer and more intense pollen seasons that will lead to more intense and persistent symptoms in sensitive patients.

Phenological characteristics of net ecosystem carbon exchange of Stipa krylovii steppe in Inner Mongolia, China and its remote sensing monitoring.

To accurately monitor the phenology of net ecosystem carbon exchange (NEE) in grasslands with remote sensing, we analyzed the variations in NEE and its phenology in the Stipa krylovii steppe and discussed the remote sensing vegetation index thresholds for NEE phenology, with the observational data from the Inner Mongolia Xilinhot National Climate Observatory's eddy covariance system and meteorological gradient observation system during 2018-2021, as well as Sentinel-2 satellite data from January 1, 2018 to December 31, 2021. Results showed that, from 2018 to 2021, NEE exhibited seasonal variations, with carbon sequestration occurring from April to October and carbon emission in other months, resulting in an overall carbon sink. The average Julian days for the start date (SCUP) and the end date (ECUP) of carbon uptake period were the 95th and 259th days, respectively, with an average carbon uptake period lasting 165 days. Photosynthetically active radiation showed a negative correlation with daily NEE, contributing to carbon absorption of grasslands. The optimal threshold for capturing SCUP was a 10% threshold of the red-edge chlorophyll index, while the normalized difference vegetation index effectively reflected ECUP with a threshold of 75%. These findings would provide a basis for remote sensing monitoring of grassland carbon source-sink dynamics.

Data-driven adjustments for combined use of NGA-East hard-rock ground motion and site amplification models

Model development in the Next Generation Attenuation-East (NGA-East) project included two components developed concurrently and independently: (1) earthquake ground-motion models (GMMs) that predict the median and aleatory variability of various intensity measures conditioned on magnitude and distance, derived for a reference hard-rock site condition with an average shear-wave velocity in the upper 30 m ( VS30) = 3000 m/s; and (2) a site amplification model that modifies intensity measures for softer site conditions. We investigate whether these models, when used in tandem, are compatible with ground-motion recordings in central and eastern North America (CENA) using an expanded version of the NGA-East database that includes new events from November 2011 (end date of NGA-East data curation) to April 2022. Following this expansion, the data set has 187 events, 2096 sites, and 16,272 three-component recordings, although the magnitude range remains limited (∼4 to 5.8). We compute residuals using 17 NGA-East GMMs and three data selection criteria that reflect within-CENA regional variations in ground-motion attributes. Mixed-effects regression of the residuals reveals a persistent pattern in which ground motions are overpredicted at short periods (0.01–0.6 s, including peak ground acceleration (PGA)) and underpredicted at longer periods. These misfits are regionally variable, with the Texas–Oklahoma–Kansas region having larger absolute misfits than other parts of CENA. Two factors potentially influencing these misfits are (1) differences in the site amplification models used to adjust the data to the reference condition during NGA-East GMM development relative to CENA amplification models applied since the 2018 National Seismic Hazard Model (NSHM), and (2) potential bias in simulation-based factors used to adjust ground motions from the hard-rock reference condition to a VS30 = 760 m/s condition. We provide adjustment factors and their epistemic uncertainties and discuss implications for applications.

Learning from the End of the Public-Private Partnership for Lesotho's National Referral Hospital Network.

Public-private partnerships (PPP) are one strategy to finance and deliver healthcare in lower-resourced settings. Lesotho's Queen 'Mamohato Memorial Hospital Integrated Network (QMMH-IN) was sub-Saharan Africa's first and largest integrated healthcare PPP. We assessed successes and challenges to performance of the QMMH-IN PPP. We conducted 26 semi-structured interviews among QMMH-IN executive leadership and staff in early 2020. Questions were guided by the WHO Health System Building Blocks Framework. We conducted a thematic analysis. Facilitators of performance included: 1) PPP leadership commitment to quality improvement supported by protocols, monitoring, and actions; 2) high levels of accountability and discipline; and 3) well-functioning infrastructure, core systems, workflows, and internal referral network. Barriers to performance included: 1) human resource management challenges and 2) broader health system and referral network limitations. Respondents anticipated the collapse of the PPP and suggested better investing in training incoming managerial staff, improving staffing, and expanding QMMH-IN's role as a training facility. The PPP contract was terminated approximately five years before its anticipated end date; in mid-2021 the government of Lesotho assumed management of QMMH-IN. Going forward, the Lesotho government and others making strategic planning decisions should consider fostering a culture of quality improvement and accountability; ensuring sustained investments in human resource management; and allocating resources in a way that recognizes the interdependency of healthcare facilities and overall system strengthening. Contracts for integrated healthcare PPPs should be flexible to respond to changing external conditions and include provisions to invest in people as substantively as infrastructure, equipment, and core systems over the full length of the PPP. Healthcare PPPs, especially in lower-resource settings, should be developed with a strong understanding of their role in the broader health system and be implemented in conjunction with efforts to ensure and sustain adequate capacity and resources throughout the health system.

Estimates of hospitalisations and deaths in patients with COVID-19 associated with undiagnosed diabetes during the first phase of the pandemic in eight low-income and middle-income countries: a modelling study

Patients with COVID-19 that had diagnosed chronic diseases - including diabetes - may experience higher rates of hospitalisation and mortality relative to the general population. However, the burden of undiagnosed co-morbidities during the pandemic has not been adequately studied. We developed a model to estimate the hospitalisation and mortality burden of patients with COVID-19 that had undiagnosed type 1 and type 2 diabetes (UD). The retrospective analytical modelling framework was informed by country-level demographic, epidemiological and COVID-19 data and parameters. Eight low-and middle-income countries (LMICs) were studied: Brazil, China, India, Indonesia, Mexico, Nigeria, Pakistan, and South Africa. The modelling period consisted of the first phase of the pandemic - starting from the date when a country identified its first COVID case to the date when the country reached 1% coverage with one dose of a COVID-19 vaccine. The end date ranged from Jan 20, 2021 for China to June 2, 2021 for Nigeria. Additionally, we estimated the change in burden under a scenario in which all individuals with UD had been diagnosed prior to the pandemic. Based on our modelling estimates, across the eight countries, 6.7 (95% uncertainty interval: 3.4-11.3) million COVID-19 hospitalised patients had UD of which 1.9 (0.9-3.4) million died. These represented 21.1% (13.4%-30.1%) of all COVID-19 hospitalisations and 30.5% (14.3%-55.5%) of all COVID-19 deaths in these countries. Based on modelling estimates, if these populations had been diagnosed for diabetes prior to the COVID-19 pandemic, 1.7% (-3.0% to 5.9%) of COVID-19 hospitalisations and 5.0% (-0.9% to 14.1%) of COVID-19 deaths could have been prevented, and 1.8 (-0.3 to 5.0) million quality-adjusted life years gained. Our findings suggest that undiagnosed diabetes contributed substantially to COVID-19 hospitalisations and deaths in many LMICs. This work was supported, in part, by the Bill & Melinda Gates Foundation [INV-029062] and FIND.

Obstetric and perinatal outcomes in women with previous breast cancer: a nationwide study of singleton births 1973-2017.

What are the obstetric and perinatal outcomes in births to breast cancer survivors compared to women without previous breast cancer? Women who conceived during the first 2 years following a breast cancer diagnosis had a higher risk for preterm birth, induced delivery, and cesarean section, while no increased risks were observed in births conceived later than 2 years after a breast cancer diagnosis. A recent meta-analysis found higher risks of cesarean section, preterm birth, low birthweight, and small for gestational age in pregnancies among breast cancer survivors. Less is known about rarer outcomes such as pre-eclampsia or congenital malformations. We conducted a population-based matched cohort study including all breast cancer survivors who gave birth to singletons 1973-2017 in Sweden, identified through linkage between the Swedish Cancer Register, the Medical Birth Register, and the National Quality Register for Breast Cancer. Each birth following breast cancer (n = 926) was matched by maternal age at delivery, parity, and calendar year at delivery to 100 births in a comparator cohort of women (n = 92 490). Conditional logistic and multinomial regression models estimated relative risks (RR) with 95% CI. Subgroup analyses by time since diagnosis and type of treatment were performed. Previous breast cancer was associated with higher risks of induced delivery (RR; 1.3, 1.0-1.6), very preterm birth (RR; 1.8, 1.1-3.0), and planned preterm birth (RR; 1.6, 1.0-2.4). Women who conceived within 1 year after breast cancer diagnosis had higher risks of cesarean section (RR; 1.7, 1.0-2.7), very preterm birth (RR; 5.3, 1.9-14.8), and low birthweight (RR; 2.7, 1.4-5.2), while the risks of induced delivery (RR; 1.8, 1.1-2.9), moderately preterm birth (RR; 2.1, 1.2-3.7), and planned preterm birth (RR; 2.5, 1.1-5.7) were higher in women who conceived during the second year after diagnosis. Women who conceived later than 2 years after breast cancer diagnosis had similar obstetric risks to their comparators. As information on the end date of treatment was unavailable, the time between the date of diagnosis and conception was used as a proxy, which does not fully capture the effect of time since end of treatment. In addition, treatments and clinical recommendations have changed over the long study period, which may impact childbearing patterns in breast cancer survivors. Risks of adverse obstetric outcomes in breast cancer survivors were confined to births conceived within 2 years of diagnosis. As family building holds significance for numerous young breast cancer patients, these findings are particularly important to inform both breast cancer survivors and clinicians about future reproductive outcomes. This work was supported by the Swedish Cancer Society (grant number 22-2044 Pj A.L.V.J.), Karolinska Institutet Foundations (grant number: 2022-01696 F.E.L., 2022-01559 A.L.V.J.), and the Swedish Research Council (grant number: 2021-01657 A.L.V.J.). K.A.R.-W. is supported by grants from the Swedish Cancer Society (20 0170 F) and the Radiumhemmets Research Foundations for clinical researchers 2020-2026. The authors declare that they have no conflicts of interest. N/A.

MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy

Excessive thyroid hormones from hyperthyroidism increase cardiovascular risks. Among 3 available treatments for hyperthyroidism, comparisons of long-term outcomes associated with antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery to treat newly diagnosed hyperthyroidism are lacking. To compare risks of major adverse cardiovascular events (MACE) and all-cause mortality among patients with hyperthyroidism treated with ATDs, RAI, or surgery. This nationwide cohort study used the Taiwan National Health Insurance Research Database. Patients aged 20 years or older with newly diagnosed hyperthyroidism between 2011 and 2020 were enrolled. Treatment groups were determined within 18 months from diagnosis, with follow-up until the development of MACE, death, or the end date of the database, whichever came first. Data were analyzed from October 2022 through December 2023. The ATD group received ATDs only. RAI and surgery groups could receive ATDs before treatment. Anyone who underwent thyroid surgery without RAI was classified into the surgery group and vice versa. The primary outcomes included MACE (a composite outcome of acute myocardial infarction, stroke, heart failure, and cardiovascular mortality) and all-cause mortality. Among 114 062 patients with newly diagnosed hyperthyroidism (mean [SD] age, 44.1 [13.6] years; 83 505 female [73.2%]), 107 052 patients (93.9%) received ATDs alone, 1238 patients (1.1%) received RAI, and 5772 patients (5.1%) underwent surgery during a mean (SD) follow-up of 4.4 (2.5) years. Patients undergoing surgery had a significantly lower risk of MACE (hazard ratio [HR] = 0.76; 95% CI, 0.59-0.98; P = .04), all-cause mortality (HR = 0.53; 95% CI, 0.41-0.68; P < .001), heart failure (HR = 0.33; 95% CI, 0.18-0.59; P < .001), and cardiovascular mortality (HR = 0.45; 95% CI, 0.26-0.79; P = .005) compared with patients receiving ATDs. Compared with ATDs, RAI was associated with lower MACE risk (HR = 0.45; 95% CI, 0.22-0.93; P = .03). Risks for acute myocardial infarction and stroke did not significantly differ between treatment groups. In this study, surgery was associated with lower long-term risks of MACE and all-cause mortality, while RAI was associated with a lower MACE risk compared with ATDs.