Fiftieth Percentile Research Articles

Higher Rates Of Homelessness Are Associated With Increases In Mortality From Accidental Drug And Alcohol Poisonings.

Alcohol and drug overdoses have multiple complex causes. In this article we contribute to the literature that links homelessness, the most extreme form of housing disruption, to accidental SUD-related poisonings. Using plausibly exogenous variation from a state's landlord-tenant policies that influence evictions, we estimated the causal impact of homelessness on SUD-related mortality. We found large effects of homelessness on SUD-related poisonings (for example, a 10percent increase in homelessness led to a 3.2percent increase in opioid poisonings in metropolitan areas). Our findings indicate that reducing local homelessness rates from the seventy-fifth to the fiftieth percentile levels could have saved more than 1,900 lives from opioid overdoses across all metropolitan localities in the final year of our study data. We conclude that strengthening the social safety net in terms of housing security could help curb the ongoing SUD-related poisoning epidemic in the US.

Clinical Outcomes of Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma in a County Hospital System

Introduction: Advances in the treatment of diffuse large B-cell lymphoma (DLBCL) have improved survival, with Surveillance, Epidemiology, and End Results (SEER) Program data showing 5-year overall survival (OS) of 64.7% (SEER*Explorer, 2023). However, insurance status in the US is related to DLBCL survival (Han et al., Cancer 2014), and real-world data for patients who are uninsured or who may have socioeconomic barriers to care remain limited. We performed a retrospective cohort study to examine outcomes for patients with newly diagnosed DLBCL treated in a large safety-net hospital system in the third most populous county in the US. Methods: Patients aged 18 years and older diagnosed with DLBCL between January 2011 and June 2022 and treated at Harris Health System, Houston, TX, were included in the analysis. Demographic, disease, treatment, response, and follow-up data were abstracted from the electronic medical record. US Census Block Group FIPS codes derived from geocoded home address at the time of initial diagnosis were used to compute the Area Deprivation Index (ADI). Eligibility for cellular therapies including hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T-cell therapy (CAR-T) was determined by the abstractors. Time-to-event analysis was performed using the Kaplan-Meier method, and Cox proportional hazards regression was used to examine factors associated with event-free survival (EFS) and OS. Results: Among 461 patients with newly diagnosed DLBCL (Table 1), the median age was 53 years (range, 18-93), 75% were uninsured, and 80% were in the most disadvantaged ADI national quartiles, defined as at or above the fiftieth percentile. Most patients had stage III or IV disease and an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0 to 1 at the time of diagnosis. One hundred ninety-eight patients (44%) had poor-risk disease by the Revised International Prognostic Index (R-IPI). Seventy-five (16%) had a history of HIV infection. Common first-line treatments included R-CHOP ( n = 210, 46%) and R-EPOCH ( n = 183, 40%); 18 received no therapy (3.9%). The median time from diagnosis to treatment initiation (DTI) was 18 days (range, 0-246); 76% completed therapy. Of 425 evaluable patients, 288 (68%) achieved a complete response (CR) and 44 (10%) had a partial response (PR); of these, 74 (22%) relapsed. Twenty-five (58%) of 43 patients eligible for cellular therapies at relapse received them: 14 (56%) underwent autologous HSCT, 8 (32%) received CAR-T, and 3 (12%) had both. Median follow-up time for the cohort was 48.8 months (range, 0.2-147). By the time of analysis, 167 patients (36%) had developed refractory/relapsed disease, and 148 (32%) had died. At 1, 2, and 5 years, EFS was 72%, 64%, and 58%, and OS was 82%, 76%, and 69% (Figure 1). At 1, 2 and 5 years, EFS was 77%, 69%, and 64% and OS was 85%, 79%, and 75% for patients with germinal center B-cell-like (GCB) DLBCL, whereas EFS was 68%, 56%, and 50% and OS was 80%, 73%, and 62% for those with non-GCB DLBCL. In multivariable Cox regression models, predictors of OS were poor-risk disease by R-IPI (HR 6.08 compared to very-good-risk disease, 95% CI 1.02-36.09), ECOG (HR 2.10 for ECOG ≥2 compared to 0-1, 95% CI 1.12-3.95), and normalized LDH (HR 1.07 per fold increase, 95% CI 1.03-1.11). Race/ethnicity, insurance status, and DTI were not associated with significant differences in OS. However, receiving fewer than planned cycles of first-line therapy was associated with higher mortality (HR 2.00, 95% CI 1.12-3.56), as was not attaining CR by the end of first-line therapy (HR 7.90, 95% CI 3.65-17.12). Conclusion: This is one of the largest real-world studies to date examining outcomes of patients with newly diagnosed DLBCL at a safety-net hospital system. Overall, patients had shorter EFS and OS compared to historical clinical trials but had similar OS to SEER estimates. In this health system with robust financial assistance programs and access to cellular therapies for some patients, uninsured status was not associated with inferior outcomes. Addressing barriers to care may improve outcomes for uninsured patients in other settings.

Sarcopenia evaluation on cardiac magnetic resonance imaging in older adults for outcomes prediction following surgical aortic valve replacement

BackgroundSarcopenia refers to a reduction in skeletal muscle mass and strength. Despite the known association between single-slice muscle measurements on lumbar computed tomography and poor outcomes in various clinical settings, studies using thoracic muscle measurements on cardiac magnetic resonance imaging (CMR) have been limited. MethodsPatients undergoing surgical aortic valve replacement (SAVR) between 2010 and 2020 were included if they were ≥ 50 years of age with preoperative CMR. Manual unilateral pectoralis major and minor skeletal muscle area measurements were made at the carina and normalized for body size by height to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile and higher-risk as the highest fiftieth percentile Society of Thoracic Surgeons' (STS) mortality score. ResultsA total of 133 patients were included, 35 (26.3%) females. The average age was 64 ± 9 years, with most Caucasian (93.2%). Compared to non-sarcopenic patients, sarcopenic patients were older with lower body mass index. During a median follow-up of 27.3 (7.6–60.4) months, 10 (22.2%) deaths occurred in the sarcopenic group and 8 (9.1%) in the non-sarcopenic group (p = 0.039 by log-rank test). On subgroup analysis (66 patients), higher-risk sarcopenic patients had 10 (37.0%) deaths compared to 8 (20.5%) in higher-risk non-sarcopenic patients (p = 0.011 by log-rank test). ConclusionsSimple unilateral pectoralis muscle measurements on preoperative CMR can be used as an adjunct to traditional risk scores for predicting mortality post-SAVR.

Abstract 12725: Sarcopenia With Low Serum Albumin is Associated With Worse Prognosis in Patients Hospitalized for Acute Decompensated Heart Failure

Introduction: Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes. Hypothesis: We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF). Methods: Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile. Results: The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p<0.001) and admission NT-proBNP (highest in SLA, p=0.029). Patients with SLA were discharged to facilities most often (55.2%, p<0.001). All-cause mortality differed among the groups (p<0.001) during a median follow-up of 23.4 (4.2-45.0) months (Figure 1B). Compared to controls, those with SLA were at the highest risk (HR 2.46, 95%CI 1.50-4.02, p<0.001), followed by patients with low albumin alone (HR 1.77, 95%CI 1.11-2.83, p=0.016) or sarcopenia alone (HR 1.73, 95%CI 0.93-3.20, p=0.082), the latter not reaching significance. Conclusions: In conclusion, sarcopenia with low serum albumin is associated with higher mortality. Available resources and interventions should be utilized during ADHF hospitalization to optimize nutrition for these patients.

OSAHS Growth Impairment and Resolution after Adenotonsillectomy in Children.

Introduction:One of the most important complications of OSAHS in children is growth delay. The aim of this study was to investigate changes in clinical body growth, and laboratory growth in children with OSAHS after adeno-tonsillar surgery.Materials and Methods:In our study, among 102 children suffering from sleep-disordered breathing, 70 met the inclusion criteria because they were affected by OSAHS and adenotonsillar hypertrophy. In total, 96 children affected by adeno-tonsillar hypertrophy (55 males and 41 females) underwent nocturnal cardiorespiratory monitoring with Embletta MPR, monitoring for post-operative 24 hours. Patients underwent blood sampling to evaluate preoperative GH and IGF-1 serum levels, “placement” in Cacciari’s growth charts and adenotonsillectomy and saturation monitoring for post-operative 24 hours. According to auxological parameters, 82.86% of the patients were below the fiftieth percentile of BMI Cacciari’s growth charts and IGF-1 preoperative serum levels were below the normal range. All patients underwent adenotonsillectomy. Results:All 70 patients recovered from OSAHS according to the results of nocturnal cardiorespiratory monitoring after six months. IGF-1 serum levels significantly increased after three months and one year after. All the auxological parameters showed a significant increase after surgery. We calculated the average annual growth in height of the patients before and after adenotonsillectomy (AT): the growth rate was impaired by OSAHS (5.4±1.3 cm/year), while in the following year post-surgery we found a significant growth speed acceleration (9.9±1.7 cm/year, P=0.001). Conclusions:In conclusion, growth delay in children can be caused by OSAHS, and when it is due to adenotonsillar hypertrophy, adenotonsillectomy is to be considered as the therapy of choice.

Effect of treadmill exercise stress testing on troponin levels in children and adolescents.

Chest pain is a common complaint among paediatric patients and cardiac troponin (cTn) level is often part of the initial emergency department evaluation. It is well known that after intense endurance exercise cTn levels can be elevated in patients with otherwise healthy hearts, however the effect shorter duration exercise has on cTn levels in this population is not known. Determine the behaviour of cTn levels in healthy children and adolescent patients after short burst, high-intensity aerobic exercise. Patients without haemodynamically significant heart disease referred for a treadmill exercise stress test (EST) were recruited over a 6-month period. cTn levels were measured prior to exercise and 4 hours after exercise. Thirteen patients enrolled. Indications for EST were exertional syncope (six), chest pain (four), and long QT syndrome (three). The median exercise time was 12.9 (9.9-13.7) minutes with an average endurance at the fiftieth percentile for age and maximum heart rate rose to an average of 92 (74-98)% of the predicted peak for age. cTn levels prior to exercise were undetectable in all patients. There was no cTn rise in any patient after exercise. There were no ischaemic changes or arrhythmias on exercise electrocardiograms. Serum cTn levels do not rise significantly in healthy children after short duration, high-intensity aerobic exercise. Physicians evaluating paediatric patients with an elevated cTn level after less than prolonged strenuous activity likely cannot attribute this lab value solely to exercise and may need to undertake further cardiac investigation.

Food Insecurity Increased During the COVID-19 Pandemic in a Pediatric Cystic Fibrosis Population but Was Not Associated With Weight or Pulmonary Function

ObjectivesThis study's purpose is to determine changes in household food security status and nutrition-related anthropometrics and pulmonary function of children with Cystic Fibrosis during the COVID-19 pandemic.MethodsThis retrospective study includede caregivers of children ages 2–18 years old with Cystic Fibrosis who had Ohio residency, a Forced Expiratory Volume in 1 second (FEV1) above 30% and consumed at least half of nutrient needs by mouth. After contacting all eligible households by phone, 30 subjects (50% response) enrolled. The validated 18 item Food Security survey module along with several supplemental questions was used to assess household food security status before and after the onset of the COVID-19 pandemic. A medical chart review collected demographics as well as weight (kg) and FEV1(%) for the visit closest to the start of the pandemic (Jan-Mar 2020) and themost current visit (July-Dec 2020). Change in weight was categorized as desirable/undesirable based on clinic standards for using the fiftieth percentile as desirable. A paired t-test was used to determine change in FEV1 since the pandemic. Changes in food security status in relation to change in weight and change in FEV1 were determined using Fisher's test and Welch's t-test, respectively.ResultsParticipants were caregivers of children who were 9.96 ± 5.02 years old, 56% female, and 83% Caucasian. Ten % of participants (n = 3) reported household food insecurity before the pandemic, which increased to thirty % (n = 9) after the pandemic. Fifty percent of participants (n = 15) experienced an undesirable weight gain (2.71 kg ± 6.32 kg; mean ± std dev). There was no change in FEV1 during the pandemic (−0.6% ± 9.02; P = .74). Changes in weight and FEV1 were not related to change in household food security status (P = 0.287 and P = .088 respectively).ConclusionsFood insecurity increased during the COVID-19 pandemic; however, it was not related to undesirable weight change or decrease in FEV1. The second part of this study will use semi-structured interviews to elucidate how families with children with cystic fibrosis coped with food insecurity during the pandemic.Funding SourcesPulmonary Division, Nationwide Children's Hospital, Columbus OH

Methodology for scaling finite element dummy and validation of a Hybrid III dummy model in crashworthiness simulation

For study of car-pedestrian crashes, it is two common methods that can be employed: conducting crash tests with mechanical dummies and simulating car crashes on computer. The former is a traditional way and gives good results compared with real life car impact; however, its disadvantage is very expensive test equipment and generally more time-consuming than the latter because after every crash test, experimental vehicles as well as dummies need repairing to be ready for the next experiments. Therefore, crash test simulation using finite-element method is more and more popular in the automobile industry because of its feasibility and cost saving. The majority of finite element dummy models used in crash simulation. Particularly, it is popular to use Hybrid III 50th dummy model which is built based on fiftieth percentile male (equal in height and weight of the average North American). Thus, it is necessary to develop a scaling algorithm to scale a reference dummy size into a desired one without rebuilding the entire model. In this paper, the Hybrid III dummy model provided by LS-DYNA software is scaled to suit Vietnamese biomechanical characteristics. Scaling algorithm comprises dummy geometry, inertial properties and joint properties is utilized. In order to estimate level of head injury – brain concussion by using numerical simulation, the correlation between Head Injury Criterion (HIC) and Abbreviated Injury Scale (AIS) is introduced. In addition, the Hybrid III dummy model in crashworthiness simulation is presented in key frame picture. Numerical simulation approach is validated by comparing results of head acceleration and HIC obtain from this study with experimental data and numerical simulation results in other publication

Reinforced recycled aggregate concrete slabs: Structural design based on Eurocode 2

This paper presents the design of simply supported one-way recycled aggregate concrete slabs in compliance with Eurocode 2 (EC2), to illustrate the design process of slabs with these materials. Calculations were based on various evidence-based assumptions from previous studies, namely the effect of incorporating RA on several properties of concrete. The design process followed conventional methods and the solutions were attained by altering the geometry of the slab’s cross-section to exhibit the same pre-determined service life, load bearing capacity and deflection limit in accordance with the ultimate limit state and serviceability limit state of EC2. Four variables were evaluated: increasing incorporation of recycled aggregates with different quality classes; two environmental exposure classes; choice of maintaining target strength class or accepting loss with increasing recycled aggregates; structural design in conservative vs. average conditions. The results showed that an increase to nominal cover and slab thickness was required with increasing replacement level, in order to maintain the same service life and mitigate deflection, the effect of which was most impacted using lower quality recycled aggregates. Between the two exposure classes, marginal relative changes were observed with the incorporation of recycled aggregates. Maintaining target strength was found to be a more practical approach and with less changes to the slabs’ cross-section dimensions. As expected, using the values corresponding to the fiftieth percentile, obtained in previous studies involving meta-analyses of data, resulted in less changes to the geometry of the slabs’ cross-section. Nevertheless, several cases in more conservative settings also required minimal alterations to limit maximum deflection within the EC2′s serviceability limit state.

Associations Of Cognition With Physical And Vascular Function In Patients With Chronic Kidney Disease.

Cognitive impairment is prevalent in patients with chronic kidney disease (CKD), but little is known about its relationship with physical and vascular function. PURPOSE: To investigate the relationship between cognitive function, and physical and vascular function in older adults with stage 3-4 CKD and preclinical cognitive impairment. We hypothesized that physical and vascular function would be related to cognitive function. METHODS: Participants (n=28) with CKD and preclinical cognitive impairment (57% female, 68% black, eGFR 43.7, age 68) completed the Trail Making Test (TMT-A: psychomotor speed, and TMT-B executive control), and digit symbol coding (DSC) (visuomotor speed/complex attention). These are standard measures that are sensitive to cognitive decline. Physical function was determined via the short physical performance battery test (SPPB) and the 6-minute walk test (6MWT). Vascular function was determined via brachial artery flow mediated vasodilation (FMD) following 5-minutes of forearm occlusion. Correlations were assessed via Pearson’s bivariate correlation. RESULTS: All participants scored below the fiftieth percentile of age and sex specific normative values on the TMT; 32% scored below the tenth percentile on the TMT-A and 50% scored below the tenth percentile for TMT-B. Age, years of education, sex, or race did not correlate with TMT-A, TMT-B, or DSC. TMT-A were inversely correlated with 6MWD (r=-.5, p=.007), SPPB score (r=-.65, p<.001), and FMD (r=-.4, p=.04). TMT-B was inversely correlated with 6MWD (r=-.39, p=.04), but not with SPPB, or FMD. DSC was correlated with 6MWD (r=.47, p=.01), but not with SPBB, or FMD. CONCLUSION: In patients with CKD, psychomotor speed is associated with indicators of physical function and fitness levels, and with vascular function. Executive control, visuomotor speed, and complex attention was associated with physical fitness levels. These results indicate a concomitance between higher levels of fitness, physical, and vascular function, and higher scores in psychomotor speed and executive control in patients with CKD. The clinical implications of our work remains to be further explored, but interventions to improve fitness levels, and physical and vascular function may contribute to lessening the impact of CKD-associated cognitive alterations.

An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial.

BackgroundElectronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children.ObjectiveThis study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy.MethodsThe Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection.ResultsA total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes.ConclusionsThe trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power.Trial RegistrationAustralian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).

Risk Adjustment In Medicare ACO Program Deters Coding Increases But May Lead ACOs To Drop High-Risk Beneficiaries.

The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries' baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if beneficiaries' risk scores rise while in the MSSP. As a result, accountable care organizations (ACOs) have an incentive to avoid increasingly sick or expensive beneficiaries. We examined whether beneficiaries' exposure to the MSSP was associated with within-beneficiary changes in risk scores and whether risk scores were associated with entry to or exit from the MSSP. We found that the MSSP was not associated with consistent changes in within-beneficiary risk scores. Conversely, beneficiaries at the ninety-fifth percentile of risk score had a 21.6percent chance of exiting the MSSP, compared to a 16.0percent chance among beneficiaries at the fiftieth percentile. The decision not to upwardly adjust risk scores in the MSSP has successfully deterred coding increases but might discourage ACOs to care for high-risk beneficiaries in the MSSP .

337. Analysis of radiation exposure of the medical staff from interventional radiology procedures and evaluation of the RaySafe i2 dosimetric system

Purpose To analyze the radiation exposure of the medical staff from various interventional radiology procedures and to evaluate the RaySafe i2 real time dosimetric system. Methods A two-stage multicentric study was conducted for about six months and involved four hospital centers. Data were collected from the RaySafe i2 dosimetric system on radiation doses absorbed by medical interventionists, nurses and patients in interventions of coronary angiography, coronary angiography followed by percutaneous transluminal coronary (PTCA), PTCA, transcatheter aortic valve implantation (TAVI) and implantation or pacemaker replacement (PM). In the first phase of the study, the RaySafe system monitor was not in the interventionist radiology room, on the contrary, in the second phase. At the end of the study, a satisfaction questionnaire was provided to the medical staff. A descriptive statistic analysis of the individual doses and the sum of the doses (both normalized with respect to the patient’s total Dose Area Product (DAP)) was carried out using the STATA software. Moreover, ANOVA test and Mann–Whitney–Wilcoxon test were performed to compare the various data samples. Results Concerning the radiation doses and the sum of the radiation doses (both normalized with respect to the patient’s total DAP), Raysafe i2 doesn’t led to a statistically significant reduction of the values for all evaluated operation types. Regarding the fiftieth percentile of dose samples, the variation ranges recorded between all centres are reported in Table 1. Conclusions The recorded differences between the two phases of this multicentric study aren’t statistically significant, probably due to the reduced number of samples. However, the medical staff has positively evaluated RaySafe i2 in optimizing its way of working and provided useful suggestions on how to use the system.

Hydrologic Characteristics of Streamflow in the Southeast Atlantic and Gulf Coast Hydrologic Region during 1939–2016 and Conceptual Map of Potential Impacts

Streamflow is one the most important variables controlling and maintaining aquatic ecosystem integrity, diversity, and sustainability. This study identified and quantified changes in 34 hydrologic characteristics and parameters at 30 long term (1939–2016) discharge stations in the Southeast Atlantic and Gulf Coast Hydrologic Region (Region 3) using Indicators of Hydrologic Alteration (IHA) variables. The southeastern United States (SEUS) is a biodiversity hotspot, and the region has experienced a number of rapid land use/land cover changes with multiple primary drivers. Studies in the SEUS have been mostly localized on specific rivers, reservoir catchments and/or species, but the overall region has not been assessed for the long-term period of 1939–2016 for multiple hydrologic characteristic parameters. The objectives of the study were to provide an overview of multiple river basins and 31 hydrologic characteristic parameters of streamflow in Region 3 for a longer period and to develop a conceptual map of impacts of selected stressors and changes in hydrology and climate in the SEUS. A seven step procedure was used to accomplish these objectively: Step 1: Download data from the 30 USGS gauging stations. Steps 2 and 3: Select and analyze the 31 IHA parameters using boxplots, scatter plots, and PDFs. Steps 4 and 5: Synthesize the drivers of changes and alterations and the various change points in streamflow in the literature. Step 6: Synthesize the climate of the SEUS in terms of temperature and precipitation changes. Step 7: Develop a conceptual map of impacts of selected stressors on hydrology using Driver–Pressure–State-Impact–Response (DPSIR) framework and IHA parameters. The 31 IHA parameters were analyzed. The meta-analysis of literature in the SEUS revealed the precipitation changes observed ranged from −30% to +35% and temperature changes from −2 °C to 6 °C by 2099. The fiftieth percentile of the Global Climate Models (GCM) predict no precipitation change and an increase in the temperature of 2.5 °C in the region by 2099. Among the GCMs, the 5th and 95th percentile of precipitation changes range between −40% and 110% and temperature changes between −2 °C and 6 °C by 2099. Meta-analysis of land use/land cover show the region has experienced changes. A number of rapid land use/land cover changes in 1957, 1970, and 1998 are some of the change points documented in the literature for precipitation and streamflow in the region. A conceptual map was developed to represent the impacts of selected drivers and the changes in hydrology and climate in the study region for three land use/land cover categories in three different periods.

Pretreatment prediction of pathologic complete response to neoadjuvant chemotherapy in breast cancer: Perfusion metrics of dynamic contrast enhanced MRI

The purpose of this study was to investigate imaging parameters predicting pathologic complete response (pCR) in pretreatment dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in breast cancer patients who were treated with neoadjuvant chemotherapy (NAC). A total of 74 patients who received NAC followed by surgery were retrospectively reviewed. All patients underwent breast MRI before NAC. Perfusion parameters including Ktrans, Kep and Ve of tumor were measured three-dimensionally. These perfusion parameters of background parenchyma of contralateral breasts were analyzed two-dimensionally. Receiver-operating characteristic (ROC) analysis and multivariable logistic regression analysis were performed to compare the ability of perfusion parameters to predict pCR. Of 74 patients, 13 achieved pCR in final pathology. The fiftieth percentile and skewness of each perfusion parameter – Ktrans, Kep, and Ve of tumor were associated with pCR. Perfusion parameters of contralateral breast parenchyma in 2D analysis also showed predictive ability for pCR. The model combining perfusion parameters of contralateral breast background parenchyma and those of the tumor had higher predictive value than each single parameter. Thus, perfusion parameters of tumor, background parenchyma of contralateral breast and their combinations in pretreatment breast MRI allow early prediction for pCR of breast cancer.

Aptitudes musicales e intelectuales en escolares de 10 a 12 años de la comunidad autónoma de la Región de Murcia

Given the importance of knowing the intellectual and musical skills in the youth of the Autonomous Community of the Region of Murcia, we set ourselves the objective to analyze the relationship between musical and intellectual abilities of Elementary School children. The participants were 932 students (488 girls and 444 boys) aged between ten and twelve. The instruments employed included the Battery of Differential and General attitudes (BADyG -E3) for the cognitive area and Seashore Test of Musical Ability to assess musical skills. The results show that musical skills of school children are located below the fiftieth percentile. Notably they stand out best at discriminating pace and duration. In conclusion, we note that there is a positive correlation of moderate intensity between the variables under study.

Preservation of the Semantic Verbal Fluency Advantage in a Large Population-Based Sample: Normative Data from the TILDA Study.

It is widely believed that phonemic fluency is more difficult than naming exemplars from a semantic category. Normative data in this regard are scarce, and there is considerable disagreement in the literature regarding the pattern in normal ageing and neurodegenerative conditions. Our objective was to provide normative data for semantic phonemic discrepancy scores from a large sample of older adults. A total of 5780 community-dwelling older adults were included in this prospective, longitudinal study. Discrepancy scores were calculated by subtracting phonemic fluency score from semantic fluency score for each participant. Quantile regression was used to estimate normative values stratified for age. Subjects did better on testing of semantic fluency. The average discrepancy score was 9.18±6.89 words, (range, -20 to 37; n=5780). At the fiftieth percentile, those in their fifth decade produced 10 more "animals" than "letter F" words. Subjects scored one word less per decade, with an average of seven more "animal" words produced by those in their eighth decade. Our study is the first to provide normative data and confirms that, for animal versus letter F fluency, the semantic advantage persists into later life in a population-based sample of community-dwelling older adults. Given that a majority of clinical samples have confirmed a reverse of this pattern in Alzheimer's dementia (i.e., loss of semantic advantage in Alzheimer's disease, yielding a phonemic advantage), our findings support the clinical utility of brief fluency tests and encourage further research into their use in diagnosis and prediction of progression to dementia.

The Relationship Between Red Blood Cell Distribution Width (RDW CV) And C Reactive Protein (CRP) With The Clinical Outcomes In Non-St Elevation Myocardial Infarction And Unstable Angina Pectoris: A 6 Months Follow Up Study

&lt;p&gt;&lt;span style="font-family: Calibri;"&gt;&lt;strong&gt;&lt;span style="font-size: medium;"&gt;OBJECTIVES &lt;/span&gt;&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;&lt;span style="font-size: medium;"&gt;RDW CV&lt;/span&gt;&lt;strong&gt;&lt;/strong&gt;&lt;span style="font-size: medium;"&gt;is a marker of variation in size of rbc.&lt;/span&gt;&lt;span style="font-size: medium;"&gt;RDW has been reported to be a predictor of cardiac events in CAD . &lt;/span&gt;&lt;span style="font-size: medium;"&gt;CRP is a pentameric protein, an acute phase reactant and an independent marker of mortality in ACS .Here &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;we hypothesized that RDW CV level on admission and CRP would be predictive of adverse outcomes in NSTEMI and USAP&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;patients.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span style="font-family: Calibri; font-size: medium;"&gt;METHODS&lt;/span&gt;&lt;/strong&gt;&lt;span style="font-family: Calibri;"&gt;&lt;span style="font-size: medium;"&gt;319 patients with ACS (240 males and&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;79 females) were prospectively analyzed. Patients were divided into two groups based on the fiftieth percentile of admission RDW levels.&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;High RDW group (n=214) was defined as those patients having RDW levels of &amp;gt;14.0.Qualitative CRP positivity was observed in 113 patients.The relationship between RDW &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;and CRP and primary endpoint (cardiovascular deaths), secondary end points (reinfarction, repeat TVR) and MACE were assessed. The median follow-up was 6 months.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span style="font-family: Calibri; font-size: medium;"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;span style="font-family: Calibri;"&gt;&lt;strong&gt;&lt;span style="font-size: medium;"&gt;RESULTS &lt;/span&gt;&lt;/strong&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;Patients in high RDW group were older (p=0.16), females with&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;history of HT diabetes and MI. They had higher admission creatinine , Killip class &amp;gt;1 ,TIMI risk score,&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;CK-MB,&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;peak creatinine Ldl and TLC and lower lvef . They had more &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;killip&amp;gt;1 (p=0.020) in hospital and at 6-months significantly increased mortality,reinfarction rates and hospitalization for heart failure was seen.&lt;/span&gt;&lt;span style="font-size: medium;"&gt;Patients with positive crp and high rdw had&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;significantly increased adverse outcomes.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span style="font-family: Calibri; font-size: medium;"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;span style="font-family: Calibri;"&gt;&lt;strong&gt;&lt;span style="font-size: medium;"&gt;CONCLUSIONS&lt;/span&gt;&lt;/strong&gt; &lt;span style="font-size: medium;"&gt;Given the advantages of the RDW levels &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;it may be used as a marker of cardiovascular risk management in NSTEMI and USAP&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;along with crp and plan early invasive strategy.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

Body Mass Exponential Index: An Age-Independent Anthropometric Nutritional Assessment

Background: Body mass index (BMI) is a squared-height power function. Nevertheless, some studies show a significant exponential weight-height correlation. Objectives: To demonstrate that the weight-height relationship from 2 to 20 years of age is better expressed by an exponential function. Design: 5th, 50th and 85th percentile weight-height curves according CDC 2000 Growth Charts. A theoretical curve was created with the data on the 50th percentiles of weight and height for each age, equivalent to the 50th percentile of the weight-for-height curve. The statistical analysis was performed applying regression analysis of the curve estimation in the power and exponential models. Results: The exponential model correlation coefficient is higher than the power model. The exponential model variable (1.9 in boys, 2 in girls) was standardized to 2 to establish the body mass exponential index (BMEI): weight/exp(2*height). Weight-for-age and exponential height-for-age fiftieth percentile curves show a stable age-independent ratio near 2. These ratios are 1.5 and 2.5 for the 5th and 85th percentiles, respectively. The shape of the well-known curve BMI-for-age is due to the disparity between a exponential curve and a power curve. Conclusions: An exponential function expresses the weight-height relationship during growth better than a power function. A BMEI of 2 with limits of 1.5 and 2.5 is useful for screening nutritional status during growth, and the weight-for-height chart is an ideal substitute for the BMI-for-age chart. The BMI-for-age curve shape and the disproportional BMI in taller children are mathematical artifacts without biological meanings.

Head Circumference Growth Reference Charts of Children Younger Than 7 Years in Chinese Rural Areas

BackgroundThe head circumference growth reference charts for children in China are presently based on urban children. However, the references may not apply to rural children because of the differences between urban and rural areas, such as economy, culture, and dietary habits. Our objective was to provide a reliable continuous set of head circumference growth reference charts for male and female children less than 7 years of age in Chinese rural areas. MethodsChildren in our study were identified by multistage stratified cluster sampling from rural areas of 10 provinces in China. Questionnaire survey and anthropometric measurements were conducted in data collection. Head circumference was measured with a nonelastic tape on a line passing over the glabella and posterior occipital protrusion in children. We compared the fiftieth percentile of our cross-sectional data with the data of Chinese cities, World Health Organization, and the United States. ResultsA total of 95,904 children (48,722 boys and 47,182 girls) were included in the study. We present age- and sex-appropriate head circumference growth charts younger than 7 years for Chinese rural areas. The head circumference percentiles of the children in rural China are much smaller than the children in Chinese urban areas, World Health Organization, and the US percentiles after 2 years old. ConclusionsHead circumference percentiles can be applied in growth monitoring, but current head circumference growth references promulgated in urban China may not be suitable for rural areas in China. Providing head circumference growth reference charts for rural Chinese children who are younger than 7 years old is very important.